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Sample records for accountable care organizations

  1. Accountable Care Organizations and Otolaryngology

    PubMed Central

    Contrera, Kevin J.; Ishii, Lisa E.; Setzen, Gavin; Berkowitz, Scott A.

    2016-01-01

    Accountable Care Organizations represent a shift in health care delivery, while providing a significant potential for improved quality and coordination of care across multiple settings. Otolaryngologists have an opportunity to become leaders in this expanding arena. However, the field of otolaryngology-head and neck surgery currently lacks many of the tools necessary to implement value-based care, including performance-measurement, electronic health infrastructure and data management. These resources will become increasingly important for surgical specialists to be active participants in population health. This article reviews the fundamental issues that otolaryngologists should consider when pursuing new roles in Accountable Care Organizations. PMID:26044787

  2. Sustainable competitive advantage for accountable care organizations.

    PubMed

    Macfarlane, Michael Alex

    2014-01-01

    In the current period of health industry reform, accountable care organizations (ACOs) have emerged as a new model for the delivery of high-quality and cost-effective healthcare. However, few ACOs operate in direct competition with one another, and the accountable care business model has yet to present a means of continually developing new marginal value for patients and network partners. With value-based purchasing and patient consumerism strengthening as market forces, ACOs must build organizational sustainability and competitive advantage to meet the value demands set by customers and competitors. This essay proposes a strategy, adapted from the disciplines of agile software development and Lean product development, through which ACOs can engage internal and external customers in the development of new products that will provide sustainability and competitive advantage to the organization by decreasing waste in development, promoting specialized knowledge, and closely targeting customer value. PMID:25154124

  3. The Economics of Medicare Accountable Care Organizations

    PubMed Central

    Blackstone, Erwin A.; Fuhr, Joseph P.

    2016-01-01

    Background Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs. Objective To examine whether the current Medicare ACOs are likely to be successful. Discussion Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful. Conclusion The question remains whether Medicare ACOs can achieve the Triple Aim of “improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs. PMID:27066191

  4. Achieving Population Health in Accountable Care Organizations

    PubMed Central

    Walker, Deborah Klein

    2013-01-01

    Although “population health” is one of the Institute for Healthcare Improvement’s Triple Aim goals, its relationship to accountable care organizations (ACOs) remains ill-defined and lacks clarity as to how the clinical delivery system intersects with the public health system. Although defining population health as “panel” management seems to be the default definition, we called for a broader “community health” definition that could improve relationships between clinical delivery and public health systems and health outcomes for communities. We discussed this broader definition and offered recommendations for linking ACOs with the public health system toward improving health for patients and their communities. PMID:23678910

  5. Medicare Accountable Care Organizations: Beneficiary Assignment Update.

    PubMed

    Vaughn, Thomas; MacKinney, A Clinton; Mueller, Keith J; Ullrich, Fred; Zhu, Xi

    2016-06-01

    This brief updates Brief No. 2014-3 and explains changes in the Centers for Medicare & Medicaid Services (CMS) Accountable Care Organization (ACO) regulations issued in June 2015 pertaining to beneficiary assignment for Medicare Shared Savings Program ACOs. Overall, the regulatory changes are intended to (1) encourage ACOs to participate in two-sided risk contracts, (2) increase the likelihood that beneficiaries are assigned to the physician (and ACO) from whom they receive most of their primary care services, and (3) make it easier for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to participate in ACOs. Understanding ACO beneficiary assignment policies is critical for ACO in managing their panel of ACO providers and beneficiaries. PMID:27416650

  6. Creating accountable care organizations: the extended hospital medical staff.

    PubMed

    Fisher, Elliott S; Staiger, Douglas O; Bynum, Julie P W; Gottlieb, Daniel J

    2007-01-01

    Many current policies and approaches to performance measurement and payment reform focus on individual providers; they risk reinforcing the fragmented care and lack of coordination experienced by patients with serious illness. In this paper we show that Medicare beneficiaries receive most of their care from relatively coherent local delivery systems comprising physicians and the hospitals where they work or admit their patients. Efforts to create accountable care organizations at this level--the extended hospital medical staff--deserve consideration as a potential means of improving the quality and lowering the cost of care. PMID:17148490

  7. The effect of accountable care organizations on oncology practice.

    PubMed

    Shulman, Lawrence N

    2014-01-01

    Cancer care accounts for a significant portion of the rise in health care costs, and therefore, as national efforts escalate to control cost, cancer care will be a focus of concern. Cost increases in cancer care are related to many factors, including increasing cancer incidence in an aging population, the introduction of new high-cost therapeutics, and the high cost of end-of-life care. Accountable care organizations (ACOs) have been one of the major efforts directed at controlling health care costs. How cancer care will fit into the rubric of ACOs is not entirely clear but will certainly evolve over the coming years. The oncology profession has the opportunity to play a role in this evolution or could leave the evolution to others driving the process, such as the Centers for Medicare and Medicaid Services (CMS), private payers, and ACOs. Ideally all parties will work together to provide a construct for high-value, high-quality care for patients with cancer while contributing to cost control in overall health care. PMID:24857141

  8. Accountable Care Organizations in California: Market Forces at Work?

    PubMed

    Whaley, Christopher; Frech, H E; Scheffler, Richard M

    2015-08-01

    Accountable care organizations (ACOs), one of the most recent and promising health care delivery innovations, encourage care coordination among providers. While ACOs hold promise for decreasing costs by reducing unnecessary procedures, improving resource use as a result of economies of scale and scope, ACOs also raise concerns about provider market power. This study examines the market-level competition factors that are associated with ACO participation and the number of ACOs. Using data from California, we find that higher levels of preexisting managed care leads to higher ACO entry and enrollment growth, while hospital concentration leads to fewer ACOs and lower enrollment. We find interesting results for physician market power - markets with concentrated physician markets have a smaller share of individuals in commercial ACOs but a larger number of commercial ACO organizations. This finding implies smaller ACOs in these markets. PMID:26124301

  9. Accountable care organizations and the allergist: challenges and opportunities.

    PubMed

    Ein, Daniel; Foggs, Michael B

    2014-01-01

    For decades, health care policy experts have wrestled with ways to solve problems of access, cost, and quality in US health care. The current consensus is that the solution to all three lies in changing financial incentives for providers and delivering care through integrated systems. The currently favored vehicle for this, both in the public and private sectors, is through Accountable Care Organizations (ACOs). Medicare has several models and has fostered rapid growth in the number of operative ACOs. At least an equal number of private ACOs are in operation. Whether or not these organizations will fulfill their promise is unknown but there is reason for cautious optimism. Allergists can and should be part of the process of this transformation in our health care system. They can be integral to helping these organizations save money by reducing hospitalizations and improving the quality of allergy and asthma care in the populations served. In order to accomplish this, allergists must become more involved in their medical communities and hospitals. PMID:24565766

  10. A Taxonomy of Accountable Care Organizations for Policy and Practice

    PubMed Central

    Shortell, Stephen M; Wu, Frances M; Lewis, Valerie A; Colla, Carrie H; Fisher, Elliott S

    2014-01-01

    Objective To develop an exploratory taxonomy of Accountable Care Organizations (ACOs) to describe and understand early ACO development and to provide a basis for technical assistance and future evaluation of performance. Data Sources/Study Setting Data from the National Survey of Accountable Care Organizations, fielded between October 2012 and May 2013, of 173 Medicare, Medicaid, and commercial payer ACOs. Study Design Drawing on resource dependence and institutional theory, we develop measures of eight attributes of ACOs such as size, scope of services offered, and the use of performance accountability mechanisms. Data are analyzed using a two-step cluster analysis approach that accounts for both continuous and categorical data. Principal Findings We identified a reliable and internally valid three-cluster solution: larger, integrated systems that offer a broad scope of services and frequently include one or more postacute facilities; smaller, physician-led practices, centered in primary care, and that possess a relatively high degree of physician performance management; and moderately sized, joint hospital–physician and coalition-led groups that offer a moderately broad scope of services with some involvement of postacute facilities. Conclusions ACOs can be characterized into three distinct clusters. The taxonomy provides a framework for assessing performance, for targeting technical assistance, and for diagnosing potential antitrust violations. PMID:25251146

  11. Accountable care organizations in the USA: types, developments and challenges.

    PubMed

    Barnes, Andrew J; Unruh, Lynn; Chukmaitov, Askar; van Ginneken, Ewout

    2014-10-01

    A historically fragmented U.S. health care system, where care has been delivered by multiple providers with little or no coordination, has led to increasing issues with access, cost, and quality. The Affordable Care Act included provisions to use Medicare, the U.S. near universal public coverage program for older adults, to broadly implement Accountable Care Organization (ACO) models with a triple aim of improving the experience of care, the health of populations, and reducing per capita costs. Private payers in the U.S. are also embracing ACO models. Various European countries are experimenting with similar reforms, particularly those in which coordinated (or integrated) care from a network of providers is reimbursed with bundled payments and/or shared savings. The challenges for these reforms remain formidable and include: (1) overcoming incentives for ACOs to engage in rationing and denial of care and taking on too much financial risk, (2) collecting meaningful data that capture quality and enable rewarding quality improvement and not just volume reduction, (3) creating incentives for ACOs that do not accept much risk to engage in prevention and health promotion, and (4) creating effective governance and IT structures that are patient-centered and integrate care. PMID:25145942

  12. Accountable care organization readiness and academic medical centers.

    PubMed

    Berkowitz, Scott A; Pahira, Jennifer J

    2014-09-01

    As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices. PMID:24979282

  13. Changes in Patients’ Experiences in Medicare Accountable Care Organizations

    PubMed Central

    McWilliams, J. Michael; Landon, Bruce E.; Chernew, Michael E.; Zaslavsky, Alan M.

    2014-01-01

    BACKGROUND Incentives for accountable care organizations (ACOs) to limit health care use and improve quality may enhance or hurt patients’ experiences with care. METHODS Using Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data covering 3 years before and 1 year after the start of Medicare ACO contracts in 2012 as well as linked Medicare claims, we compared patients’ experiences in a group of 32,334 fee-for-service beneficiaries attributed to ACOs (ACO group) with those in a group of 251,593 beneficiaries attributed to other providers (control group), before and after the start of ACO contracts. We used linear regression and a difference-in-differences analysis to estimate changes in patients’ experiences in the ACO group that differed from concurrent changes in the control group, with adjustment for the sociodemographic and clinical characteristics of the patients. RESULTS After ACO contracts began, patients’ reports of timely access to care and their primary physicians’ being informed about specialty care differentially improved in the ACO group, as compared with the control group (P = 0.01 and P = 0.006, respectively), whereas patients’ ratings of physicians, interactions with physicians, and overall care did not differentially change. Among patients with multiple chronic conditions and high predicted Medicare spending, overall ratings of care differentially improved in the ACO group as compared with the control group (P = 0.02). Differential improvements in timely access to care and overall ratings were equivalent to moving from average performance among ACOs to the 86th to 98th percentile (timely access to care) and to the 82nd to 96th percentile (overall ratings) and were robust to adjustment for group differences in trends during the preintervention period. CONCLUSIONS In the first year, ACO contracts were associated with meaningful improvements in some measures of patients’ experience and with unchanged performance in

  14. Interpretations of Integration in Early Accountable Care Organizations

    PubMed Central

    Kreindler, Sara A; Larson, Bridget K; Wu, Frances M; Carluzzo, Kathleen L; Gbemudu, Josette N; Struthers, Ashley; Van Citters, Aricca D; Shortell, Stephen M; Nelson, Eugene C; Fisher, Elliott S

    2012-01-01

    Context It is widely hoped that accountable care organizations (ACOs) will improve health care quality and reduce costs by fostering integration among diverse provider groups. But how do implementers actually envision integration, and what will integration mean in terms of managing the many social identities that ACOs bring together? Methods Using the lens of the social identity approach, this qualitative study examined how four nascent ACOs engaged with the concept of integration. During multiday site visits, we conducted interviews (114 managers and physicians), observations, and document reviews. Findings In no case was the ACO interpreted as a new, overarching entity uniting disparate groups; rather, each site offered a unique interpretation that flowed from its existing strategies for social-identity management: An independent practice association preserved members’ cherished value of autonomy by emphasizing coordination, not “integration”; a medical group promoted integration within its employed core, but not with affiliates; a hospital, engaging community physicians who mistrusted integrated systems, reimagined integration as an equal partnership; an integrated delivery system advanced its careful journey towards intergroup consensus by presenting the ACO as a cultural, not structural, change. Conclusions The ACO appears to be a model flexible enough to work in synchrony with whatever social strategies are most context appropriate, with the potential to promote alignment and functional integration without demanding common identification with a superordinate group. “Soft integration” may be a promising alternative to the vertically integrated model that, though widely assumed to be ideal, has remained unattainable for most organizations. PMID:22985278

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

    PubMed

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

    2015-06-01

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

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

    PubMed Central

    Smith, Grant; Block, Susan D.

    2015-01-01

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

  17. 76 FR 28988 - Medicare Program; Accelerated Development Sessions for Accountable Care Organizations-June 20, 21...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-19

    ... Sessions for Accountable Care Organizations--June 20, 21, and 22, 2011 AGENCY: Centers for Medicare... functions of an Accountable Care Organization (ACO) and ways to build their organization's capacity to succeed as an ACO. This 3-day, in-person ADS is to help new ACOs deliver better care and reduce costs....

  18. Can the Accountable Care Organization model facilitate integrated care in England?

    PubMed

    Ahmed, Faheem; Mays, Nicholas; Ahmed, Naeem; Bisognano, Maureen; Gottlieb, Gary

    2015-10-01

    Following the global economic recession, health care systems have experienced intense political pressure to contain costs without compromising quality. One response is to focus on improving the continuity and coordination of care, which is seen as beneficial for both patients and providers. However, cultural and structural barriers have proved difficult to overcome in the quest to provide integrated care for entire populations. By holding groups of providers responsible for the health outcomes of a designated population, in the United States, Accountable Care Organizations are regarded as having the potential to foster collaboration across the continuum of care. They could have a similar role in England's National Health Service. However, it is important to consider the difference in context before implementing a similar model, adapted to suit the system's strengths. Working together, general practice federations and the Academic Health Science Networks could form the basis of accountable care in England. PMID:26079144

  19. Public health departments and accountable care organizations: finding common ground in population health.

    PubMed

    Ingram, Richard; Scutchfield, F Douglas; Costich, Julia F

    2015-05-01

    We examined areas of potential collaboration between accountable care organizations and public health agencies, as well as perceived barriers and facilitators. We interviewed 9 key informants on 4 topics: advantages of public health agency involvement in accountable care organizations; services public health agencies could provide; practical, cultural, and legal barriers to accountable care organization-public health agency involvement; and business models that facilitate accountable care organization-public health agency collaboration. Public health agencies could help accountable care organizations partner with community organizations and reach vulnerable patients, provide population-based services and surveillance data, and promote policies that improve member health. Barriers include accountable care organizations' need for short-term financial yield, limited public health agency technical and financial capacity, and the absence of a financial model. PMID:25790392

  20. Performance Differences in Year 1 of Pioneer Accountable Care Organizations

    PubMed Central

    McWilliams, J. Michael; Chernew, Michael E.; Landon, Bruce E.; Schwartz, Aaron L.

    2015-01-01

    BACKGROUND In 2012, a total of 32 organizations entered the Pioneer accountable care organization (ACO) program, in which providers can share savings with Medicare if spending falls below a financial benchmark. Performance differences associated with characteristics of Pioneer ACOs have not been well described. METHODS In a difference-in-differences analysis of Medicare fee-for-service claims, we compared Medicare spending for beneficiaries attributed to Pioneer ACOs (ACO group) with other beneficiaries (control group) before (2009 through 2011) and after (2012) the start of Pioneer ACO contracts, with adjustment for geographic area and beneficiaries’ sociodemographic and clinical characteristics. We estimated differential changes in spending for several subgroups of ACOs: those with and those without clear financial integration between hospitals and physician groups, those with higher and those with lower baseline spending, and the 13 ACOs that withdrew from the Pioneer program after 2012 and the 19 that did not. RESULTS Adjusted Medicare spending and spending trends were similar in the ACO group and the control group during the precontract period. In 2012, the total adjusted per-beneficiary spending differentially changed in the ACO group as compared with the control group (−$29.2 per quarter, P = 0.007), consistent with a 1.2% savings. Savings were significantly greater for ACOs with baseline spending above the local average, as compared with those with baseline spending below the local average (P = 0.05 for interaction), and for those serving high-spending areas, as compared with those serving low-spending areas (P = 0.04). Savings were similar in ACOs with financial integration between hospitals and physician groups and those without, as well as in ACOs that withdrew from the program and those that did not. CONCLUSIONS Year 1 of the Pioneer ACO program was associated with modest reductions in Medicare spending. Savings were greater for ACOs with higher

  1. 76 FR 29249 - Medicare Program; Pioneer Accountable Care Organization Model: Request for Applications

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-20

    ... HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Program; Pioneer Accountable Care... participate in the Pioneer Accountable Care Organization Model for a period beginning in 2011 and ending...://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco . Application...

  2. Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey

    PubMed Central

    D’Aunno, Thomas; Friedmann, Peter D.; Chen, Qixuan; Wilson, Donna M.

    2016-01-01

    To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation’s fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors’ perceptions of market competition, organizational ownership, and geographic location are significantly related to SATinvolvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system. PMID:26124307

  3. Medicare program; Medicare Shared Savings Program: Accountable Care Organizations. Final rule.

    PubMed

    2015-06-01

    This final rule addresses changes to the Medicare Shared Savings Program including provisions relating to the payment of Accountable Care Organizations participating in the Medicare Shared Savings Program. Under the Medicare Shared Savings Program, providers of services and suppliers that participate in an Accountable Care Organizations continue to receive traditional Medicare fee-for-service payments under Parts A and B, but the Accountable Care Organizations may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. PMID:26065102

  4. The March to Accountable Care Organizations--How Will Rural Fare?

    ERIC Educational Resources Information Center

    MacKinney, A. Clinton; Mueller, Keith J.; McBride, Timothy D.

    2011-01-01

    Purpose: This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs). Methods: ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA)…

  5. 75 FR 70165 - Medicare Program; Request for Information Regarding Accountable Care Organizations and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-17

    ... HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Chapter IV Medicare Program; Request for Information Regarding Accountable Care Organizations and the Medicare Shared Saving Program AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Request for information. SUMMARY: This...

  6. 76 FR 19527 - Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-07

    ...This proposed rule would implement section 3022 of the Affordable Care Act which contains provisions relating to Medicare payments to providers of services and suppliers participating in Accountable Care Organizations (ACOs). Under these provisions, providers of services and suppliers can continue to receive traditional Medicare fee-for-service payments under Parts A and B, and be eligible for......

  7. Accountable Care Organizations: what they mean for the country and for neurointerventionalists.

    PubMed

    Meehan, Timothy M; Harvey, H Benjamin; Duszak, Richard; Meyers, Philip M; McGinty, Geraldine; Nicola, Gregory N; Hirsch, Joshua A

    2016-06-01

    The Affordable Care Act is celebrating its fifth anniversary and remains one of the most significant attempts to reform healthcare in US history. Prior to the federal legislation, Accountable Care Organizations had largely been part of an academic discussion about how to control rising healthcare costs, but have since become a fixture in our national healthcare landscape. A fundamental shift is underway in the relationship between healthcare delivery and payment models. Some elements of Accountable Care Organizations may remain unfamiliar to most healthcare providers, including neurointerventional specialists. In this paper we review the fundamental concepts behind and the current forms of Accountable Care Organizations, and discuss the challenges and opportunities they present for neurointerventionalists. PMID:25987588

  8. Early Efforts By Medicare Accountable Care Organizations Have Limited Effect On Mental Illness Care And Management.

    PubMed

    Busch, Alisa B; Huskamp, Haiden A; McWilliams, J Michael

    2016-07-01

    People with mental illness use more health care and have worse outcomes than those without such illnesses. In response to incentives to reduce spending, accountable care organizations (ACOs) may therefore attempt to improve their management of mental illness. We examined changes in mental health spending, utilization, and quality measures associated with ACO contracts in the Medicare Shared Savings Program and Pioneer model for beneficiaries with mental illness, using Medicare claims for the period 2008-13 and difference-in-differences comparisons with local non-ACO providers. Pioneer contracts were associated with lower spending on mental health admissions in the first year of the contract, an effect that was attenuated in the second year. Otherwise, ACO contracts were associated with no changes in mental health spending or readmissions, outpatient follow-up after mental health admissions, rates of depression diagnosis, or mental health status. These results suggest that ACOs have not yet focused on mental illness or have been largely unsuccessful in early efforts to improve their management of it. PMID:27385241

  9. The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities

    PubMed Central

    Bartels, Stephen J.; Gill, Lydia; Naslund, John A.

    2015-01-01

    Abstract The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA. PMID:25811340

  10. The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities.

    PubMed

    Bartels, Stephen J; Gill, Lydia; Naslund, John A

    2015-01-01

    The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA. PMID:25811340

  11. An ethical framework for the responsible leadership of accountable care organizations.

    PubMed

    McCullough, Laurence B

    2012-01-01

    Using the ethical concepts of co-fiduciary responsibility in patient care and of preventive ethics, this article provides an ethical framework to guide physician and lay leaders of accountable care organizations. The concept of co-fiduciary responsibility is based on the ethical concept of medicine as a profession, which was introduced into the history of medical ethics in the 18th century. Co-fiduciary responsibility applies to everyone who influences the processes of patient care: physicians, organizational leaders, patients, and patients' surrogates. A preventive ethics approach to co-fiduciary responsibility requires leaders of accountable care organizations to create organizational cultures of fiduciary professionalism that implement and support the following: improving quality based on candor and accountability, reasserting the physician's professional role in the informed consent process, and constraining patients' and surrogates' autonomy. Sustainable organizational cultures of fiduciary professionalism will require commitment of organizational resources and constant vigilance over the intellectual and moral integrity of organizational culture. PMID:22114154

  12. Improving Our Nation's Health Care System: Inclusion of Chiropractic in Patient-Centered Medical Homes and Accountable Care Organizations

    PubMed Central

    Meeker, William C.; Watkins, R.W.; Kranz, Karl C.; Munsterman, Scott D.; Johnson, Claire

    2014-01-01

    Objective This report summarizes the closing plenary session of the Association of Chiropractic Colleges Educational Conference—Research Agenda Conference 2014. The purpose of this session was to examine patient-centered medical homes and accountable care organizations from various speakers’ viewpoints and to discuss how chiropractic could possibly work within, and successfully contribute to, the changing health care environment. Discussion The speakers addressed the complex topic of patient-centered medical homes and accountable care organizations and provided suggestions for what leadership strategies the chiropractic profession may need to enhance chiropractic participation and contribution to improving our nation’s health. Conclusion There are many factors involved in the complex topic of chiropractic inclusion in health care models. Major themes resulting from this panel included the importance of building relationships with other professionals, demonstrating data and evidence for what is done in chiropractic practice, improving quality of care, improving health of populations, and reducing costs of health care. PMID:25431542

  13. Analysis & commentary: The accountable care organization: whatever its growing pains, the concept is too vitally important to fail.

    PubMed

    Crosson, Francis J

    2011-07-01

    The success of health reform efforts will depend, in part, on creating new and better ways to organize, deliver, and pay for health care. Increasingly central to this idea is the accountable care organization model proposed for Medicare and a slightly different model for commercial health care. But these new health care delivery and payment models face considerable skepticism. Can Medicare succeed with accountable care organizations if physicians can't determine whether patients are in the organization or not? Will commercial hospitals use their clout to create accountable care organizations, leaving physician practices in a weaker position? This article answers those and other criticisms of the developing accountable care organization movement. If the concept fails, the nation may face indiscriminate cuts to health care payments, with resulting reductions in access, service, and quality. PMID:21734197

  14. Attributing patients to accountable care organizations: performance year approach aligns stakeholders' interests.

    PubMed

    Lewis, Valerie A; McClurg, Asha Belle; Smith, Jeremy; Fisher, Elliott S; Bynum, Julie P W

    2013-03-01

    The accountable care organization (ACO) model of health care delivery is rapidly being implemented under government and private-sector initiatives. The model requires that each ACO have a defined patient population for which the ACO will be held accountable for both total cost of care and quality performance. However, there is no empirical evidence about the best way to define how patients are assigned to these groups of doctors, hospitals, and other health care providers. We examined the two major methods of defining, or attributing, patient populations to ACOs: the prospective method and the performance year method. The prospective method uses data from one year to assign patients to an ACO for the following performance year. The performance year method assigns patients to an ACO at the end of the performance year based on the population served during the performance year. We used Medicare fee-for-service claims data from 2008 and 2009 to simulate a set of ACOs to compare the two methods. Although both methods have benefits and drawbacks, we found that attributing patients using the performance year method yielded greater overlap of attributed patients and patients treated during the performance year and resulted in a higher proportion of care concentrated within an accountable care organization. Together, these results suggest that performance year attribution may more fully and accurately reflect an ACO's patient population and may better position an ACO to achieve shared savings. PMID:23459739

  15. Comparison of Healthcare Quality Outcomes Between Accountable Care Organizations and Physician Group Practices.

    PubMed

    Singh, Sukhchain; Khosla, Sandeep; Sethi, Ankur

    2015-01-01

    Accountable Care Organizations (ACOs) were created under the Affordable Care Act to deliver better quality of care at reduced cost compare with the traditional fee-for-service model. But their effectiveness in achieving healthcare quality metrics is unclear. We analyzed ACO and physician group practice (PGP) performance rates for the single coronary artery disease measure and four diabetes mellitus measures now publicly reported on the Medicare Physician Compare Web site for program year 2012. There was no statistically significant difference in reported quality measures between ACOs and PGPs. Our study shows that PGPs can achieve outcomes at par with ACOs. PMID:26223106

  16. Truth Telling and Treatment Strategies in End-of-Life Care in Physician-Led Accountable Care Organizations

    PubMed Central

    Huang, Hsien-Liang; Cheng, Shao-Yi; Yao, Chien-An; Hu, Wen-Yu; Chen, Ching-Yu; Chiu, Tai-Yuan

    2015-01-01

    Abstract Providing patient-centered care from preventive medicine to end-of-life care in order to improve care quality and reduce medical cost is important for accountable care. Physicians in the accountable care organizations (ACOs) are suitable for participating in supportive end-of-life care especially when facing issues in truth telling and treatment strategy. This study aimed to investigate patients’ attitudes toward truth telling and treatment preferences in end-of-life care and compare patients’ attitudes with their ACOs physicians’ perceptions. This nationwide study applied snowball sampling to survey physicians in physician-led ACOs and their contracted patients by questionnaire from August 2010 to July 2011 in Taiwan. The main outcome measures were beliefs about palliative care, attitudes toward truth telling, and treatment preferences. The data of 314 patients (effective response rate = 88.7%) and 177 physicians (88.5%) were analyzed. Regarding truth telling about disease prognosis, 94.3% of patients preferred to be fully informed, whereas only 80% of their physicians had that perception (P < 0.001). Significant differences were also found in attitudes toward truth telling even when encountering terminal disease status (98.1% vs 85.3%). Regarding treatment preferences in terminal illness, nearly 90% of patients preferred supportive care, but only 15.8% of physicians reported that their patients had this preference (P < 0.001). Significant discrepancies exist between patients’ preferences and physicians’ perceptions toward truth telling and treatment strategies in end-of-life care. It is important to enhance physician–patient communication about end-of-life care preferences in order to achieve the goal of ACOs. Continuing education on communication about end-of-life care during physicians’ professional development would be helpful in the reform strategies of establishing accountable care around the world. PMID:25906093

  17. The ephemeral accountable care organization-an unintended consequence of the Medicare shared savings program.

    PubMed

    Harvey, H Benjamin; Gowda, Vrushab; Gazelle, G Scott; Pandharipande, Pari V

    2014-02-01

    A fundamental element of health care payment reform under the Affordable Care Act is the development of Accountable Care Organizations (ACOs). The ACO model employs shared-risk contracts to better align the interests of health care providers and payers with the intent of driving efficiency and quality in care. The Medicare Shared Savings Program is the most popular of the Medicare ACO programs, with over 200 health systems across the nation participating at this time. However, a pitfall in the way that the Medicare Shared Savings Program is structured, specifically the benchmarking and rebasing method, could make it difficult for even top-performing ACOs to achieve sustained success, thereby threatening the long-term viability of the program. In this paper, we present this pitfall to the radiology community as well as potential solutions that can be considered by CMS moving forward. PMID:24360903

  18. Early experience of a safety net provider reorganizing into an accountable care organization.

    PubMed

    Hacker, Karen; Santos, Palmira; Thompson, Douglas; Stout, Somava S; Bearse, Adriana; Mechanic, Robert E

    2014-08-01

    Although safety net providers will benefit from health insurance expansions under the Affordable Care Act, they also face significant challenges in the postreform environment. Some have embraced the concept of the accountable care organization to help improve quality and efficiency while addressing financial shortfalls. The experience of Cambridge Health Alliance (CHA) in Massachusetts, where health care reform began six years ago, provides insight into the opportunities and challenges of this approach in the safety net. CHA's strategies include care redesign, financial realignment, workforce transformation, and development of external partnerships. Early results show some improvement in access, patient experience, quality, and utilization; however, the potential efficiencies will not eliminate CHA's current operating deficit. The patient population, payer mix, service mix, cost structure, and political requirements reduce the likelihood of financial sustainability without significant changes in these factors, increased public funding, or both. Thus the future of safety net institutions, regardless of payment and care redesign success, remains at risk. PMID:24842968

  19. Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

    PubMed Central

    Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan

    2012-01-01

    Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools – accountability measures and payment designs – to improve access to and quality of care for patients with behavioral health needs. PMID:23188486

  20. Transforming healthcare delivery: Why and how accountable care organizations must evolve.

    PubMed

    Chen, Christopher T; Ackerly, D Clay; Gottlieb, Gary

    2016-09-01

    Accountable care organizations (ACOs) have shown promise in reducing healthcare spending growth, but have proven to be financially unsustainable for many healthcare organizations. Even ACOs with shared savings have experienced overall losses because the shared savings bonuses have not covered the costs of delivering population health. As physicians and former ACO leaders, we believe in the concept of accountable care, but ACOs need to evolve if they are to have a viable future. We propose the novel possibility of allowing ACOs to bill fee-for-service for their population health interventions, a concept we call population health billing. Journal of Hospital Medicine 2016;11:658-661. © 2016 Society of Hospital Medicine. PMID:27596543

  1. Accountable care organization formation is associated with integrated systems but not high medical spending.

    PubMed

    Auerbach, David I; Liu, Hangsheng; Hussey, Peter S; Lau, Christopher; Mehrotra, Ateev

    2013-10-01

    Medicare's approximately 250 accountable care organizations (ACOs) care for a growing portion of all fee-for-service beneficiaries across the United States. We examined where ACOs have formed and what regional factors are predictive of ACO formation. Understanding these factors could help policy makers foster growth in areas with limited ACO development. We found wide variation in ACO formation, with large areas, such as the Northwest, essentially empty of ACOs, and others, such as the Northeast and Midwest, dense with the organizations. Key regional factors associated with ACO formation include a greater fraction of hospital risk sharing (capitation), larger integrated hospital systems, and primary care physicians practicing in large groups. Area income, Medicare per capita spending, Medicare Advantage enrollment rates, and physician density were not associated with ACO formation. Together, these results imply that underlying provider integration in a region may help drive the formation of ACOs. PMID:24101069

  2. Accountable Care Organizations in the United States: Market and Demographic Factors Associated with Formation

    PubMed Central

    Lewis, Valerie A; Colla, Carrie H; Carluzzo, Kathleen L; Kler, Sarah E; Fisher, Elliott S

    2013-01-01

    Background. The Accountable Care Organization (ACO) model is rapidly being implemented by Medicare, private payers, and states, but little is known about the scope of ACO implementation. Objective. To determine the number of accountable care organizations in the United States, where they are located, and characteristics associated with ACO formation. Study Design, Methods, and Data. Cross-sectional study of all ACOs in the United States as of August 2012. We identified ACOs from multiple sources; documented service locations (practices, clinics, hospitals); and linked service locations to local areas, defined as Dartmouth Atlas hospital service areas. We used multivariate analysis to assess what characteristics were associated with local ACO presence. We examined demographic characteristics (2010 American Community Survey) and health care system characteristics (2010 Medicare fee-for-service claims data). Principal Findings. We identified 227 ACOs located in 27 percent of local areas. Fifty-five percent of the US population resides in these areas. HSA-level characteristics associated with ACO presence include higher performance on quality, higher Medicare per capita spending, fewer primary care physician groups, greater managed care penetration, lower poverty rates, and urban location. Conclusions. Much of the US population resides in areas where ACOs have been established. ACO formation has taken place where it may be easier to meet quality and cost targets. Wider adoption of the ACO model may require tailoring to local context. PMID:24117222

  3. An Early Assessment of Accountable Care Organizations' Efforts to Engage Patients and Their Families.

    PubMed

    Shortell, Stephen M; Sehgal, Neil J; Bibi, Salma; Ramsay, Patricia P; Neuhauser, Linda; Colla, Carrie H; Lewis, Valerie A

    2015-10-01

    Accountable care organizations (ACOs) have incentives to meet quality and cost targets to share in any resulting savings. Achieving these goals will require ACOs to engage more actively with patients and their families. The extent to which ACOs do so is currently unknown. Using mixed methods, including a national survey, phone interviews, and site-visits, we examine the extent to which ACOs actively engage patients and their families, explore challenges involved, and consider approaches for dealing with those challenges. Results indicate that greater ACO use of patient activation and engagement (PAE) activities at the point-of-care may be related to positive perceptions among ACO leaders of the impact of PAE investments on ACO costs, quality, and outcomes of care. We identify a number of important practices associated with greater PAE, including high-level leadership commitment, goal-setting supported by adequate resources, extensive provider training, use of interdisciplinary care teams, and frequent monitoring and reporting on progress. PMID:26038349

  4. Patient Population Loss At A Large Pioneer Accountable Care Organization And Implications For Refining The Program.

    PubMed

    Hsu, John; Price, Mary; Spirt, Jenna; Vogeli, Christine; Brand, Richard; Chernew, Michael E; Chaguturu, Sreekanth K; Mohta, Namita; Weil, Eric; Ferris, Timothy

    2016-03-01

    There is an ongoing move toward payment models that hold providers increasingly accountable for the care of their patients. The success of these new models depends in part on the stability of patient populations. We investigated the amount of population turnover in a large Medicare Pioneer accountable care organization (ACO) in the period 2012-14. We found that substantial numbers of beneficiaries became part of or left the ACO population during that period. For example, nearly one-third of beneficiaries who entered in 2012 left before 2014. Some of this turnover reflected that of ACO physicians-that is, beneficiaries whose physicians left the ACO were more likely to leave than those whose physicians remained. Some of the turnover also reflected changes in care delivery. For example, beneficiaries who were active in a care management program were less likely to leave the ACO than similar beneficiaries who had not yet started such a program. We recommend policy changes to increase the stability of ACO beneficiary populations, such as permitting lower cost sharing for care received within an ACO and requiring all beneficiaries to identify their primary care physician before being linked to an ACO. PMID:26953296

  5. Alabama Physicians and Accountable Care Organizations: Will What We Don't Know Hurt Us?

    PubMed

    Powell, M Paige; Post, Lindsey R; Bishop, Blake A

    2016-01-01

    Accountable care organizations (ACOs) were designed to improve the quality of care delivered to Medicare beneficiaries while also halting the growth in Medicare spending. Many existing health systems in the Northeast, Midwest, and West have formed ACOs, whereas implementation in Southern states has been slower. The study team conducted a survey of all physician members of the Medical Association of the State of Alabama to determine the likelihood of their participation in an ACO and their attitudes toward some of the characteristics, such as quality measures, regulations, and risks versus rewards. The team found that many physicians reported a lack of knowledge about these areas. Physicians who reported that they were either likely or not likely to participate overwhelmingly held unfavorable attitudes about ACOs. It would be advantageous for Alabama physicians to become more knowledgeable about ACOs in the case that they become a more predominant form of care delivery in the future. PMID:25414377

  6. Regulatory neutrality is essential to establishing a level playing field for accountable care organizations.

    PubMed

    Bacher, Gary E; Chernew, Michael E; Kessler, Daniel P; Weiner, Stephen M

    2013-08-01

    Accountable care organizations (ACOs) are among the most widely discussed models for encouraging movement away from fee-for-service payment arrangements. Although ACOs have the potential to slow health spending growth and improve quality of care, regulating them poses special challenges. Regulations, particularly those that affect both ACOs and Medicare Advantage plans, could inadvertently favor or disfavor certain kinds of providers or payers. Such favoritism could drive efficient organizations from the market and thus increase costs or reduce quality of and access to care. To avoid this type of outcome, we propose a general principle: Regulation of ACOs should strive to preserve a level playing field among different kinds of organizations seeking the same cost, quality, and access objectives. This is known as regulatory neutrality. We describe the implications of regulatory neutrality in four key areas: antitrust, financial solvency regulation, Medicare governance requirements, and Medicare payment models. We also discuss issues relating to short-term versus long-term perspectives--to promote the goal of regulatory neutrality and allow the most efficient organizations to prevail in the marketplace. PMID:23918487

  7. Medicare Accountable Care Organizations: program eligibility, beneficiary assignment, and quality measures.

    PubMed

    MacKinney, A Clinton; Mueller, Keith J; Zhu, Xi; Vaughn, Thomas

    2014-04-01

    Accountable Care Organizations (ACOs) are groups of providers (generally physicians and/or hospitals) that may receive financial rewards by maintaining or improving care quality for a group of patients while reducing the cost of care for those patients. The Patient Protection and Affordable Care Act of 2010 (ACA) established a Medicare Shared Savings Program (MSSP) and accompanying Medicare ACOs to “facilitate coordination and cooperation among providers to improve the quality of care for Medicare fee-for-service (FFS) beneficiaries and reduce unnecessary costs.” The MSSP now includes 343 ACOs; an additional 23 ACOs participate in the Medicare Pioneer ACO demonstration program, and there are approximately 240 private ACOs. Based on our analysis, among the Medicare ACOs 119 operate in both rural and urban counties and seven operate exclusively in rural counties. A little over 24 percent of non-metropolitan counties are included in Medicare ACOs. To assist rural providers considering ACO formation, this policy brief describes MSSP eligibility and participation requirements, beneficiary assignment processes, and quality measures. PMID:25399468

  8. Accountable Care Organizations and Clinical Commissioning Groups Face an Uncertain Challenge for Improving Public Health

    PubMed Central

    Noble, Douglas J.

    2012-01-01

    Accountable Care Organizations (ACOs) in the United States of America (USA) and Clinical Commissioning Groups (CCGs) in the United Kingdom (UK) are newly proposed cross-organisational structures in health services both tasked with a role which includes improving public health. Although there are very significant differences between the UK and USA health systems, there appears to be some similar confusion as to how ACOs and CCGs will regard and address public or population health. This short perspective article gives an overview of ACOs in the USA and CCGs in the UK, with the underlying context of possible public health functions. It concludes by considering the challenges facing both countries and highlighting the opportunity for shared learning. Acknowledgments this article was based on a research proposal prepared for the Commonwealth Fund’s Harkness Fellowship in Health Care Policy and Practice 2012/2013. PMID:25170452

  9. The Economics of Provider Payment Reform: Are Accountable Care Organizations the Answer?

    PubMed

    Feldman, Roger

    2015-08-01

    A remarkable consensus has developed that the fee-for-service (FFS) approach for paying medical providers must be replaced. This payment approach is said to increase the volume of services without improving care coordination. In response to these calls, Medicare and private payers are experimenting with payment systems that combine the basic element of FFS - a fee for each service - with arrangements that allow providers to share the savings if they hold total spending per patient below a targeted amount. Medicare's accountable care organizations (ACOs) embody the shared savings approach to payment reform. Private payers have introduced total cost of care contracting (TCOC) in several locations. This article questions the consensus that FFS must go. If the fees are too high, then someone needs to "bite the bullet" and reduce fees in key areas. Hoping to control overspending by investment in ACOs is wishful thinking. I describe the theory and practice of shared savings payment systems and summarize recent TCOC contracting initiatives in the private sector. Medicare's shared savings approach is likely to be less effective than private contracts. Cutting providers' fees would be more efficient. Finally, the new payment models in the Affordable Care Act will not ease the problem of high prices for private payers. PMID:26124297

  10. Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking.

    PubMed

    Rose, Sherri; Zaslavsky, Alan M; McWilliams, J Michael

    2016-03-01

    Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients. PMID:26953298

  11. Characteristics of Rural Accountable Care Organizations (ACOs) – A Survey of Medicare ACOs with Rural Presence.

    PubMed

    Salako, Abiodun; Zhu, Xi; MacKinney, A Clinton; Ullrich, Fred; Mueller, Keith

    2015-05-01

    Accountable Care Organizations (ACOs) are groups of health care providers, principally physicians and hospitals, who develop a new entity that contracts to provide coordinated care to assigned patients with the goal of improving quality of care while controlling costs. Section 3022 of the Patient Protection and Affordable Care Act of 2010 created the Medicare Shared Savings Program (SSP). The Centers for Medicare & Medicaid Services (CMS) implements this program and has approved SSP contracts in five cycles since 2011, including some that participated in a special demonstration project that provided advance payment (as a forgivable loan). A new ACO Investment Model (AIM) program starts in 2015 that provides initial investment capital and variable monthly payments to ACO participants in rural and underserved areas who may not have access to the capital needed for successful ACO formation and operation. CMS also contracted with 32 organizations under a special demonstration project, "Pioneer ACOs" (as of November 16, 2014, there were 19 remaining).8 At the time of the research reported in this brief, there were 455 Medicare ACOs (Pioneer and SSP). While there is growing literature about ACOs, much remains to be learned about ACO development in rural areas. A previous RUPRI Center policy brief 2 examined the formation of four rural ACOs. The authors found that prior experience with risk sharing and provider integration facilitated ACO formation. This brief expands on the earlier brief by describing the findings of a survey of 27 rural ACOs, focusing on characteristics important to their formation and operation. Prospective rural ACO participants can draw from the experiences of predecessors, and the survey findings can inform policy discussions about ACO formation and operation. Key Findings from 27 Respondents. (1) Sixteen rural ACOs were formed by pre-existing integrated delivery networks. (2) Physician groups played a more prominent role than other participant

  12. Using health information technology to manage a patient population in accountable care organizations.

    PubMed

    Wu, Frances M; Rundall, Thomas G; Shortell, Stephen M; Bloom, Joan R

    2016-06-20

    Purpose - The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population. Design/methodology/approach - Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013). Findings - Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it. Research limitations/implications - Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses. Practical implications - ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population. Originality/value - Using new empirical data, this study increases understanding of the extent of ACOs' current and developing HIT capabilities to support ongoing care management. PMID:27296880

  13. An agent-based simulation model to study accountable care organizations.

    PubMed

    Liu, Pai; Wu, Shinyi

    2016-03-01

    Creating accountable care organizations (ACOs) has been widely discussed as a strategy to control rapidly rising healthcare costs and improve quality of care; however, building an effective ACO is a complex process involving multiple stakeholders (payers, providers, patients) with their own interests. Also, implementation of an ACO is costly in terms of time and money. Immature design could cause safety hazards. Therefore, there is a need for analytical model-based decision-support tools that can predict the outcomes of different strategies to facilitate ACO design and implementation. In this study, an agent-based simulation model was developed to study ACOs that considers payers, healthcare providers, and patients as agents under the shared saving payment model of care for congestive heart failure (CHF), one of the most expensive causes of sometimes preventable hospitalizations. The agent-based simulation model has identified the critical determinants for the payment model design that can motivate provider behavior changes to achieve maximum financial and quality outcomes of an ACO. The results show nonlinear provider behavior change patterns corresponding to changes in payment model designs. The outcomes vary by providers with different quality or financial priorities, and are most sensitive to the cost-effectiveness of CHF interventions that an ACO implements. This study demonstrates an increasingly important method to construct a healthcare system analytics model that can help inform health policy and healthcare management decisions. The study also points out that the likely success of an ACO is interdependent with payment model design, provider characteristics, and cost and effectiveness of healthcare interventions. PMID:24715674

  14. Price-transparency and cost accounting: challenges for health care organizations in the consumer-driven era.

    PubMed

    Hilsenrath, Peter; Eakin, Cynthia; Fischer, Katrina

    2015-01-01

    Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers. PMID:25862425

  15. 76 FR 66931 - Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-28

    ... improve the capabilities of provider organizations to coordinate the care of a population of Medicare... improve beneficiaries' quality outcomes and reduce the growth of Medicare expenditures. Completion of the... to build capacity needed to achieve better care for individuals, better population health, and...

  16. Physician Practice Participation in Accountable Care Organizations: The Emergence of the Unicorn

    PubMed Central

    Shortell, Stephen M; McClellan, Sean R; Ramsay, Patricia P; Casalino, Lawrence P; Ryan, Andrew M; Copeland, Kennon R

    2014-01-01

    Objective To provide the first nationally based information on physician practice involvement in ACOs. Data Sources/Study Setting Primary data from the third National Survey of Physician Organizations (January 2012–May 2013). Study Design We conducted a 40-minute phone survey in a sample of physician practices. A nationally representative sample of practices was surveyed in order to provide estimates of organizational characteristics, care management processes, ACO participation, and related variables for four major chronic illnesses. Data Collection/Extraction Methods We evaluated the associations between ACO participation, organizational characteristics, and a 25-point index of patient-centered medical home processes. Principal Findings We found that 23.7 percent of physician practices (n = 280) reported joining an ACO; 15.7 percent (n = 186) were planning to become involved within the next 12 months and 60.6 percent (n = 717) reported no involvement and no plans to become involved. Larger practices, those receiving patients from an IPA and/or PHO, those that were physician-owned versus hospital/health system-owned, those located in New England, and those with greater patient-centered medical home (PCMH) care management processes were more likely to have joined an ACO. Conclusions Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices. PMID:24628449

  17. Pathology service line: a model for accountable care organizations at an academic medical center.

    PubMed

    Sussman, Ira; Prystowsky, Michael B

    2012-05-01

    Accountable care is designed to manage the health of patients using a capitated cost model rather than fee for service. Pay for performance is an attempt to use quality and not service reduction as the way to decrease costs. Pathologists will have to demonstrate value to the system. This value will include (1) working with clinical colleagues to optimize testing protocols, (2) reducing unnecessary testing in both clinical and anatomic pathology, (3) guiding treatment by helping to personalize therapy, (4) designing laboratory information technology solutions that will promote and facilitate accurate, complete data mining, and (5) administering efficient cost-effective laboratories. The pathology service line was established to improve the efficiency of delivering pathology services and to provide more effective support of medical center programs. We have used this model effectively at the Montefiore Medical Center for the past 14 years. PMID:22333926

  18. Achieving interoperability for accountable care.

    PubMed

    Bordenick, Jennifer Covich; Okubo, Tracy H; Kontur, Alex; Siddiqui, Nadeen

    2015-02-01

    Based on findings of a recent survey, accountable care organizations should keep eight points in mind as they seek to establish interoperability among their provider constituents: Create a shared governance structure to make IT decisions. Conduct a readiness assessment and gap analysis. Reconfigure the technology infrastructure and processes to support new value-based care delivery protocols. Consider targeting programs around high-risk groups. Develop real-time data-sharing systems. Ensure privacy and security policies and procedures are in place. Assess and address workforce issues expeditiously. Participate in broader interoperability efforts. PMID:26665540

  19. Moving toward implementation: the potential for accountable care organizations and private-public partnerships to advance active neighborhood design.

    PubMed

    Zusman, Edie E; Carr, Sara Jensen; Robinson, Judy; Kasirye, Olivia; Zell, Bonnie; Miller, William Jahmal; Duarte, Teri; Engel, Adrian B; Hernandez, Monica; Horton, Mark B; Williams, Frank

    2014-12-01

    The 2010 Affordable Care Act's (ACA) aims of lowering costs and improving quality of care will renew focus on preventive health strategies. This coincides with a trend in medicine to reconsider population health approaches as part of the standard curriculum. This intersection of new policy and educational climates presents a unique opportunity to reconsider traditional healthcare structures. This paper introduces and advances an alignment that few have considered. We propose that accountable care organizations (ACOs), which are expected to proliferate under the ACA, present the best opportunity to establish partnerships between healthcare, public health, and community-based organizations to achieve the legislation's goals. One example is encouraging daily physical activity via built environment interventions and programs, which is recommended by numerous groups. We highlight how nonprofit organizations in Sacramento, California have been able to leverage influence, capital, and policy to encourage design for active living, and how their work is coordinating with public health and healthcare initiatives. In conclusion, we critically examine potential barriers to the success of partnerships between ACOs and community organizations and encourage further exploration and evaluation. PMID:25117525

  20. New Summary Measures of Population Health and Well-Being for Implementation by Health Plans and Accountable Care Organizations

    PubMed Central

    Gallagher, Jason M.; Rauri, Sachin; Tillema, Juliana O.; Pronk, Nicolaas P.; Knudson, Susan M.

    2016-01-01

    Health plans and accountable care organizations measure many indicators of patient health, with standard metrics that track factors such as patient experience and cost. They lack, however, a summary measure of the third leg of the Triple Aim, population health. In response, HealthPartners has developed summary measures that align with the recommendations of the For the Public’s Health series of reports from the Institute of Medicine. (The series comprises the following 3 reports: For the Public’s Health: Investing in a Healthier Future, For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges, and For the Public’s Health: The Role of Measurement in Action and Accountability.) The summary measures comprise 3 components: current health, sustainability of health, and well-being. The measure of current health is disability-adjusted life years (DALYs) calculated from health care claims and death records. The sustainability of health measure comprises member reporting of 6 behaviors associated with health plus a clinical preventive services index that indicates adherence to evidence-based preventive care guidelines. Life satisfaction represents the summary measure of subjective well-being. HealthPartners will use the summary measures to identify and address conditions and factors that have the greatest impact on the health and well-being of its patients, members, and community. The method could easily be implemented by other institutions and organizations in the United States, helping to address a persistent need in population health measurement for improvement. PMID:27390075

  1. New Summary Measures of Population Health and Well-Being for Implementation by Health Plans and Accountable Care Organizations.

    PubMed

    Kottke, Thomas E; Gallagher, Jason M; Rauri, Sachin; Tillema, Juliana O; Pronk, Nicolaas P; Knudson, Susan M

    2016-01-01

    Health plans and accountable care organizations measure many indicators of patient health, with standard metrics that track factors such as patient experience and cost. They lack, however, a summary measure of the third leg of the Triple Aim, population health. In response, HealthPartners has developed summary measures that align with the recommendations of the For the Public's Health series of reports from the Institute of Medicine. (The series comprises the following 3 reports: For the Public's Health: Investing in a Healthier Future, For the Public's Health: Revitalizing Law and Policy to Meet New Challenges, and For the Public's Health: The Role of Measurement in Action and Accountability.) The summary measures comprise 3 components: current health, sustainability of health, and well-being. The measure of current health is disability-adjusted life years (DALYs) calculated from health care claims and death records. The sustainability of health measure comprises member reporting of 6 behaviors associated with health plus a clinical preventive services index that indicates adherence to evidence-based preventive care guidelines. Life satisfaction represents the summary measure of subjective well-being. HealthPartners will use the summary measures to identify and address conditions and factors that have the greatest impact on the health and well-being of its patients, members, and community. The method could easily be implemented by other institutions and organizations in the United States, helping to address a persistent need in population health measurement for improvement. PMID:27390075

  2. 76 FR 21894 - Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-19

    ... to Health Care Entities With Which They Have Financial Relationships (Phase II), 69 FR 16094 (Mar. 26... II), 69 FR 16094 (Mar. 26, 2004). 3. Calculate the ACO's PSA share for each common service in each... of the circulatory system--MDC 05) and orthopedic care (i.e., services related to diseases...

  3. Ethical Practice Under Accountable Care.

    PubMed

    Graber, Abraham D; Bhandary, Asha; Rizzo, Matthew

    2016-06-01

    Accountable Care Organizations (ACOs) are a key mechanism of the Patient Protection and Affordable Care Act (PPACA). ACOs will influence incentives for providers, who must understand these changes to make well-considered treatment decisions. Our paper defines an ethical framework for physician decisions and action within ACOs. Emerging ethical pressures providers will face as members of an ACO were classified under major headings representing three of the four principles of bioethics: autonomy, beneficence, and justice (no novel conflicts with non-maleficence were identified). Conflicts include a bias against transient populations, a motive to undertreat conditions lacking performance measures, and the mandate to improve population health incentivizing life intrusions. After introducing and explaining each conflict, recommendations are offered for how providers ought to precede in the face of novel ethical choices. Our description of novel ethical choices will help providers know what to expect and our recommendations can guide providers in choosing well. PMID:26002491

  4. 76 FR 67801 - Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-02

    .... In the April 7, 2011 Federal Register (76 FR 19528), we published the Shared Savings Program proposed...-based purchasing initiatives, please refer to section I.A. of the proposed rule (76 FR 19530). B... within section 3022 of the Affordable Care Act is in section I.B. of the proposed rule (see 76 FR...

  5. 75 FR 57039 - Medicare Program; Workshop Regarding Accountable Care Organizations, and Implications Regarding...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-17

    ... 1128B(b) of the Act), and the civil monetary penalty (CMP) law (sections 1128A(b)(1) and (2) of the Act... anti-kickback statute and CMP law and imposes CMPs for knowing violations of the physician self... Organizations,'' Policy Brief (May 2010), available at:...

  6. 76 FR 50224 - Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-12

    ... Federal Register (76 FR 28988). Each participating team should consist of two to four senior-level leaders... the opportunity to learn about core functions of an ACO and ways to build their organization's... at https://acoregister.rti.org/ . Click on ``contact us'' to send questions or comments via...

  7. Changes in Low-Value Services in Year 1 of the Medicare Pioneer Accountable Care Organization Program

    PubMed Central

    Schwartz, Aaron L.; Chernew, Michael E.; Landon, Bruce E.; McWilliams, J. Michael

    2016-01-01

    Importance Wasteful practices are widespread in the US health care system. It is unclear if payment models intended to improve health care efficiency, such as the Medicare accountable care organization (ACO) programs, discourage the provision of low-value services. Objective To assess whether the first year of the Medicare Pioneer ACO program was associated with a reduction in use of low-value services. Design, Setting and Participants In a difference-in-differences analysis, we compared use of low-value services between Medicare fee-for-service beneficiaries attributed to provider groups that entered the Pioneer program (ACO group) and beneficiaries attributed to other providers (control group) before (2009–2011) vs. after (2012) Pioneer ACO contracts began. We adjusted comparisons for beneficiaries’ sociodemographic and clinical characteristics and for geography. We decomposed estimates according to service characteristics (clinical category, price, and sensitivity to patient preferences) and compared estimates between subgroups of ACOs with higher vs. lower baseline use of low-value services. Main Outcomes and Measures Use of, and spending on, 31 services in instances that provide minimal clinical benefit. Results During the pre-contract period, trends in use of low-value services were similar for the ACO and control groups. The first year of ACO contracts was associated with a differential reduction of 0.8 low-value services per 100 beneficiaries for the ACO group (95% CI: −1.2, −0.4; P<0.001), corresponding to a 1.9% reduction in service quantity (95% CI: −2.9%, −0.9%) and a 4.5% differential reduction in spending on low-value services (95% CI: −7.5%, −1.4%; P=0.004). Differential reductions were similar for services less vs. more sensitive to patient preferences and for higher- vs. lower-priced services. ACOs with higher than their markets average baseline levels of low-value service use experienced greater service reductions (−1.2 services

  8. Home and Community Care Sector Accountability

    PubMed Central

    Gray, Carolyn Steele; Berta, Whitney; Deber, Raisa B.; Lum, Janet

    2014-01-01

    This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support the delivery of high-quality care. PMID:25305389

  9. Home and community care sector accountability.

    PubMed

    Steele Gray, Carolyn; Berta, Whitney; Deber, Raisa B; Lum, Janet

    2014-09-01

    This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support the delivery of high-quality care. PMID:25305389

  10. Ensuring quality and accountability in managed care.

    PubMed

    Dobalian, A; Rivers, P A

    1998-01-01

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

  11. From clinical integration to accountable care.

    PubMed

    Shields, Mark

    2011-01-01

    Four key challenges to reforming health care organizations can be addressed by a clinical integration model patterned after Advocate Physician Partners (APP). These challenges are: predominance of small group practices, dominant fee-for-service reimbursement methods, weaknesses of the traditional hospital medical staff structure and a need to partner with commercial insurance companies. APP has demonstrated teamwork between 3800 physicians and hospitals to improve quality, patient safety and cost-effectiveness. Building on this model, an innovative contract with Blue Cross Blue Shield of Illinois serves as a prototype for a commercial Accountable Care Organization. For this contract to succeed, APP must outperform the market competition. To accomplish this, APP has implemented strategies to reduce readmissions, avoid unnecessary admissions and emergency room visits, expand primary care access, and enhance quality and patient safety. PMID:21910315

  12. Legal mechanisms supporting accountable care principles.

    PubMed

    Ramanathan, Tara

    2014-11-01

    Public health and private providers and facilities may shape the future of the US health system by engaging in new ways to deliver care to patients. "Accountable care" contracts allow private health care and public health providers and facilities to collaboratively serve defined populations. Accountable care frameworks emphasize health care quality and cost savings, among other goals. In this article, I explore the legal context for accountable care, including the mechanisms by which providers, facilities, and public health coordinate activities, avoid inefficiencies, and improve health outcomes. I highlight ongoing evaluations of the impact of accountable care on public health outcomes. PMID:25211740

  13. Accounting Procedures for Student Organizations.

    ERIC Educational Resources Information Center

    California State Dept. of Education, Sacramento.

    This two-part handbook presents information on accounting procedures for student organizations, with a focus on the laws, policies, and procedures that affect student body organizations. Part 1 contains information about: (1) legal status of a school's student body organization; (2) principles governing student body finance; (3) administration of…

  14. Legal Mechanisms Supporting Accountable Care Principles

    PubMed Central

    Ramanathan, Tara

    2016-01-01

    Public health and private providers and facilities may shape the future of the US health system by engaging in new ways to deliver care to patients. “Accountable care” contracts allow private health care and public health providers and facilities to collaboratively serve defined populations. Accountable care frameworks emphasize health care quality and cost savings, among other goals. In this article, I explore the legal context for accountable care, including the mechanisms by which providers, facilities, and public health coordinate activities, avoid inefficiencies, and improve health outcomes. I highlight ongoing evaluations of the impact of accountable care on public health outcomes. PMID:25211740

  15. Acute care hospitals' accountability to provincial funders.

    PubMed

    Kromm, Seija K; Ross Baker, G; Wodchis, Walter P; Deber, Raisa B

    2014-09-01

    Ontario's acute care hospitals are subject to a number of tools, including legislation and performance measurement for fiscal accountability and accountability for quality. Examination of accountability documents used in Ontario at the government, regional and acute care hospital levels reveals three trends: (a) the number of performance measures being used in the acute care hospital sector has increased significantly; (b) the focus of the health system has expanded from accountability for funding and service volumes to include accountability for quality and patient safety; and (c) the accountability requirements are misaligned at the different levels. These trends may affect the success of the accountability approach currently being used. PMID:25305386

  16. Acute Care Hospitals' Accountability to Provincial Funders

    PubMed Central

    Kromm, Seija K.; Ross Baker, G.; Wodchis, Walter P.; Deber, Raisa B.

    2014-01-01

    Ontario's acute care hospitals are subject to a number of tools, including legislation and performance measurement for fiscal accountability and accountability for quality. Examination of accountability documents used in Ontario at the government, regional and acute care hospital levels reveals three trends: (a) the number of performance measures being used in the acute care hospital sector has increased significantly; (b) the focus of the health system has expanded from accountability for funding and service volumes to include accountability for quality and patient safety; and (c) the accountability requirements are misaligned at the different levels. These trends may affect the success of the accountability approach currently being used. PMID:25305386

  17. What is accountability in health care?

    PubMed

    Emanuel, E J; Emanuel, L L

    1996-01-15

    Accountability has become a major issue in health care. Accountability entails the procedures and processes by which one party justifies and takes responsibility for its activities. The concept of accountability contains three essential components: 1) the loci of accountability--health care consists of at least 11 different parties that can be held accountable or hold others accountable; 2) the domains of accountability--in health care, parties can be held accountable for as many as six activities: professional competence, legal and ethical conduct, financial performance, adequacy of access, public health promotion, and community benefit; and 3) the procedures of accountability, including formal and informal procedures for evaluating compliance with domains and for disseminating the evaluation and responses by the accountable parties. Different models of accountability stress different domains, evaluative criteria, loci, and procedures. We characterize and compare three dominant models of accountability: 1) the professional model, in which the individual physician and patient participate in shared decision making and physicians are held accountable to professional colleagues and to patients; 2) the economic model, in which the market is brought to bear in health care and accountability is mediated through consumer choice of providers; and 3) the political model, in which physicians and patients interact as citizen-members within a community and in which physicians are accountable to a governing board elected from the members of the community, such as the board of a managed care plan. We argue that no single model of accountability is appropriate to health care. Instead, we advocate a stratified model of accountability in which the professional model guides the physician-patient relationship, the political model operates within managed care plans and other integrated health delivery networks, and the economic and political models operate in the relations between

  18. Academic Medical Centers Forming Accountable Care Organizations and Partnering With Community Providers: The Experience of the Johns Hopkins Medicine Alliance for Patients.

    PubMed

    Berkowitz, Scott A; Ishii, Lisa; Schulz, John; Poffenroth, Matt

    2016-03-01

    Academic medical centers (AMCs)--which include teaching hospital(s) and additional care delivery entities--that form accountable care organizations (ACOs) must decide whether to partner with other provider entities, such as community practices. Indeed, 67% (33/49) of AMC ACOs through the Medicare Shared Savings Program through 2014 are believed to include an outside community practice. There are opportunities for both the AMC and the community partners in pursuing such relationships, including possible alignment around shared goals and adding ACO beneficiaries. To create the Johns Hopkins Medicine Alliance for Patients (JMAP), in January 2014, Johns Hopkins Medicine chose to partner with two community primary care groups and one cardiology practice to support clinical integration while adding approximately 60 providers and 5,000 Medicare beneficiaries. The principal initial interventions within JMAP included care coordination for high-risk beneficiaries and later, in 2014, generating dashboards of ACO quality measures to facilitate quality improvement and early efforts at incorporating clinical pathways and Choosing Wisely recommendations. Additional interventions began in 2015.The principal initial challenges JMAP faced were data integration, generation of quality measure reports among disparate electronic medical records, receiving and then analyzing claims data, and seeking to achieve provider engagement; all these affected timely deployment of the early interventions. JMAP also created three regional advisory councils as a forum promoting engagement of local leadership. Network strategies among AMCs, including adding community practices in a nonemployment model, will continue to require thoughtful strategic planning and a keen understanding of local context. PMID:26535867

  19. Using accountability to improve reproductive health care.

    PubMed

    George, Asha

    2003-05-01

    Accountability is best understood as a referee of the dynamics in two-way relationships, often between unequal partners. The literature on accountability distinguishes between political, fiscal, administrative, legal and constitutional accountability. This paper focuses on accountability mechanisms in health care and how they mediate between service providers and communities and between different kinds of health personnel at the primary health care level. It refers to case studies of participatory processes for improving sexual and reproductive health service delivery. Information, dialogue and negotiation are important elements that enable accountability mechanisms to address problems by supporting change and engagement between participants. In order to succeed, however, efforts towards better accountability that broaden the participation of users must take into account the social contexts and the policy and service delivery systems in which they are applied, address power relations and improve the representation of marginalised groups within communities and service delivery systems. PMID:12800713

  20. new lease accounting and health care.

    PubMed

    Berman, Mindy

    2016-05-01

    Recently released lease accounting standards from the Financial Accounting Standards Board (FASB) present three significant challenges for healthcare organizations: All leases must be reported on a company's balance sheet, increasing liabilities on the balance sheets of healthcare organizations considerably. Contractual agreements not previously considered leases will now be treated as leases. Classification of some equipment leases could change. PMID:27382712

  1. Examining Factors Influencing Colorectal Cancer Screening of Rural Nebraskans Using Data from Clinics Participating in an Accountable Care Organization: A Study Protocol

    PubMed Central

    Young, Lufei; Kim, Jungyoon; Wang, Hongmei; Chen, Li-Wu

    2015-01-01

    Background: Although mortality rates of colorectal cancer (CRC) can be significantly reduced through increased screening, rural communities are still experiencing lower rates of screening compared to urban counterparts. Understanding and eliminating barriers to cancer screening will decrease cancer burden and lead to substantial gains in quality and quantity of life for rural populations. However, existing studies have shown inconsistent findings and fail to address how contextual and provider-level factors impact CRC screening in addition to individual-level factors.  Purpose: The purpose of the study is to examine multi-level factors related to CRC screening, and providers’ perception of barriers and facilitators of CRC screening in rural patients cared for by accountable care organization (ACO) clinics. Methods/Design: This is a convergent mixed method design. For the quantitative component, multiple data sources, such as electronic health records (EHRs), Area Resource File (ARF), and provider survey data, will be used to examine patient-, provider-, clinic-, and county-level factors. About 21,729 rural patients aged between 50 and 75 years who visited the participating ACO clinics in the past 12 months are included in the quantitative analysis. The qualitative methods include semi-structured in-depth interviews with healthcare professionals in selected rural clinics. Both quantitative and qualitative data will be merged for result interpretation. Quantitative data identifies “what” factors influence CRC screening, while qualitative data explores “how” these factors interact with CRC screening. The study setting is 10 ACO clinics located in nine rural Nebraska counties. Discussion: This will be the first study examining multi-level factors related to CRC screening in the new healthcare delivery system (i.e., ACO clinics) in rural communities. The study findings will enhance our understanding of how the ACO model, particularly in rural areas, interacts

  2. Accountable Communities for Health: Moving From Providing Accountable Care to Creating Health.

    PubMed

    Tipirneni, Renuka; Vickery, Katherine Diaz; Ehlinger, Edward P

    2015-01-01

    Lessons from community-oriented primary care in the United States can offer insights into how we could improve population health by integrating the public health, social service, and health care sectors to form accountable communities for health (ACHs). Unlike traditional accountable care organizations (ACOs) that address population health from a health care perspective, ACHs address health from a community perspective and consider the total investment in health across all sectors. The approach embeds the ACO in a community context where multiple stakeholders come together to share responsibility for tackling multiple determinants of health. ACOs using the ACH model provide a roadmap for embedding health care in communities in a way that uniquely addresses local social determinants of health. PMID:26195684

  3. Should health care providers be accountable for patients' care experiences?

    PubMed

    Anhang Price, Rebecca; Elliott, Marc N; Cleary, Paul D; Zaslavsky, Alan M; Hays, Ron D

    2015-02-01

    Measures of patients' care experiences are increasingly used as quality measures in accountability initiatives. As the prominence and financial impact of patient experience measures have increased, so too have concerns about the relevance and fairness of including them as indicators of health care quality. Using evidence from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys, the most widely used patient experience measures in the United States, we address seven common critiques of patient experience measures: (1) consumers do not have the expertise needed to evaluate care quality; (2) patient "satisfaction" is subjective and thus not valid or actionable; (3) increasing emphasis on improving patient experiences encourages health care providers and plans to fulfill patient desires, leading to care that is inappropriate, ineffective, and/or inefficient; (4) there is a trade-off between providing good patient experiences and providing high-quality clinical care; (5) patient scores cannot be fairly compared across health care providers or plans due to factors beyond providers' control; (6) response rates to patient experience surveys are low, or responses reflect only patients with extreme experiences; and (7) there are faster, cheaper, and more customized ways to survey patients than the standardized approaches mandated by federal accountability initiatives. PMID:25416601

  4. The health care learning organization.

    PubMed

    Hult, G T; Lukas, B A; Hult, A M

    1996-01-01

    To many health care executives, emphasis on marketing strategy has become a means of survival in the threatening new environment of cost attainment, intense competition, and prospective payment. This paper develops a positive model of the health care organization based on organizational learning theory and the concept of the health care offering. It is proposed that the typical health care organization represents the prototype of the learning organization. Thus, commitment to a shared vision is proposed to be an integral part of the health care organization and its diagnosis, treatment, and delivery of the health care offering, which is based on the exchange relationship, including its communicative environment. Based on the model, strategic marketing implications are discussed. PMID:10158798

  5. Organization theory. Analyzing health care organizations.

    PubMed

    Cors, W K

    1997-02-01

    Organization theory (OT) is a tool that can be applied to analyze and understand health care organizations. Transaction cost theory is used to explain, in a unifying fashion, the myriad changes being undertaken by different groups of constituencies in health care. Agency theory is applied to aligning economic incentives needed to ensure Integrated Delivery System (IDS) success. By using tools such as OT, a clearer understanding of organizational changes is possible. PMID:10164970

  6. Accounting for care: Healthcare Resource Groups for paediatric critical care.

    PubMed

    Murphy, Janet; Morris, Kevin

    2008-02-01

    Healthcare Resource Groups are a way of grouping patients in relation to the amount of healthcare resources they consume. They are the basis for implementation of Payment by Results by the Department of Health in England. An expert working group was set up to define a dataset for paediatric critical care that would in turn support the derivation of Healthcare Resource Groups. Three relevant classification systems were identified and tested with data from ten PICUs, including data about diagnoses, number of organ systems supported, interventions and nursing activity. Each PICU provided detailed costing for the financial year 2005/2006. Eighty-three per cent of PICU costs were found to be related to staff costs, with the largest cost being nursing costs. The Nursing Activity Score system was found to be a poor predictor of staff resource use, as was the adult HRG model based on the number of organ systems supported. It was decided to develop the HRGs based on a 'levels of care' approach; 32 data items were defined to support HRG allocation. From October 2007, data have been collected daily to identify the HRGs for each PICU patient and are being used by the Department of Health to estimate reference costs for PICU services. The data can also be used to support improved audit of PICU activity nationally as well as comparison of workload across different units and modelling of staff requirements within a unit. PMID:18335904

  7. Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations--Revised Benchmark Rebasing Methodology, Facilitating Transition to Performance-Based Risk, and Administrative Finality of Financial Calculations. Final rule.

    PubMed

    2016-06-10

    Under the Medicare Shared Savings Program (Shared Savings Program), providers of services and suppliers that participate in an Accountable Care Organization (ACO) continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. This final rule addresses changes to the Shared Savings Program, including: Modifications to the program's benchmarking methodology, when resetting (rebasing) the ACO's benchmark for a second or subsequent agreement period, to encourage ACOs' continued investment in care coordination and quality improvement; an alternative participation option to encourage ACOs to enter performance-based risk arrangements earlier in their participation under the program; and policies for reopening of payment determinations to make corrections after financial calculations have been performed and ACO shared savings and shared losses for a performance year have been determined. PMID:27295736

  8. Savings account for health care costs

    MedlinePlus

    ... can set aside tax-exempt money for your health care expenses. This means you will pay no or ... offers reimbursement for those expenses when you use health care. HRAs can be set up for any type ...

  9. A systematic method of accountability. Sound policies allow facilities to account for the level of charity care they provide.

    PubMed

    Schmitz, H H; Weiss, S J; Melichar, C

    1992-11-01

    Charity care policies can help hospitals accurately determine, define, and account for the level of charity care they provide. This information will help hospitals budget appropriately and measure trends that will ultimately affect the organization's viability. State governments, the federal government, and the Internal Revenue Service are more closely scrutinizing not-for-profit hospitals' tax-exempt status. As a result, the American Institute of Certified Public Accountants (AICPA) has revised its requirement to report on charity care. To meet the AICPA's requirement, healthcare providers must develop their own definition of charity and determine criteria for providing care free or at a reduced rate. Setting policies to support the organization's definition of charity is necessary for the development of internal systems that promote the early identification of individuals seeking healthcare who will be unable to pay for services. Several policy implications may result from the facility's charity care determination process. For example, patients exhibiting extreme hardship might still be eligible to receive charity care even though their income and assets exceed the hospital's income guidelines. An organization planning to develop a charity care policy must first thoroughly assess its current charity care practices and cost accounting capabilities. Obtaining input from all the departments involved in the development of the charity care policy is necessary to make the transition as smooth as possible. PMID:10122079

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

    PubMed

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

    2015-02-01

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

  11. Health care transformation and CEO accountability.

    PubMed

    Barrett, Craig; Lee, Peter V

    2009-01-01

    Unless President-elect Barack Obama-America's CEO-and the CEOs who run large businesses work together, health care changes will not occur. The government and private sector must abandon business as usual to reduce costs, reward outcomes, and stimulate innovative ways to achieve those outcomes. President-elect Obama will find a willing partner in corporate America if he reaches out in ways that recognize that solutions must put the patient at the center of our health care system and also drive efficiencies to allow U.S. companies to compete globally. It is past time for the nation's elected and appointed CEOs to take action to transform U.S. health care. PMID:19151004

  12. Savings account for health care costs

    MedlinePlus

    An HSA is a bank account you use to save money for medical expenses. The amount you can set aside changes from year to year. ... was $3,300 for a single person. A bank or insurance company usually holds the money for ...

  13. Primary care groups in the United Kingdom: quality and accountability.

    PubMed

    Bindman, A B; Weiner, J P; Majeed, A

    2001-01-01

    With the introduction of primary care groups (PCGs), the British National Health Service has attempted to integrate delivery, finance, and quality improvement into a locally directed care system with a strong sense of community accountability. PCGs will eventually hold the budgets for primary care, specialist, hospital, and community-based services and have the flexibility to reapportion these budgets. Through clinical governance, PCGs are attempting to coordinate education, guidelines, audit and feedback, and other quality improvement approaches around health problems that are relevant to their patient panels and local communities. PCGs offer other nations attempting to improve the quality and accountability of health care an innovative approach that merits consideration. PMID:11585160

  14. Compassionate Accountability in Residential Care: A Trauma Informed Model

    ERIC Educational Resources Information Center

    Cimmarusti, Rocco A.; Gamero, Soe L.

    2009-01-01

    This article examines techniques for holding youth in residential care accountable for their behavior. Based on the use of trauma treatment theory, the authors believe that holding one accountable can actually be conceptualized and put into practice as a nurturing operation. For traumatized individuals, more traditional approaches to…

  15. Creating a culture of accountability in health care.

    PubMed

    O'Hagan, Joshua; Persaud, David

    2009-01-01

    Health care providers are constantly striving to improve quality and efficiency by using performance management systems and quality improvement initiatives. Creating and maintaining a culture of accountability are important for achieving this end because accountability is the reason for measuring and improving performance. The keys to creating a culture of accountability will be explicated by examining the extant literature, and from this, 6 methods will be outlined for creating such a culture. PMID:19433930

  16. Integrated care organizations in Switzerland

    PubMed Central

    Berchtold, Peter; Peytremann-Bridevaux, Isabelle

    2011-01-01

    Introduction The Swiss health care system is characterized by its decentralized structure and high degree of local autonomy. Ambulatory care is provided by physicians working mainly independently in individual private practices. However, a growing part of primary care is provided by networks of physicians and health maintenance organizations (HMOs) acting on the principles of gatekeeping. Towards integrated care in Switzerland The share of insured choosing an alternative (managed care) type of basic health insurance and therefore restrict their choice of doctors in return for lower premiums increased continuously since 1990. To date, an average of one out of eight insured person in Switzerland, and one out of three in the regions in north-eastern Switzerland, opted for the provision of care by general practitioners in one of the 86 physician networks or HMOs. About 50% of all general practitioners and more than 400 other specialists have joined a physician networks. Seventy-three of the 86 networks (84%) have contracts with the healthcare insurance companies in which they agree to assume budgetary co-responsibility, i.e., to adhere to set cost targets for particular groups of patients. Within and outside the physician networks, at regional and/or cantonal levels, several initiatives targeting chronic diseases have been developed, such as clinical pathways for heart failure and breast cancer patients or chronic disease management programs for patients with diabetes. Conclusion and implications Swiss physician networks and HMOs were all established solely by initiatives of physicians and health insurance companies on the sole basis of a healthcare legislation (Swiss Health Insurance Law, KVG) which allows for such initiatives and developments. The relevance of these developments towards more integration of healthcare as well as their implications for the future are discussed. PMID:21677845

  17. Strategic implementation and accountability: the case of the long-term care alliance.

    PubMed

    Seaman, Al; Elias, Maria; O'Neill, Bill; Yatabe, Karen

    2010-01-01

    A group of chief executives of long-term care homes formed an alliance in order to tap the resources residing within their management teams. Adopting a strategic implementation project based on a framework of accountability, the executives were able to better understand the uncertainties of the environment and potentially structure their strategic implementation to best use scarce resources. The framework of accountability allowed the homes to recognize the need for a strong business approach to long-term care. Communication improved throughout the organizations while systems and resources showed improved utilization. Quality became the driving force for all actions taken to move the organizations toward achieving their visions. PMID:20357544

  18. Approaches to accountability in long-term care.

    PubMed

    Berta, Whitney; Laporte, Audrey; Wodchis, Walter P

    2014-09-01

    This paper discusses the array of approaches to accountability in Ontario long-term care (LTC) homes. A focus group involving key informants from the LTC industry, including both for-profit and not-for-profit nursing home owners/operators, was used to identify stakeholders involved in formulating and implementing LTC accountability approaches and the relevant regulations, policies and initiatives relating to accountability in the LTC sector. These documents were then systematically reviewed. We found that the dominant mechanisms have been financial incentives and oversight, regulations and information; professionalism has played a minor role. More recently, measurement for accountability in LTC has grown to encompass an array of fiscal, clinical and public accountability measurement mechanisms. The goals of improved quality and accountability are likely more achievable using these historical regulatory approaches, but the recent rapid increase in data and measurability could also enable judicious application of market-based approaches. PMID:25305396

  19. Approaches to Accountability in Long-Term Care

    PubMed Central

    Berta, Whitney; Laporte, Audrey; Wodchis, Walter P.

    2014-01-01

    This paper discusses the array of approaches to accountability in Ontario long-term care (LTC) homes. A focus group involving key informants from the LTC industry, including both for-profit and not-for-profit nursing home owners/operators, was used to identify stakeholders involved in formulating and implementing LTC accountability approaches and the relevant regulations, policies and initiatives relating to accountability in the LTC sector. These documents were then systematically reviewed. We found that the dominant mechanisms have been financial incentives and oversight, regulations and information; professionalism has played a minor role. More recently, measurement for accountability in LTC has grown to encompass an array of fiscal, clinical and public accountability measurement mechanisms. The goals of improved quality and accountability are likely more achievable using these historical regulatory approaches, but the recent rapid increase in data and measurability could also enable judicious application of market-based approaches. PMID:25305396

  20. Undercontribution bias in health care spending account decisions.

    PubMed

    Schweitzer, M E; Hershey, J C

    1997-01-01

    Results from this work describe 239 responses to a mailed survey regarding employee benefits decisions at a large eastern university. The primary objective of this work is to test for an undercontribution bias in health care financing decisions. The results establish the existence of an undercontribution bias in both actual employee decisions and hypothetical flexible spending account contribution decisions. We describe this bias within the context of related biases including loss aversion, mental accounting, status quo and omission biases. Surprisingly, we find a significant order effect in this study and posit that preference construction in this context is an active, reference-dependent process. In addition, results from this work demonstrate the endogenous nature of health care flexible spending account expenditures. The results have important implications both for the descriptive framework of and the normative solution to the flexible spending account contribution decision. PMID:10167155

  1. The CARE model of social accountability: promoting cultural change.

    PubMed

    Meili, Ryan; Ganem-Cuenca, Alejandra; Leung, Jannie Wing-sea; Zaleschuk, Donna

    2011-09-01

    On the 10th anniversary of Health Canada and the Association of Faculties of Medicine of Canada's publication in 2001 of Social Accountability: A Vision for Canadian Medical Schools, the authors review the progress at one Canadian medical school, the College of Medicine at the University of Saskatchewan, in developing a culture of social accountability. They review the changes that have made the medical school more socially accountable and the steps taken to make those changes possible. In response to calls for socially accountable medical schools, the College of Medicine created a Social Accountability Committee to oversee the integration of these principles into the college. The committee developed the CARE model (Clinical activity, Advocacy, Research, Education and training) as a guiding tool for social accountability initiatives toward priority health concerns and as a means of evaluation. Diverse faculty and student committees have emerged as a result and have had far-reaching impacts on the college and communities: from changes in curricula and admissions to community programming and international educational experiences. Although a systematic assessment of the CARE model is needed, early evidence shows that the most significant effects can be found in the cultural shift in the college, most notably among students. The CARE model may serve as an important example for other educational institutions in the development of health practitioners and research that is responsive to the needs of their communities. PMID:21785308

  2. Insurance Accounts: The Cultural Logics of Health Care Financing.

    PubMed

    Mulligan, Jessica

    2016-03-01

    The financial exuberance that eventually culminated in the recent world economic crisis also ushered in dramatic shifts in how health care is financed, administered, and imagined. Drawing on research conducted in the mid-2000s at a health insurance company in Puerto Rico, this article shows how health care has been financialized in many ways that include: (1) privatizing public services; (2) engineering new insurance products like high deductible plans and health savings accounts; (3) applying financial techniques to premium payments to yield maximum profitability; (4) a managerial focus on shareholder value; and (5) prioritizing mergers and financial speculation. The article argues that financial techniques obfuscate how much health care costs, foster widespread gaming of reimbursement systems that drives up prices, and "unpool" risk by devolving financial and moral responsibility for health care onto individual consumers.[insurance, health reform, managed care, financialization, Medicare]. PMID:25331937

  3. No Pipe Dream: Achieving Care That Is Accountable for Cost, Quality, and Outcomes.

    PubMed

    Terrell, Grace E

    2016-01-01

    The April 2015 passage of the Medicare Access and Children's Health Insurance Program Reauthorization Act is accelerating the move of the US health care industry from traditional fee-for-service provider payments to alternative payment methods that are focused on value rather than volume of services. Medicaid, private employers, and consumer groups are also developing similar payment models. Learning from the experience of the 27 early accountable care organizations in North Carolina, such as Cornerstone Health Care, will help to accelerate the transformation that will be necessary across the health care delivery ecosystem in our state. PMID:27422949

  4. Power, blame, and accountability: Medicaid managed care for mental health services in New Mexico.

    PubMed

    Willging, Cathleen E

    2005-03-01

    I examine the provision of mental health services to Medicaid recipients in New Mexico to illustrate how managed care accountability models subvert the allocation of responsibility for delivering, monitoring, and improving care for the poor. The downward transfer of responsibility is a phenomenon emergent in this hierarchically organized system. I offer three examples to clarify the implications of accountability discourse. First, I problematize the public-private "partnership" between the state and its managed care contractors to illuminate the complexities of exacting state oversight in a medically underserved, rural setting. Second, I discuss the strategic deployment of accountability discourse by members of this partnership to limit use of expensive services by Medicaid recipients. Third, I focus on transportation for Medicaid recipients to show how market triumphalism drives patient care decisions. Providers and patients with the least amount of formal authority and power are typically blamed for system deficiencies. PMID:15789628

  5. Narrative accountability and quality awareness: Learning about (re)presenting narrative care.

    PubMed

    Ubels, Gerdienke M

    2015-08-01

    Over the years, the dominant accountability structures for eldercare in the Netherlands have conceptualized "care" in mainly quantitative terms, based on measurable outcomes and performance indicators. This article describes a two-year program that was designed to find ways for a renewed story of accountability and quality with a more "story conscious" way of engaging with the realities of both life and care. From the autoethnographical stance of the program manager, the article first provides the historical background of the program, tracing its roots in narrative gerontology. Second, it outlines the design of the program, which was meant to combine the practice of care organizations with scientific research and policy making. Third, it sheds light on issues of quality and accountability when eldercare is approached as a social constructionist practice. It concludes with some thoughts on how the learning gained in setting up the program are relevant to future policies regarding quality and accountability in eldercare. PMID:26162741

  6. Job satisfaction in health-care organizations

    PubMed Central

    Bhatnagar, Kavita; Srivastava, Kalpana

    2012-01-01

    Job satisfaction among health-care professionals acquires significance for the purpose of maximization of human resource potential. This article is aimed at emphasizing importance of studying various aspects of job satisfaction in health-care organizations. PMID:23766585

  7. Individual Health Accounts: An Alternative Health Care Financing Approach

    PubMed Central

    Stano, Miron

    1981-01-01

    After examining the major determinants of inefficiency in health care markets and several recent proposals to correct these problems, this paper introduces a market-oriented alternative which could be highly efficient while meeting all the established goals of a national health plan. To achieve these objectives, traditional forms of insurance would be replaced by a system with the following characteristics: (1) Instead of buying insurance, individuals and their employers would be required to contribute into individual health accounts from which each family would pay for medical care; (2) Once accumulations attain a designated level, any excess accumulations are distributed to the individual; and (3) A national health fund is established to support those without regular accumulations or those whose accounts have been depleted. This paper develops these principles to show how everyone would have access to care as well as the financial security normally associated with comprehensive insurance. But, by inducing many patients to behave as if they were paying for the full cost of care through reductions in potential earnings from their accounts, the paper explains how significant savings in total spending could also be achieved. PMID:10309471

  8. Cost-accounting techniques for health care providers.

    PubMed

    Pelfrey, S

    1995-12-01

    The author reviews cost-accounting techniques and systems used by manufacturing companies. Some of the concepts and techniques used by for-profit companies can be implemented for health care institutions. Nurse executives can learn many lessons in product cost accounting from these for-profit companies. Understanding the various cost-accounting methodologies and techniques that are available can help nurse executives design, implement, and use a cost accounting system that will identify the costs associated with products and services provided. The author also reviews and explains standard costing systems. These systems can serve as valuable tools for budgeting, evaluating, and controlling departmental costs. When used in these instances, they can prove useful, and they furnish important information that is necessary for pricing products, determining alternatives or substitute services, and controlling costs. PMID:10153619

  9. Fostering accountable health care: moving forward in medicare.

    PubMed

    Fisher, Elliott S; McClellan, Mark B; Bertko, John; Lieberman, Steven M; Lee, Julie J; Lewis, Julie L; Skinner, Jonathan S

    2009-01-01

    To succeed, health care reform must slow spending growth while improving quality. We propose a new approach to help achieve more integrated and efficient care by fostering local organizational accountability for quality and costs through performance measurement and "shared savings" payment reform. The approach is practical and feasible: it is voluntary for providers, builds on current referral patterns, requires no change in benefits or lock-in for beneficiaries, and offers the possibility of sustained provider incomes even as total costs are constrained. We simulate the potential expenditure impact and show that significant Medicare savings are possible. PMID:19174383

  10. Disruptive innovation in academic medical centers: balancing accountable and academic care.

    PubMed

    Stein, Daniel; Chen, Christopher; Ackerly, D Clay

    2015-05-01

    Numerous academic medicine leaders have argued that academic referral centers must prepare for the growing importance of accountability-driven payment models by adopting population health initiatives. Although this shift has merit, execution of this strategy will prove significantly more problematic than most observers have appreciated. The authors describe how successful implementation of an accountable care health strategy within a referral academic medical center (AMC) requires navigating a critical tension: The academic referral business model, driven by tertiary-level care, is fundamentally in conflict with population health. Referral AMCs that create successful value-driven population health systems within their organizations will in effect disrupt their own existing tertiary care businesses. The theory of disruptive innovation suggests that balancing the push and pull of academic and accountable care within a single organization is achievable. However, it will require significant shifts in resource allocation and changes in management structure to enable AMCs to make the inherent difficult choices and trade-offs that will ensue. On the basis of the theories of disruptive innovation, the authors present recommendations for how academic health systems can successfully navigate these issues as they transition toward accountability-driven care. PMID:25517702

  11. Ethical climate in managed care organizations.

    PubMed

    Bell, Sue Ellen

    2003-01-01

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

  12. Health systems organization for emergency care.

    PubMed

    Pedroto, Isabel; Amaro, Pedro; Romãozinho, José Manuel

    2013-10-01

    The increasing number of acute and severe digestive diseases presenting to hospital emergency departments, mainly related with an ageing population, demands an appropriate answer from health systems organization, taking into account the escalating pressure on cost reduction. However, patients expect and deserve a response that is appropriate, effective, efficient and safe. The huge variety of variables which can influence the evolution of such cases warranting intensive monitoring, and the coordination and optimization of a range of human and technical resources involved in the care of these high-risk patients, requires their admission in hospital units with conveniently equipped facilities, as is done for heart attack and stroke patients. Little information of gastroenterology emergencies as a function of structure, processes and outcome is available at the organizational level. Surveys that have been conducted in different countries just assess local treatment outcome and question the organizational structure and existing resources but its impact on the outcome is not clear. Most studies address the problem of upper gastrointestinal bleeding and the out-of-hours endoscopy services in the hospital setting. The demands placed on emergency (part of the overall continuum of care) are obvious, as are the needs for the efficient use of resources and processes to improve the quality of care, meaning data must cover the full care cycle. Gastrointestinal emergencies, namely gastrointestinal bleeding, must be incorporated into the overall emergency response as is done for heart attack and stroke. This chapter aims to provide a review of current literature/evidence on organizational health system models towards a better management of gastroenterology emergencies and proposes a research agenda. PMID:24160936

  13. Quality improvement and accountability in the Danish health care system.

    PubMed

    Mainz, Jan; Kristensen, Solvejg; Bartels, Paul

    2015-12-01

    Denmark has unique opportunities for quality measurement and benchmarking since Denmark has well-developed health registries and unique patient identifier that allow all registries to include patient-level data and combine data into sophisticated quality performance monitoring. Over decades, Denmark has developed and implemented national quality and patient safety initiatives in the healthcare system in terms of national clinical guidelines, performance and outcome measurement integrated in clinical databases for important diseases and clinical conditions, measurement of patient experiences, reporting of adverse events, national handling of patient complaints, national accreditation and public disclosure of all data on the quality of care. Over the years, Denmark has worked up a progressive and transparent just culture in quality management; the different actors at the different levels of the healthcare system are mutually attentive and responsive in a coordinated effort for quality of the healthcare services. At national, regional, local and hospital level, it is mandatory to participate in the quality initiatives and to use data and results for quality management, quality improvement, transparency in health care and accountability. To further develop the Danish governance model, it is important to expand the model to the primary care sector. Furthermore, a national quality health programme 2015-18 recently launched by the government supports a new development in health care focusing upon delivering high-quality health care-high quality is defined by results of value to the patients. PMID:26443814

  14. Methods development for total organic carbon accountability

    NASA Technical Reports Server (NTRS)

    Benson, Brian L.; Kilgore, Melvin V., Jr.

    1991-01-01

    This report describes the efforts completed during the contract period beginning November 1, 1990 and ending April 30, 1991. Samples of product hygiene and potable water from WRT 3A were supplied by NASA/MSFC prior to contract award on July 24, 1990. Humidity condensate samples were supplied on August 3, 1990. During the course of this contract chemical analyses were performed on these samples to qualitatively determine specific components comprising, the measured organic carbon concentration. In addition, these samples and known standard solutions were used to identify and develop methodology useful to future comprehensive characterization of similar samples. Standard analyses including pH, conductivity, and total organic carbon (TOC) were conducted. Colorimetric and enzyme linked assays for total protein, bile acid, B-hydroxybutyric acid, methylene blue active substances (MBAS), urea nitrogen, ammonia, and glucose were also performed. Gas chromatographic procedures for non-volatile fatty acids and EPA priority pollutants were also performed. Liquid chromatography was used to screen for non-volatile, water soluble compounds not amenable to GC techniques. Methods development efforts were initiated to separate and quantitate certain chemical classes not classically analyzed in water and wastewater samples. These included carbohydrates, organic acids, and amino acids. Finally, efforts were initiated to identify useful concentration techniques to enhance detection limits and recovery of non-volatile, water soluble compounds.

  15. Roadmap for reform: outlook for imaging under accountable care.

    PubMed

    Lund, Ingrid V; Hartman, Jacob

    2011-01-01

    The primary goals of the Patient Protection and Affordable Care Act are to expand insurance coverage through an individual mandate, and to reduce growing healthcare costs through new risk-based payment models and the formation of ACOs. With the high cost of exams and steady growth through the last decade, imaging appears to be a prime target for savings under accountable care. Given that some of the reform payment models are set to begin as early as next year, and private payers are increasingly instituting similar risk-based payment models in their plans, it is critical for imaging leaders to understand how these models will affect their growth strategy and prepare accordingly. A thorough analysis of the various payment models, considering all possible targets for cost savings, is required to accurately determine the timing and impact for imaging. PMID:22235736

  16. Being accountable for care of the poor. CHA's social accountability budget helps facilities keep track of charitable activity.

    PubMed

    Trocchio, J; Eckels, T

    1989-06-01

    The Catholic Health Association's social accountability budget is a set of tools to help Catholic healthcare facilities plan for, administer, and report benefits provided to their communities, especially the poor. It defines a full roster of community benefits that a healthcare organization may provide. The benefits fall into three major categories: activities and services, policies and procedures, and community leadership. The social accountability budget also presents guidelines for assessing the facility's existing services, activities, policies, and procedures and discusses how the facility can conduct or be part of a community needs assessment. Information collected through this assessment is used in the planning and budgeting processes. This ensures that uncompensated care and charitable services receive consideration along with traditional planning and budgeting items. Additional guidelines show the facility how to track and measure its services to the community. The final step, often absent from Catholic healthcare facilities' programs, is reporting community benefits. PMID:10293327

  17. The promise and peril of accountable care for vulnerable populations: a framework for overcoming obstacles.

    PubMed

    Lewis, Valerie A; Larson, Bridget Kennedy; McClurg, Asha Belle; Boswell, Rebecca Goldman; Fisher, Elliott S

    2012-08-01

    Accountable care organizations (ACOs) are a promising payment model aimed at reducing costs while also improving the quality of care. However, there is a risk that vulnerable populations may not be fully incorporated into this new model. We define two distinct vulnerable populations, clinically at-risk and socially disadvantaged, and we discuss how ACOs may benefit each group. We provide a framework to use in considering challenges for both vulnerable patients and health systems on the path to accountable care. We identify policies that can help overcome these obstacles: strategies that support ACO formation in diverse settings and that monitor, measure, and reward the performance of providers that reach all patients, including vulnerable populations. PMID:22869656

  18. Redefining accountability in health care: managing the plurality of medical interests.

    PubMed

    Sorensen, Roslyn; Iedema, Rick

    2008-01-01

    Conflict in health service delivery is common. It is often attributed to disputes between clinicians and patients or their families about treatment decisions and is particularly common in intensive care units (ICUs), in the form of ;futility disputes' between families and medical clinicians about decisions to terminate the active treatment of a dying family member. More common, but less prominent in the literature, is conflict within the medical profession about patient care goals and treatment. We contend that managing the plurality of medical interests is essential in achieving a more managed and positive experience for patients and families of the care they receive, and for achieving standards of quality and resource use. From an ethnographic study undertaken in a large ICU in Sydney, Australia, we found that the knowledge and practice differences of multiple medical decision-makers generated conflict, inconsistency of practice and subjectivity of decision-making that impeded coherent clinical decision-making and integrated patient care planning, coordination and care review. Improving patients' and families' experience of care requires medical clinicians and medical managers to accept responsibility for institutionalizing effective communication and decision-making processes within clinical networks and between clinical and managerial domains. Thus, strategies to improve patient care will need to extend beyond the medical profession to incorporate administrative management. We conclude that restructuring communication and decision-making processes is imperative to achieve clinical accountability in the workplace and systems accountability in the organization. PMID:18073248

  19. Proton Beam Therapy and Accountable Care: The Challenges Ahead

    SciTech Connect

    Elnahal, Shereef M.; Kerstiens, John; Helsper, Richard S.; Zietman, Anthony L.; Johnstone, Peter A.S.

    2013-03-15

    Purpose: Proton beam therapy (PBT) centers have drawn increasing public scrutiny for their high cost. The behavior of such facilities is likely to change under the Affordable Care Act. We modeled how accountable care reform may affect the financial standing of PBT centers and their incentives to treat complex patient cases. Methods and Materials: We used operational data and publicly listed Medicare rates to model the relationship between financial metrics for PBT center performance and case mix (defined as the percentage of complex cases, such as pediatric central nervous system tumors). Financial metrics included total daily revenues and debt coverage (daily revenues − daily debt payments). Fee-for-service (FFS) and accountable care (ACO) reimbursement scenarios were modeled. Sensitivity analyses were performed around the room time required to treat noncomplex cases: simple (30 minutes), prostate (24 minutes), and short prostate (15 minutes). Sensitivity analyses were also performed for total machine operating time (14, 16, and 18 h/d). Results: Reimbursement under ACOs could reduce daily revenues in PBT centers by up to 32%. The incremental revenue gained by replacing 1 complex case with noncomplex cases was lowest for simple cases and highest for short prostate cases. ACO rates reduced this incremental incentive by 53.2% for simple cases and 41.7% for short prostate cases. To cover daily debt payments after ACO rates were imposed, 26% fewer complex patients were allowable at varying capital costs and interest rates. Only facilities with total machine operating times of 18 hours per day would cover debt payments in all scenarios. Conclusions: Debt-financed PBT centers will face steep challenges to remain financially viable after ACO implementation. Paradoxically, reduced reimbursement for noncomplex cases will require PBT centers to treat more such cases over cases for which PBT has demonstrated superior outcomes. Relative losses will be highest for those

  20. 18 CFR 367.3010 - Account 301, Organization.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER THE PUBLIC UTILITY HOLDING COMPANY ACT OF 2005, FEDERAL... THE PROVISIONS OF THE PUBLIC UTILITY HOLDING COMPANY ACT OF 2005, FEDERAL POWER ACT AND NATURAL GAS ACT Service Company Property Chart of Accounts § 367.3010 Account 301, Organization. (a) This...

  1. Strategic relevance and accountability expectations: new perspectives for health care information technology design.

    PubMed

    Tan, J K; Modrow, R E

    1999-05-01

    In this article, we discuss the traditional systems analysis perspective on end-user information requirements analysis and extend it to merge with the new accountability expectations perspective to guide the future planning and design of health organization information systems. Underlying the strategic relevance of health care information technology (HCIT) are three critical questions: (1) What is the ideal HCIT model for the health organization in terms of achieving strategic expertise and competitive advantage? Specifically, how does this model link industry performance standards with organizational performance and accountability expectations? (2) How should the limitations of past HCIT models be reconciled to the benefits presented by the superior arrangement of the ideal model in the context of changing accountability expectations? (3) How should alternative HCIT solutions be evaluated in light of evidence-based accountability and organizational performance benchmarking? Insights into these questions will ensure that health care managers, HCIT practitioners and researchers can continue to focus on the most critical issues in harnessing today's fast-paced changing technologies for evolving strategically relevant, performance-based health organization systems. PMID:10387658

  2. Improving health care costing with resource consumption accounting.

    PubMed

    Ozyapici, Hasan; Tanis, Veyis Naci

    2016-07-11

    Purpose - The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital. Design/methodology/approach - A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS). Findings - The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service's selling price and variable costs incurred in providing that service. Research limitations/implications - The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital. Practical implications - This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest

  3. Is accounting for acute care beds enough? A proposal for measuring infection prevention personnel resources.

    PubMed

    Gase, Kathleen A; Babcock, Hilary M

    2015-02-01

    There is still little known about how infection prevention (IP) staffing affects patient outcomes across the country. Current evaluations mainly focus on the ratio of IP resources to acute care beds (ACBs) and have not strongly correlated with patient outcomes. The scope of IP and the role of the infection preventionist in health care have expanded and changed dramatically since the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) recommended a 1 IP resource to 250 ACB ration in the 1980s. Without a universally accepted model for accounting for additional IP responsibilities, it is difficult to truly assess IP staffing needs. A previously suggested alternative staffing model was applied to acute care hospitals in our organization to determine its utility. PMID:25480447

  4. 32 CFR 732.25 - Accounting classifications for nonnaval medical and dental care expenses.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... and dental care expenses. 732.25 Section 732.25 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE Accounting Classifications for Nonnaval Medical and Dental Care Expenses and Standard Document Numbers § 732.25 Accounting classifications...

  5. 32 CFR 732.25 - Accounting classifications for nonnaval medical and dental care expenses.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... and dental care expenses. 732.25 Section 732.25 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE Accounting Classifications for Nonnaval Medical and Dental Care Expenses and Standard Document Numbers § 732.25 Accounting classifications...

  6. 32 CFR 732.25 - Accounting classifications for nonnaval medical and dental care expenses.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... and dental care expenses. 732.25 Section 732.25 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE Accounting Classifications for Nonnaval Medical and Dental Care Expenses and Standard Document Numbers § 732.25 Accounting classifications...

  7. 32 CFR 732.25 - Accounting classifications for nonnaval medical and dental care expenses.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... and dental care expenses. 732.25 Section 732.25 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE Accounting Classifications for Nonnaval Medical and Dental Care Expenses and Standard Document Numbers § 732.25 Accounting classifications...

  8. 32 CFR 732.25 - Accounting classifications for nonnaval medical and dental care expenses.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... and dental care expenses. 732.25 Section 732.25 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE Accounting Classifications for Nonnaval Medical and Dental Care Expenses and Standard Document Numbers § 732.25 Accounting classifications...

  9. How to organize a study day: a practical account.

    PubMed

    Thomas, V

    Organizing a memorable study day is a great challenge. A good study day has the potential to stimulate innovative ideas and improve nursing practice. It is therefore imperative that study days are of high quality, are relevant and well organized. This article highlights some valuable lessons that were learnt from the experience of organizing a study day at a London hospital. It discusses the processes involved including brainstorming, programme preparation, advertising and the provision of care for delegates. The areas that could have been improved are also highlighted. PMID:10624214

  10. [Organizing health care: an ethical perspective].

    PubMed

    2013-06-01

    Health care at population level is a complex problem. Having this in mind, the purpose of this paper is to focus on the goods that are ethically relevant in the process of caring for health at this level. We briefly analyze some of the Chilean health statistics that, although they show important improvements along the years, demonstrate that certain conditions are to be deemed as inadequate by both healthcare providers and patients. Ethics is a central component to determine how to structure and organize health care systems and how they should operate. We emphasize human dignity as an ethical corner stone of the health care system, along with other important values such as justice and humanization, under the scope of the ends of medicine, and other components such as technical competence of providers and the financing of the whole process. We conclude that as far as a health care system is organized in a way that medical practice is well ordered, primarily and fundamentally according the ends of medicine and the good of persons, such a health care system is ethically adequate. PMID:24121582

  11. Cost accounting for end-of-life care: recommendations to the field by the Cost Accounting Workgroup.

    PubMed

    Seninger, Stephen; Smith, Dean G

    2004-01-01

    Accurate measurement of economic costs is prerequisite to progress in improving the care delivered to Americans during the last stage of life. The Robert Wood Johnson Excellence in End-of-Life Care national program assembled a Cost Accounting Workgroup to identify accurate and meaningful methods to measure palliative and end-of-life health care use and costs. Eight key issues were identified: (1) planning the cost analysis; (2) identifying the perspective for cost analysis; (3) describing the end-of-life care program; (4) identifying the appropriate comparison group; (5) defining the period of care to be studied; (6) identifying the units of health care services; (7) assigning monetary values to health care service units; and (8) calculating costs. Economic principles of cost measurement and cost measurement issues encountered by practitioners were reviewed and incorporated into a set of recommendations. PMID:15682955

  12. Governance issues in the transition to accountable care: a case study of Silver Cross Hospital.

    PubMed

    Morrissette, Stephen G

    2012-01-01

    Recent developments in healthcare reform legislation and in the private-payer marketplace have increased impetus toward clinical integration. Industry changes require that healthcare delivery institutions confront fundamental scope and scale structural issues that may lead to increased vertical integration. To accomplish integration, firms must decide the organizational form of integration (alliance or merger/acquisition). One form of integration, accountable care organizations (ACOs), has featured prominently in recent legislation. Clinical integration and ACOs present significant shared-governance challenges that must be understood by hospital boards. The author outlines these governance issues using a case study of Silver Cross Hospital's governance structure for its ACO. PMID:23216264

  13. Cost accounting, management control, and planning in health care.

    PubMed

    Siegrist, R B; Blish, C S

    1988-02-01

    Advantages and pharmacy applications of computerized hospital management-control and planning systems are described. Hospitals must define their product lines; patient cases, not tests or procedures, are the end product. Management involves operational control, management control, and strategic planning. Operational control deals with day-to-day management on the task level. Management control involves ensuring that managers use resources effectively and efficiently to accomplish the organization's objectives. Management control includes both control of unit costs of intermediate products, which are procedures and services used to treat patients and are managed by hospital department heads, and control of intermediate product use per case (managed by the clinician). Information from the operation and management levels feeds into the strategic plan; conversely, the management level controls the plan and the operational level carries it out. In the system developed at New England Medical Center, Boston, Massachusetts, the intermediate product-management system enables managers to identify intermediate products, develop standard costs, simulate changes in departmental costs, and perform variance analysis. The end-product management system creates a patient-level data-base, identifies end products (patient-care groupings), develops standard resource protocols, models alternative assumptions, performs variance analysis, and provides concurrent reporting. Examples are given of pharmacy managers' use of such systems to answer questions in the areas of product costing, product pricing, variance analysis, productivity monitoring, flexible budgeting, modeling and planning, and comparative analysis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3284338

  14. [Ethical dilemmas in public health care organizations].

    PubMed

    Pereda Vicandi, M

    2014-01-01

    Today you can ask if you can apply ethics to organizations because much of the greater overall impact decisions are not made by private individuals, are decided by organizations. Any organization is legitimate because it satisfies a need of society and this legitimacy depends if the organization does with quality. To offer a good service, quality service, organizations know they need to do well, but seem to forget that should do well not only instrumental level, must also make good on the ethical level. Public health care organizations claim to promote attitudes and actions based on ethics, level of their internal functioning and level of achievement of its goals, but increased awareness and analysis of its inner workings can question it. Such entities, for its structure and procedures, may make it difficult for ethical standards actually govern its operation, also can have negative ethical consequences at the population level. A healthcare organization must not be organized, either structurally or functionally, like any other organization that offers services. In addition, members of the organization can not simply be passive actors. It is necessary that operators and users have more pro-ethical behaviors. Operators from the professionalism and users from liability. PMID:25467632

  15. Delivering On Accountable Care: Lessons From A Behavioral Health Program To Improve Access And Outcomes.

    PubMed

    Clarke, Robin M A; Jeffrey, Jessica; Grossman, Mark; Strouse, Thomas; Gitlin, Michael; Skootsky, Samuel A

    2016-08-01

    Patients with behavioral health disorders often have worse health outcomes and have higher health care utilization than patients with medical diseases alone. As such, people with behavioral health conditions are important populations for accountable care organizations (ACOs) seeking to improve the efficiency of their delivery systems. However, ACOs have historically faced numerous barriers in implementing behavioral health population-based programs, including acquiring reimbursement, recruiting providers, and integrating new services. We developed an evidence-based, all-payer collaborative care program called Behavioral Health Associates (BHA), operated as part of UCLA Health, an integrated academic medical center. Building BHA required several innovations, which included using our enterprise electronic medical record for behavioral health referrals and documentation; registering BHA providers with insurance plans' mental health carve-out products; and embedding BHA providers in primary care practices throughout the UCLA Health system. Since 2012 BHA has more than tripled the number of patients receiving behavioral health services through UCLA Health. After receiving BHA treatment, patients had a 13 percent reduction in emergency department use. Our efforts can serve as a model for other ACOs seeking to integrate behavioral health care into routine practice. PMID:27503975

  16. Goal achievement and the accountability of consumer-run organizations.

    PubMed

    Brown, Louis D; Shepherd, Matthew D; Wituk, Scott A; Meissen, Greg

    2007-01-01

    This study explores how consumer-run organizations (CROs) can maintain independence while meeting the accountability needs of funding agencies. The importance of both funding agency needs for accountability and CRO needs for independence are discussed. A goal-tracking process is proposed as a potential strategy for balancing the potentially conflicting needs of accountability and independence. To demonstrate the utility of the goal tracking approach, this study analyzes goal tracking documentation in 3 years of quarterly reports from 21 CROs (also known as consumer drop-in centers and self-help agencies). Results detail the different goals of CROs. A 68% goal achievement rate suggests general organizational competence. Furthermore, CRO operations appear to be relatively cost-efficient, with an average of $11.51 spent per person per day. The analysis of quarterly reports leads to a discussion of several insights that may be useful to CROs, funding agencies, researchers, and mental health professionals. PMID:17180718

  17. Space Station Freedom Water Recovery test total organic carbon accountability

    NASA Technical Reports Server (NTRS)

    Davidson, Michael W.; Slivon, Laurence; Sheldon, Linda; Traweek, Mary

    1991-01-01

    Marshall Space Flight Center's (MSFC) Water Recovery Test (WRT) addresses the concept of integrated hygiene and potable reuse water recovery systems baselined for Space Station Freedom (SSF). To assess the adequacy of water recovery system designs and the conformance of reclaimed water quality to established specifications, MSFC has initiated an extensive water characterization program. MSFC's goal is to quantitatively account for a large percentage of organic compounds present in waste and reclaimed hygiene and potable waters from the WRT and in humidity condensate from Spacelab missions. The program is coordinated into Phase A and B. Phase A's focus is qualitative and semi-quantitative. Precise quantitative analyses are not emphasized. Phase B's focus centers on a near complete quantitative characterization of all water types. Technical approaches along with Phase A and partial Phase B investigations on the compositional analysis of Total Organic Carbon (TOC) Accountability are presented.

  18. Medical informatics and health care organizations.

    PubMed

    Holden, F M

    1991-01-01

    A dialogue between upper management and operational elements over an organization's informatics policies and procedures could take place in an environment in which both parties could succeed. Excellent patient care practices can exist in organizational settings where upper management is not concerned with the specifics of the medical care process. But as the medical care process itself becomes costly, complex, and part of the purview of upper management, solutions to ambiguous informatics policies and practices need to be found. As the discussion of cost determination suggests, a comprehensive "top-down" solution may not be feasible. Allowing patient care expertise to drive the design and implementation of clinical computing modules without unduly restrictive specifications from above is probably the best way to proceed. But if the organization needs to know the specifics of a treatment episode, then the informatics definitions specific to treatment episodes need to be unambiguous and consistently applied. As the discussion of Social Security numbers suggests, communication of information across various parts of the organization not only requires unambiguous data structure definitions, but also suggests that the communication process not be dependent on the content of the messages. Both ideas--consistent data structure definitions for essential data and open system communication architectures--are current in the medical informatician's vocabulary. The same ideas are relevant to the management and operation of large and diffuse health care enterprises. The lessons we are learning about informatics policy and practice controls in clinical computing need to be applied to the enterprise as a whole. PMID:1921663

  19. A professional response to demands for accountability: practical recommendations regarding ethical aspects of patient care. Working Group on Accountability.

    PubMed

    Emanuel, L L

    1996-01-15

    Forceful new demands for accountability in medicine are arising from many interested parties. To maintain professional standards, physicians need to establish which demands are desirable and which are not. We adopt a model of stratified accountability that includes three major components: the accountable parties, the subject matter, and the processes for accountability. To begin describing the model, we focus on physicians and health care institutions. We focus on the ethical dimensions of medical practice, both because the difficulty of measuring such behaviors makes this a test case for accountability and because of the importance of ethical standards in maintaining patient trust. We first identify eight widely endorsed content areas for accountability in ethical conduct: medical decision making, confidentiality, fiduciary obligations (including conflicts of interest), responsibilities arising from patient vulnerability, personal standards, equity among patients, cultural representation, and procedures for resolving dilemmas. We then identify the currently most valid and reliable methods for assessing conduct: surveys among all involved parties, testing methods used for accreditation, limited audits, publication of policy, and careful use of report cards. A prototypical survey and report card are illustrated. However, we also note the need for improved accountability assessment methods. We next identify mechanisms for taking responsibility: sharing information, exchanging perspectives, making adjustments, and enforcing standards when necessary. Finally, because this report only begins to describe a small part of the accountability model, we urge explicit identification and development of professional standards for accountability in the many other areas of medicine. PMID:8534000

  20. A transparency and accountability framework for high-value inpatient nursing care.

    PubMed

    Kurtzman, Ellen T

    2010-01-01

    Transparency and accountability are terms that typically refer to activities aimed at measuring and holding providers responsible for their performance through such vehicles as public disclosure of comparative results. Today, transparency and accountability policies are widely accepted strategies to drive quality improvement and stimulate consumer choice. Yet nursing, the single largest health care profession, has not yet been engaged in these policy directions nor considered in their design or implementation. The framework reported here offers nurses and their professional organizations a model for which to advocate for policy change. Hospital and health system executives who have the freedom to establish institutional policies might implement this framework to achieve higher value. This framework provides both the context and components of a system that, if implemented, would measure, report, and reward hospital nursing's contributions to high value. PMID:21158250

  1. Creating High Reliability in Health Care Organizations

    PubMed Central

    Pronovost, Peter J; Berenholtz, Sean M; Goeschel, Christine A; Needham, Dale M; Sexton, J Bryan; Thompson, David A; Lubomski, Lisa H; Marsteller, Jill A; Makary, Martin A; Hunt, Elizabeth

    2006-01-01

    Objective The objective of this paper was to present a comprehensive approach to help health care organizations reliably deliver effective interventions. Context Reliability in healthcare translates into using valid rate-based measures. Yet high reliability organizations have proven that the context in which care is delivered, called organizational culture, also has important influences on patient safety. Model for Improvement Our model to improve reliability, which also includes interventions to improve culture, focuses on valid rate-based measures. This model includes (1) identifying evidence-based interventions that improve the outcome, (2) selecting interventions with the most impact on outcomes and converting to behaviors, (3) developing measures to evaluate reliability, (4) measuring baseline performance, and (5) ensuring patients receive the evidence-based interventions. The comprehensive unit-based safety program (CUSP) is used to improve culture and guide organizations in learning from mistakes that are important, but cannot be measured as rates. Conclusions We present how this model was used in over 100 intensive care units in Michigan to improve culture and eliminate catheter-related blood stream infections—both were accomplished. Our model differs from existing models in that it incorporates efforts to improve a vital component for system redesign—culture, it targets 3 important groups—senior leaders, team leaders, and front line staff, and facilitates change management—engage, educate, execute, and evaluate for planned interventions. PMID:16898981

  2. How Health Care Organizations Are Using Data on Patients' Race and Ethnicity to Improve Quality of Care

    PubMed Central

    Thorlby, Ruth; Jorgensen, Selena; Siegel, Bruce; Ayanian, John Z

    2011-01-01

    Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system. Reducing these disparities requires action by health care organizations. Collecting accurate data from patients about their race and ethnicity is an essential first step for health care organizations to take such action, but these data are not systematically collected and used for quality improvement purposes in the United States. This study explores the challenges encountered by health care organizations that attempted to collect and use these data to reduce disparities. Methods: Purposive sampling was used to identify eight health care organizations that collected race and ethnicity data to measure and reduce disparities in the quality and outcomes of health care. Staff, including senior managers and data analysts, were interviewed at each site, using a semi-structured interview format about the following themes: the challenges of collecting and collating accurate data from patients, how organizations defined a disparity and analyzed data, and the impact and uses of their findings. Findings: To collect accurate self-reported data on race and ethnicity from patients, most organizations had upgraded or modified their IT systems to capture data and trained staff to collect and input these data from patients. By stratifying nationally validated indicators of quality for hospitals and ambulatory care by race and ethnicity, most organizations had then used these data to identify disparities in the quality of care. In this process, organizations were taking different approaches to defining and measuring disparities. Through these various methods, all organizations had found some disparities, and some had invested in interventions designed to address them, such as extra staff, extended hours, or services in new locations. Conclusion: If policymakers wish to hold health care organizations accountable for disparities in the quality of the care they

  3. Patient-centred care: making cancer treatment centres accountable.

    PubMed

    Zucca, Alison; Sanson-Fisher, Rob; Waller, Amy; Carey, Mariko

    2014-07-01

    Patient-centred care is argued to be an essential component in the delivery of quality health and cancer care. This manuscript discusses the need to generate credible data which indicates the quality of patient-centred care provided by cancer treatment centres. Patient-centred care covers six domains including physical comfort; emotional support; respect for patients' preferences and values; integration and coordination; involvement of family and friends; and the provision of information, communication and education to enable patients to understand and make informed decisions about their care. First, we identify priority areas within each domain. Next, we propose three questions that should be asked of every patient across the six domains of patient-centred care. The first question explores whether patients were specifically asked by a healthcare provider at the cancer treatment centre about their concerns, values and preferences. Research indicates that it cannot be assumed that clinicians are aware of patient's needs or preferences in these six areas. Second, if the answer from the patient suggests that they would like assistance, then it would be expected that this would be offered. Thirdly, if the patient indicates that they would like such assistance and it is provided, then it might be expected that the patient would report that the provided assistance did relieve their suffering, or the assistance provided was consistent with their preferences, needs and values. Regular measurement and reporting of these aspects of patient-centred cancer care has the potential to identify deficits and inequities in care delivery, allow for comparisons across treatment centres and stimulate an improvement in the patient-centred care provided to cancer patients. PMID:24696084

  4. Population health, public health, and accountable care: emerging roles and relationships.

    PubMed

    Costich, Julia F; Scutchfield, F Douglas; Ingram, Richard C

    2015-05-01

    To identify roles for public health agencies (PHAs) in accountable care organizations (ACOs), along with their obstacles and facilitators, we interviewed individuals from 9 ACOs, including Medicare, Medicaid, and commercial payers. We learned that PHAs participate in ACO-like partnerships with state Medicaid agencies, but interviewees identified barriers to collaboration with Medicare and commercial ACOs, including Medicare participation requirements, membership cost, risk-bearing restrictions, data-sharing constraints, differences between medicine and public health, and ACOs' investment yield needs. Collaboration was more likely when organizations had common objectives, ACO sponsors had substantial market share, PHA representatives served on ACO advisory boards, and there were preexisting contractual relationships. ACO-PHA relationships are not as straightforward as their shared use of the term "population health" would suggest, but some ACO partnerships could give PHAs access to new revenue streams. PMID:25790394

  5. CARES Helps Explain Secondary Organic Aerosols

    SciTech Connect

    Zaveri, Rahul

    2014-03-28

    What happens when urban man-made pollution mixes with what we think of as pristine forest air? To know more about what this interaction means for the climate, the Carbonaceous Aerosol and Radiative Effects Study, or CARES, field campaign was designed in 2010. The sampling strategy during CARES was coordinated with CalNex 2010, another major field campaign that was planned in California in 2010 by the California Air Resources Board (CARB), the National Oceanic and Atmospheric Administration (NOAA), and the California Energy Commission (CEC). "We found two things. When urban pollution mixes with forest pollutions we get more secondary organic aerosols," said Rahul Zaveri, FCSD scientist and project lead on CARES. "SOAs are thought to be formed primarily from forest emissions but only when they interact with urban emissions. The data is saying that there will be climate cooling over the central California valley because of these interactions." Knowledge gained from detailed analyses of data gathered during the CARES campaign, together with laboratory experiments, is being used to improve existing climate models.

  6. CARES Helps Explain Secondary Organic Aerosols

    ScienceCinema

    Zaveri, Rahul

    2014-06-02

    What happens when urban man-made pollution mixes with what we think of as pristine forest air? To know more about what this interaction means for the climate, the Carbonaceous Aerosol and Radiative Effects Study, or CARES, field campaign was designed in 2010. The sampling strategy during CARES was coordinated with CalNex 2010, another major field campaign that was planned in California in 2010 by the California Air Resources Board (CARB), the National Oceanic and Atmospheric Administration (NOAA), and the California Energy Commission (CEC). "We found two things. When urban pollution mixes with forest pollutions we get more secondary organic aerosols," said Rahul Zaveri, FCSD scientist and project lead on CARES. "SOAs are thought to be formed primarily from forest emissions but only when they interact with urban emissions. The data is saying that there will be climate cooling over the central California valley because of these interactions." Knowledge gained from detailed analyses of data gathered during the CARES campaign, together with laboratory experiments, is being used to improve existing climate models.

  7. The role of employee flexible spending accounts in health care financing.

    PubMed

    Schweitzer, M; Asch, D A

    1996-08-01

    Employee flexible spending accounts for health care represent one component of the current health care financing system that merits serious reform. These accounts create a system of undesirable incentives, force employees and employers to take complicated gambles, reduce tax revenues, and fail to meet their purported policy objectives. This paper describes shortcomings in these accounts from both a theoretical and an empirical perspective. Some proposed alternatives; including medical spending accounts and zero balance accounts, resolve many of these concerns but not all of them. PMID:8712264

  8. Organization of ambulatory care provision: a critical determinant of health system performance in developing countries.

    PubMed Central

    Berman, P.

    2000-01-01

    Success in the provision of ambulatory personal health services, i.e. providing individuals with treatment for acute illness and preventive health care on an ambulatory basis, is the most significant contributor to the health care system's performance in most developing countries. Ambulatory personal health care has the potential to contribute the largest immediate gains in health status in populations, especially for the poor. At present, such health care accounts for the largest share of the total health expenditure in most lower income countries. It frequently comprises the largest share of the financial burden on households associated with health care consumption, which is typically regressively distributed. The "organization" of ambulatory personal health services is a critical determinant of the health system's performance which, at present, is poorly understood and insufficiently considered in policies and programmes for reforming health care systems. This article begins with a brief analysis of the importance of ambulatory care in the overall health system performance and this is followed by a summary of the inadequate global data on ambulatory care organization. It then defines the concept of "macro organization of health care" at a system level. Outlined also is a framework for analysing the organization of health care services and the major pathways through which the organization of ambulatory personal health care services can affect system performance. Examples of recent policy interventions to influence primary care organization--both government and nongovernmental providers and market structure--are reviewed. It is argued that the characteristics of health care markets in developing countries and of most primary care goods result in relatively diverse and competitive environments for ambulatory care services, compared with other types of health care. Therefore, governments will be required to use a variety of approaches beyond direct public provision

  9. The missing link in Aboriginal care: resource accounting.

    PubMed

    Ashton, C W; Duffie-Ashton, Denise

    2008-01-01

    Resource accounting principles provide more effective planning for Aboriginal healthcare delivery through driving best management practices, efficacious techniques for long-term resource allocation, transparency of information and performance measurement. Major improvements to Aboriginal health in New Zealand and Australia were facilitated in the context of this public finance paradigm, rather than cash accounting systems that remain the current method for public departments in Canada. Multiple funding sources and fragmented delivery of Aboriginal healthcare can be remedied through similar adoption of such principles. PMID:18536535

  10. Care of the Self in a Context of Accountability

    ERIC Educational Resources Information Center

    Gunzenhauser, Michael G.

    2008-01-01

    Background/Context: This article is a part of a larger philosophical and empirical project by the author and collaborators to understand the ways in which high-stakes accountability policy fosters normalizing educational practices and concomitant resistance by educators and students. Purpose/Objective/Research Question/Focus of Study: In this…

  11. Independent practice associations and physician-hospital organizations can improve care management for smaller practices.

    PubMed

    Casalino, Lawrence P; Wu, Frances M; Ryan, Andrew M; Copeland, Kennon; Rittenhouse, Diane R; Ramsay, Patricia P; Shortell, Stephen M

    2013-08-01

    Pay-for-performance, public reporting, and accountable care organization programs place pressures on physicians to use health information technology and organized care management processes to improve the care they provide. But physician practices that are not large may lack the resources and size to implement such processes. We used data from a unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which independent practice associations (IPAs) and physician-hospital organizations (PHOs) might make it possible for these smaller practices to share resources to improve care. Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients. On average, practices participating in these organizations provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did (10.4 versus 3.8). Half of these processes were provided only by IPAs or PHOs. These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations. PMID:23918481

  12. Caring for a common future: medical schools' social accountability.

    PubMed

    Woollard, Robert F

    2006-04-01

    ORIGINS AND CONTEXT: The concept of 'the social accountability of medical schools' is moving from the peripheral preoccupation of a few to a more central concern of medical schools themselves. Born of concerns about the professionalism and relevance of both the institutions and their graduates, it is seen increasingly as an urgent call to focus the considerable social resources vested in academic health science institutions on addressing the priority health concerns of the societies they serve. For a profession embedded in an ethos of service, this would seem an obvious transition. However, as with any movement towards transformative change, it runs the risk of being more mantra and rhetoric than mandate and responsibility. NEEDED RESPONSE: Proceeding from the assumption that good intentions alone are not enough, this paper seeks to outline the historical development and some current expression of the concept throughout the world. The sadly divergent wealth and health status of modern societies calls for very different actions by medical schools across the spectrum from the least endowed to the wealthiest of schools. In a profession claiming centuries of cohesive commitment to the welfare of others, it is increasingly urgent that the current generation of medical educators converge on a relevant set of principles and coherent activities. TOOLS FOR THE TASK: While recognising that they are closely intertwined, the paper outlines the difference between the social accountability of the institutions themselves and the social accountability of the graduates they produce. It outlines both individual examples and the international initiatives that are fostering and facilitating institutional collaborations to bring both progress and optimism to this daunting task. It provides connections to practical resources for those who are committed to that task. Other papers in this series add further practical insights into the central role that medical educators must play if we

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

    PubMed

    Dobalian, A; Rivers, P A

    1998-01-01

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

  14. The Australian experiment: how primary health care organizations supported the evolution of a primary health care system.

    PubMed

    Nicholson, Caroline; Jackson, Claire L; Marley, John E; Wells, Robert

    2012-03-01

    Primary health care in Australia has undergone 2 decades of change. Starting with a vision for a national health strategy with general practice at its core, Australia established local meso-level primary health care organizations--Divisions of General Practice--moving from focus on individual practitioners to a professional collective local voice. The article identifies how these meso-level organizations have helped the Australian primary health care system evolve by supporting the roll-out of initiatives including national practice accreditation, a focus on quality improvement, expansion of multidisciplinary teams into general practice, regional integration, information technology adoption, and improved access to care. Nevertheless, there are still challenges to ensuring equitable access and the supply and distribution of a primary care workforce, addressing the increasing rates of chronic disease and obesity, and overcoming the fragmentation of funding and accountability in the Australian system. PMID:22403246

  15. An Interdisciplinary Health Care Accounting Class: Content, Student Response, and Lessons Learned.

    ERIC Educational Resources Information Center

    Steadman, Mark E.

    2000-01-01

    A graduate course in health care accounting and finance was presented by an interdisciplinary team of accounting, nursing, and allied health faculty. Recommendations for the course included early planning, team teaching, integration, student engagement in presentations, cross-listing of classes, case study method, and team projects. (SK)

  16. Significance of scientific evidence in organizing care processes.

    PubMed

    Hasson, Henna; Blomberg, Staffan; Dunér, Anna; Sarvimäki, Anneli

    2016-06-20

    Purpose - The purpose of this paper is to analyze how staff and managers in health and social care organizations use scientific evidence when making decisions about the organization of care practices. Design/methodology/approach - Document analysis and repeated interviews (2008-2010) with staff (n=39) and managers (n=26) in health and social care organizations. The respondents were involved in a randomized controlled study about testing a continuum of care model for older people. Findings - Scientific evidence had no practical function in the social care organization, while it was a prioritized source of information in the health care organization. This meant that the decision making regarding care practices was different in these organizations. Social care tended to rely on ad hoc practice-based information and political decisions when organizing care, while health care to some extent also relied in an unreflected manner on the scientific knowledge. Originality/value - The study illustrates several difficulties that might occur when managers and staff try to consider scientific evidence when making complicated decisions about care practices. PMID:27296881

  17. Communicating in Multicultural Health Care Organizations.

    ERIC Educational Resources Information Center

    Kreps, Gary L.; Kunimoto, Elizabeth

    This paper investigates the multicultural demands of health care delivery by examining the role of organizational communication in promoting effective multicultural relations in modern health care systems. The paper describes the multicultural make-up of modern health care systems--noting, for example that providers from different professional…

  18. Care through Authenticity: Teacher Preparation for an Ethic of Care in an Age of Accountability

    ERIC Educational Resources Information Center

    Rabin, Colette

    2013-01-01

    This study elucidates the role that authenticity--knowing and being one's self--plays in preservice teachers' introduction to care ethics in a multicultural urban context. In one teacher education program, in observations, interviews, and surveys, preservice teachers described that caring required authenticity to avoid complying with…

  19. 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

  20. Medical savings accounts: assessing their impact on efficiency, equity and financial protection in health care.

    PubMed

    Wouters, Olivier J; Cylus, Jonathan; Yang, Wei; Thomson, Sarah; McKee, Martin

    2016-07-01

    Medical savings accounts (MSAs) allow enrolees to withdraw money from earmarked funds to pay for health care. The accounts are usually accompanied by out-of-pocket payments and a high-deductible insurance plan. This article reviews the association of MSAs with efficiency, equity, and financial protection. We draw on evidence from four countries where MSAs play a significant role in the financing of health care: China, Singapore, South Africa, and the United States of America. The available evidence suggests that MSA schemes have generally been inefficient and inequitable and have not provided adequate financial protection. The impact of these schemes on long-term health-care costs is unclear. Policymakers and others proposing the expansion of MSAs should make explicit what they seek to achieve given the shortcomings of the accounts. PMID:26883211

  1. Accountability in the City of Toronto's 10 long-term care homes.

    PubMed

    Wyers, Lindsay; Gamble, Brenda; Deber, Raisa B

    2014-09-01

    Long-term care (LTC) residential homes provide a supportive environment for residents requiring nursing care and assistance with daily living activities. The LTC sector is highly regulated. We examine the approaches taken to ensure the delivery of quality and safe care in 10 LTC homes owned and operated by the City of Toronto, Ontario, focusing on mandatory accountability agreements with the Local Health Integration Networks (LHINs). Results are based on document review and seven interviews with LTC managers responsible for the management and operation of the 10 LTC homes. One issue identified was the challenges associated with implementing new legislative and regulatory requirements to multiple bodies with differing requirements, particularly when boundaries do not coincide (e.g., the City of Toronto's Long-Term Care Homes and Services Division must establish 10 different accountability agreements with the five LHINs that span into the City of Toronto's geographic area). PMID:25305393

  2. Accountability in the City of Toronto's 10 Long-Term Care Homes

    PubMed Central

    Wyers, Lindsay; Gamble, Brenda; Deber, Raisa B.

    2014-01-01

    Long-term care (LTC) residential homes provide a supportive environment for residents requiring nursing care and assistance with daily living activities. The LTC sector is highly regulated. We examine the approaches taken to ensure the delivery of quality and safe care in 10 LTC homes owned and operated by the City of Toronto, Ontario, focusing on mandatory accountability agreements with the Local Health Integration Networks (LHINs). Results are based on document review and seven interviews with LTC managers responsible for the management and operation of the 10 LTC homes. One issue identified was the challenges associated with implementing new legislative and regulatory requirements to multiple bodies with differing requirements, particularly when boundaries do not coincide (e.g., the City of Toronto's Long-Term Care Homes and Services Division must establish 10 different accountability agreements with the five LHINs that span into the City of Toronto's geographic area). PMID:25305393

  3. e-business means survival for health care organizations in 2010.

    PubMed

    Lutz, S

    2000-01-01

    Within the next five years, most health care organizations will communicate with suppliers, other providers, payers, regulators, and patients through the Internet. The Internet will recalibrate expectations of speed and service for patients and providers, but it also will increase accountability in which digitalized information is tracked and analyzed. The rate at which health care organizations are developing Web-based solutions is neck-snapping in the United States. As individual product lines, departments, and subsidiaries grow their own e-health businesses, organizations must decide which initiatives they must fund, which are essential to survival, and which could be financial black holes. PMID:11184343

  4. Enhancing learning, innovation, adaptation, and sustainability in health care organizations: the ELIAS performance management framework.

    PubMed

    Persaud, D David

    2014-01-01

    The development of sustainable health care organizations that provide high-quality accessible care is a topic of intense interest. This article provides a practical performance management framework that can be utilized to develop sustainable health care organizations. It is a cyclical 5-step process that is premised on accountability, performance management, and learning practices that are the foundation for a continuous process of measurement, disconfirmation, contextualization, implementation, and routinization This results in the enhancement of learning, innovation, adaptation, and sustainability (ELIAS). Important considerations such as recognizing that health care organizations are complex adaptive systems and the presence of a dynamic learning culture are necessary contextual factors that maximize the effectiveness of the proposed framework. Importantly, the ELIAS framework utilizes data that are already being collected by health care organizations for accountability, improvement, evaluation, and strategic purposes. Therefore, the benefit of the framework, when used as outlined, would be to enhance the chances of health care organizations achieving the goals of ongoing adaptation and sustainability, by design, rather than by chance. PMID:25068873

  5. Primary Care of the Solid Organ Transplant Recipient.

    PubMed

    Wong, Christopher J; Pagalilauan, Genevieve

    2015-09-01

    Solid organ transplantation (SOT) is one of the major advances in medicine. Care of the SOT recipient is complex and continued partnership with the transplant specialist is essential to manage and treat complications and maintain health. The increased longevity of SOT recipients will lead to their being an evolving part of primary care practice, with ever more opportunities for care, education, and research of this rewarding patient population. This review discusses the overall primary care management of adult SOT recipients. PMID:26320047

  6. Organizing for effective managed care contracting.

    PubMed

    Mayer, T

    2001-01-01

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

  7. Accountability.

    ERIC Educational Resources Information Center

    The Newsletter of the Comprehensive Center-Region VI, 1999

    1999-01-01

    Controversy surrounding the accountability movement is related to how the movement began in response to dissatisfaction with public schools. Opponents see it as one-sided, somewhat mean-spirited, and a threat to the professional status of teachers. Supporters argue that all other spheres of the workplace have accountability systems and that the…

  8. Accountability.

    ERIC Educational Resources Information Center

    Lashway, Larry

    1999-01-01

    This issue reviews publications that provide a starting point for principals looking for a way through the accountability maze. Each publication views accountability differently, but collectively these readings argue that even in an era of state-mandated assessment, principals can pursue proactive strategies that serve students' needs. James A.…

  9. Core competencies of the entrepreneurial leader in health care organizations.

    PubMed

    Guo, Kristina L

    2009-01-01

    The purpose of this article is to discuss core competencies that entrepreneurial health care leaders should acquire to ensure the survival and growth of US health care organizations. Three overlapping areas of core competencies are described: (1) health care system and environment competencies, (2) organization competencies, and (3) interpersonal competencies. This study offers insight into the relationship between leaders and entrepreneurship in health care organizations and establishes the foundation for more in-depth studies on leadership competencies in health care settings. The approach for identifying core competencies and designing a competency model is useful for practitioners in leadership positions in complex health care organizations, so that through the understanding and practice of these 3 areas of core competencies, they can enhance their entrepreneurial leadership skills to become more effective health care entrepreneurial leaders. This study can also be used as a tool by health care organizations to better understand leadership performance, and competencies can be used to further the organization's strategic vision and for individual improvement purposes. PMID:19225332

  10. Oregon's Coordinated Care Organizations Increased Timely Prenatal Care Initiation And Decreased Disparities.

    PubMed

    Muoto, Ifeoma; Luck, Jeff; Yoon, Jangho; Bernell, Stephanie; Snowden, Jonathan M

    2016-09-01

    Policies at the state and federal levels affect access to health services, including prenatal care. In 2012 the State of Oregon implemented a major reform of its Medicaid program. The new model, called a coordinated care organization (CCO), is designed to improve the coordination of care for Medicaid beneficiaries. This reform effort provides an ideal opportunity to evaluate the impact of broad financing and delivery reforms on prenatal care use. Using birth certificate data from Oregon and Washington State, we evaluated the effect of CCO implementation on the probability of early prenatal care initiation, prenatal care adequacy, and disparities in prenatal care use by type of insurance. Following CCO implementation, we found significant increases in early prenatal care initiation and a reduction in disparities across insurance types but no difference in overall prenatal care adequacy. Oregon's reforms could serve as a model for other Medicaid and commercial health plans seeking to improve prenatal care quality and reduce disparities. PMID:27605642

  11. National Hospice and Palliative Care Organization

    MedlinePlus

    ... Strategic Planning for Hospice Hospice Policy and Advocacy Healthcare Reform and Innovation Inspirational Address Booking Policies Contact NHPCO ... Webinar Registration MP4 Recordings Pay for CE/CME Online Learning E-OL Courses Interdisciplinary Team Palliative Care ...

  12. Day Care Legal Handbook: Legal Aspects of Organizing and Operating Day Care Programs.

    ERIC Educational Resources Information Center

    Aikman, William F.

    This guide for providers of day care services presents information on business regulations and other legal considerations affecting for-profit and not-for-profit day care programs. Three basic topics covered are: (1) choosing the type of organization (sole proprietorship, partnership or corporation), (2) forming the organization, and (3) operating…

  13. Who is Using Telehealth in Primary Care? Safety Net Clinics and Health Maintenance Organizations (HMOs).

    PubMed

    Coffman, Megan; Moore, Miranda; Jetty, Anuradha; Klink, Kathleen; Bazemore, Andrew

    2016-01-01

    Despite rapid advancements in telehealth services, only 15% of family physicians in a 2014 survey reported using telehealth; use varied widely according to the physician's practice setting or designation. Users were significantly more likely than nonusers to work in federally designated "safety net" clinics and health maintenance organizations (HMOs) but not more likely than nonusers to report working in a patient-centered medical home (PCMH) or accountable care organization. PMID:27390373

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

    PubMed Central

    Kohn, L T

    2000-01-01

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

  15. Ethical budgets: a critical success factor in implementing new public management accountability in health care.

    PubMed

    Bosa, Iris M

    2010-05-01

    New public management accountability is increasingly being introduced into health-care systems throughout the world - albeit with mixed success. This paper examines the successful introduction of new management accounting systems among general practitioners (GPs) as an aspect of reform in the Italian health-care system. In particular, the study examines the critical role played by the novel concept of an 'ethical budget' in engaging the willing cooperation of the medical profession in implementing change. Utilizing a qualitative research design, with in-depth interviews with GPs, hospital doctors and managers, along with archival analysis, the present study finds that management accounting can be successfully implemented among medical professionals provided there is alignment between the management imperative and the ethical framework in which doctors practise their profession. The concept of an 'ethical budget' has been shown to be an innovative and effective tool in achieving this alignment. PMID:20424275

  16. Organizations As Overlapping Jurisdictions: Restoring Reason in Organizational Accounts.

    ERIC Educational Resources Information Center

    Blau, Judith R.

    1996-01-01

    As Stern and Barley suggest, what is social about organizations is currently undertheorized, given the aspatial character of administration and financing, the reliance on external labor markets, and the global character of production and distribution. The "jurisdiction" concept provides a framework for considering organizations' social character…

  17. Conflicts between managed care organizations and emergency departments in California.

    PubMed Central

    Johnson, L A; Derlet, R W

    1996-01-01

    To control costs, managed care organizations have begun to restrict the use of hospital emergency departments by their enrollees. They are doing this by educating enrollees, providing better access to 24-hour urgent care, denying preauthorizations for care for some patients who do present to emergency departments, and retrospectively denying payment for certain patients who use emergency services. Changing traditional use of emergency departments has resulted in conflicts between managed care organizations and these departments. Because federal law mandates access to emergency care for all persons, disagreements occur over the precise definition of an emergency medical condition. In addition, conflicts occur over the scope and payment for the medical screening examination required by federal law of persons presenting to an emergency department. Finally, issues arise related to the safety of patients who present to emergency departments and request care but are denied care because the managed care organization does not authorize the visit. Recent legislation in California has attempted to reconcile differences between managed care practices and federal and state laws; however, areas of continued conflict need to be resolved to prevent possible adverse consequences for patients actually needing emergency care. PMID:8775727

  18. A New Look at Accountability for Your Sales Organization

    ERIC Educational Resources Information Center

    Chabot, Daniel

    1976-01-01

    The problem of increasing costs in acquiring sales can be met by training salespeople to become more effective and productive. An accountability system for salespeople and sales managers is presented based on the return on investment management formula, a combination which considers responsibilities, objectives, and indicators. (EC)

  19. Accountability through Assessment of Administrative Organizations in Higher Education

    ERIC Educational Resources Information Center

    Kniola, David J.

    2013-01-01

    Accountability is among the least understood policy issues in higher education (Burke 2005). The rapid rise in tuition costs in both public and private institutions (Heller 2006) in all corners of the globe (Altbach, Reisberg, and Rumbley 2009) has challenged the idea of higher education as a public good. Student learning outcomes is one…

  20. Accounting for results: how conservation organizations report performance information.

    PubMed

    Rissman, Adena R; Smail, Robert

    2015-04-01

    Environmental program performance information is in high demand, but little research suggests why conservation organizations differ in reporting performance information. We compared performance measurement and reporting by four private-land conservation organizations: Partners for Fish and Wildlife in the US Fish and Wildlife Service (national government), Forest Stewardship Council-US (national nonprofit organization), Land and Water Conservation Departments (local government), and land trusts (local nonprofit organization). We asked: (1) How did the pattern of performance reporting relationships vary across organizations? (2) Was political conflict among organizations' principals associated with greater performance information? and (3) Did performance information provide evidence of program effectiveness? Based on our typology of performance information, we found that most organizations reported output measures such as land area or number of contracts, some reported outcome indicators such as adherence to performance standards, but few modeled or measured environmental effects. Local government Land and Water Conservation Departments reported the most types of performance information, while local land trusts reported the fewest. The case studies suggest that governance networks influence the pattern and type of performance reporting, that goal conflict among principles is associated with greater performance information, and that performance information provides unreliable causal evidence of program effectiveness. Challenging simple prescriptions to generate more data as evidence, this analysis suggests (1) complex institutional and political contexts for environmental program performance and (2) the need to supplement performance measures with in-depth evaluations that can provide causal inferences about program effectiveness. PMID:25549998

  1. Accounting for Results: How Conservation Organizations Report Performance Information

    NASA Astrophysics Data System (ADS)

    Rissman, Adena R.; Smail, Robert

    2015-04-01

    Environmental program performance information is in high demand, but little research suggests why conservation organizations differ in reporting performance information. We compared performance measurement and reporting by four private-land conservation organizations: Partners for Fish and Wildlife in the US Fish and Wildlife Service (national government), Forest Stewardship Council—US (national nonprofit organization), Land and Water Conservation Departments (local government), and land trusts (local nonprofit organization). We asked: (1) How did the pattern of performance reporting relationships vary across organizations? (2) Was political conflict among organizations' principals associated with greater performance information? and (3) Did performance information provide evidence of program effectiveness? Based on our typology of performance information, we found that most organizations reported output measures such as land area or number of contracts, some reported outcome indicators such as adherence to performance standards, but few modeled or measured environmental effects. Local government Land and Water Conservation Departments reported the most types of performance information, while local land trusts reported the fewest. The case studies suggest that governance networks influence the pattern and type of performance reporting, that goal conflict among principles is associated with greater performance information, and that performance information provides unreliable causal evidence of program effectiveness. Challenging simple prescriptions to generate more data as evidence, this analysis suggests (1) complex institutional and political contexts for environmental program performance and (2) the need to supplement performance measures with in-depth evaluations that can provide causal inferences about program effectiveness.

  2. 7 CFR 1770.16 - Supplementary accounts required of nonprofit organizations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... organizations. Class of company Account No. A B Account title Current Assets 1350.1 1350.1 Subscriptions to... Certificates. 1350.4 1350.4 Other Current Assets. Current Liabilities 4130.1 4130.1 Patronage Capital Payable... and nonredeemable certificates. 1350.4 1350.4 Other Current Assets This account shall include...

  3. The new organization of the health care delivery system.

    PubMed

    Shortell, S M; Hull, K E

    1996-01-01

    The U.S. health care system is restructuring at a dizzying pace. In many parts of the country, managed care has moved into third-generation models emphasizing capitated payment for enrolled lives and, in the process, turning most providers and institutions into cost centers to be managed rather than generators of revenue. While the full impact of the new managed care models remains to be seen, most evidence to date suggests that it tends to reduce inpatient use, may be associated with greater use of physician services and preventive care, and appears to result in no net differences either positive or negative with regard to quality or outcomes of care in comparison with fee-for-service plans. Some patients, however, tend to be somewhat less satisfied with scheduling of appointments and the amount of time spent with providers. There is no persuasive evidence that managed care lowers the rate of growth in overall health care costs within a given market. Further, managed care performance varies considerably across the country, and the factors influencing managed care performance are not well understood. Organized delivery systems are a somewhat more recent phenomenon representing various forms of ownership and strategic alliances among hospitals, physicians, and insurers designed to provide more cost-effective care to defined populations by achieving desired levels of functional, physician-system, and clinical integration. Early evidence suggests that organized delivery systems that are more integrated have the potential to provide more accessible coordinated care across the continuum, and appear to be associated with higher levels of inpatient productivity, greater total system revenue, greater total system cash flow, and greater total system operating margin than less integrated delivery forms. Some key success factors for developing organized delivery systems have been identified. Important roles are played by organizational culture, information systems, internal

  4. Accounting Procedures for Student Organizations. 1979 Edition. School Business Administration Publication No. 3.

    ERIC Educational Resources Information Center

    California Association of School Business Officials, Sacramento.

    This manual focuses attention on the problems involved in accounting for student body organization funds and offers information that may be used by school districts in establishing, reviewing, and revising fiscal policies and accounting procedures for student body organizations. It is intended that the application of the basic principles set forth…

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

    PubMed

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

    1998-01-01

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

  6. Strengthening fairness, transparency and accountability in health care priority setting at district level in Tanzania

    PubMed Central

    Maluka, Stephen Oswald

    2011-01-01

    Health care systems are faced with the challenge of resource scarcity and have insufficient resources to respond to all health problems and target groups simultaneously. Hence, priority setting is an inevitable aspect of every health system. However, priority setting is complex and difficult because the process is frequently influenced by political, institutional and managerial factors that are not considered by conventional priority-setting tools. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority setting in district health management were studied. This review is based on a PhD thesis that aimed to analyse health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness (A4R) approach to priority setting in Tanzania. A qualitative case study in Mbarali district formed the basis of exploring the sociopolitical and institutional contexts within which health care decision making takes place. The study also explores how the A4R intervention was shaped, enabled and constrained by the contexts. Key informant interviews were conducted. Relevant documents were also gathered and group priority-setting processes in the district were observed. The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality. The study also found that while the A4R approach was perceived to be helpful in strengthening transparency, accountability and stakeholder engagement, integrating the innovation into the district health system was challenging. This study underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority-setting decisions. A broader

  7. Strengthening fairness, transparency and accountability in health care priority setting at district level in Tanzania.

    PubMed

    Maluka, Stephen Oswald

    2011-01-01

    Health care systems are faced with the challenge of resource scarcity and have insufficient resources to respond to all health problems and target groups simultaneously. Hence, priority setting is an inevitable aspect of every health system. However, priority setting is complex and difficult because the process is frequently influenced by political, institutional and managerial factors that are not considered by conventional priority-setting tools. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority setting in district health management were studied. This review is based on a PhD thesis that aimed to analyse health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness (A4R) approach to priority setting in Tanzania. A qualitative case study in Mbarali district formed the basis of exploring the sociopolitical and institutional contexts within which health care decision making takes place. The study also explores how the A4R intervention was shaped, enabled and constrained by the contexts. Key informant interviews were conducted. Relevant documents were also gathered and group priority-setting processes in the district were observed. The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality. The study also found that while the A4R approach was perceived to be helpful in strengthening transparency, accountability and stakeholder engagement, integrating the innovation into the district health system was challenging. This study underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority-setting decisions. A broader

  8. The ultimately accountable job: leading today's sales organization.

    PubMed

    Colletti, Jerome A; Fiss, Mary S

    2006-01-01

    In recent years, sales leaders have had to devote considerable time and energy to establishing and maintaining disciplined processes. The thing is, many of them stop there--and they can't afford to, because the business environment has changed. Customers have gained power and gone global, channels have proliferated, more product companies are selling services, and many suppliers have begun providing a single point of contact for customers. Such changes require today's sales leaders to fill various new roles: Company leader. The best sales chiefs actively help formulate and execute company strategy, and they collaborate with all functions of the business to deliver value to customers. Customer champion. Customers want C-level relationships with suppliers in order to understand product strategy, look at offerings in advance, and participate in decisions made about future products--and sales leaders are in the best position to offer that kind of contact. Process guru. Although sales chiefs must look beyond the sales and customer processes they have honed over the past decade, they can't abandon them. The focus on process has become only more important as many organizations have begun bundling products and services to meet important customers' individual needs. Organization architect. Good sales leaders spend a lot of time evaluating and occasionally redesigning the sales organization's structure to ensure that it supports corporate strategy. Often, this involves finding the right balance between specialized and generalized sales roles. Course corrector. Sales leaders must watch the horizon, but they can't take their hands off the levers or forget about the dials. If they do, they might fail to respond when quick adjustments in priorities are needed. PMID:16846195

  9. A framework for describing health care delivery organizations and systems.

    PubMed

    Piña, Ileana L; Cohen, Perry D; Larson, David B; Marion, Lucy N; Sills, Marion R; Solberg, Leif I; Zerzan, Judy

    2015-04-01

    Describing, evaluating, and conducting research on the questions raised by comparative effectiveness research and characterizing care delivery organizations of all kinds, from independent individual provider units to large integrated health systems, has become imperative. Recognizing this challenge, the Delivery Systems Committee, a subgroup of the Agency for Healthcare Research and Quality's Effective Health Care Stakeholders Group, which represents a wide diversity of perspectives on health care, created a draft framework with domains and elements that may be useful in characterizing various sizes and types of care delivery organizations and may contribute to key outcomes of interest. The framework may serve as the door to further studies in areas in which clear definitions and descriptions are lacking. PMID:24922130

  10. [Organ donation after euthanasia. Handle with great care].

    PubMed

    Abdo, W F Farid

    2014-01-01

    Recently, organ donation after euthanasia has been a topic of discussion in the Dutch media and scientific literature. Unfortunately, both the articles in question and the media interviews contained several unsubstantiated statements. This article describes the background of organ donation after euthanasia and refutes some of the recent statements. It discusses why it is expected that organ donation after euthanasia will result in a far fewer additional organ donors that originally stated. In conclusion, euthanasia is a topic that should be handled with great care. PMID:25492739

  11. 7 CFR 1770.16 - Supplementary accounts required of nonprofit organizations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 12 2010-01-01 2010-01-01 false Supplementary accounts required of nonprofit organizations. 1770.16 Section 1770.16 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) ACCOUNTING REQUIREMENTS FOR RUS TELECOMMUNICATIONS BORROWERS Uniform System of...

  12. Increasing access to care for cultural and linguistic minorities: ethnicity-specific health care organizations and infrastructure.

    PubMed

    Yang, Joshua S; Kagawa-Singer, Marjorie

    2007-08-01

    Racial and ethnic disparities in health care have been attributed in part to cultural and linguistic dissonance between certain patient populations and the health care system. Yet in the long term, structural solutions for ameliorating health care disparities have not been forthcoming. One strategy for increasing access to care for cultural and linguistic minorities is ethnicity-specific subsystems of care. The historical experiences of the Chinese community in San Francisco are used to reconstruct the evolution of its ethnicity-specific health care infrastructure and to create an organizational development model for ethnicity-specific health care organizations and infrastructures. The four stages of the model include developing and recruiting a bicultural and bilingual health care workforce, structuring health care resources for maximum accessibility, expanding health care organizations, and integrating ethnicity-specific health care resources into the mainstream health care system. Policy recommendations to develop ethnicity-specific subsystems of care are presented. PMID:17675712

  13. Intensive care nurses' experiences of caring for brain dead organ donor patients.

    PubMed

    Pearson, A; Robertson-Malt, S; Walsh, K; Fitzgerald, M

    2001-01-01

    This study was designed to identify the feelings and experiences of critical care nurses who have been involved in nursing brain dead patients prior to organ donation. The purpose of the study was to generate knowledge which informs the discipline of nursing. A number of themes relating to nurses' experiences of caring for brain dead organ donor patients were uncovered in this interpretative study. Overall, caring for patients who are diagnosed as brain dead is a challenging experience for nurses and they are intensely involved in a search for meaning in each event. The interpretative analysis in this study has revealed a range of meanings articulated by the nurses involved. However, the primary focus of care--as identified by the participating nurses--was the donor family. PMID:11820230

  14. Separate, dedicated care teams for living organ donors.

    PubMed

    McQuarrie, Brenda; Gordon, Debra

    2003-06-01

    Living donation is an increasingly common option offered to patients in most transplant programs. Staff involved in the education, assessment, and care of this patient group is faced with increasingly complicated assessments both medically and psychologically. Supporting arguments for dedicated care teams for living organ donors include the large number of transplantations performed using living donors, the continued need to promote living organ donation, and the growing complexity of both medical and psychological factors in donor assessments. In addition, there is a need to implement the standards proposed by the 2000 Consensus Group, as well as to develop a body of evidence-based research related both to short- and long-term issues for this patient group. The ethical issues related to simultaneous involvement with both donors and recipients, and a need to ensure confidentiality are additional supporting arguments for the need to provide separate care providers for donors and recipients. PMID:12841513

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

    PubMed

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

    1997-01-01

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

  16. [Refractory cardiac arrest patients in prehospital care, potential organ donors].

    PubMed

    Le Jan, Arnaud; Dupin, Aurélie; Garrigue, Bruno; Sapir, David

    2016-09-01

    Under the authority of the French Biomedicine Agency, a new care pathway integrates refractory cardiac arrest patients into a process of organ donation. It is a medical, logistical and ethical challenge for the staff of the mobile emergency services. PMID:27596502

  17. Intensive care medicine and organ donation: exploring the last frontiers?

    PubMed

    Escudero, D; Otero, J

    2015-01-01

    The main, universal problem for transplantation is organ scarcity. The gap between offer and demand grows wider every year and causes many patients in waiting list to die. In Spain, 90% of transplants are done with organs taken from patients deceased in brain death but this has a limited potential. In order to diminish organ shortage, alternative strategies such as donations from living donors, expanded criteria donors or donation after circulatory death, have been developed. Nevertheless, these types of donors also have their limitations and so are not able to satisfy current organ demand. It is necessary to reduce family denial and to raise donation in brain death thus generalizing, among other strategies, non-therapeutic elective ventilation. As intensive care doctors, cornerstone to the national donation programme, we must consolidate our commitment with society and organ transplantation. We must contribute with the values proper to our specialization and try to reach self-sufficiency by rising organ obtainment. PMID:25841298

  18. How critical care nurses' roles and education affect organ donation.

    PubMed

    Jawoniyi, Oluwafunmilayo Ololade; Gormley, Kevin

    Organ and tissue dysfunction and failure cause high mortality rates around the world. Tissue and organs transplantation is an established, cost-effective, life-saving treatment for patients with organ failure. However, there is a large gap between the need for and the supply of donor organs. Acute and critical care nurses have a central role in the organ donation process, from identifying and assessing potential donors and supporting their families to involvement in logistics. Nurses with an in-depth knowledge of donation understand its clinical and technical aspects as well as the moral and legal considerations. Nurses have a major role to play in tackling organ and tissue shortages. Such a role cannot be adequately performed if nurses are not fully educated about donation and transplant. Such education could be incorporated into mandatory training and completed by all nurses. PMID:26153810

  19. A retrospective evaluation of the Perfecting Patient Care University training program for health care organizations.

    PubMed

    Morganti, Kristy Gonzalez; Lovejoy, Susan; Beckjord, Ellen Burke; Haviland, Amelia M; Haas, Ann C; Farley, Donna O

    2014-01-01

    This study evaluated how the Perfecting Patient Care (PPC) University, a quality improvement (QI) training program for health care leaders and clinicians, affected the ability of organizations to improve the health care they provide. This training program teaches improvement methods based on Lean concepts and principles of the Toyota Production System and is offered in several formats. A retrospective evaluation was performed that gathered data on training, other process factors, and outcomes after staff completed the PPC training. A majority of respondents reported gaining QI competencies and cultural achievements from the training. Organizations had high average scores for the success measures of "outcomes improved" and "sustainable monitoring" but lower scores for diffusion of QI efforts. Total training dosage was significantly associated with the measures of QI success. This evaluation provides evidence that organizations gained the PPC competencies and cultural achievements and that training dosage is a driver of QI success. PMID:23572230

  20. Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework.

    PubMed

    Maluka, Stephen; Kamuzora, Peter; San Sebastiån, Miguel; Byskov, Jens; Olsen, Øystein E; Shayo, Elizabeth; Ndawi, Benedict; Hurtig, Anna-Karin

    2010-08-01

    Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest it should have been. Priority-setting usually occurred in the context of budget cycles and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicized through circulars and notice boards, but there were no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level in the contexts of low-income countries. Second, it provides guidance to decision-makers on how to improve fairness, legitimacy, and sustainability of the priority-setting process. PMID

  1. Professionalism: good for patients and health care organizations.

    PubMed

    Brennan, Michael D; Monson, Verna

    2014-05-01

    Professionalism is an indispensable element in the compact between the medical profession and society that is based on trust and putting the needs of patients above all other considerations. The resurgence of interest in professionalism dates back to the 1980s when health maintenance organizations were formed and proprietary influences in health care increased. Since then, a rich and comprehensive literature has emerged in defining professionalism, including desirable individual attributes and behaviors and how they may be taught, promoted, and assessed. More recently, scholarship has shifted from individual to organizational professionalism. This literature addresses the role that health care organizations can play to establish environments that are conducive to the consistent expression of professionalism by individuals and health care teams. We reviewed interdisciplinary empirical studies from health care effectiveness and outcomes, organizational sciences, positive psychology, and social psychology, finding evidence that organizational and individual professionalism is associated with a wide range of benefits to patients and the organization. We identify actionable organizational strategies and approaches that, if adopted, can foster and promote combined organizational and individual professionalism. In doing so, trust in the medical profession and its institutions can be enhanced, which in turn will reconfirm a commitment to the social compact. PMID:24797645

  2. Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

    PubMed

    Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; O'Keeffe, Daniel F

    2015-01-01

    Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have a role in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now. PMID:25857371

  3. Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

    PubMed

    Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; OʼKeeffe, Daniel F

    2015-05-01

    Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have a role in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now. PMID:25932832

  4. Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

    PubMed

    Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; O'Keeffe, Daniel F

    2015-01-01

    Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have roles in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now. PMID:25851413

  5. [The development of organization of medical social care of adolescents].

    PubMed

    Chicherin, L P; Nagaev, R Ia

    2014-01-01

    The model of the subject of the Russian Federation is used to consider means of development of health protection and health promotion in adolescents including implementation of the National strategy of activities in interest of children for 2012-2017 approved by decree No761 of the President of Russia in June 1 2012. The analysis is carried out concerning organization of medical social care to this group of population in medical institutions and organizations of different type in the Republic of Bashkortostan. Nowadays, in 29 territories medical social departments and rooms, 5 specialized health centers for children, 6 clinics friendly to youth are organized. The analysis of manpower support demonstrates that in spite of increasing of number of rooms and departments of medical social care for children and adolescents decreasing of staff jobs both of medical personnel and psychologists and social workers occurs. The differences in priorities of functioning of departments and rooms of medical social care under children polyclinics, health centers for children and clinics friendly to youth are established. The questionnaire survey of pediatricians and adolescents concerning perspectives of development of adolescent service established significant need in development of specialized complex center. At the basis of such center problems of medical, pedagogical, social, psychological, legal profile related to specific characteristics of development and medical social needs of adolescents can be resolved. The article demonstrates organizational form of unification on the functional basis of the department of medical social care of children polyclinic and clinic friendly to youth. During three years, number of visits of adolescents to specialists of the center increases and this testifies awareness of adolescents and youth about activities of department of medical social care. The most percentage of visits of adolescents to specialists was made with prevention purpose. Among

  6. Managing the transition to integrated health care organizations.

    PubMed

    Griffith, J R

    1996-01-01

    Today's successful community hospitals should and will evolve into integrated health care organizations (IHCOs) that will share several common characteristics. IHCOs will have a community--not a membership--orientation, and this will be a distinguishing characteristic and a source of market appeal. The transition to IHCO will be a slow one, and to prosper, the IHCO will have to accommodate both price-oriented markets and traditional ones. Successful IHCOs will expand technical skills and capabilities to control costs and quality. New strategic competencies will have to be developed, and to do this, emerging IHCOs will improve the ability of managers to support decisions and sell them both to the buyers and the public at large. Excellent patient care will rest upon better trained, advised, and informed management teams. Making the change to an IHCO will take time and money, but organizations that make steady progress are likely to succeed. PMID:10156172

  7. Regional collaboration as a model for fostering accountability and transforming health care.

    PubMed

    Speir, Alan M; Rich, Jeffrey B; Crosby, Ivan; Fonner, Edwin

    2009-01-01

    An era of increasing budgetary constraints, misaligned payers and providers, and a competitive system where United States health outcomes are outpaced by less well-funded nations is motivating policy-makers to seek more effective means for promoting cost-effective delivery and accountability. This article illustrates an effective working model of regional collaboration focused on improving health outcomes, containing costs, and making efficient use of resources in cardiovascular surgical care. The Virginia Cardiac Surgery Quality Initiative is a decade-old collaboration of cardiac surgeons and hospital providers in Virginia working to improve outcomes and contain costs by analyzing comparative data, identifying top performers, and replicating best clinical practices on a statewide basis. The group's goals and objectives, along with 2 generations of performance improvement initiatives, are examined. These involve attempts to improve postoperative outcomes and use of tools for decision support and modeling. This work has led the group to espouse a more integrated approach to performance improvement and to formulate principles of a quality-focused payment system. This is one in which collaboration promotes regional accountability to deliver quality care on a cost-effective basis. The Virginia Cardiac Surgery Quality Initiative has attempted to test a global pricing model and has implemented a pay-for-performance program where physicians and hospitals are aligned with common objectives. Although this collaborative approach is a work in progress, authors point out preconditions applicable to other regions and medical specialties. A road map of short-term next steps is needed to create an adaptive payment system tied to the national agenda for reforming the delivery system. PMID:19632558

  8. Building IT capability in health-care organizations.

    PubMed

    Khatri, Naresh

    2006-05-01

    While computer technology has revolutionized industries such as banking and airlines, it has done little for health care so far. Most of the health-care organizations continue the early-computer-era practice of buying the latest technology without knowing how it might effectively be employed in achieving business goals. By investing merely in information technology (IT) rather than in IT capabilities they acquire IT components--primarily hardware, software, and vendor-provided services--which they do not understand and, as a result, are not capable of fully utilizing for achieving organizational objectives. In the absence of internal IT capabilities, health-care organizations have relied heavily on the fragmented IT vendor market in which vendors do not offer an open architecture, and are unwilling to offer electronic interfaces that would make their 'closed' systems compatible with those of other vendors. They are hamstrung as a result because they have implemented so many different technologies and databases that information stays in silos. Health systems can meet this challenge by developing internal IT capabilities that would allow them to seamlessly integrate clinical and business IT systems and develop innovative uses of IT. This paper develops a comprehensive conception of IT capability grounded in the resource-based theory of the firm as a remedy to the woes of IT investments in health care. PMID:16643706

  9. Implementing information systems in health care organizations: myths and challenges.

    PubMed

    Berg, M

    2001-12-01

    Successfully implementing patient care information systems (PCIS) in health care organizations appears to be a difficult task. After critically examining the very notions of 'success' and 'failure', and after discussing the problematic nature of lists of 'critical success- or failure factors', this paper discusses three myths that often hamper implementation processes. Alternative insights are presented, and illustrated with concrete examples. First of all, the implementation of a PCIS is a process of mutual transformation; the organization and the technology transform each other during the implementation process. When this is foreseen, PCIS implementations can be intended strategically to help transform the organization. Second, such a process can only get off the ground when properly supported by both central management and future users. A top down framework for the implementation is crucial to turn user-input into a coherent steering force, creating a solid basis for organizational transformation. Finally, the management of IS implementation processes is a careful balancing act between initiating organizational change, and drawing upon IS as a change agent, without attempting to pre-specify and control this process. Accepting, and even drawing upon, this inevitable uncertainty might be the hardest lesson to learn. PMID:11734382

  10. Information technology and knowledge exchange in health-care organizations.

    PubMed Central

    Vimarlund, V.; Timpka, T.; Patel, V. L.

    1999-01-01

    Despite the increasing global interest in information technology among health care institutions, little has been discussed about its importance for the effectiveness of knowledge management. In this study, economic theories are used to analyze and describe a theoretical framework for the use of information technology in the exchange of knowledge. The analyses show that health care institutions would benefit from developing global problem-solving collaboration, which allows practitioners to exchange knowledge unrestricted by time and geographical barriers. The use of information technology for vertical integration of health-care institutions would reduce knowledge transaction costs, i.e. decrease costs for negotiating and creating communication channels, and facilitating the determination of what, when, and how to produce knowledge. A global network would allow organizations to increase existing knowledge, and thus total productivity, while also supporting an environment where the generation of new ideas is unrestricted. Using all the intellectual potential of market actors and thereby releasing economic resources can reduce today's global budget conflicts in the public sector, i.e. the necessity to choose between health care services and, for instance, schools and support for the elderly. In conclusion, global collaboration and coordination would reduce the transaction costs inherent in knowledge administration and allow a more effective total use of scarce health-care resources. PMID:10566436

  11. Five focus strategies to organize health care delivery.

    PubMed

    Peltokorpi, Antti; Linna, Miika; Malmström, Tomi; Torkki, Paulus; Lillrank, Paul Martin

    2016-03-14

    Purpose - The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations. Design/methodology/approach - First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies. Findings - The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes. Research limitations/implications - Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination. Practical implications - Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organization's strategy and key performance indicators. Originality/value - Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care. PMID:26959897

  12. Faith-based organizations and the Affordable Care Act: Reducing Latino mental health care disparities.

    PubMed

    Villatoro, Alice P; Dixon, Elizabeth; Mays, Vickie M

    2016-02-01

    The Patient Protection and Affordable Care Act (ACA; 2010) is expected to increase access to mental health care through provisions aimed at increasing health coverage among the nation's uninsured, including 10.2 million eligible Latino adults. The ACA will increase health coverage by expanding Medicaid eligibility to individuals living below 138% of the federal poverty level, subsidizing the purchase of private insurance among individuals not eligible for Medicaid, and requiring employers with 50 or more employees to offer health insurance. An anticipated result of this landmark legislation is improvement in the screening, diagnosis, and treatment of mental disorders in racial/ethnic minorities, particularly for Latinos, who traditionally have had less access to these services. However, these efforts alone may not sufficiently ameliorate mental health care disparities for Latinos. Faith-based organizations (FBOs) could play an integral role in the mental health care of Latinos by increasing help seeking, providing religion-based mental health services, and delivering supportive services that address common access barriers among Latinos. Thus, in determining ways to eliminate Latino mental health care disparities under the ACA, examining pathways into care through the faith-based sector offers unique opportunities to address some of the cultural barriers confronted by this population. We examine how partnerships between FBOs and primary care patient-centered health homes may help reduce the gap of unmet mental health needs among Latinos in this era of health reform. We also describe the challenges FBOs and primary care providers need to overcome to be partners in integrated care efforts. PMID:26845492

  13. Brain death and care of the organ donor

    PubMed Central

    Kumar, Lakshmi

    2016-01-01

    Brain death has specific implications for organ donation with the potential for saving several lives. Awareness on maintenance of the brain dead has increased over the last decade with the progress in the field of transplant. The diagnosis of brain death is clinical and can be confirmed by apnea testing. Ancillary tests can be considered when the apnea test cannot be completed or is inconclusive. Reflexes of spinal origin may be present and should not be confused against the diagnosis of brain death. Adequate care for the donor targeting hemodynamic indices and lung protective ventilator strategies can improve graft quality for donation. Hormone supplementation using thyroxine, antidiuretic hormone, corticosteroid and insulin has shown to improve outcomes following transplant. India still ranks low compared to the rest of the world in deceased donation. The formation of organ sharing networks supported by state governments has shown a substantial increase in the numbers of deceased donors primarily by creating awareness and ensuring protocols in caring for the donor. This review describes the steps in the establishment of brain death and the management of the organ donor. Material for the review was collected through a Medline search, and the search terms included were brain death and organ donation. PMID:27275040

  14. Managing corporate governance risks in a nonprofit health care organization.

    PubMed

    Troyer, Glenn T; Brashear, Andrea D; Green, Kelly J

    2005-01-01

    Triggered by corporate scandals, there is increased oversight by governmental bodies and in part by the Sarbanes-Oxley Act of 2002. Corporations are developing corporate governance compliance initiatives to respond to the scrutiny of regulators, legislators, the general public and constituency groups such as investors. Due to state attorney general initiatives, new legislation and heightened oversight from the Internal Revenue Service, nonprofit entities are starting to share the media spotlight with their for-profit counterparts. These developments are changing nonprofit health care organizations as well as the traditional role of the risk manager. No longer is the risk manager focused solely on patients' welfare and safe passage through a complex delivery system. The risk manager must be aware of corporate practices within the organization that could allow the personal objectives of a few individuals to override the greater good of the community in which the nonprofit organization serves. PMID:20200865

  15. Forecasting Performance in Organizations: An Application of Current-Value Human Resources Accounting. Final Report.

    ERIC Educational Resources Information Center

    Pecorella, Patricia A.; And Others

    A methodology to describe current-value human resources accounting (HRA) was developed to aid management in decision making and provide information about the effects of organizational policies and practices on the value of the organizations' human resources. A two-phase activity was designed to investigate the nature of the relationship between…

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

    PubMed

    Silow-Carroll, Sharon; Rodin, Diana

    2013-04-01

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

  17. [For a coordination of the supportive care for people affected by severe illnesses: proposition of organization in the public and private health care centres].

    PubMed

    Krakowski, Ivan; Boureau, François; Bugat, Roland; Chassignol, Laurent; Colombat, Philippe; Copel, Laure; d'Hérouville, Daniel; Filbet, Marylène; Laurent, Bernard; Memran, Nadine; Meynadier, Jacques; Parmentier, Gérard; Poulain, Philippe; Saltel, Pierre; Serin, Daniel; Wagner, Jean-Philippe

    2004-05-01

    The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor communication between the teams, by the administrative difficulties encountered by the teams participating in the supportive care. The working group insists on the fact that the supportive care is not a new speciality. He proposes the creation of units. departments or pole of responsibility of supportive care with a "basic coordination" involving the activities of chronic pain, palliative care, psycho-oncology, and social care. This coordination can be extended, according to the "history" and missions of health care centres. Service done with the implementation of a "unique counter" for the patients and the teams is an important point. The structure has to comply with the terms and conditions of contract (Consultation, Unit or Centre of chronic pain, structures of palliative care, of psycho-oncology, of nutrition, of social care). A common technical organization is one of the interests. The structure has to set up strong links with the private practitioners, the networks, the home medical care (HAD) and the nurses

  18. Managing facility risk: external threats and health care organizations.

    PubMed

    Reid, Daniel J; Reid, William H

    2014-01-01

    Clinicians and clinical administrators should have a basic understanding of physical and financial risk to mental health facilities related to external physical threat, including actions usually viewed as "terrorism" and much more common sources of violence. This article refers to threats from mentally ill persons and those acting out of bizarre or misguided "revenge," extortionists and other outright criminals, and perpetrators usually identified as domestic or international terrorists. The principles apply both to relatively small and contained acts (such as a patient or ex-patient attacking a staff member) and to much larger events (such as bombings and armed attack), and are relevant to facilities both within and outside the U.S. Patient care and accessibility to mental health services rest not only on clinical skills, but also on a place to practice them and an organized system supported by staff, physical facilities, and funding. Clinicians who have some familiarity with the non-clinical requirements for care are in a position to support non-clinical staff in preventing care from being interrupted by external threats or events such as terrorist activity, and/or to serve at the interface of facility operations and direct clinical care. Readers should note that this article is an introduction to the topic and cannot address all local, state and national standards for hospital safety, or insurance providers' individual facility requirements. PMID:24733720

  19. A case study of the elder care functions of a Chilean non-governmental organization.

    PubMed

    Pereira, Javier; Angel, Ronald J; Angel, Jacqueline L

    2007-05-01

    This paper examines the history and role of a faith-based Chilean nonprofit organization, Hogar de Cristo (Christ's Home), in providing elderly care in the context of recent economic and sociopolitical changes in the country. Chile has been at the forefront of market-based reforms in the delivery of social services and its experience provides insights into the intersecting roles of the state, the market, and the non-governmental sector in addressing basic human needs. Based on in-depth interviews, archival data, and field observations, we investigate the institutional, political, and social factors that account for the organization's success. These result from a number of factors including a capacity to adapt to changing client needs, the successful adoption of an entrepreneurial style of management and outreach, and the building of trust through effective public relations. Although conditions unique to the situation of this faith-based organization in a highly Catholic country may account for its success, the experience of Hogar de Cristo provides useful lessons for the future of elder care policy in the Americas. PMID:17376575

  20. Run the numbers. Case study: using management accounting in an academic health care setting.

    PubMed

    Quintana, Olga; Ortiz, Cesar A

    2003-03-01

    Management accounting can help administrators manage academic physician practices. Its basic cost-capturing systems can instill accountability and behavior modification in those directly responsible. PMID:12661223

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

    PubMed

    Schaecher, Kenneth L

    2016-06-01

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

  2. The Importance of Interprofessional Practice and Education in the Era of Accountable Care.

    PubMed

    Nester, Jane

    2016-01-01

    In order to succeed in today's health care environment, interprofessional teams are essential. The terms "multidisciplinary care" and "interdisciplinary care" have been replaced by the more contemporary term "interprofessional practice and education" (IPE), which occurs when individuals "from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes." This commentary discusses new models of care, team members who contribute to IPE, and incentives and challenges. PMID:26961838

  3. Which care? Whose responsibility? And why family? A Confucian account of long-term care for the elderly.

    PubMed

    Fan, Ruiping

    2007-01-01

    Across the world, socio-economic forces are shifting the locus of long-term care from the family to institutional settings, producing significant moral, not just financial costs. This essay explores these costs and the distortions in the role of the family they involve. These reflections offer grounds for critically questioning the extent to which moral concerns regarding long-term care in Hong Kong and in mainland China are the same as those voiced in the United States, although family resemblances surely exist. Chinese moral values such as virtue and filial piety embedded in a Confucian moral and social context cannot be recast without distortion in terms of modern Western European notions. The essay concludes that the Confucian resources must be taken seriously in order to develop an authentic Chinese bioethics of long-term care and a defensible approach to long-term care policy for contemporary society in general and Chinese society in particular. PMID:17924274

  4. Why give birth in health facility? Users’ and providers’ accounts of poor quality of birth care in Tanzania

    PubMed Central

    2013-01-01

    Background In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members. Methods Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region. Results Health care users and health providers experienced poor quality caring and working environments in the health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation. Conclusions There was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study

  5. The changing nature of the measurement of the economic impact of nursing care on health care organizations.

    PubMed

    Covaleski, Mark A

    2005-01-01

    This paper adapts the perspective of organizational contingency theory to consider the changing nature of how the economic impact of nursing care upon health care organizations is measured. It is argued that useful measures of the economic impact of nursing care are a function of environmental, organizational, and technological circumstances. The increasing and diverse demands of health care consumers (environmental), the dramatic restructuring and re-engineering of the health care delivery system (organizational), and recent developments in the capabilities of and insights from information measurement practices (technological), have all provided opportunities for more meaningful measurement of the contributions of nursing care to the economic well-being of health care organizations. PMID:16360703

  6. Using a social entrepreneurial approach to enhance the financial and social value of health care organizations.

    PubMed

    Liu, Sandra S; Lu, Jui-Fen Rachel; Guo, Kristina L

    2014-01-01

    In this study, a conceptual framework was developed to show that social entrepreneurial practices can be effectively translated to meet the social needs in health care. We used a theory-in-use case study approach that encompasses postulation of a working taxonomy from literature scanning and a deliberation of the taxonomy through triangulation of multilevel data of a case study conducted in a Taiwan-based hospital system. Specifically, we demonstrated that a nonprofit organization can adopt business principles that emphasize both financial and social value. We tested our model and found comprehensive accountability across departments throughout the case hospital system, and this led to sustainable and continual growth of the organization. Through social entrepreneurial practices, we established that both financial value creation and fulfilling the social mission for the case hospital system can be achieved. PMID:25223158

  7. An exploratory study of organization design configurations in health care delivery organizations.

    PubMed

    Sheppeck, Mick; Militello, Jack

    2014-01-01

    Organizations are configurations of variables that support each other to achieve customer satisfaction. Based on Treacy and Wiersema (1995), we predicted the emergence of two configurations, one supporting a product leadership stance and one predicting the customer intimate approach from a set of 73 for profit health care clinics. In addition, we predicted the emergence of a configuration where the scores on most variables were near the mean for each variable. Using cluster analysis and discriminant function analysis, we identified three configurations: one a "master of two" strategy, one "stuck-in-the-middle," and one showing scores well below the mean on most variables. The implications for organization design and manager actions in the health care industry are discussed. PMID:25004706

  8. In sickness and in dignity: A philosophical account of the meaning of dignity in health care.

    PubMed

    Barclay, Linda

    2016-09-01

    The meaning of dignity in health care has been primarily explored using interviews and surveys with various patient groups, as well as with health care practitioners. Philosophical analysis of dignity is largely avoided, as the existing philosophical literature is complex, multifaceted and of unclear relevance to health care settings. The aim of this paper is to develop a straightforward philosophical concept of dignity which is then applied to existing qualitative research. In health care settings, a patient has dignity when he or she is able to live in accordance with his or her standards and values. Accordingly, health care practitioners respect a patient's dignity when they refrain from transgressing the patient's standards and values, or refrain from forcing the patient to transgress his or her standards and values. This concept is shown to explain and illuminate most of the key qualitative findings. It therefore provides a more coherent and synthesised concept of dignity in health care. PMID:27351830

  9. 17 CFR 239.17c - Form N-6, registration statement for separate accounts organized as unit investment trusts that...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and on GPO... statement for separate accounts organized as unit investment trusts that offer variable life insurance..., registration statement for separate accounts organized as unit investment trusts that offer variable...

  10. 17 CFR 239.17c - Form N-6, registration statement for separate accounts organized as unit investment trusts that...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and at www... statement for separate accounts organized as unit investment trusts that offer variable life insurance..., registration statement for separate accounts organized as unit investment trusts that offer variable...

  11. The Physician Quality Improvement Initiative: Engaging Physicians in Quality Improvement, Patient Safety, Accountability and their Provision of High-Quality Patient Care.

    PubMed

    Wentlandt, Kirsten; Degendorfer, Niki; Clarke, Cathy; Panet, Hayley; Worthington, Jim; McLean, Richard F; Chan, Charlie K N

    2016-01-01

    University Health Network has been working to become a high-reliability organization, with a focus on safe, quality patient care. In response, the Medical Affairs Department has implemented several strategic initiatives to drive accountability, quality improvement and engagement with our physician population. One of these initiatives, the Physician Quality Improvement Initiative (PQII) is a physician-led project designed to provide active medical staff, in collaboration with their physician department chiefs, a comprehensive approach to focused and practical quality improvement in their practice. In this document, we outline the project, including its implementation strategy, logic model and outcomes, and provide discussion on how it fits into UHN's global strategy to provide safe, quality patient care. PMID:27009706

  12. Citizenship Education as an Educational Outcome for Young People in Care: A Phenomenological Account

    ERIC Educational Resources Information Center

    Spiteri, Damian

    2012-01-01

    This qualitative study presents a retrospective analysis of how a cohort of young men, who as boys were assigned to residential care in Malta, perceive the citizenship education that they received while "in care" as having empowered them--as boys, adolescents, and eventually as young adults. Rather than focusing on citizenship education that is…

  13. Kathleen Mears Memorial Lecture: personal accountability: your key to survival in health care reform.

    PubMed

    Galloway, Sabrina G

    2014-09-01

    Over the past thirty years the rising cost of healthcare has produced changes in reimbursement strategies. Continually, pressures are placed on the practitioners to reduce the length of the patient hospital stay and provide services in a high quality, risk free, cost effective manner. Following the implementation of diagnostic related groups (DRGs) in the 1980s and Managed Care in the 1990s we are now faced with embracing and surviving the Affordable Health Care Act-H.R.3590 (HHS 2013) that is linking reimbursement to quality outcomes. In short, financial constraints in the funding of health care will once more alter the patterns of delivery and challenge the practitioners to maintain superior care. As Neurodiagnostic Professionals this new reform offers another opportunity to review our process of care and the Neurodiagnostic labs role in the delivery of healthcare. For success, close examination of routine workflows, recognizing and solving existing delivery limitations, developing team care coordination, and increasing the neurodiagnostic professionals profile within the work environment will be required. Embracing your role in this overall process will most likely demand more paperwork, changing protocols, learning and implementing new policies, accepting new work schedules, implementing new quality standards, and pursuing additional education or credentials. Unlike never before more emphasis will be placed on measuring and reporting on the quality of the care we deliver in our labs, intensive care units, and operating rooms. PMID:25351032

  14. Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State

    PubMed Central

    2012-01-01

    Background Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance. Methods We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus. Results Innovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation. Conclusions Patient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets and addressing conditions for

  15. Consumer-directed health plans: are medical and health savings accounts viable options for financing American health care?

    PubMed

    Masri, Maysoun Demachkie; Oetjen, Reid M; Campbell, Claudia

    2010-01-01

    When Americans voted in November 2008, many had the presidential candidates' positions on health care reform in mind. Health savings accounts, which are high deductible health plans coupled with a tax-protected savings account, are 1 type of consumer-directed health plan (CDHP) that gained strong support from the Bush administration. Despite evidence of the effectiveness of CDHPs in constraining costs in other countries, the Obama health plan contains no mention of their role in future US health reform. This article seeks to provide the reader with a better understanding of how CDHPs can help to improve the use of health resources and reduce national health care expenditures by exploring the history and previous research on several types of consumer-directed plans and by providing a comparative analysis of the use of CDHPs in other countries. PMID:20686396

  16. 2013 Winning Essay: The Accountable Care Paradigm Shift: New Ethical Considerations.

    PubMed

    McNamara, Andrew R

    2015-07-01

    The current state of our health care system is analogous to the status of science that Kuhn describes as "a proliferation of compelling articulations, the willingness to try anything, the expression of explicit discontent, the recourse to philosophy and to debate over fundamentals" [27]. ACOs represent a paradigm shift in the way health care is delivered. As with any dramatic public policy change, ethical issues will arise. These are surmountable challenges, and with open communication, physicians such as the Midstate group can partner effectively with hospital systems to ensure the delivery of quality, evidence-based care while at the same reorienting the culture to be attentive to its fiduciary responsibilities. PMID:26158809

  17. Responsiveness and accountability in long-term care: strategies for policy development and empowerment.

    PubMed

    Wells, L M

    1990-01-01

    This paper presents a model for engaging planners, service providers and consumers in a collaborative process of improving quality of life in long-term care facilities, discussing the implications of this approach for standards of care and policy development. This empowerment model was refined and tested in a large system of skilled-nursing-care facilities using a matched-pair comparison group design. The rationale, theory base and the relationship of the empowerment model to current concepts of health promotion are shown. Subsequent follow-up indicated examples of the impact of the model on broader aspects of public policy. PMID:2123737

  18. Attitudes and perceptions of health care workers in Northeastern Germany about multidrug-resistant organisms.

    PubMed

    Marschall, P; Hübner, N-O; Maletzki, S; Wilke, F; Dittmann, K; Kramer, A

    2016-06-01

    There were 256 health care workers in 39 facilities who were interviewed about their perceptions of the quality of care of patients with and without multidrug-resistant organisms based on a standardized questionnaire. There are remarkable differences in the responses between facility types (acute care hospitals, long-term care hospitals, rehabilitation hospitals, and home care services). Hygiene management must be specifically tailored to the requirements of each facility. PMID:26897700

  19. Joint Commission on Accreditation of Healthcare Organizations' expectations for transfusion medicine in health care organizations.

    PubMed

    Belanger, A C

    1999-06-01

    This article provides an overview of the Joint Commission on Accreditation of Healthcare Organizations' standards related to transfusion medicine found in its hospital, laboratory, and home care accreditation manuals. Hospital standards focus on the review and evaluation of the entire transfusion process from the order through the outcome to the patient, with special attention to the blood use review process. Laboratory standards provide the structure for the detailed review of the technical procedures and practices for collecting, processing, storing, testing, and transporting blood products. Home care standards relate to policies and procedures, infection control practices, education of the patient and family, and monitoring of adverse events and complications for transfusions of blood products performed in the home. PMID:10383795

  20. Recursive Health Care Structures and Choice in the Manner of Our Dying: An Auto-Ethnographic Account.

    PubMed

    Wackers, Ger

    2016-03-01

    Science has shaped our understanding of the diseases we are diagnosed with. Medical treatment has transformed their natural courses. The law has married medical knowledge and experience to the legal competence of physicians to make ultimate decisions for the patient at the end of life. When it is our time to die, we will confront a pre-structured health care landscape affording some courses of action while limiting others. In this article, I provide an auto-ethnographic account of the dying of one woman, my wife, diagnosed with ovarian cancer. It speaks of our meeting with oncology, her refusal of aggressive treatment, and the palliative care allies we found for her way of dying. It also speaks of the opportunities for choice in dying that emerge when participants in the care collective accept that one of them must die while the others live on. PMID:25814522

  1. Health-care organizations as "patients": transforming the fundamental od paradigm.

    PubMed

    Rubin, Irwin M

    2011-01-01

    Hidden behind such frequently used phrases as "The system/policy requires...," "The organization has decided..." is one simple fact. Systems/policies don't drop from the sky etched in stone tablets and organizations don't decide anything. People make decisions and design systems and write policies. Embracing this fact increases the likelihood that the provision of health-care emanates from a "care dealership" in contrast to a "car dealership." Ignoring this fact leads to less humane, less effective, and more costly health-care. This chapter will challenge all of us concerned with caring for all of us--from Organizational Development (OD). Practitioners to CEOs to ... to ... all of us at some point in our lives--to step up to the need to transform our most basic paradigms. To remind ourselves that human beings give birth to, nurture, sustain, and care for that which we call an organization. In so doing, we will be able to begin to act from the premise that a health-care organization is itself a living breathing human organism, a "Patient" in need of care. The quality of care we afford this "Patient" directly and inevitably impacts the quality of care we are afforded as patients. Acting from this premise will transform all of health-care, all "care dealerships" ... and potentially "car dealerships" as well. OD professionals, therefore, can propel us all to a fourth dimension of caring for all of us. PMID:21887954

  2. The logic of transaction cost economics in health care organization theory.

    PubMed

    Stiles, R A; Mick, S S; Wise, C G

    2001-01-01

    Health care is, at its core, comprised of complex sequences of transactions among patients, providers, and other stakeholders; these transactions occur in markets as well as within systems and organizations. Health care transactions serve one of two functions: the production of care (i.e., the laying on of hands) or the coordination of that care (i.e., scheduling, logistics). Because coordinating transactions is integral to care delivery, it is imperative that they are executed smoothly and efficiently. Transaction cost economics (TCE) is a conceptual framework for analyzing health care transactions and quantifying their impact on health care structures (organizational forms), processes, and outcomes. PMID:11293015

  3. The social organization of a sedentary life for residents in long-term care.

    PubMed

    Benjamin, Kathleen; Rankin, Janet; Edwards, Nancy; Ploeg, Jenny; Legault, Frances

    2016-06-01

    Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add-on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC. PMID:26314937

  4. Justifying medication decisions in mental health care: Psychiatrists' accounts for treatment recommendations.

    PubMed

    Angell, Beth; Bolden, Galina B

    2015-08-01

    Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients' concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists' orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship. PMID:26046726

  5. Justifying medication decisions in mental health care: Psychiatrists’ accounts for treatment recommendations

    PubMed Central

    Angell, Beth; Bolden, Galina B.

    2015-01-01

    Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients’ concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists’ orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship. PMID:26046726

  6. Intensive care practices in brain death diagnosis and organ donation.

    PubMed

    Escudero, D; Valentín, M O; Escalante, J L; Sanmartín, A; Perez-Basterrechea, M; de Gea, J; Martín, M; Velasco, J; Pont, T; Masnou, N; de la Calle, B; Marcelo, B; Lebrón, M; Pérez, J M; Burgos, M; Gimeno, R; Kot, P; Yus, S; Sancho, I; Zabalegui, A; Arroyo, M; Miñambres, E; Elizalde, J; Montejo, J C; Domínguez-Gil, B; Matesanz, R

    2015-10-01

    We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%). PMID:26040194

  7. [Ex situ tracheobronchoplastic operations using the organ care system].

    PubMed

    Krüger, M; Zinne, N; Höffler, H; Zhang, R; Kropivnitskaja, I; Schmitto, J; Ciubotaru, A; Haverich, A

    2013-03-01

    First clinical experiences with the organ care system (OCS) in lung transplantation showed that this device allows perfusion and ventilation of the lungs under practically physiological conditions. Some pulmonary pathologies necessitate ex situ operations, e.g. to avoid pneumonectomy. The objective of this work was to investigate the feasibility of ex situ pulmonary surgery within the OCS.In the first procedure a large tracheobronchial leakage was covered with a pericardial patch. The procedure was authorized by the local committee of animal welfare. In the second surgery a replacement of the distal trachea using an aortic graft was performed after removal of the heart-lung segment from a pig from the slaughterhouse. The postoperative ventilation of both lungs was free of problems. The mean pressure of the pulmonary artery remained steady during the whole experiment. The setup to prevent lung edema was basically successful.Performing thoracic surgery with the OCS is feasible; however, this approach is reserved for very special indications. Further investigations to optimize technical details of the OCS setup for this purpose are necessary. PMID:23354560

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

    PubMed

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

    2014-12-01

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

  9. Transparency and accountability in mass media campaigns about organ donation: a response to Morgan and Feeley.

    PubMed

    Rady, Mohamed Y; McGregor, Joan L; Verheijde, Joseph L

    2013-11-01

    We respond to Morgan and Feeley's critique on our article "Mass Media in Organ Donation: Managing Conflicting Messages and Interests." We noted that Morgan and Feeley agree with the position that the primary aims of media campaigns are: "to educate the general public about organ donation process" and "help individuals make informed decisions" about organ donation. For those reasons, the educational messages in media campaigns should not be restricted to "information from pilot work or focus groups" but should include evidence-based facts resulting from a comprehensive literature research. We consider the controversial aspects about organ donation to be relevant, if not necessary, educational materials that must be disclosed in media campaigns to comply with the legal and moral requirements of informed consent. With that perspective in mind, we address the validity of Morgan and Feeley's claim that media campaigns have no need for informing the public about the controversial nature of death determination in organ donation. Scientific evidence has proven that the criteria for death determination are inconsistent with the Uniform Determination of Death Act and therefore potentially harmful to donors. The decision by campaign designers to use the statutory definition of death without disclosing the current controversies surrounding that definition does not contribute to improved informed decision making. We argue that if Morgan and Feeley accept the important role of media campaigns to enhance informed decision making, then critical controversies should be disclosed. In support of that premise, we will outline: (1) the wide-spread scientific challenges to brain death as a concept of death; (2) the influence of the donor registry and team-huddling on the medical care of potential donors; (3) the use of authorization rather than informed consent for donor registration; (4) the contemporary religious controversy; and (5) the effects of training desk clerks as organ

  10. Accountability for After-School Care: Devising Standards and Measuring Adherence to Them.

    ERIC Educational Resources Information Center

    Beckett, Megan; Hawken, Angela; Jacknowitz, Alison

    As the number of after-school programs has expanded, states are increasingly interested in information that helps in the design, selection, and management of such programs. With the sponsorship of Stone Soup Child Care Programs in California, the RAND Child Policy Project and the Promising Practices Network was commissioned to measure adherence of…

  11. 17 CFR 274.11d - Form N-6, registration statement of separate accounts organized as unit investment trusts that...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... statement of separate accounts organized as unit investment trusts that offer variable life insurance... variable life insurance policies. Form N-6 shall be used as the registration statement to be filed pursuant to section 8(b) of the Investment Company Act of 1940 by separate accounts that offer variable...

  12. 17 CFR 274.11d - Form N-6, registration statement of separate accounts organized as unit investment trusts that...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... statement of separate accounts organized as unit investment trusts that offer variable life insurance... variable life insurance policies. Form N-6 shall be used as the registration statement to be filed pursuant to section 8(b) of the Investment Company Act of 1940 by separate accounts that offer variable...

  13. Sitting on the Fishbowl Rim with Foucault: A Reflexive Account of HPE Teachers' Caring

    ERIC Educational Resources Information Center

    McCuaig, Louise

    2007-01-01

    This article draws on Bourdieu's analogy of a fish in water, to provide a four-stage self-reflexive account of one Health and Physical Education (HPE) teacher's acquisition of a Foucaldian analytic lens, one with which to explore the moral and governing practices of HPE. Drawing on this research journey, the author seeks to demonstrate her growing…

  14. 32 CFR 644.368 - Procedures and responsibilities for care, custody, accountability, and maintenance.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Works Property. DEs will retain custody and accountability of all excess civil works real property under... Force real property. However, upon request by the Air Force DEs may assume custody if no costs are.... Where the Corps of Engineers is acting as real estate agent for other Federal agencies, DEs, at...

  15. 32 CFR 644.368 - Procedures and responsibilities for care, custody, accountability, and maintenance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Army Civil Works Property. DEs will retain custody and accountability of all excess civil works real... excess Air Force real property. However, upon request by the Air Force DEs may assume custody if no costs.... Where the Corps of Engineers is acting as real estate agent for other Federal agencies, DEs, at...

  16. 32 CFR 644.368 - Procedures and responsibilities for care, custody, accountability, and maintenance.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Army Civil Works Property. DEs will retain custody and accountability of all excess civil works real... excess Air Force real property. However, upon request by the Air Force DEs may assume custody if no costs.... Where the Corps of Engineers is acting as real estate agent for other Federal agencies, DEs, at...

  17. 32 CFR 644.368 - Procedures and responsibilities for care, custody, accountability, and maintenance.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Works Property. DEs will retain custody and accountability of all excess civil works real property under... Force real property. However, upon request by the Air Force DEs may assume custody if no costs are.... Where the Corps of Engineers is acting as real estate agent for other Federal agencies, DEs, at...

  18. 32 CFR 644.368 - Procedures and responsibilities for care, custody, accountability, and maintenance.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Works Property. DEs will retain custody and accountability of all excess civil works real property under... Force real property. However, upon request by the Air Force DEs may assume custody if no costs are.... Where the Corps of Engineers is acting as real estate agent for other Federal agencies, DEs, at...

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

    PubMed

    Guo, Kristina L

    2010-01-01

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

  20. Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment

    PubMed Central

    Vernazza, Christopher R; Rousseau, Nikki; Steele, Jimmy G; Ellis, Janice S; Thomason, John Mark; Eastham, Jane; Exley, Catherine

    2015-01-01

    Objectives The decision-making process within health care has been widely researched, with shared decision-making, where both patients and clinicians share technical and personal information, often being cited as the ideal model. To date, much of this research has focused on systems where patients receive their care and treatment free at the point of contact (either in government-funded schemes or in insurance-based schemes). Oral health care often involves patients making direct payments for their care and treatment, and less is known about how this payment affects the decision-making process. It is clear that patient characteristics influence decision-making, but previous evidence suggests that clinicians may assume characteristics rather than eliciting them directly. The aim was to explore the influences on how dentists' engaged in the decision-making process surrounding a high-cost item of health care, dental implant treatments (DITs). Methods A qualitative study using semi-structured interviews was undertaken using a purposive sample of primary care dentists (n = 25). Thematic analysis was undertaken to reveal emerging key themes. Results There were differences in how dentists discussed and offered implants. Dentists made decisions about whether to offer implants based on business factors, professional and legal obligations and whether they perceived the patient to be motivated to have treatment and their ability to pay. There was evidence that assessment of these characteristics was often based on assumptions derived from elements such as the appearance of the patient, the state of the patient's mouth and demographic details. The data suggest that there is a conflict between three elements of acting as a healthcare professional: minimizing provision of unneeded treatment, trying to fully involve patients in shared decisions and acting as a business person with the potential for financial gain. Conclusions It might be expected that in the context of a high

  1. The paradox of physicians and administrators in health care organizations.

    PubMed

    Peirce, J C

    2000-01-01

    Rapidly changing times in health care challenge both physicians and health care administrators to manage the paradox of providing orderly, high quality, and efficient care while bringing forth innovations to address present unmet problems and surprises that emerge. Health care has grown throughout the past several centuries through differentiation and integration, becoming a highly complex biological system with the hospital as the central attractive force--or "strange attractor"--during this century. The theoretical model of complex adaptive systems promises more effective strategic direction in addressing these chaotic times where the new strange attractor moves beyond the hospital. PMID:10710724

  2. [Part I. End-stage chronic organ failures: a position paper on shared care planning. The Integrated Care Pathway].

    PubMed

    Gristina, Giuseppe R; Orsi, Luciano; Carlucci, Annalisa; Causarano, Ignazio R; Formica, Marco; Romanò, Massimo

    2014-01-01

    In Italy the birth rate decrease together with the continuous improvement of living conditions on one hand, and the health care progress on the other hand, led in recent years to an increasing number of patients with chronic mono- or multi-organ failures and in an extension of their life expectancy. However, the natural history of chronic failures has not changed and the inescapable disease's worsening at the end makes more rare remissions, increasing hospital admissions rate and length of stay. Thus, when the "end-stage" get close clinicians have to engage the patient and his relatives in an advance care planning aimed to share a decision making process regarding all future treatments and related ethical choices such as patient's best interests, rights, values, and priorities. A right approach to the chronic organ failures end-stage patients consists therefore of a careful balance between the new powers of intervention provided by the biotechnology and pharmacology (intensive care), both with the quality of remaining life supplied by physicians to these patients (proportionality and beneficence) and the effective resources rationing and allocation (distributive justice). However, uncertainty still marks the criteria used by doctors to assess prognosis of these patients in order to make decisions concerning intensive or palliative care. The integrated care pathway suggested in this position paper shared by nine Italian medical societies, has to be intended as a guide focused to identify end-stage patients and choosing for them the best care option between intensive treatments and palliative care. PMID:24553592

  3. How Community Organizations Promote Continuity of Care for Young People with Mental Health Problems.

    PubMed

    Polgar, Michael F; Cabassa, Leopoldo J; Morrissey, Joseph P

    2016-04-01

    Young people between the ages of 16 and 25 who experience mental health problems experience transitions and need help from a variety of organizations. Organizations promote continuity of care by assisting young adults with developmental, service, and systemic transitions. Providers offer specific services to help transitions and also form cooperative relationships with other community organizations. Results from a survey of 100 service providers in one community describe organizational attributes and practices which are associated with continuity of care in a regional system for young adults. Data analyses show that full-service organizations which practice cultural competence offer more specific services that foster continuity of care. Larger, full-service organizations are also more likely to have more extensive and collaborative inter-organizational networks that help young adults continue care over time within the regional system of care. PMID:24833485

  4. Improving Quality of Depression Care Using Organized Systems of Care: A Review of the Literature

    PubMed Central

    Guico-Pabia, Christine J.

    2011-01-01

    Objective: To establish the need for a chronic disease management strategy for major depressive disorder (MDD), discuss the challenges involved in implementing guideline-level treatment for MDD, and provide examples of successful implementation of collaborative care programs. Data Sources: A systematic literature search of MEDLINE and the US National Library of Medicine was performed. Study Selection: We reviewed clinical studies evaluating the effectiveness of collaborative care interventions for the treatment of depression in the primary care setting using the keywords collaborative care, depression, and MDD. This review includes 45 articles relevant to MDD and collaborative care published through May 2010 and excludes all non–English-language articles. Results: Collaborative care interventions include a greater role for nonmedical specialists and a supervising psychiatrist with the major goal of improving quality of depression care in primary care systems. Collaborative care programs restructure clinical practice to include a patient care strategy with specific goals and an implementation plan, support for self-management training, sustained patient follow-up, and decision support for medication changes. Key components associated with the most effective collaborative care programs were improvement in antidepressant adherence, use of depression case managers, and regular case load supervision by a psychiatrist. Across studies, primary care patients randomized to collaborative care interventions experienced enhanced treatment outcomes compared with those randomized to usual care, with overall outcome differences approaching 30%. Conclusions: Collaborative care interventions may help to achieve successful, guideline-level treatment outcomes for primary care patients with MDD. Potential benefits of collaborative care strategies include reduced financial burden of illness, increased treatment adherence, and long-term improvement in depression symptoms and

  5. Standardized nomenclatures: keys to continuity of care, nursing accountability and nursing effectiveness.

    PubMed

    Keenan, G; Aquilino, M L

    1998-01-01

    Standardized nursing nomenclatures must be included in clinical documentation systems to generate data that more accurately represent nursing practice than outcomes-related measures currently used to support important policy decisions. NANDA, NIC, and NOC--comprehensive nomenclatures for the needed variables of nursing diagnoses, interventions, and outcomes--are described. Added benefits of using NANDA, NIC, and NOC in everyday practice are outlined, including facilitation of the continuity of care of patients in integrated health systems. PMID:9582821

  6. Health Insurance Portability and Accountability Act (HIPAA) legislation and its implication on speech privacy design in health care facilities

    NASA Astrophysics Data System (ADS)

    Tocci, Gregory C.; Storch, Christopher A.

    2005-09-01

    The Health Insurance Portability and Accountability Act (HIPAA) of 1996 (104th Congress, H.R. 3103, January 3, 1986), among many things, individual patient records and information be protected from unnecessary issue. This responsibility is assigned to the U.S. Department of Health and Human Services (HHS) which has issued a Privacy Rule most recently dated August 2002 with a revision being proposed in 2005 to strengthen penalties for inappropriate breaches of patient privacy. Despite this, speech privacy, in many instances in health care facilities need not be guaranteed by the facility. Nevertheless, the regulation implies that due regard be given to speech privacy in both facility design and operation. This presentation will explore the practical aspects of implementing speech privacy in health care facilities and make recommendations for certain specific speech privacy situations.

  7. [The organization of a post-intensive care rehabilitation unit].

    PubMed

    Barnay, Claire; Luauté, Jacques; Tell, Laurence

    2015-01-01

    When a patient is admitted to a post-intensive care rehabilitation unit, the functional outcome is the main objective of the care. The motivation of the team relies on strong cohesion between professionals. Personalised support provides a heightened observation of the patient's progress. Listening and sharing favour a relationship of trust between the patient, the team and the families. PMID:26365639

  8. The impact of activity based cost accounting on health care capital investment decisions.

    PubMed

    Greene, J K; Metwalli, A

    2001-01-01

    For the future survival of the rural hospitals in the U.S., there is a need to make sound financial decisions. The Activity Based Cost Accounting (ABC) provides more accurate and detailed cost information to make an informed capital investment decision taking into consideration all the costs and revenue reimbursement from third party payors. The paper analyzes, evaluates and compares two scenarios of acquiring capital equipment and attempts to show the importance of utilizing the ABC method in making a sound financial decision as compared to the traditional cost method. PMID:11794757

  9. Bringing Person- and Family-Centred Care Alive in Home, Community and Long-Term Care Organizations.

    PubMed

    Bender, Danielle; Holyoke, Paul

    2016-01-01

    It is now more important than ever for person- and family-centred care (PFCC) to be at the forefront of program and service design and delivery; yet, to date, very little guidance is available to assist home, community and long-term care (LTC) organizations to operationalize this concept and overcome inherent challenges. This article provides a list of practical strategies for healthcare leaders to promote and support a culture shift towards PFCC in their organizations and identifies and addresses five common concerns. The unique opportunities and challenges for practicing PFCC in home, community and LTC settings are also discussed. PMID:27133612

  10. [Methodological Approaches to the Organization of Counter Measures Taking into Account Landscape Features of Radioactively Contaminated Territories].

    PubMed

    Kuznetsov, V K; Sanzharova, N I

    2016-01-01

    Methodological approaches to the organization of counter measures are considered taking into account the landscape features of the radioactively contaminated territories. The current status and new requirements to the organization of counter measures in the contaminated agricultural areas are analyzed. The basic principles, objectives and problems of the formation of counter measures with regard to the landscape characteristics of the territory are presented; also substantiated are the organization and optimization of the counter measures in radioactively contaminated agricultural landscapes. PMID:27245009

  11. Maternal satisfaction with organized perinatal care in Serbian public hospitals

    PubMed Central

    2014-01-01

    Background Understanding the experiences and expectations of women across the continuum of antenatal, perinatal, and postnatal care is important to assess the quality of maternal care and to determine problematic areas which could be improved. The objective of this study was to identify the factors associated with maternal satisfaction with hospital-based perinatal care in Serbia. Methods Our survey was conducted from January 2009 to January 2010 using a 28-item, self-administered questionnaire. The sample consisted of 50% of women who expected childbirths during the study period from all 76 public institutions with obstetric departments in Serbia. The following three composite outcome variables were constructed: satisfaction with technical and professional aspects of care; communication and interpersonal aspects of care; and environmental factors. Results We analyzed 34,431 completed questionnaires (84.2% of the study sample). The highest and lowest average satisfaction scores (4.43 and 3.25, respectively) referred to the overall participation of midwives during delivery and the quality of food served in the hospital, respectively. Younger mothers and multiparas were less concerned with the environmental conditions (OR = 0.55, p = 0.006; OR = 1.82, p = 0.004). Final model indicated that mothers informed of patients’ rights, pregnancy and delivery through the Maternal Counseling Service were more likely to be satisfied with all three outcome variables. The highest value of the Pearson’s coefficient of correlation was between the overall satisfaction score and satisfaction with communication and interpersonal aspects of care. Conclusions Our study illuminated the importance of interpersonal aspects of care and education for maternal satisfaction. Improvement of the environmental conditions in hospitals, the WHO program, Baby-friendly Hospital, and above all providing all pregnant women with antenatal education, are recommendations which would

  12. Report a Complaint (about a Health Care Organization)

    MedlinePlus

    ... What Is Accreditation? Become Accredited Download the Gold Seal Find Accredited Organizations Newsletters Publicity Kits State Recognition ... What Is Certification? Become Certified Download the Gold Seal Find Certified Organizations Newsletters Publicity Kit State Recognition ...

  13. Organization of Hospital Nursing, Provision of Nursing Care, and Patient Experiences With Care in Europe

    PubMed Central

    Bruyneel, Luk; Li, Baoyue; Ausserhofer, Dietmar; Lesaffre, Emmanuel; Dumitrescu, Irina; Smith, Herbert L.; Sloane, Douglas M.; Aiken, Linda H.; Sermeus, Walter

    2015-01-01

    This study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals in eight European countries shows that patient care experience is better in hospitals with better nurse staffing and a more favorable work environment in which less clinical care is left undone. Clinical care left undone is a mediator in this relationship. Clinical care is left undone less frequently in hospitals with better nurse staffing and more favorable nurse work environments, and in which nurses work less overtime and are more experienced. Higher proportions of nurses with a bachelor’s degree reduce the effect of worse nurse staffing on more clinical care left undone. PMID:26062612

  14. Re-visioning Ultrasound through Women’s Accounts of Pre-abortion Care in England

    PubMed Central

    2015-01-01

    Feminist scholarship has demonstrated the importance of sustained critical engagement with ultrasound visualizations of pregnant women’s bodies. In response to portrayals of these images as “objective” forms of knowledge about the fetus, it has drawn attention to the social practices through which the meanings of ultrasound are produced. This article makes a novel contribution to this project by addressing an empirical context that has been neglected in the existing feminist literature concerning ultrasound, namely, its use during pregnancies that women decide to terminate. Drawing on semi-structured interviews with women concerning their experiences of abortion in England, I explore how the meanings of having an ultrasound prior to terminating a pregnancy are discursively constructed. I argue that women’s accounts complicate dominant representations of ultrasound and that in so doing, they multiply the subject positions available to pregnant women. PMID:26435577

  15. Value in Pediatric Orthopaedic Surgery Health Care: the Role of Time-driven Activity-based Cost Accounting (TDABC) and Standardized Clinical Assessment and Management Plans (SCAMPs).

    PubMed

    Waters, Peter M

    2015-01-01

    The continuing increases in health care expenditures as well as the importance of providing safe, effective, timely, patient-centered care has brought government and commercial payer pressure on hospitals and providers to document the value of the care they deliver. This article introduces work at Boston Children's Hospital on time-driven activity-based accounting to determine cost of care delivery; combined with Systemic Clinical Assessment and Management Plans to reduce variation and improve outcomes. The focus so far has been on distal radius fracture care for children and adolescents. PMID:26049304

  16. Organization position statements and the stance of "studied neutrality" on euthanasia in palliative care.

    PubMed

    Johnstone, Megan-Jane

    2012-12-01

    In recent years, palliative care and related organizations have increasingly adopted a stance of "studied neutrality" on the question of whether euthanasia should be legalized as a bona fide medical regimen in palliative care contexts. This stance, however, has attracted criticism from both opponents and proponents of euthanasia. Pro-euthanasia activists see the stance as an official position of indecision that is fundamentally disrespectful of a patient's right to "choose death" when life has become unbearable. Some palliative care constituents, in turn, are opposed to the stance, contending that it reflects an attitude of "going soft" on euthanasia and as weakening the political resistance that has hitherto been successful in preventing euthanasia from becoming more widely legalized. In this article, attention is given to examining critically the notion and possible unintended consequences of adopting a stance of studied neutrality on euthanasia in palliative care. It is argued that although palliative care and related organizations have an obvious stake in the outcome of the euthanasia debate, it is neither unreasonable nor inconsistent for such organizations to be unwilling to take a definitive stance on the issue. It is further contended that, given the long-standing tenets of palliative care, palliative care organizations have both a right and a responsibility to defend the integrity of the principles and practice of palliative care and to resist demands for euthanasia to be positioned either as an integral part or logical extension of palliative care. PMID:22771130

  17. Accountability, efficiency, and the "bottom line" in non-profit organizations.

    PubMed

    Cutt, J

    1982-01-01

    Financial reporting by non-profit organizations deals only with accountability for propriety and regularity, and ignores output measurement. The development of output measures of a physical or index nature offers a means of relating dollar costs to output in the form of cost-efficiency or cost-effectiveness measures, but does not provide any measure of the absolute value or worthwhileness of such programs. This fundamental absolute value question should be asked of all non-profit programs and documented to the greatest possible extent in budgetary submissions, and subsequent control and audit. In public sector non-profit programs, the posing of this question requires information on consumer demand other than in aggregative and imprecise form through the political process, and much improved information on the cost side. Eliciting demand information is feasible in the case of public programs with separable benefits by the use of a variety of pricing techniques, direct or imputed, whether or not the service in question is ultimately financed on a user-pay basis. The problem of eliciting demand is more difficult in the case of public goods, but improved demand information can be obtained, ideally by an approach such as the use of a Clarke tax. The argument can be extended to encompass questions of income distribution, stabilization, regulation and tax policy. Recent developments in program evaluation in the federal government are important, but remain deficient in failing to address the question of absolute value. PMID:10257032

  18. The Organization of Group Care Environments: The Infant Day Care Center.

    ERIC Educational Resources Information Center

    Cataldo, Michael F.; Risley, Todd R.

    In designing group day care for infants, special attention has been given to efficient care practices, so that all the children's health needs can be met and so that the staff will have ample time to interact with the children. One efficient method is to assign each staff member the responsibility of a particular area rather than a particular…

  19. The Organization of Multidisciplinary Care Teams: Modeling Internal and External Influences on Cancer Care Quality

    PubMed Central

    Prabhu Das, Irene; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew

    2010-01-01

    Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancer care. PMID:20386055

  20. Design of high reliability organizations in health care

    PubMed Central

    Carroll, J S; Rudolph, J W

    2006-01-01

    To improve safety performance, many healthcare organizations have sought to emulate high reliability organizations from industries such as nuclear power, chemical processing, and military operations. We outline high reliability design principles for healthcare organizations including both the formal structures and the informal practices that complement those structures. A stage model of organizational structures and practices, moving from local autonomy to formal controls to open inquiry to deep self‐understanding, is used to illustrate typical challenges and design possibilities at each stage. We suggest how organizations can use the concepts and examples presented to increase their capacity to self‐design for safety and reliability. PMID:17142607

  1. Using high-performance work practices in health care organizations: a perspective for nursing.

    PubMed

    McAlearney, Ann Scheck; Robbins, Julie

    2014-01-01

    Studies suggest that the use of high-performance work practices (HPWPs) may help improve quality in health care. We interviewed 67 administrators and clinicians across 5 health care organizations and found that the use of HPWPs was valued and salient for nurses. Communication appeared particularly important to facilitate HPWP use. Enhancing our understanding of HPWP use may help improve the work environment for nurses while also increasing care quality. PMID:24052139

  2. Improving Organ Donor Registration Using Kiosks in Primary Care Clinics

    ERIC Educational Resources Information Center

    Salim, Ali; Berry, Cherisse; Ley, Eric J.; Schulman, Danielle; Anderson, Jacqueline; Navarro, Sonia; Zheng, Ling; Chan, Linda S.

    2015-01-01

    Objective: In the USA, organ donor shortage is especially pronounced among minority ethnic populations such as Hispanics, who are 60% less likely to donate compared to non-Hispanic Whites. Recent evidence suggests that US Hispanics may consent to organ donation via a registry within a doctor's office. The objective of this study was to investigate…

  3. State Estimates of Organized Child Care Facilities. Population Division Working Paper Series No. 21.

    ERIC Educational Resources Information Center

    Casper, Lynne M.; O'Connell, Martin

    Census Bureau data have traditionally focused on national estimates of the numbers of children in organized child care facilities using various household surveys. In contrast, this paper presents data on the characteristics of child care businesses for individual states from the Census of Service Industries. Although focusing primarily on the most…

  4. Organization of Care for Acute Myocardial Infarction in Rural and Urban Hospitals in Kansas

    ERIC Educational Resources Information Center

    Ellerbeck, Edward F.; Bhimaraj, Arvind; Perpich, Denise

    2004-01-01

    One in 4 Americans lives in a rural community and relies on rural hospitals and medical systems for emergent care of acute myocardial infarctions (AMI). The infrastructure and organization of AMI care in rural and urban Kansas hospitals was examined. Using a nominal group process, key elements within hospitals that might influence quality of AMI…

  5. The Infant Center: A Complete Guide to Organizing and Managing Infant Day Care.

    ERIC Educational Resources Information Center

    Herbert-Jackson, Emily; And Others

    This book is a guide to organizing and managing an infant day care center. Part I includes two chapters: About Infant Day Care; and Arranging Space for Babies. Part II discusses being a caregiver and includes chapters on play; feeding; diapering; sleep; receiving/departing; and handling emergencies and illnesses. Part III focuses on the role of…

  6. 7 CFR 226.12 - Administrative payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT... sponsoring organizations of child care centers or outside-school-hours care centers, independent centers, and... section shall be entitled to receive start-up payments to develop or expand successful Program...

  7. Organizations Concerned with Early Care and Education in Illinois: A Sample

    ERIC Educational Resources Information Center

    Early Childhood Research & Practice, 2013

    2013-01-01

    Several sectors and levels of organizations, agencies, and projects are involved in promoting and providing education, care, and intervention services for young children and their families in Illinois. State government entities involved in matters of early care and education include the Illinois State Board of Education (ISBE), the Department of…

  8. Development of a College Student's Mistrust of Health Care Organizations Scale

    ERIC Educational Resources Information Center

    Price, James H.; Kirchofer, Gregg M.; Khubchandani, Jagdish; Kleinfelder, JoAnn; Bryant, Michele

    2013-01-01

    Objective: The purpose of this study was to develop a College Student's Mistrust of Health Care Organizations (CSMHCO) scale and determine the relationship between medical mistrust with the use of a variety of health care services. Methods: A convenience sample of college students (n = 545) at 2 universities in the United States was recruited in…

  9. Managing the conflict between individual needs and group interests--ethical leadership in health care organizations.

    PubMed

    Shale, Suzanne

    2008-03-01

    This paper derives from a grounded theory study of how Medical Directors working within the UK National Health Service manage the moral quandaries that they encounter as leaders of health care organizations. The reason health care organizations exist is to provide better care for individuals through providing shared resources for groups of people. This creates a paradox at the heart of health care organization, because serving the interests of groups sometimes runs counter to serving the needs of individuals. The paradox presents ethical dilemmas at every level of the organization, from the boardroom to the bedside. Medical Directors experience these organizational ethical dilemmas most acutely by virtue of their position in the organization. As doctors, their professional ethic obliges them to put the interests of individual patients first. As executive directors, their role is to help secure the delivery of services that meet the needs of the whole patient population. What should they do when the interests of groups of patients, and of individual patients, appear to conflict? The first task of an ethical healthcare organization is to secure the trust of patients, and two examples of medical ethical leadership are discussed against this background. These examples suggest that conflict between individual and population needs is integral to health care organization, so dilemmas addressed at one level of the organization inevitably re-emerge in altered form at other levels. Finally, analysis of the ethical activity that Medical Directors have described affords insight into the interpersonal components of ethical skill and knowledge. PMID:18382123

  10. Palliative and end-of-life care in pediatric solid organ transplantation.

    PubMed

    Fowler, Amy; Freiberger, Dawn; Moonan, Marilyn

    2015-02-01

    End-of-life care is a component of palliative care and takes a holistic, individualized approach to patients, focusing on the assessment of quality of life and its maintenance until the end of life, and beyond, for the patient's family. Transplant teams do not always make timely referrals to palliative care teams due to various clinician and perceived family barriers, an important one being the simultaneous, active care plan each patient would have alongside an end-of-life plan. Application of findings and further research specific to the pediatric solid organ population would be of significant benefit to guide transplant teams as to the most effective time to introduce end-of-life care, who to involve in ongoing discussions, and important ethical and cultural considerations to include in care planning. Attention must also be paid to clinician training and support in this challenging area of health care. PMID:25422076

  11. Organization of Nursing and Quality of Care for Veterans at the End of Life

    PubMed Central

    Kutney-Lee, Ann; Brennan, Caitlin W.; Meterko, Mark; Ersek, Mary

    2015-01-01

    Context The Veterans Health Administration (VA) has improved the quality of end-of-life (EOL) care over the past several years. Several structural and process variables are associated with better outcomes. Little is known, however, about the relationship between the organization of nursing care and EOL outcomes. Objectives To examine the association between the organization of nursing care, including the nurse work environment and nurse staffing levels, and quality of EOL care in VA acute care facilities. Methods Secondary analysis of linked data from the Bereaved Family Survey (BFS), electronic medical record, administrative data, and the VA Nursing Outcomes Database. The sample included 4908 veterans who died in one of 116 VA acute care facilities nationally between October 2010 and September 2011. Unadjusted and adjusted generalized estimating equations were used to examine associations between nursing and BFS outcomes. Results BFS respondents were 17% more likely to give an excellent overall rating of the quality of EOL care received by the veteran in facilities with better nurse work environments (P ≤ 0.05). The nurse work environment also was a significant predictor of providers listening to concerns and providing desired treatments. Nurse staffing was significantly associated with an excellent overall rating, alerting of the family before death, attention to personal care needs, and the provision of emotional support after the patient’s death. Conclusion Improvement of the nurse work environment and nurse staffing in VA acute care facilities may result in enhanced quality of care received by hospitalized veterans at the EOL. PMID:25116912

  12. Taking values seriously: Ethical challenges in organ donation and transplantation for critical care professionals.

    PubMed

    Aulisio, Mark P; Devita, Michael; Luebke, Donna

    2007-02-01

    Last year, >28,000 people received organ transplants from >14,000 donors in the United States. Unfortunately, the wait list now tops 91,000, with the gap between recipient needs and available donor organs at around 60,000. This has motivated a host of efforts to increase organ supply, including driver's license and donor registry initiatives, educational and advertising campaigns, and "required request" and mandatory Organ Procurement Organization notification when a patient's death is imminent. Other more controversial efforts to increase the donor pool include expanded criteria for cadaveric donors, such as older or sicker donors and so-called non-heart-beating donation, now referred to as donation after cardiac death. Perhaps the most controversial of all efforts to address the organ shortage have focused on increasing the number of living organ donors, which in 2001 for the first time exceeded the number of cadaveric donors. Critical care professionals know the sad reality behind the statistical scarcity of organ supply. They must manage anxious patients and family members who may be waiting for an organ that never comes, triage patients into and out of the intensive care unit, and work through the propriety of shifting goals from cure to comfort when those same patients deteriorate to the point that transplant may no longer be an appropriate medical option or when a transplant fails. Equally significant ethical challenges arise on the donor side, whether it is working through difficult end-of-life decisions, identifying when to call the organ procurement organization, caring for brain-dead patients, managing a candidate for donation after cardiac death, or caring for a living donor postoperatively. This article discusses some of the difficult ethical challenges raised by organ donation and transplantation for critical care professionals, focusing on end-of-life decision making, donation after cardiac death, and living organ donation. PMID:17242610

  13. Palliative care consultation in the process of organ donation after cardiac death.

    PubMed

    Kelso, Catherine McVearry; Lyckholm, Laurie J; Coyne, Patrick J; Smith, Thomas J

    2007-02-01

    Palliative care consultation has been demonstrated to be useful in many situations in which expert symptom management, communication around sensitive issues, and family support may serve to enhance or improve care. The process of organ donation is an example of this concept, specifically the process of donation after cardiac death (DCD). DCD allows patients with severe, irreversible brain injuries that do not meet standard criteria for brain death to donate organs when death is declared by cardiopulmonary criteria. The DCD method of donation has been deemed an ethically appropriate means of organ donation and is supported by the organ procurement and medical communities, as well as the public. The palliative care (PC) team can make a significant contribution to the care of the patient and family in the organ donation process. In this paper we describe the controlled DCD process at one institution that utilizes the PC team to provide expert end-of-life care, including comprehensive medical management and family support. PC skills and principles applicable to the DCD process include communication, coordination of care, and skillful ventilator withdrawal. If death occurs within 90 minutes of withdrawal of life support, organs may be successfully recovered for transplantation. If the patient survives longer than 90 minutes, his or her care continues to be provided by the PC team. Palliative care can contribute to standardizing quality end-of-life care practices in the DCD process and provide education for involved personnel. Further experience, research and national discussions will be helpful in refining these practices, to make this difficult and challenging experience as gentle and supportive as possible for the courageous families who participate in this process. PMID:17298260

  14. Role of urgent care staff in organ donation.

    PubMed

    Garside, Marie; Garside, Jules

    2010-10-01

    A detailed review of donation activity since the introduction of an embedded specialist nurse in organ donation (SNOD) in Norfolk and Norwich University Hospitals NHS Foundation Trust has confirmed the benefits of this role for the identification and referral of potential donors by emergency department (ED) staff. This article argues that, as EDs across the U.K. introduce SNODs, more organs will become available for transplant. PMID:21066923

  15. Customer centered health care: why managed care organizations must capitalize on new technology to build brands and customer loyalty.

    PubMed

    Fell, D

    1998-01-01

    Now, more than ever, health care organizations are desperately trying to reach out to customers and establish stronger relationships that will generate increased loyalty and repeat business. As technology, like the Internet and related mediums, allow us to do a better job of managing information and communication, health care executives must invest the time and resources necessary to bring these new advances into the day-to-day operations of their businesses. Those that do will have a head start in building their brand and their customer loyalty. PMID:10181710

  16. Management accounting use and financial performance in public health-care organisations: evidence from the Italian National Health Service.

    PubMed

    Macinati, Manuela S; Anessi-Pessina, E

    2014-07-01

    Reforms of the public health-care sector have emphasised the role of management accounting (MA). However, there is little systematic evidence on its use and benefits. To fill this gap, we propose a contingency-based model which addresses three related issues, that is, whether: (i) MA use is influenced by contextual variables and MA design; (ii) top-management satisfaction with MA mediates the relationship between MA design and MA use; and (iii) financial performance is influenced by MA use. A questionnaire was mailed out to all Italian public health-care organisations. Structural equation modelling was performed to validate the research hypotheses. The response rate was 49%. Our findings suggest that: (i) cost-containment strategies encourage more sophisticated MA designs; (ii) MA use is directly and indirectly influenced by contingency, organisational, and behavioural variables; (iii) a weakly significant positive relationship exists between MA use and financial performance. These findings are relevant from the viewpoint of both top managers and policymakers. The former must make sure that MA is not only technically advanced, but also properly understood and appreciated by users. The latter need to be aware that MA may improve performance in ways and along dimensions that may not fully translate into better financial results. PMID:24767311

  17. 'Who's coming up next to do this work?' Generational tensions in accounts of providing HIV care in the community.

    PubMed

    Newman, Christy E; de Wit, John Bf; Reynolds, Robert H; Canavan, Peter G; Kidd, Michael R

    2016-05-01

    Generational change is believed to be transforming the educational and employment preferences of medical trainees. In this article, we examine generational tensions in interviews with policy leaders and clinicians on workforce issues within one subset of the Australian medical profession: general practitioners who provide care to people with HIV in community settings. Integrating the accounts of policy leaders (n = 24) and clinicians representing the 'first generation' (n = 21) and 'next generation' (n = 23) of clinicians to do this work, shared and divergent perspectives on the role of generational change in shaping professional engagement were revealed. While those engaged in the early response to HIV believed younger clinicians to be less interested in the scientific and political dimensions of HIV care and more concerned about financial security and life balance, the next generation both countered and integrated these beliefs into new ways of conceptualising the value and appeal of this field of medicine. Critical appraisal of the assumptions that underpin generational discourse is essential in appreciating the changing views of providers over time, particularly in fields of medicine which have featured significant historical turning points. PMID:25948697

  18. 76 FR 33305 - Medicare Program; Accelerated Development Sessions for Accountable Care Organizations-June 20, 21...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-08

    .... Background In FR Doc. 2011-12342 of May 19, 2011 (76 FR 28988), there were a number of technical errors that... technical and typographical errors in the May 19, 2011 notice (76 FR 28988 and 28989) which include the... central daylight time. III. Correction of Errors In FR Doc. 2011-12342 of May 19, 2011 (76 FR 28988),...

  19. 76 FR 67025 - Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-28

    ... earlier this year, 76 FR 21,894 (Apr. 19, 2011), in two significant respects. First, the entire final... Financial Relationships (Phase II), 69 FR 16,094 (Mar. 26, 2004). \\29\\ See Appendix to the Policy Statement... Which They Have Financial Relationships (Phase II), 69 FR 16,094 (Mar. 26, 2004). 3. Separately for...

  20. An approach to correlate the CTDIvol to organ dose for thorax and abdomen CT taking tube current modulation and patient size into account

    NASA Astrophysics Data System (ADS)

    Lopez-Rendon, X.; Zanca, F.; Oyen, R.; Bosmans, H.

    2013-03-01

    Purpose: To estimate conversion factors for calculating effective dose (E) and organ dose taking tube current modulation (TCM) and patient size into account in adult thorax and abdomen CT examinations. Method: 99 consecutive adult patients were included in this study. All examinations were performed with TCM (CareDose 4D. Siemens Definition Flash) at 120 kVp and 110 (thorax) and 200 (abdomen) reference mAs. E and organ dose were estimated with PCXMC 2.0 (STUK. Helsinki. Finland). using an extension of the software from a planar geometry to spiral acquisitions of aCT scanner. This software accounts for patient size by rescaling the anthropomorphic phantom to actual patient weights and heights. E and organ doses were normalized to the CTDivol as reported in the patient's report. These conversion factors (dE and dorgan were studied as a function of different patient metrics: lateral and anterior-posterior (AP) diameter. sum of the lateral and AP diameter, area of a cross section image and effective diameter. Results:. No trend was found for any of the metrics neither forE nor for the organs investigated (lungs. breasts. stomach and liver). Average value +/- 2 standard deviation were calculated. For a thorax examination, the average dE was 0.57 +/- 0.14 mSv/mGy. dlungs was 1.26 +/- 0.28 mGy/mGy and dbreasts was 1.29 +/- 0.40 mGy/mGy. For an abdomen scan dE was 0.82 +/- 0.18. mSv/mGy. d,tomooh was 1.42 +/- 0.26 mGy/mGy. dliver was 1.42 +/- 0.30 mGy/mGy. Conclusion:. For the scanner studied, average conversion factors, which account for TCM and patient size, were proposed. This is a first step towards patient-specific dosimetry.

  1. Organizing principles and management climate in high-performing municipal elderly care.

    PubMed

    Kajonius, Petri; Kazemi, Ali; Tengblad, Stefan

    2016-01-01

    Purpose - Previous research has shown that user-oriented care predicts older persons' satisfaction with care. What is yet to be researched is how senior management facilitates the implementation of user-oriented care. The purpose of this study is to investigate the organizing principles and management climate characterizing successful elderly care. Design/methodology/approach - The department in one highly ranked municipality was selected and compared with a more average municipality. On-site in-depth semi-structured interviews with department managers and participatory observations at managers' meetings were conducted in both municipalities. Findings - Results revealed three key principles for successful elderly care: organizing care from the viewpoint of the older person; recruiting and training competent and autonomous employees; instilling a vision for the mission that guides operations at all levels in the organization. Furthermore, using climate theory to interpret the empirical material, in the highly successful municipality the management climate was characterized by affective support and cognitive autonomy, in contrast to a more instrumental work climate primarily focusing on organizational structure and doing the right things characterizing the more average municipality. Originality/value - The authors suggest that guiding organizing principles are intertwined with management climate and that there are multiple perspectives that must be considered by the management, that is, the views of the older persons, the co-workers and the mission. These results can guide future care quality developments, and increase the understanding of the importance of organizational climate at the senior management level. PMID:26764962

  2. The Hospital Medicine Reengineering Network (HOMERuN): A learning organization focused on improving hospital care

    PubMed Central

    Auerbach, Andrew D.; Patel, Mitesh S.; Metlay, Josh; Schnipper, Jeffrey; Williams, Mark V.; Robinson, Edmondo; Kripalani, Sunil; Lindenauer, Peter K.

    2016-01-01

    Converting the health care delivery system into a learning organization is a key strategy for improving health outcomes. While the learning organization approach has been successful in neonatal intensive care units and disease specific collaboratives there are few examples in general medicine and fewer still have leveraged the role of hospitalists to implement improvements. This paper describes the rationale for and early work of the Hospital Medicine Reengineering Network (HOMERuN), a collaborative of hospitals, hospitalists, and care teams whose overarching purpose is to use data to guide collaborative efforts aimed at improving the care of hospitalized patients. We review HOMERuN’s collaborative model, which focuses on a community-based participatory approach modified to include hospital-based as well as the larger community, and HOMERuN’s initial project focusing on care transition improvement using perspectives from the patient and caregiver. PMID:24448050

  3. The organization and delivery of women's health care in Department of Veterans Affairs Medical Center.

    PubMed

    Yano, Elizabeth M; Washington, Donna L; Goldzweig, Caroline; Caffrey, Cynthia; Turner, Carole

    2003-01-01

    Congressional eligibility reforms have profoundly changed the array of services to be made available to women veterans in Department of Veterans Affairs (VA) health care facilities. These include access not only to primary and specialty care services already afforded VA users, but also to a full spectrum of gender-specific services, including prenatal, obstetric, and infertility services never before provided in VA settings. The implications of this legislative mandate for delivering care to women veterans are poorly understood, as little or no information has been available about how care for women veterans is organized. This article reports on the first national assessment of variations in the organization of care for women veterans. PMID:12732441

  4. 17 CFR 274.11b - Form N-3, registration statement of separate accounts organized as management investment companies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 17 Commodity and Securities Exchanges 3 2013-04-01 2013-04-01 false Form N-3, registration statement of separate accounts organized as management investment companies. 274.11b Section 274.11b Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) FORMS PRESCRIBED UNDER THE INVESTMENT COMPANY ACT OF 1940...

  5. Organizing delivery care: what works for safe motherhood?

    PubMed Central

    Koblinsky, M. A.; Campbell, O.; Heichelheim, J.

    1999-01-01

    The various means of delivering essential obstetric services are described for settings in which the maternal mortality ratio is relatively low. This review yields four basic models of care, which are best described by organizational characteristics relating to where women give birth and who performs deliveries. In Model 1, deliveries are conducted at home by a community member who has received brief training. In Model 2, delivery takes place at home but is performed by a professional. In Model 3, delivery is performed by a professional in a basic essential obstetric care facility, and in Model 4 all women give birth in a comprehensive essential obstetric care facility with the help of professionals. In each of these models it is assumed that providers do not increase the risk to women, either iatrogenically or through traditional practices. Although there have been some successes with Model 1, there is no evidence that it can provide a maternal mortality ratio under 100 per 100,000 live births. If strong referral mechanisms are in place the introduction of a professional attendant can lead to a marked reduction in the maternal mortality ratio. Countries using Models 2-4, involving the use of professional attendants at delivery, have reduced maternal mortality ratios to 50 or less per 100,000. However, Model 4, although arguably the most advanced, does not necessarily reduce the maternal mortality ratio to less than 100 per 100,000. It appears that not all countries are ready to adopt Model 4, and its affordability by many developing countries is doubtful. There are few data making it possible to determine which configuration with professional attendance is the most cost-effective, and what the constraints are with respect to training, skill maintenance, supervision, regulation, acceptability to women, and other criteria. A successful transition to Models 2-4 requires strong links with the community through either traditional providers or popular demand. PMID

  6. How do urban organized health care delivery systems link with rural providers?

    PubMed

    Christianson, J B; Wellever, A; Radcliff, T; Knutson, D J

    2000-01-01

    Organized delivery systems are becoming an increasingly important component of urban health care markets and are expanding their influence in rural areas as well. They also are developing new linkages with rural providers. This article, based on the experiences of 20 diverse organizations, identifies and describes the strategies being used by urban systems to redefine linkages with rural hospitals and, particularly, physicians. PMID:10937336

  7. 42 CFR 475.105 - Prohibition against contracting with health care facilities, affiliates, and payor organizations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Prohibition against contracting with health care facilities, affiliates, and payor organizations. 475.105 Section 475.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT...

  8. 7 CFR 226.13 - Food service payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT..., each sponsoring organization must conduct reasonable edit checks on the day care homes' meal claims... and types of meals served each day to each enrolled child by name. The sponsoring organization...

  9. Caring for the Environment while Teaching Organic Chemistry

    ERIC Educational Resources Information Center

    Santos, Elvira Santos; Gavilan Garcia, Irma Cruz; Lejarazo Gomez, Eva Florencia

    2004-01-01

    A comprehensive program in the field of green chemistry, which concentrates on processing and managing of wastes produced during laboratory experiments, is presented. The primary aim of the program is to instill a sense of responsibility and a concern for the environment through organic chemistry education.

  10. Behavioral Groups as Preventive Care in a Health Maintenance Organization.

    ERIC Educational Resources Information Center

    Shapiro, Joan; And Others

    This paper describes the use of a particular therapeutic modality--behavioral groups--in a relatively new delivery system called a Health Maintenance Organization. The program described, run under the George Washington University Health Plan, offers short-term structured groups designed to aid people at particularly difficult or vulnerable…

  11. [Part II. Scientific evidence in end-stage chronic organ failure. A position paper on shared care planning].

    PubMed

    Gristina, Giuseppe R; Orsi, Luciano; Carlucci, Annalisa; Causarano, Ignazio R; Formica, Marco; Romanò, Massimo

    2014-01-01

    The therapeutic options related to chronic organ failure are interconnected to the variability of human biological responses and the personal history and choices of the chronically ill patient on one hand, and with the variable human answers to therapies on the other hand. All these aspects may explain the small number and low quality of studies aimed to define the clinical criteria useful in identifying end-stage chronically ill patients, as highlighted through the 2012-2013 Medline survey performed by the task force. These results prevented the grading of scientific evidence. However, taking into account the evidence based medicine definition, the task force believes the clinical reasoning and the individual experience of clinicians as well as the patients and families preferences cannot be replaced "tout court" with a strict methodological research. Accordingly, the working method selected by the task force members was to draw up a set of clinical parameters based on the available scientific literature, submitting it to a peer review process carried out by an expert panel. This paper discusses a set of clinical parameters included in the clinical decision-making algorithm and shared by nine medical societies. For each chronic organ failure these clinical parameters should be intended not as a rigid cutoff system to make a choice between two selected care options (intensive vs palliative), rather as the starting point for a joint and careful consideration regarding the opportunity to adopt the clinical decision-making algorithm care proposed in Part I. PMID:24553593

  12. Organizing integrated care in a university hospital: application of a conceptual framework

    PubMed Central

    Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne

    2014-01-01

    Background and aim As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. Theory and methods The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. Results The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. Conclusions It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care. PMID:24966806

  13. The effect of normative social forces on managed care organizations: implications for strategic management.

    PubMed

    Kirby, E G; Sebastian, J G

    1998-01-01

    Drawing on institutional theory, this study examines how adherence to a number of "institutional" and "technical" environmental forces can influence the business success of managed care organizations (MCOs). The standards studied include: (1) institutional forces: socially accepted procedures for delivering care (access to quality care, availability of information, and delivery of care in a personal manner); and (2) technical forces: industry standards for cost control and efficient use of financial and medical resources. The most significant finding is that successful MCOs must conform to both institutional and technical forces to be successful. MCOs that conform to either one or the other type of standard were no more successful than those that conformed to neither. These findings have several important implications for MCO strategy. First, to be successful, MCO executives must understand the external environment in which they operate. They must anticipate and respond to shifts in that environment. Second, this understanding of the external environment must place equal emphasis on societal demands (e.g., for accessible care and information) and on technical demands (e.g., for cost-efficient care). These findings may well reflect that once managed care penetration reaches relatively high levels, marketshare can no longer be gained through cost-efficiency alone; rather, enrollee satisfaction based on societal demands becomes a key factor in maintaining and gaining marketshare. Institutional theory provides' some strategies for accomplishing these goals. Cost-containment strategies include implementing policies for cutting costs in areas that do not affect the quality of care, such as using generic drugs and reducing administrative excesses and redundancies. At the same time, MCOs must implement strategies aimed at improving conformity to prevailing societal perceptions of appropriate care, including providing patients more freedom to choose their physicians and

  14. Organization of health care in small plants in the USA

    PubMed Central

    Miller, Seward E.

    1955-01-01

    In the USA, the concept of an occupational health programme has grown steadily, and now embraces the total health of the worker. Elements of basic in-plant health programmes have been identified and patterns developed for successful operation. Today, health services in small plants still fall far short of optimal requirements. No more than 5% of workers in small plants enjoy the benefit of occupational health services. The main reason for the arrested development of these programmes is the lack of organizational and administrative techniques for providing health services in small plants. Recently, however, several projects have demonstrated that these difficulties can be overcome, and the future development of such programmes in small plants thus looks hopeful. Other recent developments hold promise of strengthening the health services available to workers. Union health centres, now being established in increasing numbers, offer the workers varying services, ranging from diagnostic and preventive procedures to complete medical care. Further benefits to both the worker and his family are being provided under collective bargaining agreements by voluntary health-insurance schemes. In addition to making services available to large numbers of workers previously not covered, the development of both union health centres and the prepaid health-insurance schemes offer future possibilities for integration of these programmes into the preventive and diagnostic services offered in the plant. Finally, governmental occupational health agencies, in addition to their industrial hygiene activities, are taking an increasing interest in the establishment and development of in-plant health programmes. PMID:13276820

  15. [The role of the geriatrician in the organization of the health care system].

    PubMed

    Petermans, J

    2014-01-01

    The purpose of this paper is to define the role of the geriatrician in the organization of the health care for the elderly. In Belgium, the healthcare program for the geriatric patient defines the various functions; at present, the classical geriatric hospitalization, the hospital day care, and the internal links within the hospital are well developed around the geriatrician. The standardized, comprehensive geriatric assessment of hospitalized patients has demonstrated its value for the prevention of functional decline. The efficiency of the day care services and of the link teams remains to be further appraised. Outside the hospital, the general practionner plays the major role in the treatment of the elderly living at home, or in nursing homes. The demographic evolution and the frailty of the elderly require a good coordination of all those involved in the care of the aged. A model of healthcare organization is proposed to better coordinate the in- and out of hospital activities. PMID:25065225

  16. Clinical review: Moral assumptions and the process of organ donation in the intensive care unit

    PubMed Central

    Streat, Stephen

    2004-01-01

    The objective of the present article is to review moral assumptions underlying organ donation in the intensive care unit. Data sources used include personal experience, and a Medline search and a non-Medline search of relevant English-language literature. The study selection included articles concerning organ donation. All data were extracted and analysed by the author. In terms of data synthesis, a rational, utilitarian moral perspective dominates, and has captured and circumscribed, the language and discourse of organ donation. Examples include "the problem is organ shortage", "moral or social duty or responsibility to donate", "moral responsibility to advocate for donation", "requesting organs" or "asking for organs", "trained requesters", "pro-donation support persons", "persuasion" and defining "maximising donor numbers" as the objective while impugning the moral validity of nonrational family objections to organ donation. Organ donation has recently been described by intensivists in a morally neutral way as an "option" that they should "offer", as "part of good end-of-life care", to families of appropriate patients. In conclusion, the review shows that a rational utilitarian framework does not adequately encompass interpersonal interactions during organ donation. A morally neutral position frees intensivists to ensure that clinical and interpersonal processes in organ donation are performed to exemplary standards, and should more robustly reflect societal acceptability of organ donation (although it may or may not "produce more donors"). PMID:15469581

  17. The development and current status of Intensive Care Unit management of prospective organ donors

    PubMed Central

    Ellis, Margaret Kathleen Menzel; Sally, Mitchell Brett; Malinoski, Darren

    2016-01-01

    Introduction: Despite continuous advances in transplant medicine, there is a persistent worldwide shortage of organs available for donation. There is a growing body of research that supports that optimal management of deceased organ donors in Intensive Care Unit can substantially increase the availability of organs for transplant and improve outcomes in transplant recipients. Methods: A systematic literature review was performed, comprising a comprehensive search of the PubMed database for relevant terms, as well as individual assessment of references included in large original investigations, and comprehensive society guidelines. Results: In addition to overall adherence to catastrophic brain injury guidelines, optimization of physiologic state in accordance with established donor management goals (DMGs), and establishment of system-wide processes for ensuring early referral to organ procurement organizations (OPOs), several specific critical care management strategies have been associated with improved rates and outcomes of renal transplantation from deceased donors. These include vasoactive medication selection, maintenance of euvolemia, avoidance of hydroxyethyl starch, glycemic control, targeted temperature management, and blood transfusions if indicated. Conclusions: Management of deceased organ donors should focus first on maintaining adequate perfusion to all organ systems through adherence to standard critical care guidelines, early referral to OPOs, and family support. Furthermore, several specific DMGs and strategies have been recently shown to improve both the rates and outcomes of organ transplantation. PMID:27555674

  18. Inter-organization Cooperation for Care of the Elderly

    NASA Astrophysics Data System (ADS)

    Costa, Ricardo; Novais, Paulo; Machado, José; Alberto, Carlos; Neves, José

    With the growing numbers of the elderly population, the society is face to face with a set of new problems, namely the lack of resources to assist their living in a noble mode. Nevertheless, with the use of new computational technologies and novel methodologies for problem solving, some solutions to these problems are emerging (e.g., remote sensing/assistance/supervision). Therefore, it is our goal to show that under such scenarios, it is possible to bring into play different interconnected virtual organizations, through which will be provided to the population, in general, and the elderly, in particular, a number of services (e.g., healthcare, entertainment, learning), without delocalization or messing up with their routine.

  19. Regulated wet nursing: managed care or organized crime?

    PubMed

    Obladen, Michael

    2012-01-01

    Wet nursing was widely practiced from antiquity. For the wealthy, it was a way to overcome the burdens of breastfeeding and increase the number of offspring. For the poor, it was an organized industry ensuring regular payment, and in some parishes the major source of income. The abuse of wet nursing, especially the taking in of several nurslings, prompted legislation which became the basis of public health laws in the second half of the 19th century. The qualifications demanded from a mercenary nurse codified by Soran in the 2nd century CE remained unchanged for 1,700 years. When artificial feeding lost its threat thanks to sewage disposal, improved plumbing, the introduction of rubber teats, cooling facilities and commercial formula, wet nursing declined towards the end of the 19th century. PMID:22833013

  20. A new approach to optimal selection of services in health care organizations.

    PubMed

    Adolphson, D L; Baird, M L; Lawrence, K D

    1991-01-01

    A new reimbursement policy adopted by Medicare in 1983 caused financial difficulties for many hospitals and health care organizations. Several organizations responded to these difficulties by developing systems to carefully measure their costs of providing services. The purpose of such systems was to provide relevant information about the profitability of hospital services. This paper presents a new method of making hospital service selection decisions: it is based on an optimization model that avoids arbitrary cost allocations as a basis for computing the costs of offering a given service. The new method provides more reliable information about which services are profitable or unprofitable, and it provides an accurate measure of the degree to which a service is profitable or unprofitable. The new method also provides useful information about the sensitivity of the optimal decision to changes in costs and revenues. Specialized algorithms for the optimization model lead to very efficient implementation of the method, even for the largest health care organizations. PMID:10111676

  1. The Social Organization of School Counseling in the Era of Standards-Based Accountability

    ERIC Educational Resources Information Center

    Dorsey, Alexander C.

    2011-01-01

    The reform policies of standards-based accountability, as outlined in NCLB, impede the functioning of school counseling programs and the delivery of services to students. Although recent studies have focused on the transformation of the school counseling profession, a gap exists in the literature with regard to how the experiences of school…

  2. Goal Statements and Goal-Directed Behavior: A Relational Frame Account of Goal Setting in Organizations

    ERIC Educational Resources Information Center

    O'Hora, Denis; Maglieri, Kristen A.

    2006-01-01

    Goal setting has consistently been shown to increase performance under specific conditions. These goal setting effects have previously been explored from both a cognitive perspective and in terms of traditional behavioral concepts. We highlight limitations of these approaches and propose a novel account based on Relational Frame Theory. This…

  3. [Health care organization and health in a region of Zaire].

    PubMed

    Campanella, N; Tarantini, F

    1989-01-01

    Kampene is a roughly 10,000 inhabitants village in Kivu, eastern region of Republic of Zaire. The equatorial rainforest in river Zaire basin surrounds it, far from the main and most crowded roads. Climate is warm and wet, rainfalls constant throughout ten months a years. Eighty seven per cent of the population of Kampene and of its administrative district (around 100,000 inhabitants) work in agriculture. Most of the remainder gets by on mineral search and mining (tin, cassiterite, gold). Health facilities and their organisation should be set up as according to Zaire Health Planning, worked out of 1977 Alma Ata Conference's guidelines on Primary Health Care, but actually they are hard to be implemented because of the wide territory, of the scattered settlements to be served, because of infrastructure and funds shortages. High children death ratio (roughly from 104 to 200/1000 altogether, short mean lifetimes and generally morbidity are caused by: parasitoses (malaria, filariasis, gut worms, bilharziosis, amebiasis), bacterial infections (breast feeding babies' toxic enteritis, tuberculosis, salmonellosis, shigellosis, gonococcosis, tetanus, epidemic meningitis), viral diseases (measles, poliomyelitis, virus B hepatitis, AIDS), protein-energy malnutrition, obstetric pathology (uterus fractures, ectopic pregnancy, obstructed labour). The management of Kampene Hospital is taken over by a Zaire-Italian team, according to the "Progetto Socio-Sanitario a Kampene", project carried out by Centro Volontari Marchigiani, a not-governmental organisation recognized and financed by Italian Foreign Office. The utilization of Kampene hospital wards has been investigated throughout 20 months (since 1/1/1986 to 31/8/1987) by working some parameters out: numbers of admissions, numbers of hospital days, man length of stay, bed occupancy rate, turnover index for bed. The utilisation of outpatient clinic has been investigated by means of the number of outpatients and outpatients per

  4. Outsourcing. Health care organizations are considering strategic goals in making outsourcing decisions.

    PubMed

    Chin, T L

    1997-08-01

    More health care organizations are outsourcing the management of some or all of their information systems. Executives at many organizations that have tried outsourcing say it enables them to focus on core competencies, better allocate resources, get more information technology at less cost, share risks of implementing information technology with outsourcers and guarantee access to skilled labor. But the information technology outsourcing market remains relatively small in health care because many CIOs still are wary of turning over control of important functions to outsiders. PMID:10170261

  5. [Governance of primary health-care-based health-care organization].

    PubMed

    Báscolo, Ernesto

    2010-01-01

    An analytical framework was developed for explaining the conditions for the effectiveness of different strategies promoting integrated primary health-care (PHC) service-based systems in Latin-America. Different modes of governance (clan, incentives and hierarchy) were characterised from a political economics viewpoint for representing alternative forms of regulation promoting innovation in health-service-providing organisations. The necessary conditions for guaranteeing the modes of governance's effectiveness are presented, as are their implications in terms of posts in play. The institutional construction of an integrated health system is interpreted as being a product of a social process in which different modes of governance are combined, operating with different ways of resolving normative aspects for regulating service provision (with the hierarchical mode), resource distribution (with the incentives mode) and on the social values legitimising such process (with the clan mode). PMID:20963299

  6. The Hospital Medicine Reengineering Network (HOMERuN): a learning organization focused on improving hospital care.

    PubMed

    Auerbach, Andrew D; Patel, Mitesh S; Metlay, Joshua P; Schnipper, Jeffrey L; Williams, Mark V; Robinson, Edmondo J; Kripalani, Sunil; Lindenauer, Peter K

    2014-03-01

    Converting the health care delivery system into a learning organization is a key strategy for improving health outcomes. Although the collaborative learning organization approach has been successful in neonatal intensive care units and disease-specific collaboratives, there are few examples in general medicine and none in adult medicine that have leveraged the role of hospitalists nationally across multiple institutions to implement improvements. The authors describe the rationale for and early work of the Hospital Medicine Reengineering Network (HOMERuN), a collaborative of hospitals, hospitalists, and multidisciplinary care teams founded in 2011 that seeks to measure, benchmark, and improve the efficiency, quality, and outcomes of care in the hospital and afterwards. Robust and timely evaluation, with learning and refinement of approaches across institutions, should accelerate improvement efforts. The authors review HOMERuN's collaborative model, which focuses on a community-based participatory approach modified to include hospital-based staff as well as the larger community. HOMERuN's initial project is described, focusing on care transition measurement using perspectives from the patient, caregiver, and providers. Next steps and sustainability of the organization are discussed, including benchmarking, collaboration, and effective dissemination of best practices to stakeholders. PMID:24448050

  7. Marketing the health care experience: eight steps to infuse brand essence into your organization.

    PubMed

    Lofgren, Diane Gage; Rhodes, Sonia; Miller, Todd; Solomon, Jared

    2006-01-01

    One of the most elusive challenges in health care marketing is hitting on a strategy to substantially differentiate your organization in the community and drive profitable business. This article describes how Sharp HealthCare, the largest integrated health care delivery system in San Diego, has proven that focusing first on improving the health care experience for patients, physicians, and employees can provide the impetus for a vital marketing strategy that can lead to increased market share and net revenue. Over the last five years, this nonprofit health system has transformed the health care experience into tangible actions that are making a difference in the lives of all those the system serves. That difference has become Sharp's "brand essence"--a promise to the community that has been made through marketing, public relations, and advertising and then delivered through the dedicated work of Sharp's 14,000 team members. They call this performance improvement strategy The Sharp Experience. This article outlines the eight-step journey that led the organization to this brand essence marketing campaign, a campaign whose centerpiece is an award-winning 30-minute television documentary that use real-time patient stories to demonstrate Sharp's focus on service and patient-centered care against a backdrop of clinical quality and state-of-the-art technology, and documentary-style radio and television commercials. PMID:18681201

  8. Residential treatment centers and other organized mental health care for children and youth: United States, 1988.

    PubMed

    Sunshine, J H; Witkin, M J; Atay, J E; Manderscheid, R W

    1991-07-01

    Residential treatment centers (RTCs) for emotionally disturbed children are an important component of the mental health services delivery system in the United States. The 440 RTCs operating in 1988 represented 9 percent of all mental health organizations in the U.S. in that year. They served approximately 10 percent of the patients who received inpatient and residential treatment care and approximately 2 percent of outpatient psychiatric visits in organized settings. Their 39,000 full-time equivalent (FTE) staff and $1.3 billion expenditures were, respectively, 7 percent and 6 percent of the total for all mental health organizations. Between 1986 and 1988, the number of RTCs increased slightly, while the volume of residential treatment care changed little. However, partial care and outpatient care expanded in RTCs, with the number of visits in these categories increasing by 75 percent and 42 percent, respectively. FTE staff grew by 13 percent, and expenditures increased by 33 percent between 1986 and 1988. In 1988, RTCs were located in all States except North Dakota. The largest number were found in California (48), Massachusetts (38), and New York (28). By definition, all RTCs provided residential treatment care. About one-third of them also provided partial care and one-third provided outpatient care. The highest rates of additions to residential treatment care in RTCs per 100,000 civilian population were found in Minnesota and Colorado. Reflecting the role of RTCs as providers of care to children and youth, 94 percent of residential treatment patients in RTCs were under age 18. Seventy percent of residential treatment patients were male; 28 percent, black; and 10 percent, Hispanic. Approximately 94 percent had mental illness as their principal disability. In December 1988, 43,000 staff worked in RTCs; 14 percent were employed part-time, and 3 percent were trainees. Among others, the staff included approximately 900 psychiatrists, 300 other physicians, 1

  9. Academic Accountability and University Adaptation: The Architecture of an Academic Learning Organization.

    ERIC Educational Resources Information Center

    Dill, David D.

    1999-01-01

    Discussses various adaptations in organizational structure and governance of academic learning institutions, using case studies of universities that are attempting to improve the quality of teaching and the learning process. Identifies five characteristics typical of such organizations: (1) a culture of evidence; (2) improved coordination of…

  10. A resource-based view of partnership strategies in health care organizations.

    PubMed

    Yarbrough, Amy K; Powers, Thomas L

    2006-01-01

    The distribution of management structures in health care has been shifting from independent ownership to interorganizational relationships with other firms. A shortage of resources has been cited as one cause for such collaboration among health care entities. The resource- based view of the firm suggests that organizations differentiate between strategic alliances and acquisition strategies based on a firm's internal resources and the types of resources a potential partner organization possesses. This paper provides a review of the literature using the resource-based theory of the firm to understand what conditions foster different types of health care partnerships. A model of partnership alliances using the resource-based view is presented, strategic linkages are presented, managerial implications are outlined, and directions for future research are given. PMID:17062534

  11. Directory of Early Childhood Care and Education Organizations in the Arab States.

    ERIC Educational Resources Information Center

    United Nations Educational, Scientific, and Cultural Organization, Paris (France).

    The care and education of children is a primary task of all societies, and the role of parents, families, and communities is essential in this process. This directory describes the major activities of 64 non-governmental and governmental organizations, based on 12 Arab countries (Algeria, Djibouti, Egypt, Jordan, Kuwait, Lebanon, Mauritania,…

  12. Directory of Early Childhood Care and Education Organizations in Sub-Saharan Africa. First Edition.

    ERIC Educational Resources Information Center

    United Nations Educational, Scientific, and Cultural Organization, Paris (France).

    This directory describes 241 non-governmental and governmental organizations, based in 40 sub-Saharan African countries, involved in early childhood care, development, and education. A useful information source for those working with and for children, the directory encourages and facilitates communication and information-sharing between…

  13. Towards a Healthy District: Organizing and Managing District Health Systems Based on Primary Health Care.

    ERIC Educational Resources Information Center

    Tarimo, E.

    This book is concerned with orienting health care workers in district health systems in developing countries to ways and means of overcoming problems, and describes briefly how district health systems can be improved. The book is organized around nine issues in nine chapters, each of which is an integral part of a district planning cycle. The…

  14. Health Care, Heal Thyself! An Exploration of What Drives (and Sustains) High Performance in Organizations Today

    ERIC Educational Resources Information Center

    Wolf, Jason A.

    2008-01-01

    What happens when researching the radical unveils the simplest of solutions? This article tells the story of the 2007 ISPI Annual Conference Encore Presentation, Healthcare, Heal Thyself, sharing the findings of an exploration into high-performance health care facilities and their relevance to all organizations today. It shows how to overcome…

  15. Directory of Early Childhood Care and Education Organization in Asia and the Pacific.

    ERIC Educational Resources Information Center

    United Nations Educational, Scientific, and Cultural Organization, Paris (France).

    The care and education of children is a primary task of all societies, and the role of parents, families, and communities is essential in this process. This directory describes the major activities of 360 non-governmental and governmental organizations, based in 30 countries in Asia and the Pacific region (Australia; Bangladesh; Bhutan; Cambodia;…

  16. 7 CFR 226.12 - Administrative payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... amount of administrative payments and food service payments for day care home operations. (b) Start-up... section shall be entitled to receive start-up payments to develop or expand successful Program operations... start-up payments only once for any eligible sponsoring organization, but may approve expansion...

  17. Economic organization of medicine and the Committee on the Costs of Medical Care.

    PubMed Central

    Perkins, B B

    1998-01-01

    Recent strategies in managed care and managed competition illustrate how health care reforms may reproduce the patterns of economic organization of their times. Such a reform approach is not a new development in the United States. The work of the 1927-1932 Committee on the Costs of Medical Care exemplifies an earlier effort that applied forms of economic organization to medical care. The committee tried to restructure medicine along lines consistent with its economic environment while attributing its models variously to science, profession, and business. Like current approaches, the committee's reports defined costs as the major problem and business models of organization as the major solution. The reports recommended expanded financial management and group medicine, which would include growth in self-supporting middle-class services such as fee clinics and middle-rate hospital units. Identifying these elements as corporate practice of medicine, the American Medical Association-based minority dissented from the final report in favor of conserving individual entrepreneurial practice. This continuum in forms of economic organization has limited structural reform strategies in medicine for the remainder of the century. PMID:9807547

  18. 7 CFR 226.13 - Food service payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT... and types of meals served each day to each enrolled child by name. The sponsoring organization shall... enrolled child in the day care home), or attendance lists (which show, by days or meals, the rate...

  19. A response to Edzi (AIDS): Malawi faith-based organizations' impact on HIV prevention and care.

    PubMed

    Lindgren, Teri; Schell, Ellen; Rankin, Sally; Phiri, Joel; Fiedler, Rachel; Chakanza, Joseph

    2013-01-01

    African faith-based organization (FBO) leaders influence their members' HIV knowledge, beliefs, and practices, but their roles in HIV prevention and care are poorly understood. This article expands the work of Garner (2000) to test the impact of FBO influence on member risk and care behaviors, embedding it in the Theory of Planned Behavior. Qualitative interviews and quantitative surveys were collected from five FBOs (Christian and Muslim) in Malawi and analyzed using mixed methods. Contrary to Garner, we found that the level of power and influence of the FBO had no significant impact on the risk-taking behaviors of members; however, leaders' HIV knowledge predicted members' behaviors. Stigmatizing attitudes of leaders significantly decreased members' care behaviors, but FBO hierarchy tended to increase members' care behaviors. The power of local church and mosque leaders to influence behavior could be exploited more effectively by nurses by providing support, knowledge, and encouragement to churches and mosques. PMID:22959480

  20. HRM and its effect on employee, organizational and financial outcomes in health care organizations

    PubMed Central

    2014-01-01

    Background One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction. Methods This study uses a unique dataset, based on the ‘ActiZ Benchmark in Healthcare’, a benchmark study conducted in Dutch home care, nursing care and care homes. Data from autumn 2010 to autumn 2011 were analyzed. In total, 162 organizations participated during this period (approximately 35% of all Dutch care organizations). Employee data were collected using a questionnaire (61,061 individuals, response rate 42%). Clients were surveyed using the Client Quality Index for long-term care, via stratified sampling. Financial outcomes were collected using annual reports. SEM analyses were conducted to test the hypotheses. Results It was found that HR practices are - directly or indirectly - linked to all three outcomes. The use of HR practices is related to improved financial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR outcomes (measure: sickness absence). The impact of HR practices on HR outcomes and organizational outcomes proved substantially larger than their impact on financial outcomes. Furthermore, with respect to HR and organizational outcomes, the hypotheses concerning the full mediating effect of job satisfaction are confirmed. This is in line with the view that employee attitudes are an important element in the ‘black box’ between HRM and performance. Conclusion The results underscore the importance of HRM in the health care sector, especially for HR and

  1. Accounting for non-independent detection when estimating abundance of organisms with a Bayesian approach

    USGS Publications Warehouse

    Martin, Julien; Royle, J. Andrew; MacKenzie, Darryl I.; Edwards, Holly H.; Kery, Marc; Gardner, Beth

    2011-01-01

    Summary 1. Binomial mixture models use repeated count data to estimate abundance. They are becoming increasingly popular because they provide a simple and cost-effective way to account for imperfect detection. However, these models assume that individuals are detected independently of each other. This assumption may often be violated in the field. For instance, manatees (Trichechus manatus latirostris) may surface in turbid water (i.e. become available for detection during aerial surveys) in a correlated manner (i.e. in groups). However, correlated behaviour, affecting the non-independence of individual detections, may also be relevant in other systems (e.g. correlated patterns of singing in birds and amphibians). 2. We extend binomial mixture models to account for correlated behaviour and therefore to account for non-independent detection of individuals. We simulated correlated behaviour using beta-binomial random variables. Our approach can be used to simultaneously estimate abundance, detection probability and a correlation parameter. 3. Fitting binomial mixture models to data that followed a beta-binomial distribution resulted in an overestimation of abundance even for moderate levels of correlation. In contrast, the beta-binomial mixture model performed considerably better in our simulation scenarios. We also present a goodness-of-fit procedure to evaluate the fit of beta-binomial mixture models. 4. We illustrate our approach by fitting both binomial and beta-binomial mixture models to aerial survey data of manatees in Florida. We found that the binomial mixture model did not fit the data, whereas there was no evidence of lack of fit for the beta-binomial mixture model. This example helps illustrate the importance of using simulations and assessing goodness-of-fit when analysing ecological data with N-mixture models. Indeed, both the simulations and the goodness-of-fit procedure highlighted the limitations of the standard binomial mixture model for aerial

  2. Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings

    PubMed Central

    2013-01-01

    Background District level health system governance is recognised as an important but challenging element of health system development in low and middle-income countries. Accountability is a more recent focus in health system debates. Accountability mechanisms are governance tools that seek to regulate answerability between the health system and the community (external accountability) and/or between different levels of the health system (bureaucratic accountability). External accountability has attracted significant attention in recent years, but bureaucratic accountability mechanisms, and the interactions between the two forms of accountability, have been relatively neglected. This is an important gap given that webs of accountability relationships exist within every health system. There is a need to strike a balance between achieving accountability upwards within the health system (for example through information reporting arrangements) while at the same time allowing for the local level innovation that could improve quality of care and patient responsiveness. Methods Using a descriptive literature review, this paper examines the factors that influence the functioning of accountability mechanisms and relationships within the district health system, and draws out the implications for responsiveness to patients and communities. We also seek to understand the practices that might strengthen accountability in ways that improve responsiveness – of the health system to citizens’ needs and rights, and of providers to patients. Results The review highlights the ways in which bureaucratic accountability mechanisms often constrain the functioning of external accountability mechanisms. For example, meeting the expectations of relatively powerful managers further up the system may crowd out efforts to respond to citizens and patients. Organisational cultures characterized by supervision and management systems focused on compliance to centrally defined outputs and targets

  3. Consistency endangered by FASB-GASB (Financial Accounting Standards Board, Government Accounting Standards Board ) dispute.

    PubMed

    Garner, M; Grossman, W

    1991-02-01

    The Financial Accounting Foundation's (FAF's) November 1989 decision to uphold the 1984 jurisdictional arrangement between the Financial Accounting Standards Board (FASB) and the Government Accounting Standards Board (GASB) leaves little doubt that the healthcare industry will now be subject to two sets of accounting standards. The FAF's decision created a distinction between the accounting practices of government-owned hospitals and non-hospital governmental entities and their adherence to standards set by FASB, GASB, and the American Institute of Certified Public Accountants. A governmental healthcare organization should carefully determine which accounting rules it follows and remain attentive to further GASB developments. PMID:10145384

  4. Modelling of trace metal uptake by roots taking into account complexation by exogenous organic ligands

    NASA Astrophysics Data System (ADS)

    Jean-Marc, Custos; Christian, Moyne; Sterckeman, Thibault

    2010-05-01

    The context of this study is phytoextraction of soil trace metals such as Cd, Pb or Zn. Trace metal transfer from soil to plant depends on physical and chemical processes such as minerals alteration, transport, adsorption/desorption, reactions in solution and biological processes including the action of plant roots and of associated micro-flora. Complexation of metal ions by organic ligands is considered to play a role on the availability of trace metals for roots in particular in the event that synthetic ligands (EDTA, NTA, etc.) are added to the soil to increase the solubility of the contaminants. As this role is not clearly understood, we wanted to simulate it in order to quantify the effect of organic ligands on root uptake of trace metals and produce a tool which could help in optimizing the conditions of phytoextraction.We studied the effect of an aminocarboxilate ligand on the absorption of the metal ion by roots, both in hydroponic solution and in soil solution, for which we had to formalize the buffer power for the metal. We assumed that the hydrated metal ion is the only form which can be absorbed by the plants. Transport and reaction processes were modelled for a system made up of the metal M, a ligand L and the metal complex ML. The Tinker-Nye-Barber model was adapted to describe the transport of solutes M, L and ML in the soil and absorption of M by the roots. This allowed to represent the interactions between transport, chelating reactions, absorption of the solutes at the root surface, root growth with time, in order to simulate metal uptake by a whole root system.Several assumptions were tested such as i) absorption of the metal by an infinite sink and according to a Michaelis-Menten kinetics, solutes transport by diffusion with and without ii) mass flow and iii) soil buffer power for the ligand L. In hydroponic solution (without soil buffer power), ligands decreased the trace metal flux towards roots, as they reduced the concentration of hydrated

  5. Problems and the potential direction of reforms for the current individual medical savings accounts in the Chinese health care system.

    PubMed

    Kong, Xiangjin; Yang, Yang; Gong, Fuqing; Zhao, Mingjie

    2012-12-01

    Individual health savings accounts are an important part of the current basic medical insurance system for urban workers in China. Since 1998 when the system of personal medical insurance accounts was first implemented, there has been considerable controversy over its function and significance within different social communities. This paper analyzes the main problems in the practical implementation of individual medical insurance accounts and discusses the social and cultural foundations for the establishment of family health savings accounts from the perspective of Chinese Confucian familism. Accordingly, it addresses the direction of the reform and the development of the current system of individual health insurance accounts in China. PMID:23192456

  6. The power of servant leadership to transform health care organizations for the 21st-century economy.

    PubMed

    Schwartz, Richard W; Tumblin, Thomas F

    2002-12-01

    Physician leadership is emerging as a vital component in transforming the nation's health care industry. Because few physicians have been introduced to the large body of literature on leadership and organizations, we herein provide a concise review, as this literature relates to competitive health care organizations and the leaders who serve them. Although the US health care industry has transitioned to a dynamic market economy governed by a wide range of internal and external forces, health care organizations continue to be dominated by leaders who practice an outmoded transactional style of leadership and by organizational hierarchies that are inherently stagnant. In contrast, outside the health care sector, service industries have repeatedly demonstrated that transformational, situational, and servant leadership styles are most successful in energizing human resources within organizations. This optimization of intellectual capital is further enhanced by transforming organizations into adaptable learning organizations where traditional institutional hierarchies are flattened and efforts to evoke change are typically team driven and mission oriented. PMID:12470112

  7. The relative importance of decomposition and transport mechanisms in accounting for soil organic carbon profiles

    NASA Astrophysics Data System (ADS)

    Guenet, B.; Eglin, T.; Vasilyeva, N.; Peylin, P.; Ciais, P.; Chenu, C.

    2013-04-01

    Soil is the major terrestrial reservoir of carbon and a substantial part of this carbon is stored in deep layers, typically deeper than 50 cm below the surface. Several studies underlined the quantitative importance of this deep soil organic carbon (SOC) pool and models are needed to better understand this stock and its evolution under climate and land-uses changes. In this study, we tested and compared three simple theoretical models of vertical transport for SOC against SOC profiles measurements from a long-term bare fallow experiment carried out by the Central-Chernozem State Natural Biosphere Reserve in the Kursk Region of Russia. The transport schemes tested are diffusion, advection and both diffusion and advection. They are coupled to three different formulations of soil carbon decomposition kinetics. The first formulation is a first order kinetics widely used in global SOC decomposition models; the second one, so-called "priming" model, links SOC decomposition rate to the amount of fresh organic matter, representing the substrate interactions. The last one is also a first order kinetics, but SOC is split into two pools. Field data are from a set of three bare fallow plots where soil received no input during the past 20, 26 and 58 yr, respectively. Parameters of the models were optimised using a Bayesian method. The best results are obtained when SOC decomposition is assumed to be controlled by fresh organic matter (i.e., the priming model). In comparison to the first-order kinetic model, the priming model reduces the overestimation in the deep layers. We also observed that the transport scheme that improved the fit with the data depended on the soil carbon mineralisation formulation chosen. When soil carbon decomposition was modelled to depend on the fresh organic matter amount, the transport mechanism which improved best the fit to the SOC profile data was the model representing both advection and diffusion. Interestingly, the older the bare fallow is, the

  8. The impact of primary care organization on avoidable hospital admissions for diabetes in 23 countries

    PubMed Central

    Van Loenen, Tessa; Faber, Marjan J.; Westert, Gert P.; Van den Berg, Michael J.

    2016-01-01

    Objective Diabetes is a so-called ambulatory care sensitive condition. It is assumed that by appropriate and timely primary care, hospital admissions for complications of such conditions can be avoided. This study examines whether differences between countries in diabetes-related hospitalization rates can be attributed to differences in the organization of primary care in these countries. Design Data on characteristics of primary care systems were obtained from the QUALICOPC study that includes surveys held among general practitioners and their patients in 34 countries. Data on avoidable hospitalizations were obtained from the OECD Health Care Quality Indicator project. Negative binomial regressions were carried out to investigate the association between characteristics of primary care and diabetes-related hospitalizations. Setting A total of 23 countries. Subjects General practitioners and patients. Main outcome measures Diabetes-related avoidable hospitalizations. Results Continuity of care was associated with lower rates of diabetes-related hospitalization. Broader task profiles for general practitioners and more medical equipment in general practice were associated with higher rates of admissions for uncontrolled diabetes. Countries where patients perceive better access to care had higher rates of hospital admissions for long-term diabetes complications. There was no association between disease management programmes and rates of diabetes-related hospitalization. Hospital bed supply was strongly associated with admission rates for uncontrolled diabetes and long-term complications. Conclusions Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related hospitalizations. Hospital bed supply appeared to be a very important factor in this relationship. Apparently, it takes more than strong primary care to avoid hospitalizations. Key pointsCountries with elements of strong primary care do not necessarily have lower rates of

  9. A Requirement Engineering Framework for Electronic Data Sharing of Health Care Data Between Organizations

    NASA Astrophysics Data System (ADS)

    Liu, Xia; Peyton, Liam; Kuziemsky, Craig

    Health care is increasingly provided to citizens by a network of collaboration that includes multiple providers and locations. Typically, that collaboration is on an ad-hoc basis via phone calls, faxes, and paper based documentation. Internet and wireless technologies provide an opportunity to improve this situation via electronic data sharing. These new technologies make possible new ways of working and collaboration but it can be difficult for health care organizations to understand how to use the new technologies while still ensuring that their policies and objectives are being met. It is also important to have a systematic approach to validate that e-health processes deliver the performance improvements that are expected. Using a case study of a palliative care patient receiving home care from a team of collaborating health organizations, we introduce a framework based on requirements engineering. Key concerns and objectives are identified and modeled (privacy, security, quality of care, and timeliness of service). And, then, proposed business processes which use new technologies are modeled in terms of these concerns and objectives to assess their impact and ensure that electronic data sharing is well regulated.

  10. MULTIDISCIPLINARY ACUTE CARE RESEARCH ORGANIZATION (MACRO): IF YOU BUILD IT THEY WILL COME

    PubMed Central

    Early, Barbara J.; Huang, David T.; Callaway, Clifton; Zenati, Mazen; Angus, Derek C.; Gunn, Scott; Yealy, Donald M.; Unikel, Daniel; Billiar, Timothy R.; Peitzman, Andrew B.; Sperry, Jason L.

    2013-01-01

    Background Clinical research will increasingly play a core role in the evolution and growth of acute care surgery (ACS) program development across the country. What constitutes an efficient and effective clinical research infrastructure in the current fiscal and academic environment remains obscure. We sought to characterize the effects of implementation of a multidisciplinary acute care research organization (MACRO) at a busy tertiary referral university setting. Methods In 2008, to minimize redundancy, cost, and maximize existing resources promoting acute care research, MACRO was created unifying clinical research infrastructure between the Departments of Critical Care Medicine, Emergency Medicine and Surgery. Over the time periods 2008–2012 we performed a retrospective analysis and determined volume of clinical studies, patient enrollment for both observational (OBS) and interventional (INTV) trials, and staff growth since MACROs origination and characterized changes over time. Results From 2008 to 2011, the volume of patients enrolled in clinical studies which MACRO facilitates has significantly increased over 300%. The % of INTV/OBS trials has remained stable over the same time period (50–60%). Staff has increased from 6 coordinators to 10 with an additional 15 research associates allowing 24/7 service. With this significant growth, MACRO has become financially self-sufficient and additional outside departments now seek MACROs services. Conclusions Appropriate organization of acute care clinical research infrastructure minimizes redundancy and can promote sustainable, efficient growth in the current academic environment. Further studies are required to determine if similar models can be successful at other ACS programs. PMID:23778448

  11. Characteristics of health care organizations associated with learning and development: lessons from a pilot study.

    PubMed

    Nyström, Monica

    2009-01-01

    Characteristics of health care organizations associated with an ability to learn from experiences and to develop and manage change were explored in this study. Understanding of these characteristics is necessary to identify factors influencing success in learning from the past and achieving future health care quality objectives. A literature review of the quality improvement, strategic organizational development and change management, organizational learning, and microsystems fields identified 20 organizational characteristics, grouped under (a) organizational systems, (b) key actors, and (c) change management processes. Qualitative methods, using interviews, focus group reports, and archival records, were applied to find associations between identified characteristics and 6 Swedish health care units externally evaluated as delivering high-quality care. Strong support for a characteristic was defined as units having more than 4 sources describing the characteristic as an important success factor. Eighteen characteristics had strong support from at least 2 units. The strongest evidence was found for the following: (i) key actors have long-term commitment, provide support, and make sense of ambiguous situations; (ii) organizational systems encourage employee commitment, participation, and involvement; and (iii) change management processes are employed systematically. Based on the results, a new model of "characteristics associated with learning and development in health care organizations" is proposed. PMID:19851236

  12. Development of Health Equity Indicators in Primary Health Care Organizations Using a Modified Delphi

    PubMed Central

    Wong, Sabrina T.; Browne, Annette J.; Varcoe, Colleen; Lavoie, Josée; Fridkin, Alycia; Smye, Victoria; Godwin, Olive; Tu, David

    2014-01-01

    Objective The purpose of this study was to develop a core set of indicators that could be used for measuring and monitoring the performance of primary health care organizations' capacity and strategies for enhancing equity-oriented care. Methods Indicators were constructed based on a review of the literature and a thematic analysis of interview data with patients and staff (n = 114) using procedures for qualitatively derived data. We used a modified Delphi process where the indicators were circulated to staff at the Health Centers who served as participants (n = 63) over two rounds. Indicators were considered part of a priority set of health equity indicators if they received an overall importance rating of>8.0, on a scale of 1–9, where a higher score meant more importance. Results Seventeen indicators make up the priority set. Items were eliminated because they were rated as low importance (<8.0) in both rounds and were either redundant or more than one participant commented that taking action on the indicator was highly unlikely. In order to achieve health care equity, performance at the organizational level is as important as assessing the performance of staff. Two of the highest rated “treatment” or processes of care indicators reflects the need for culturally safe and trauma and violence-informed care. There are four indicators that can be used to measure outcomes which can be directly attributable to equity responsive primary health care. Discussion These indicators and subsequent development of items can be used to measure equity in the domains of treatment and outcomes. These areas represent targets for higher performance in relation to equity for organizations (e.g., funding allocations to ongoing training in equity-oriented care provision) and providers (e.g., reflexive practice, skill in working with the health effects of trauma). PMID:25478914

  13. 42 CFR 426.516 - Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD review process.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  14. 42 CFR 426.516 - Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD review process.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  15. For Profit Organizations Showing Signs of Turnaround: Twenty-Fourth Annual Status Report on for Profit Child Care

    ERIC Educational Resources Information Center

    Neugebauer, Roger; Hartzell, Debra

    2011-01-01

    The year 2010 will not be remembered as a banner year for large for profit child care organizations. But it appears that heading into 2011, optimism has returned. This article presents the twenty-fourth annual status report on for profit child care organizations. In 2010, the total capacity of the three largest for profit chains in North America,…

  16. On the Nature and Strategies of Organized Interests in Health Care Policy Making

    PubMed Central

    Contandriopoulos, Damien

    2012-01-01

    Relying on a sweeping review of the literature on interest group influence in health care policy making, we propose a basic definition and a typology of interest groups in provincial health care policy making. Then, using Milbrath’s communication framework, we analyze organized interests’ strategies for influencing policy making. This article is a modest attempt to cross-fertilize the group theory and resource dependency literature. This theoretical framework allows us to explore many of the recurring questions about groups’ origins and strategies from an original standpoint. PMID:23087490

  17. Risk adjustment for health care financing in chronic disease: What are we missing by failing to account for disease severity?

    PubMed Central

    Omachi, Theodore A.; Gregorich, Steven E.; Eisner, Mark D.; Penaloza, Renee A.; Tolstykh, Irina V.; Yelin, Edward H.; Iribarren, Carlos; Dudley, R. Adams; Blanc, Paul D.

    2013-01-01

    BACKGROUND Adjustment for differing risks among patients is usually incorporated into newer payment approaches, and current risk models rely on age, gender, and diagnosis codes. It is unknown the extent to which controlling additionally for disease severity improves cost prediction. Failure to adjust for within-disease variation may create incentives to avoid sicker patients. We address this issue among patients with chronic obstructive pulmonary disease (COPD). METHODS Cost and clinical data were collected prospectively from 1,202 COPD patients at Kaiser Permanente. Baseline analysis included age, gender, and diagnosis codes (using the Diagnostic Cost Group Relative Risk Score [RRS]) in a general linear model predicting total medical costs in the following year. We determined whether adding COPD severity measures—FEV1, 6 minute walk test, dyspnea score, body-mass index, and BODE Index (composite of the other four measures)—improved predictions. Separately, we examined household income as a cost predictor. RESULTS Mean costs were $12,334/year. Controlling for RRS, each ½ standard deviation worsening in COPD severity factor was associated with $629 to $1,135 in increased annual costs (all p<0.01). The lowest stratum of FEV1 (<30% normal) predicted $4,098 (95%CI $576–$8,773) additional costs. Household income predicted excess costs when added to the baseline model (p=0.038), but this became non-significant when also incorporating BODE Index. CONCLUSIONS Disease severity measures explain significant cost variations beyond current risk models, and adding them to such models appears important to fairly compensate organizations that accept responsibility for sicker COPD patients. Appropriately controlling for disease severity also accounts for costs otherwise associated with lower socioeconomic status. PMID:23703646

  18. Qui tam claims: threat to voluntary compliance programs in health care organizations.

    PubMed

    Ruhnka, J C; Gac, E J; Boerstler, H

    2000-04-01

    The Department of Justice (DOJ) reports that after violent crime, health care fraud is the department's top priority. The number of health care fraud investigations pending at the DOJ increased from 270 cases in 1992 to more than 4,000 in 1997. The DOJ's primary weapon in prosecuting health care fraud is the federal False Claims Act (FCA) of 1863 (31 U.S.C. secs. 3729-3733). Almost unique among federal antifraud provisions, the FCA may also be used by "private prosecutors" to file lawsuits on behalf of the federal government charging organizations with submitting false claims to the government. The FCA rewards such whistle-blowers with a share of any resulting recoveries as a bounty and protects them from discharge for filing false claims lawsuits against their employers. It also requires defendants to pay the costs and attorneys fees of successful claimants. Although the private "bounty hunter" features of the FCA data back to the Civil War, these so-called qui tam claims were nearly dormant until 1986, when Congress amended the FCA to revive their use. Following the 1986 amendments, and paralleling the rapid increase in federal reimbursements for health care costs, private qui tam claims have far expanded beyond their traditional purview of defense contracts into the field of health care. By 1997, health care providers were the targets of 54 percent of the 530 private qui tam lawsuits field that year. PMID:10946381

  19. Accounting for natural organic matter in aqueous chemical equilibrium models: a review of the theories and applications

    NASA Astrophysics Data System (ADS)

    Dudal, Yves; Gérard, Frédéric

    2004-08-01

    Soil organic matter consists of a highly complex and diversified blend of organic molecules, ranging from low molecular weight organic acids (LMWOAs), sugars, amines, alcohols, etc., to high apparent molecular weight fulvic and humic acids. The presence of a wide range of functional groups on these molecules makes them very reactive and influential in soil chemistry, in regards to acid-base chemistry, metal complexation, precipitation and dissolution of minerals and microbial reactions. Out of these functional groups, the carboxylic and phenolic ones are the most abundant and most influential in regards to metal complexation. Therefore, chemical equilibrium models have progressively dealt with organic matter in their calculations. This paper presents a review of six chemical equilibrium models, namely N ICA-Donnan, E Q3/6, G EOCHEM, M INTEQA2, P HREEQC and W HAM, in light of the account they make of natural organic matter (NOM) with the objective of helping potential users in choosing a modelling approach. The account has taken various faces, mainly by adding specific molecules within the existing model databases (E Q3/6, G EOCHEM, and P HREEQC) or by using either a discrete (W HAM) or a continuous (N ICA-Donnan and M INTEQA2) distribution of the deprotonated carboxylic and phenolic groups. The different ways in which soil organic matter has been integrated into these models are discussed in regards to the model-experiment comparisons that were found in the literature, concerning applications to either laboratory or natural systems. Much of the attention has been focused on the two most advanced models, W HAM and N ICA-Donnan, which are able to reasonably describe most of the experimental results. Nevertheless, a better knowledge of the humic substances metal-binding properties is needed to better constrain model inputs with site-specific parameter values. This represents the main axis of research that needs to be carried out to improve the models. In addition to

  20. Closing the health equity gap: evidence-based strategies for primary health care organizations

    PubMed Central

    2012-01-01

    Introduction International evidence shows that enhancement of primary health care (PHC) services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a) the key dimensions of equity-oriented services to guide PHC organizations, and (b) strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations. Methods The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a) in-depth interviews with a total of 114 participants (73 patients; 41 staff), (b) over 900 hours of participant observation, and (c) an analysis of key organizational documents, which shed light on the policy and funding environments. Results Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions. Conclusions These evidence- and theoretically-informed key dimensions and

  1. Organic UV filters in personal care products in Switzerland: a survey of occurrence and concentrations.

    PubMed

    Manová, Eva; von Goetz, Natalie; Hauri, Urs; Bogdal, Christian; Hungerbühler, Konrad

    2013-07-01

    Organic ultraviolet (UV) filters are a group of compounds designed to absorb UV radiation and hence protect our skin against UV-induced damage. Apart from traditional sunscreens, they can be found in many other categories of personal care products (PCPs). These include skin care, facial makeup and lip care products, which are often used simultaneously, and on a regular basis. The frequency of occurrence as well as concentrations of organic UV filters contained in PCPs change over time. Furthermore, in Switzerland the exact UV filter concentrations are confidential. To date, only limited data are available for the levels of organic UV filters in PCPs, and these data refer mainly to sunscreens. In this paper, we provide an up-to-date frequency of occurrence and concentrations of organic UV filters in PCPs, including for the first time PCPs used in everyday life. A total of 116 PCPs was selected on the basis of a product-use questionnaire and distributed among seven PCP categories: lip care products, lipsticks, face creams, liquid makeup foundations, aftershaves, hand creams, and sunscreens. Concentrations of 22 organic UV filters were measured in the selected PCPs. The most frequently occurring UV filters were butyl methoxydibenzoylmethane (BMBM) detected in 82 products (71%), ethylhexyl methoxycinnamate (EHMC) in 59 products (51%) and octocrylene (OCT) in 50 products (43%). BMBM, EHMC and OCT concentrations averaged 2.6%, 4.0%, and 6.0%, respectively. Overall, UV filter concentrations in PCPs applied regularly throughout the year can be as high as those in sunscreens that are primarily used for sun protection and hence applied only on selected days. PCPs that are used on a regular basis, and often simultaneously, thus represent an important and, as yet, unquantified source of UV filter exposure. This study provides essential information for aggregate exposure assessments that combine data on concentrations of individual UV filters widely used in a variety of PCP

  2. An uncertain risk: the World Health Organization's account of H1N1.

    PubMed

    Abeysinghe, Sudeepa

    2014-09-01

    Scientific uncertainty is fundamental to the management of contemporary global risks. In 2009, the World Health Organization (WHO) declared the start of the H1N1 Influenza Pandemic. This declaration signified the risk posed by the spread of the H1N1 virus, and in turn precipitated a range of actions by global public health actors. This article analyzes the WHO's public representation of risk and examines the centrality of scientific uncertainty in the case of H1N1. It argues that the WHO's risk narrative reflected the context of scientific uncertainty in which it was working. The WHO argued that it was attempting to remain faithful to the scientific evidence, and the uncertain nature of the threat. However, as a result, the WHO's public risk narrative was neither consistent nor socially robust, leading to the eventual contestation of the WHO's position by other global public health actors, most notably the Council of Europe. This illustrates both the significance of scientific uncertainty in the investigation of risk, and the difficulty for risk managing institutions in effectively acting in the face of this uncertainty. PMID:25233744

  3. The role for leaders of health care organizations in patient safety.

    PubMed

    Clarke, John R; Lerner, Jeffrey C; Marella, William

    2007-01-01

    We review what leaders of health care systems, including chief executive officers and board members, need to know to have "patient safety literacy" and do to make their systems safe. High reliability organizations produce reliable results that are not dependent on providers being perfect. Their characteristics include the commitment of leadership to safety as a system responsibility, with a culture of safety that decreases variability with standardized care and does not condone "at-risk behavior." A business case can be made for investing resources into systems that produce good outcomes reliably. Leaders must see patient safety problems as problems with their system, not with their employees. Leaders need to give providers information to make and monitor system progress. All medical errors, including near misses, and processes associated with all adverse events may provide information for system improvement. Improving systems should produce better long-term results than educating workers to be more careful. PMID:17804390

  4. Queues and care: how medical residents organize their work in a busy clinic.

    PubMed

    Finlay, W; Mutran, E J; Zeitler, R R; Randall, C S

    1990-09-01

    How do medical residents organize their work in settings where queue demands are heavy and resources are limited? Under such conditions, a queue theory would predict the delivery of care that is indifferent to clients' needs or that gets rid of clients as quickly as possible. In an exploratory case study of medical residents in a Veterans Administration outpatient clinic, we found instead that the medical residents' work was characterized by a high level of professional commitment: they provided thorough medical examinations and attempted to expedite patient care in other ways. We attribute the residents' professional ethos to opportunities provided in the VA hospital to learn the craft of routine medicine and to be directly responsible for patient care; such opportunities were not available in other settings. PMID:2133482

  5. Baseline map of organic carbon in Australian soil to support national carbon accounting and monitoring under climate change.

    PubMed

    Viscarra Rossel, Raphael A; Webster, Richard; Bui, Elisabeth N; Baldock, Jeff A

    2014-09-01

    We can effectively monitor soil condition-and develop sound policies to offset the emissions of greenhouse gases-only with accurate data from which to define baselines. Currently, estimates of soil organic C for countries or continents are either unavailable or largely uncertain because they are derived from sparse data, with large gaps over many areas of the Earth. Here, we derive spatially explicit estimates, and their uncertainty, of the distribution and stock of organic C in the soil of Australia. We assembled and harmonized data from several sources to produce the most comprehensive set of data on the current stock of organic C in soil of the continent. Using them, we have produced a fine spatial resolution baseline map of organic C at the continental scale. We describe how we made it by combining the bootstrap, a decision tree with piecewise regression on environmental variables and geostatistical modelling of residuals. Values of stock were predicted at the nodes of a 3-arc-sec (approximately 90 m) grid and mapped together with their uncertainties. We then calculated baselines of soil organic C storage over the whole of Australia, its states and territories, and regions that define bioclimatic zones, vegetation classes and land use. The average amount of organic C in Australian topsoil is estimated to be 29.7 t ha(-1) with 95% confidence limits of 22.6 and 37.9 t ha(-1) . The total stock of organic C in the 0-30 cm layer of soil for the continent is 24.97 Gt with 95% confidence limits of 19.04 and 31.83 Gt. This represents approximately 3.5% of the total stock in the upper 30 cm of soil worldwide. Australia occupies 5.2% of the global land area, so the total organic C stock of Australian soil makes an important contribution to the global carbon cycle, and it provides a significant potential for sequestration. As the most reliable approximation of the stock of organic C in Australian soil in 2010, our estimates have important applications. They could support

  6. Baseline map of organic carbon in Australian soil to support national carbon accounting and monitoring under climate change

    PubMed Central

    Viscarra Rossel, Raphael A; Webster, Richard; Bui, Elisabeth N; Baldock, Jeff A

    2014-01-01

    We can effectively monitor soil condition—and develop sound policies to offset the emissions of greenhouse gases—only with accurate data from which to define baselines. Currently, estimates of soil organic C for countries or continents are either unavailable or largely uncertain because they are derived from sparse data, with large gaps over many areas of the Earth. Here, we derive spatially explicit estimates, and their uncertainty, of the distribution and stock of organic C in the soil of Australia. We assembled and harmonized data from several sources to produce the most comprehensive set of data on the current stock of organic C in soil of the continent. Using them, we have produced a fine spatial resolution baseline map of organic C at the continental scale. We describe how we made it by combining the bootstrap, a decision tree with piecewise regression on environmental variables and geostatistical modelling of residuals. Values of stock were predicted at the nodes of a 3-arc-sec (approximately 90 m) grid and mapped together with their uncertainties. We then calculated baselines of soil organic C storage over the whole of Australia, its states and territories, and regions that define bioclimatic zones, vegetation classes and land use. The average amount of organic C in Australian topsoil is estimated to be 29.7 t ha−1 with 95% confidence limits of 22.6 and 37.9 t ha−1. The total stock of organic C in the 0–30 cm layer of soil for the continent is 24.97 Gt with 95% confidence limits of 19.04 and 31.83 Gt. This represents approximately 3.5% of the total stock in the upper 30 cm of soil worldwide. Australia occupies 5.2% of the global land area, so the total organic C stock of Australian soil makes an important contribution to the global carbon cycle, and it provides a significant potential for sequestration. As the most reliable approximation of the stock of organic C in Australian soil in 2010, our estimates have important applications. They

  7. Back to the future? Health benefits, organized labor, and universal health care.

    PubMed

    Gottschalk, Marie

    2007-12-01

    The umbrella of employment-based health benefits is growing increasingly threadbare. As a result, health benefits are once again a major arena of labor-management strife, and once again calls for universal health care by many labor leaders mask important differences between them over health care reform. Some labor leaders advocate a bottom-up mobilization in support of a single-payer solution that would dismantle the system of job-based benefits rooted in private insurance. Others stake their health care strategy on wooing key business leaders to be constructive partners in some kind of unspecified comprehensive reform of the health system. Organized labor faces enormous obstacles, both institutional and ideological, to forging an effective united front to fight for comprehensive, high-quality, affordable health care for all. Two entrenched features of the shadow welfare state of job-based benefits, notably the Employee Retirement Income Security Act (ERISA) of 1974 and the union-run health and welfare funds created under the Taft-Hartley Act, remain daunting barriers on the road to reform, exacerbating tensions and differences within organized labor. Moreover, a dramatic ideological schism in the labor movement about its future direction vexes its stance on health care reform. These ideological differences fuel vastly different views within organized labor about how best to confront the unraveling of job-based health benefits and the growing popularity among business leaders, insurers, and public officials of the "individual-mandate" solution, which would penalize people who do not have adequate health insurance. PMID:18000156

  8. Ergonomic considerations loom large as hospitals and other health care organizations rapidly adopt IT tools.

    PubMed

    2013-03-01

    Unless hospitals and other health care organizations change course, they can expect to see a steep rise in repetitive strain injuries among providers related to the adoption of electronic medical record (EMR) systems and other IT tools, according to ergonomic experts.They urge hospital and ED administrators to consider how and where technology will be used when planning IT installations, and to take steps to ensure that workstations, mobile devices, and other IT tools are used properly, with minimal provider discomfort. Researchers queried 179 physicians about their computer use, finding that a majority of female physicians and more than 40% of male physicians were suffering from upper-body repetitive strain ailments on at least a weekly basis. Ergonomic experts say that hospitals and other health care organizations need to heed the missteps of other industries that computerized in the 1980s and 1990s, resulting in a flood of repetitive strain injuries. PMID:23479815

  9. Assessing governance theory and practice in health-care organizations: a survey of UK hospices.

    PubMed

    Chambers, Naomi; Benson, Lawrence; Boyd, Alan; Girling, Jeff

    2012-05-01

    This paper sets out a theoretical framework for analyzing board governance, and describes an empirical study of corporate governance practices in a subset of non-profit organizations (hospices in the UK). It examines how practices in hospice governance compare with what is known about effective board working. We found that key strengths of hospice boards included a strong focus on the mission and the finances of the organizations, and common weaknesses included a lack of involvement in strategic matters and a lack of confidence, and some nervousness about challenging the organization on the quality of clinical care. Finally, the paper offers suggestions for theoretical development particularly in relation to board governance in non-profit organizations. It develops an engagement theory for boards which comprises a triadic proposition of high challenge, high support and strong grip. PMID:22673698

  10. Utilization of the organ care system as ex-vivo lung perfusion after cold storage transportation.

    PubMed

    Mohite, P N; Maunz, O; Popov, A-F; Zych, B; Patil, N P; Simon, A R

    2015-11-01

    The Organ Care System (OCS) allows perfusion and ventilation of the donor lungs under physiological conditions. Ongoing trials to compare preservation with OCS Lung with standard cold storage do not include donor lungs with suboptimal gas exchange and donor lungs treated with OCS following cold storage transportation. We present a case of a 48-yr-old man who received such lungs after cold storage transportation treated with ex-vivo lung perfusion utilizing OCS. PMID:25662732

  11. [Fluid management and care for multiple organ dysfunction syndrome in patients with extensive burns].

    PubMed

    Shinozawa, Yotaro

    2005-12-01

    Burn shock and multiple organ dysfunction syndrome (MODS) are the main causes of death in patients with extensive burns, and thus fluid management and care for MODS are crucial in the treatment of these patients. Several fluid formulas have been developed, although there is still controversy over the best formula. The important point is to understand how to deal with the different side effects inevitable with each fluid therapy: fluid restriction and/or diuretic administration in the refilling phase in fluid therapy with crystalloid, care for hypernatremia and/or a hyperosmolar state in fluid therapy with hypertonic lactated solution (HLS), etc. Precise fluid management is needed for aged patients, patients with extensive inhalation injury, extensive electric injury, and myocardial dysfunction, or patients in whom the start of fluid treatment was delayed. MODS in extensively burned patients is attributed to overwhelming burn stress and complicated sepsis, including bacterial translocation (BT). A dysfunctioning organ impairs another organ (organ interrelationships), and therefore substitution and/or recovery of a dysfunctioning organ are crucial. Debridement of skin with third-degree burns, suppression of BT, sanitary airway management, avoidance of unnecessary stress, and mediator modulation to stop the mediator cascade inducing MODS are also crucial. PMID:16869126

  12. Redesigning Health Care Organizations: The Influence of Government Policy and Methods of Payment.

    PubMed

    Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

    2015-12-01

    Over the last 5 years, there has been a growing trend toward consolidation in the health care field. As reimbursement moves from a fee-for-service model to a value-based model, there will be continued pressure on physicians to either be a hospital employee or to be in a large multidisciplinary practice. This is largely due to the Accountable Care Act, which directs payers to utilize population-based cost analyses, rather than an individual patient-based analysis. To succeed in this environment, practices will have to break down traditional organizational barriers to create evidence-based algorithms for the treatment of individual diagnoses from the initial onset of symptoms until the resolution of symptoms. PMID:26536095

  13. Diversity and cultural competence training in health care organizations: hallmarks of success.

    PubMed

    Curtis, Ellen Foster; Dreachslin, Janice L; Sinioris, Marie

    2007-01-01

    The authors reviewed recent literature on diversity training interventions and identified effective practices for health care organizations. Self-reported satisfaction was especially likely to be found as a result of training, whereas attitude change measured by standardized instruments was mixed. Although those responsible for diversity training in the workplace agree that behavioral change is key, awareness building and associated attitude change remain the focus of most diversity training in the workplace. Consequently, the authors recommend a systems approach to diversity training interventions wherein training is a key component of a health care organization's strategic approach to organizational performance, and diversity training is linked to the organizations' strategic goals for improved quality of care. The systems approach requires these steps: determine diversity and cultural competence goals in the context of strategy, measure current performance against needs, design training to address the gap, implement the training, assess training effectiveness, and strive for continuous improvement. Higher level evaluations measuring whether employees have transferred learning from training to their jobs are paramount to the systems approach to diversity training interventions. Measuring other positive changes in a "return on investment" format can be used to convince stakeholders of training's value. PMID:17938595

  14. Emerging opportunities for educational partnerships between managed care organizations and academic health centers.

    PubMed Central

    Nash, D B; Veloski, J J

    1998-01-01

    Medical schools, teaching hospitals, and managed care organizations have a vested interest in shaping the knowledge, skills, and attitudes of the next generation of physicians who must adapt to significant changes in the financing and delivery of health care. This article summarizes the rationale for educational partnerships between managed care and academic medicine based on a review of three decades of well-documented experimentation in the literature. Discussed are some of the most important characteristics of the successful partnerships being forged in the current healthcare environment based on new kinds of relationships between faculty and non-university clinician educators. What had been referred to in previous decades as the "teaching-HMO" is now being complemented by community-based links between academic health centers and managed care plans. Several public and private sources have been generous in providing venture capital to support many of these innovations. However, their continued operation will depend on models for health care networks that can identify and manage the revenue and costs associated with the missions of education, clinical services, and research. PMID:9614788

  15. Mergers and acquisitions in Western European health care: exploring the role of financial services organizations.

    PubMed

    Angeli, Federica; Maarse, Hans

    2012-05-01

    Recent policy developments in Western European health care - for example in the Netherlands - aim to enhance efficiency and curb public expenditures by strengthening the role of private sector. Mergers and acquisitions (M&As) play an important role in this respect. This article presents an analysis of 1606 acquisition deals targeting health care provider organizations in Western Europe between 1990 and 2009. We particularly investigate the role of financial services organisations as acquirers. Our analysis highlights (a) a rise of M&As in Western Europe since 2000, (b) an increase of M&As with financial service organisations acting as acquirer in absolute terms, and (c) a dominant role of the latter type of M&As in cross-border deals. To explain these developments, we make a distinction between an integration and a diversification rationale for M&As and we argue that the deals with financial services organisations in the role of acquirer are driven by a diversification rationale. We then provide arguments why health care, from the acquirer's perspective, can be considered as an interesting target in a diversification strategy and we advance reasons why health care providers may welcome this development. Although caution in drawing conclusions is needed, our findings suggest a penetration of private capital into health care provision that may be interpreted as a specific form of privatisation. Furthermore, they point to a rising internationalisation of health care. Both findings may entail far-reaching implications for health care, as they may induce both cultural privatisation and cultural internationalisation. PMID:22440195

  16. Accounting for Accountability.

    ERIC Educational Resources Information Center

    Colorado State Dept. of Education, Denver. Cooperative Accountability Project.

    This publication reports on two Regional Educational Accountability Conferences on Techniques sponsored by the Cooperative Accountability Project. Accountability is described as an "emotionally-charged issue" and an "operationally demanding concept." Overviewing accountability, major speakers emphasized that accountability is a means toward…

  17. Future Performance Trend Indicators: A Current Value Approach to Human Resources Accounting. Report II: Internal Consistencies and Relationships to Performance in Organization VI. Technical Report.

    ERIC Educational Resources Information Center

    Pecorella, Patricia A.; Bowers, David G.

    Conventional accounting systems provide no indication as to what conditions and events lead to reported outcomes, since they traditionally do not include measurements of the human organization and its relationship to events at the outcome stage. Human resources accounting is used to measure these additional types of data. This research is…

  18. Growing and Watching: For Profit Organizations Cautious about 2009--Twenty-Second Annual Status Report on for Profit Care

    ERIC Educational Resources Information Center

    Neugebauer, Roger; Weiss, Shasta Zenelle; Wilson, Mike

    2009-01-01

    This article presents the 22nd annual status report on for profit care. Despite a slowing economy, many larger for profit organizations managed to expand last year. During 2008, the second and third largest for profit organizations experienced changes in ownership. This year many of the surveyed organizations shared stories of efforts they are…

  19. Balancing Accountability with Caring Relationships: The Influence of Leadership Styles on the Behaviors of Secondary School Administrators

    ERIC Educational Resources Information Center

    Nell, Karen R.

    2012-01-01

    This case study examines secondary school leaders' perceptions of their ability to build positive relationships with the adolescents in their care as a means for improving students' academic performance. A sample of administrator participants was chosen from four suburban high schools with similar demographics located in the South Central…

  20. Organizing for Accountability

    ERIC Educational Resources Information Center

    Bennis, Warren

    1975-01-01

    A college president challenges personnel administrators to play a leadership role in human resource management. Notes the need for career development programs for middle managers particularly and recommends an organizational development approach to faculty and staff career development. (JT)

  1. [ANMCO/SIC Consensus document: The heart failure network: organization of outpatient care].

    PubMed

    Aspromonte, Nadia; Gulizia, Michele Massimo; Di Lenarda, Andrea; Mortara, Andrea; Battistoni, Ilaria; De Maria, Renata; Gabriele, Michele; Iacoviello, Massimo; Navazio, Alessandro; Pini, Daniela; Di Tano, Giuseppe; Marini, Marco; Ricci, Renato Pietro; Alunni, Gianfranco; Radini, Donatella; Metra, Marco; Romeo, Francesco

    2016-01-01

    Changing demographics and an increasing burden of multiple chronic comorbidities in western countries dictate refocusing of heart failure (HF) services from acute in-hospital care to better support the long inter-critical out-of-hospital phases of HF. The needs of the HF population are not adequately addressed by current HF outpatient services, as documented by differences in age, gender, comorbidities and recommended therapies between patients discharged for hospitalized HF and those followed up at HF clinics.The Working Group on Heart Failure of the Italian Association of Hospital Cardiologists (ANMCO) has drafted a consensus document for the organization of a national HF care network. The aims of this document are to describe tasks and requirements of the different health system points of contact for HF patients, and to define how diagnosis, management and care processes should be documented and shared among healthcare professionals. In this document, HF clinics are classified into three groups: 1) community HF clinics, devoted to the management of stable patients in strict liaison with primary care, regular re-evaluation of emerging clinical needs and prompt treatment of impending destabilizations, 2) hospital HF clinics, that target both new-onset and chronic HF patients for diagnostic assessment, treatment planning and early post-discharge follow-up. They act as main referral for medicine units and community clinics; 3) advanced HF clinics, directed at patients with severe disease or persistent clinical instability, candidates to advanced treatment options such as heart transplant or mechanical circulatory support. These different types of HF clinics are integrated in a dedicated network for the management of HF patients on a regional basis, according to geographic features. By sharing predefined protocols and communication systems, these HF networks integrate multiprofessional providers to ensure continuity of care. This consensus document is expected to

  2. Demonstrating marketing accountability.

    PubMed

    Gombeski, William R; Britt, Jason; Taylor, Jan; Riggs, Karen; Wray, Tanya; Adkins, Wanda; Springate, Suzanne

    2008-01-01

    Pressure on health care marketers to demonstrate effectiveness of their strategies and show their contribution to organizational goals is growing. A seven-tiered model based on the concepts of structure (having the right people, systems), process (doing the right things in the right way), and outcomes (results) is discussed. Examples of measures for each tier are provided and the benefits of using the model as a tool for measuring, organizing, tracking, and communicating appropriate information are provided. The model also provides a framework for helping management understand marketing's value and can serve as a vehicle for demonstrating marketing accountability. PMID:19064476

  3. Implications of new accounting rules for income taxes.

    PubMed

    Reinstein, A; Carmichael, B J; Spaulding, A D

    1994-02-01

    The provisions of the Financial Accounting Standards Board (FASB) Statement No. 109, Accounting for Income Taxes, require all organizations that issue financial statements to shift the focus of their accounting for income taxes from the income statement to the balance sheet. This change can alter significantly a healthcare organization's financial position. The change also may affect the way in which investors, lenders, regulators, and other users of financial statements evaluate corporations in the healthcare industry. Hospitals and other healthcare organizations, particularly for-profit organizations, therefore, should review carefully their methods of accounting for such items as deferred tax assets and loss and expense reserves. PMID:10145953

  4. [Care in a birth center according to the recommendations of the World Health Organization].

    PubMed

    Barbosa da Silva, Flora Maria; Rego da Paixão, Taís Couto; de Oliveira, Sonia Maria Junqueira Vasconcellos; Leite, Jaqueline Sousa; Riesco, Maria Luiza Gonzalez; Osava, Ruth Hitomi

    2013-10-01

    Birth centers are maternal care models that use appropriate technology when providing care to birthing women. This descriptive study aimed to characterize intrapartum care in a freestanding birth center, in light of the practices recommended by the World Health Organization (WHO), with 1,079 assisted births from 2006 to 2009 in the Sapopemba Birth Center, São Paulo, Brazil. Results included the use of intermittent auscultation (mean=7 controls); maternal positions during delivery: semi-sitting (82.3%), side-lying (16.0%), other positions (1.7%), oral intake (95.6%); companionship (93.3%); exposure to up to three vaginal examinations (85.4%), shower bathing (84.0%), walking (68.0%), massage (60.1%), exercising with a Swiss ball (51.7%); amniotomy (53.4%), oxytocin use during the first (31.0%) and second stages of labor (25.8%), bath immersion (29.3%) and episiotomy (14.1%). In this birth center, care providers used practices recommended by the WHO, although some practices might have been applied less frequently. PMID:24346440

  5. Tracking the Global Distribution of Persistent Organic Pollutants Accounting for E-Waste Exports to Developing Regions.

    PubMed

    Breivik, Knut; Armitage, James M; Wania, Frank; Sweetman, Andrew J; Jones, Kevin C

    2016-01-19

    Elevated concentrations of various industrial-use Persistent Organic Pollutants (POPs), such as polychlorinated biphenyls (PCBs), have been reported in some developing areas in subtropical and tropical regions known to be destinations of e-waste. We used a recent inventory of the global generation and exports of e-waste to develop various global scale emission scenarios for industrial-use organic contaminants (IUOCs). For representative IUOCs (RIUOCs), only hypothetical emissions via passive volatilization from e-waste were considered whereas for PCBs, historical emissions throughout the chemical life-cycle (i.e., manufacturing, use, disposal) were included. The environmental transport and fate of RIUOCs and PCBs were then simulated using the BETR Global 2.0 model. Export of e-waste is expected to increase and sustain global emissions beyond the baseline scenario, which assumes no export. A comparison between model predictions and observations for PCBs in selected recipient regions generally suggests a better agreement when exports are accounted for. This study may be the first to integrate the global transport of IUOCs in waste with their long-range transport in air and water. The results call for integrated chemical management strategies on a global scale. PMID:26669722

  6. Sequential organ failure assessment scoring and prediction of patient's outcome in Intensive Care Unit of a tertiary care hospital

    PubMed Central

    Jain, Aditi; Palta, Sanjeev; Saroa, Richa; Palta, Anshu; Sama, Sonu; Gombar, Satinder

    2016-01-01

    Background and Aims: The objective was to determine the accuracy of sequential organ failure assessment (SOFA) score in predicting outcome of patients in Intensive Care Unit (ICU). Material and Methods: Forty-four consecutive patients between 15 and 80 years admitted to ICU over 8 weeks period were studied prospectively. Three patients were excluded. SOFA score was determined 24 h postadmission to ICU and subsequently every 48 h for the first 10 days. Patients were followed till discharge/death/transfer from the ICU. Initial SOFA score, highest and mean SOFA scores were calculated and correlated with mortality and duration of stay in ICU. Results: The mortality rate was 39% and the mean duration of stay in the ICU was 9 days. The maximum score in survivors (3.92 ± 2.17) was significantly lower than nonsurvivors (8.9 ± 3.45). The initial SOFA score had a strong statistical correlation with mortality. Cardiovascular score on day 1 and 3, respiratory score on day 7, and coagulation profile on day 3 correlated significantly with the outcome. Duration of the stay did not correlate with the survival (P = 0.461). Conclusion: SOFA score is a simple, but effective prognostic indicator and evaluator for patient progress in ICU. Day 1 SOFA can triage the patients into risk categories. For further management, mean and maximum score help determine the severity of illness and can act as a guide for the intensity of therapy required for each patient.

  7. An organized approach to trauma care: legacy of R Adams Cowley.

    PubMed

    Edlich, Richard F; Wish, John R; Britt, L D; Long, William B

    2004-01-01

    The organized approach to caring for trauma patients was introduced into the civilian setting by the innovative pioneer, R Adams Cowley. His system in Maryland has the following 11 components: (1) a State Police Aviation Division that transports patients throughout the State; (2) trained paramedics at the scene of the accident as well as on the helicopter, who will stabilize the patients en route to the Shock Trauma Center; (3) one central dispatch communication center in Baltimore that coordinates information between paramedics and the Trauma Center; (4) a Shock Trauma Center with a helicopter landing zone near the building; (5) trained trauma nurses and trauma technicians to transfer the patient from the helicopter by stretcher to the resuscitation area; if there is a special complication, such as an airway problem, the anesthesiologist and or trauma surgeon may meet the helicopter on the roof as well; (6) trauma surgeons, board-certified in surgery, with a certificate of added qualification in surgical critical care, to treat the critically ill trauma patients in the resuscitation area; (7) a CT scan and portable X-ray units in the admission area that aid in the diagnosis of the injury; (8) operating rooms adjacent to the admission area for repair of trauma injuries; (9) a surgical intensive unit to care for the trauma patient; (10) a team of specialty physicians trained in a wide variety of specialties who work as a multidisciplinary unit caring for the hospitalized patient; and (11) an ambulatory outpatient unit that allows the patient to be followed in the center after discharge. Dr. R Adams Cowley incorporated each of these 11 components for an organized trauma center into Maryland. In recognition of his landmark contributions to trauma, the eight-story Shock Trauma Center was named the R Adams Cowley Shock Trauma Center. There is growing evidence that this organized system in trauma care seen in Maryland must be replicated in every state in our nation. The

  8. Information on Prime Sponsor CETA Expenditures Related to Membership Organizations. Report to the Honorable William L. Clay, House of Representatives, by the U.S. General Accounting Office.

    ERIC Educational Resources Information Center

    Comptroller General of the U.S., Washington, DC.

    The United States General Accounting Office reviewed prime sponsor use of Comprehensive Employment and Training Act (CETA) funds for activities related to membership organizations. Data was gathered by mailed questionnaires to 474 prime sponsors (89 percent response rate), site visits to national membership organizations, attendance at conferences…

  9. The effect of for-profit laboratories on the accountability, integration, and cost of Canadian health care services

    PubMed Central

    Sutherland, Ross

    2012-01-01

    Abstract Canadian public health care systems pay for-profit corporations to provide essential medical laboratory services. This practice is a useful window on the effects of using for-profit corporations to provide publicly funded services. Because private corporations are substantially protected by law from the public disclosure of “confidential business information,” increased for-profit delivery has led to decreased transparency, thus impeding informed debate on how laboratory services are delivered. Using for-profit laboratories increases the cost of diagnostic testing and hinders the integration of health care services more generally. Two useful steps toward ending the for-profit provision of laboratory services would be to stop fee-for-service funding and to integrate all laboratory work within public administrative structures. PMID:23687532

  10. Enabling student placement through strategic partnerships between a health-care organization and tertiary institutions.

    PubMed

    Henderson, Amanda; Heel, Alison; Twentyman, Michelle

    2007-01-01

    Nursing management needs to demonstrate its commitment to clinical education for undergraduate nursing students. The vision for the nursing leadership and management team at Princess Alexandra Hospital is to guide and support the development of hospital clinicians, at all levels in the organization, to effectively facilitate undergraduate students' learning during their clinical practical experiences. This paper examines the evolution of the meaning, commitment and practices that have been intrinsic to the development of strategic partnerships between the health-care organization and tertiary institutions to ensure that hospital staff who consistently facilitate student learning in the clinical context are well supported. The partnerships are based on open channels of communication between the health-care organization and the tertiary institutions whereby each party identifies its needs and priorities. This has resulted in increased hospital staff satisfaction through greater involvement by them in the placements of students, and enhanced understanding of clinicians of the student placement process that has contributed to improved satisfaction and outcomes for the students. PMID:17207012

  11. Safety subcultures in health-care organizations and managing medical error.

    PubMed

    Sirriyeh, Reema; Lawton, Rebecca; Armitage, Gerry; Gardner, Peter; Ferguson, Sally

    2012-02-01

    Leadership has been proposed as a key latent factor influencing the safety culture of an organization, the likelihood of errors occurring and the way in which these are managed. Therefore, when an error occurs, managers have an integral role to ensure that the most desirable outcomes are achieved for patients, health-care staff and their organization. Semistructured interviews were conducted in a large UK teaching hospital to explore the perspectives of staff who are tasked in some way with managing patient safety. Data from 26 transcripts were analysed using an adapted version of Spencer's (2003) qualitative framework, which revealed five primary themes. This paper reports findings from two overarching primary themes, described as being management and safety subcultures. These themes describe experiences of managing medical errors and the subgroup variations between professions, ranks and specialties in attitudes and behaviours towards error, and its management in a large National Health Service Trust. We discuss implications for health-care managers and health professionals in developing a stronger and more unified safety culture in their organizations, along with considerations for academic researchers when undertaking health services research. PMID:22323667

  12. [Dental care of patients with organ transplants or prosthetic joints--a survey of specialty hospitals].

    PubMed

    Nusime, Anne; Heide, Clarissa V D; Hornecker, Else; Mausberg, Rainer F; Ziebolz, Dirk

    2011-01-01

    The aim of the investigation was to collect information from specialized hospitals regarding dental care before and after organ transplantation or replacement of prosthetic joints. 50 transplantation centres and 100 orthopaedic hospitals in Germany were chosen. A questionnaire was used to elucidate the following aspects: Is a dental examination carried out preoperatively? When the patient is discharged, is he or she recommended to have antibiotic prophylaxis before dental treatment? If so, which antibiotic is recommended? The response rate was 56% (n = 28) for transplantation centres. 89% arranged a dental examination before the transplantation. 83% of those questioned recommend antibiotic prophylaxis before dental treatment: Amoxicillin was mentioned most frequently (36%). The response rate of the orthopaedic hospitals was 31% (n = 31). 3% of those questioned arranged a dental examination before insertion of an endoprothesis. 55% recommend antibiotic prophylaxis when dental treatment is to be carried out following the insertion of the endoprosthesis. Cephalosporine was most frequently mentioned (33%). It was not possible to identify a uniform recommendation regarding dental care before and after organ transplantation or replacement of prosthetic joints either for patients with an organ transplant or those having a prosthetic joint. PMID:21656390

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

    PubMed

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

    1998-05-15

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

  14. Corporate compliance plans in health care organizations: a top-down perspective.

    PubMed

    Forgione, D A

    1998-01-01

    Recently, at an all-day professional meeting that was targeted at about 100 junior-level health care financial professionals, we covered a whole spectrum of subjects. We covered topics ranging from the Hill-Burton Act to Medicare managed care organizations (MCOs) and capitation; the Stark rules on physician self-referral; the financial incentives within various payment systems for physicians, hospitals, and other providers; Medicare fraud and abuse rules; and the need for well-designed corporate compliance plans. After responding to a number of the participants' questions, I could not help but be reminded of the students every semester who ask me, "Will this be on the test?" In other words, if there are no real teeth in the subject, then they have too many other urgent priorities demanding their attention to give the issue serious consideration. Perhaps this highlights the need for taking corporate compliance planning seriously--starting at the top levels of the organization. It is well documented that leadership attitudes filter downward in any organization. If change for the better is going to take place in the area of corporate compliance, it needs to begin with each of us as individuals, from the top down. PMID:9612741

  15. 42 CFR 476.72 - Review of the quality of care of risk-basis health maintenance organizations and competitive...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT... Quality Improvement Organizations (QIOs) General Provisions § 476.72 Review of the quality of care of risk... 42 Public Health 4 2011-10-01 2011-10-01 false Review of the quality of care of risk-basis...

  16. Care of the old—A matter of ethics, organization and relationships

    PubMed Central

    Engström, Gabriella

    2012-01-01

    The world stands on the threshold of a demographic revolution called global ageing. According to the World Health Organization (WHO), the population aged 60 and over is expected to increase from today's 650 million to an estimated 2 billion by 2050. Alongside demographic changes, dramatic changes can also be observed in older people's services. The shift has resulted in reduced government spending on caring for ill and frail older people in health care. Today, many governments have developed strategies to keep older people living well in their private home for as long as possible and have replaced long-term care institutions with residential homes. The aim of this study was to illuminate the meaning of caring for older people as experienced by health care students and professionals working in this field. Interviews were carried out with 17 women and one man, aged 21–65 years; six were Registered Nurses (RN), six were Enrolled Nurses (EN) and six were nursing students. The interviews were analyzed with a phenomenological hermeneutical approach and provided three themes and eight sub-themes: Ethical moral self with sub-themes “meeting the needs of the old”, “pliability towards the old”, and “difficulties in meeting aggressiveness”; Organizational and co-workers ethical moral actions with sub-themes, “co-workers who are offensive”, and “supportive and non-supportive leaders”: The relation with the old persons and their relatives with sub-themes “fellowship and closeness in the relation”, “uncertainty and fear in the relation”, and, “demands from the older persons’ close relatives”. PMID:22577469

  17. The nursing organization and the transformation of health care delivery for the 21st century.

    PubMed

    Gilmartin, M J

    1998-01-01

    Market transformations occurring within the health care industry require new patterns of organization and management to meet the increasing complexity of service delivery. A greater understanding of the innovation and entrepreneurial dynamic allows administrators, managers, and leaders to create a new vision of service delivery. Central management and leadership objectives include the development of service technologies that capitalize upon the inherent knowledge of workers to meet consumer needs. A strong sense of innovation and entrepreneurship leading to the introduction of new or improved nursing technologies is a primary component in the evolution of professional nursing practice for the 21st century. PMID:9505707

  18. The process and results of departmental specific safety surveys for health care organizations. Successful program.

    PubMed

    Meittunen, E; Snyder, B; Meyer, M

    2001-04-01

    1. Meeting compliance and accreditation standards can be challenging for any organization, especially in the health care setting. Safety surveys can play a strategic role in proactively preparing for such events. 2. Implementing department specific safety surveys offers a tailored approach to monitoring and addressing the occupational safety issues that occur within each department. 3. Safety surveys are a method for assessing and monitoring the environment and employee training needs, and for driving safety decisions. 4. Safety in the workplace must be a shared and continuous responsibility among employees. A formal safety survey process instilling a culture of responsibility and "buy in" by all employees is necessary. PMID:11760523

  19. Transfer of risk: "right to sue" legislation and managed care organization stock performance.

    PubMed

    Weeks, W B; Nells, T; Wallace, A E

    2001-01-01

    We examined whether Congress's consideration of legislation that gave consumers the right to sue managed care organizations impacted the performance of these companies' stocks relative to that of the market. For each company examined, the total return related to such legislation was negative and substantially lower than that expected from the market model; losses in market value were from 17 percent to 48 percent for individual companies and 22 percent for a capitalization-weighted portfolio. The study suggests that equity markets responded to the proposed legislation quickly and that the impact of proposed legislation is felt through loss of market value and increased corporate risk. PMID:11669290

  20. Understanding Effects of Flexible Spending Accounts on People with Disabilities: The Case of a Consumer-Directed Care Program.

    PubMed

    Lombe, Margaret; Inoue, Megumi; Mahoney, Kevin; Chu, Yoosun; Putnam, Michelle

    2016-01-01

    This study set out to explore the saving behavior, barriers, and facilitators along with effects of participating in a consumer-directed care program among people with disabilities in the state of West Virginia (N = 29). Results suggest that respondents were able to save money through the program to enable them to purchase goods and services they needed to enhance their welfare and quality of life. Generally, items saved for fell into 3 broad categories: household equipment, individual functioning, and home modification. Facilitators and barriers to saving were also indicated and so were the benefits of program participation. Program and policy implications are presented. PMID:26623566

  1. Utilization of health services in Western Canada: basic Canadian data from the World Health Organization/International Collaborative Study of Medical Care Utilization.

    PubMed Central

    Matthews, V. L.; Feather, J.

    1976-01-01

    In a household health survey more than 15 000 individuals in four areas of Canada were interviewed as part of the World Health Organization/International Collaborative Study of Medical Care Utilization. Data were collected to describe the health services system in each area and to measure the population's utilization of health professionals, hospitals, medicines and selected preventive services, perceived acute and chronic morbidity, attitudes and beliefs about health and health care, and sociodemographic characteristics. The proportion of persons with perceived morbidity was twice that of persons reporting visits with a physician in the same 2-week period. Prescribed and nonprescribed medications had been used by more than 50% of respondents in each area in the 2 days before the interview, nonprescribed medicines accounting for more than half of this use. Respondents were found to be more sceptical of medical doctors than of medical science. PMID:1253067

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

    PubMed

    Gorski, Lisa A; Johnson, Kathy

    2003-01-01

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

  3. Stakeholders’ perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms

    PubMed Central

    2014-01-01

    Background Adequate care for individuals living with chronic illnesses calls for a healthcare system redesign, moving from acute, disease-centered to patient-centered models. The aim of this study was to identify Belgian stakeholders’ perceptions on the strengths, weaknesses, opportunities and threats of the healthcare system for people with chronic diseases in Belgium. Methods Four focus groups were held with stakeholders from the micro and meso level, in addition to two interviews with stakeholders who could not attend the focus group sessions. Data collection and the discussion were based on the Chronic Care model. Thematic analysis of the transcripts allowed for the identification of the strengths, weaknesses, opportunities and threats of the current health care system with focus on chronic care. Results Informants stressed the overall good quality of the acute health care system and the level of reimbursement of care as an important strength of the current system. In contrast, the lack of integration of care was identified as one of the biggest weaknesses of today’s health care system, along with the unclear definitions of the roles and functions of health professionals involved in care processes. Patient education to support self-management exists for patients with diabetes and/or terminal kidney failure but not for those living with other or multiple chronic conditions. The current overall fee-for-service system is a barrier to integrated care, as are the lack of incentives for integrated care. Attending multidisciplinary meetings, for example, is underfinanced to date. Finally, clinical information systems lack interoperability, which further impedes the information flow across settings and disciplines. Conclusion Our study’s methods allowed for the identification of problematic domains in the health system for people living with chronic conditions. These findings provided useful insights surrounding perceived priorities. This methodology may inspire

  4. Women and managed care.

    PubMed

    England, M J; Muchnick-Baku, S

    1997-01-01

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

  5. Critical Care for Multiple Organ Failure Secondary to Ebola Virus Disease in the United States

    PubMed Central

    Sueblinvong, Viranuj; Johnson, Daniel W.; Weinstein, Gary L.; Connor, Michael J.; Crozier, Ian; Liddell, Allison M.; Franch, Harold A.; Wall, Bruce R.; Kalil, Andre C.; Feldman, Mark; Lisco, Steven J.; Sevransky, Jonathan E.

    2016-01-01

    Objective This report describes three patients with Ebola virus disease who were treated in the United States and developed for severe critical illness and multiple organ failure secondary to Ebola virus infection. The patients received mechanical ventilation, renal replacement therapy, invasive monitoring, vasopressor support, and investigational therapies for Ebola virus disease. Data Sources Patient medical records from three tertiary care centers (Emory University Hospital, University of Nebraska Medical Center, and Texas Health Presbyterian Dallas Hospital). Study Selection Not applicable. Data Extraction Not applicable. Data Synthesis Not applicable. Conclusion In the severe form, patients with Ebola virus disease may require life-sustaining therapy, including mechanical ventilation and renal replacement therapy. In conjunction with other reported cases, this series suggests that respiratory and renal failure may occur in severe Ebola virus disease, especially in patients burdened with high viral loads. Ebola virus disease complicated by multiple organ failure can be survivable with the application of advanced life support measures. This collective, multicenter experience is presented with the hope that it may inform future treatment of patients with Ebola virus disease requiring critical care treatment. PMID:26196353

  6. Plasticity-Driven Self-Organization under Topological Constraints Accounts for Non-random Features of Cortical Synaptic Wiring

    PubMed Central

    Miner, Daniel; Triesch, Jochen

    2016-01-01

    Understanding the structure and dynamics of cortical connectivity is vital to understanding cortical function. Experimental data strongly suggest that local recurrent connectivity in the cortex is significantly non-random, exhibiting, for example, above-chance bidirectionality and an overrepresentation of certain triangular motifs. Additional evidence suggests a significant distance dependency to connectivity over a local scale of a few hundred microns, and particular patterns of synaptic turnover dynamics, including a heavy-tailed distribution of synaptic efficacies, a power law distribution of synaptic lifetimes, and a tendency for stronger synapses to be more stable over time. Understanding how many of these non-random features simultaneously arise would provide valuable insights into the development and function of the cortex. While previous work has modeled some of the individual features of local cortical wiring, there is no model that begins to comprehensively account for all of them. We present a spiking network model of a rodent Layer 5 cortical slice which, via the interactions of a few simple biologically motivated intrinsic, synaptic, and structural plasticity mechanisms, qualitatively reproduces these non-random effects when combined with simple topological constraints. Our model suggests that mechanisms of self-organization arising from a small number of plasticity rules provide a parsimonious explanation for numerous experimentally observed non-random features of recurrent cortical wiring. Interestingly, similar mechanisms have been shown to endow recurrent networks with powerful learning abilities, suggesting that these mechanism are central to understanding both structure and function of cortical synaptic wiring. PMID:26866369

  7. A decaying factor accounts for contained activity in neuronal networks with no need of hierarchical or modular organization

    NASA Astrophysics Data System (ADS)

    Amancio, Diego R.; Oliveira, Osvaldo N., Jr.; Costa, Luciano da F.

    2012-11-01

    The mechanisms responsible for containing activity in systems represented by networks are crucial in various phenomena, for example, in diseases such as epilepsy that affect the neuronal networks and for information dissemination in social networks. The first models to account for contained activity included triggering and inhibition processes, but they cannot be applied to social networks where inhibition is clearly absent. A recent model showed that contained activity can be achieved with no need of inhibition processes provided that the network is subdivided into modules (communities). In this paper, we introduce a new concept inspired in the Hebbian theory, through which containment of activity is achieved by incorporating a dynamics based on a decaying activity in a random walk mechanism preferential to the node activity. Upon selecting the decay coefficient within a proper range, we observed sustained activity in all the networks tested, namely, random, Barabási-Albert and geographical networks. The generality of this finding was confirmed by showing that modularity is no longer needed if the dynamics based on the integrate-and-fire dynamics incorporated the decay factor. Taken together, these results provide a proof of principle that persistent, restrained network activation might occur in the absence of any particular topological structure. This may be the reason why neuronal activity does not spread out to the entire neuronal network, even when no special topological organization exists. .

  8. Plasticity-Driven Self-Organization under Topological Constraints Accounts for Non-random Features of Cortical Synaptic Wiring.

    PubMed

    Miner, Daniel; Triesch, Jochen

    2016-02-01

    Understanding the structure and dynamics of cortical connectivity is vital to understanding cortical function. Experimental data strongly suggest that local recurrent connectivity in the cortex is significantly non-random, exhibiting, for example, above-chance bidirectionality and an overrepresentation of certain triangular motifs. Additional evidence suggests a significant distance dependency to connectivity over a local scale of a few hundred microns, and particular patterns of synaptic turnover dynamics, including a heavy-tailed distribution of synaptic efficacies, a power law distribution of synaptic lifetimes, and a tendency for stronger synapses to be more stable over time. Understanding how many of these non-random features simultaneously arise would provide valuable insights into the development and function of the cortex. While previous work has modeled some of the individual features of local cortical wiring, there is no model that begins to comprehensively account for all of them. We present a spiking network model of a rodent Layer 5 cortical slice which, via the interactions of a few simple biologically motivated intrinsic, synaptic, and structural plasticity mechanisms, qualitatively reproduces these non-random effects when combined with simple topological constraints. Our model suggests that mechanisms of self-organization arising from a small number of plasticity rules provide a parsimonious explanation for numerous experimentally observed non-random features of recurrent cortical wiring. Interestingly, similar mechanisms have been shown to endow recurrent networks with powerful learning abilities, suggesting that these mechanism are central to understanding both structure and function of cortical synaptic wiring. PMID:26866369

  9. A study of the perception and experiences of critical care nurses in caring for potential and actual organ donors: implications for nurse education.

    PubMed

    Watkinson, G E

    1995-11-01

    This paper describes a research study designed to explore the knowledge, perceptions and attitudes of practising critical care nurses towards caring for 'brain stem dead' cadaver organ donors and their families. The influence of formal nurse education and experiential learning were investigated together with what nurses felt could better prepare them for this role. Data were collected through self-completion questionnaires from 103 critical care nurses. This was instrumental in forming a semi-structured interview schedule whereby seven respondents were interviewed. The findings of the study suggest that nurses are very favourable towards organ donation and this correlated with their knowledge of brain stem death (P < 0.024). Nurses with between 6 and 10 years critical care experience had a significantly higher knowledge base (P < 0.05) than those of less or greater experience. Nevertheless, when challenged some nurses were less comfortable with the concept of brain stem death and caring for these patients. A degree of cognitive dissonance was identified. Discussion revealed that all nurses need to have a better understanding of their role in organ donation, no mater what nursing discipline they practice. This may help to expel some of the myths that have, undeservedly, become established and given the donor process a rather sinister image. PMID:8568068

  10. [THE ORGANIZATION OF REHABILITATION CARE OF POPULATION USING INNOVATIVE MEDICAL ORGANIZATIONAL TECHNOLOGIES AND PRINCIPLES OF PUBLIC PRIVATE PARTNERSHIP].

    PubMed

    Totskaia, E G; Sheliakina, O W; Sadovoii, M A; Netchaev, V S

    2015-01-01

    The article considers actual problems of actual stage of development of health care related to using innovative approaches to organization and management of rehabilitation care ofpopulation. The rehabilitation is most important direction of medical sector supporting complex of services in closed cycle of rendering medical care to population and significant social economic effects. The capacity and extreme unprofitability of rehabilitation services determine necessity of searching alternative forms of organization of this type of care and financing including mechanisms of public-private partnership. The experience is presented related to involvement of resources of non-public medical organizations for implementing public commitments on rendering qualitative rehabilitation services to population using innovative medical organizational technologies. PMID:26987174

  11. Realizing good care within a context of cross-cultural diversity: an ethical guideline for healthcare organizations in Flanders, Belgium.

    PubMed

    Denier, Yvonne; Gastmans, Chris

    2013-09-01

    In our globalizing world, health care professionals and organizations increasingly experience cross-cultural challenges in care relationships, which give rise to ethical questions regarding "the right thing to do" in such situations. For the time being, the international literature lacks examples of elaborated ethical guidelines for cross-cultural healthcare on the organizational level. As such, the ethical responsibility of healthcare organizations in realizing cross-cultural care remains underexposed. This paper aims to fill this gap by offering a case-study that illustrates the bioethical practice on a large-scale organizational level by presenting the ethical guideline developed in the period 2007-2011 by the Ethics Committee of Zorgnet Vlaanderen, a Christian-inspired umbrella organization for over 500 social profit healthcare organizations in Flanders, Belgium. The guideline offers an ethical framework within which fundamental ethical values are being analyzed within the context of cross-cultural care. The case study concludes with implications for healthcare practice on four different levels: (1) the level of the healthcare organization, (2) staff, (3) care receivers, and (4) the level of care supply. The study combines content-based ethics with process-based benchmarks. PMID:23906119

  12. Quality, value, accountability and information as transforming strategies for patient-centred care: a commentary from an international perspective.

    PubMed

    Ramirez, Bernardo; Nazaretian, Mihran

    2005-01-01

    The reviewed paper describes how one of the largest integrated healthcare systems in the US has successfully transformed itself to provide 21st-century healthcare. Even though there are other examples of successful transformation of public health services, it is difficult for large, bureaucratic systems to change, and a substantial number of ministries of health or social security health systems in the developing world are run under the assumption that change is very difficult if not impossible to achieve. The VA has significant differences and more financial resources compared to most of the developing world public health institutions; but still, change is often not only about money, but also about strategic direction, commitment and leadership. On the basis of the main strategies used by the VA in its transformation process, the author makes some comments and suggestions for improving developing world healthcare organizations through lessons learned from the VA management strategies. Demand-driven or patient-centred systems are key for success and for the buy-in and involvement of the population and users of healthcare services, but this is easier said than done, especially in developing healthcare systems with immature information systems, access mechanisms and knowledge management. There is a belief in general that large bureaucratic organizations have a hard time adapting and transforming in response to the rapid change of society, technology and most importantly the needs and expectations of their users. The article describes how the largest integrated healthcare organization in the United States, the Veterans Health Administration, has undertaken changes that have turned it into a modern, well-managed organization that outperforms its competitors and has significantly increased its efficiency and users' satisfaction. PMID:16088310

  13. Organ transplantation and the inevitable debate as to what constitutes a basic health care benefit.

    PubMed

    Evans, R W

    1993-01-01

    The need for health care reform is an economic reality. The urgency with which it must be pursued is apparent. The direction it will take is clear. The implications it has for transplantation are ambiguous. Managed competition will take time to implement, but managed care is here now and will surely become more prevalent. Thus, it is timely to examine the future of transplantation from the perspective of managed care. Foremost among our concerns is just how transplantation will factor into the debate as to what constitutes a basic health care benefits package. The National Cooperative Transplantation Study (NCTS) was undertaken to address a variety of clinical, economic, social, ethical, and quality-of-care issues. Based on a random sample of all transplants performed in the United States in 1988, individual assessments were made of charges for kidney, heart, liver, heart-lung, and pancreas transplantation. Insurance coverage and reimbursement policies and practices were also analyzed. In 1988 dollars Medicare procedure charges from date of transplant through date of initial discharge were as follows: kidney, $39,625; heart, $91,570; liver, $145,795; heart-lung, $134,881; and pancreas, $66,917. Both patient charges and outcomes were adversely affected by the patient's status prior to surgery, and by the need for retransplantation. The associations among transplant program activity, procedure charges, and patient outcomes varied. While insurance coverage for transplantation has steadily improved, hospital reimbursement is often well below billed charges, as a result, access for some patients may be limited. Organ transplantation is often criticized as too costly, given other health care needs. A recent report indicates that the total first-year charges for transplantation continue to increase. Estimated charges in 1993 dollars are as follows: kidney, $87,700; heart, $209,100; liver, $302,900; heart-lung, $246,000; pancreas, $65,000; and lung, $243,600. Although

  14. SU-E-J-62: Estimating Plausible Treatment Course Dose Distributions by Accounting for Registration Uncertainty and Organ Motion

    SciTech Connect

    Thor, M; Saleh, Z; Oh, JH; Apte, A; Deasy, J; Muren, L

    2014-06-01

    Purpose: Dose accumulation following deformable image registration (DIR) is challenging. In this study, we used a statistical sampling approach, which takes into account both DIR uncertainties and patient-specific organ motion, to study the distribution of possible true dose distributions. Methods: The study included ten patients (six CT scans/patient) treated with radiotherapy for prostate cancer. For each patient, the planned dose was re-calculated on the repeated geometries, following rigid registration based on fiducial markers. The dose re-calculated on the first CT served as our snapshot dose distribution (D1) and the average of the first five repeat scans as our treatment course reference dose distribution (Dref). Patient-specific motion and DIR-uncertainties, at each voxel in CT1, were assessed using a previously developed DIR performance measure, the distance discordance metric (DDM). To sample the distribution of possible true, predicted dose distributions (Dpred), we resampled D1 by perturbing the location of each voxel with the corresponding DDM. The three dose distribution approaches are compared for the rectum and the bladder. Results: The bladder generalized equivalent uniform dose (gEUD) from the averaged Dpred was closer to the gEUDref than to the gEUD1 (difference: 0.6 vs. 1.0 Gy). For both structures, the gEUDpred was higher than the gEUDref, and significantly higher (p≤0.05) for the rectum (average: 50.8 Gy vs. 48.0 Gy). Conclusion: We have shown that the bladder gEUD values resulting from our DIR-uncertainty inclusive dose sampling approach, Dpred, were closer to the gEUD from Dref than the gEUD values from D1. For the rectum, gEUDpred overestimated gEUDref. Theoretically however, gEUDpred values, sampled from DDM uncertainties are more representative of dose uncertainties.

  15. Beyond Care?

    ERIC Educational Resources Information Center

    Hedge, Nicki; Mackenzie, Alison

    2012-01-01

    Care is a feature of all of our lives, all of the time. An analysis of Scotland's Curriculum for Excellence reveals that care and caring permeate complex dimensions of life in and after school and we ask here, if, on some accounts, care can do the work required of it. Acknowledging the significance of her contribution to care, we focus on the work…

  16. [Health care levels and minimum recommendations for neonatal care].

    PubMed

    Rite Gracia, S; Fernández Lorenzo, J R; Echániz Urcelay, I; Botet Mussons, F; Herranz Carrillo, G; Moreno Hernando, J; Salguero García, E; Sánchez Luna, M

    2013-07-01

    A policy statement on the levels of care and minimum recommendations for neonatal healthcare was first proposed by the Standards Committee and the Board of the Spanish Society of Neonatology in 2004. This allowed us to define the level of care of each center in our country, as well as the health and technical requirements by levels of care to be defined. This review takes into account changes in neonatal care in the last few years and to optimize the location of resources. Facilities that provide care for newborn infants should be organized within a regionalized system of perinatal care. The functional capabilities of each level of care should be defined clearly and uniformly, including requirements for equipment, facilities, personnel, ancillary services, training, and the organization of services (including transport) needed to cover each level of care. PMID:23266243

  17. [Organization and delivery of therapeutic care in modern local wars and armed conflicts].

    PubMed

    Khalimov, Iu Sh; Tkachuk, N A; Zhekalov, A N

    2014-08-01

    The system of providing therapeutic care within a united system of staged treatment of wounded and sick and evacuation was established during the Great Patriotic War of 1941-1945 and helped to return 90,6% of casualties to duty. In terms of local wars and armed conflicts the most important task of military field therapy is to improve the provision of therapeutic support through regional and territorial principles, echeloning of forces and facilities, optimization of allocation of medical institutions in accordance with their capabilities, evacuation routes, etc. The organization of therapeutic assistance should be guided primarily by the size and structure of sanitary losses. In modern local wars cannot exclude the occurrence of massive sanitary losses with limited use of weapons of mass destruction, as a result of failure (with a conventional weapon or as a result of sabotage) of nuclear power plants, chemical plants, and transport containers containing toxic chemicals. PMID:25546952

  18. Programming, budgeting, and control in health care organization: the state of the art.

    PubMed Central

    Vraciu, R A

    1979-01-01

    The planning, budgeting, and controlling processes (PBCP) largely subsume all of the planning and controlling activities of an organization. This paper discusses these activities within the context of a single management control system, focusing on three topics. First, a brief historical perspective of management concerns which relate to PBCP is presented and several important external pressures currently imposed on the health care industry are discussed. Second, normative models of the processes--programming, budgeting, and controlling--are presented. The discussion focuses on the elements and relationships of these processes, and numerous references to the literature are provided. Third, several issues related to the gap between the state of the art in PBCP for hospitals and the current state of practice are discussed. PMID:116990

  19. Interprofessional meetings in geriatric assessment units: a matter of care organization.

    PubMed

    Leclerc, Bernard-Simon; Presse, Nancy; Bolduc, Aline; Dutilleul, Aurore; Couturier, Yves; Kergoat, Marie-Jeanne

    2013-11-01

    Inpatient geriatric assessment units (GAUs) exist in Quebec, Canada, to deliver comprehensive, integrated care to older vulnerable patients. Most cases should be discussed at interprofessional meetings (IMs), but research has shown this not to be so for 39% of GAU patients. Consequently, a study was undertaken to (1) describe GAU team composition and (2) identify GAU and patient characteristics associated with case discussion at IMs at least once during a patient's stay. To this end, 877 hospitalization records from 44 GAUs were reviewed. Results showed most teams were composed of attending physicians, nurses, physical and occupational therapists, dietitians and social workers; 66% included clinical pharmacists and 43% liaison nurses. Multilevel modeling showed longer length of stay to be the strongest predictor of case discussion at an IM. Case discussion was also more likely for patients admitted via in- or inter-hospital transfer rather than via the emergency department, if the GAU included a liaison nurse, and if the GAU was not located in an urban area. In summary, case discussion at an IM depended more on how and where a patient was admitted than on the patient characteristics per se, suggesting that this is a matter of care organization. PMID:23802732

  20. The role of performance measures for improving quality in managed care organizations.

    PubMed Central

    Scanlon, D P; Darby, C; Rolph, E; Doty, H E

    2001-01-01

    OBJECTIVES: To understand how managed care plans use performance measures for quality improvement and to identify the strengths and weaknesses of currently used standardized performance measures such as the Health Plan Employer Data and Information Set (HEDIS) and the Consumer Assessment of Health Plans (CAHPS) survey. DATA SOURCES/STUDY SETTING: Representatives (chief executive officers, medical directors, and quality-improvement directors) from 24 health plans in four states were surveyed. The overall response rate was 58.3 percent, with a mean of 1.8 respondents per plan. STUDY DESIGN: This exploratory qualitative research used a purposive sample of respondents. Two study authors conducted separate one-hour tape-recorded telephone interviews with multiple respondents from each health plan. PRINCIPAL FINDINGS: All managed care organizations interviewed use performance measures for quality improvement but the degree and sophistication of use varies. Many of our respondent plans use performance measures to target quality-improvement initiatives, evaluate current performance, establish goals for quality improvement, identify the root cause of problems, and monitor performance. CONCLUSION: Performance measures are used for quality improvement in addition to informing external constituents, but additional research is needed to understand how the benefits of measurement can be maximized. Images Figure 1 PMID:11482592

  1. [Health maintenance organizations: starting point of a market economical reform of health care].

    PubMed

    Hauser, H

    1981-05-01

    The present work was based on the observations that, as regards health care costs, the major problem in most present systems is that those who are responsible for the treatment decision (physician and patient) do not bear a direct financial responsibility for it, and that the overall system is very fragmented, which leads to numerous externalities. In accordance with this diagnosis, a reform strategy should particularly aim at creating units which are responsible for the provision and the financial coverage of comprehensive health services to a given population. Health Maintenance Organizations (HMOs) are a private economy oriented solution in this direction. They have proved to be a real possibility in the USA over years, at least for part of the population, and show interesting performances as regards costs. They were able to develop and evolve in the largely open US institutional framework. In Switzerland, we have more strongly structured systems, which appear to stand in relative contradiction to the HMO solution. A potential adaptation of the concept to our country would therefore require a preliminary in depth discussion about the meaning of the present collective (insurance) contract structure, the position of hospitals in a private economy health care system as well as about the conditions of the sought for competition in the HMO model. PMID:7303928

  2. Reducing Health Disparities: Strategy Planning and Implementation in Israel's Largest Health Care Organization

    PubMed Central

    Balicer, Ran D; Shadmi, Efrat; Lieberman, Nicky; Greenberg-Dotan, Sari; Goldfracht, Margalit; Jana, Liora; Cohen, Arnon D; Regev-Rosenberg, Sigal; Jacobson, Orit

    2011-01-01

    Objective To describe an organization-wide disparity reduction strategy and to assess its success in quality improvement and reduction of gaps in health and health care. Study Setting Clalit Health Services, Israel's largest non-for-profit insurer and provider serving 3.8 million persons. Study Design Before and after design: quality assessment before and 12-month postinitiation of the strategic plan. A composite weighted score of seven quality indicators, measuring attainment of diabetes, blood pressure, and lipid control, lack of anemia in infants, and performance of mammography, occult blood tests, and influenza vaccinations. Data Extraction Methods Quality indicator scores, derived from Clalit's central data warehouse, based on data from electronic medical records. Principal Findings Low-performing clinics, of low-socioeconomic and minority populations, were targeted for intervention. Twelve months after the initiation of the project continuous improvement was observed coupled with a reduction of 40 percent of the gap between disadvantaged clinics, serving ∼10 percent of enrollees, and all other medium-large clinics. Conclusion The comprehensive strategy, following a quality improvement framework, with a top-down top-management incentives and monitoring, and a bottom-up locally tailored interventions, approach, is showing promising results of overall quality improvement coupled with disparity reduction in key health and health care indicators. PMID:21352224

  3. From the primary care organizations consortium's proposal to the Interdisciplinary Generalist Curriculum Project.

    PubMed

    Bazell, C; Kahn, R

    2001-04-01

    The Interdisciplinary Generalist Curriculum (IGC) Project was one element of an overall federal government strategy designed to promote primary care education. This project, undertaken by the Division of Medicine and Dentistry (DMD), Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services, was the first large-scale medical education contract initiated by DMD. The IGC Project was based on a model proposed by the Primary Care Organizations Consortium (PCOC). The PCOC thesis was that "if students are to decide to pursue a generalist career they must have the opportunity to be taught by generalists." The PCOC Program required an explicit curriculum focusing on generalist knowledge and skills with an emphasis on technology, in the context of education that required training in ambulatory office-based settings. The PCOC Program specified that responsibility for the program's planning, implementation, and evaluation be shared by the three generalist physician faculties of family medicine, general internal medicine, and general pediatrics. In implementation of this demonstration project in ten medical schools across the nation, several lessons have been learned relative to enhancement of generalist education. Among these lessons is that seed money targeted to initiate modest change can act as a catalyst and improve the knowledge and skills afforded medical students concerning generalist practice. Limited funds provided over a sufficient period of time can induce schools to undertake significant curricular change. PMID:11299165

  4. Out-of-Plan Pharmacy Use by Members of a Managed Care Organization

    PubMed Central

    Delate, Thomas; Albrecht, Gale; Olson, Kari L

    2012-01-01

    Background: Bargain generic programs have proliferated rapidly since 2006. Little is known about the use of these programs. The purpose of this study was to assess the rate and characteristics of prescriptions written in a managed care organization (MCO) to an out-of-plan pharmacy (OOPP). Methods: This retrospective health services investigation examined characteristics of patients in an MCO who did and did not have a prescription written to an OOPP from October 1, 2006 through September 30, 2010, and patients who had a prescription transferred to an OOPP in September 2008 (only month with data available). Descriptions of the longitudinal rate of OOPP use, OOPP patient and medication characteristics, and OOPPs where prescriptions were transferred are reported. Patient characteristics independently associated with an OOPP prescription were analyzed with logistic regression modeling. Results: A total of 10,353,283 prescriptions were included. The monthly rate of OOPP usage during the study period increased from 1.5% to 5.2% and then stabilized at around 5%. Prescriptions written to an OOPP were more likely to be for chronic disease states. Patient age and MCO termination were associated with having a prescription written to an OOPP; whereas increasing medication purchases, a drug benefit, and a health maintenance organization plan type were associated with not having a prescription written to an OOPP. More than 80% of transferred prescriptions went to an OOPP with a bargain generic program. Conclusion: The rate of OOPP prescriptions increased rapidly over the study period. Prescriptions written to an OOPP were predominantly for chronic diseases. Further research is warranted to assess if OOPP use results in reduced quality of health care system oversight or compromises patient health. PMID:22745611

  5. Surviving, and Maybe Thriving, on Vouchers: A Guide for Organizations Making the Transition to Individual Training Accounts under the Workforce Investment Act. Working Ventures.

    ERIC Educational Resources Information Center

    Maguire, Sheila

    This booklet, which is intended for organizations making the transition to individual training accounts (ITAs) under the Workforce Investment Act (WIA), explains how educational and training institutions can make vouchers work for them. After a brief overview of the WIA's main provisions regarding ITAs and the future of voucher programs, the…

  6. Child Care Success for Your Kids and You: A Guide and Organizer for Working Parents.

    ERIC Educational Resources Information Center

    Austin, Elizabeth M.; And Others

    This guide is designed to assist employed parents in preparing themselves and their children for a successful child care experience. Chapter 1 covers child care selection, including resources available to aid in selection, characteristics of quality care, comparative shopping, and changing child care programs. Chapter 2 provides tips for preparing…

  7. What's in a Name? The Necessary Transformation of the Academic Medical Center in the Era of Population Health and Accountable Care.

    PubMed

    DiSesa, Verdi J; Kaiser, Larry R

    2015-07-01

    Academic medical centers (AMCs) and the physicians and other professionals who lead them need to recognize they are in a business that is making a transition from a system of "sickness" care to one of "health" care, accountable for the health of defined populations and for the value (quality divided by cost) of the services provided. This change has profound implications for how AMCs conceive themselves, how they function, and how they are paid for the work that they do. A failure to recognize how the disruption of the mission of AMCs is changing may impair them as irrevocably as other changes caused the demise of Kodak, once the world's leader in the manufacture and sale of photographic film and cameras. Leaders of academic medicine need to understand, respond to, and ultimately lead the transformation of our system of health. In this Commentary, the authors review the pressures driving these changes and potential responses to them-a process already under way. They summarize the issues in the question "Should the words 'health' and 'system' take the place of 'medical' and 'center' in our institutions' names and, more important, in how we conceive of what we do?" The authors propose the name "academic health system" to better identify primary objectives to measure success by the health of patients. PMID:26414052

  8. Employed Family Physician Satisfaction and Commitment to Their Practice, Work Group, and Health Care Organization

    PubMed Central

    Karsh, Ben-Tzion; Beasley, John W; Brown, Roger L

    2010-01-01

    Objective Test a model of family physician job satisfaction and commitment. Data Sources/Study Setting Data were collected from 1,482 family physicians in a Midwest state during 2000–2001. The sampling frame came from the membership listing of the state's family physician association, and the analyzed dataset included family physicians employed by large multispecialty group practices. Study Design and Data Collection A cross-sectional survey was used to collect data about physician working conditions, job satisfaction, commitment, and demographic variables. Principal Findings The response rate was 47 percent. Different variables predicted the different measures of satisfaction and commitment. Satisfaction with one's health care organization (HCO) was most strongly predicted by the degree to which physicians perceived that management valued and recognized them and by the extent to which physicians perceived the organization's goals to be compatible with their own. Satisfaction with one's workgroup was most strongly predicted by the social relationship with members of the workgroup; satisfaction with one's practice was most strongly predicted by relationships with patients. Commitment to one's workgroup was predicted by relationships with one's workgroup. Commitment to one's HCO was predicted by relationships with management of the HCO. Conclusions Social relationships are stronger predictors of employed family physician satisfaction and commitment than staff support, job control, income, or time pressure. PMID:20070386

  9. The Meaning of ‘Dining’: The Social Organization of Food in Long-term Care

    PubMed Central

    Lowndes, Ruth; Armstrong, Pat; Daly, Tamara

    2016-01-01

    Objective To explore the social organization of food provision in publicly funded and regulated long-term care facilities. Methods Observations were conducted, along with 90 interviews with residents, families, and health providers in two Southern Ontario sites using rapid site-switching ethnography within a feminist political economy framework as part of an international, interdisciplinary study investigating healthy ageing. Results Food is purchased within a daily $7.80/per resident allotment, limiting high quality choices, which is further problematized by privatization of food services. Funding restrictions also result in low staffing levels, creating tensions in aligning with other Ministry mandated tasks such as bathing, and documenting: competing demands often lead to rushed meals. Regulations, primarily set in response to scandals and to ensure appropriate measured nutrition, reinforce the problem. Further, regulations regarding set meal times result in lack of resident agency, which is compounded by fixed menu options and seating arrangements in one common dining room. Rather than being viewed as an important part of resident socialization, food is reduced to a medicalized task, organized within a climate of cost-containment. Implications Findings warrant Ministry financial support for additional staff and for food provision. Policy changes are also required to give primacy to this population’s quality of life. PMID:27088052

  10. The use of interest rate swaps by nonprofit organizations: evidence from nonprofit health care providers.

    PubMed

    Stewart, Louis J; Trussel, John

    2006-01-01

    Although the use of derivatives, particularly interest rate swaps, has grown explosively over the past decade, derivative financial instrument use by nonprofits has received only limited attention in the research literature. Because little is known about the risk management activities of nonprofits, the impact of these instruments on the ability of nonprofits to raise capital may have significant public policy implications. The primary motivation of this study is to determine the types of derivatives used by nonprofits and estimate the frequency of their use among these organizations. Our study also extends contemporary finance theory by an empirical examination of the motivation for interest rate swap usage among nonprofits. Our empirical data came from 193 large nonprofit health care providers that issued debt to the public between 2000 and 2003. We used a univariate analysis and a multivariate analysis relying on logistic regression models to test alternative explanations of interest rate swaps usage by nonprofits, finding that more than 45 percent of our sample, 88 organizations, used interest rate swaps with an aggregate notional value in excess of $8.3 billion. Our empirical tests indicate the primary motive for nonprofits to use interest rate derivatives is to hedge their exposure to interest rate risk. Although these derivatives are a useful risk management tool, under conditions of falling bond market interest rates these derivatives may also expose a nonprofit swap user to the risk of a material unscheduled termination payment. Finally, we found considerable diversity in the informativeness of footnote disclosure among sample organizations that used interest rate swaps. Many nonprofits did not disclose these risks in their financial statements. In conclusion, we find financial managers in large nonprofits commonly use derivative financial instruments as risk management tools, but the use of interest rate swaps by nonprofits may expose them to other risks

  11. A qualitative analysis of information sharing for children with medical complexity within and across health care organizations

    PubMed Central

    2014-01-01

    Background Children with medical complexity (CMC) are characterized by substantial family-identified service needs, chronic and severe conditions, functional limitations, and high health care use. Information exchange is critically important in high quality care of complex patients at high risk for poor care coordination. Written care plans for CMC are an excellent test case for how well information sharing is currently occurring. The purpose of this study was to identify the barriers to and facilitators of information sharing for CMC across providers, care settings, and families. Methods A qualitative study design with data analysis informed by a grounded theory approach was utilized. Two independent coders conducted secondary analysis of interviews with parents of CMC and health care professionals involved in the care of CMC, collected from two studies of healthcare service delivery for this population. Additional interviews were conducted with privacy officers of associated organizations to supplement these data. Emerging themes related to barriers and facilitators to information sharing were identified by the two coders and the research team, and a theory of facilitators and barriers to information exchange evolved. Results Barriers to information sharing were related to one of three major themes; 1) the lack of an integrated, accessible, secure platform on which summative health care information is stored, 2) fragmentation of the current health system, and 3) the lack of consistent policies, standards, and organizational priorities across organizations for information sharing. Facilitators of information sharing were related to improving accessibility to a common document, expanding the use of technology, and improving upon a structured communication plan. Conclusions Findings informed a model of how various barriers to information sharing interact to prevent optimal information sharing both within and across organizations and how the use of technology to

  12. Managed Care

    MedlinePlus

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

  13. A survey of the use of complementary and alternative medicine in Illinois hospice and palliative care organizations.

    PubMed

    Van Hyfte, Gregory J; Kozak, Leila E; Lepore, Michael

    2014-08-01

    This research assesses complementary and alternative medicine (CAM) use and administration for patients and family caregivers in Illinois hospice and palliative care organizations. An online survey was administered to a sample of 108 contacts of Illinois organizations listed in the National Hospice and Palliative Care Organization website, and 90.3% of the responding organizations offered some type of CAM. The top 5 most frequently offered CAM modalities to patients were pet therapy (64.5%), music therapy (61.3%), massage therapy (54.8%), art therapy (29.0%), and energy therapies (25.8%); these were the same top 5 offered to families but with different frequencies. Findings regarding utilization, administration, financing, and spiritual/cultural competency are discussed with policy recommendations for data collection, administrative improvements, and integration of CAM providers into service delivery. PMID:23943631

  14. Xpert CARBA-R Assay for the Detection of Carbapenemase-Producing Organisms in Intensive Care Unit Patients of a Korean Tertiary Care Hospital

    PubMed Central

    Kim, Do-Kyun; Kim, Hyoung Sun; Pinto, Naina; Jeon, Jongsoo; D'Souza, Roshan; Kim, Myung Sook; Choi, Jun Yong; Jeong, Seok Hoon; Lee, Kyungwon

    2016-01-01

    Carbapenemase-producing organisms (CPO) are rapidly disseminating worldwide, and their presence in tertiary care hospitals poses a significant threat to the management of nosocomial infections. There is a need to control CPO, especially in intensive care unit (ICU) patients, because these organisms are resistant to most β-lactam antibiotics and are easily transmitted. At present, the identification of CPO is time-consuming; hence, this study focused on the use of the Xpert CARBA-R assay (Cepheid, USA) to determine intestinal colonization rates of CPO in patients admitted to the ICU of a tertiary care hospital in Korea. Forty clinical stool samples were collected and inoculated both in a CARBA-R cartridge and in conventional culture plates. The CARBA-R assay required only ~one hour to screen CPO, while the time required for conventional culture was over three days. We also found that the prevalences of intestinal colonization by carbapenem-resistant organisms and Enterobacteriaceae were 17.5% (7 out of 40) and 7.5% (3 out of 40), respectively. Among the colonizing strains, three that contained carbapenemase, including Klebsiella pneumonia carbapenemase (KPC), and imipenem (IMP) and Verona integron-mediated metallo-β-lactamase (VIM) were found. With its convenience, the Xpert CARBA-R assay can be included in CPO surveillance strategies. PMID:26709264

  15. Xpert CARBA-R Assay for the Detection of Carbapenemase-Producing Organisms in Intensive Care Unit Patients of a Korean Tertiary Care Hospital.

    PubMed

    Kim, Do-Kyun; Kim, Hyoung Sun; Pinto, Naina; Jeon, Jongsoo; D'Souza, Roshan; Kim, Myung Sook; Choi, Jun Yong; Yong, Dongeun; Jeong, Seok Hoon; Lee, Kyungwon

    2016-03-01

    Carbapenemase-producing organisms (CPO) are rapidly disseminating worldwide, and their presence in tertiary care hospitals poses a significant threat to the management of nosocomial infections. There is a need to control CPO, especially in intensive care unit (ICU) patients, because these organisms are resistant to most β-lactam antibiotics and are easily transmitted. At present, the identification of CPO is time-consuming; hence, this study focused on the use of the Xpert CARBA-R assay (Cepheid, USA) to determine intestinal colonization rates of CPO in patients admitted to the ICU of a tertiary care hospital in Korea. Forty clinical stool samples were collected and inoculated both in a CARBA-R cartridge and in conventional culture plates. The CARBA-R assay required only ~one hour to screen CPO, while the time required for conventional culture was over three days. We also found that the prevalences of intestinal colonization by carbapenem-resistant organisms and Enterobacteriaceae were 17.5% (7 out of 40) and 7.5% (3 out of 40), respectively. Among the colonizing strains, three that contained carbapenemase, including Klebsiella pneumonia carbapenemase (KPC), and imipenem (IMP) and Verona integron-mediated metallo-β-lactamase (VIM) were found. With its convenience, the Xpert CARBA-R assay can be included in CPO surveillance strategies. PMID:26709264

  16. CCN Activity of Organic Aerosols Observed Downwind of Urban Emissions during CARES

    SciTech Connect

    Mei, Fan; Setyan, Ari; Zhang, Qi; Wang, J. X.

    2013-12-17

    During the Carbonaceous Aerosols and Radiative Effects Study (CARES), activation fraction of size-resolved aerosol particles and aerosol chemical composition were characterized at the T1 site (~60 km downwind of Sacramento, California) from 10 June to 28 June 2010. The hygroscopicity of CCN-active particles (KCCN) with diameter from 100 to 170 nm, derived from the size-resolved activated fraction, varied from 0.10 to 0.21, with an average of 0.15, which was substantially lower than that proposed for continental sites in earlier studies. The low KCCN value was due to the high organic volume fraction, averaged over 80% at the T1 site. The derived KCCN exhibited little diurnal variation, consistent with the relatively constant organic volume fraction observed. At any time, over 90% of the size selected particles with diameter between 100 and 171nm were CCN active, suggesting most particles within this size range were aged background particles. Due to the large organic volume fraction, organic hygroscopicity (Korg) strongly impacted particle hygroscopicity and therefore calculated CCN concentration. For vast majority of the cases, an increase of Korg from 0.03 to 0.18, which are within the typical range, doubled the calculated CCN concentration. Organic hygroscopicity was derived from KCCN and aerosol chemical composition, and its variations with the fraction of total organic mass spectral signal at m/z 44 (f44) and O:C were compared to results from previous studies. Overall, the relationships between Korg and f44 are quite consistent for organic aerosol (OA) observed during field studies and those formed in smog chamber. Compared to the relationship between Korg and f44, the relationship between Korg and O:C exhibits more significant differences among different studies, suggesting korg may be better parameterized using f44. A

  17. Teaching Evidence Assimilation for Collaborative Health Care (TEACH) 2009–2014: Building Evidence-Based Capacity within Health Care Provider Organizations

    PubMed Central

    Wyer, Peter C.; Umscheid, Craig A.; Wright, Stewart; Silva, Suzana A.; Lang, Eddy

    2015-01-01

    Background: Clinical guidelines, prediction tools, and computerized decision support (CDS) are underutilized outside of research contexts, and conventional teaching of evidence-based practice (EBP) skills fails to change practitioner behavior. Overcoming these challenges requires traversing practice, policy, and implementation domains. In this article, we describe a program’s conceptual design, the results of institutional participation, and the program’s evolution. Next steps include integration of instruction in principles of CDS. Conceptual Model: Teaching Evidence Assimilation for Collaborative Health Care (TEACH) is a multidisciplinary annual conference series involving on- and off-site trainings and facilitation within health care provider organizations (HPOs). Separate conference tracks address clinical policy and guideline development, implementation science, and foundational EBP skills. The implementation track uses a model encompassing problem delineation, identifying knowing-doing gaps, synthesizing evidence to address those gaps, adapting guidelines for local use, assessing implementation barriers, measuring outcomes, and sustaining evidence use. Training in CDS principles is an anticipated component within this track. Within participating organizations, the program engages senior administration, middle management, and frontline care providers. On-site care improvement projects serve as vehicles for developing ongoing, sustainable capabilities. TEACH facilitators conduct on-site workshops to enhance project development, integration of stakeholder engagement and decision support. Both on- and off-site components emphasize narrative skills and shared decision-making. Experience: Since 2009, 430 participants attended TEACH conferences. Delegations from five centers attended an initial series of three conferences. Improvement projects centered on stroke care, hospital readmissions, and infection control. Successful implementation efforts were

  18. Implications of the World Health Organization study of mental illness in general health care for training primary care staff.

    PubMed

    Goldberg, D; Gater, R

    1996-08-01

    A substantial international study of mental disorders seen in primary care settings has shown that there are marked differences in prevalence between centres. Detection of mental disorders is better in centres using a 'personal' style of clinical service, and where there has been close collaboration between psychiatrists and general practitioners. However, even in the better centres, substantial numbers of mental disorders are missed and treatment often appears to be given regardless of diagnosis. It is argued that changes need to be made to the way in which both undergraduates and vocational trainees are taught about mental disorders, so that teaching emphasizes the psychological syndromes that general practitioners are likely to meet in their everyday work. Training packages need to be developed for primary care staff in the detection and management of mental disorders. PMID:8949331

  19. Implications of the World Health Organization study of mental illness in general health care for training primary care staff.

    PubMed Central

    Goldberg, D; Gater, R

    1996-01-01

    A substantial international study of mental disorders seen in primary care settings has shown that there are marked differences in prevalence between centres. Detection of mental disorders is better in centres using a 'personal' style of clinical service, and where there has been close collaboration between psychiatrists and general practitioners. However, even in the better centres, substantial numbers of mental disorders are missed and treatment often appears to be given regardless of diagnosis. It is argued that changes need to be made to the way in which both undergraduates and vocational trainees are taught about mental disorders, so that teaching emphasizes the psychological syndromes that general practitioners are likely to meet in their everyday work. Training packages need to be developed for primary care staff in the detection and management of mental disorders. PMID:8949331

  20. Addressing Burnout in Oncology: Why Cancer Care Clinicians Are At Risk, What Individuals Can Do, and How Organizations Can Respond.

    PubMed

    Hlubocky, Fay J; Back, Anthony L; Shanafelt, Tait D

    2016-01-01

    Despite their benevolent care of others, today, more than ever, the cancer care professional who experiences overwhelming feelings of exhaustion, cynicism, and inefficacy is in grave jeopardy of developing burnout. Clinicians are repeatedly physically and emotionally exposed to exceedingly long hours in direct care with seriously ill patients/families, limited autonomy over daily responsibilities, endless electronic documentation, and a shifting medical landscape. The physical and emotional well-being of the cancer care clinician is critical to the impact on quality care, patient satisfaction, and overall success of their organizations. The prevention of burnout as well as targeting established burnout need to be proactively addressed at the individual level and organizational level. In fact, confronting burnout and promoting wellness are the shared responsibility of both oncology clinicians and their organizations. From an individual perspective, oncology clinicians must be empowered to play a crucial role in enhancing their own wellness by identification of burnout symptoms in both themselves and their colleagues, learning resilience strategies (e.g., mindful self-compassion), and cultivating positive relationships with fellow clinician colleagues. At the organizational level, leadership must recognize the importance of oncology clinician well-being; engage leaders and physicians in collaborative action planning, improve overall practice environment, and provide institutional wellness resources to physicians. These effective individual and organizational interventions are crucial for the prevention and improvement of overall clinician wellness and must be widely and systematically integrated into oncology care. PMID:27249706

  1. The feasibility of a scanner-independent technique to estimate organ dose from MDCT scans: Using CTDIvol to account for differences between scanners

    PubMed Central

    Turner, Adam C.; Zankl, Maria; DeMarco, John J.; Cagnon, Chris H.; Zhang, Di; Angel, Erin; Cody, Dianna D.; Stevens, Donna M.; McCollough, Cynthia H.; McNitt-Gray, Michael F.

    2010-01-01

    Purpose: Monte Carlo radiation transport techniques have made it possible to accurately estimate the radiation dose to radiosensitive organs in patient models from scans performed with modern multidetector row computed tomography (MDCT) scanners. However, there is considerable variation in organ doses across scanners, even when similar acquisition conditions are used. The purpose of this study was to investigate the feasibility of a technique to estimate organ doses that would be scanner independent. This was accomplished by assessing the ability of CTDIvol measurements to account for differences in MDCT scanners that lead to organ dose differences. Methods: Monte Carlo simulations of 64-slice MDCT scanners from each of the four major manufacturers were performed. An adult female patient model from the GSF family of voxelized phantoms was used in which all ICRP Publication 103 radiosensitive organs were identified. A 120 kVp, full-body helical scan with a pitch of 1 was simulated for each scanner using similar scan protocols across scanners. From each simulated scan, the radiation dose to each organ was obtained on a per mA s basis (mGy∕mA s). In addition, CTDIvol values were obtained from each scanner for the selected scan parameters. Then, to demonstrate the feasibility of generating organ dose estimates from scanner-independent coefficients, the simulated organ dose values resulting from each scanner were normalized by the CTDIvol value for those acquisition conditions. Results: CTDIvol values across scanners showed considerable variation as the coefficient of variation (CoV) across scanners was 34.1%. The simulated patient scans also demonstrated considerable differences in organ dose values, which varied by up to a factor of approximately 2 between some of the scanners. The CoV across scanners for the simulated organ doses ranged from 26.7% (for the adrenals) to 37.7% (for the thyroid), with a mean CoV of 31.5% across all organs. However, when organ

  2. 42 CFR 426.516 - Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD review process.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD review process. 426.516 Section 426.516 Public Health CENTERS FOR... OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS Review of an NCD § 426.516...

  3. 42 CFR 476.72 - Review of the quality of care of risk-basis health maintenance organizations and competitive...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... disclosure of peer review information; and (2) Part 1004 of Chapter V regarding a QIO's responsibilities, and... 42 Public Health 4 2010-10-01 2010-10-01 false Review of the quality of care of risk-basis health... ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality...

  4. 42 CFR 476.72 - Review of the quality of care of risk-basis health maintenance organizations and competitive...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... disclosure of peer review information; and (2) Part 1004 of Chapter V regarding a QIO's responsibilities, and... 42 Public Health 4 2012-10-01 2012-10-01 false Review of the quality of care of risk-basis health... ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality...

  5. 42 CFR 426.416 - Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review. 426.416 Section 426.416 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED)...

  6. 42 CFR 426.416 - Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review. 426.416 Section 426.416 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED)...

  7. 42 CFR 426.416 - Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review. 426.416 Section 426.416 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM REVIEW OF...

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

    ERIC Educational Resources Information Center

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

    2002-01-01

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

  9. The Balanced Scorecard as a management tool for assessing and monitoring strategy implementation in health care organizations.

    PubMed

    Bisbe, Josep; Barrubés, Joan

    2012-10-01

    Both prior literature and reported managerial practices have claimed that the Balanced Scorecard is a management tool that can help organizations to effectively implement strategies. In this article, we examine some of the contributions, dilemmas, and limitations of Balanced Scorecards in health care organizations. First, we describe the evolution of Balanced Scorecards from multidimensional performance measurement systems to causal representations of formulated strategies, and analyze the applicability of Balanced Scorecards in health care settings. Next, we discuss several issues under debate regarding Balanced Scorecard adoption in health care organizations. We distinguish between issues related to the design of Balanced Scorecards and those related to the use of these tools. We conclude that the Balanced Scorecard has the potential to contribute to the implementation of strategies through the strategically-oriented performance measurement systems embedded within it. However, effective adoption requires the adaptation of the generic instrument to the specific realities of health care organizations. Full English text available from:www.revespcardiol.org. PMID:22917775

  10. An Identification of Communication Skills and Problems Found in Health Care Organizations.

    ERIC Educational Resources Information Center

    Di Salvo, Vincent Stephen; Backus, Dencil K.

    A study was conducted to address the communication concerns of health care professionals. To identify the communication activities and problems of health care communication situations, the Communication Activity Questionnaire (CAQ) was administered to the personnel of 18 human service agencies involved with care of the physically and mentally ill…

  11. 77 FR 26280 - Patient Safety Organizations: Voluntary Relinquishment From CareRise LLC

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-03

    ... Relinquishment From CareRise LLC AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Notice of Delisting. SUMMARY: AHRQ has accepted a notification of voluntary relinquishment from CareRise LLC... quality of health care delivery. HHS issued the Patient Safety and Quality Improvement Final Rule...

  12. "When doing good is just the start to being good": a possible tool to improve the organizational effectiveness of non-profit health care organizations.

    PubMed

    Mueller, Jens

    2007-01-01

    Health care is an area where many non-profit organizations do good work, relieving governments and for-profit providers of workload. They contribute often specific knowledge and competence or provide better access to patients through their cultural and ethnic affiliations. Non-profit organizations, NPOs, are often dependent on one or more significant donors, sometimes governments, sometimes for-profit health providers and mostly private/corporate donors with an interest in specific medical areas, such as Alzheimers, or in unique communities, such as the Laotian neighborhoods in Southern California. In the media, high profile scandals involving financial irresponsibility have caused shock waves around the world. Concerns among some donors over the lack of a transparent performance measurement of non-profit entities have increased with the greater call for transparency and good governance in the corporate world. Not all the scandals have been in the commercial sector; some Not for Profit Organizations (NPOs) have been identified as having less than credible governance structures (Thomson, 2003). The watchdog organization SustainAbility reported that accountability and transparency are issues on which several NPOs are found wanting (Anon., 2003) and the New York Times reports that until recently NPOs were thought to be exempt from traditional oversight; their do-good nature and the commitment of their participants were thought to be sufficient to produce positive results (Christensen, 2004). PMID:18072704

  13. The Deviant Organization and the Bad Apple CEO: Ideology and Accountability in Media Coverage of Corporate Scandals

    ERIC Educational Resources Information Center

    Benediktsson, Michael Owen

    2010-01-01

    What role do the media play in the identification and construction of white-collar crimes? Few studies have examined media coverage of corporate deviance. This study investigates news coverage of six large-scale accounting scandals that broke in 2001 and 2002. Using a variety of empirical methods to analyze the 51 largest U.S. newspapers, the…

  14. 17 CFR 274.11b - Form N-3, registration statement of separate accounts organized as management investment companies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... List of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and on... INVESTMENT COMPANY ACT OF 1940 Registration Statements § 274.11b Form N-3, registration statement of separate... to be filed pursuant to section 8(b) of the Investment Company Act of 1940 by separate accounts...

  15. 17 CFR 274.11c - Form N-4, registration statement of separate accounts organized as unit investment trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... chapter). Editorial Note: For Federal Register citations affecting Form N-4, see the List of CFR Sections... COMPANY ACT OF 1940 Registration Statements § 274.11c Form N-4, registration statement of separate... filed pursuant to section 8(b) of the Investment Company Act of 1940 by separate accounts that...

  16. 17 CFR 274.11b - Form N-3, registration statement of separate accounts organized as management investment companies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... List of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and at... INVESTMENT COMPANY ACT OF 1940 Registration Statements § 274.11b Form N-3, registration statement of separate... to be filed pursuant to section 8(b) of the Investment Company Act of 1940 by separate accounts...

  17. 17 CFR 274.11b - Form N-3, registration statement of separate accounts organized as management investment companies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... List of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and at... INVESTMENT COMPANY ACT OF 1940 Registration Statements § 274.11b Form N-3, registration statement of separate... to be filed pursuant to section 8(b) of the Investment Company Act of 1940 by separate accounts...

  18. 17 CFR 274.11b - Form N-3, registration statement of separate accounts organized as management investment companies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... List of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and at... INVESTMENT COMPANY ACT OF 1940 Registration Statements § 274.11b Form N-3, registration statement of separate... to be filed pursuant to section 8(b) of the Investment Company Act of 1940 by separate accounts...

  19. Victimless vapour? Health care organizations should restrict the use of e-cigarettes.

    PubMed

    Bean, Sally T; Smith, Maxwell J

    2015-01-01

    Electronic cigarettes (e-cigarettes) are battery-powered devices that heat a liquid containing either vegetable glycerin or propylene glycol in combination with nicotine and/or flavours; an aerosol is produced that is inhaled by the user. Health Canada currently prohibits the importation, marketing or selling of e-cigarettes containing nicotine, although they can be easily purchased. Because of the availability of e-cigarettes, patients and visitors to health care organizations (HCOs) are inquiring about their use within and on the grounds of those facilities. We contend that in provinces or municipalities where e-cigarette use has not been restricted, HCOs should develop institutional policies to do so. We argue that the following reasons collectively justify measures to restrict the use of e-cigarettes within HCOs: unknown long-term safety, uncertain effectiveness in harm reduction, the conflict with the mission of HCOs to promote health, the potential negative health impacts on vulnerable patients with a compromised health status, and the risk of re-normalization of smoking. However, because of the rapidly developing evidence base in this area, HCOs should remain responsive to emerging evidence regarding the status of e-cigarettes as an effective harm reduction tool. PMID:26986904

  20. Determination of organic carbon and ionic accountability of various waste and product waters derived from ECLSS water recovery tests and Spacelab humidity condensate

    NASA Technical Reports Server (NTRS)

    Carter, Donald L.; Cole, Harold; Habercom, Mark; Griffith, Guy

    1992-01-01

    The development of a closed-loop water recovery system for Space Station Freedom involves many technical challenges associated with contaminant removal. Attention is presently given to the characterization of contaminants constituting total organic carbon (TOC), and to the Hubaux and Vos (1970) statistical model for low level TOC that has been employed. A tabulation is given for TOC accountability in the case of both potable and hygiene waters.

  1. Lived Experiences of Iranian Nurses Caring for Brain Death Organ Donor Patients: Caring as “Halo of Ambiguity and Doubt”

    PubMed Central

    Keshtkaran, Zahra; Sharif, Farkhondeh; Navab, Elham; Gholamzadeh, Sakineh

    2016-01-01

    Background: Brain death is a concept in which its criteria have been expressed as documentations in Harvard Committee of Brain Death. The various perceptions of caregiver nurses for brain death patients may have effect on the chance of converting potential donors into actual organ donors. Objective: The present study has been conducted in order to perceive the experiences of nurses in care-giving to the brain death of organ donor patients. Methods: This qualitative study was carried out by means of Heidegger’s hermeneutic phenomenology. Eight nurses who have been working in ICU were interviewed. The semi-structured interviews were recorded by a tape-recorder and the given texts were transcribed and the analyses were done by Van-Mannen methodology and (thematic) analysis. Results: One of the foremost themes extracted from this study included ‘Halo of ambiguity and doubt’ that comprised of two sub-themes of ‘having unreasonable hope’ and ‘Conservative acceptance of brain death’. The unreasonable hope included lack of trust (uncertainty) in diagnosis and verification of brain death, passing through denial wall, and avoidance from explicit and direct disclosure of brain death in patients’ family. In this investigation, the nurses were involved in a type of ambiguity and doubt in care-giving to the potentially brain death of organ donor patients, which were also evident in their interaction with patients’ family and for this reason, they did not definitely announce the brain death and so far they hoped for treatment of the given patient. Such confusion and hesitance both caused annoyance of nurses and strengthening the denial of patients’ family to be exposed to death. Conclusion: The results of this study reveal the fundamental perceived care-giving of brain death in organ donor patients and led to developing some strategies to improve care-giving and achievement in donation of the given organ and necessity for presentation of educational and

  2. Preserving community in health care.

    PubMed

    Emanuel, E J; Emanuel, L L

    1997-02-01

    There are two prominent trends in health care today: first, increasing demands for accountabilty, and second, increasing provision of care through managed care organizations. These trends promote the question: What form of account-ability is appropriate to managed care plans? Accountability is the process by which a party justifies its actions and policies. Components of accountability include parties that can be held or hold others accountable, domains and content areas being assessed, and procedures of assessment. Traditionally, the professional model of accountability has operated in medical care. In this model, physicians establish the standards of accountability and hold each other accountable through professional organizations. This form of accountability seems outdated and inapplicable to managed care plans. The alternatives are the economic and the political models of accountability. In the economic model, medicine becomes more like a commodity, and "exit" (consumers changing providers for reasons of cost and quality) is the dominant procedure of accountability. In the political model, medicine becomes more like a community good, and "voice" (citizens communicating their views in public forums or on policy committees, or in elections for representatives) is the dominant procedure of accountability. The economic model's advantages affirm American individualism, make minimal demands on consumers, and use a powerful incentive, money. Its disadvantages undermine health care as a nonmarket good, undermine individual autonomy, undermine good medical practice, impose significant demands on consumers to be informed, sustain differentials of power, and use indirect procedures of accountability. The political model's advantages affirm health care as a matter of justice, permit selecting domains other than price and quality for accountability, reinforce good medical practice, and equalize power between patients and physicians. Its disadvantages include inefficiency in

  3. The impact of university provided nurse electronic medical record training on health care organizations: an exploratory simulation approach.

    PubMed

    Abrahamson, Kathleen; Anderson, James G; Borycki, Elizabeth M; Kushniruk, Andre W; Malovec, Shannon; Espejo, Angela; Anderson, Marilyn

    2015-01-01

    Training providers appropriately, particularly early in their caregiving careers, is an important aspect of electronic medical record (EMR) implementation. Considerable time and resources are needed to bring the newly hired providers 'up to speed' with the actual use practices of the organization. Similarly, universities lose valuable clinical training hours when students are required to spend those hours learning organization-specific EMR systems in order to participate in care during clinical rotations. Although there are multiple real-world barriers to university/health care organization training partnerships, the investment these entities share in training care providers, specifically nurses, to use and understand EMR technology encourages a question: What would be the cumulative effect of integrating a mutually agreed upon EMR system training program in to nursing classroom training on downstream hospital costs in terms of hours of direct caregiving lost, and benefits in terms of number of overall EMR trained nurses hired? In order to inform the development of a large scale study, we employed a dynamic systems modeling approach to simulate the theoretical relationships between key model variables and determine the possible effect of integrating EMR training into nursing classrooms on hospital outcomes. The analysis indicated that integrating EMR training into the nursing classroom curriculum results in more available time for nurse bedside care. Also, the simulation suggests that efficiency of clinical training can be potentially improved by centralizing EMR training within the nursing curriculum. PMID:25676937

  4. Advanced pricing strategies for hospitals in contracting with managed care organizations.

    PubMed

    Horowitz, J L; Kleiman, M A

    1994-01-01

    This article provides both a conceptual overview of pricing health care services and two pricing strategy examples. The overview addresses the underlying concepts of pricing, the factors that influence it, and the risk continuum of pricing approaches. The pricing strategy examples highlight some of the issues and considerations involved in pricing services in a changing health care market. Because the payors of health care will continue to shift economic risk to the providers of health care, the examples emphasize the importance of managing risk. PMID:10131103

  5. Legal responsibility and accountability.

    PubMed

    Cox, Chris

    2010-06-01

    Shifting boundaries in healthcare roles have led to anxiety among some nurses about their legal responsibilities and accountabilities. This is partly because of a lack of education about legal principles that underpin healthcare delivery. This article explains the law in terms of standards of care, duty of care, vicarious liability and indemnity insurance. PMID:20583648

  6. [Experience in performing the medical expert assessment of persons comprising organized contingents taking into account the ecological characteristics].

    PubMed

    Trofimov, A V; Gal'perov, B V; Bogoslova, N S

    1991-03-01

    The testing influence of a magnetic field, which is used as a new variant of a functional trial, may furnish an additional information about the possibilities of the human organism in concrete heliophysical conditions. Positive hypertensive reactions caused by the magnetic signal in 20% of cases show a high sensibility of a human organism to natural and induced magnetic fields. During the formation of crews and teams for actions in extreme heliophysical regions or for works with the sources of radioelectronic emission, the restrictions must be imposed for operators who have a high magnetic sensibility. This method may be used for the purpose of improving the quality of military medical expertise. PMID:1853595

  7. Survey of Nongovernmental Organizations Providing Pediatric Cardiovascular Care in Low- and Middle-Income Countries

    PubMed Central

    Nguyen, Nguyenvu; Jacobs, Jeffrey P.; Dearani, Joseph A.; Weinstein, Samuel; Novick, William M.; Jacobs, Marshall L.; Massey, Jeremy; Pasquali, Sara K.; Walters, Henry L.; Drullinsky, David; Stellin, Giovanni; Tchervenkov, Christo I.

    2014-01-01

    Background Nearly 90% of the children with heart disease in low- and middle-income countries (LMICs) cannot access cardiovascular (CV) services. Limitations include inadequate financial, human, and infrastructure resources. Nongovernmental organizations (NGOs) have played crucial roles in providing clinical services and infrastructure supports to LMICs CV programs; however, these outreach efforts are dispersed, inadequate, and lack coordination. Methods A survey was sent to members of the World Society for Pediatric and Congenital Heart Society and PediHeart. Results A clearinghouse was created to provide information on NGO structures, geographic reach, and scope of services. The survey identified 80 NGOs supporting CV programs in 92 LMICs. The largest outreach efforts were in South and Central America (42%), followed by Africa (18%), Europe (17%), Asia (17%), and Asia-Western Pacific (6%). Most NGOs (51%) supported two to five outreach missions per year. The majority (87%) of NGOs provided education, diagnostics, and surgical or catheter-based interventions. Working jointly with LMIC partners, 59% of the NGOs performed operations in children and infants; 41% performed nonbypass neonatal operations. Approximately a quarter (26%) reported that partner sites do not perform interventions in between missions. Conclusions Disparity and inadequacy in pediatric CV services remain an important problem for LMICs. A global consensus and coordinated efforts are needed to guide strategies on the development of regional centers of excellence, a global outcome database, and a CV program registry. Future efforts should be held accountable for impacts such as growth in the number of independent LMIC programs as well as reduction in mortality and patient waiting lists. PMID:24668973

  8. For Profit Organizations Adjusting to New Realities. Fifteenth Annual Status Report on For Profit Child Care.

    ERIC Educational Resources Information Center

    Neugebauer, Roger

    2002-01-01

    Until August 2001, demand for child care services was strong, with the for-profit sector registering modest growth. However, the deepening recession and terrorist attacks of September 11, 2001 contributed to changing priorities for child care providers. Rising unemployment has lessened demand for services, and anxieties resulting from the…

  9. 7 CFR 226.13 - Food service payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... use the information submitted by the homes to produce an actual count, by type and by category (tier I... system, day care homes shall be required to submit the number of meals served, by type, to enrolled... calculation. Under this system, day care homes shall be required to submit the number of meals served, by...

  10. 7 CFR 226.13 - Food service payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... use the information submitted by the homes to produce an actual count, by type and by category (tier I... system, day care homes shall be required to submit the number of meals served, by type, to enrolled... calculation. Under this system, day care homes shall be required to submit the number of meals served, by...

  11. 7 CFR 226.13 - Food service payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... use the information submitted by the homes to produce an actual count, by type and by category (tier I... system, day care homes shall be required to submit the number of meals served, by type, to enrolled... calculation. Under this system, day care homes shall be required to submit the number of meals served, by...

  12. [A.S. Puchkov as an organizer of the Moscow station of emergency medical care].

    PubMed

    Blokhina, N N

    2013-01-01

    The article is devoted to the 125th anniversary of outstanding Russian physician, health administrator, honored physician Aleksander Sergeyevitch Putchkov (1887-1952). During thirty years, from 1923, he continuously headed the Moscow station of emergency medical care based at the Sheremetoyevskiy hospital, nowadays the N.V. Sklifosofskiy research institute of emergency care. PMID:24175393

  13. [An oral health care network organized by large municipalities in Santa Catarina State, Brazil].

    PubMed

    Godoi, Heloisa; Mello, Ana Lúcia Schaefer Ferreira de; Caetano, João Carlos

    2014-02-01

    This study aims to analyze the oral health care network in Santa Catarina State, Brazil, in municipalities with 100,000 inhabitants or more, focusing on the identification and integration of the network's essential elements. Primary data were obtained through a structured questionnaire applied to oral health care administrators. Secondary data were collected from official databases and provided by the Municipal and State Health Departments. The municipalities offer oral health services at all levels of care, but they are in different stages in implementation of the network. They have taken some measures to consolidate the network, such as inclusion of tools for integration of primary services to specialized care and reorientation of primary health care as the network's central coordinating element. Limitations include difficulty in defining the network's clientele based on epidemiological criteria, insufficient logistics and governance systems, and the need to expand oral health teams in the family health strategy, operating under health surveillance principles. PMID:24627060

  14. Patients on state organ donor registries receive similar levels of intensive care compared to those who are not: an opportunity to increase public intent to donate.

    PubMed

    Patel, Madhukar S; Raza, Shariq S; Bhakta, Akash; Ewing, Tyler; Bukur, Marko; Vagefi, Parsia A; Salim, Ali; Malinoski, Darren J

    2016-06-01

    The intent to donate organs is affected by the public perception that patients on state registries receive less aggressive life-saving care in order to allow organ donation to proceed. However, the association between first person authorization to donate organs and the actual care received by eventual organ donors in hospitals is unknown. From August 2010 to April 2011, all eight organ procurement organizations in United Network for Organ Sharing Region 5 prospectively recorded demographic data and organ utilization rates on all donors after neurologic determination of death (DNDDs). Critical care and physiologic parameters were also recorded at referral for imminent neurologic death and prior to authorization for donation to reflect the aggressiveness of provided care. There were 586 DNDDs and 23% were on a state registry. Compared to non-registered DNDDs, those on state registries were older but were noted to have similar critical care parameters at both referral and authorization. Furthermore, there was no significant difference in organs procured per donor or organs transplanted per donor between registered and non-registered DNDDs. Thus, DNDDs who are on state donor registries receive similar levels of intensive care compared to non-registered donors. The association noted in this study may therefore help to dispel a common misperception that decreases the intent to donate. PMID:26992655

  15. The Accountability Controversy

    ERIC Educational Resources Information Center

    Glisson, Charles

    1975-01-01

    Author discusses accountability controversy concerning effectiveness of social services. Turem's mechanistic and Gruber's organic models of accountability are compared and an alternate open system model of organization is offered which combines positive aspects of Turem's and Gruber's models as well as adds other constructive elements to them. (SE)

  16. A qualitative analysis of a significant barrier to organ and tissue donation: receiving less-than-optimal medical care.

    PubMed

    Denvir, Paul; Pomerantz, Anita

    2009-10-01

    A key reason for the shortage of transplantable organs and tissue in the United States is the degree of resistance among the public to donating organs and tissue after death. In this article, we explore a single barrier to donation: the concern that medical personnel might provide "less-than-optimal" care to intended donors. Using 2 qualitative methodologies-analysis of family discussions about donation and analysis of in-depth interviews about donation-we explore what participants' discourse reveals about the variations and texture of this concern. The analysis revealed 4 aspects of this concern: (a) Participants expressed different versions of less-than-optimal care, each reflecting different assumptions about how medical personnel may approach the treatment of potential donors. (b) Participants expressed their concerns by describing hypothetical scenarios of medical treatment. These scenarios were designed to play up the plausibility of receiving less-than-optimal care and situated the speaker as the victim in the scenario. (c) Participants' uncertainty about the quality of medical treatment was sufficient grounds for not donating. (d) Participants expressed their concerns about medical treatment in terms of the perceived corruptibility of sociocultural institutions, including medical institutions. This analysis also revealed the lines of reasoning through which participants overcame a concern about receiving less-than-optimal-care. In our view, the most promising line of reasoning expressed by participants was to trust the legal and procedural protections built into the recovery process. PMID:20183368

  17. An opportunity for coordinated cancer care: intersection of health care reform, primary care providers, and cancer patients.

    PubMed

    Collins, Lauren G; Wender, Richard; Altshuler, Marc

    2010-01-01

    The US health care system has become increasingly unsustainable, threatened by poor quality and spiraling costs. Many Americans are not receiving recommended preventive care, including cancer screening tests. Passage of the Affordable Care Act in March 2010 has the potential to reverse this course by increasing access to primary care providers, extending coverage and affordability of health insurance, and instituting proven quality measures. In order for health care reform to succeed, it will require a stronger primary care workforce, a new emphasis on patient-centered care, and payment incentives that reward quality over quantity. Innovations such as patient-centered medical homes, accountable care organizations, and improved quality reporting methods are central features of a redesigned health care delivery system and will ultimately change the face of cancer care in the United States. PMID:21131791

  18. The evolution of public relations and the use of the internet: the implications for health care organizations.

    PubMed

    Berkowitz, Eric N

    2007-01-01

    Over the past several years the discipline and practice of public relations has evolved. Historically, this field within health care organizations was a one-way management of communications and often was reactive in nature dealing with a crisis situation with an organization. Recent theoretical development within the discipline suggests that public relations involves more relationship building with key constituencies and on-going-dialogue. Concomitant with this evolution is the technological development of the internet. Most particularly is the use of podcasting and blogging as key tools which have been underutilized by health car providers but have significant potential in both communication and relationship opportunities as discussed in this article. PMID:19042531

  19. Effectiveness in professional organizations: the impact of surgeons and surgical staff organizations on the quality of care in hospitals.

    PubMed Central

    Flood, A B; Scott, W R; Ewy, W; Forrest, W H

    1982-01-01

    In this research, we examine the relative importance of different structural units in a professional organization, the hospital, as they affect organizational effectiveness. The difficulties of measuring effectiveness in a complex professional organization are discussed, and an adjusted measure of surgical outcome is developed. Data are drawn from a prospective study of over 8,000 surgical patients treated by more than 500 surgeons in 15 hospitals throughout the nation. Two different types of analyses are presented, both indicating that hospital features have more impact on surgical outcomes than do surgeon characteristics. The second analysis assesses the relative importance of specific attributes of the hospital, surgical staff organization, and surgeon characteristics on surgical outcomes. PMID:7152960

  20. Organizing person-centred care in paediatric diabetes: multidisciplinary teams, long-term relationships and adequate documentation

    PubMed Central

    2014-01-01

    Background Type 1 diabetes is one of the most frequent long-term endocrine childhood disorders and the Swedish National Diabetes Register for children states that adolescents (12–18 years) constitute the most vulnerable patient group in terms of metabolic control. The aim of this study was to examine how a multidisciplinary team functions when caring for adolescents with type 1 diabetes. Methods Qualitative interviews were performed with 17 health professionals at a Paediatric Diabetes Care Unit in a Swedish university hospital. The interviews were analysed to gain insight into a multidisciplinary care team’s experiences of various organizational processes and circumstances related to the provision of person-centred paediatric diabetes care. Results Building long-term relationships with adolescents, the establishment of a multidisciplinary care team and ensuring adequate documentation are vital for the delivery of person-centred care (PCC). Furthermore, a PCC process and/or practice requires more than the mere expression of person-centred values. The contribution of this study is that it highlights the necessity of facilitating and safeguarding the organization of PCC, for which three processes are central: 1. Facilitating long-term relationships with adolescents and their families; 2. Facilitating multi-professional teamwork; and 3. Ensuring adequate documentation. Conclusion Three processes emerged as important for the functioning of the multidisciplinary team when caring for adolescents with type 1 diabetes: building a long-term relationship, integrating knowledge by means of multidisciplinary team work and ensuring adequate documentation. This study demonstrates the importance of clearly defining and making use of the specific role of each team member in the paediatric diabetes care unit (PDCU). Team members should receive training in PCC and a PCC approach should form the foundation of all diabetes care. Every adolescent suffering from type 1 diabetes

  1. Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome

    PubMed Central

    2012-01-01

    Introduction Recognition of patterns of organ failure may be useful in characterizing the clinical course of critically ill patients. We investigated the patterns of early changes in organ dysfunction/failure in intensive care unit (ICU) patients and their relation to outcome. Methods Using the database from a large prospective European study, we studied 2,933 patients who had stayed more than 48 hours in the ICU and described patterns of organ failure and their relation to outcome. Patients were divided into three groups: patients without sepsis, patients in whom sepsis was diagnosed within the first 48 hours after ICU admission, and patients in whom sepsis developed more than 48 hours after admission. Organ dysfunction was assessed by using the sequential organ failure assessment (SOFA) score. Results A total of 2,110 patients (72% of the study population) had organ failure at some point during their ICU stay. Patients who exhibited an improvement in organ function in the first 24 hours after admission to the ICU had lower ICU and hospital mortality rates compared with those who had unchanged or increased SOFA scores (12.4 and 18.4% versus 19.6 and 24.5%, P < 0.05, pairwise). As expected, organ failure was more common in sepsis than in nonsepsis patients. In patients with single-organ failure, in-hospital mortality was greater in sepsis than in nonsepsis patients. However, in patients with multiorgan failure, mortality rates were similar regardless of the presence of sepsis. Irrespective of the presence of sepsis, delta SOFA scores over the first 4 days in the ICU were higher in nonsurvivors than in survivors and decreased significantly over time in survivors. Conclusions Early changes in organ function are strongly related to outcome. In patients with single-organ failure, in-hospital mortality was higher in sepsis than in nonsepsis patients. However, in multiorgan failure, mortality rates were not influenced by the presence of sepsis. PMID:23158219

  2. The Organization for Economic Cooperation and Development and Health Care Reform in the United States.

    PubMed

    McCanne, Don R

    2009-01-01

    Among OECD nations, the United States is an outlier in having the highest per capita health care costs in a system that unnecessarily exposes many individuals to financial hardship, physical suffering, and even death. President Obama and Congress are currently involved in a process to reform the flawed health care system. The OECD has contributed to that process by releasing a paper, "Health Care Reform in the United States," which describes some of the problems that must be addressed, but then provides proposed solutions that omit consideration of a more equitable and efficient universal public insurance program. The same omission is taking place in Washington, DC. By reinforcing proposals that support the private insurance industry, the source of much of the waste and inequities in health care, the authors of the OECD paper have failed in their responsibility to inform on policies rather than politics. PMID:19927410

  3. 7 CFR 226.12 - Administrative payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... made to a sponsoring organization, the State agency shall consider the anticipated level of start-up or... administrative costs. During any fiscal year, administrative costs payments to a sponsoring organization may not... organization's budget, or (3) the sum of the products obtained by multiplying each month the...

  4. 7 CFR 226.12 - Administrative payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... made to a sponsoring organization, the State agency shall consider the anticipated level of start-up or... administrative costs. During any fiscal year, administrative costs payments to a sponsoring organization may not... organization's budget, or (3) the sum of the products obtained by multiplying each month the...

  5. 7 CFR 226.12 - Administrative payments to sponsoring organizations for day care homes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... made to a sponsoring organization, the State agency shall consider the anticipated level of start-up or... administrative costs. During any fiscal year, administrative costs payments to a sponsoring organization may not... organization's budget, or (3) the sum of the products obtained by multiplying each month the...

  6. Opening the Black Box: Toward Classifying Care and Treatment for Children and Adolescents with Behavioral and Emotional Problems within and across Care Organizations

    ERIC Educational Resources Information Center

    Evenboer, K. E.; Huyghen, A. M. N.; Tuinstra, J.; Reijneveld, S. A.; Knorth, E. J.

    2016-01-01

    Objective: The Taxonomy of Care for Youth was developed to gather information about the care offered to children and adolescents with behavioral and emotional problems in various care settings. The aim was to determine similarities and differences in the content of care and thereby to classify the care offered to these children and youth within…

  7. Coverage and development of specialist palliative care services across the World Health Organization European Region (2005–2012): Results from a European Association for Palliative Care Task Force survey of 53 Countries

    PubMed Central

    Centeno, Carlos; Lynch, Thomas; Garralda, Eduardo; Carrasco, José Miguel; Guillen-Grima, Francisco; Clark, David

    2015-01-01

    Background: The evolution of the provision of palliative care specialised services is important for planning and evaluation. Aim: To examine the development between 2005 and 2012 of three specialised palliative care services across the World Health Organization European Region – home care teams, hospital support teams and inpatient palliative care services. Design and setting: Data were extracted and analysed from two editions of the European Association for Palliative Care Atlas of Palliative Care in Europe. Significant development of each type of services was demonstrated by adjusted residual analysis, ratio of services per population and 2012 coverage (relationship between provision of available services and demand services estimated to meet the palliative care needs of a population). For the measurement of palliative care coverage, we used European Association for Palliative Care White Paper recommendations: one home care team per 100,000 inhabitants, one hospital support team per 200,000 inhabitants and one inpatient palliative care service per 200,000 inhabitants. To estimate evolution at the supranational level, mean comparison between years and European sub-regions is presented. Results: Of 53 countries, 46 (87%) provided data. Europe has developed significant home care team, inpatient palliative care service and hospital support team in 2005–2012. The improvement was statistically significant for Western European countries, but not for Central and Eastern countries. Significant development in at least a type of services was in 21 of 46 (46%) countries. The estimations of 2012 coverage for inpatient palliative care service, home care team and hospital support team are 62%, 52% and 31% for Western European and 20%, 14% and 3% for Central and Eastern, respectively. Conclusion: Although there has been a positive development in overall palliative care coverage in Europe between 2005 and 2012, the services available in most countries are still insufficient

  8. MO-E-17A-06: Organ Dose in Abdomen-Pelvis CT: Does TG 111 Equilibrium Dose Concept Better Accounts for KVp Dependence Than Conventional CTDI?

    SciTech Connect

    Li, X; Morgan, A; Davros, W; Dong, F; Primak, A; Segars, W

    2014-06-15

    Purpose: In CT imaging, a desirable quality assurance (QA) dose quantity should account for the dose variability across scan parameters and scanner models. Recently, AAPM TG 111 proposed to use equilibrium dose-pitch product, in place of CT dose index (CTDI100), for scan modes involving table translation. The purpose of this work is to investigate whether this new concept better accounts for the kVp dependence of organ dose than the conventional CTDI concept. Methods: The adult reference female extended cardiac-torso (XCAT) phantom was used for this study. A Monte Carlo program developed and validated for a 128-slice CT system (Definition Flash, Siemens Healthcare) was used to simulate organ dose for abdomenpelvis scans at five tube voltages (70, 80, 100, 120, 140 kVp) with a pitch of 0.8 and a detector configuration of 2x64x0.6 mm. The same Monte Carlo program was used to simulate CTDI100 and equilibrium dose-pitch product. For both metrics, the central and peripheral values were used together with helical pitch to calculate a volume-weighted average, i.e., CTDIvol and (Deq)vol, respectively. Results: While other scan parameters were kept constant, organ dose depended strongly on kVp; the coefficient of variation (COV) across the five kVp values ranged between 70–75% for liver, spleen, stomach, pancreas, kidneys, colon, small intestine, bladder, and ovaries, all of which were inside the primary radiation beam. One-way analysis of variance (ANOVA) for the effect of kVp was highly significant (p=3e−30). When organ dose was normalized by CTDIvol, the COV across the five kVp values reduced to 7–16%. The effect of kVp was still highly significant (p=4e−4). When organ dose was normalized by (Deq)vol, the COV further reduced to 4−12%. The effect of kVp was borderline significant (p=0.04). Conclusion: In abdomen-pelvis CT, TG 111 equilibrium dose concept better accounts for kVp dependence than the conventional CTDI. This work is supported by a faculty startup

  9. Osteopathic Medical Education and Social Accountability.

    PubMed

    Phillips-Madson, Robyn; Dharamsi, Shafik

    2016-04-01

    The public's trust in physicians continues to decline. As a way to begin regaining this trust, stakeholders, including physicians, medical educators, patient advocacy groups, and community-based organizations, have called for medical education to meet societal health needs, particularly the needs of those members who are most vulnerable, by incorporating social accountability into the medical school curriculum. The unique attributes of the osteopath-ic medical profession provide an enabling and conducive environment for broader social accountability in the health care system. Osteopathic medical schools must actively safeguard the profession's unequivocal commitment to producing healers that are fiduciaries for their patients, communities, and populations at large. PMID:27018954

  10. Governance, organization, accountability and sustainability of a region-wide school-based deworming program in Loreto, Peru.

    PubMed

    Ferruci, Hugo Rodriguez; Razuri, H; Casapia, M; Rahme, E; Silva, H; Ault, S; Blouin, B; Mofid, L S; Montresor, A; Gyorkos, T W

    2016-07-01

    Chau Cuica was the name given by the regional government of Loreto in Peru for its school-based deworming program which was initiated in 2012 with a donation of mebendazole from an international non-governmental organization. Embedded in the program from the start was a sentinel surveillance component which consisted of 16 sentinel schools representing Loreto's seven provinces. Coverage rates varied between 35% and 61% over the first two years of the program (and seven deworming cycles). Initial prevalences of soil-transmitted helminth infections were high, with 82.4% of schoolchildren having at least one infection and prevalences of both Ascaris lumbricoides and Trichuris trichiura infections both exceeding 60%. After two years, these prevalences had dropped to 56% for any STH infection, 38% for A. lumbricoides and 34% for T. trichiura. Importantly, the proportions of children with moderate and heavy infections also dropped. Both the regional Ministry of Health and the Ministry of Education were jointly charged to implement this deworming program. The program's costs were estimated to be approximately 22 cents (USD) per child per deworming cycle. The responsibility for the surveillance component was initially undertaken by research partners from a local NGO and a Canadian university, which transferred gradually over the course of the deworming program to being entirely the responsibility of the Ministry of Health. This regional deworming program may serve as a model for other jurisdictions that are planning a school-based deworming program with an integrated surveillance component to monitor impact. PMID:27048990

  11. Allocation of patients with liver cirrhosis and organ failure to intensive care: Systematic review and a proposal for clinical practice

    PubMed Central

    Lindvig, Katrine Prier; Teisner, Ane Søgaard; Kjeldsen, Jens; Strøm, Thomas; Toft, Palle; Furhmann, Valentin; Krag, Aleksander

    2015-01-01

    AIM: To propose an allocation system of patients with liver cirrhosis to intensive care unit (ICU), and developed a decision tool for clinical practice. METHODS: A systematic review of the literature was performed in PubMed, MEDLINE and EMBASE databases. The search includes studies on hospitalized patients with cirrhosis and organ failure, or acute on chronic liver failure and/or intensive care therapy. RESULTS: The initial search identified 660 potentially relevant articles. Ultimately, five articles were selected; two cohort studies and three reviews were found eligible. The literature on this topic is scarce and no studies specifically address allocation of patients with liver cirrhosis to ICU. Throughout the literature, there is consensus that selection criteria for ICU admission should be developed and validated for this group of patients and multidisciplinary approach is mandatory. Based on current available data we developed an algorithm, to determine if a patient is candidate to intensive care if needed, based on three scoring systems: premorbid Child-Pugh Score, Model of End stage Liver Disease score and the liver specific Sequential Organ Failure Assessment score. CONCLUSION: There are no established systems for allocation of patients with liver cirrhosis to the ICU and no evidence-based recommendations can be made. PMID:26269687

  12. Leveraging Geographic Information Systems in an Integrated Health Care Delivery Organization

    PubMed Central

    Clift, Kathryn; Scott, Luther; Johnson, Michael; Gonzalez, Carlos

    2014-01-01

    A handful of the many changes resulting from the Affordable Care Act underscore the need for a geographic understanding of existing and prospective member communities. Health exchanges require that health provider networks are geographically accessible to underserved populations, and nonprofit hospitals nationwide are required to conduct community health needs assessments every three years. Beyond these requirements, health care providers are using maps and spatial analysis to better address health outcomes that are related in complex ways to social and economic factors. Kaiser Permanente is applying geographic information systems, with spatial analytics and map-based visualizations, to data sourced from its electronic medical records and from publicly and commercially available datasets. The results are helping to shape an understanding of the health needs of Kaiser Permanente members in the context of their communities. This understanding is part of a strategy to inform partnerships and interventions in and beyond traditional care delivery settings. PMID:24694317

  13. Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration.

    PubMed

    Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A

    2016-03-01

    This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation. PMID:25414376

  14. Multidisciplinary cancer care in Spain, or when the function creates the organ: qualitative interview study

    PubMed Central

    2011-01-01

    Background The Spanish National Health System recognised multidisciplinary care as a health priority in 2006, when a national strategy for promoting quality in cancer care was first published. This institutional effort is being implemented on a co-operative basis within the context of Spain's decentralised health care system, so a high degree of variability is to be expected. This study was aimed to explore the views of professionals working with multidisciplinary cancer teams and identify which barriers to effective team work should be considered to ensure implementation of health policy. Methods Qualitative interview study with semi-structured, one-to-one interviews. Data were examined inductively, using content analysis to generate categories and an explanatory framework. 39 professionals performing their tasks, wholly or in part, in different multidisciplinary cancer teams were interviewed. The breakdown of participants' medical specialisations was as follows: medical oncologists (n = 10); radiation oncologists (n = 8); surgeons (n = 7); pathologists or radiologists (n = 6); oncology nurses (n = 5); and others (n = 3). Results Teams could be classified into three models of professional co-operation in multidisciplinary cancer care, namely, advisory committee, formal co-adaptation and integrated care process. The following barriers to implementation were posed: existence of different gateways for the same patient profile; variability in development and use of clinical protocols and guidelines; role of the hospital executive board; outcomes assessment; and the recording and documenting of clinical decisions in a multidisciplinary team setting. All these play a key role in the development of cancer teams and their ability to improve quality of care. Conclusion Cancer team development results from an specific adaptation to the hospital environment. Nevertheless, health policy plays an important role in promoting an organisational approach that changes the way in

  15. Frequency of musculoskeletal complications among the patients receiving solid organ transplantation in a tertiary health-care center.

    PubMed

    Movassaghi, Shafieh; Nasiri Toosi, Mohsen; Bakhshandeh, Alireza; Niksolat, Fatemeh; Khazaeipour, Zahra; Tajik, Ali

    2012-08-01

    Solid organ transplantation is an important lifesaving procedure mainly performed in patients with end-stage organ failure such as liver cirrhosis, congestive heart failure, and end-stage renal disease. While these complications are among the most preventable adverse effects of solid organ transplantation, these are generally neglected by physicians. Accordingly, this study was performed to evaluate the frequency of musculoskeletal complications among the patients receiving solid organ transplantation in a tertiary health-care center in a developing country. This cohort study was performed from 2000 to 2009, among fifty patients receiving organ transplantation (liver, heart, and lung) attending to a training hospital in Tehran, Iran. The main variables were musculoskeletal complaints and findings that were measured according to patients' self-report and clinical examination. The mean age of the patients was 40.2 ± 10.9 years ranging from 5 to 58 years. Twenty out of 50 patients (40%) had musculoskeletal complaints that the most common complaint was the arthralgia. Also, the mechanical arthritis was the most common clinical finding in clinical examination (24%). Low serum level of vitamin D (74.4%) and high serum alkaline phosphatase level (27.9%) were the most common biochemical abnormalities in understudy population. Finally, it may be concluded that nearly forty percent of patients receiving solid organ transplantation may develop musculoskeletal findings and/or complaints. These complications may be found and treated with regular examinations to reduce the burden of disease. PMID:21644040

  16. Struggling to invent high-reliability organizations in health care settings: Insights from the field.

    PubMed

    Dixon, Nancy M; Shofer, Marjorie

    2006-08-01

    The Mission of the Agency for Healthcare Research and Quality (AHRQ) has been to support and conduct health services research and to disseminate those research findings. Recently the Agency has changed its mission to: "Improving the quality, safety, efficiency and effectiveness of health care for all Americans." For agency personnel working with the topic of patient safety, that change has created a need to develop greater awareness of the current patient safety initiatives underway at leading health care systems in order to determine where AHRQ might best play a role in helping these systems more rapidly adopt new practices to improve patient safety. In order to make that determination, AHRQ conducted a customer needs assessment of leaders in selected health care systems, asking them questions about their current implementation initiatives and their perceived needs for continued implementation of patient safety initiatives. Although not designed or conducted as a research study, the hour-long interviews produced rich insights into the implementation efforts of patient safety initiatives. The senior leaders interviewed in each of the health care systems, described implementing patient safety initiatives on multiple fronts-in some systems as many as 15 initiatives were underway. As the number of initiatives attests, there was no lack of knowledge about what patient safety practices should be implemented (CPOE, rapid response teams, reduction in surgical site infections) rather the major struggle these health care systems faced was the "how to" of implementation. Most initiatives were only newly begun, so these leaders were not yet confident about what they had learned from these efforts or whether they could be sustained over time. These health care systems drew many of the ideas for initiatives from outside of health care, for example, the nuclear power industry or aviation. The executives expressed concern about a number of issues including: how patient safety

  17. Moving towards Midlife Care as Negotiated Family Business: Accounts of People with Intellectual Disabilities and Their Families "Just Getting along with Their Lives Together"

    ERIC Educational Resources Information Center

    Knox, Marie; Bigby, Christine

    2007-01-01

    This study explores meanings of family care held by seven families that include a middle-aged adult with intellectually disability. In-depth interviews were conducted with members of each family--the person with intellectual disability, parents, siblings, and sibling spouses. Participants described care as simply getting on with their lives, as…

  18. Food Assistance: Efforts To Control Fraud and Abuse in the Child and Adult Care Food Program Should Be Strengthened. United States General Accounting Office Report to Congressional Committees.

    ERIC Educational Resources Information Center

    Robertson, Robert E.

    The Child and Adult Care Food Program provides over $1.5 billion in benefits annually to children and adults in day care. In order to address the longstanding problems of fraud and abuse present in the program, state agencies have been charged with the responsibility for implementing Food and Nutrition Service's (FNS) regulations to prevent and…

  19. Everyday Routines: A Window into the Cultural Organization of Family Child Care

    ERIC Educational Resources Information Center

    Tonyan, Holli A.

    2015-01-01

    Eco(logical)-cultural Theory suggests that a daily routine results from individuals adapting cultural ideas to the constraints of a local context or ecology. Using Ecocultural Theory, this research examined family child care providers' descriptions of daily activities and overall approach to understand cultural models. The results highlighted a…

  20. Interventions to reduce bullying in health care organizations: a scoping review.

    PubMed

    Quinlan, Elizabeth; Robertson, Susan; Miller, Natasha; Robertson-Boersma, Danielle

    2014-01-01

    The problem of staff-to-staff bullying and its consequences in the health care sector has given rise to urgent knowledge needs among health care employers, union representatives, and professional associations. The purpose of this scoping review is to increase the uptake and application of synthesized research results of interventions designed to address bullying among coworkers within health care workplaces. The scoping review's methodology uses an adapted version of the Arksey and O'Malley framework to locate and review empirical studies involving interventions designed to address bullying in health care workplaces. The findings of the review reveal eight articles from three countries discussing interventions that included educative programming, bullying champions/advocates, and zero-tolerance policies. The reported evaluations extend beyond bullying to include organizational culture, trust in management, retention rates, and psychosocial health. The most promising reported outcomes are from participatory interventions. The results of the review make a compelling case for bullying interventions based on participatory principles. PMID:25595015