Science.gov

Sample records for administrative health databases

  1. Database Administrator

    ERIC Educational Resources Information Center

    Moore, Pam

    2010-01-01

    The Internet and electronic commerce (e-commerce) generate lots of data. Data must be stored, organized, and managed. Database administrators, or DBAs, work with database software to find ways to do this. They identify user needs, set up computer databases, and test systems. They ensure that systems perform as they should and add people to the…

  2. Veterans Health Administration multiple sclerosis surveillance registry: The problem of case-finding from administrative databases.

    PubMed

    Culpepper, William J; Ehrmantraut, Mary; Wallin, Mitchell T; Flannery, Kathleen; Bradham, Douglas D

    2006-01-01

    Establishment of a national multiple sclerosis (MS) surveillance registry (MSSR) is a primary goal of the Department of Veterans Affairs (VA) MS Center of Excellence. The initial query of Veterans Health Administration (VHA) databases identified 25,712 patients (labeled "VHA MS User Cohort") from fiscal years 1998 to 2002 based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code; service-connection for MS; and/or disease-modifying agent (DMA) use. Because of ICD-9-CM limitations, the initial query was overinclusive and resulted in many non-MS cases. Thus, we needed a more rigorous case-finding method. Our gold standard was chart review of the Computerized Patient Record System for the mid-Atlantic VA medical centers. After chart review, we classified patients as not having MS or having MS/possible MS. We also applied a statistical algorithm to classify cases based on service-connection for MS, DMA use, and/or at least one healthcare encounter a year with MS coded as the primary diagnosis. We completed two analyses with kappa coefficient and sensitivity analysis. The first analysis (efficacy) was limited to cases with a definitive classification based on chart review (n = 600). The kappa coefficient was 0.85, sensitivity was 0.93, and specificity was 0.92. The second analysis (effectiveness) included unknown cases that were classified as MS/possible MS (N = 682). The kappa coefficient was 0.82, sensitivity was 0.93, and specificity was 0.90. These findings suggest that the database algorithm reliably eliminated non-MS cases from the initial MSSR population and is a reasonable case-finding method at this intermediate stage of MSSR development.

  3. Veterans Administration Databases

    Cancer.gov

    The Veterans Administration Information Resource Center provides database and informatics experts, customer service, expert advice, information products, and web technology to VA researchers and others.

  4. Nursing leadership succession planning in Veterans Health Administration: creating a useful database.

    PubMed

    Weiss, Lizabeth M; Drake, Audrey

    2007-01-01

    An electronic database was developed for succession planning and placement of nursing leaders interested and ready, willing, and able to accept an assignment in a nursing leadership position. The tool is a 1-page form used to identify candidates for nursing leadership assignments. This tool has been deployed nationally, with access to the database restricted to nurse executives at every Veterans Health Administration facility for the purpose of entering the names of developed nurse leaders ready for a leadership assignment. The tool is easily accessed through the Veterans Health Administration Office of Nursing Service, and by limiting access to the nurse executive group, ensures candidates identified are qualified. Demographic information included on the survey tool includes the candidate's demographic information and other certifications/credentials. This completed information form is entered into a database from which a report can be generated, resulting in a listing of potential candidates to contact to supplement a local or Veterans Integrated Service Network wide position announcement. The data forms can be sorted by positions, areas of clinical or functional experience, training programs completed, and geographic preference. The forms can be edited or updated and/or added or deleted in the system as the need is identified. This tool allows facilities with limited internal candidates to have a resource with Department of Veterans Affairs prepared staff in which to seek additional candidates. It also provides a way for interested candidates to be considered for positions outside of their local geographic area.

  5. Methods for systematic reviews of administrative database studies capturing health outcomes of interest.

    PubMed

    McPheeters, Melissa L; Sathe, Nila A; Jerome, Rebecca N; Carnahan, Ryan M

    2013-12-30

    This report provides an overview of methods used to conduct systematic reviews for the US Food and Drug Administration (FDA) Mini-Sentinel project, which is designed to inform the development of safety monitoring tools for FDA-regulated products including vaccines. The objective of these reviews was to summarize the literature describing algorithms (e.g., diagnosis or procedure codes) to identify health outcomes in administrative and claims data. A particular focus was the validity of the algorithms when compared to reference standards such as diagnoses in medical records. The overarching goal was to identify algorithms that can accurately identify the health outcomes for safety surveillance. We searched the MEDLINE database via PubMed and required dual review of full text articles and of data extracted from studies. We also extracted data on each study's methods for case validation. We reviewed over 5600 abstracts/full text studies across 15 health outcomes of interest. Nearly 260 studies met our initial criteria (conducted in the US or Canada, used an administrative database, reported case-finding algorithm). Few studies (N=45), however, reported validation of case-finding algorithms (sensitivity, specificity, positive or negative predictive value). Among these, the most common approach to validation was to calculate positive predictive values, based on a review of medical records as the reference standard. Of the studies reporting validation, the ease with which a given clinical condition could be identified in administrative records varied substantially, both by the clinical condition and by other factors such as the clinical setting, which relates to the disease prevalence.

  6. Redis database administration tool

    SciTech Connect

    Martinez, J. J.

    2013-02-13

    MyRedis is a product of the Lorenz subproject under the ASC Scirntific Data Management effort. MyRedis is a web based utility designed to allow easy administration of instances of Redis databases. It can be usedd to view and manipulate data as well as run commands directly against a variety of different Redis hosts.

  7. Quantifying limitations in chemotherapy data in administrative health databases: implications for measuring the quality of colorectal cancer care.

    PubMed

    Urquhart, Robin; Rayson, Daniel; Porter, Geoffrey A; Grunfeld, Eva

    2011-08-01

    Reliable chemotherapy data are critical to evaluate the quality of care for patients with colorectal cancer who are treated with curative intent. In Canada, limitations in the availability and completeness of chemotherapy data exist in many administrative health databases. In this paper, we discuss these limitations and present findings from a chart review in Nova Scotia that quantifies the completeness of chemotherapy capture in existing databases. The results demonstrate that even basic information on cancer treatment in administrative databases can be insufficient to perform the types of analyses that most decision-makers require for quality-of-care measurement.

  8. Good agreement between questionnaire and administrative databases for health care use and costs in patients with osteoarthritis

    PubMed Central

    2011-01-01

    Background Estimating costs is essential to the economic analysis of health care programs. Health care costs are often captured from administrative databases or by patient report. Administrative records only provide a partial representation of health care costs and have additional limitations. Patient-completed questionnaires may allow a broader representation of health care costs; however the validity and feasibility of such methods have not been firmly established. This study was conducted to assess the validity and feasibility of using a patient-completed questionnaire to capture health care use and costs for patients with osteoarthritis, and to compare the research costs of the data-capture methods. Methods We designed a patient questionnaire and applied it in a clinical trial. We captured equivalent data from four administrative databases. We evaluated aspects of the questionnaire's validity using sensitivity and specificity, Lin's concordance correlation coefficient (ρc), and Bland-Altman comparisons. Results The questionnaire's response rate was 89%. Acceptable sensitivity and specificity levels were found for all types of health care use. The numbers of visits and the majority of medications reported by patients were in agreement with the database-derived estimates (ρc > 0.40). Total cost estimates from the questionnaire agreed with those from the databases. Patient-reported co-payments agreed with administrative records with respect to GP office transactions, but not pharmaceutical co-payments. Research costs for the questionnaire-based method were less than one-third of the costs for the databases method. Conclusion A patient-completed questionnaire is feasible for capturing health care use and costs for patients with osteoarthritis, and data collected using it mostly agree with administrative databases. Caution should be exercised when applying unit costs and collecting co-payment data. PMID:21489280

  9. Using linked electronic data to validate algorithms for health outcomes in administrative databases.

    PubMed

    Lee, Wan-Ju; Lee, Todd A; Pickard, Alan Simon; Shoaibi, Azadeh; Schumock, Glen T

    2015-08-01

    The validity of algorithms used to identify health outcomes in claims-based and administrative data is critical to the reliability of findings from observational studies. The traditional approach to algorithm validation, using medical charts, is expensive and time-consuming. An alternative method is to link the claims data to an external, electronic data source that contains information allowing confirmation of the event of interest. In this paper, we describe this external linkage validation method and delineate important considerations to assess the feasibility and appropriateness of validating health outcomes using this approach. This framework can help investigators decide whether to pursue an external linkage validation method for identifying health outcomes in administrative/claims data.

  10. Veterans Health Administration

    MedlinePlus

    ... code here VA » Veterans Health Administration Veterans Health Administration Marine Continues to Serve by Serving Veterans David ... Read more » VA Medical Centers The Veterans Health Administration is home to the United States’ largest integrated ...

  11. Database Support for Research in Public Administration

    ERIC Educational Resources Information Center

    Tucker, James Cory

    2005-01-01

    This study examines the extent to which databases support student and faculty research in the area of public administration. A list of journals in public administration, public policy, political science, public budgeting and finance, and other related areas was compared to the journal content list of six business databases. These databases…

  12. TWRS information locator database system administrator`s manual

    SciTech Connect

    Knutson, B.J., Westinghouse Hanford

    1996-09-13

    This document is a guide for use by the Tank Waste Remediation System (TWRS) Information Locator Database (ILD) System Administrator. The TWRS ILD System is an inventory of information used in the TWRS Systems Engineering process to represent the TWRS Technical Baseline. The inventory is maintained in the form of a relational database developed in Paradox 4.5.

  13. Prevalence and Costs of Multimorbidity by Deprivation Levels in the Basque Country: A Population Based Study Using Health Administrative Databases

    PubMed Central

    Orueta, Juan F.; García-Álvarez, Arturo; García-Goñi, Manuel; Paolucci, Francesco; Nuño-Solinís, Roberto

    2014-01-01

    Background Multimorbidity is a major challenge for healthcare systems. However, currently, its magnitude and impact in healthcare expenditures is still mostly unknown. Objective To present an overview of the prevalence and costs of multimorbidity by socioeconomic levels in the whole Basque population. Methods We develop a cross-sectional analysis that includes all the inhabitants of the Basque Country (N = 2,262,698). We utilize data from primary health care electronic medical records, hospital admissions, and outpatient care databases, corresponding to a 4 year period. Multimorbidity was defined as the presence of two or more chronic diseases out of a list of 52 of the most important and common chronic conditions given in the literature. We also use socioeconomic and demographic variables such as age, sex, individual healthcare cost, and deprivation level. Predicted adjusted costs were obtained by log-gamma regression models. Results Multimorbidity of chronic diseases was found among 23.61% of the total Basque population and among 66.13% of those older than 65 years. Multimorbid patients account for 63.55% of total healthcare expenditures. Prevalence of multimorbidity is higher in the most deprived areas for all age and sex groups. The annual cost of healthcare per patient generated for any chronic disease depends on the number of coexisting comorbidities, and varies from 637 € for the first pathology in average to 1,657 € for the ninth one. Conclusion Multimorbidity is very common for the Basque population and its prevalence rises in age, and unfavourable socioeconomic environment. The costs of care for chronic patients with several conditions cannot be described as the sum of their individual pathologies in average. They usually increase dramatically according to the number of comorbidities. Given the ageing population, multimorbidity and its consequences should be taken into account in healthcare policy, the organization of care and medical research

  14. Topical medication utilization and health resources consumption in adult patients affected by psoriasis: findings from the analysis of administrative databases of local health units

    PubMed Central

    Perrone, Valentina; Sangiorgi, Diego; Buda, Stefano; Degli Esposti, Luca

    2017-01-01

    Aim The objectives of this study were to: 1) analyze the drug utilization pattern among adult psoriasis patients who were newly prescribed with topical medication; and 2) assess their adherence to topical therapy and the possibility of switching to other strategies in the treatment process. Methods An observational retrospective analysis was conducted based on administrative databases of two Italian local health units. All adult subjects who were diagnosed with psoriasis or who were newly prescribed for topical medication with at least one prescription between January 1, 2010, and December 31, 2014, were screened. Only patients who were “non-occasional users of topical drugs” (if they had at least two prescriptions of topical drugs in a time space of 2 years) were considered for the first and second objectives in the analysis. The date of the first prescription of topical agents was identified as the index date (ID), which was then followed for all time available from ID (follow-up period). The adherence to therapy was assessed on the basis of cycles of treatment covered in the 6 months before the end of the follow-up period. The mean health care costs in patients who switched to disease-modifying antirheumatic drugs (DMARDs) or biologics after the ID were evaluated. Results A total of 17,860 patients with psoriasis who were newly prescribed for topical medication were identified. A total of 2,477 were identified as “non-occasional users of topical drugs”, of whom 70.2% had a prescription for a topical fixed combination regimen at ID. Around 19% adhered to their medication, whereas 6% switched to other options of psoriasis treatment. Multivariable logistic regression model shows that patients on fixed combination treatment were less likely to be non-adherent to treatment and less likely to switch to other treatments. The annual mean pharmaceutical costs were €567.70 and €10,606.10 for patients who switched to DMARDs and biologics, respectively

  15. Capturing and classifying functional status information in administrative databases.

    PubMed

    Iezzoni, Lisa I; Greenberg, Marjorie S

    2003-01-01

    The health care delivery system aims to improve the functioning of Americans, but little information exists to judge progress toward meeting this goal. Administrative data generated through running and overseeing health care delivery offer considerable information about diagnoses and procedures in coded formats comparable across settings of care. This article explores the issues raised when considering adding coded information about functional status to administrative databases throughout the health care system. The National Committee on Vital and Health Statistics (NCVHS) identified the International Classification of Functioning, Disability and Health (ICF) as the only viable code set for consistently reporting functional status.

  16. A Database System for Course Administration.

    ERIC Educational Resources Information Center

    Benbasat, Izak; And Others

    1982-01-01

    Describes a computer-assisted testing system which produces multiple-choice examinations for a college course in business administration. The system uses SPIRES (Stanford Public Information REtrieval System) to manage a database of questions and related data, mark-sense cards for machine grading tests, and ACL (6) (Audit Command Language) to…

  17. 47 CFR 15.715 - TV bands database administrator.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false TV bands database administrator. 15.715 Section... Band Devices § 15.715 TV bands database administrator. The Commission will designate one or more entities to administer a TV bands database. Each database administrator shall: (a) Maintain a database...

  18. A practical tool for public health surveillance: Semi-automated coding of short injury narratives from large administrative databases using Naïve Bayes algorithms.

    PubMed

    Marucci-Wellman, Helen R; Lehto, Mark R; Corns, Helen L

    2015-11-01

    Public health surveillance programs in the U.S. are undergoing landmark changes with the availability of electronic health records and advancements in information technology. Injury narratives gathered from hospital records, workers compensation claims or national surveys can be very useful for identifying antecedents to injury or emerging risks. However, classifying narratives manually can become prohibitive for large datasets. The purpose of this study was to develop a human-machine system that could be relatively easily tailored to routinely and accurately classify injury narratives from large administrative databases such as workers compensation. We used a semi-automated approach based on two Naïve Bayesian algorithms to classify 15,000 workers compensation narratives into two-digit Bureau of Labor Statistics (BLS) event (leading to injury) codes. Narratives were filtered out for manual review if the algorithms disagreed or made weak predictions. This approach resulted in an overall accuracy of 87%, with consistently high positive predictive values across all two-digit BLS event categories including the very small categories (e.g., exposure to noise, needle sticks). The Naïve Bayes algorithms were able to identify and accurately machine code most narratives leaving only 32% (4853) for manual review. This strategy substantially reduces the need for resources compared with manual review alone.

  19. Description of two waterborne disease outbreaks in France: a comparative study with data from cohort studies and from health administrative databases.

    PubMed

    Mouly, D; Van Cauteren, D; Vincent, N; Vaissiere, E; Beaudeau, P; Ducrot, C; Gallay, A

    2016-02-01

    Waterborne disease outbreaks (WBDO) of acute gastrointestinal illness (AGI) are a public health concern in France. Their occurrence is probably underestimated due to the lack of a specific surveillance system. The French health insurance database provides an interesting opportunity to improve the detection of these events. A specific algorithm to identify AGI cases from drug payment reimbursement data in the health insurance database has been previously developed. The purpose of our comparative study was to retrospectively assess the ability of the health insurance data to describe WBDO. Data from the health insurance database was compared with the data from cohort studies conducted in two WBDO in 2010 and 2012. The temporal distribution of cases, the day of the peak and the duration of the epidemic, as measured using the health insurance data, were similar to the data from one of the two cohort studies. However, health insurance data accounted for 54 cases compared to the estimated 252 cases accounted for in the cohort study. The accuracy of using health insurance data to describe WBDO depends on the medical consultation rate in the impacted population. As this is never the case, data analysis underestimates the total number of AGI cases. However this data source can be considered for the development of a detection system of a WBDO in France, given its ability to describe an epidemic signal.

  20. 47 CFR 52.25 - Database architecture and administration.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 3 2014-10-01 2014-10-01 false Database architecture and administration. 52.25... (CONTINUED) NUMBERING Number Portability § 52.25 Database architecture and administration. (a) The North... databases for the provision of long-term database methods for number portability. (b) All...

  1. 47 CFR 15.714 - TV bands database administration fees.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 1 2013-10-01 2013-10-01 false TV bands database administration fees. 15.714 Section 15.714 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL RADIO FREQUENCY DEVICES Television Band Devices § 15.714 TV bands database administration fees. (a) A TV bands database...

  2. 47 CFR 15.714 - TV bands database administration fees.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 1 2014-10-01 2014-10-01 false TV bands database administration fees. 15.714 Section 15.714 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL RADIO FREQUENCY DEVICES Television Band Devices § 15.714 TV bands database administration fees. (a) A TV bands database...

  3. 47 CFR 15.714 - TV bands database administration fees.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 1 2011-10-01 2011-10-01 false TV bands database administration fees. 15.714 Section 15.714 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL RADIO FREQUENCY DEVICES Television Band Devices § 15.714 TV bands database administration fees. (a) A TV bands database...

  4. 47 CFR 15.714 - TV bands database administration fees.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 1 2012-10-01 2012-10-01 false TV bands database administration fees. 15.714 Section 15.714 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL RADIO FREQUENCY DEVICES Television Band Devices § 15.714 TV bands database administration fees. (a) A TV bands database...

  5. 47 CFR 15.714 - TV bands database administration fees.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false TV bands database administration fees. 15.714 Section 15.714 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL RADIO FREQUENCY DEVICES Television Band Devices § 15.714 TV bands database administration fees. (a) A TV bands database...

  6. Administrators Say Funding Inhibits Use of Databases.

    ERIC Educational Resources Information Center

    Gerhard, Michael E.

    1990-01-01

    Surveys journalism and mass communication department heads to address questions related to the use of online databases in journalism higher education, database policy, resources used in providing online services, and satisfaction with database service. Reports that electronic information retrieval is just beginning to penetrate journalism at the…

  7. 47 CFR 52.25 - Database architecture and administration.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... carriers shall have equal and open access to the regional databases. (c) The NANC shall select a local number portability administrator(s) (LNPA(s)) to administer the regional databases within seven months of the initial meeting of the NANC. (d) The NANC shall determine whether one or multiple...

  8. 47 CFR 52.25 - Database architecture and administration.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... carriers shall have equal and open access to the regional databases. (c) The NANC shall select a local number portability administrator(s) (LNPA(s)) to administer the regional databases within seven months of the initial meeting of the NANC. (d) The NANC shall determine whether one or multiple...

  9. Health Ethics Education for Health Administration Chaplains

    ERIC Educational Resources Information Center

    Porter, Russell; Broussard, Amelia; Duckett, Todd

    2008-01-01

    It is imperative for divinity and health administration programs to improve their level of ethics education for their graduates who work as health administration chaplains. With an initial presentation of the variation of ethical dilemmas presented in health care facilities covering social, organizational, and patient levels, we indicate the need…

  10. Use of an administrative database to determine clinical management and outcomes in congenital heart disease.

    PubMed

    Gutgesell, Howard P; Hillman, Diane G; McHugh, Kimberly E; Dean, Peter; Matherne, G Paul

    2011-10-01

    We review our 16-year experience using the large, multi-institutional database of the University HealthSystem Consortium to study management and outcomes in congenital heart surgery for hypoplastic left heart syndrome, transposition of the great arteries, and neonatal coarctation. The advantages, limitations, and use of administrative databases by others to study congenital heart surgery are reviewed.

  11. A review of accessibility of administrative healthcare databases in the Asia-Pacific region

    PubMed Central

    Milea, Dominique; Azmi, Soraya; Reginald, Praveen; Verpillat, Patrice; Francois, Clement

    2015-01-01

    Objective We describe and compare the availability and accessibility of administrative healthcare databases (AHDB) in several Asia-Pacific countries: Australia, Japan, South Korea, Taiwan, Singapore, China, Thailand, and Malaysia. Methods The study included hospital records, reimbursement databases, prescription databases, and data linkages. Databases were first identified through PubMed, Google Scholar, and the ISPOR database register. Database custodians were contacted. Six criteria were used to assess the databases and provided the basis for a tool to categorise databases into seven levels ranging from least accessible (Level 1) to most accessible (Level 7). We also categorised overall data accessibility for each country as high, medium, or low based on accessibility of databases as well as the number of academic articles published using the databases. Results Fifty-four administrative databases were identified. Only a limited number of databases allowed access to raw data and were at Level 7 [Medical Data Vision EBM Provider, Japan Medical Data Centre (JMDC) Claims database and Nihon-Chouzai Pharmacy Claims database in Japan, and Medicare, Pharmaceutical Benefits Scheme (PBS), Centre for Health Record Linkage (CHeReL), HealthLinQ, Victorian Data Linkages (VDL), SA-NT DataLink in Australia]. At Levels 3–6 were several databases from Japan [Hamamatsu Medical University Database, Medi-Trend, Nihon University School of Medicine Clinical Data Warehouse (NUSM)], Australia [Western Australia Data Linkage (WADL)], Taiwan [National Health Insurance Research Database (NHIRD)], South Korea [Health Insurance Review and Assessment Service (HIRA)], and Malaysia [United Nations University (UNU)-Casemix]. Countries were categorised as having a high level of data accessibility (Australia, Taiwan, and Japan), medium level of accessibility (South Korea), or a low level of accessibility (Thailand, China, Malaysia, and Singapore). In some countries, data may be available but

  12. Creating a computerized database from administrative claims data.

    PubMed

    Piecoro, L T; Wang, L S; Dixon, W S; Crovo, R J

    1999-07-01

    The creation of a computerized database from Medicaid administrative claims data for research purposes is described. Researchers should consult with computer experts at their institution before selecting software for data manipulation and conversion. It is essential to have an accurate layout of the file record before attempting to convert raw claims data into data sets or other data formats. The location of data elements within the claim will vary depending on whether the record comes from a provider, an institution, or a pharmacy. Each claim contains a common header, a variable header, and a claim detail section. The difficulty in analyzing data elements within a claim detail lies in locating the starting point of the claim detail section. So that data elements not in character or numeric formats can be converted, the file record layout must describe the exact format of each data element and its COBOL notation. A data element dictionary is necessary for translating data element coding into usable data. Data elements not necessary for any planned analysis must be eliminated. The data are then "cleaned" to remove any denied or reversed claims and claims that contain incomplete or erroneous data. Regardless of the format data are obtained in, an accurate file record layout and a data element dictionary are essential to the conversion of administrative claims data into a computerized database for data analysis and research purposes.

  13. Stroke surveillance in Manitoba, Canada: estimates from administrative databases.

    PubMed

    Moore, D F; Lix, L M; Yogendran, M S; Martens, P; Tamayo, A

    2008-01-01

    This study investigated the use of population-based administrative databases for stroke surveillance. First, a meta-analysis was conducted of four studies, identified via a PubMed search, which estimated the sensitivity and specificity of hospital data for ascertaining cases of stroke when clinical registries or medical charts were the gold standard. Subsequently, case-ascertainment algorithms based on hospital, physician and prescription drug records were developed and applied to Manitoba's administrative data, and prevalence estimates were obtained for fiscal years 1995/96 to 2003/04 by age group, sex, region of residence and income quintile. The meta-analysis results revealed some over-ascertainment of stroke cases from hospital data when the algorithm was based on diagnosis codes for any type of cerebrovascular disease (Mantel-Haenszel Odds-Ratio [OR] - 1.70 [95% confidence interval (CI): 1.53 - 1.88]). Analyses of Manitoba administrative data revealed that while the total number of stroke cases varied substantially across the algorithms, the trend in prevalence was stable regardless of the algorithm adopted.

  14. Validity of chronic obstructive pulmonary disease diagnoses in a large administrative database

    PubMed Central

    Lacasse, Yves; Daigle, Jean-Marc; Martin, Sylvie; Maltais, François

    2012-01-01

    BACKGROUND: Administrative databases are often used for research purposes, with minimal attention devoted to the validity of the included diagnoses. AIMS: To determine whether the principal diagnoses of chronic obstructive pulmonary disease (COPD) made in hospitalized patients and recorded in a large administrative database are valid. METHODS: The medical charts of 1221 patients hospitalized in 40 acute care centres in Quebec and discharged between April 1, 2003 and March 31, 2004, with a principal discharge diagnosis of COPD (International Classification of Diseases, Ninth Revision codes 491, 492 or 496) were reviewed. The diagnosis of COPD was independently adjudicated by two pulmonologists using clinical history (including smoking status) and spirometry. The primary outcome measure was the positive predictive value (PPV) of the database for the diagnosis of COPD (ie, the proportion of patients with an accurate diagnosis of COPD corroborated by clinical history and spirometry). RESULTS: The diagnosis of COPD was validated in 616 patients (PPV 50.4% [95% CI 47.7% to 53.3%]), with 372 patients (30.5%) classified as ‘indeterminate’. Older age and female sex were associated with a lower probability of an accurate diagnosis of COPD. Hospitalization in a teaching institution was associated with a twofold increase in the probability of a correct diagnosis. CONCLUSIONS: The results support the routine ascertainment of the validity of diagnoses before using administrative databases in clinical and health services research. PMID:22536584

  15. Classified Computer Configuration Control System (C{sup 4}S), Revision 3, Database Administrator`s Guide

    SciTech Connect

    O`Callaghan, P.B.; Nelson, R.A.; Grambihler, A.J.

    1994-04-01

    This document provides a guide for database administration and specific information for the Classified Computer Configuration Control System (C{sup 4}S). As a guide, this document discusses required database administration functions for the set up of database tables and for users of the system. It is assumed that general and user information has been obtained from the Classified Computer Configuration Control System (C{sup 4}S), Revision 3, User`s Information (WHC 1994).

  16. 47 CFR 15.715 - TV bands database administrator.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... functions of a TV bands database, such as a data repository, registration, and query services, to be divided... inaccuracies in the database to its attention. This requirement applies only to information that the...

  17. 47 CFR 15.715 - TV bands database administrator.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) based on their geographic location and provide accurate lists of available channels to fixed and Mode II... functions of a TV bands database, such as a data repository, registration, and query services, to be divided... responsible for coordination of the overall functioning of a database and providing services to TVBDs....

  18. 47 CFR 52.25 - Database architecture and administration.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... the initial meeting of the NANC. (d) The NANC shall determine whether one or multiple administrator(s... user interface between telecommunications carriers and the LNPA(s), the network interface between...

  19. 47 CFR 52.25 - Database architecture and administration.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the initial meeting of the NANC. (d) The NANC shall determine whether one or multiple administrator(s... user interface between telecommunications carriers and the LNPA(s), the network interface between...

  20. 47 CFR 15.715 - TV bands database administrator.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... functions of a TV bands database, such as a data repository, registration, and query services, to be divided... its attention. This requirement applies only to information that the Commission requires to be...

  1. 47 CFR 15.715 - TV bands database administrator.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... functions of a TV bands database, such as a data repository, registration, and query services, to be divided... its attention. This requirement applies only to information that the Commission requires to be...

  2. The Air Toxics Health Effects Database (ATHED).

    PubMed

    Woodall, George M; Smith, Roy L

    2008-11-15

    The Air Toxics Health Effects Database (ATHED) is currently used by the EPA's Office of Air Quality Planning and Standards (OAQPS) to support risk assessments for the Residual Risk Program. An assessment of the residual risk is required to be performed at a specified time (typically 8 years) following the promulgation of a technology-based Maximum Achievable Control Technologies (MACT) standard. The goal of the Residual Risk Program is to assure that the risk that remains after MACT standards are implemented (i.e., the "residual risk") is acceptable, and if not, to propose additional regulations to mitigate those risks. ATHED maintains all available reference values for each chemical as separate data records, and includes values for all exposure durations (acute, short-term, subchronic and chronic). These values are used as benchmarks to determine acceptable exposure levels to the hazardous air pollutants (HAPs) listed in Section 112 of the Clean Air Act. ATHED also provides useful background information on the uncertainty and/or modifying factors that were applied in the derivation of each reference value, as well as the point of departure and the critical study/studies. To facilitate comparisons across durations for a specific chemical, ATHED data can be graphically presented.

  3. Validity of peptic ulcer disease and upper gastrointestinal bleeding diagnoses in administrative databases: a systematic review protocol

    PubMed Central

    Montedori, Alessandro; Abraha, Iosief; Chiatti, Carlos; Cozzolino, Francesco; Orso, Massimiliano; Luchetta, Maria Laura; Rimland, Joseph M; Ambrosio, Giuseppe

    2016-01-01

    Introduction Administrative healthcare databases are useful to investigate the epidemiology, health outcomes, quality indicators and healthcare utilisation concerning peptic ulcers and gastrointestinal bleeding, but the databases need to be validated in order to be a reliable source for research. The aim of this protocol is to perform the first systematic review of studies reporting the validation of International Classification of Diseases, 9th Revision and 10th version (ICD-9 and ICD-10) codes for peptic ulcer and upper gastrointestinal bleeding diagnoses. Methods and analysis MEDLINE, EMBASE, Web of Science and the Cochrane Library databases will be searched, using appropriate search strategies. We will include validation studies that used administrative data to identify peptic ulcer disease and upper gastrointestinal bleeding diagnoses or studies that evaluated the validity of peptic ulcer and upper gastrointestinal bleeding codes in administrative data. The following inclusion criteria will be used: (a) the presence of a reference standard case definition for the diseases of interest; (b) the presence of at least one test measure (eg, sensitivity, etc) and (c) the use of an administrative database as a source of data. Pairs of reviewers will independently abstract data using standardised forms and will evaluate quality using the checklist of the Standards for Reporting of Diagnostic Accuracy (STARD) criteria. This systematic review protocol has been produced in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) 2015 statement. Ethics and dissemination Ethics approval is not required given that this is a protocol for a systematic review. We will submit results of this study to a peer-reviewed journal for publication. The results will serve as a guide for researchers validating administrative healthcare databases to determine appropriate case definitions for peptic ulcer disease and upper gastrointestinal

  4. Comparison of scientific and administrative database management systems

    NASA Technical Reports Server (NTRS)

    Stoltzfus, J. C.

    1983-01-01

    Some characteristics found to be different for scientific and administrative data bases are identified and some of the corresponding generic requirements for data base management systems (DBMS) are discussed. The requirements discussed are especially stringent for either the scientific or administrative data bases. For some, no commercial DBMS is fully satisfactory, and the data base designer must invent a suitable approach. For others, commercial systems are available with elegant solutions, and a wrong choice would mean an expensive work-around to provide the missing features. It is concluded that selection of a DBMS must be based on the requirements for the information system. There is no unique distinction between scientific and administrative data bases or DBMS. The distinction comes from the logical structure of the data, and understanding the data and their relationships is the key to defining the requirements and selecting an appropriate DBMS for a given set of applications.

  5. Planning the future of JPL's management and administrative support systems around an integrated database

    NASA Technical Reports Server (NTRS)

    Ebersole, M. M.

    1983-01-01

    JPL's management and administrative support systems have been developed piece meal and without consistency in design approach over the past twenty years. These systems are now proving to be inadequate to support effective management of tasks and administration of the Laboratory. New approaches are needed. Modern database management technology has the potential for providing the foundation for more effective administrative tools for JPL managers and administrators. Plans for upgrading JPL's management and administrative systems over a six year period evolving around the development of an integrated management and administrative data base are discussed.

  6. Review of Veterans Health Administration telemedicine interventions.

    PubMed

    Hill, Robert D; Luptak, Marilyn K; Rupper, Randall W; Bair, Byron; Peterson, Cherie; Dailey, Nancy; Hicken, Bret L

    2010-12-01

    The Veterans Health Administration (VHA) is a leader in developing and implementing innovative healthcare technology. We review 19 exemplary peer-reviewed articles published between 2000 and 2009 of controlled, VHA-supported telemedicine intervention trials that focused on health outcomes. These trials underscore the role of telemedicine in large managed healthcare organizations in support of (1) chronic disease management, (2) mental health service delivery through in-home monitoring and treatment, and (3) interdisciplinary team functioning through electronic medical record information interchange. Telemedicine is advantageous when ongoing monitoring of patient symptoms is needed, as in chronic disease care (eg, for diabetes) or mental health treatment. Telemedicine appears to enhance patient access to healthcare professionals and provides quick access to patient medical information. The sustainability of telemedicine interventions for the broad spectrum of veteran patient issues and the ongoing technology training of patients and providers are challenges to telemedicine-delivered care.

  7. 78 FR 61367 - Health Resources and Services Administration

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-03

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency Information Collection Activities; Proposed Collection; Public Comment Request AGENCY: Health Resources and Services Administration,...

  8. 78 FR 14806 - Health Resources and Services Administration

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-07

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Statement of Organization, Functions and Delegations of Authority; Correction AGENCY: Health Resources and Services Administration (HRSA), HHS....

  9. Geospatial Database for Strata Objects Based on Land Administration Domain Model (ladm)

    NASA Astrophysics Data System (ADS)

    Nasorudin, N. N.; Hassan, M. I.; Zulkifli, N. A.; Rahman, A. Abdul

    2016-09-01

    Recently in our country, the construction of buildings become more complex and it seems that strata objects database becomes more important in registering the real world as people now own and use multilevel of spaces. Furthermore, strata title was increasingly important and need to be well-managed. LADM is a standard model for land administration and it allows integrated 2D and 3D representation of spatial units. LADM also known as ISO 19152. The aim of this paper is to develop a strata objects database using LADM. This paper discusses the current 2D geospatial database and needs for 3D geospatial database in future. This paper also attempts to develop a strata objects database using a standard data model (LADM) and to analyze the developed strata objects database using LADM data model. The current cadastre system in Malaysia includes the strata title is discussed in this paper. The problems in the 2D geospatial database were listed and the needs for 3D geospatial database in future also is discussed. The processes to design a strata objects database are conceptual, logical and physical database design. The strata objects database will allow us to find the information on both non-spatial and spatial strata title information thus shows the location of the strata unit. This development of strata objects database may help to handle the strata title and information.

  10. A Database Practicum for Teaching Database Administration and Software Development at Regis University

    ERIC Educational Resources Information Center

    Mason, Robert T.

    2013-01-01

    This research paper compares a database practicum at the Regis University College for Professional Studies (CPS) with technology oriented practicums at other universities. Successful andragogy for technology courses can motivate students to develop a genuine interest in the subject, share their knowledge with peers and can inspire students to…

  11. Tufts Health Sciences Database: Lessons, Issues, and Opportunities.

    ERIC Educational Resources Information Center

    Lee, Mary Y.; Albright, Susan A.; Alkasab, Tarik; Damassa, David A.; Wang, Paul J.; Eaton, Elizabeth K.

    2003-01-01

    Describes a seven-year experience with developing the Tufts Health Sciences Database, a database-driven information management system that combines the strengths of a digital library, content delivery tools, and curriculum management. Identifies major effects on teaching and learning. Also addresses issues of faculty development, copyright and…

  12. Veterans Health Administration and Medicare Outpatient Health Care Utilization by Older Rural and Urban New England Veterans

    ERIC Educational Resources Information Center

    Weeks, William B.; Bott, David M.; Lamkin, Rebecca P.; Wright, Steven M.

    2005-01-01

    Older veterans often use both the Veterans Health Administration (VHA) and Medicare to obtain health care services. The authors sought to compare outpatient medical service utilization of Medicare-enrolled rural veterans with their urban counterparts in New England. The authors combined VHA and Medicare databases and identified veterans who were…

  13. Belgian health-related data in three international databases

    PubMed Central

    2011-01-01

    Aims of the study This study wants to examine the availability of Belgian healthcare data in the three main international health databases: the World Health Organization European Health for All Database (WHO-HFA), the Organisation for Economic Co-operation and Development Health Data 2009 and EUROSTAT. Methods For the indicators present in the three databases, the availability of Belgian data and the source of these data were checked. Main findings The most important problem concerning the availability of Belgian health-related data in the three major international databases is the lack of recent data. Recent data are available for 27% of the indicators of the WHO-HFA database, 73% of the OECD Health Data, and for half of the Eurostat indicators. Especially recent data about health status (including mortality-based indicators) are lacking. Discussion Only the availability of the health-related data is studied in this article. The quality of the Belgian data is however also important to examine. The main problem concerning the availability of health data is the timeliness. One of the causes of this lack of (especially mortality) data is the reform of the Belgian State. Nowadays mortality data are provided by the communities. This results in a delay in the delivery of national mortality data. However several efforts are made to catch up. PMID:22958554

  14. CHID: a unique health information and education database.

    PubMed

    Lunin, L F; Stein, R S

    1987-04-01

    The public's growing interest in health information and the health professions' increasing need to locate health education materials can be answered in part by the new Combined Health Information Database (CHID). This unique database focuses on materials and programs in professional and patient education, general health education, and community risk reduction. Accessible through BRS, CHID suggests sources for procuring brochures, pamphlets, articles, and films on community services, programs at HMOs and hospitals, aspects of coping, and more. CHID is a joint project of six federally funded agencies in the Public Health Service. CHID provides citations with abstracts to major health journals, books, reports, pamphlets, hard-to-find information resources, and to health education programs under way in state and local health departments and other locations.

  15. Occupational Safety and Health Administration (OSHA) Technical Support Committee

    DTIC Science & Technology

    2000-12-29

    0575 N5-95-1 Occupational Safety & Health Administration (OSHA) Technical Support Committee U.S. DEPARTMENT OF THE NAVY CARDEROCK DIVISION, NAVAL...4. TITLE AND SUBTITLE The National Shipbuilding Research Program, Occupational Safety & Health Administration (OSHA) Technical Support...SPECIFICALLY DISCLAIMED. Sp-5 Safety and Health Final Report Occupational Safety & Health Administration (OSHA) Technical Support Committee Task No

  16. Chronic disease prevalence from Italian administrative databases in the VALORE project: a validation through comparison of population estimates with general practice databases and national survey

    PubMed Central

    2013-01-01

    Background Administrative databases are widely available and have been extensively used to provide estimates of chronic disease prevalence for the purpose of surveillance of both geographical and temporal trends. There are, however, other sources of data available, such as medical records from primary care and national surveys. In this paper we compare disease prevalence estimates obtained from these three different data sources. Methods Data from general practitioners (GP) and administrative transactions for health services were collected from five Italian regions (Veneto, Emilia Romagna, Tuscany, Marche and Sicily) belonging to all the three macroareas of the country (North, Center, South). Crude prevalence estimates were calculated by data source and region for diabetes, ischaemic heart disease, heart failure and chronic obstructive pulmonary disease (COPD). For diabetes and COPD, prevalence estimates were also obtained from a national health survey. When necessary, estimates were adjusted for completeness of data ascertainment. Results Crude prevalence estimates of diabetes in administrative databases (range: from 4.8% to 7.1%) were lower than corresponding GP (6.2%-8.5%) and survey-based estimates (5.1%-7.5%). Geographical trends were similar in the three sources and estimates based on treatment were the same, while estimates adjusted for completeness of ascertainment (6.1%-8.8%) were slightly higher. For ischaemic heart disease administrative and GP data sources were fairly consistent, with prevalence ranging from 3.7% to 4.7% and from 3.3% to 4.9%, respectively. In the case of heart failure administrative estimates were consistently higher than GPs’ estimates in all five regions, the highest difference being 1.4% vs 1.1%. For COPD the estimates from administrative data, ranging from 3.1% to 5.2%, fell into the confidence interval of the Survey estimates in four regions, but failed to detect the higher prevalence in the most Southern region (4.0% in

  17. TODAY: EPA Administrator Joins Senior Administration Officials at White House for Climate and Health Event

    EPA Pesticide Factsheets

    W ASHINGTON- Today, during National Public Health Week, EPA Administrator Gina McCarthy will join senior Obama Administration officials and representatives from the public and private sectors at the White House for a climate and public health

  18. Development of the Community Health Improvement Navigator Database of Interventions

    PubMed Central

    Roy, Brita; Stanojevich, Joel; Stange, Paul; Jiwani, Nafisa; King, Raymond; Koo, Denise

    2016-01-01

    Summary With the passage of the Patient Protection and Affordable Care Act, the requirements for hospitals to achieve tax-exempt status include performing a triennial community health needs assessment and developing a plan to address identified needs. To address community health needs, multisector collaborative efforts to improve both health care and non–health care determinants of health outcomes have been the most effective and sustainable. In 2015, CDC released the Community Health Improvement Navigator to facilitate the development of these efforts. This report describes the development of the database of interventions included in the Community Health Improvement Navigator. The database of interventions allows the user to easily search for multisector, collaborative, evidence-based interventions to address the underlying causes of the greatest morbidity and mortality in the United States: tobacco use and exposure, physical inactivity, unhealthy diet, high cholesterol, high blood pressure, diabetes, and obesity. PMID:26917110

  19. Healthcare Databases in Thailand and Japan: Potential Sources for Health Technology Assessment Research

    PubMed Central

    Saokaew, Surasak; Sugimoto, Takashi; Kamae, Isao; Pratoomsoot, Chayanin; Chaiyakunapruk, Nathorn

    2015-01-01

    Background Health technology assessment (HTA) has been continuously used for value-based healthcare decisions over the last decade. Healthcare databases represent an important source of information for HTA, which has seen a surge in use in Western countries. Although HTA agencies have been established in Asia-Pacific region, application and understanding of healthcare databases for HTA is rather limited. Thus, we reviewed existing databases to assess their potential for HTA in Thailand where HTA has been used officially and Japan where HTA is going to be officially introduced. Method Existing healthcare databases in Thailand and Japan were compiled and reviewed. Databases’ characteristics e.g. name of database, host, scope/objective, time/sample size, design, data collection method, population/sample, and variables were described. Databases were assessed for its potential HTA use in terms of safety/efficacy/effectiveness, social/ethical, organization/professional, economic, and epidemiological domains. Request route for each database was also provided. Results Forty databases– 20 from Thailand and 20 from Japan—were included. These comprised of national censuses, surveys, registries, administrative data, and claimed databases. All databases were potentially used for epidemiological studies. In addition, data on mortality, morbidity, disability, adverse events, quality of life, service/technology utilization, length of stay, and economics were also found in some databases. However, access to patient-level data was limited since information about the databases was not available on public sources. Conclusion Our findings have shown that existing databases provided valuable information for HTA research with limitation on accessibility. Mutual dialogue on healthcare database development and usage for HTA among Asia-Pacific region is needed. PMID:26560127

  20. Prototype Food and Nutrient Database for Dietary Studies: Branded Food Products Database for Public Health Proof of Concept

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Prototype Food and Nutrient Database for Dietary Studies (Prototype FNDDS) Branded Food Products Database for Public Health is a proof of concept database. The database contains a small selection of food products which is being used to exhibit the approach for incorporation of the Branded Food ...

  1. The health periodicals database: full-text access to consumer and technical health information.

    PubMed

    Lingle, V A

    1990-01-01

    The HEALTH PERIODICALS DATABASE, produced by the Information Access Company, is a unique online file which provides full-text access to both general interest health-related literature and key technical resources in the medical field. Available on DIALOG and CompuServe, the database is described as a useful tool for information on the health, fitness, and nutrition industries. Special features of the database are reviewed and comparisons are made with resources of similar scope.

  2. Development of an Ada programming support environment database SEAD (Software Engineering and Ada Database) administration manual

    NASA Technical Reports Server (NTRS)

    Liaw, Morris; Evesson, Donna

    1988-01-01

    Software Engineering and Ada Database (SEAD) was developed to provide an information resource to NASA and NASA contractors with respect to Ada-based resources and activities which are available or underway either in NASA or elsewhere in the worldwide Ada community. The sharing of such information will reduce duplication of effort while improving quality in the development of future software systems. SEAD data is organized into five major areas: information regarding education and training resources which are relevant to the life cycle of Ada-based software engineering projects such as those in the Space Station program; research publications relevant to NASA projects such as the Space Station Program and conferences relating to Ada technology; the latest progress reports on Ada projects completed or in progress both within NASA and throughout the free world; Ada compilers and other commercial products that support Ada software development; and reusable Ada components generated both within NASA and from elsewhere in the free world. This classified listing of reusable components shall include descriptions of tools, libraries, and other components of interest to NASA. Sources for the data include technical newletters and periodicals, conference proceedings, the Ada Information Clearinghouse, product vendors, and project sponsors and contractors.

  3. Inaccurate Ascertainment of Morbidity and Mortality due to Influenza in Administrative Databases: A Population-Based Record Linkage Study

    PubMed Central

    Muscatello, David J.; Amin, Janaki; MacIntyre, C. Raina; Newall, Anthony T.; Rawlinson, William D.; Sintchenko, Vitali; Gilmour, Robin; Thackway, Sarah

    2014-01-01

    Background Historically, counting influenza recorded in administrative health outcome databases has been considered insufficient to estimate influenza attributable morbidity and mortality in populations. We used database record linkage to evaluate whether modern databases have similar limitations. Methods Person-level records were linked across databases of laboratory notified influenza, emergency department (ED) presentations, hospital admissions and death registrations, from the population (∼6.9 million) of New South Wales (NSW), Australia, 2005 to 2008. Results There were 2568 virologically diagnosed influenza infections notified. Among those, 25% of 40 who died, 49% of 1451 with a hospital admission and 7% of 1742 with an ED presentation had influenza recorded on the respective database record. Compared with persons aged ≥65 years and residents of regional and remote areas, respectively, children and residents of major cities were more likely to have influenza coded on their admission record. Compared with older persons and admitted patients, respectively, working age persons and non-admitted persons were more likely to have influenza coded on their ED record. On both ED and admission records, persons with influenza type A infection were more likely than those with type B infection to have influenza coded. Among death registrations, hospital admissions and ED presentations with influenza recorded as a cause of illness, 15%, 28% and 1.4%, respectively, also had laboratory notified influenza. Time trends in counts of influenza recorded on the ED, admission and death databases reflected the trend in counts of virologically diagnosed influenza. Conclusions A minority of the death, hospital admission and ED records for persons with a virologically diagnosed influenza infection identified influenza as a cause of illness. Few database records with influenza recorded as a cause had laboratory confirmation. The databases have limited value for estimating incidence

  4. Connecting the Library's Patron Database to Campus Administrative Software: Simplifying the Library's Accounts Receivable Process

    ERIC Educational Resources Information Center

    Oliver, Astrid; Dahlquist, Janet; Tankersley, Jan; Emrich, Beth

    2010-01-01

    This article discusses the processes that occurred when the Library, Controller's Office, and Information Technology Department agreed to create an interface between the Library's Innovative Interfaces patron database and campus administrative software, Banner, using file transfer protocol, in an effort to streamline the Library's accounts…

  5. 47 CFR 64.615 - TRS User Registration Database and administrator.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 3 2013-10-01 2013-10-01 false TRS User Registration Database and administrator. 64.615 Section 64.615 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) MISCELLANEOUS RULES RELATING TO COMMON CARRIERS Telecommunications...

  6. 47 CFR 64.615 - TRS User Registration Database and administrator.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 3 2014-10-01 2014-10-01 false TRS User Registration Database and administrator. 64.615 Section 64.615 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) MISCELLANEOUS RULES RELATING TO COMMON CARRIERS Telecommunications...

  7. Establishing a high-risk neuroblastoma cohort using the Pediatric Health Information System Database.

    PubMed

    Desai, Ami V; Kavcic, Marko; Huang, Yuan-Shung; Herbst, Nicole; Fisher, Brian T; Seif, Alix E; Li, Yimei; Hennessy, Sean; Aplenc, Richard; Bagatell, Rochelle

    2014-06-01

    International Classification of Diseases, 9th Revision (ICD-9) code(s) for neuroblastoma do not exist, preventing identification of these patients in administrative databases. To overcome this challenge, a three-step algorithm, using ICD-9 codes, exclusion criteria, and manual review of chemotherapy billing data, was utilized to assemble a high-risk neuroblastoma cohort (n = 952) from the Pediatric Health Information System (PHIS) Database and validated at a single institution [sensitivity 89.1%; positive predictive value (PPV) 96.1%]. This cohort provides a data source for future comparative effectiveness and clinical epidemiology studies in high-risk neuroblastoma patients.

  8. The use of relational databases in health care information systems.

    PubMed

    Borok, L S

    1995-01-01

    The relational database is especially well suited to be the cornerstone of the next generation of health care information systems. Health care organizations can take advantage of the lessons learned from major corporations that have built entire information infrastructures using it. The relational model's strength in handling the analysis of transaction data makes it ideal for fulfilling complex utilization review requirements and providing a solid foundation for the increasing operational demands of large physician-managed managed care networks.

  9. A Support Database System for Integrated System Health Management (ISHM)

    NASA Technical Reports Server (NTRS)

    Schmalzel, John; Figueroa, Jorge F.; Turowski, Mark; Morris, John

    2007-01-01

    The development, deployment, operation and maintenance of Integrated Systems Health Management (ISHM) applications require the storage and processing of tremendous amounts of low-level data. This data must be shared in a secure and cost-effective manner between developers, and processed within several heterogeneous architectures. Modern database technology allows this data to be organized efficiently, while ensuring the integrity and security of the data. The extensibility and interoperability of the current database technologies also allows for the creation of an associated support database system. A support database system provides additional capabilities by building applications on top of the database structure. These applications can then be used to support the various technologies in an ISHM architecture. This presentation and paper propose a detailed structure and application description for a support database system, called the Health Assessment Database System (HADS). The HADS provides a shared context for organizing and distributing data as well as a definition of the applications that provide the required data-driven support to ISHM. This approach provides another powerful tool for ISHM developers, while also enabling novel functionality. This functionality includes: automated firmware updating and deployment, algorithm development assistance and electronic datasheet generation. The architecture for the HADS has been developed as part of the ISHM toolset at Stennis Space Center for rocket engine testing. A detailed implementation has begun for the Methane Thruster Testbed Project (MTTP) in order to assist in developing health assessment and anomaly detection algorithms for ISHM. The structure of this implementation is shown in Figure 1. The database structure consists of three primary components: the system hierarchy model, the historical data archive and the firmware codebase. The system hierarchy model replicates the physical relationships between

  10. Large-scale Health Information Database and Privacy Protection*1

    PubMed Central

    YAMAMOTO, Ryuichi

    2016-01-01

    Japan was once progressive in the digitalization of healthcare fields but unfortunately has fallen behind in terms of the secondary use of data for public interest. There has recently been a trend to establish large-scale health databases in the nation, and a conflict between data use for public interest and privacy protection has surfaced as this trend has progressed. Databases for health insurance claims or for specific health checkups and guidance services were created according to the law that aims to ensure healthcare for the elderly; however, there is no mention in the act about using these databases for public interest in general. Thus, an initiative for such use must proceed carefully and attentively. The PMDA*2 projects that collect a large amount of medical record information from large hospitals and the health database development project that the Ministry of Health, Labour and Welfare (MHLW) is working on will soon begin to operate according to a general consensus; however, the validity of this consensus can be questioned if issues of anonymity arise. The likelihood that researchers conducting a study for public interest would intentionally invade the privacy of their subjects is slim. However, patients could develop a sense of distrust about their data being used since legal requirements are ambiguous. Nevertheless, without using patients’ medical records for public interest, progress in medicine will grind to a halt. Proper legislation that is clear for both researchers and patients will therefore be highly desirable. A revision of the Act on the Protection of Personal Information is currently in progress. In reality, however, privacy is not something that laws alone can protect; it will also require guidelines and self-discipline. We now live in an information capitalization age. I will introduce the trends in legal reform regarding healthcare information and discuss some basics to help people properly face the issue of health big data and privacy

  11. Large-scale Health Information Database and Privacy Protection.

    PubMed

    Yamamoto, Ryuichi

    2016-09-01

    Japan was once progressive in the digitalization of healthcare fields but unfortunately has fallen behind in terms of the secondary use of data for public interest. There has recently been a trend to establish large-scale health databases in the nation, and a conflict between data use for public interest and privacy protection has surfaced as this trend has progressed. Databases for health insurance claims or for specific health checkups and guidance services were created according to the law that aims to ensure healthcare for the elderly; however, there is no mention in the act about using these databases for public interest in general. Thus, an initiative for such use must proceed carefully and attentively. The PMDA projects that collect a large amount of medical record information from large hospitals and the health database development project that the Ministry of Health, Labour and Welfare (MHLW) is working on will soon begin to operate according to a general consensus; however, the validity of this consensus can be questioned if issues of anonymity arise. The likelihood that researchers conducting a study for public interest would intentionally invade the privacy of their subjects is slim. However, patients could develop a sense of distrust about their data being used since legal requirements are ambiguous. Nevertheless, without using patients' medical records for public interest, progress in medicine will grind to a halt. Proper legislation that is clear for both researchers and patients will therefore be highly desirable. A revision of the Act on the Protection of Personal Information is currently in progress. In reality, however, privacy is not something that laws alone can protect; it will also require guidelines and self-discipline. We now live in an information capitalization age. I will introduce the trends in legal reform regarding healthcare information and discuss some basics to help people properly face the issue of health big data and privacy

  12. A health/patient education database for family practice.

    PubMed Central

    Gibson, P A; Ruby, C; Craig, M D

    1991-01-01

    Using pilot project funding from the W. K. Kellogg Foundation, the American Academy of Family Physicians Foundation (AAFP/F) developed a program by which health/patient education print materials were reviewed. Favorably reviewed materials were entered into a database accessible through the AAFP/F's Huffington Library. The review service and resulting database were designed to help the busy clinician identify scientifically accurate, reliable materials for use in patient education. The review process developed for the project is described, as is the database and its use by family physicians. Research findings from the pilot project are discussed, some of which assisted in planning the self-supporting second phase of the program. PMID:1958908

  13. Risk assessment and toxicology databases for health effects assessment

    SciTech Connect

    Lu, P.Y.; Wassom, J.S.

    1990-12-31

    Scientific and technological developments bring unprecedented stress to our environment. Society has to predict the results of potential health risks from technologically based actions that may have serious, far-reaching consequences. The potential for error in making such predictions or assessment is great and multiplies with the increasing size and complexity of the problem being studied. Because of this, the availability and use of reliable data is the key to any successful forecasting effort. Scientific research and development generate new data and information. Much of the scientific data being produced daily is stored in computers for subsequent analysis. This situation provides both an invaluable resource and an enormous challenge. With large amounts of government funds being devoted to health and environmental research programs and with maintenance of our living environment at stake, we must make maximum use of the resulting data to forecast and avert catastrophic effects. Along with the readily available. The most efficient means of obtaining the data necessary for assessing the health effects of chemicals is to utilize applications include the toxicology databases and information files developed at ORNL. To make most efficient use of the data/information that has already been prepared, attention and resources should be directed toward projects that meticulously evaluate the available data/information and create specialized peer-reviewed value-added databases. Such projects include the National Library of Medicine`s Hazardous Substances Data Bank, and the U.S. Air Force Installation Restoration Toxicology Guide. These and similar value-added toxicology databases were developed at ORNL and are being maintained and updated. These databases and supporting information files, as well as some data evaluation techniques are discussed in this paper with special focus on how they are used to assess potential health effects of environmental agents. 19 refs., 5 tabs.

  14. CQL: a database in smart card for health care applications.

    PubMed

    Paradinas, P C; Dufresnes, E; Vandewalle, J J

    1995-01-01

    The CQL-Card is the first smart card in the world to use Database Management Systems (DBMS) concepts. The CQL-Card is particularly suited to a portable file in health applications where the information is required by many different partners, such as health insurance organizations, emergency services, and General Practitioners. All the information required by these different partners can be shared with independent security mechanisms. Database engine functions are carried out by the card, which manages tables, views, and dictionaries. Medical Information is stored in tables and views are logical and dynamic subsets of tables. For owner-partners like MIS (Medical Information System), it is possible to grant privileges (select, insert, update, and delete on table or view) to other partners. Furthermore, dictionaries are structures that contain requested descriptions and which allow adaptation to computer environments. Health information held in the CQL-Card is accessed using CQL (Card Query Language), a high level database query language which is a subset of the standard SQL (Structured Query Language). With this language, CQL-Card can be easily integrated into Medical Information Systems.

  15. 77 FR 62243 - Health Resources and Services Administration

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-12

    ... No: 2012-25192] DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps Notice of Meeting In accordance with section... following meeting: Name: National Advisory Council on the National Health Service Corps (NHSC). Dates...

  16. Integrated Electronic Health Record Database Management System: A Proposal.

    PubMed

    Schiza, Eirini C; Panos, George; David, Christiana; Petkov, Nicolai; Schizas, Christos N

    2015-01-01

    eHealth has attained significant importance as a new mechanism for health management and medical practice. However, the technological growth of eHealth is still limited by technical expertise needed to develop appropriate products. Researchers are constantly in a process of developing and testing new software for building and handling Clinical Medical Records, being renamed to Electronic Health Record (EHR) systems; EHRs take full advantage of the technological developments and at the same time provide increased diagnostic and treatment capabilities to doctors. A step to be considered for facilitating this aim is to involve more actively the doctor in building the fundamental steps for creating the EHR system and database. A global clinical patient record database management system can be electronically created by simulating real life medical practice health record taking and utilizing, analyzing the recorded parameters. This proposed approach demonstrates the effective implementation of a universal classic medical record in electronic form, a procedure by which, clinicians are led to utilize algorithms and intelligent systems for their differential diagnosis, final diagnosis and treatment strategies.

  17. Training of Health Service Personnel in the Veterans' Administration.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. House Committee on Veterans' Affairs.

    During fiscal year 1970, more than 49,000 persons received training through the Veterans' Administration (VA) in 125 different health services programs, including 21,550 physicians, 1,359 dentists, and 26,142 trainees in the allied and administrative health fields. Many VA hospitals and out-patient clinics indicated that more than 12,000…

  18. Linking Canadian population health data: maximizing the potential of cohort and administrative data.

    PubMed

    Doiron, Dany; Raina, Parminder; Fortier, Isabel

    2013-03-06

    Linkage of data collected by large Canadian cohort studies with provincially managed administrative health databases can offer very interesting avenues for multidisciplinary and cost-effective health research in Canada. Successfully co-analyzing cohort data and administrative health data (AHD) can lead to research results capable of improving the health and well-being of Canadians and enhancing the delivery of health care services. However, such an endeavour will require strong coordination and long-term commitment between all stakeholders involved. The challenges and opportunities of a pan-Canadian cohort-to-AHD data linkage program have been considered by cohort study investigators and data custodians from each Canadian province. Stakeholders acknowledge the important public health benefits of establishing such a program and have established an action plan to move forward.

  19. Tufts Health Sciences Database: lessons, issues, and opportunities.

    PubMed

    Lee, Mary Y; Albright, Susan A; Alkasab, Tarik; Damassa, David A; Wang, Paul J; Eaton, Elizabeth K

    2003-03-01

    The authors present their seven-year experience with developing the Tufts Health Sciences Database (Tufts HSDB), a database-driven information management system that combines the strengths of a digital library, content delivery tools, and curriculum management. They describe a future where online tools will provide a health sciences learning infrastructure that fosters the work of an increasingly interdisciplinary community of learners and allows content to be shared across institutions as well as with academic and commercial information repositories. The authors note the key partners in Tufts HSDB's success--the close collaboration of the health sciences library, educational affairs, and information technology staff. Tufts HSDB moved quickly from serving the medical curriculum to supporting Tufts' veterinary, dental, biomedical sciences, and nutrition schools, thus leveraging Tufts HSDB research and development with university-wide efforts including Internet2 middleware, wireless access, information security, and digital libraries. The authors identify major effects on teaching and learning, e.g., what is better taught with multimedia, how faculty preparation and student learning time can be more efficient and effective, how content integration for interdisciplinary teaching and learning is promoted, and how continuous improvement methods can be integrated. Also addressed are issues of faculty development, copyright and intellectual property, budgetary concerns, and coordinating IT across schools and hospitals. The authors describe Tufts' recent experience with sharing its infrastructure with other schools, and welcome inquiries from those wishing to explore national and international partnerships to create a truly open and integrated infrastructure for education across the health sciences.

  20. Health care change: challenge for nurse administrators.

    PubMed

    Bonalumi, N; Fisher, K

    1999-01-01

    Nursing administrators facing reorganization understand the difficulties and resistance that accompany organizational change. This article discusses resilience, a critical character trait for successfully managing change. Understanding the change process can assist those charged with the challenge of leading organizational change to manage the journey more effectively.

  1. Grants for graduate programs in health administration and grants for traineeships in health administration--PHS. Amendments to final regulations.

    PubMed

    1984-05-22

    These amendments conform provisions in 42 CFR Part 58, Subpart A, "Grants for Graduate Programs in Health Administration," and Subpart D, entitled "Grants for Traineeships in Health Administration, Hospital Administration, or Health Policy Analysis and Planning at Public or Nonprofit Private Educational Institutions Other Than Schools of Public Health" to statutory amendments made by the Orphan Drug Act, Pub . L. 97-414: the Omnibus Budget Reconciliation Act of 1981, Pub . L. 97-35; and Pub . L. 94-241, the Commonwealth-- Covenant to Establish--Northern Mariana Islands.

  2. Administrative Competencies in Education and the Allied Health Professions.

    ERIC Educational Resources Information Center

    Morgan, Margaret K., Ed.; Canfield, Albert A., Ed.

    A 2-day conference was designed by the staff of the University of Florida Center for Allied Health Instructional Personnel to identify competencies of department chairmen, clinical supervisors, deans of schools of allied health professions, administrators or coordinators of health agencies, and educational leaders in professional or governmental…

  3. 77 FR 22358 - Occupational Safety and Health Administration

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-13

    ... Occupational Safety and Health Administration Preparations for the 23rd Session of the UN Sub-Committee of... Stakeholder Input for the Regulatory Coordination Council (RCC) AGENCY: Occupational Safety and Health... classification of chemicals according to their health, physical, and environmental effects. It also...

  4. 77 FR 76052 - Health Resources and Services Administration

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-26

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency Information Collection Activities... States Code, as amended by the Paperwork Reduction Act of 1995, Public Law 104-13), the Health...

  5. TBC2health: a database of experimentally validated health-beneficial effects of tea bioactive compounds.

    PubMed

    Zhang, Shihua; Xuan, Hongdong; Zhang, Liang; Fu, Sicong; Wang, Yijun; Yang, Hua; Tai, Yuling; Song, Youhong; Zhang, Jinsong; Ho, Chi-Tang; Li, Shaowen; Wan, Xiaochun

    2016-07-06

    Tea is one of the most consumed beverages in the world. Considerable studies show the exceptional health benefits (e.g. antioxidation, cancer prevention) of tea owing to its various bioactive components. However, data from these extensively published papers had not been made available in a central database. To lay a foundation in improving the understanding of healthy tea functions, we established a TBC2health database that currently documents 1338 relationships between 497 tea bioactive compounds and 206 diseases (or phenotypes) manually culled from over 300 published articles. Each entry in TBC2health contains comprehensive information about a bioactive relationship that can be accessed in three aspects: (i) compound information, (ii) disease (or phenotype) information and (iii) evidence and reference. Using the curated bioactive relationships, a bipartite network was reconstructed and the corresponding network (or sub-network) visualization and topological analyses are provided for users. This database has a user-friendly interface for entry browse, search and download. In addition, TBC2health provides a submission page and several useful tools (e.g. BLAST, molecular docking) to facilitate use of the database. Consequently, TBC2health can serve as a valuable bioinformatics platform for the exploration of beneficial effects of tea on human health. TBC2health is freely available at http://camellia.ahau.edu.cn/TBC2health.

  6. Unleashing the power of administrative health data: the Scottish model.

    PubMed

    Pavis, Stephen; Morris, Andrew D

    2015-09-30

    Data and information generated through the provision and administration of health and social care provide potentially valuable untapped resources that can contribute to the development of effective and efficient services. We describe the Scottish system, which seeks to unleash, at scale, the power of administrative and health service data as part of the UK-wide Farr Institute of Health Informatics Research program. The 'Scottish model' balances current public attitudes and views around the use of administrative and health data for research purposes with researchers' data requirements, and does so within Scotland's legal framework. The past 3 years has seen the completion of more than 150 projects by researchers from industry (17%), academia (53%) and health service providers (30%). In the future, the aim will be to ensure that research findings are disseminated widely and used to both improve health service provision and further develop public trust.

  7. MONDAY: EPA Administrator Joins Senior Administration Officials at White House for Climate and Health Event

    EPA Pesticide Factsheets

    W ASHINGTON- On Monday, EPA Administrator Gina McCarthy will join senior Obama Administration officials and representatives from the public and private sectors at the White House for a climate and health announcement from the U.S. Global Chang

  8. Region 11 Health Care and Administration Costs

    DTIC Science & Technology

    2001-09-01

    average length of stay , we’ve used average values drawn from 1999 data representing averages across the Kaiser-Permanente health care system (including the... average length of stay (ALOS). Here, we provide the ALOS for enrollees who used civilian facilities (through the contractor) and those who used the MTF

  9. School-Based Health Services: Administrative Rules.

    ERIC Educational Resources Information Center

    Oregon State Dept. of Human Resources, Salem.

    This manual outlines the State of Oregon's program to reimburse medical providers furnishing health services to students with medical disabilities in special education settings. The program was established to comply with federal provisions of the Individuals with Disabilities Education Act of 1990. The guide will assist school personnel in…

  10. EPA Administrator Visits Childrens Health Group in Dallas

    EPA Pesticide Factsheets

    DALLAS - (April 10, 2015) U.S. Environmental Protection Agency (EPA) Administrator Gina McCarthy recently visited health professionals working to address childhood asthma in the Dallas area. With 60,000 children in Dallas County diagnosed with asthm

  11. Mary Wakefield: Health Resources and Services Administrator. Interview.

    PubMed

    Wakefield, Mary

    2014-06-01

    Dr. Mary Wakefield is the administrator of the Health Resources and Services Administration. She came from the University of North Dakota, where she directed the Center for Rural Health. She has served as director of the Center for Health Policy, Research and Ethics at George Mason University and has worked with the World Health Organization's Global Programme on AIDS in Geneva, Switzerland. She is a fellow in the American Academy of Nursing and was elected to the Institute of Medicine of the National Academies. A native of North Dakota, Wakefield holds a doctoral degree in nursing from the University of Texas.

  12. Health seeking behaviors of African Americans: implications for health administration.

    PubMed

    Hewins-Maroney, Barbara; Schumaker, Alice; Williams, Ethel

    2005-01-01

    Disparities in health care and good health between African Americans and other populations while established in the literature are traditionally based on socioeconomic measures of race, income, age, and education (Bailey, 2000; Lillie-Blanton, Brodie, Rowland, Altman and McIntosh, 2000; Ren and Amick, 1996; Watson, 2001; Weinick, Zuvekas, and Cohen, 2000). This study broadens the scope by exploring how sociocultural (poverty, racism, prejudice, and discrimination) and psychosocial factors (perceived health status, the lack of personal efficacy in contributing to decisions about health care. feelings of helplessness, and the lack of trust in the health care providers) relate to health-seeking behaviors of African Americans (Bailey, 1991; Ren and Amick, 1996, Watson, 2001). Interviews were conducted with 111 African American adult patients at a community health center, focusing on health-seeking behaviors, and sociocultural and psychosocial factors. Results suggest that when these negative factors are removed, the health seeking behaviors of African Americans closely mirror the behaviors of the majority population. Subjects did not view themselves in poorer health, fail to seek medical attention when needed, or distrust their primary health care providers. In general, fears associated with health care were attributed to illness rather than health care providers, although a weak linkage was found between patient self-esteem and fear or dislike of future treatment by physicians (adj R2= .362, S.E. =15, F=21, sig. <.001). The study highlights the need for further study in two areas: cultural competency of health care providers, especially those from Asia and Africa who are often assigned to community health centers, and the impact of an accessible community health center on the health seeking behaviors and health status of predominately African American communities.

  13. Development of an electronic breast pathology database in a community health system

    PubMed Central

    Nelson, Heidi D.; Weerasinghe, Roshanthi; Martel, Maritza; Bifulco, Carlo; Assur, Ted; Elmore, Joann G.; Weaver, Donald L.

    2014-01-01

    Background: Health care systems rely on electronic patient data, yet access to breast tissue pathology results continues to depend on interpreting dictated free-text reports. Objective: The objective was to develop a method to electronically search and categorize pathologic diagnoses of patients’ breast tissue specimens from dictated free-text pathology reports in a large health system for multiple users including clinicians. Design: A database integrating existing patient-level administrative and clinical information for breast cancer screening and diagnostic services and a web-based application for comprehensive searching of pathology reports were developed by a health system team led by pathologists. The Breast Pathology Assessment Tool and Hierarchy for Diagnosis (BPATH-Dx) provided search terms and guided electronic transcription of diagnoses from text fields on breast pathology clinical reports to standardized categories. Approach: Breast pathology encounters in the pathology database were matched with administrative data for 7332 women with breast tissue specimens obtained from an initial procedure in the health system from January 1, 2008 to December 31, 2011. Sequential queries of the pathology text based on BPATH-Dx categorized biopsies according to their worst pathological diagnosis, as is standard practice. Diagnoses ranged from invasive breast cancer (23.3%), carcinoma in situ (7.8%), atypical lesions (6.39%), proliferative lesions without atypia (27.9%), and nonproliferative lesions (34.7%), and were further classified into subcategories. A random sample of 5% of reports that were manually reviewed indicated 97.5% agreement. Conclusions: Sequential queries of free-text pathology reports guided by a standardized assessment tool in conjunction with a web-based search application provide an efficient and reproducible approach to accessing nonmalignant breast pathology diagnoses. This method advances the use of pathology data and electronic health

  14. Teaching Health Care Administration in Athletic Training: A Unique Approach

    ERIC Educational Resources Information Center

    Sage, Bradley W.

    2013-01-01

    Health care administration is a challenging topic to teach due to the inability for students to directly engage in many of the activities such as insurance billing, inventory, and ordering equipment and supplies. The objective of this article is to describe how a discussion-based meeting format can be used to engage students in health care…

  15. Improving Performance through Knowledge Translation in the Veterans Health Administration

    ERIC Educational Resources Information Center

    Francis, Joseph; Perlin, Jonathan B.

    2006-01-01

    The Veterans Health Administration (VA) provides a case study for linking performance measurement, information technology, and aligned research efforts to facilitate quality improvement in a large, complex health system. Dialogue between clinical researchers and VA leaders occurs through structured activities (e.g., the Quality Enhancement…

  16. The Quick Health Data Online: the ultimate interactive database on recent trends in women's health.

    PubMed

    Choi, Colleen S; Haynes, Suzanne; Konsella, Laurie; Goodman, Colleen; Meltzer, Alfred

    2007-09-01

    A growing number of nonprofit and government agencies have developed interactive databases to help their website visitors and constituents obtain information about past and recent trends in healthcare. The Office on Women's Health of the Department of Health and Human Services has joined this pursuit by launching Quick Health Data Online (QHData), an interactive database providing health statistics that specifically pertain to women. Since its inception, QHData has quickly emerged as the leader in sophisticated and user-friendly interactive databases. What is so remarkable about QHData? This database is capable of generating health statistics by race (i.e., blacks, whites, Asian and Pacific Islanders, Hispanics, and Native Americans), gender, and age. The results can also be produced across different geographic levels-the nation, by region, state, and county; the jurisdiction statuses of the counties can also be identified as a border, frontier, metropolitan, urban, or rural. Users also have the flexibility of presenting the results in tables, bar graphs, and maps or exporting results to other processing or display tools.

  17. Health Services Research and Development: the Veterans Administration Program.

    PubMed Central

    Goldschmidt, P G

    1986-01-01

    Health expenditures are rising inexorably; health status shows relatively little gain; technological possibilities are outstripping our ability or willingness to provide a commensurate level of resources. Clinical and administrative managers face increasingly difficult choices among alternative interventions in attempting to resolve these problems. If health services research is to succeed as a tool for assisting these decisions, clinicians, administrators, and researchers must view it as an integral part of management. This paper describes this concept of health services research and its implementation by the VA HSR&D Service, results from 1981 to date, and future directions. Four programs implement the Service's system to make relevant, valid information accessible to VA staff who can use it to improve veterans' health care: Investigator-Initiated Research (IIR) Program; HSR&D Field Program, which implements the Service's mission in various local areas VA-wide; Special Projects Program, responsive to system-wide issues, including technology assessment and transfer; and Resources Program, the Service's own management system. The Service's impact on improving veterans health care is already apparent. However, the true value of the HSR&D system will become apparent only in the 1990s, after the capacity for conducting health services research has been built and integrated fully with clinical and administrative practice. The VA, the nation's largest health care system, has a unique opportunity to demonstrate how health services research can improve health care. PMID:3081467

  18. An electronic health record-enabled obesity database

    PubMed Central

    2012-01-01

    Background The effectiveness of weight loss therapies is commonly measured using body mass index and other obesity-related variables. Although these data are often stored in electronic health records (EHRs) and potentially very accessible, few studies on obesity and weight loss have used data derived from EHRs. We developed processes for obtaining data from the EHR in order to construct a database on patients undergoing Roux-en-Y gastric bypass (RYGB) surgery. Methods Clinical data obtained as part of standard of care in a bariatric surgery program at an integrated health delivery system were extracted from the EHR and deposited into a data warehouse. Data files were extracted, cleaned, and stored in research datasets. To illustrate the utility of the data, Kaplan-Meier analysis was used to estimate length of post-operative follow-up. Results Demographic, laboratory, medication, co-morbidity, and survey data were obtained from 2028 patients who had undergone RYGB at the same institution since 2004. Pre-and post-operative diagnostic and prescribing information were available on all patients, while survey laboratory data were available on a majority of patients. The number of patients with post-operative laboratory test results varied by test. Based on Kaplan-Meier estimates, over 74% of patients had post-operative weight data available at 4 years. Conclusion A variety of EHR-derived data related to obesity can be efficiently obtained and used to study important outcomes following RYGB. PMID:22640398

  19. Incidence of Appendicitis over Time: A Comparative Analysis of an Administrative Healthcare Database and a Pathology-Proven Appendicitis Registry

    PubMed Central

    Clement, Fiona; Zimmer, Scott; Dixon, Elijah; Ball, Chad G.; Heitman, Steven J.; Swain, Mark; Ghosh, Subrata

    2016-01-01

    Importance At the turn of the 21st century, studies evaluating the change in incidence of appendicitis over time have reported inconsistent findings. Objectives We compared the differences in the incidence of appendicitis derived from a pathology registry versus an administrative database in order to validate coding in administrative databases and establish temporal trends in the incidence of appendicitis. Design We conducted a population-based comparative cohort study to identify all individuals with appendicitis from 2000 to2008. Setting & Participants Two population-based data sources were used to identify cases of appendicitis: 1) a pathology registry (n = 8,822); and 2) a hospital discharge abstract database (n = 10,453). Intervention & Main Outcome The administrative database was compared to the pathology registry for the following a priori analyses: 1) to calculate the positive predictive value (PPV) of administrative codes; 2) to compare the annual incidence of appendicitis; and 3) to assess differences in temporal trends. Temporal trends were assessed using a generalized linear model that assumed a Poisson distribution and reported as an annual percent change (APC) with 95% confidence intervals (CI). Analyses were stratified by perforated and non-perforated appendicitis. Results The administrative database (PPV = 83.0%) overestimated the incidence of appendicitis (100.3 per 100,000) when compared to the pathology registry (84.2 per 100,000). Codes for perforated appendicitis were not reliable (PPV = 52.4%) leading to overestimation in the incidence of perforated appendicitis in the administrative database (34.8 per 100,000) as compared to the pathology registry (19.4 per 100,000). The incidence of appendicitis significantly increased over time in both the administrative database (APC = 2.1%; 95% CI: 1.3, 2.8) and pathology registry (APC = 4.1; 95% CI: 3.1, 5.0). Conclusion & Relevance The administrative database overestimated the incidence of appendicitis

  20. The Health Resources and Services Administration diversity data collection.

    PubMed

    White, Kathleen M; Zangaro, George; Kepley, Hayden O; Camacho, Alex

    2014-01-01

    The Health Resources and Services Administration maintains a strong emphasis on increasing the diversity of the health-care workforce through its grant programs. Increasing the diversity of the workforce is important for reducing health disparities in the population caused by socioeconomic, geographic, and race/ethnicity factors because evidence suggests that minority health professionals are more likely to serve in areas with a high proportion of underrepresented racial and ethnic minority groups. The data show success in increasing the diversity of enrollees in five nursing programs.

  1. Veterans Health Administration mentoring model for new nurse executives.

    PubMed

    Weiss, Lizabeth M; Williams, Carol A; Wetzel, Donald E; Drake, Audrey C; Cumberlander, Lula B; Gordon, Cynthia L

    2008-01-01

    A nurse executive mentoring program was implemented through the Veterans Health Administration Office of Nursing Service to standardize orientation and increase retention rates in this vital healthcare role. The Veterans Health Administration system has 154 nurse executives throughout the United States with 74% eligible for retirement. This mentoring program is intended to support the integration of new appointees into the nurse executive role. The program has produced a written resource to support effective functioning in the role. The program includes a leader skills self-assessment to evaluate the leadership style and assist with senior leadership team integration.

  2. Development of the Veterans Healthcare Administration (VHA) Ophthalmic Surgical Outcome Database (OSOD) project and the role of ophthalmic nurse reviewers.

    PubMed

    Lara-Smalling, Agueda; Cakiner-Egilmez, Tulay; Miller, Dawn; Redshirt, Ella; Williams, Dale

    2011-01-01

    Currently, ophthalmic surgical cases are not included in the Veterans Administration Surgical Quality Improvement Project data collection. Furthermore, there is no comprehensive protocol in the health system for prospectively measuring outcomes for eye surgery in terms of safety and quality. There are 400,000 operative cases in the system per year. Of those, 48,000 (12%) are ophthalmic surgical cases, with 85% (41,000) of those being cataract cases. The Ophthalmic Surgical Outcome Database Pilot Project was developed to incorporate ophthalmology into VASQIP, thus evaluating risk factors and improving cataract surgical outcomes. Nurse reviewers facilitate the monitoring and measuring of these outcomes. Since its inception in 1778, the Veterans Administration (VA) Health System has provided comprehensive healthcare to millions of deserving veterans throughout the U.S. and its territories. Historically, the quality of healthcare provided by the VA has been the main focus of discussion because it did not meet a standard of care comparable to that of the private sector. Information regarding quality of healthcare services and outcomes data had been unavailable until 1986, when Congress mandated the VA to compare its surgical outcomes to those of the private sector (PL-99-166). 1 Risk adjustment of VA surgical outcomes began in 1987 with the Continuous Improvement in Cardiac Surgery Program (CICSP) in which cardiac surgical outcomes were reported and evaluated. 2 Between 1991 and 1993, the National VA Surgical Risk Study (NVASRS) initiated a validated risk-adjustment model for predicting surgical outcomes and comparative assessment of the quality of surgical care in 44 VA medical centers. 3 The success of NVASRS encouraged the VA to establish an ongoing program for monitoring and improving the quality of surgical care, thus developing the National Surgical Quality Improvement Program (NSQIP) in 1994. 4 According to a prospective study conducted between 1991-1997 in 123

  3. The Undergraduate Program in the Administration of Health Services.

    ERIC Educational Resources Information Center

    Schneeweiss, Stephen M.

    On July 1, 1968, Ithaca College launched an experimental undergraduate program aimed at alleviating the chronic shortage of well trained administrators at the middle management level in hospitals, nursing homes and other public and private patient care health facilities. A brief description is provided in this announcement of the program's…

  4. Dental Technology Program Administrators' Attitudes toward Credentialing Health Manpower.

    ERIC Educational Resources Information Center

    Thomson, William A.; And Others

    1982-01-01

    Dental technology program administrators surveyed supported the credentialing of health manpower, felt program accreditation was valuable in meeting demands for educational quality assurance, and saw certification of technicians as beneficial but of little value in terms of recognition and economic gain for the credential holder. (MSE)

  5. Assessing administrative costs of mental health and substance abuse services.

    PubMed

    Broyles, Robert W; Narine, Lutchmie; Robertson, Madeline J

    2004-05-01

    Increasing competition in the market for mental health and substance abuse MHSA services and the potential to realize significant administrative savings have created an imperative to monitor, evaluate, and control spending on administrative functions. This paper develops a generic model that evaluates spending on administrative personnel by a group of providers. The precision of the model is demonstrated by examining a set of data assembled from five MHSA service providers. The model examines a differential cost construction derived from inter-facility comparisons of administrative expenses. After controlling for the scale of operations, the results enable MHSA programs to control the efficiency of administrative personnel and related rates of compensation. The results indicate that the efficiency of using the administrative complement and the scale of operations represent the lion's share of the total differential cost. The analysis also indicates that a modest improvement in the use of administrative personnel results in substantial cost savings, an increase in the net cash flow derived from operations, an improvement in the fiscal performance of the provider, and a decline in opportunity costs that assume the form of foregone direct patient care.

  6. The Veterans Health Administration: An American Success Story?

    PubMed Central

    Oliver, Adam

    2007-01-01

    The Veterans Health Administration (VHA) provides health care for U.S. military veterans. By the early 1990s, the VHA had a reputation for delivering limited, poor-quality care, which led to health care reforms. By 2000, the VHA had substantially improved in terms of numerous indicators of process quality, and some evidence shows that its overall performance now exceeds that of the rest of U.S. health care. Recently, however, the VHA has started to become a victim of its own success, with increased demands on the system raising concerns from some that access is becoming overly restricted and from others that its annual budget appropriations are becoming excessive. Nonetheless, the apparent turnaround in the VHA's performance offers encouragement that health care that is both financed and provided by the public sector can be an effective organizational form. PMID:17319805

  7. Validity of ICD-9-CM codes for breast, lung and colorectal cancers in three Italian administrative healthcare databases: a diagnostic accuracy study protocol

    PubMed Central

    Abraha, Iosief; Serraino, Diego; Giovannini, Gianni; Stracci, Fabrizio; Casucci, Paola; Alessandrini, Giuliana; Bidoli, Ettore; Chiari, Rita; Cirocchi, Roberto; De Giorgi, Marcello; Franchini, David; Vitale, Maria Francesca; Fusco, Mario; Montedori, Alessandro

    2016-01-01

    Introduction Administrative healthcare databases are useful tools to study healthcare outcomes and to monitor the health status of a population. Patients with cancer can be identified through disease-specific codes, prescriptions and physician claims, but prior validation is required to achieve an accurate case definition. The objective of this protocol is to assess the accuracy of International Classification of Diseases Ninth Revision—Clinical Modification (ICD-9-CM) codes for breast, lung and colorectal cancers in identifying patients diagnosed with the relative disease in three Italian administrative databases. Methods and analysis Data from the administrative databases of Umbria Region (910 000 residents), Local Health Unit 3 of Napoli (1 170 000 residents) and Friuli-Venezia Giulia Region (1 227 000 residents) will be considered. In each administrative database, patients with the first occurrence of diagnosis of breast, lung or colorectal cancer between 2012 and 2014 will be identified using the following groups of ICD-9-CM codes in primary position: (1) 233.0 and (2) 174.x for breast cancer; (3) 162.x for lung cancer; (4) 153.x for colon cancer and (5) 154.0–154.1 and 154.8 for rectal cancer. Only incident cases will be considered, that is, excluding cases that have the same diagnosis in the 5 years (2007–2011) before the period of interest. A random sample of cases and non-cases will be selected from each administrative database and the corresponding medical charts will be assessed for validation by pairs of trained, independent reviewers. Case ascertainment within the medical charts will be based on (1) the presence of a primary nodular lesion in the breast, lung or colon–rectum, documented with imaging or endoscopy and (2) a cytological or histological documentation of cancer from a primary or metastatic site. Sensitivity and specificity with 95% CIs will be calculated. Dissemination Study results will be disseminated widely through

  8. Employee Health in the Mental Health Workplace: Clinical, Administrative, and Organizational Perspectives.

    PubMed

    Shah, Jai L; Kapoor, Reena; Cole, Robert; Steiner, Jeanne L

    2016-04-01

    Issues of mental health and employee health have risen to increasing prominence in recent years. However, there have been few explorations of the clinical and administrative challenges that these issues raise, particularly in settings that are themselves mental health workplaces. In order to identify and understand such challenges, a brief case of acute employee illness in a mental health workplace is described followed by a discussion of salient clinical, administrative, and organizational considerations. The case raises questions about medicolegal responsibilities and relationships between clinicians and patients in mental health settings, illuminates tensions between clinical staff and human resources processes, and draws attention to the need for illness prevention and mental health promotion initiatives in the workplace. Increased awareness of these issues, complications, and potential solutions would benefit clinicians, administrators, and mental health institutions.

  9. Expectations and outcome skills of a generalist health care administrator.

    PubMed

    Jones, V B; Taylor, L C

    1990-01-01

    The question of the degree of technical versus managerial competence to be found in future graduates from health administration programs is not easily resolved. In the HIMSS 1988 survey of CIOs the attributes needed for success are listed in descending rank order as follows: leadership ability, vision/imagination, knowledge of hospital systems, business acumen, decisiveness, and technical competence. CIOs ranked technical competence as less important than other attributes associated with general management success. The expectations for attitudes, knowledge, and skills presented in this article support the greater importance of management abilities relative to pure technical competence. However, it is vital that an appropriate level of technical knowledge and skill be maintained to enable future alumni of health administration programs to function effectively as administrators. Depending on their role in a health care organization, greater or lesser technical knowledge may be needed. Those pursuing a career path toward CIO must, of necessity, have greater technical knowledge and skill. We have discussed necessary and expected attitudes, knowledge, and skills that will be needed by the generalist health administration graduate in the future. It will be important to develop and maintain an attitude that MIS is a strategic tool, that health care technology is a corporate asset, and that information is power. Graduates must recognize the necessity of maintaining and enhancing their knowledge and skills through continuing education. The knowledge base of MIS education should focus on determining information needs to support strategic goals, understanding of general systems theory, principles of systems analysis, design, implementation and maintenance, awareness and exposure to standard application software, and an awareness of external sources of data.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Experience and education of home health administrators and nursing home administrators and the relationship to establishment ownership.

    PubMed

    Decker, Frederic H; Decker, Sandra L

    2012-01-01

    Administrators in long-term care may have an important influence on quality of care. Limited prior research has described the characteristics of nursing home administrators. Despite growing emphasis on home health care as an alternative to nursing homes, almost no research has described the characteristics of administrators of home health agencies. Using the 2004 National Nursing Home Survey and the 2007 National Home and Hospice Care Survey, we describe the career experience of administrators, and examine the relationship between experience and education of administrators both within and across the nursing home and home health sectors. We also explore the characteristics of nursing homes and home health agencies, including establishment ownership (e.g., nonchain not-for-profit), that are associated with being able to attract administrators with the most experience. We find that home health administrators have, on average, less experience than nursing home administrators. Among home health agencies, administrators with the least experience also tend to have less education. In nursing homes, administrators with less experience tend to have more education. Results from multivariate analysis suggest that chain for-profits may be the least able to attract experienced administrators. More research on the effects of different levels of experience and education among administrators is needed.

  11. Enhancing Clinical Content and Race/Ethnicity Data in Statewide Hospital Administrative Databases: Obstacles Encountered, Strategies Adopted, and Lessons Learned

    PubMed Central

    Pine, Michael; Kowlessar, Niranjana M; Salemi, Jason L; Miyamura, Jill; Zingmond, David S; Katz, Nicole E; Schindler, Joe

    2015-01-01

    Objectives Eight grant teams used Agency for Healthcare Research and Quality infrastructure development research grants to enhance the clinical content of and improve race/ethnicity identifiers in statewide all-payer hospital administrative databases. Principal Findings Grantees faced common challenges, including recruiting data partners and ensuring their continued effective participation, acquiring and validating the accuracy and utility of new data elements, and linking data from multiple sources to create internally consistent enhanced administrative databases. Successful strategies to overcome these challenges included aggressively engaging with providers of critical sources of data, emphasizing potential benefits to participants, revising requirements to lessen burdens associated with participation, maintaining continuous communication with participants, being flexible when responding to participants’ difficulties in meeting program requirements, and paying scrupulous attention to preparing data specifications and creating and implementing protocols for data auditing, validation, cleaning, editing, and linking. In addition to common challenges, grantees also had to contend with unique challenges from local environmental factors that shaped the strategies they adopted. Conclusions The creation of enhanced administrative databases to support comparative effectiveness research is difficult, particularly in the face of numerous challenges with recruiting data partners such as competing demands on information technology resources. Excellent communication, flexibility, and attention to detail are essential ingredients in accomplishing this task. Additional research is needed to develop strategies for maintaining these databases when initial funding is exhausted. PMID:26119470

  12. Insights from advanced analytics at the Veterans Health Administration.

    PubMed

    Fihn, Stephan D; Francis, Joseph; Clancy, Carolyn; Nielson, Christopher; Nelson, Karin; Rumsfeld, John; Cullen, Theresa; Bates, Jack; Graham, Gail L

    2014-07-01

    Health care has lagged behind other industries in its use of advanced analytics. The Veterans Health Administration (VHA) has three decades of experience collecting data about the veterans it serves nationwide through locally developed information systems that use a common electronic health record. In 2006 the VHA began to build its Corporate Data Warehouse, a repository for patient-level data aggregated from across the VHA's national health system. This article provides a high-level overview of the VHA's evolution toward "big data," defined as the rapid evolution of applying advanced tools and approaches to large, complex, and rapidly changing data sets. It illustrates how advanced analysis is already supporting the VHA's activities, which range from routine clinical care of individual patients--for example, monitoring medication administration and predicting risk of adverse outcomes--to evaluating a systemwide initiative to bring the principles of the patient-centered medical home to all veterans. The article also shares some of the challenges, concerns, insights, and responses that have emerged along the way, such as the need to smoothly integrate new functions into clinical workflow. While the VHA is unique in many ways, its experience may offer important insights for other health care systems nationwide as they venture into the realm of big data.

  13. 42 CFR 88.13 - WTC Program Administrator's certification of health conditions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false WTC Program Administrator's certification of health... OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES WORLD TRADE CENTER HEALTH PROGRAM § 88.13 WTC Program Administrator's certification of health conditions. (a) WTC-related health condition. (1) The...

  14. 42 CFR 88.13 - WTC Program Administrator's certification of health conditions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false WTC Program Administrator's certification of health... OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES WORLD TRADE CENTER HEALTH PROGRAM § 88.13 WTC Program Administrator's certification of health conditions. (a) WTC-related health condition. (1) The...

  15. 42 CFR 88.13 - WTC Program Administrator's certification of health conditions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false WTC Program Administrator's certification of health... OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES WORLD TRADE CENTER HEALTH PROGRAM § 88.13 WTC Program Administrator's certification of health conditions. (a) WTC-related health condition. (1) The...

  16. 42 CFR 88.13 - WTC Program Administrator's certification of health conditions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false WTC Program Administrator's certification of health... OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES WORLD TRADE CENTER HEALTH PROGRAM § 88.13 WTC Program Administrator's certification of health conditions. (a) WTC-related health condition. (1) The...

  17. True rise in anaphylaxis incidence: Epidemiologic study based on a national health insurance database.

    PubMed

    Yang, Min-Suk; Kim, Ju-Young; Kim, Byung-Keun; Park, Heung-Woo; Cho, Sang-Heon; Min, Kyung-Up; Kang, Hye-Ryun

    2017-02-01

    The incidence trend of anaphylaxis in Asia is not well investigated. The aim of this study is to estimate the entire population-based incidence of anaphylaxis in Korea using a nationwide administrative database.Data over a 7-year period (2008-2014) was obtained from the Korean National Health Insurance (NHI) claims database which covers 97.9% of the entire Korean population. Using diagnosis codes from the International Classification of Diseases-10 for anaphylaxis (T78.0, T78.2, T80.5, and T88.6), we identified the annual number of patients who had visited any hospital with a primary diagnosis of anaphylaxis. Incidence rates were calculated using the population distribution data of all NHI beneficiaries.The incidence of anaphylaxis in Korea was 32.19 episodes per 100,000 person-years in 2014, which nearly doubled from 2008 (16.02 episodes per 100,000 person-years). The incidence of anaphylaxis increased continuously throughout these years regardless of gender and age groups (P for trend < 0.001). Female was significantly less predisposed than male (adjusted odds ratio [OR], 0.69; 95% confident interval [CI], 0.66-0.72; P < 0.001). The incidence was the lowest in 0 to 19 age group and the highest in 40 to 69 age group (adjusted OR, 2.41; 95% CI, 2.29-2.54; P < 0.001).In conclusion, we report the increasing time trend of anaphylaxis incidence rates using nationwide claims database for the first time in Asia.

  18. EPA Releases Updated Environmental and Public Health Indicators in Online Database

    EPA Pesticide Factsheets

    WASHINGTON - Today, the U.S. Environmental Protection Agency (EPA) released updated environmental and public health indicators in an online database, making information about the current and historical condition of the nation's environment and human

  19. [The complex interplay between health services administration, health professionals and patients. A challenge to take up].

    PubMed

    Del Puente, Antonio; Esposito, Antonella; Lombardi, Vinicio; Bova, Aldo; Zecca, Roberto; Torella, Roberto

    2013-02-01

    The risk of loss of essential elements of our professionalism, such as sense of duty, altruism and collegiality, contributes to the difficulties in the interplay between health services administration, health professionals and patients. It is not enough to increase salaries or change organization models. It is also insufficient a generic reference to the values of our profession, but it is mandatory to overcome the self-referencing attitude of health professions.

  20. Hospital administrator's perspectives regarding the health care industry.

    PubMed

    McDermott, D R; Little, M W

    1988-01-01

    Based on responses from 52 hospital administrators, four areas of managerial concern have been addressed, including: (1) decision-making factors; (2) hospital service offerings: current and future; (3) marketing strategy and service priorities; and (4) health care industry challenges. Of the total respondents, 35 percent indicate a Director of Marketing has primary responsibility for making marketing-related decisions in their hospital, and 19 percent, a Vice-President of Marketing, thus demonstrating the increased priority of the marketing function. The continued importance of the physician being the primary market target is highlighted by 70 percent of the administrators feeling physician referrals will be more important regarding future admissions than in the past, compared to only two percent feeling the physicians' role will be less important. Of primary importance to patients selecting a hospital, as perceived by the administrators, are the physician's referral, the patient's previous experience, the hospital's reputation, and the courtesy of the staff. The clear majority of the conventional-care hospitals surveyed offer out-patient surgery, a hospital pharmacy, obstetrics/maternity care, and diabetic services. The future emphasis on expanding services is evidenced by some 50 percent of the hospital administrators indicating they either possibly or definitely plan to offer long-term nursing care, out-patient substance abuse programs, and cancer clinics by 1990. In addition, some one-third of the respondents are likely to expand their offerings to include wellness/fitness centers, in-patient substance abuse programs, remote or satellite primary care clinics, and diabetic services. Other areas having priority for future offerings include services geared specifically toward women and the elderly. Perceived as highest in priority by the administrators regarding how their hospital can achieve its goals in the next three years are market development strategies

  1. Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Disaster Response App.

    PubMed

    Seligman, Jamie; Felder, Stephanie S; Robinson, Maryann E

    2015-10-01

    The Substance Abuse and Mental Health Services Administration (SAMHSA) in the Department of Health and Human Services offers extensive disaster behavior health resources to assist disaster survivors in preparing for, responding to, and recovering from natural and manmade disasters. One of SAMHSA's most innovative resources is the SAMHSA Behavioral Health Disaster Response App (SAMHSA Disaster App). The SAMHSA Disaster App prepares behavioral health responders for any type of traumatic event by allowing them to access disaster-related materials and other key resources right on their phone, at the touch of a button. The SAMHSA Disaster App is available on iPhone, Android, and BlackBerry devices.

  2. The diffusion of health economics knowledge in Europe : The EURONHEED (European Network of Health Economics Evaluation Database) project.

    PubMed

    de Pouvourville, Gérard; Ulmann, Philippe; Nixon, John; Boulenger, Stéphanie; Glanville, Julie; Drummond, Michael

    2005-01-01

    This paper overviews the EURONHEED (EUROpean Network of Health Economics Evaluation Databases) project. Launched in 2003, this project is funded by the EU. Its aim is to create a network of national and international databases dedicated to health economic evaluation of health services and innovations. Seven centres (France, Germany, Italy, The Netherlands, Spain, Sweden and the UK) are involved covering 17 countries. The network is based on two existing databases, the French CODECS (COnnaissance et Decision en EConomie de la Sante) database, created in 2000 by the French Health Economists Association (College des Economistes de la Sante), and the UK NHS-EED (NHS Economic Electronic Database), run by the Centre for Reviews and Dissemination, University of York, York, England. The network will provide bibliographic records of published full health economic evaluation studies (cost-benefit, cost-utility and cost-effectiveness studies) as well as cost studies, methodological articles and review papers. Moreover, a structured abstract of full evaluation studies will be provided to users, allowing them access to a detailed description of each study and to a commentary stressing the implications and limits, for decision making, of the study. Access will be free of charge. The database features and its ease of access (via the internet: http://www.euronheed.org) should facilitate the diffusion of existing economic evidence on health services and the generalisation of common standards in the field at the European level, thereby improving the quality, generalisability and transferability of results across countries.

  3. FastStats: a public health statistics database.

    PubMed

    Vardell, Emily

    2014-01-01

    FastStats is a site that provides quick and easy access to public health statistics. The freely available website is maintained by the Centers for Disease Control and Prevention's National Center for Health Statistics. Users can browse alphabetically by topic and state/territory or search across the National Center for Health Statistics site. A description of the browsing capabilities and sample searches are presented.

  4. The National Shipbuilding Research Program. Occupational Safety & Health Administration (OSHA) Technical Advisory Committee

    DTIC Science & Technology

    2000-12-29

    0576 N5-97-3 Occupational Safety & Health Administration (OSHA) Technical Advisory Committee U.S. DEPARTMENT OF THE NAVY CARDEROCK DIVISION, NAVAL...4. TITLE AND SUBTITLE The National Shipbuilding Research Program, Occupational Safety & Health Administration (OSHA) Technical Support

  5. PUBLIC HEALTH AND EPIDEMIOLOGICAL DATABASES FOR THE ENHANCEMENT OF MEDICAL EDUCATION

    PubMed Central

    Jamal, Qazi Mohammad Sajid; Siddiqui, Mughees Uddin; Alzohairy, Mohammad Abdulrahman; Al Karaawi, Mohammed Abdullah

    2015-01-01

    The collaboration of public health education and information technology has made patient care safer and more reliable than before. Nurses and doctors use handheld computers to record a patient's medical history and check that they are administering the correct treatment. Fortunately Public Health Informatics (PHI) is the intersecting point of technology and public health. Therefore, the inclusion of online medical and epidemiology databases in the course curriculum of budding medical professionals and postgraduate students would be beneficial in enhancing the quality of health care, extensive epidemiological research, health education, health policies, health planning and consumer satisfaction as well. The purpose of this article is to discuss and provide introduction of various databases which have huge information and it could be used to enhance the public health education. PMID:26392847

  6. [The approach of sciences of complexity in health services administration].

    PubMed

    Fajardo-Ortiz, Guillermo; Ortiz-Montalvo, Armando

    2013-01-01

    Historically, health services administration has been managed under a Taylorist, Fayolist, humanist and bureaucratic focus approach. However, today dynamic and competitive behaviors that require others approaches in management are developing. Because of the social, scientific and technological changes that are occurring, it is necessary to abandon hierarchical and authoritarian schemes, "up and down" lines, prescriptive rules and order line up must be left behind. Health services administration is an adapted complex system that is not proportional, neither predictable in direction or magnitude. A new proposal is to focus on the sciences of complexity, where the social factors, materials, economics, human and ethics coincide with order and disorder, reason and unreason, and in which we must accept that the phenomenon that emerges creates different organizing different structures from the addition or subtraction of components. There is distance in the process of cause and direct effect. The mirage from the sciences of complexity are trans-disciplinary and we have accepted this in others branches of knowledge, such as quantum physics, non-linear mathematics and cybernetics, so we have to accept the influence of entropy, non-entropy, attractors, the theory of chaos and fractals.

  7. Big bad data: law, public health, and biomedical databases.

    PubMed

    Hoffman, Sharona; Podgurski, Andy

    2013-03-01

    The accelerating adoption of electronic health record (EHR) systems will have far-reaching implications for public health research and surveillance, which in turn could lead to changes in public policy, statutes, and regulations. The public health benefits of EHR use can be significant. However, researchers and analysts who rely on EHR data must proceed with caution and understand the potential limitations of EHRs. Because of clinicians' workloads, poor user-interface design, and other factors, EHR data can be erroneous, miscoded, fragmented, and incomplete. In addition, public health findings can be tainted by the problems of selection bias, confounding bias, and measurement bias. These flaws may become all the more troubling and important in an era of electronic "big data," in which a massive amount of information is processed automatically, without human checks. Thus, we conclude the paper by outlining several regulatory and other interventions to address data analysis difficulties that could result in invalid conclusions and unsound public health policies.

  8. Validation of ICD-9 Code 787.2 for identification of individuals with dysphagia from administrative databases.

    PubMed

    González-Fernández, Marlís; Gardyn, Michael; Wyckoff, Shamolie; Ky, Paul K S; Palmer, Jeffrey B

    2009-12-01

    The aim of this study was to determine the accuracy of dysphagia coding using the International Classification of Diseases version 9 (ICD-9) code 787.2. We used the administrative database of a tertiary hospital and sequential videofluorographic swallowing study (VFSS) reports for patients admitted to the same hospital from January to June 2007. The VFSS reports were abstracted and the hospital's database was queried to abstract the coding associated with the admission during which the VFSS was performed. The VFSS and administrative data were merged for data analysis. Dysphagia was coded (using code 787.2) in 36 of 168 cases that had a VFSS. Of these, 34 had dysphagia diagnosed by VFSS (our gold standard) and one had a prior history of dysphagia. Code 787.2 had sensitivity of 22.8, specificity of 89.5, and positive and negative predictive values of 94.4 and 12.9, respectively. Dysphagia was largely undercoded in this database, but when the code was present those individuals were very likely to be dysphagic. Selection of dysphagic cases using the ICD-9 code is appropriate for within-group comparisons. Absence of the code, however, is not a good predictor of the absence of dysphagia.

  9. Pilot Variability Study for Federal Aviation Administration Health and Usage Monitoring Mock Certification

    DTIC Science & Technology

    2015-09-01

    ARL-TR-6922 ● SEP 2015 US Army Research Laboratory Pilot Variability Study for Federal Aviation Administration Health and Usage...Laboratory Pilot Variability Study for Federal Aviation Administration Health and Usage Monitoring Mock Certification by Natasha C Bradley...October 2009–April 2014 4. TITLE AND SUBTITLE Pilot Variability Study for Federal Aviation Administration Health and Usage Monitoring Mock Certification

  10. A European Flood Database: facilitating comprehensive flood research beyond administrative boundaries

    NASA Astrophysics Data System (ADS)

    Hall, J.; Arheimer, B.; Aronica, G. T.; Bilibashi, A.; Boháč, M.; Bonacci, O.; Borga, M.; Burlando, P.; Castellarin, A.; Chirico, G. B.; Claps, P.; Fiala, K.; Gaál, L.; Gorbachova, L.; Gül, A.; Hannaford, J.; Kiss, A.; Kjeldsen, T.; Kohnová, S.; Koskela, J. J.; Macdonald, N.; Mavrova-Guirguinova, M.; Ledvinka, O.; Mediero, L.; Merz, B.; Merz, R.; Molnar, P.; Montanari, A.; Osuch, M.; Parajka, J.; Perdigão, R. A. P.; Radevski, I.; Renard, B.; Rogger, M.; Salinas, J. L.; Sauquet, E.; Šraj, M.; Szolgay, J.; Viglione, A.; Volpi, E.; Wilson, D.; Zaimi, K.; Blöschl, G.

    2015-06-01

    The current work addresses one of the key building blocks towards an improved understanding of flood processes and associated changes in flood characteristics and regimes in Europe: the development of a comprehensive, extensive European flood database. The presented work results from ongoing cross-border research collaborations initiated with data collection and joint interpretation in mind. A detailed account of the current state, characteristics and spatial and temporal coverage of the European Flood Database, is presented. At this stage, the hydrological data collection is still growing and consists at this time of annual maximum and daily mean discharge series, from over 7000 hydrometric stations of various data series lengths. Moreover, the database currently comprises data from over 50 different data sources. The time series have been obtained from different national and regional data sources in a collaborative effort of a joint European flood research agreement based on the exchange of data, models and expertise, and from existing international data collections and open source websites. These ongoing efforts are contributing to advancing the understanding of regional flood processes beyond individual country boundaries and to a more coherent flood research in Europe.

  11. Estimating the Prevalence of Treated Epilepsy Using Administrative Health Data and Its Validity: ESSENCE Study

    PubMed Central

    Lee, Seo-Young; Chung, Soo-Eun; Kim, Dong Wook; Eun, So-Hee; Kang, Hoon Chul; Cho, Yong Won; Yi, Sang Do; Kim, Heung Dong

    2016-01-01

    Background and Purpose Few of the epidemiologic studies of epilepsy have utilized well-validated nationwide databases. We estimated the nationwide prevalence of treated epilepsy based on a comprehensive medical payment database along with diagnostic validation. Methods We collected data on patients prescribed of antiepileptic drugs (AEDs) from the Health Insurance Review and Assessment service, which covers the entire population of Korea. To assess the diagnostic validity, a medical records survey was conducted involving 6,774 patients prescribed AEDs from 43 institutions based on regional clusters and referral levels across the country. The prevalence of treated epilepsy was estimated by projecting the diagnostic validity on the number of patients prescribed AEDs. Results The mean positive predictive value (PPV) for epilepsy was 0.810 for those prescribed AEDs with diagnostic codes that indicate epilepsy or seizure (Diagnosis-E), while it was 0.066 for those without Diagnosis-E. The PPV tended to decrease with age in both groups, with lower values seen in females. The prevalence was 3.84 per 1,000, and it was higher among males, children, and the elderly. Conclusions The prevalence of epilepsy in Korea was comparable to that in other East Asian countries. The diagnostic validity of administrative health data varies depending on the method of case ascertainment, age, and sex. The prescriptions of AEDs even without relevant diagnostic codes should be considered as a tracer for epilepsy. PMID:27273925

  12. [Government funding for health and the reliability of national databases in Brazil, 2001-2002].

    PubMed

    Lima, Claudia Risso de Araujo; Carvalho, Marilia Sá; Schramm, Joyce Mendes de Andrade

    2006-09-01

    Created in 1999, the Information System on Government Health Budgets (SIOPS) provides information on health revenues and expenditures at the three government levels: Municipal, State, and Federal. The lack of other databases with nationwide coverage and detailed information on municipal expenditures makes SIOPS the main source of data for such studies or estimates. The current study aims to compare the revenues declared in SIOPS by the municipalities and the National Health Fund records in order to assess the reliability of the two databases and identify which variables are most discordant. It also compares the data on Municipal expenditures with those from National Treasury records. The Intra-Class Correlation Coefficient (CCIC) was used for this analysis, complemented by a scatterplot of the mean values for the two databases and their differences. The 2002 data showed better quality. The recognition that SIOPS provides reliable data should stimulate new studies including financial aspects in the analysis of population health.

  13. Protocol for validating cardiovascular and cerebrovascular ICD-9-CM codes in healthcare administrative databases: the Umbria Data Value Project

    PubMed Central

    Cozzolino, Francesco; Orso, Massimiliano; Mengoni, Anna; Cerasa, Maria Francesca; Eusebi, Paolo; Ambrosio, Giuseppe; Montedori, Alessandro

    2017-01-01

    Introduction Administrative healthcare databases can provide a comprehensive assessment of the burden of diseases in terms of major outcomes, such as mortality, hospital readmissions and use of healthcare resources, thus providing answers to a wide spectrum of research questions. However, a crucial issue is the reliability of information gathered. Aim of this protocol is to validate International Classification of Diseases, 9th Revision—Clinical Modification (ICD-9-CM) codes for major cardiovascular diseases, including acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF) and stroke. Methods and analysis Data from the centralised administrative database of the entire Umbria Region (910 000 residents, located in Central Italy) will be considered. Patients with a first hospital discharge for AMI, HF, AF or stroke, between 2012 and 2014, will be identified in the administrative database using the following groups of ICD-9-CM codes located in primary position: (1) 410.x for AMI; (2) 427.31 for AF; (3) 428 for HF; (4) 433.x1, 434 (excluding 434.x0), 436 for ischaemic stroke, 430 and 431 for haemorrhagic stroke (subarachnoid haemorrhage and intracerebral haemorrhage). A random sample of cases, and of non-cases, will be selected, and the corresponding medical charts retrieved and reviewed for validation by pairs of trained, independent reviewers. For each condition considered, case adjudication of disease will be based on symptoms, laboratory and diagnostic tests, as available in medical charts. Divergences will be resolved by consensus. Sensitivity and specificity with 95% CIs will be calculated. Ethics and dissemination Research protocol has been granted approval by the Regional Ethics Committee. Study results will be disseminated widely through peer-reviewed publications and presentations at national and international conferences. PMID:28360241

  14. Hospitalizations of Infants and Young Children with Down Syndrome: Evidence from Inpatient Person-Records from a Statewide Administrative Database

    ERIC Educational Resources Information Center

    So, S. A.; Urbano, R. C.; Hodapp, R. M.

    2007-01-01

    Background: Although individuals with Down syndrome are increasingly living into the adult years, infants and young children with the syndrome continue to be at increased risk for health problems. Using linked, statewide administrative hospital discharge records of all infants with Down syndrome born over a 3-year period, this study "follows…

  15. Analysis of workplace compliance measurements of asbestos by the U.S. Occupational Safety and Health Administration (1984-2011).

    PubMed

    Cowan, Dallas M; Cheng, Thales J; Ground, Matthew; Sahmel, Jennifer; Varughese, Allysha; Madl, Amy K

    2015-08-01

    The United States Occupational Safety and Health Administration (OSHA) maintains the Chemical Exposure Health Data (CEHD) and the Integrated Management Information System (IMIS) databases, which contain quantitative and qualitative data resulting from compliance inspections conducted from 1984 to 2011. This analysis aimed to evaluate trends in workplace asbestos concentrations over time and across industries by combining the samples from these two databases. From 1984 to 2011, personal air samples ranged from 0.001 to 175 f/cc. Asbestos compliance sampling data associated with the construction, automotive repair, manufacturing, and chemical/petroleum/rubber industries included measurements in excess of 10 f/cc, and were above the permissible exposure limit from 2001 to 2011. The utility of combining the databases was limited by the completeness and accuracy of the data recorded. In this analysis, 40% of the data overlapped between the two databases. Other limitations included sampling bias associated with compliance sampling and errors occurring from user-entered data. A clear decreasing trend in both airborne fiber concentrations and the numbers of asbestos samples collected parallels historically decreasing trends in the consumption of asbestos, and declining mesothelioma incidence rates. Although air sampling data indicated that airborne fiber exposure potential was high (>10 f/cc for short and long-term samples) in some industries (e.g., construction, manufacturing), airborne concentrations have significantly declined over the past 30 years. Recommendations for improving the existing exposure OSHA databases are provided.

  16. 77 FR 1555 - Administrative Simplification: Adoption of Standards for Health Care Electronic Funds Transfers...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-10

    ... and 162 Administrative Simplification: Adoption of Standards for Health Care Electronic Funds... Health Care Electronic Funds Transfers (EFTs) and Remittance Advice AGENCY: Office of the Secretary, HHS... facilitate health care EFT transmissions. DATES: Effective Date: These regulations are effective on...

  17. Development of a Publicly Available, Comprehensive Database of Fiber and Health Outcomes: Rationale and Methods

    PubMed Central

    Livingston, Kara A.; Chung, Mei; Sawicki, Caleigh M.; Lyle, Barbara J.; Wang, Ding Ding; Roberts, Susan B.; McKeown, Nicola M.

    2016-01-01

    Background Dietary fiber is a broad category of compounds historically defined as partially or completely indigestible plant-based carbohydrates and lignin with, more recently, the additional criteria that fibers incorporated into foods as additives should demonstrate functional human health outcomes to receive a fiber classification. Thousands of research studies have been published examining fibers and health outcomes. Objectives (1) Develop a database listing studies testing fiber and physiological health outcomes identified by experts at the Ninth Vahouny Conference; (2) Use evidence mapping methodology to summarize this body of literature. This paper summarizes the rationale, methodology, and resulting database. The database will help both scientists and policy-makers to evaluate evidence linking specific fibers with physiological health outcomes, and identify missing information. Methods To build this database, we conducted a systematic literature search for human intervention studies published in English from 1946 to May 2015. Our search strategy included a broad definition of fiber search terms, as well as search terms for nine physiological health outcomes identified at the Ninth Vahouny Fiber Symposium. Abstracts were screened using a priori defined eligibility criteria and a low threshold for inclusion to minimize the likelihood of rejecting articles of interest. Publications then were reviewed in full text, applying additional a priori defined exclusion criteria. The database was built and published on the Systematic Review Data Repository (SRDR™), a web-based, publicly available application. Conclusions A fiber database was created. This resource will reduce the unnecessary replication of effort in conducting systematic reviews by serving as both a central database archiving PICO (population, intervention, comparator, outcome) data on published studies and as a searchable tool through which this data can be extracted and updated. PMID:27348733

  18. Comprehensive national database of tree effects on air quality and human health in the United States.

    PubMed

    Hirabayashi, Satoshi; Nowak, David J

    2016-08-01

    Trees remove air pollutants through dry deposition processes depending upon forest structure, meteorology, and air quality that vary across space and time. Employing nationally available forest, weather, air pollution and human population data for 2010, computer simulations were performed for deciduous and evergreen trees with varying leaf area index for rural and urban areas in every county in the conterminous United States. The results populated a national database of annual air pollutant removal, concentration changes, and reductions in adverse health incidences and costs for NO2, O3, PM2.5 and SO2. The developed database enabled a first order approximation of air quality and associated human health benefits provided by trees with any forest configurations anywhere in the conterminous United States over time. Comprehensive national database of tree effects on air quality and human health in the United States was developed.

  19. Rural versus urban: Tennessee health administrators' strategies on recruitment and retention for allied health professionals.

    PubMed

    Slagle, Derek R; Byington, Randy L; Verhovsek, Ester L

    2012-01-01

    Due to an increase in the need for allied health professionals, there is a growing interest to assess the allied health workforce and its employment needs. This is especially true in medically underserved rural areas where there is a critical shortage of allied health professionals. A survey was sent to allied health administrators across a variety of allied health disciplines working in Tennessee hospitals in order to gauge opinions on retention and recruitment strategies. Overall successful strategies for recruitment and retention of allied health professionals were reported as well as differences between urban and rural areas, differences of perceptions of strategy effectiveness among allied health disciplines, and key strategies for rural allied health recruitment. Little is known about organizational policies impacting recruitment and retention practices of allied health professionals in Tennessee hospitals. Understanding of this problem is vital to the prevention of a critical shortage of allied health professionals. Therefore, this study sought to compare rural and urban hospital in Tennessee with respect to recruitment and retention needs.

  20. Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration

    PubMed Central

    Hunt, Christine M; Beste, Lauren A; Lowy, Elliott; Suzuki, Ayako; Moylan, Cynthia A; Tillmann, Hans L; Ioannou, George N; Lim, Joseph K; Kelley, Michael J; Provenzale, Dawn

    2016-01-01

    AIM: To evaluate pretreatment hepatitis B virus (HBV) testing, vaccination, and antiviral treatment rates in Veterans Affairs patients receiving anti-CD20 Ab for quality improvement. METHODS: We performed a retrospective cohort study using a national repository of Veterans Health Administration (VHA) electronic health record data. We identified all patients receiving anti-CD20 Ab treatment (2002-2014). We ascertained patient demographics, laboratory results, HBV vaccination status (from vaccination records), pharmacy data, and vital status. The high risk period for HBV reactivation is during anti-CD20 Ab treatment and 12 mo follow up. Therefore, we analyzed those who were followed to death or for at least 12 mo after completing anti-CD20 Ab. Pretreatment serologic tests were used to categorize chronic HBV (hepatitis B surface antigen positive or HBsAg+), past HBV (HBsAg-, hepatitis B core antibody positive or HBcAb+), resolved HBV (HBsAg-, HBcAb+, hepatitis B surface antibody positive or HBsAb+), likely prior vaccination (isolated HBsAb+), HBV negative (HBsAg-, HBcAb-), or unknown. Acute hepatitis B was defined by the appearance of HBsAg+ in the high risk period in patients who were pretreatment HBV negative. We assessed HBV antiviral treatment and the incidence of hepatitis, liver failure, and death during the high risk period. Cumulative hepatitis, liver failure, and death after anti-CD20 Ab initiation were compared by HBV disease categories and differences compared using the χ2 test. Mean time to hepatitis peak alanine aminotransferase, liver failure, and death relative to anti-CD20 Ab administration and follow-up were also compared by HBV disease group. RESULTS: Among 19304 VHA patients who received anti-CD20 Ab, 10224 (53%) had pretreatment HBsAg testing during the study period, with 49% and 43% tested for HBsAg and HBcAb, respectively within 6 mo pretreatment in 2014. Of those tested, 2% (167/10224) had chronic HBV, 4% (326/7903) past HBV, 5% (427

  1. Interest in Long-Term Care among Health Services Administration Students

    ERIC Educational Resources Information Center

    Temple, April; Thompson, Jon M.

    2011-01-01

    The aging of the population has created increased opportunities for health administrators in long-term care. This study consisted of a cross-sectional survey of 68 undergraduate health services administration students to explore factors related to interest in a career in long-term care administration. One third expressed interest working in the…

  2. Laminin-database v.2.0: an update on laminins in health and neuromuscular disorders.

    PubMed

    Golbert, Daiane C F; Santana-van-Vliet, Eliane; Mundstein, Alex S; Calfo, Vicente; Savino, Wilson; de Vasconcelos, Ana Tereza R

    2014-01-01

    The laminin (LM)-database, hosted at http://www.lm.lncc.br, was published in the NAR database 2011 edition. It was the first database that provided comprehensive information concerning a non-collagenous family of extracellular matrix proteins, the LMs. In its first version, this database contained a large amount of information concerning LMs related to health and disease, with particular emphasis on the haemopoietic system. Users can easily access several tabs for LMs and LM-related molecules, as well as LM nomenclatures and direct links to PubMed. The LM-database version 2.0 integrates data from several publications to achieve a more comprehensive knowledge of LMs in health and disease. The novel features include the addition of two new tabs, 'Neuromuscular Disorders' and 'miRNA--LM Relationship'. More specifically, in this updated version, an expanding set of data has been displayed concerning the role of LMs in neuromuscular and neurodegenerative diseases, as well as the putative involvement of microRNAs. Given the importance of LMs in several biological processes, such as cell adhesion, proliferation, differentiation, migration and cell death, this upgraded version expands for users a panoply of information, regarding complex molecular circuitries that involve LMs in health and disease, including neuromuscular and neurodegenerative disorders.

  3. The glass ceiling in academe: health administration is no exception.

    PubMed

    Stoskopf, C H; Xirasagar, S

    1999-01-01

    This paper reviews gender issues in academe and presents findings of a limited survey of ACEHSA-accredited health administration graduate programs. The survey shows gender ratios adverse to women at the full, associate, and assistant professor levels. Men to women ratio among faculty was 1.98, among full-time faculty it was 2.24, and among tenured/tenure-track faculty it was 2.69, despite an excess of female students over male students in graduate programs, and despite equal proportions of women and men faculty holding doctoral degrees. Distribution by rank showed 48.5 percent full professors, 27.8 percent associate professors, and, 20.1 percent assistant professors among men, vs. 27.4 percent, 41.1 percent, and 31.5 percent respectively among women. In other academic fields similar gender ratios prevail, and many researchers have documented evidence of continuing gender inequities in tenure, promotion and salary, given comparable performance, despite the enactment of Title IX in 1972. Gender disparities are rooted in a complex web of gender-specific constraints interwoven with secular human capital and structural variables, and confounded by sexist discriminatory factors. In light of these issues, recommendations are made toward creating an equitable academic climate without compromising the ideal of meritocracy, through gender-sensitive initiatives and vigilance mechanisms to bring policies to fruition.

  4. Integrating mental health into primary care within the Veterans Health Administration.

    PubMed

    Post, Edward P; Metzger, Maureen; Dumas, Patricia; Lehmann, Laurent

    2010-06-01

    The Veterans Health Administration (VHA) has been undertaking a major transformational program of integrating collaborative mental health resources into primary care settings. Key components of the program include colocated collaborative care provided by mental health professionals; care management; and blended programs that combine elements of these two components, whose functions are highly complementary to each other. The program has grown since 2007 from an initiative implementing pilot programs at participating facilities, to a routine expectation of primary care within all VHA medical centers and large community-based outpatient clinics. The national program office supports this VHA initiative in multiple ways, including technical assistance to sites, program and policy development, dissemination of informational tools to facilitate continuous quality improvement, education and training, and partnerships with other existing and emerging VHA programs such as postdeployment health clinics and the patient-centered medical home.

  5. Management Team Stressors and Their Impact on Administrators' Health.

    ERIC Educational Resources Information Center

    Gmelch, Walter H.; Swent, Boyd

    School administrators suffer greater stress from administrative constraints than from any other stress factors, according to a survey of over 1,150 Oregon elementary and secondary principals and vice-principals, superintendents, and central office administrators. Researchers isolated 35 stressors, or stress-inducing situations, that could be…

  6. The evolution of a health hazard assessment database management system for military weapons, equipment, and materiel.

    PubMed

    Murnyak, George R; Spencer, Clark O; Chaney, Ann E; Roberts, Welford C

    2002-04-01

    During the 1970s, the Army health hazard assessment (HHA) process developed as a medical program to minimize hazards in military materiel during the development process. The HHA Program characterizes health hazards that soldiers and civilians may encounter as they interact with military weapons and equipment. Thus, it is a resource for medical planners and advisors to use that can identify and estimate potential hazards that soldiers may encounter as they train and conduct missions. The U.S. Army Center for Health Promotion and Preventive Medicine administers the program, which is integrated with the Army's Manpower and Personnel Integration program. As the HHA Program has matured, an electronic database has been developed to record and monitor the health hazards associated with military equipment and systems. The current database tracks the results of HHAs and provides reporting designed to assist the HHA Program manager in daily activities.

  7. Rural health resource databases: a little nurturing goes a long way.

    PubMed

    McGrail, M R; Robinson, A; Blue, I

    2003-01-01

    Access to rural health research information together with the type and availability of educational resources in rural areas, are important to rural health care providers, community members, researchers, students, planners and policy makers. The Rural Health Research Register (RHRR) focuses on current and recent research activity being undertaken in Australia in the field of rural health, while the Health Education Rural Remote Resources Database (HERRD) focuses on education courses and resources relevant to the practice and professional development of rural and remote health professionals throughout Australia. Early versions of these databases were established between 1992 and 1997, and in the period 1998-2001 both information resources were systematically updated through targeted promotion, registrations and the creation of web-accessible search facilities. They continue to be maintained and updated. Detailed information is available by searching the RHRR and HERRD databases via the web or by contacting the relevant coordinator. This article examines some of the issues in developing and maintaining these resources and demonstrates the usefulness of their contents to rural healthcare workers.

  8. Assessing availability of scientific journals, databases, and health library services in Canadian health ministries: a cross-sectional study

    PubMed Central

    2013-01-01

    Background Evidence-informed health policymaking logically depends on timely access to research evidence. To our knowledge, despite the substantial political and societal pressure to enhance the use of the best available research evidence in public health policy and program decision making, there is no study addressing availability of peer-reviewed research in Canadian health ministries. Objectives To assess availability of (1) a purposive sample of high-ranking scientific journals, (2) bibliographic databases, and (3) health library services in the fourteen Canadian health ministries. Methods From May to October 2011, we conducted a cross-sectional survey among librarians employed by Canadian health ministries to collect information relative to availability of scientific journals, bibliographic databases, and health library services. Availability of scientific journals in each ministry was determined using a sample of 48 journals selected from the 2009 Journal Citation Reports (Sciences and Social Sciences Editions). Selection criteria were: relevance for health policy based on scope note information about subject categories and journal popularity based on impact factors. Results We found that the majority of Canadian health ministries did not have subscription access to key journals and relied heavily on interlibrary loans. Overall, based on a sample of high-ranking scientific journals, availability of journals through interlibrary loans, online and print-only subscriptions was estimated at 63%, 28% and 3%, respectively. Health Canada had a 2.3-fold higher number of journal subscriptions than that of the provincial ministries’ average. Most of the organisations provided access to numerous discipline-specific and multidisciplinary databases. Many organisations provided access to the library resources described through library partnerships or consortia. No professionally led health library environment was found in four out of fourteen Canadian health ministries

  9. Proposal for a European Public Health Research Infrastructure for Sharing of health and Medical administrative data (PHRIMA).

    PubMed

    Burgun, Anita; Oksen, Dina V; Kuchinke, Wolfgang; Prokosch, Hans-Ulrich; Ganslandt, Thomas; Buchan, Iain; van Staa, Tjeerd; Cunningham, James; Gjerstorff, Marianne L; Dufour, Jean-Charles; Gibrat, Jean-Francois; Nikolski, Macha; Verger, Pierre; Cambon-Thomsen, Anne; Masella, Cristina; Lettieri, Emanuele; Bertele, Paolo; Salokannel, Marjut; Thiebaut, Rodolphe; Persoz, Charles; Chêne, Geneviève; Ohmann, Christian

    2015-01-01

    In Europe, health and medical administrative data is increasingly accumulating on a national level. Looking further than re-use of this data on a national level, sharing health and medical administrative data would enable large-scale analyses and European-level public health projects. There is currently no research infrastructure for this type of sharing. The PHRIMA consortium proposes to realise the Public Health Research Infrastructure for Sharing of health and Medical Administrative data (PHRIMA) which will enable and facilitate the efficient and secure sharing of healthcare data.

  10. Present epidemiology of chronic subdural hematoma in Japan: analysis of 63,358 cases recorded in a national administrative database.

    PubMed

    Toi, Hiroyuki; Kinoshita, Keita; Hirai, Satoshi; Takai, Hiroki; Hara, Keijiro; Matsushita, Nobuhisa; Matsubara, Shunji; Otani, Makoto; Muramatsu, Keiji; Matsuda, Shinya; Fushimi, Kiyohide; Uno, Masaaki

    2017-02-03

    OBJECTIVE Aging of the population may lead to epidemiological changes with respect to chronic subdural hematoma (CSDH). The objectives of this study were to elucidate the current epidemiology and changing trends of CSDH in Japan. The authors analyzed patient information based on reports using a Japanese administrative database associated with the diagnosis procedure combination (DPC) system. METHODS This study included patients with newly diagnosed CSDH who were treated in hospitals participating in the DPC system. The authors collected data from the administrative database on the following clinical and demographic characteristics: patient age, sex, and level of consciousness on admission; treatment procedure; and outcome at discharge. RESULTS A total of 63,358 patients with newly diagnosed CSDH and treated in 1750 DPC participation hospitals were included in this study. Analysis according to patient age showed that the most common age range for these patients was the 9th decade of life (in their 80s). More than half of patients 70 years old or older presented with some kind of disturbance of consciousness. Functional outcomes at discharge were good in 71.6% (modified Rankin Scale [mRS] score 0-2) of cases and poor in 28.4% (mRS score 3-6). The percentage of poor outcomes tended to be higher in elderly patients. Approximately 40% of patients 90 years old or older could not be discharged to home. The overall recurrence rate for CSDH was 13.1%. CONCLUSIONS This study shows a chronological change in the age distribution of CSDH among Japanese patients, which may be affecting the prognosis of this condition. In the aging population of contemporary Japan, patients in their 80s were affected more often than patients in other age categories, and approximately 30% of patients with CSDH required some help at discharge. CSDH thus may no longer have as good a prognosis as had been thought.

  11. Reinventing Veterans Health Administration: focus on primary care.

    PubMed

    Armstrong, Brent; Levesque, Odette; Perlin, Jonathan B; Rick, Cathy; Schectman, Gordon

    2005-01-01

    Can we improve access in primary care without compromising the quality of care? The purpose of this article is to demonstrate how timely access to primary care can be achieved without compromising the quality of the care being delivered. The Veterans Health Administration (VHA) is an integrated healthcare system that has implemented change to improve primary care access to the veterans it serves, while not only maintaining but also actually improving the quality of care. Many healthcare executives are struggling with achieving desirable access to care and continuity of care. To confront this problem, many large and small practices have initiated an approach known as advanced clinic access, open access, or same-day scheduling, introduced by the Institute for Healthcare Improvement (IHI). This approach has increasingly been used to reduce waits and delays in primary care without adding resources. To measure quality of care, specific performance measures were developed to quantify the effectiveness of primary care in VHA. Although it was initially viewed with concern and suspicion and was seen as a symptom of unnecessary micromanagement, healthcare team members were encouraged to use performance feedback as an opportunity for systems improvement as well as self-assessment and performance improvement for the team. All quality data are posted quarterly on VHA's internal web site, providing visible accountability at all levels of the organization. Clinical workflow redesign leads to reduced wait times without compromising quality of care. These large system improvements are applicable to large and small organizations looking to tackle change through the use of a collaborative model.

  12. System administrator's manual (SAM) for the enhanced logistics intratheater support tool (ELIST) database instance segment version 8.1.0.0 for solaris 7.

    SciTech Connect

    Dritz, K.

    2002-03-06

    This document is the System Administrator's Manual (SAM) for the Enhanced Logistics Intratheater Support Tool (ELIST) Database Instance Segment. It covers errors that can arise during the segment's installation and deinstallation, and it outlines appropriate recovery actions. It also tells how to change the password for the SYSTEM account of the database instance after the instance is created, and it discusses the creation of a suitable database instance for ELIST by means other than the installation of the segment. The latter subject is covered in more depth than its introductory discussion in the Installation Procedures (IP) for the Enhanced Logistics Intratheater Support Tool (ELIST) Global Data Segment, Database Instance Segment, Database Fill Segment, Database Segment, Database Utility Segment, Software Segment, and Reference Data Segment (referred to in portions of this document as the ELIST IP). The information in this document is expected to be of use only rarely. Other than errors arising from the failure to follow instructions, difficulties are not expected to be encountered during the installation or deinstallation of the segment. By the same token, the need to create a database instance for ELIST by means other than the installation of the segment is expected to be the exception, rather than the rule. Most administrators will only need to be aware of the help that is provided in this document and will probably not actually need to read and make use of it.

  13. Fleet-Wide Prognostic and Health Management Suite: Asset Fault Signature Database

    SciTech Connect

    Vivek Agarwal; Nancy J. Lybeck; Randall Bickford; Richard Rusaw

    2015-06-01

    Proactive online monitoring in the nuclear industry is being explored using the Electric Power Research Institute’s Fleet-Wide Prognostic and Health Management (FW-PHM) Suite software. The FW-PHM Suite is a set of web-based diagnostic and prognostic tools and databases that serves as an integrated health monitoring architecture. The FW-PHM Suite has four main modules: (1) Diagnostic Advisor, (2) Asset Fault Signature (AFS) Database, (3) Remaining Useful Life Advisor, and (4) Remaining Useful Life Database. The paper focuses on the AFS Database of the FW-PHM Suite, which is used to catalog asset fault signatures. A fault signature is a structured representation of the information that an expert would use to first detect and then verify the occurrence of a specific type of fault. The fault signatures developed to assess the health status of generator step-up transformers are described in the paper. The developed fault signatures capture this knowledge and implement it in a standardized approach, thereby streamlining the diagnostic and prognostic process. This will support the automation of proactive online monitoring techniques in nuclear power plants to diagnose incipient faults, perform proactive maintenance, and estimate the remaining useful life of assets.

  14. Genomics and Public Health Research: Can the State Allow Access to Genomic Databases?

    PubMed Central

    Cousineau, J; Girard, N; Monardes, C; Leroux, T; Jean, M Stanton

    2012-01-01

    Because many diseases are multifactorial disorders, the scientific progress in genomics and genetics should be taken into consideration in public health research. In this context, genomic databases will constitute an important source of information. Consequently, it is important to identify and characterize the State’s role and authority on matters related to public health, in order to verify whether it has access to such databases while engaging in public health genomic research. We first consider the evolution of the concept of public health, as well as its core functions, using a comparative approach (e.g. WHO, PAHO, CDC and the Canadian province of Quebec). Following an analysis of relevant Quebec legislation, the precautionary principle is examined as a possible avenue to justify State access to and use of genomic databases for research purposes. Finally, we consider the Influenza pandemic plans developed by WHO, Canada, and Quebec, as examples of key tools framing public health decision-making process. We observed that State powers in public health, are not, in Quebec, well adapted to the expansion of genomics research. We propose that the scope of the concept of research in public health should be clear and include the following characteristics: a commitment to the health and well-being of the population and to their determinants; the inclusion of both applied research and basic research; and, an appropriate model of governance (authorization, follow-up, consent, etc.). We also suggest that the strategic approach version of the precautionary principle could guide collective choices in these matters. PMID:23113174

  15. Sustainability in Primary Care and Mental Health Integration Projects in Veterans Health Administration

    PubMed Central

    Ford, James H.; Krahn, Dean; Oliver, Karen Anderson; Kirchner, JoAnn

    2015-01-01

    Objective To explore staff perceptions about sustainability, commitment to change, participation in change process, and information received about the change project within the Veterans Administration Primary Care and Mental Health Integration (PC-MHI) initiative and to examine differences from the Veterans Health Administration Mental Health Systems Redesign (MHSR) initiative. Data Sources Surveys of change team members involved in the Veterans Affairs PC-MHI and MHSR initiatives. Study Design One-way analysis of variance examined the relationship between commitment, participation and information, and sustainability. Differences in PC-MHI sustainability were explored by location and job classification. Staff sustainability perceptions were compared with MHSR results. Principal Findings Sustainability differed by staff discipline. Difference between MHSR and PC-MHI existed by job function and perceptions about the change benefits. Participation in the change process and information received about the change process were positively correlated with sustainability. Staff commitment to change was positively associated with staff perceptions about the benefits of change and staff attitudes toward change. Conclusions Sustainability is an important part of organizational change efforts. Change complexity seems to influence perception about sustainability and impacts staff perceptions about the benefits of change. These perceptions seem to be driven by the information received and opportunities to participate in the change process. Further research is needed to understand how information and participation influence sustainability and affect employee commitment to change. PMID:23011071

  16. Human health risk assessment database, 'the NHSRC toxicity value database': Supporting the risk assessment process at US EPA's National Homeland Security Research Center

    SciTech Connect

    Moudgal, Chandrika J.

    2008-11-15

    The toxicity value database of the United States Environmental Protection Agency's (EPA) National Homeland Security Research Center has been in development since 2004. The toxicity value database includes a compilation of agent property, toxicity, dose-response, and health effects data for 96 agents: 84 chemical and radiological agents and 12 biotoxins. The database is populated with multiple toxicity benchmark values and agent property information from secondary sources, with web links to the secondary sources, where available. A selected set of primary literature citations and associated dose-response data are also included. The toxicity value database offers a powerful means to quickly and efficiently gather pertinent toxicity and dose-response data for a number of agents that are of concern to the nation's security. This database, in conjunction with other tools, will play an important role in understanding human health risks, and will provide a means for risk assessors and managers to make quick and informed decisions on the potential health risks and determine appropriate responses (e.g., cleanup) to agent release. A final, stand alone MS ACESSS working version of the toxicity value database was completed in November, 2007.

  17. Older Adult Participation in Health Promotion Programs: Perspectives of Facility Administrators

    ERIC Educational Resources Information Center

    Wright, Tim; Hyner, Gerald C.

    2011-01-01

    Administrators of older adult-centered facilities must identify barriers to the planning and implementation of health promotion programs. In this qualitative research those barriers were identified through in-depth interviews with administrators of older adult-centered facilities. As identified by administrators, the predominant barriers to the…

  18. Recent Cases: Administrative Law--Occupational Safety and Health Act

    ERIC Educational Resources Information Center

    Harvard Law Review, 1976

    1976-01-01

    Implications of the Occupational Safety and Health Act of 1970 are described in two cases: Brennan v. Occupational Safety and Health Review Commission (Underhill Construction Corp.), and Anning-Johnson Co. v. United States Occupational Safety and Health Review Commission. (LBH)

  19. Connecting the dots: interprofessional health education and delivery system redesign at the Veterans Health Administration.

    PubMed

    Gilman, Stuart C; Chokshi, Dave A; Bowen, Judith L; Rugen, Kathryn Wirtz; Cox, Malcolm

    2014-08-01

    Health systems around the United States are embracing new models of primary care using interprofessional team-based approaches in pursuit of better patient outcomes, higher levels of satisfaction among patients and providers, and improved overall value. Less often discussed are the implications of new models of care for health professions education, including education for physicians, nurse practitioners, physician assistants, and other professions engaged in primary care. Described here is the interaction between care transformation and redesign of health professions education at the largest integrated delivery system in the United States: the Veterans Health Administration (VA). Challenges and lessons learned are discussed in the context of a demonstration initiative, the VA Centers of Excellence in Primary Care Education. Five sites, involving VA medical centers and their academic affiliates in Boise, Cleveland, San Francisco, Seattle, and West Haven, introduced interprofessional primary care curricula for resident physicians and nurse practitioner students beginning in 2011. Implementation struggles largely revolved around the operational logistics and cultural disruption of integrating educational redesign for medicine and nursing and facilitating the interface between educational and clinical activities. To realize new models for interprofessional teaching, faculty, staff, and trainees must understand the histories, traditions, and program requirements across professions and experiment with new approaches to achieving a common goal. Key recommendations for redesign of health professions education revolve around strengthening the union between interprofessional learning, team-based practice, and high-value care.

  20. Implementation of health information technology in Veterans Health Administration to support transformational change: telehealth and personal health records.

    PubMed

    Chumbler, Neale R; Haggstrom, David; Saleem, Jason J

    2011-12-01

    The Institute of Medicine report, Crossing the Quality Chasm, called for significant improvements in 6 elements of healthcare performance: safety, effectiveness, patient centeredness, timeliness, efficiency, and equity. To meet the changing care needs of older veterans, many of whom are trying to manage the complexities of their chronic diseases in their own homes, the Veterans Health Administration (VHA) has promoted many of the Institute of Medicine elements by implementing health information technology (health IT), such as telehealth and a personal health record (PHR). To that end, approximately 5 years ago, VHA created the Office of Care Coordination and in particular a patient-centered Care Coordination/Home Telehealth (CCHT) program, which uses telehealth technologies (eg, messaging devices) to coordinate care directly from a patient's home to help self-manage their chronic diseases. VHA has also developed a PHR, My HealtheVet, which is a secure web-based portal that provides veterans the capability to access and manage health information. This article discusses the mechanisms by which these forms of health IT have been implemented to improve access to care and improve health. For telehealth, we present the outcomes from some of the published literature. For PHRs, we outline what is known to date and future research directions. The article also examines some structural, policy-related, and organizational barriers to health IT implementation and offers suggestions for future research.

  1. Monitoring of equine health in Denmark: the importance, purpose, research areas and content of a future database.

    PubMed

    Hartig, Wendy; Houe, Hans; Andersen, Pia Haubro

    2013-04-01

    The plentiful data on Danish horses are currently neither organized nor easily accessible, impeding register-based epidemiological studies on Danish horses. A common database could be beneficial. In principle, databases can contain a wealth of information, but no single database can serve every purpose. Hence the establishment of a Danish equine health database should be preceded by careful consideration of its purpose and content, and stakeholder attitudes should be investigated. The objectives of the present study were to identify stakeholder attitudes to the importance, purpose, research areas and content of a health database for horses in Denmark. A cross-sectional study was conducted with 13 horse-related stakeholder groups in Denmark. The groups surveyed included equine veterinarians, researchers, veterinary students, representatives from animal welfare organizations, horse owners, trainers, farriers, authority representatives, ordinary citizens, and representatives from laboratories, insurance companies, medical equipment companies and pharmaceutical companies. Supplementary attitudes were inferred from qualitative responses. The overall response rate for all stakeholder groups was 45%. Stakeholder group-specific response rates were 27-80%. Sixty-eight percent of questionnaire respondents thought a national equine health database was important. Most respondents wanted the database to contribute to improved horse health and welfare, to be used for research into durability and disease heritability, and to serve as a basis for health declarations for individual horses. The generally preferred purpose of the database was thus that it should focus on horse health and welfare rather than on performance or food safety, and that it should be able to function both at a population and an individual horse level. In conclusion, there is a positive attitude to the establishment of a health database for Danish horses. These results could enrich further reflection on the

  2. The European Network of Health Economic Evaluation Databases (EURO NHEED) Project.

    PubMed

    Nixon, John; Ulmann, Philippe; Glanville, Julie; Boulenger, Stéphanie; Drummond, Michael; de Pouvourville, Gérard

    2004-06-01

    This paper provides a first outline of the European Network of Health Economic Evaluation Databases (EURO NHEED) project. The project is funded by the European Commission and will implement, in 7 European centres based in France, Germany, Italy, The Netherlands, Spain, Sweden and the United Kingdom, databases on the economic evaluation of healthcare interventions. The network will be based on two existing and well-established resources, namely the UK's NHS Economic Evaluation Database (NHS EED), and France's Connaissances et Décision en EConomie de la Santé (CODECS) database. EURO NHEED will initially cover 17 European countries and will provide its users with bibliographic records, detailing the main characteristics of all included studies. In addition, structured abstracts will be provided for articles identified as full economic evaluations (cost-benefit, cost-effectiveness or cost-utility), which will offer a detailed critique of the findings and the methodology used. These databases will be accessible free of charge on the Internet. The EURO NHEED project is the first attempt to develop such a resource on a multi-national basis. The project will bring together Health Economists and Information Scientists from the European Union and beyond and is anticipated to facilitate a number of benefits and advances in the field of Health Economics. These include harmonisation and increased understanding of the theory and methodology of economic evaluation in healthcare, the interpretation of the generalisability of studies to target settings, and the influence of healthcare system variations among the European countries. The project will therefore advance the state of the art in collecting, summarising, critiquing and disseminating economic evaluations of healthcare conducted within Europe.

  3. [Bavarian mental health reform 1851. An instrument of administrative modernization].

    PubMed

    Burgmair, Wolfgang; Weber, Matthias M

    2008-01-01

    By 1850 the reformation of institutional psychiatric care in Bavaria was given the highest priority by monarchy and administration. Cooperating with experts, especially the psychiatrist Karl August von Solbrig, they provided for new asylums to be established throughout Bavaria in a surprisingly short period of time. It was, however, only at personal intervention of King Max II. that the administrative and financial difficulties which had existed since the beginning of the 19th century could be overcome. The planning of asylums done by each administrative district of Bavaria vividly reflects rivalry as well as cooperation between all governmental and professional agencies involved. Modernization of psychiatry was publicly justified by referring to scientism, the need for a more progressive restructuring of administration, and the paternalistic care of the monarchy, whereas, from an administrative point of view, aspects of psychiatric treatment, like what kind of asylum would be best, were rather insignificant. The structures established by means of the alliance between state administration and psychiatric care under the rule of King Max II. had a lasting effect on the further development of Bavaria.

  4. DianaHealth.com, an On-Line Database Containing Appraisals of the Clinical Value and Appropriateness of Healthcare Interventions: Database Development and Retrospective Analysis

    PubMed Central

    Bonfill, Xavier; Osorio, Dimelza; Solà, Ivan; Pijoan, Jose Ignacio; Balasso, Valentina; Quintana, Maria Jesús; Puig, Teresa; Bolibar, Ignasi; Urrútia, Gerard; Zamora, Javier; Emparanza, José Ignacio; Gómez de la Cámara, Agustín; Ferreira-González, Ignacio

    2016-01-01

    Objective To describe the development of a novel on-line database aimed to serve as a source of information concerning healthcare interventions appraised for their clinical value and appropriateness by several initiatives worldwide, and to present a retrospective analysis of the appraisals already included in the database. Methods and Findings Database development and a retrospective analysis. The database DianaHealth.com is already on-line and it is regularly updated, independent, open access and available in English and Spanish. Initiatives are identified in medical news, in article references, and by contacting experts in the field. We include appraisals in the form of clinical recommendations, expert analyses, conclusions from systematic reviews, and original research that label any health care intervention as low-value or inappropriate. We obtain the information necessary to classify the appraisals according to type of intervention, specialties involved, publication year, authoring initiative, and key words. The database is accessible through a search engine which retrieves a list of appraisals and a link to the website where they were published. DianaHealth.com also provides a brief description of the initiatives and a section where users can report new appraisals or suggest new initiatives. From January 2014 to July 2015, the on-line database included 2940 appraisals from 22 initiatives: eleven campaigns gathering clinical recommendations from scientific societies, five sets of conclusions from literature review, three sets of recommendations from guidelines, two collections of articles on low clinical value in medical journals, and an initiative of our own. Conclusions We have developed an open access on-line database of appraisals about healthcare interventions considered of low clinical value or inappropriate. DianaHealth.com could help physicians and other stakeholders make better decisions concerning patient care and healthcare systems sustainability

  5. Applying Knowledge Discovery in Databases in Public Health Data Set: Challenges and Concerns

    PubMed Central

    Volrathongchia, Kanittha

    2003-01-01

    In attempting to apply Knowledge Discovery in Databases (KDD) to generate a predictive model from a health care dataset that is currently available to the public, the first step is to pre-process the data to overcome the challenges of missing data, redundant observations, and records containing inaccurate data. This study will demonstrate how to use simple pre-processing methods to improve the quality of input data. PMID:14728545

  6. Health Care Costs for Patients With Chronic Spinal Cord Injury in the Veterans Health Administration

    PubMed Central

    French, Dustin D; Campbell, Robert R; Sabharwal, Sunil; Nelson, Audrey L; Palacios, Polly A; Gavin-Dreschnack, Deborah

    2007-01-01

    Background/Objective: Recurring annual costs of caring for patients with chronic spinal cord injury (SCI) is a large economic burden on health care systems, but information on costs of SCI care beyond the acute and initial postacute phase is sparse. The objective of this study was to establish a frame of reference and estimate of the annual direct medical costs associated with health care for a sample of patients with chronic SCI (ie, >2 years after injury). Methods: Patients were recruited from 3 Veterans Health Administration (VHA) SCI facilities; baseline patient information was cross-referenced to the Decision Support System (DSS) National Data Extracts (NDE) to obtain patient-specific health care costs in VHA. Descriptive statistical analysis of annual DSS-NDE cost of patients with SCI (N = 675) for fiscal year (FY) 2005 by level and completeness of injury was conducted. Results: Total (inpatient and outpatient) annual (FY 2005) direct medical costs for 675 patients with SCI exceeded $14.47 million or $21,450 per patient. Average annual total costs varied from $28,334 for cervical complete SCI to $16,792 for thoracic incomplete SCI. Two hundred thirty-three of the 675 patients with SCI who were hospitalized over the study period accounted for a total of 378 hospital discharges, costing in excess of $7.19 million. This approximated a cost of outpatient care received of $7.28 million for our entire sample. Conclusions: The comprehensive nature of health care delivery and related cost capture for people with chronic SCI in the VHA provided us the opportunity to accurately determine health care costs for this population. Future SCI postacute care cost analyses should consider case-mix adjusting patients at high risk for rehospitalization. PMID:18092564

  7. The Obama administration's options for health care cost control: hope versus reality.

    PubMed

    Marmor, Theodore; Oberlander, Jonathan; White, Joseph

    2009-04-07

    Controlling the costs of medical care has long been an elusive goal in U.S. health policy. This article examines the options for health care cost control under the Obama administration. The authors argue that the administration's approach to health reform offers some potential for cost control but also embraces many strategies that are not likely to be successful. Lessons the United States can learn from other countries' experiences in constraining medical care spending are then explored.

  8. Does administering a comprehensive examination affect pass rates on the Registered Health Information Administrator certification examination?

    PubMed

    McNeill, Marjorie H

    2009-01-01

    The purpose of this research study was to determine whether the administration of a comprehensive examination before graduation increases the percentage of students passing the Registered Health Information Administrator certification examination. A t-test for independent means yielded a statistically significant difference between the Registered Health Information Administrator certification examination pass rates of health information administration programs that administer a comprehensive examination and programs that do not administer a comprehensive examination. Programs with a high certification examination pass rate do not require a comprehensive examination when compared with those programs with a lower pass rate. It is concluded that health information administration faculty at the local level should perform program self-analysis to improve student progress toward achievement of learning outcomes and entry-level competencies.

  9. Diversity in health administration doctoral education: alternative scenarios for the future.

    PubMed

    Begun, J W

    2001-01-01

    Doctoral programs in health administration are characterized by extreme diversity in focus, format, content, and market. The observed diversity reflects two key structural attributes of health administration as a doctoral field of study: 1) its multidisciplinary base, and 2) its small size. These attributes leave doctoral programs vulnerable to a host of external pressures. The field lacks structure and organizing principles at the national or international level, and students, employers, and other stakeholders suffer some damaging consequences. Pressures from the institutional environment are weak and splintered (among the constituent disciplines of health administration), while the technical environment (economic forces such as competition for students and research funding) produces a powerful set of incentives that shape the form and substance of health administration doctoral education. As alternatives to the current hybrid nature of the field, two additional future scenarios are considered: Integration with Health Services Research, and Integration with Business Administration. The future of health administration doctoral education is interdependent with 1) the continued differentiation of health administration as a master's field of study; 2) trends in research funding; and 3) economies in the delivery of small-scale or individually customized doctoral education. At the least, programs and students currently would benefit from more information classifying program breadth and goals and reporting outcomes; more adequate information on careers and placement; and a modicum of workforce planning.

  10. Substance Abuse and Mental Health Services Administration. March/April 2008

    ERIC Educational Resources Information Center

    Goodman, Deborah, Ed.

    2008-01-01

    "SAMHSA News" is the national newsletter of the Substance Abuse and Mental Health Services Administration. Published six times a year (bimonthly) by SAMHSA's Office of Communications, SAMHSA News contains information about the latest substance abuse and mental health treatment and prevention practices, recent statistics on mental health and…

  11. Health Literacy Assessment of the STOFHLA: Paper versus Electronic Administration Continuation Study

    ERIC Educational Resources Information Center

    Chesser, Amy K.; Keene Woods, Nikki; Wipperman, Jennifer; Wilson, Rachel; Dong, Frank

    2014-01-01

    Low health literacy is associated with poor health outcomes. Research is needed to understand the mechanisms and pathways of its effects. Computer-based assessment tools may improve efficiency and cost-effectiveness of health literacy research. The objective of this preliminary study was to assess if administration of the Short Test of Functional…

  12. 77 FR 22949 - Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-17

    ... April 17, 2012 Part III Department of Health and Human Services 45 CFR Part 162 Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider... Rules#0;#0; ] DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Part 162 RIN...

  13. Health Consequences of Typhoon Haiyan in the Eastern Visayas Region Using a Syndromic Surveillance Database

    PubMed Central

    Salazar, Miguel Antonio; Law, Ronald; Pesigan, Arturo; Winkler, Volker

    2017-01-01

    Introduction: Typhoon Haiyan was the strongest storm recorded in Philippine history. Surveillance in Post Extreme Emergencies and Disasters (SPEED) was activated during the typhoon response. This study analyzes the health impact of different diseases during different timeframes post-disaster during Typhoon Haiyan in 2013 using a syndromic surveillance database. Methods: SPEED reports medical consultations based on 21 syndromes covering a range of conditions from three syndrome groups: communicable diseases, injuries, and non-communicable diseases (NCDs). We analyzed consultation rates for 150 days post-disaster by syndrome, syndrome group, time period, and health facility type for adults as well as for children under the age of five. Results: Communicable diseases had the highest consultation rates followed by similar rates for both injuries and NCDs. While communicable diseases were the predominant syndrome group for children, wounds and hypertension were common syndromes observed in adults. Village health centers had the most consultations amongst health facilities, but also showed the highest variability. Discussion: Children were more vulnerable to communicable diseases compared to adults. Community health centers showing consistently high consultation rates point out a need for their prioritization. The predominance of primary care conditions requires disaster managers to focus on basic health care and public health measures in community health centers that target the young, elderly and impoverished appropriate to the time period. PMID:28255519

  14. A Health Services Research Agenda for Bariatric Surgery Within the Veterans Health Administration.

    PubMed

    Funk, L M; Gunnar, W; Dominitz, J A; Eisenberg, D; Frayne, S; Maggard-Gibbons, M; Kalarchian, M A; Livingston, E; Sanchez, V; Smith, B R; Weidenbacher, H; Maciejewski, Matthew L

    2017-04-01

    In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and bariatric surgery workgroups. This article summarizes the bariatric surgery workgroup (BSWG) findings and recommendations for future research. The BSWG agreed that there is evidence from randomized trials and large observational studies suggesting that bariatric surgery is superior to medical therapy for short- and intermediate-term remission of type 2 diabetes, long-term weight loss, and long-term survival. Priority evidence gaps include long-term comorbidity remission, mental health, substance abuse, and health care costs. Evidence of the role of endoscopic weight loss options is also lacking. The BSWG also noted the limited evidence regarding optimal timing for bariatric surgery referral, barriers to bariatric surgery itself, and management of high-risk bariatric surgery patients. Clinical trials of pre- and post-surgery interventions may help to optimize patient outcomes. A registry of overweight and obese veterans and a workforce assessment to determine the VHA's capacity to increase bariatric surgery access were recommended. These will help inform policy modifications and focus the research agenda to improve the ability of the VHA to deliver population-based weight management.

  15. Lead: Occupational health hazards. (Latest citations from the NTIS bibliographic database). Published Search

    SciTech Connect

    1996-03-01

    The bibliography contains citations concerning the health hazards of working with lead-containing material and processes. Health hazards from lead exposure in industrial settings such as resource recovery plants, iron foundries, lead ore processing plants, mines, scrap metal processing plants and yards, tanning facilities, and printing facilities are evaluated. Clinical studies of worker exposure to lead are presented. Occupational Safety and Health Administration (OSHA) lead standards are discussed with regard to abatement procedures for lead exposure in the workplace. (Contains 50-250 citations and includes a subject term index and title list.) (Copyright NERAC, Inc. 1995)

  16. Human resources for health in Botswana: The results of in-country database and reports analysis

    PubMed Central

    Peersman, Wim; Willcox, Merlin; Mash, Robert; Phaladze, Nthabiseng

    2014-01-01

    Abstract Background Botswana is a large middle-income country in Southern Africa with a population of just over two million. Shortage of human resources for health is blamed for the inability to provide high quality accessible health services. There is however a lack of integrated, comprehensive and readily-accessible data on the health workforce. Aim The aim of this study was to analyse the existing databases on health workforce in Botswana in order to quantify the human resources for health. Method The Department of Policy, Planning, Monitoring and Evaluation at the Ministry of Health, Ministry of Education and Skills Development, the Botswana Health Professions Council, the Nursing and Midwifery Council of Botswana and the in-country World Health Organization office provided raw data on human resources for health in Botswana. Results The densities of doctors and nurses per 10 000 population were four and 42, respectively; three and 26 for rural districts; and nine and 77 for urban districts. The average vacancy rate in 2007 and 2008 was 5% and 13% in primary and hospital care, respectively, but this is projected to increase to 53% and 43%, respectively, in 2016. Only 21% of the doctors registered with the Botswana Health Professions Council were from Botswana, the rest being mainly from other African countries. Botswana trained 77% of its health workforce locally. Conclusion Although the density of health workers is relatively high compared to the region, they are concentrated in urban areas, insufficient to meet the projected requirements and reliant on migrant professionals. PMID:26245420

  17. Classifying injury narratives of large administrative databases for surveillance-A practical approach combining machine learning ensembles and human review.

    PubMed

    Marucci-Wellman, Helen R; Corns, Helen L; Lehto, Mark R

    2017-01-01

    Injury narratives are now available real time and include useful information for injury surveillance and prevention. However, manual classification of the cause or events leading to injury found in large batches of narratives, such as workers compensation claims databases, can be prohibitive. In this study we compare the utility of four machine learning algorithms (Naïve Bayes, Single word and Bi-gram models, Support Vector Machine and Logistic Regression) for classifying narratives into Bureau of Labor Statistics Occupational Injury and Illness event leading to injury classifications for a large workers compensation database. These algorithms are known to do well classifying narrative text and are fairly easy to implement with off-the-shelf software packages such as Python. We propose human-machine learning ensemble approaches which maximize the power and accuracy of the algorithms for machine-assigned codes and allow for strategic filtering of rare, emerging or ambiguous narratives for manual review. We compare human-machine approaches based on filtering on the prediction strength of the classifier vs. agreement between algorithms. Regularized Logistic Regression (LR) was the best performing algorithm alone. Using this algorithm and filtering out the bottom 30% of predictions for manual review resulted in high accuracy (overall sensitivity/positive predictive value of 0.89) of the final machine-human coded dataset. The best pairings of algorithms included Naïve Bayes with Support Vector Machine whereby the triple ensemble NBSW=NBBI-GRAM=SVM had very high performance (0.93 overall sensitivity/positive predictive value and high accuracy (i.e. high sensitivity and positive predictive values)) across both large and small categories leaving 41% of the narratives for manual review. Integrating LR into this ensemble mix improved performance only slightly. For large administrative datasets we propose incorporation of methods based on human-machine pairings such as we

  18. Community health agency administrators' access to public health data for program planning, evaluation, and grant preparation.

    PubMed

    Lane, Sandra D; Cashman, Donna M; Keefe, Robert H; Narine, Lutchmie; Ducre, Bradford; Chesna, Sharon; Hall, Meghan; Oliver, David

    2017-02-01

    The Affordable Care Act mandates that public health data be made available for community agency use. Having access to such data allows community agencies to tailor interventions, evaluations, and funding requests more effectively. This study, jointly undertaken by Syracuse University faculty and students with the New York State Perinatal Association, sought to understand community agencies' access to requests for governmental data, as well as to identify areas for improving data access. Results from this survey of administrators from 43 agencies in New York State found that only one-half of their requests for data were successful. Difficulties in obtaining access to needed data included fiscal and staffing constraints of the state-level agencies that house the data, as well as possible overinterpretation of confidentiality policies. In addition, some of community agency respondents reported that their staff lacked skills in data analysis and would benefit from training in epidemiology and quantitative evaluation.

  19. Undergraduate Full Text Databases: "Bell and Howell Medical Complete" and "InfoTrac Health Reference Center - Academic."

    ERIC Educational Resources Information Center

    Salisbury, Lutishoor; Davidson, Bryan; Bailey, Alberta

    2000-01-01

    Compares/contrasts InfoTrac and ProQuest primarily as full-text resources to supplement retrieval of references contained in the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database. These databases are analyzed by examining their scope in terms of the number and types of serials covered within specific areas using…

  20. [Knowledge and use of the Information System on Public Health Budgets (SIOPS) by municipal health administrators, Pernambuco State, Brazil].

    PubMed

    Silva, Keila Silene de Brito E; Bezerra, Adriana Falangola Benjamin; Sousa, Islândia Maria Carvalho de; Gonçalves, Rogério Fabiano

    2010-02-01

    Considering the importance of Brazil's Information System on Public Health Budgets (SIOPS) as a tool for planning, management, and social control of public expenditures in health, this article aimed to evaluate the relationship between the regularity of data entry into the SIOPS and knowledge and use of the system by municipal health administrators in Pernambuco State, Brazil. Ten municipalities were selected from the State's five meso-regions, five of which entered information into the system and five only on an irregular basis. Semi-structured interviews were performed with the municipal health secretaries. Analysis of the data showed that command of information technology and knowledge of the System do not affect the regularity of data entry, as a function of the distance between the Municipal Health Secretariat administrators and the SIOPS, such that the data are normally entered by outsourced services. Thus, the resulting information has not been fully explored by systems administrators as a management tool.

  1. Health Care Reform and Its Implications for the Administrative Sciences.

    ERIC Educational Resources Information Center

    Kolassa, E. M.

    1994-01-01

    It is argued that the discipline of pharmacoeconomics has much to offer the pharmacy field during a period of health care reform but that these specialists must let their colleagues in related fields know how they can assist in facilitating change. (MSE)

  2. Privacy protection and public goods: building a genetic database for health research in Newfoundland and Labrador

    PubMed Central

    Pullman, Daryl; Perrot-Daley, Astrid; Hodgkinson, Kathy; Street, Catherine; Rahman, Proton

    2013-01-01

    Objective To provide a legal and ethical analysis of some of the implementation challenges faced by the Population Therapeutics Research Group (PTRG) at Memorial University (Canada), in using genealogical information offered by individuals for its genetics research database. Materials and methods This paper describes the unique historical and genetic characteristics of the Newfoundland and Labrador founder population, which gave rise to the opportunity for PTRG to build the Newfoundland Genealogy Database containing digitized records of all pre-confederation (1949) census records of the Newfoundland founder population. In addition to building the database, PTRG has developed the Heritability Analytics Infrastructure, a data management structure that stores genotype, phenotype, and pedigree information in a single database, and custom linkage software (KINNECT) to perform pedigree linkages on the genealogy database. Discussion A newly adopted legal regimen in Newfoundland and Labrador is discussed. It incorporates health privacy legislation with a unique research ethics statute governing the composition and activities of research ethics boards and, for the first time in Canada, elevating the status of national research ethics guidelines into law. The discussion looks at this integration of legal and ethical principles which provides a flexible and seamless framework for balancing the privacy rights and welfare interests of individuals, families, and larger societies in the creation and use of research data infrastructures as public goods. Conclusion The complementary legal and ethical frameworks that now coexist in Newfoundland and Labrador provide the legislative authority, ethical legitimacy, and practical flexibility needed to find a workable balance between privacy interests and public goods. Such an approach may also be instructive for other jurisdictions as they seek to construct and use biobanks and related research platforms for genetic research. PMID

  3. Is There a Role for Community Health Workers in Tobacco Cessation Programs? Perceptions of Administrators and Health Care Professionals

    PubMed Central

    2014-01-01

    Introduction: Studies have shown that with appropriate training, Community Health Workers (CHWs) can be actively involved in health promotion and disease prevention (including tobacco cessation). This study examined the perceptions of administrators and health care professionals regarding the actual and potential role(s) of CHWs in a tobacco cessation program (TCP) within a universal health care system. Methods: This study was part of a larger exploratory, cross-sectional comprehensive assessment of the implementation of the TCP through the primary care public health system in 7 towns in the state of Paraná, Brazil. Questionnaires were administered to 84 administrators at different levels (regional, municipal, and health units) and 80 health care professionals who were directly involved in the TCP. For this study, we assessed the perceptions of administrators and health care professionals on the actual and potential role(s) of CHWs in the TCP. Results: The overall response rate was 56.2%. Although 48.4% of respondents indicated that CHWs already participated in the TCP, there was a wide range in the participants’ responses regarding their involvement (33.3% among regional administrators and 65% among health care professionals). Identification/referral of patients and promotion of the TCP in the community were the most frequent CHWs’ activities reported. Overall, respondents were very receptive about trained CHWs having multiple roles in the TCP, except for delivery of a brief intervention. Conclusion: With appropriate training, health care administrators and health care professionals are very receptive regarding the involvement of CHWs in a TCP delivered through a public health system. PMID:24420327

  4. Fact Sheet: Revisions to the Occupational Safety and Health Administration Hazard Communication Standards (HCS)

    EPA Pesticide Factsheets

    On March 26, 2012, Occupational Safety and Health Administration (OSHA) modified its HCS to conform to the United Nations’ (UN) Globally Harmonized System of Classification and Labeling of Chemicals (GHS), to improve consistency and quality of information.

  5. Burnout in Veterans Health Administration mental health providers in posttraumatic stress clinics.

    PubMed

    Garcia, Hector A; McGeary, Cindy A; McGeary, Donald D; Finley, Erin P; Peterson, Alan L

    2014-02-01

    The purpose of this study was to conduct the first assessment of burnout among Veterans Health Administration (VHA) mental health clinicians providing evidence-based posttraumatic stress disorder (PTSD) care. This study consisted of 138 participants and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.2). Recruitment was directed through VHA PTSD Clinical Teams (PCT) throughout the United States based on a nationwide mailing list of PCT Clinic Directors. Participants completed an electronic survey that assessed demographics, organizational work factors, absenteeism, and burnout (assessed through the Maslach Burnout Inventory-General Survey, MBI-GS). Twelve percent of the sample reported low Professional Efficacy, 50% reported high levels of Exhaustion, and 47% reported high levels of Cynicism as determined by the MBI-GS cut-off scores. Only workplace characteristics were significantly associated with provider scores on all 3 scales. Exhaustion and Cynicism were most impacted by perceptions of organizational politics/bureaucracy, increased clinical workload, and control over how work is done. Organizational factors were also significantly associated with provider absenteeism and intent to leave his or her job. Findings suggest that providers in VHA specialty PTSD-care settings may benefit from programs or supports aimed at preventing and/or ameliorating burnout.

  6. Burnout in Veterans Health Administration Mental Health Providers in Posttraumatic Stress Clinics

    PubMed Central

    Garcia, Hector A.; McGeary, Cindy A.; McGeary, Donald D.; Finley, Erin P.; Peterson, Alan L.

    2015-01-01

    The purpose of this study was to conduct the first assessment of burnout among Veterans Health Administration (VHA) mental health clinicians providing evidence-based posttraumatic stress disorder (PTSD) care. This study consisted of 138 participants and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.2). Recruitment was directed through VHA PTSD Clinical Teams (PCT) throughout the United States based on a nationwide mailing list of PCT Clinic Directors. Participants completed an electronic survey that assessed demographics, organizational work factors, absenteeism, and burnout (assessed through the Maslach Burnout Inventory-General Survey, MBI-GS). Twelve percent of the sample reported low Professional Efficacy, 50% reported high levels of Exhaustion, and 47% reported high levels of Cynicism as determined by the MBI-GS cut-off scores. Only workplace characteristics were significantly associated with provider scores on all 3 scales. Exhaustion and Cynicism were most impacted by perceptions of organizational politics/bureaucracy, increased clinical workload and control over how work is done. Organizational factors were also significantly associated with provider absenteeism and intent to leave his/her job. Findings suggest that providers in VHA specialty PTSD care settings may benefit from programs or supports aimed at preventing and/or ameliorating burnout. PMID:24564443

  7. Circumstance of endoscopic and laparoscopic treatments for gastric cancer in Japan: A review of epidemiological studies using a national administrative database.

    PubMed

    Murata, Atsuhiko; Matsuda, Shinya

    2015-02-16

    Currently, endoscopic submucosal dissection (ESD) and laparoscopic gastrectomy (LG) have become widely accepted and increasingly play important roles in the treatment of gastric cancer. Data from an administrative database associated with the diagnosis procedure combination (DPC) system have revealed some circumstances of ESD and LG in Japan. Some studies demonstrated that medical costs or length of stay of patients receiving ESD for gastric cancer had become significantly reduced while length of hospitalization and costs were significantly increased in older patients. With respect to LG, some recent reports have shown that this has been a cost-beneficial treatment for patients compared with open gastrectomy while simultaneous LG and cholecystectomy is a safe procedure for patients with both gastric cancer and gallbladder stones. These epidemiological studies using the administrative database in the DPC system closely reflect clinical circumstances of endoscopic and surgical treatment for gastric cancer in Japan. However, DPC database does not contain detailed clinical data such as histological types and lesion size of gastric cancer. The link between the DPC database and another detailed clinical database may be vital for future research into endoscopic and laparoscopic treatments for gastric cancer.

  8. National Database for Autism Research (NDAR): Big Data Opportunities for Health Services Research and Health Technology Assessment

    PubMed Central

    Payakachat, Nalin; Tilford, J. Mick; Ungar, Wendy J.

    2015-01-01

    The National Database for Autism Research (NDAR) is a US National Institutes of Health (NIH)-funded research data repository created by integrating heterogeneous datasets through data sharing agreements between autism researchers and the NIH. To date, NDAR is considered the largest neuroscience and genomic data repository for autism research. In addition to biomedical data, NDAR contains a large collection of clinical and behavioral assessments and health outcomes from novel interventions. Importantly, NDAR has a global unique patient identifier that can be linked to aggregated individual-level data for hypothesis generation and testing, and for replicating research findings. As such, NDAR promotes collaboration and maximizes public investment in the original data collection. As screening and diagnostic technologies as well as interventions for children with autism are expensive, health services research (HSR) and health technology assessment (HTA) are needed to generate more evidence to facilitate implementation when warranted. This article describes NDAR and explains its value to health services researchers and decision scientists interested in autism and other mental health conditions. We provide a description of the scope and structure of NDAR and illustrate how data are likely to grow over time and become available for HSR and HTA. PMID:26446859

  9. National Database for Autism Research (NDAR): Big Data Opportunities for Health Services Research and Health Technology Assessment.

    PubMed

    Payakachat, Nalin; Tilford, J Mick; Ungar, Wendy J

    2016-02-01

    The National Database for Autism Research (NDAR) is a US National Institutes of Health (NIH)-funded research data repository created by integrating heterogeneous datasets through data sharing agreements between autism researchers and the NIH. To date, NDAR is considered the largest neuroscience and genomic data repository for autism research. In addition to biomedical data, NDAR contains a large collection of clinical and behavioral assessments and health outcomes from novel interventions. Importantly, NDAR has a global unique patient identifier that can be linked to aggregated individual-level data for hypothesis generation and testing, and for replicating research findings. As such, NDAR promotes collaboration and maximizes public investment in the original data collection. As screening and diagnostic technologies as well as interventions for children with autism are expensive, health services research (HSR) and health technology assessment (HTA) are needed to generate more evidence to facilitate implementation when warranted. This article describes NDAR and explains its value to health services researchers and decision scientists interested in autism and other mental health conditions. We provide a description of the scope and structure of NDAR and illustrate how data are likely to grow over time and become available for HSR and HTA.

  10. The Administration of Education for the Health Professions: A Time for Reappraisal.

    ERIC Educational Resources Information Center

    Hogness, John R.

    Past and current practices as well as anticipated changes in administrative patterns in the health sciences are reviewed in the general context of the changing patterns of administration in higher education. The changes discussed include those in financial support, priorities, controls, and expectations. Several specific questions are addressed:…

  11. Indiana Health Occupations Education: Student Modules for Administration of Medications for Unlicensed Nursing Personnel. Revised Edition.

    ERIC Educational Resources Information Center

    Bilger, Phyllis; And Others

    These learning modules are designed to provide health care workers involved with medications with basic information about the nature and administration of medications. The 30 modules are organized into six units. An overview of preparation and administration of medicines, principles of medication therapy, and medication fundamentals are presented…

  12. The academic elite in health services administration: linkages among top-ranked graduate programs.

    PubMed

    Bair, J H; Barrons, J C

    1997-01-01

    The eleven top-ranked graduate programs in health services administration, based on a national survey of deans, top administrators, and senior faculty, were linked to one another by hiring one another's graduates. It is suggested that this linkage helps these programs maintain and enhance their prestige.

  13. A Privacy-Preserved Analytical Method for eHealth Database with Minimized Information Loss

    PubMed Central

    Chen, Ya-Ling; Cheng, Bo-Chao; Chen, Hsueh-Lin; Lin, Chia-I; Liao, Guo-Tan; Hou, Bo-Yu; Hsu, Shih-Chun

    2012-01-01

    Digitizing medical information is an emerging trend that employs information and communication technology (ICT) to manage health records, diagnostic reports, and other medical data more effectively, in order to improve the overall quality of medical services. However, medical information is highly confidential and involves private information, even legitimate access to data raises privacy concerns. Medical records provide health information on an as-needed basis for diagnosis and treatment, and the information is also important for medical research and other health management applications. Traditional privacy risk management systems have focused on reducing reidentification risk, and they do not consider information loss. In addition, such systems cannot identify and isolate data that carries high risk of privacy violations. This paper proposes the Hiatus Tailor (HT) system, which ensures low re-identification risk for medical records, while providing more authenticated information to database users and identifying high-risk data in the database for better system management. The experimental results demonstrate that the HT system achieves much lower information loss than traditional risk management methods, with the same risk of re-identification. PMID:22969273

  14. Physical and Mental Health and Access to Care among Nonmetropolitan Veterans Health Administration Patients Younger than 65 Years

    ERIC Educational Resources Information Center

    West, Alan; Weeks, William B.

    2006-01-01

    Context: The 4.5 million military veterans treated by the Veterans Health Administration (VA) are believed to experience poorer physical and mental health than nonveterans. Furthermore, nonmetropolitan residents have less access to medical services, whether or not they are veterans in VA care. A direct comparison of metropolitan and…

  15. Comprehensive Index for Community Health Assessment of Typical District Administrative Units in Maharashtra State, India

    PubMed Central

    Doke, Prakash Prabhakarrao

    2016-01-01

    Background: Health administrators require status of health of different administrative units under them. Use of large number of indicators may create confusion and uncertainty about health status. Availability of a comprehensive index is certainly useful. Objective: To evolve one comprehensive health index for a district as unit and measure district wise disparity. Materials and Methods: Ten indicators from categories of health outcomes, health system, determinants of health, and utilization of services were considered. Data for districts in Maharashtra State were obtained from different sources.For each indicator the best performing district was given score of 100 and other districts were given marks proportionately. Results: The comprehensive index for the state was 0.52. The district scoring lowest value of 0.36 was a tribal district and scoring highest value of 0.66 was a nontribal district. Conclusion: Computing such index of districts for monitoring and allocation of resources may be useful managerial tool. PMID:27890979

  16. Standardization of the Food Composition Database Used in the Latin American Nutrition and Health Study (ELANS).

    PubMed

    Kovalskys, Irina; Fisberg, Mauro; Gómez, Georgina; Rigotti, Attilio; Cortés, Lilia Yadira; Yépez, Martha Cecilia; Pareja, Rossina G; Herrera-Cuenca, Marianella; Zimberg, Ioná Z; Tucker, Katherine L; Koletzko, Berthold; Pratt, Michael

    2015-09-16

    Between-country comparisons of estimated dietary intake are particularly prone to error when different food composition tables are used. The objective of this study was to describe our procedures and rationale for the selection and adaptation of available food composition to a single database to enable cross-country nutritional intake comparisons. Latin American Study of Nutrition and Health (ELANS) is a multicenter cross-sectional study of representative samples from eight Latin American countries. A standard study protocol was designed to investigate dietary intake of 9000 participants enrolled. Two 24-h recalls using the Multiple Pass Method were applied among the individuals of all countries. Data from 24-h dietary recalls were entered into the Nutrition Data System for Research (NDS-R) program after a harmonization process between countries to include local foods and appropriately adapt the NDS-R database. A food matching standardized procedure involving nutritional equivalency of local food reported by the study participants with foods available in the NDS-R database was strictly conducted by each country. Standardization of food and nutrient assessments has the potential to minimize systematic and random errors in nutrient intake estimations in the ELANS project. This study is expected to result in a unique dataset for Latin America, enabling cross-country comparisons of energy, macro- and micro-nutrient intake within this region.

  17. Standardization of the Food Composition Database Used in the Latin American Nutrition and Health Study (ELANS)

    PubMed Central

    Kovalskys, Irina; Fisberg, Mauro; Gómez, Georgina; Rigotti, Attilio; Cortés, Lilia Yadira; Yépez, Martha Cecilia; Pareja, Rossina G.; Herrera-Cuenca, Marianella; Zimberg, Ioná Z.; Tucker, Katherine L.; Koletzko, Berthold; Pratt, Michael

    2015-01-01

    Between-country comparisons of estimated dietary intake are particularly prone to error when different food composition tables are used. The objective of this study was to describe our procedures and rationale for the selection and adaptation of available food composition to a single database to enable cross-country nutritional intake comparisons. Latin American Study of Nutrition and Health (ELANS) is a multicenter cross-sectional study of representative samples from eight Latin American countries. A standard study protocol was designed to investigate dietary intake of 9000 participants enrolled. Two 24-h recalls using the Multiple Pass Method were applied among the individuals of all countries. Data from 24-h dietary recalls were entered into the Nutrition Data System for Research (NDS-R) program after a harmonization process between countries to include local foods and appropriately adapt the NDS-R database. A food matching standardized procedure involving nutritional equivalency of local food reported by the study participants with foods available in the NDS-R database was strictly conducted by each country. Standardization of food and nutrient assessments has the potential to minimize systematic and random errors in nutrient intake estimations in the ELANS project. This study is expected to result in a unique dataset for Latin America, enabling cross-country comparisons of energy, macro- and micro-nutrient intake within this region. PMID:26389952

  18. Confounding in observational studies based on large health care databases: problems and potential solutions - a primer for the clinician.

    PubMed

    Nørgaard, Mette; Ehrenstein, Vera; Vandenbroucke, Jan P

    2017-01-01

    Population-based health care databases are a valuable tool for observational studies as they reflect daily medical practice for large and representative populations. A constant challenge in observational designs is, however, to rule out confounding, and the value of these databases for a given study question accordingly depends on completeness and validity of the information on confounding factors. In this article, we describe the types of potential confounding factors typically lacking in large health care databases and suggest strategies for confounding control when data on important confounders are unavailable. Using Danish health care databases as examples, we present the use of proxy measures for important confounders and the use of external adjustment. We also briefly discuss the potential value of active comparators, high-dimensional propensity scores, self-controlled designs, pseudorandomization, and the use of positive or negative controls.

  19. Confounding in observational studies based on large health care databases: problems and potential solutions – a primer for the clinician

    PubMed Central

    Nørgaard, Mette; Ehrenstein, Vera; Vandenbroucke, Jan P

    2017-01-01

    Population-based health care databases are a valuable tool for observational studies as they reflect daily medical practice for large and representative populations. A constant challenge in observational designs is, however, to rule out confounding, and the value of these databases for a given study question accordingly depends on completeness and validity of the information on confounding factors. In this article, we describe the types of potential confounding factors typically lacking in large health care databases and suggest strategies for confounding control when data on important confounders are unavailable. Using Danish health care databases as examples, we present the use of proxy measures for important confounders and the use of external adjustment. We also briefly discuss the potential value of active comparators, high-dimensional propensity scores, self-controlled designs, pseudorandomization, and the use of positive or negative controls.

  20. Processes and Outcomes of the Veterans Health Administration Safe Patient Handling Program: Study Protocol

    PubMed Central

    Toyinbo, Peter; Patel, Nitin; Powell-Cope, Gail; Hahm, Bridget; Elnitsky, Christine; Besterman-Dahan, Karen; Campbell, Robert; Sutton, Bryce

    2013-01-01

    Background Health care workers, such as nurses, nursing aides, orderlies, and attendants, who manually move patients, are consistently listed in the top professions for musculoskeletal injuries (MSIs) by the Bureau of Labor Statistics. These MSIs are typically caused by high-risk patient caregiving activities. In 2008, a safe patient handling (SPH) program was implemented in all 153 Veterans Administration Medical Centers (VAMCs) throughout the United States to reduce patient handling injuries. Objective The goal of the present study is to evaluate the effects associated with the national implementation of a comprehensive SPH program. The primary objectives of the research were to determine the effectiveness of the SPH program in improving direct care nursing outcomes and to provide a context for understanding variations in program results across sites over time. Secondary objectives of the present research were to evaluate the effectiveness of the program in reducing direct and indirect costs associated with patient handling, to explore the potential mediating and moderating mechanisms, and to identify unintended consequences of implementing the program. Methods This 3-year longitudinal study used mixed methods of data collection at 6- to 9-month intervals. The analyses will include data from surveys, administrative databases, individual and focus group interviews, and nonparticipant observations. For this study, a 3-tiered measurement plan was used. For Tier 1, the unit of analysis was the facility, the data source was the facility coordinator or administrative data, and all 153 VAMCs participated. For Tier 2, frontline caregivers and program peer leaders at 17 facilities each completed different surveys. For Tier 3, six facilities completed qualitative site visits, which included individual interviews, focus groups, and nonparticipant observations. Multiple regression models were proposed to test the effects of SPH components on nursing outcomes related to

  1. Final Report on the Development of a Baccalaureate External Degree Program in Health Services Administration With a Major in Long Term Care Administration.

    ERIC Educational Resources Information Center

    Kleppick, Annabelle L.; And Others

    A project undertaken at the Graduate School of Public Health of the University of Pittsburgh to develop an undergraduate external degree program in health services administration with a major in long-term care administration is described. Program activities were designed to: develop a work plan, identify the parameters of knowledge and skills…

  2. Evolution of Medication Administration Workflow in Implementing Electronic Health Record System

    ERIC Educational Resources Information Center

    Huang, Yuan-Han

    2013-01-01

    This study focused on the clinical workflow evolutions when implementing the health information technology (HIT). The study especially emphasized on administrating medication when the electronic health record (EHR) systems were adopted at rural healthcare facilities. Mixed-mode research methods, such as survey, observation, and focus group, were…

  3. Incorporating the e-HIM[R] Virtual Lab into the Health Information Administration Professional Practice Experience

    ERIC Educational Resources Information Center

    Barefield, Amanda C.; Condon, Jim; McCuen, Charlotte; Sayles, Nanette B.

    2010-01-01

    This article will highlight the experiences of two baccalaureate Health Information Administration (HIA) programs in the adoption of the American Health Information Management Association's (AHIMA) e-HIM Virtual Laboratory (Virtual Lab) into the Professional Practice Experience (PPE). Information is provided describing the implementation of the…

  4. Occupational Safety and Health Program Guidelines for Colleges and Universities. An Administrative Resource Manual.

    ERIC Educational Resources Information Center

    Godbey, Frank W.; Hatch, Loren L.

    Designed as an aid for establishing and strengthening occupational safety and health programs on college and university campuses, this administrator guide is divided into four chapters. The first chapter defines and gives background information on the Occupational Safety and Health Act (OSHA). In addition, it presents a discussion of what the OSHA…

  5. Data Analytic Process of a Nationwide Population-Based Study Using National Health Information Database Established by National Health Insurance Service.

    PubMed

    Lee, Yong Ho; Han, Kyungdo; Ko, Seung Hyun; Ko, Kyung Soo; Lee, Ki Up

    2016-02-01

    In 2014, the National Health Insurance Service (NHIS) signed a memorandum of understanding with the Korean Diabetes Association to provide limited open access to its databases for investigating the past and current status of diabetes and its management. NHIS databases include the entire Korean population; therefore, it can be used as a population-based nationwide study for various diseases, including diabetes and its complications. This report presents how we established the analytic system of nation-wide population-based studies using the NHIS database as follows: the selection of database study population and its distribution and operational definition of diabetes and patients of currently ongoing collaboration projects.

  6. 42 CFR 455.436 - Federal database checks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Federal database checks. 455.436 Section 455.436....436 Federal database checks. The State Medicaid agency must do all of the following: (a) Confirm the... databases. (b) Check the Social Security Administration's Death Master File, the National Plan and...

  7. 42 CFR 455.436 - Federal database checks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Federal database checks. 455.436 Section 455.436....436 Federal database checks. The State Medicaid agency must do all of the following: (a) Confirm the... databases. (b) Check the Social Security Administration's Death Master File, the National Plan and...

  8. 42 CFR 455.436 - Federal database checks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Federal database checks. 455.436 Section 455.436....436 Federal database checks. The State Medicaid agency must do all of the following: (a) Confirm the... databases. (b) Check the Social Security Administration's Death Master File, the National Plan and...

  9. Use of Fibrates Monotherapy in People with Diabetes and High Cardiovascular Risk in Primary Care: A French Nationwide Cohort Study Based on National Administrative Databases

    PubMed Central

    Roussel, Ronan; Chaignot, Christophe; Weill, Alain; Travert, Florence; Hansel, Boris; Marre, Michel; Ricordeau, Philippe; Alla, François; Allemand, Hubert

    2015-01-01

    Background and Aim According to guidelines, diabetic patients with high cardiovascular risk should receive a statin. Despite this consensus, fibrate monotherapy is commonly used in this population. We assessed the frequency and clinical consequences of the use of fibrates for primary prevention in patients with diabetes and high cardiovascular risk. Design Retrospective cohort study based on nationwide data from the medical and administrative databases of French national health insurance systems (07/01/08-12/31/09) with a follow-up of up to 30 months. Methods Lipid-lowering drug-naive diabetic patients initiating fibrate or statin monotherapy were identified. Patients at high cardiovascular risk were then selected: patients with a diagnosis of diabetes and hypertension, and >50 (men) or 60 (women), but with no history of cardiovascular events. The composite endpoint comprised myocardial infarction, stroke, amputation, or death. Results Of the 31,652 patients enrolled, 4,058 (12.8%) received a fibrate. Age- and gender-adjusted annual event rates were 2.42% (fibrates) and 2.21% (statins). The proportionality assumption required for the Cox model was not met for the fibrate/statin variable. A multivariate model including all predictors was therefore calculated by dividing data into two time periods, allowing Hazard Ratios to be calculated before (HR<540) and after 540 days (HR>540) of follow-up. Multivariate analyses showed that fibrates were associated with an increased risk for the endpoint after 540 days: HR<540 = 0.95 (95% CI: 0.78–1.16) and HR>540 = 1.73 (1.28–2.32). Conclusion Fibrate monotherapy is commonly prescribed in diabetic patients with high cardiovascular risk and is associated with poorer outcomes compared to statin therapy. PMID:26398765

  10. Criminal liability research in vaccine administration by public health nurse: a case study of the Nantou vaccine administration case.

    PubMed

    Lin, Jui-Chu; Wang, Triumph

    2008-03-01

    Immunization is recognized as a powerful public health tool in disease control and eradication. Registered nurses (RNs) are the principal health professionals responsible for administering vaccines, not only in terms of childhood immunization but also increasingly in administering travel vaccines and annual influenza vaccinations. The RN often provides leadership in developing and maintaining a high quality program. The legal position of nurses when administering a vaccine conflicts with their role as care providers, and nurses must be aware of their legal position when administering a vaccine that has not been individually prescribed by a doctor. A recent case involving a baby who died after receiving a vaccine administered by a public health nurse without a doctor's prescription resulted in the prosecutor initiating a prosecution against the nurse and chief of Health Bureau for a violation of Article 28 of the Physician's Act and the criminal law. Although the nurse and Bureau Chief were judged not guilty, the first trial court pointed out that the behavior of this nurse still violated Article 28. This reflects the conflict that exists between empirical practice and legal regulations. In order to guarantee that prophylactic inoculation is implemented properly under legitimate and effective conditions (specially in remote districts), in May 23, 2006, Legislative Yuan passed an amendment to Article 4 of the Communicable Disease Control Act, which specified that no public health nurse can be prosecuted for violations of Article 28 of the Physician's Act as a result of vaccine administration. In the future, nurses in clinics located in remote districts may conduct prophylactic inoculation work without fear of the terms of Article 28 and focus on implementing public prophylactic inoculation responsibilities. However, a public health nurse can still be liable for the malpractice in criminal law during the vaccination. Therefore, following procedure is still necessary

  11. 42 CFR 495.364 - Review and assessment of administrative activities and expenses of Medicaid provider health...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... and expenses of Medicaid provider health information technology adoption and operation. 495.364... administrative activities and expenses of Medicaid provider health information technology adoption and operation... its approved HIT planning advance planning document and health information technology...

  12. 42 CFR 495.364 - Review and assessment of administrative activities and expenses of Medicaid provider health...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... and expenses of Medicaid provider health information technology adoption and operation. 495.364... administrative activities and expenses of Medicaid provider health information technology adoption and operation... its approved HIT planning advance planning document and health information technology...

  13. 42 CFR 495.364 - Review and assessment of administrative activities and expenses of Medicaid provider health...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... and expenses of Medicaid provider health information technology adoption and operation. 495.364... administrative activities and expenses of Medicaid provider health information technology adoption and operation... its approved HIT planning advance planning document and health information technology...

  14. 42 CFR 495.364 - Review and assessment of administrative activities and expenses of Medicaid provider health...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... and expenses of Medicaid provider health information technology adoption and operation. 495.364... administrative activities and expenses of Medicaid provider health information technology adoption and operation... its approved HIT planning advance planning document and health information technology...

  15. 42 CFR 495.364 - Review and assessment of administrative activities and expenses of Medicaid provider health...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... and expenses of Medicaid provider health information technology adoption and operation. 495.364... administrative activities and expenses of Medicaid provider health information technology adoption and operation... its approved HIT planning advance planning document and health information technology...

  16. Acute adverse event signalling scheme using the Saskatchewan Administrative health care utilization datafiles: results for two benzodiazepines.

    PubMed

    Rawson, N S; Rawson, M J

    1999-01-01

    Linked administrative health care utilization databases offer potential benefits for postmarketing surveillance. The value of the Saskatchewan datafiles in an acute adverse event signalling scheme has been evaluated using two benzodiazepines. The first 20,000 patients dispensed lorazepam and the first 8525 patients dispensed alprazolam were followed through the datafiles over the year after their initial prescription of the relevant drug, and all medical services occurring during treatment were recorded. The most frequent adverse drug reactions to benzodiazepines are drowsiness, depression, impaired intellectual function and memory, lethargy, impaired coordination, dizziness, nausea and/or vomiting, skin rash, and respiratory disturbance. Data from our study showed that sleep disorders, depressive disorders, dizziness and/or vertigo, respiratory symptoms, esophagus and stomach disorders, and inflammatory skin conditions occurred significantly more often in the first 30 days after the initial prescription than in the succeeding six months in both drug groups, indicating that they are important adverse events. There are several limitations to the methodology; however, the results of the analysis indicate that the use of administrative health care utilization datafiles in a systematic assessment to signal potential acute adverse drug reactions is a feasible proposition, but further studies are required to assess whether events are real adverse reactions.

  17. A plan for a more effective federal and state health administration. 1919.

    PubMed

    Hoffman, Frederick L

    2009-10-01

    This Classic article is a reprint of the original work by Frederick L. Hoffman, LLD, A Plan for a More Effective Federal and State Health Administration. An accompanying biographical sketch on Frederick L. Hoffman, LLD, is available at DOI 10.1007/s11999-009-1001-9. The Classic Article is (c)1919 by the American Public Health Association and is reprinted with permission from Hoffman FL. A plan for a more effective federal and state health administration. Am J Public Health. 1919;9:161-169. The article can also be accessed on the American Journal of Public Health web site at (http://www.ajph.org/cgi/reprint/9/3/161-a).

  18. Assessment of administrative claims data for public health reporting of Salmonella in Tennessee.

    PubMed

    Marder, Ellyn; Garman, Katie; Jones, Timothy F; Dunn, John; Jones, Stephen

    2015-04-01

    In the USA, approximately 4% of the estimated 1 million Salmonella infections occurring annually are reported to public health. Administrative claims data from large health insurance companies capture disease-specific data which could potentially enhance public health surveillance. To determine the utility of medical claims data for public health reporting of Salmonella, we assessed medical claims data from BlueCross BlueShield of Tennessee (BCBST) members compared to Tennessee Department of Health (TDH) surveillance data. BCBST Salmonella cases diagnosed during 2007-2011 were matched to TDH Salmonella cases reported during the same time period. Matches and non-matches were validated using medical records. Of the 450 BCBST cases identified, 72% matched TDH cases. All culture-confirmed BCBST cases were reported to TDH. Non-matched BCBST cases included clinical diagnoses which were culture negative or not tested. Our findings indicate administrative claims data are not currently a viable mechanism for enhancing routine reporting of Salmonella infections.

  19. Complying with Occupational Safety and Health Administration regulations: a guide for compounding pharmacists.

    PubMed

    Mixon, Bill; Nain, John

    2013-01-01

    In the compounding pharmacy, compliance with Occupational Safety and Health Administration regulations is essential to protect employees and customers from exposure to hazardous substances and a dangerous environment, to avert heavy fines and penalties levied for noncompliance, and to fulfill the moral obligation of pharmacists to do no harm. Without adequate vigilance, compounders are vulnerable to lapses in adherence to Occupational Safety and Health Administration requirements, the results of which can be dire in a climate of increased scrutiny about the safety and integrity of pharmaceutical compounding. Proactively addressing necessary compliance with essential safety regulations can only benefit compounders and their staff and clients, and guidance from an expert in Occupational Safety and Health Administration requirements can be a key factor in accomplishing that goal.

  20. Bridging international law and rights-based litigation: mapping health-related rights through the development of the Global Health and Human Rights Database.

    PubMed

    Meier, Benjamin Mason; Cabrera, Oscar A; Ayala, Ana; Gostin, Lawrence O

    2012-06-15

    The O'Neill Institute for National and Global Health Law at Georgetown University, the World Health Organization, and the Lawyers Collective have come together to develop a searchable Global Health and Human Rights Database that maps the intersection of health and human rights in judgments, international and regional instruments, and national constitutions. Where states long remained unaccountable for violations of health-related human rights, litigation has arisen as a central mechanism in an expanding movement to create rights-based accountability. Facilitated by the incorporation of international human rights standards in national law, this judicial enforcement has supported the implementation of rights-based claims, giving meaning to states' longstanding obligations to realize the highest attainable standard of health. Yet despite these advancements, there has been insufficient awareness of the international and domestic legal instruments enshrining health-related rights and little understanding of the scope and content of litigation upholding these rights. As this accountability movement evolves, the Global Health and Human Rights Database seeks to chart this burgeoning landscape of international instruments, national constitutions, and judgments for health-related rights. Employing international legal research to document and catalogue these three interconnected aspects of human rights for the public's health, the Database's categorization by human rights, health topics, and regional scope provides a comprehensive means of understanding health and human rights law. Through these categorizations, the Global Health and Human Rights Database serves as a basis for analogous legal reasoning across states to serve as precedents for future cases, for comparative legal analysis of similar health claims in different country contexts, and for empirical research to clarify the impact of human rights judgments on public health outcomes.

  1. 78 FR 59121 - Basic Health Program: State Administration of Basic Health Programs; Eligibility and Enrollment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ...This proposed rule would establish the Basic Health Program, as required by section 1331 of the Affordable Care Act. The Basic Health Program provides states the flexibility to establish a health benefits coverage program for low-income individuals who would otherwise be eligible to purchase coverage through the state's Affordable Insurance Exchange (Exchange, also called a Health Insurance......

  2. The Institute of Public Administration's Document Center: From Paper to Electronic Records--A Full Image Government Documents Database.

    ERIC Educational Resources Information Center

    Al-Zahrani, Rashed S.

    Since its establishment in 1960, the Institute of Public Administration (IPA) in Riyadh, Saudi Arabia has had responsibility for documenting Saudi administrative literature, the official publications of Saudi Arabia, and the literature of regional and international organizations through establishment of the Document Center in 1961. This paper…

  3. A civic engagement paradigm for reforming health administration education and recreating the community.

    PubMed

    Renick, Oren; Metzler, Leanne; Murray, Jennifer; Renick, Judy

    2005-01-01

    The education of students of health administration has traditionally combined both the theoretical and practical to enhance and balance the learning experience. Classroom exposure to the principles of management, law, organizations, and finance is coupled with problem solving, practicum, internship, and administrative residency experiences. However, just as recent years have seen the developmentof courses from managed care and alternative delivery systems to total quality management and continuous quality improvement, there is also emerging an awareness of the need to enhance the practical side of the learning equation. Perhaps this need is finding expression in curricular opportunities for students to learn from a participatory model known as civic engagement (CE). CE is a way of integrating academic study and community service to strengthen learning while promoting civic and personal responsibility to strengthen communities. Based on experiences with graduate and undergraduate students spanning the last ten years at Texas State University--San Marcos (Texas State), it is suggested that a CE paradigm has been developed within the Department of Health Administration that merits consideration by other programs of health administration. As a model for change, it has the potential for reforming both health administration education and most other higher education disciplines as well.

  4. 78 FR 9701 - Draft Joint Food and Drug Administration/Health Canada Quantitative Assessment of the Risk of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-11

    ... HUMAN SERVICES Food and Drug Administration Draft Joint Food and Drug Administration/Health Canada... and Canada AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA or we) is announcing the availability of a draft ``Joint Food and Drug...

  5. No more "Let them eat admonitions": the Clinton Administration's emerging approach to minority health.

    PubMed

    Mondragón, D

    1993-01-01

    The startling health disparities between whites and racial and ethnic minorities in the United States are partly the result of six major assumptions about health promotion that permeated the Reagan and Bush Administrations. These assumptions, which placed the responsibility for maintaining health on individual Americans, are consistent with policymakers' reliance on market forces to address social issues. While this model may serve persons with a continuum of options and resources to elicit change, it does not benefit the underserved. In contrast, the Clinton Administration's approach, rooted in broad-based participation and multisector planning, is consistent with international models and promises long-overdue recognition that health problems in underserved communities stem from poverty--not the poor.

  6. Exploration of pressure ulcer and related skin problems across the spectrum of health care settings in Ontario using administrative data.

    PubMed

    Woo, Kevin Y; Sears, Kim; Almost, Joan; Wilson, Rosemary; Whitehead, Marlo; VanDenKerkhof, Elizabeth G

    2017-02-01

    This is a prospective cohort study using population-level administrative data to describe the scope of pressure ulcers in terms of its prevalence, incidence risk, associating factors and the extent to which best practices were applied across a spectrum of health care settings. The data for this study includes the information of Ontario residents who were admitted to acute care, home care, long term care or continuing care and whose health care data is contained in the resident assessment instrument-minimum data set (RAI-MDS) and the health outcomes for better information and care (HOBIC) database from 2010 to 2013. The analysis included 203 035 unique patients. The overall prevalence of pressure ulcers was approximately 13% and highest in the complex continuing care setting. Over 25% of pressure ulcers in long-term care developed one week after discharge from acute care hospitalisation. Individuals with cardiovascular disease, dementia, bed mobility problems, bowel incontinence, end-stage diseases, daily pain, weight loss and shortness of breath were more likely to develop pressure ulcers. While there were a number of evidence-based interventions implemented to treat pressure ulcers, only half of the patients received nutritional interventions.

  7. Comparing physical assessment with administrative data for detecting pressure ulcers in a large Canadian academic health sciences centre

    PubMed Central

    Vanderloo, Saskia E; Miller, Toba B; Freeman, Lisa; Forster, Alan J

    2016-01-01

    Objective This study aimed to compare classification of pressure ulcers from administrative data with a gold standard assessment, specifically; pressure ulcers confirmed by an independent physical assessment performed by trained nurse surveyors. Setting A retrospective analysis of pooled cross-sectional samples of inpatients assessed across 3 consecutive prevalence surveys in a large academic health sciences centre between 2012 and 2013. Participants There were 2001 patients for whom physical and chart assessments were completed, and for whom a discharge abstract was also available at the time of analysis. The cohort's mean age was 65 years and 55% were women. Results Based on the physical assessment findings, 14.6% of patients (n=292) had at least 1 pressure ulcer, with a total of 345 pressure ulcers documented among these patients: (stage I=162; stage II=120; stage III=22; stage IV=22 and unstageable=19). Based on coded information, 78 (3.9%) of patients had a pressure ulcer. Of patients with a pressure ulcer determined by the physical assessment, only 21% also had a pressure ulcer captured in the administrative data. Furthermore, only 6% of the patients with a hospital-acquired pressure ulcer, stage II or greater determined by the physical assessment were coded in the Discharge Abstract Database (DAD). Conclusions The results of this study demonstrate that coding in the DAD may under-report and fail to accurately reflect the true burden of pressure ulcers in hospitalised patients. This may occur because the presence of pressure ulcers is currently documented in the health record by nurses and not by physicians, yet the administrative data recorded in the DAD only includes physician documented pressure ulcers. We recommend enhancements to the coding methods to monitor and report on pressure ulcers. PMID:27707831

  8. A profile of women CEOs/administrators in community and migrant health centers.

    PubMed

    Samuels, M E; Shi, L; Cochran, C R; Glover, S; Beattie, C M

    1999-01-01

    Most of the current research on women executives has focused on models in which few women achieve the highest position (e.g. hospital CEOs). This article looks at the nation's Community and Migrant Health Centers where substantial numbers of women hold the highest executive position. A national profile of women Community and Migrant Health Centers (C/MHCs) Chief Executive Officers/Administrators is provided in terms of their personal and work characteristics, as well as their values and beliefs regarding successful C/MHC attributes and important managerial practices. The study compares C/MHC Chief Executive Officers/Administrators based on gender. The study found that 41 percent of the CEO/Administrators were women and that they shared similar values and beliefs about functions/critical managerial factors and managerial characteristics of C/MHCs with their male colleagues. However, the study did find a comparable salary differential of over $11,000 in favor of male Chief Executive Officers/Administrators. The article reviews the literature of female executives in health care and concludes with recommendations for further study using the C/MHCs CEO/Administrators as a model study population.

  9. Integrating databases for research on health and performance in small animals and horses in the Nordic countries.

    PubMed

    Egenvall, Agneta; Nødtvedt, Ane; Roepstorff, Lars; Bonnett, Brenda

    2011-01-01

    In a world of limited resources, using existing databases in research is a potentially cost-effective way to increase knowledge, given that correct and meaningful results are gained.Nordic examples of the use of secondary small animal and equine databases include studies based on data from tumour registries, breeding registries, young horse quality contest results, competition data, insurance databases, clinic data, prescription data and hunting ability tests. In spite of this extensive use of secondary databases, integration between databases is less common. The aim of this presentation is to briefly review key papers that exemplify different ways of utilizing data from multiple sources, to highlight the benefits and limitations of the approaches, to discuss key issues/challenges that must be addressed when integrating data and to suggest future directions. Data from pedigree databases have been individually merged with competition data and young horse quality contest data, and true integration has also been done with canine insurance data and with equine clinical data. Data have also been merged on postal code level; i.e. insurance data were merged to a digitized map of Sweden and additional meteorological information added. In addition to all the data quality and validity issues inherent in the use of a single database, additional obstacles arise when combining information from several databases. Loss of individuals due to incorrect or mismatched identifying information can be considerable. If there are any possible biases affecting whether or not individuals can be properly linked, misinformation may result in a further reduction in power. Issues of confidentiality may be more difficult to address across multiple databases. For example, human identity information must be protected, but may be required to ensure valid merging of data. There is a great potential to better address complex issues of health and disease in companion animals and horses by integrating

  10. 38 CFR 17.506 - Appeal of decision by Veterans Health Administration to deny disclosure.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Appeal of decision by Veterans Health Administration to deny disclosure. 17.506 Section 17.506 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance...

  11. 38 CFR 17.506 - Appeal of decision by Veterans Health Administration to deny disclosure.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Appeal of decision by Veterans Health Administration to deny disclosure. 17.506 Section 17.506 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance...

  12. 38 CFR 17.506 - Appeal of decision by Veterans Health Administration to deny disclosure.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Appeal of decision by Veterans Health Administration to deny disclosure. 17.506 Section 17.506 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance...

  13. 38 CFR 17.506 - Appeal of decision by Veterans Health Administration to deny disclosure.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Appeal of decision by Veterans Health Administration to deny disclosure. 17.506 Section 17.506 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance...

  14. 38 CFR 17.506 - Appeal of decision by Veterans Health Administration to deny disclosure.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Appeal of decision by Veterans Health Administration to deny disclosure. 17.506 Section 17.506 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance...

  15. Integrating hospital administrative data to improve health care efficiency and outcomes: "the socrates story".

    PubMed

    Lawrence, Justin; Delaney, Conor P

    2013-03-01

    Evaluation of health care outcomes has become increasingly important as we strive to improve quality and efficiency while controlling cost. Many groups feel that analysis of large datasets will be useful in optimizing resource utilization; however, the ideal blend of clinical and administrative data points has not been developed. Hospitals and health care systems have several tools to measure cost and resource utilization, but the data are often housed in disparate systems that are not integrated and do not permit multisystem analysis. Systems Outcomes and Clinical Resources AdministraTive Efficiency Software (SOCRATES) is a novel data merging, warehousing, analysis, and reporting technology, which brings together disparate hospital administrative systems generating automated or customizable risk-adjusted reports. Used in combination with standardized enhanced care pathways, SOCRATES offers a mechanism to improve the quality and efficiency of care, with the ability to measure real-time changes in outcomes.

  16. Integrating Hospital Administrative Data to Improve Health Care Efficiency and Outcomes: “The Socrates Story”

    PubMed Central

    Lawrence, Justin; Delaney, Conor P.

    2013-01-01

    Evaluation of health care outcomes has become increasingly important as we strive to improve quality and efficiency while controlling cost. Many groups feel that analysis of large datasets will be useful in optimizing resource utilization; however, the ideal blend of clinical and administrative data points has not been developed. Hospitals and health care systems have several tools to measure cost and resource utilization, but the data are often housed in disparate systems that are not integrated and do not permit multisystem analysis. Systems Outcomes and Clinical Resources AdministraTive Efficiency Software (SOCRATES) is a novel data merging, warehousing, analysis, and reporting technology, which brings together disparate hospital administrative systems generating automated or customizable risk-adjusted reports. Used in combination with standardized enhanced care pathways, SOCRATES offers a mechanism to improve the quality and efficiency of care, with the ability to measure real-time changes in outcomes. PMID:24436649

  17. Optimizing the electronic health record to standardize administration and documentation of nutritional supplements.

    PubMed

    Citty, Sandra W; Kamel, Amir; Garvan, Cynthia; Marlowe, Lee; Westhoff, Lynn

    2017-01-01

    Malnutrition in hospitalized patients is a major cause for hospital re-admission, pressure ulcers and increased hospital costs. Methods to improve the administration and documentation of nutritional supplements for hospitalized patients are needed to improve patient care, outcomes and resource utilization. Staff at a medium-sized academic health science center hospital in the southeastern United States noted that nutritional supplements ordered for patients at high risk for malnutrition were not offered or administered to patients in a standardized manner and/or not documented clearly in the electronic health record as per prescription. This paper reports on a process improvement project that redesigned the ordering, administration and documentation process of oral nutritional supplements in the electronic health record. By adding nutritional products to the medication order sets and adding an electronic nutrition administration record (ENAR) tab, the multidisciplinary team sought to standardize nutritional supplement ordering, documentation and administration at prescribed intervals. This process improvement project used a triangulated approach to evaluating pre- and post-process change including: medical record reviews, patient interviews, and nutrition formula room log reports. Staff education and training was carried out prior to initiation of the system changes. This process change resulted in an average decrease in the return of unused nutritional formula from 76% returned at baseline to 54% post-process change. The process change resulted in 100% of nutritional supplement orders having documentation about nutritional medication administration and/or reason for non-administration. Documentation in the ENAR showed that 41% of ONS orders were given and 59% were not given. Significantly more patients reported being offered the ONS product (p=0.0001) after process redesign and more patients (5% before ENAR and 86% after ENAR reported being offered the correct

  18. Optimizing the electronic health record to standardize administration and documentation of nutritional supplements

    PubMed Central

    Citty, Sandra W.; Kamel, Amir; Garvan, Cynthia; Marlowe, Lee; Westhoff, Lynn

    2017-01-01

    Malnutrition in hospitalized patients is a major cause for hospital re-admission, pressure ulcers and increased hospital costs. Methods to improve the administration and documentation of nutritional supplements for hospitalized patients are needed to improve patient care, outcomes and resource utilization. Staff at a medium-sized academic health science center hospital in the southeastern United States noted that nutritional supplements ordered for patients at high risk for malnutrition were not offered or administered to patients in a standardized manner and/or not documented clearly in the electronic health record as per prescription. This paper reports on a process improvement project that redesigned the ordering, administration and documentation process of oral nutritional supplements in the electronic health record. By adding nutritional products to the medication order sets and adding an electronic nutrition administration record (ENAR) tab, the multidisciplinary team sought to standardize nutritional supplement ordering, documentation and administration at prescribed intervals. This process improvement project used a triangulated approach to evaluating pre- and post-process change including: medical record reviews, patient interviews, and nutrition formula room log reports. Staff education and training was carried out prior to initiation of the system changes. This process change resulted in an average decrease in the return of unused nutritional formula from 76% returned at baseline to 54% post-process change. The process change resulted in 100% of nutritional supplement orders having documentation about nutritional medication administration and/or reason for non-administration. Documentation in the ENAR showed that 41% of ONS orders were given and 59% were not given. Significantly more patients reported being offered the ONS product (p=0.0001) after process redesign and more patients (5% before ENAR and 86% after ENAR reported being offered the correct

  19. Development of an algorithm for identifying rheumatoid arthritis in the Korean National Health Insurance claims database.

    PubMed

    Cho, Soo-Kyung; Sung, Yoon-Kyoung; Choi, Chan-Bum; Kwon, Jeong-Mi; Lee, Eui-Kyung; Bae, Sang-Cheol

    2013-12-01

    This study aimed to develop an identification algorithm for validating the International Classification of Diseases-Tenth diagnostic codes for rheumatoid arthritis (RA) in the Korean National Health Insurance (NHI) claims database. An individual copayment beneficiaries program for rare and intractable diseases, including seropositive RA (M05), began in South Korea in July 2009. Patients registered in this system pay only 10 % of their total medical costs, but registration requires an official report from a doctor documenting that the patient fulfills the 1987 ACR criteria. We regarded patients registered in this system as gold standard RA and examined the validity of several algorithms to define RA diagnosis using diagnostic codes and prescription data. We constructed nine algorithms using two highly specific prescriptions (positive predictive value >90 % and specificity >90 %) and one prescription with high sensitivity (>80 %) and accuracy (>75 %). A total of 59,823 RA patients were included in this validation study. Among them, 50,082 (83.7 %) were registered in the individual copayment beneficiaries program and considered true RA. We tested nine algorithms that incorporated two specific regimens [biologics and leflunomide alone, methotrexate plus leflunomide, or more than 3 disease-modifying anti-rheumatic drugs (DMARDs)] and one sensitive drug (any non-steroidal anti-inflammatory drug (NSAID), any DMARD, or any NSAID plus any DMARD). The algorithm that included biologics, more than 3 DMARDs, and any DMARD yielded the highest accuracy (91.4 %). Patients with RA diagnostic codes with prescription of biologics or any DMARD can be considered as accurate cases of RA in Korean NHI claims database.

  20. Serotonin-Norepinephrine Reuptake Inhibitors and the Risk of AKI: A Cohort Study of Eight Administrative Databases and Meta-Analysis

    PubMed Central

    Renoux, Christel; Lix, Lisa M.; Patenaude, Valérie; Bresee, Lauren C.; Paterson, J. Michael; Lafrance, Jean-Philippe; Tamim, Hala; Mahmud, Salaheddin M.; Alsabbagh, Mhd. Wasem; Hemmelgarn, Brenda; Dormuth, Colin R.

    2015-01-01

    Background and objectives A safety signal regarding cases of AKI after exposure to serotonin-norepinephrine reuptake inhibitors (SNRIs) was identified by Health Canada. Therefore, this study assessed whether the use of SNRIs increases the risk of AKI compared with selective serotonin reuptake inhibitors (SSRIs) and examined the risk associated with each individual SNRI. Design, setting, participants, & measurements Multiple retrospective population-based cohort studies were conducted within eight administrative databases from Canada, the United States, and the United Kingdom between January 1997 and March 2010. Within each cohort, a nested case-control analysis was performed to estimate incidence rate ratios (RRs) of AKI associated with SNRIs compared with SSRIs using conditional logistic regression, with adjustment for high-dimensional propensity scores. The overall effect across sites was estimated using meta-analytic methods. Results There were 38,974 cases of AKI matched to 384,034 controls. Current use of SNRIs was not associated with a higher risk of AKI compared with SSRIs (fixed-effect RR, 0.97; 95% confidence interval [95% CI], 0.94 to 1.01). Current use of venlafaxine and desvenlafaxine considered together was not associated with a higher risk of AKI (RR, 0.96; 95% CI, 0.92 to 1.00). For current use of duloxetine, there was significant heterogeneity among site-specific estimates such that a random-effects meta-analysis was performed showing a 16% higher risk, although this risk was not statistically significant (RR, 1.16; 95% CI, 0.96 to 1.40). This result is compatible with residual confounding, because there was a substantial imbalance in the prevalence of diabetes between users of duloxetine and users of others SNRIs or SSRIs. After further adjustment by including diabetes as a covariate in the model along with propensity scores, the fixed-effect RR was 1.02 (95% CI, 0.95 to 1.10). Conclusions There is no evidence that use of SNRIs is associated with a

  1. The Florida Department of Health and the Florida Association of County Health Department Business Administrators: a model of successful collaboration to sustain operational excellence.

    PubMed

    Napier, Michael J; Street, Phillip; Wright, Robin; Kouba, James Michael; Ciereck, Christina; Dillon, Matthew J; Dollar, Rosemary C; Parizek, William A; Stapp, Charles Philip; Dickinson, Ross

    2004-01-01

    The Florida Association of County Health Department Business Administrators, Inc., is an organization of public health business professionals working collaboratively with the state's department of health administrative offices in promoting best practices throughout local county health departments. This article discusses a number of joint initiatives, past and present, that are benefiting public health services in Florida. In addition, mentoring and training, contract management, cost allocation, and financial reporting, among others, are "hot button" topics of interest to all states in promoting improved administration of their public health programs.

  2. The administrative costs of community-based health insurance: a case study of the community health fund in Tanzania.

    PubMed

    Borghi, Josephine; Makawia, Suzan; Kuwawenaruwa, August

    2015-02-01

    Community-based health insurance expansion has been proposed as a financing solution for the sizable informal sector in low-income settings. However, there is limited evidence of the administrative costs of such schemes. We assessed annual facility and district-level costs of running the Community Health Fund (CHF), a voluntary health insurance scheme for the informal sector in a rural and an urban district from the same region in Tanzania. Information on resource use, CHF membership and revenue was obtained from district managers and health workers from two facilities in each district. The administrative cost per CHF member household and the cost to revenue ratio were estimated. Revenue collection was the most costly activity at facility level (78% of total costs), followed by stewardship and management (13%) and pooling of funds (10%). Stewardship and management was the main activity at district level. The administration cost per CHF member household ranged from USD 3.33 to USD 12.12 per year. The cost to revenue ratio ranged from 50% to 364%. The cost of administering the CHF was high relative to revenue generated. Similar studies from other settings should be encouraged.

  3. The administrative costs of community-based health insurance: a case study of the community health fund in Tanzania

    PubMed Central

    Borghi, Josephine; Makawia, Suzan; Kuwawenaruwa, August

    2015-01-01

    Community-based health insurance expansion has been proposed as a financing solution for the sizable informal sector in low-income settings. However, there is limited evidence of the administrative costs of such schemes. We assessed annual facility and district-level costs of running the Community Health Fund (CHF), a voluntary health insurance scheme for the informal sector in a rural and an urban district from the same region in Tanzania. Information on resource use, CHF membership and revenue was obtained from district managers and health workers from two facilities in each district. The administrative cost per CHF member household and the cost to revenue ratio were estimated. Revenue collection was the most costly activity at facility level (78% of total costs), followed by stewardship and management (13%) and pooling of funds (10%). Stewardship and management was the main activity at district level. The administration cost per CHF member household ranged from USD 3.33 to USD 12.12 per year. The cost to revenue ratio ranged from 50% to 364%. The cost of administering the CHF was high relative to revenue generated. Similar studies from other settings should be encouraged. PMID:24334331

  4. The Clinical Nurse Leader: impact on practice outcomes in the Veterans Health Administration.

    PubMed

    Ott, Karen M; Haddock, K Sue; Fox, Sandra E; Shinn, Julie K; Walters, Sandra E; Hardin, James W; Durand, Kerri; Harris, James L

    2009-01-01

    The Clinical Nurse Leader (CNL) role was designed to meet an identified need for expert clinical leadership at the point of care. The Veterans Health Administration (VHA) became early adopters of the CNL role, foreseeing the value of this pivotal clinical leader at the point of care to meet the complex health care needs of America's veterans and shape health care delivery. Impact data were collected and assimilated from seven Veterans Administration Medical Centers to support how CNLs impact the delivery of quality and safe patient care and how practice changes could be sustained. Data collection and analyses resulted in many lessons learned. The new CNL role was implemented in a variety of settings in the VHA system. Integration of the CNL role in all areas of practice in every care setting has the promise of streamlining coordination of care for veterans across all spectrums in the provision of care.

  5. [Socioeconomic status, toothbrushing frequency, and health-related behaviors in adolescents: an analysis using the PeNSE database].

    PubMed

    Vettore, Mario Vianna; Moysés, Samuel Jorge; Sardinha, Luciana Monteiro Vasconcelos; Iser, Betine Pinto Moehlecke

    2012-01-01

    This study investigated the association between oral and general health-related behaviors and socioeconomic status, and the relationship between health-related behaviors and toothbrushing among adolescents. The database used here was the National School-Based Health Survey (PeNSE), a cross-sectional population-based study in 2009 with students from 27 Brazilian State capitals. Socio-demographic and health-related behavior data were collected. The survey included 49,189 adolescents (47.5% males), the majority of whom were 14 years of age and enrolled in public schools. The associations between toothbrushing frequency and other health-related behaviors and socioeconomic status varied between boys and girls. Associations were observed between health-related habits and toothbrushing frequency in both sexes, but with variations according to socioeconomic status. Planning health promotion interventions for adolescents should take their individual characteristics and family and social context into account.

  6. Innovating team-based outpatient mental health care in the Veterans Health Administration: Staff-perceived benefits and challenges to pilot implementation of the Behavioral Health Interdisciplinary Program (BHIP).

    PubMed

    Barry, Catherine N; Abraham, Kristen M; Weaver, Kendra R; Bowersox, Nicholas W

    2016-05-01

    In the past decade, the demand for Veterans Health Administration (VHA) mental health care has increased rapidly. In response to the increased demand, the VHA developed the Behavioral Health Interdisciplinary Program (BHIP) team model as an innovative approach to transform VHA general outpatient mental health delivery. The present formative evaluation gathered information about pilot implementation of BHIP to understand the struggles and successes that staff experienced during facility transitions to the BHIP model. Using a purposive, nonrandom sampling approach, we conducted 1-on-1, semistructured interviews with 37 licensed and nonlicensed clinical providers and 13 clerical support staff assigned to BHIP teams in 21 facilities across the VHA. Interviews revealed that having actively involved facility mental health leaders, obtaining adequate staffing for teams to meet the requirements of the BHIP model, creating clear descriptions and expectations for team member roles within the BHIP framework, and allocating designated time for BHIP team meetings challenged many VHA sites but are crucial for successful BHIP implementation. Despite the challenges, staff reported that the transition to BHIP improved team work and improved patient care. Staff specifically highlighted the potential for the BHIP model to improve staff working relationships and enhance communication, collaboration, morale, and veteran treatment consistency. Future evaluations of the BHIP implementation process and BHIP team functioning focusing on patient outcomes, organizational outcomes, and staff functioning are recommended for fully understanding effects of transitioning to the BHIP model within VHA general mental health clinics and to identify best practices and areas for improvement. (PsycINFO Database Record

  7. Making influenza vaccination mandatory for health care workers: the views of NSW Health administrators and clinical leaders.

    PubMed

    Leask, Julie; Helms, Charles M; Chow, Maria Y; Robbins, Spring C Cooper; McIntyre, Peter B

    2010-01-01

    The challenges of maintaining high influenza vaccination rates in health care workers have focused worldwide attention on mandatory measures. In 2007, NSW Health issued a policy directive requiring health care workers to be screened/vaccinated for certain infectious diseases. Annual influenza vaccine continued to be recommended but not required. This paper describes the views of NSW Health administrators and clinical leaders about adding influenza vaccination to the requirements. Of 55 staff interviewed, 45 provided a direct response. Of these, 23 supported inclusion, 14 did not and eight were undecided. Analysis of interviews indicated that successfully adding influenza vaccination to the current policy directive would require four major issues to be addressed: (1) providing and communicating a solid evidence base supporting the policy directive; (2) addressing the concerns of staff about the vaccine; (3) ensuring staff understand the need to protect patients; and (4) addressing the logistical challenges of enforcing an annual vaccination.

  8. Use of Veterans Health Administration Mental Health and Substance Use Disorder Treatment After Exiting Prison: The Health Care for Reentry Veterans Program.

    PubMed

    Finlay, Andrea K; Stimmel, Matthew; Blue-Howells, Jessica; Rosenthal, Joel; McGuire, Jim; Binswanger, Ingrid; Smelson, David; Harris, Alex H S; Frayne, Susan M; Bowe, Tom; Timko, Christine

    2017-03-01

    The Veterans Health Administration (VA) Health Care for Reentry Veterans (HCRV) program links veterans exiting prison with treatment. Among veterans served by HCRV, national VA clinical data were used to describe contact with VA health care, and mental health and substance use disorder diagnoses and treatment use. Of veterans seen for an HCRV outreach visit, 56 % had contact with VA health care. Prevalence of mental health disorders was 57 %; of whom 77 % entered mental health treatment within a month of diagnosis. Prevalence of substance use disorders was 49 %; of whom 37 % entered substance use disorder treatment within a month of diagnosis. For veterans exiting prison, increasing access to VA health care, especially for rural veterans, and for substance use disorder treatment, are important quality improvement targets.

  9. Osteoporosis prevention among chronic glucocorticoid users: results from a public health insurance database

    PubMed Central

    Trijau, Sophie; de Lamotte, Gaëlle; Pradel, Vincent; Natali, François; Allaria-Lapierre, Véronique; Coudert, Hervé; Pham, Thao; Sciortino, Vincent; Lafforgue, Pierre

    2016-01-01

    Introduction Long-term glucocorticoid therapy is the leading cause of secondary osteoporosis. The management of glucocorticoid-induced osteoporosis (GIOP) seems to be inadequate in many European countries. Objective To evaluate the rate of screening and treatment of GIOP. Design Information was collected from a national public health-insurance database in our geographic area of Provence-Alpes-Côte-d'Azur and in Corsica, from September 2009 through August 2011. Patients We identified participants aged 15 years and over starting glucocorticoid therapy (≥7.5 mg of prednisone equivalent per day during at least 90 days consecutive). This cohort was compared with an age-matched and sex-matched population that did not receive glucocorticoids. Main outcome measures Bone mass, prescription of bone antiresorptive medication and use of calcium and/or vitamin D treatment. Results We identified 32 812 patients who were prescribed glucocorticoid therapy, yielding 1% prevalence. Incidence of glucocorticoid therapy was 2.8/1000 inhabitants/year. Males represented 44%, the mean age was 58 years. The median prednisone-equivalent dose was 11 mg/day (IQR 9–18 mg/day). 8% underwent bone mass measurement. Calcium and/or vitamin D, and bisphosphonates were prescribed in 18% and 12%, respectively. Results were lower for the control population: 3% underwent bone mass measurement and 3% received bisphosphonate therapy. The rates of osteodensitometry and treatments were higher in women over 55 years of age than in men and women 55 years of age and younger, and also when glucocorticoid therapy was initiated by a rheumatologist versus other physician specialty. Conclusions The management of GIOP remains very inadequate, despite the availability of a statutory health insurance system. Targeted interventions are needed to improve the management of GIOP. PMID:27486526

  10. Executive management studies: the application of real-time science in health administration education.

    PubMed

    Stone, Tamara T; Brown, Gordon D; Mantese, Annamarie

    2005-01-01

    While sound scientific research, such as randomized controlled trials (RCTs), has produced findings leading to significant gains in healthcare, real-time science learning gives administrators and providers a way of responding to immediate need and rapid change while improving performance and the quality of care delivered. Real-time science learning is a cycle of team reflection on and exchange of theory and practical knowledge that produces many benefits for the individual, the organization, and the healthcare field. By questioning principles and analyzing information, teams generate recommendations for organizational improvement as well as develop their individual abilities to address other unforeseen demands in differentcontexts. All of this serves as a foundation for more rigorous scientific research that leads to the advancement of the healthcare field. This article shows how the Department of Health Management and Informatics at the University of Missouri-Columbia adapted real-time science into the Executive Management Study (EMS) requirement of the Master of Health Administration (M.H.A.) and the Master of Science in Health Informatics (M.S.) curriculums. The process is represented by a cycle of Health Administration Education, experienced through a Practical Application, which leads to the creation and dissemination of information and Research Advancing the Field.

  11. Scaling up health knowledge at European level requires sharing integrated data: an approach for collection of database specification.

    PubMed

    Menditto, Enrica; Bolufer De Gea, Angela; Cahir, Caitriona; Marengoni, Alessandra; Riegler, Salvatore; Fico, Giuseppe; Costa, Elisio; Monaco, Alessandro; Pecorelli, Sergio; Pani, Luca; Prados-Torres, Alexandra

    2016-01-01

    Computerized health care databases have been widely described as an excellent opportunity for research. The availability of "big data" has brought about a wave of innovation in projects when conducting health services research. Most of the available secondary data sources are restricted to the geographical scope of a given country and present heterogeneous structure and content. Under the umbrella of the European Innovation Partnership on Active and Healthy Ageing, collaborative work conducted by the partners of the group on "adherence to prescription and medical plans" identified the use of observational and large-population databases to monitor medication-taking behavior in the elderly. This article describes the methodology used to gather the information from available databases among the Adherence Action Group partners with the aim of improving data sharing on a European level. A total of six databases belonging to three different European countries (Spain, Republic of Ireland, and Italy) were included in the analysis. Preliminary results suggest that there are some similarities. However, these results should be applied in different contexts and European countries, supporting the idea that large European studies should be designed in order to get the most of already available databases.

  12. Research and writing in the history of health sciences, 1970-1982: a quantitative analysis of NLM's HISTLINE database.

    PubMed Central

    Kopp, J J

    1985-01-01

    HISTLINE, the MEDLARS file on the history of the health sciences, was analyzed to determine predominant areas of historical research and publication in the years 1970-1982, as reflected in this database produced within the History of Medicine Division at the National Library of Medicine. Subject content, chronologic and geographic breakdowns, and subjects of biographical studies are examined in view of their frequency in the file. Speculation for the predominance of particular descriptors and individuals is presented. An examination is made of the journals publishing the most medical history. Strengths and weaknesses of the database as reflected in this study also are discussed. PMID:3888330

  13. Getting Home Safe and Sound: Occupational Safety and Health Administration at 38

    PubMed Central

    Silverstein, Michael

    2008-01-01

    The Occupational Safety and Health Act of 1970 (OSHAct) declared that every worker is entitled to safe and healthful working conditions, and that employers are responsible for work being free from all recognized hazards. Thirty-eight years after these assurances, however, it is difficult to find anyone who believes the promise of the OSHAct has been met. The persistence of preventable, life-threatening hazards at work is a failure to keep a national promise. I review the history of the Occupational Safety and Health Administration and propose measures to better ensure that those who go to work every day return home safe and sound. These measures fall into 6 areas: leverage and accountability, safety and health systems, employee rights, equal protection, framing, and infrastructure. PMID:18235060

  14. Complying with the Occupational Safety and Health Administration: guidelines for the dental office.

    PubMed

    Boyce, Ricardo; Mull, Justin

    2008-07-01

    This article outlines Occupational Safety and Health Administration (OSHA) guidelines for maintaining a safe dental practice workplace and covers requirements, such as education and protection for dental health care personnel. OSHA regulations aim to reduce exposure to blood-borne pathogens. Environmental infection control in dental offices and operatories is the goal of enforcement of OSHA codes of practice. Universal precautions reduce the risk for infectious disease. OSHA has a mandate to protect workers in the United States from potential workplace injuries. OSHA standards are available through online and print publications and owners of dental practices must meet OSHA standards for the workplace.

  15. U.S. Army-Baylor University Health Care Administration Program: evidenced-based outcomes in the military health system.

    PubMed

    Mangelsdorff, A David; Rogers, Jody; Finstuen, Kenn; Pryor, Rene

    2004-01-01

    The purpose of this research is to assess the impact of an educational program on the Military Health System on some of the evidence-based educational outcomes for the Individual (student) and the Society (all Army Medical Treatment Facilities). The U.S. Army-Baylor University HCA program provides a unique opportunity to assess the impact of an educational program on the Military Health System (MHS). Since the majority of the graduate students are military officers who serve in military medical treatment facilities (MTFs), tracking their career progression allows assessing the value added of the U.S. Army-Baylor University HCA experience from 1951 to 2001 (n = 2234). The context of Society outcomes includes all the Army MTFs where U.S. Army-Baylor University HCA graduates execute their leadership skills. During the time from 1994 to 2001, all of the Army MTFs in the MHS (n = 38) were examined by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). In a similar but shorter time frame (1997-2001), DoD patient satisfaction assessments were conducted. The Individual outcomes (career advancement, increase in status, higher professional association membership) demonstrate that the selection criteria used for program admission appear to be successful. The Society outcomes showed higher JCAHO scores and satisfied consumers in Army facilities with Baylor graduates as the Deputy Commander for Administration (DCA). Continued internal program assessments (curriculum reviews) and external reviews (Accrediting Commission on Education for Health Services Administration accreditations of 5 years in 1987, 8 years in 1993 and 7 years in 2001, and 7 ACHE student chapter awards) attest to the strengths of the U.S. Army-Baylor University HCA program. Educating the MHS shareholders (patients, beneficiaries, professional and support staff, senior leaders) and leveraging technology to. share best practices for all administrators (including non-Baylor graduates) will

  16. Burden of osteoporosis in adults in Korea: a national health insurance database study.

    PubMed

    Choi, Hyung Jin; Shin, Chan Soo; Ha, Yong-Chan; Jang, Sunmee; Jang, Sun-Mee; Jang, Suhyun; Jang, Su-Hyun; Park, Chanmi; Park, Chan Mi; Yoon, Hyun-Koo; Lee, Seong-Su

    2012-01-01

    We evaluated the number of osteoporosis patients under treatment and secular trends in 2005-2008 in South Korea. We investigated nationwide data regarding the number of osteoporosis patients under treatment in South Korea using data from the Health Insurance Review and Assesment Service (HIRA), which includes nationwide information [corrected]. Reimbursement records from the HIRA database between 1 January 2004 and 31 December 2008 were investigated. Patients aged ≥30 years old with osteoporosis were identified based on a study-defined algorithm using prescription data and diagnostic codes. During the study periods, the number of patients receiving medical treatment related to osteoporosis increased from 1,034,399 to 1,392,189 for women and from 120,496 to 171,902 for men. The calculated proportion of osteoporosis patients under treatment in the general population over 50 years of age was 6.1% for men and 33.3% for women, and in the general population over 30 years of age was 2.7% for men and 16.6% for woman. More than 40% of patients (59.1% for women; 41.2% for men) were treated with medication indicated only for osteoporosis. About 4-7% of osteoporosis patients had a past medical history suggesting a secondary cause of osteoporosis. More than 80% of all osteoporosis patients were women older than 50 years, reflecting the pronounced burden of osteoporosis among postmenopausal women. This study demonstrated a substantial increasing trend in medical claims related to osteoporosis in 2005-2008 among adults in Korea and a pronounced burden of osteoporosis among postmenopausal women.

  17. Veterans Health Care: Veterans Health Administration Processes for Responding to Reported Adverse Events

    DTIC Science & Technology

    2012-08-24

    outpatient, residential, and inpatient services.1 These health care services are delivered by physicians, dentists , and other providers and range...that may pose the risk of injury to a patient as the result of a medical intervention or lack of an appropriate intervention, such as a missed or...intervention. Close calls receive the same level of scrutiny as adverse events that result in actual patient injury. Adverse events may or may not

  18. Preventing the Transmission of Tuberculosis in Health Care Settings: Administrative Control

    PubMed Central

    2017-01-01

    It is well established that health care workers (HCWs) have a considerably higher risk of occupationally acquired tuberculosis (TB). To reduce the transmission of TB to HCWs and patients, TB infection control programs should be implemented in health care settings. The first and most important level of all protection and control programs is administrative control. Its goals are to prevent HCWs, other staff, and patients from being exposed to TB, and to reduce the transmission of infection by ensuring rapid diagnosis and treatment of affected individuals. Administrative control measures recommended by the United States Centers for Disease Control and Prevention and the World Health Organization include prompt identification of people with TB symptoms, isolation of infectious patients, control of the spread of the pathogen, and minimization of time spent in health care facilities. Another key component of measures undertaken is the baseline and serial screening for latent TB infection in HCWs who are at risk of exposure to TB. Although the interferon-gamma release assay has some advantages over the tuberculin skin test, the former has serious limitations, mostly due to its high conversion rate. PMID:28119743

  19. Use of Pooled State Administrative Data for Mental Health Services Research.

    PubMed

    Hoagwood, Kimberly Eaton; Essock, Susan; Morrissey, Joseph; Libby, Anne; Donahue, Sheila; Druss, Benjamin; Finnerty, Molly; Frisman, Linda; Narasimhan, Meera; Stein, Bradley D; Wisdom, Jennifer; Zerzan, Judy

    2016-01-01

    State systems are a rich, albeit challenging, laboratory for policy-relevant services research studies. State mental health authorities routinely devote resources to collect data for state planning and reporting purposes. However, these data are rarely used in cross-state comparisons to inform state or federal policy development. In 2008, in response to key recommendations from the National Institute of Mental Health (NIMH) Advisory Council's "The Road Ahead: Research Partnership to Transform Services," (http://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/road-ahead.pdf), NIMH issued a request for applications (RFA) to support studies on the impact of state policy changes on access, cost, quality and outcomes of care for individuals with mental disorders. The purpose of the RFA was to bridge the divide between research and policy by encouraging research that used state administrative data across states, and to address significant state-defined health policy initiatives. Five projects involving eight states were selected through peer review for funding. Projects began in 2009 and were funded for 3 years. This report provides a brief description of the five projects, followed by an analysis of the impact, challenges, and lessons learned from these policy-partnered studies. We conclude by offering suggestions on ways to use state administrative data for informing state health policies, which is especially timely given national and state changes in the structure and financing of healthcare.

  20. Evaluation of a Baccalaureate External Degree Program in Health Services Administration with a Major in Long Term Care Administration.

    ERIC Educational Resources Information Center

    Kleppick, Annabelle L.; And Others

    The development and evaluation of a nontraditional program with a major in Long Term Care Administration is presented. Part 1 presents an evaluation of the impact of the program on students, faculty, the curricula for long term care administration, and in the field of practice. Student characteristics are established and the performance of the…

  1. Workplace Measurements by the US Occupational Safety and Health Administration since 1979: Descriptive Analysis and Potential Uses for Exposure Assessment

    PubMed Central

    2013-01-01

    Background : Inspectors from the US Occupational Safety and Health Administration (OSHA) have been collecting industrial hygiene samples since 1972 to verify compliance with Permissible Exposure Limits. Starting in 1979, these measurements were computerized into the Integrated Management Information System (IMIS). In 2010, a dataset of over 1 million personal sample results analysed at OSHA’s central laboratory in Salt Lake City [Chemical Exposure Health Data (CEHD)], only partially overlapping the IMIS database, was placed into public domain via the internet. We undertook this study to inform potential users about the relationship between this newly available OSHA data and IMIS and to offer insight about the opportunities and challenges associated with the use of OSHA measurement data for occupational exposure assessment. Methods : We conducted a literature review of previous uses of IMIS in occupational health research and performed a descriptive analysis of the data recently made available and compared them to the IMIS database for lead, the most frequently sampled agent. Results : The literature review yielded 29 studies reporting use of IMIS data, but none using the CEHD data. Most studies focused on a single contaminant, with silica and lead being most frequently analysed. Sixteen studies addressed potential bias in IMIS, mostly by examining the association between exposure levels and ancillary information. Although no biases of appreciable magnitude were consistently reported across studies and agents, these assessments may have been obscured by selective under-reporting of non-detectable measurements. The CEHD data comprised 1 450 836 records from 1984 to 2009, not counting analytical blanks and erroneous records. Seventy eight agents with >1000 personal samples yielded 1 037 367 records. Unlike IMIS, which contain administrative information (company size, job description), ancillary information in the CEHD data is mostly analytical. When the IMIS and

  2. [The theme of disaster in health care: profile of technical and scientific production in the specialized database on disasters of the Virtual Health Library - VHL].

    PubMed

    Rocha, Vania; Ximenes, Elisa Francioli; Carvalho, Mauren Lopes de; Alpino, Tais de Moura Ariza; Freitas, Carlos Machado de

    2014-09-01

    In the specialized database of the Virtual Health Library (VHL), the DISASTER database highlights the importance of the theme for the health sector. The scope of this article is to identify the profiles of technical and scientific publications in the specialized database. Based on systematic searches and the analysis of results it is possible to determine: the type of publication; the main topics addressed; the most common type of disasters mentioned in published materials, countries and regions as subjects, historic periods with the most publications and the current trend of publications. When examining the specialized data in detail, it soon becomes clear that the number of major topics is very high, making a specific search process in this database a challenging exercise. On the other hand, it is encouraging that the disaster topic is discussed and assessed in a broad and diversified manner, associated with different aspects of the natural and social sciences. The disaster issue requires the production of interdisciplinary knowledge development to reduce the impacts of disasters and for risk management. In this way, since the health sector is a interdisciplinary area, it can contribute to knowledge production.

  3. Organizational Correlates of Implementation of Colocation of Mental Health and Primary Care in the Veterans Health Administration

    PubMed Central

    Guerrero, Erick G.; Heslin, Kevin C.; Chang, Evelyn; Fenwick, Karissa; Yano, Elizabeth

    2014-01-01

    This study explored the role of organizational factors in the ability of Veterans Health Administration (VHA) clinics to implement colocated mental health care in primary care settings (PC-MH). The study used data from the VHA Clinical Practice Organizational Survey collected in 2007 from 225 clinic administrators across the United States. Clinic degree of implementation of PC-MH was the dependent variable, whereas independent variables included policies and procedures, organizational context, and leaders’ perceptions of barriers to change. Pearson bivariate correlations and multivariable linear regression were used to test hypotheses. Results show that depression care training for primary care providers and clinics’ flexibility and participation were both positively correlated with implementation of PC-MH. However, after accounting for other factors, regressions show that only training primary care providers in depression care was marginally associated with degree of implementation of PC-MH (p = 0.051). Given the importance of this topic for implementing integrated care as part of health care reform, these null findings underscore the need to improve theory and testing of more proximal measures of colocation in future work. PMID:25096986

  4. Medical procedures and outcomes of Japanese patients with trisomy 18 or trisomy 13: analysis of a nationwide administrative database of hospitalized patients.

    PubMed

    Ishitsuka, Kazue; Matsui, Hiroki; Michihata, Nobuaki; Fushimi, Kiyohide; Nakamura, Tomoo; Yasunaga, Hideo

    2015-08-01

    The choices of aggressive treatment for trisomy 18 (T18) and trisomy 13 (T13) remain controversial. Here, we describe the current medical procedures and outcomes of patients with T18 and T13 from a nationwide administrative database of hospitalized patients in Japan. We used the database to identify eligible patients with T18 (n = 438) and T13 (n = 133) who were first admitted to one of 200 hospitals between July 2010 and March 2013. Patients were divided into admission at day <7 (early neonatal) and admission at day ≥7 (late neonatal and post neonatal) groups, and we described the medical intervention and status at discharge for each group. In the day <7 groups, surgical interventions were performed for 56 (19.9%) T18 patients and 22 (34.4%) T13 patients, including pulmonary artery banding, and procedures for esophageal atresia and omphalocele. None received intracardiac surgery. The rate of patients discharged to home was higher in the day ≥7 groups than the day <7 groups (T18: 72.6 vs. 38.8%; T13: 73.9 vs. 21.9%, respectively). Our data show that a substantial number of patients with trisomy received surgery and were then discharged home, but, of these, a considerable number required home medical care. This included home oxygen therapy, home mechanical ventilation, and tube feeding. These findings will be useful to clinicians or families who care for patients with T18 and T13.

  5. Initial experiences with building a health care infrastructure based on Java and object-oriented database technology.

    PubMed Central

    Dionisio, J. D.; Sinha, U.; Dai, B.; Johnson, D. B.; Taira, R. K.

    1999-01-01

    A multi-tiered telemedicine system based on Java and object-oriented database technology has yielded a number of practical insights and experiences on their effectiveness and suitability as implementation bases for a health care infrastructure. The advantages and drawbacks to their use, as seen within the context of the telemedicine system's development, are discussed. Overall, these technologies deliver on their early promise, with a few remaining issues that are due primarily to their relative newness. PMID:10566412

  6. Consolidated Human Activity Database (CHAD) for use in human exposure and health studies and predictive models

    EPA Pesticide Factsheets

    EPA scientists have compiled detailed data on human behavior from 22 separate exposure and time-use studies into CHAD. The database includes more than 54,000 individual study days of detailed human behavior.

  7. Health-selective migration among patients with rheumatoid arthritis in Québec: a cohort study using administrative data.

    PubMed

    Labrecque, Jeremy A; Kyle, Ryan P; Joseph, Lawrence; Bernatsky, Sasha

    2016-09-01

    Little is known about how rheumatoid arthritis (RA) affects an individual's ability to relocate. The current literature suggests the relationship between health and migration is often disease-specific. We sought to estimate the impact of RA diagnosis on migration within a Canadian province, comparing migration rates in residents before and after RA diagnosis. We identified a cohort of 81,181 individuals diagnosed with RA between 1998 and 2009 using Québec administrative databases. A migration was defined as a change in the first three characters of the postal code. We categorized migrations as urban or rural depending upon an individual's origin and destination. We estimated the association between RA diagnosis and migration by fitting marginal models using a generalized estimating equations approach, adjusting for age, sex, and population level socioeconomic status indicators. The vast majority of moves after RA diagnosis were within urban areas. RA diagnosis was associated with increased migration except for people around age 50 moving within urban areas. Although RA was associated with increased inter-urban migration in many demographic groups, the net result did not translate to higher rates of rural-to-urban migration after RA diagnosis. Our results suggest fairly complex associations between RA diagnosis and migration. Both age and location (urban or rural) modify this effect. Overall, we did not see a greater movement from rural-to-urban areas after RA diagnosis. This is of interest for studies of regional environmental effects on chronic disease patterns.

  8. Administrative "health courts" for medical injury claims: the federal constitutional issues.

    PubMed

    Elliott, E Donald; Narayan, Sanjay A; Nasmith, Moneen S

    2008-08-01

    Our article analyzes whether the federal government may constitutionally supplant a traditional system of common-law trials before state judges and juries with new federal institutions designed by statute for compensating victims of medical injuries. Specifically, this article examines the federal constitutional issues raised by various proposals to replace traditional medical malpractice litigation in state courts with a federal system of administrative "health courts." In doing so, we address the following constitutional issues: 1. Is there federal authority to preempt state law (the commerce clause and spending clause issues)? 2. May jurisdiction be created in non-article 3 tribunals, and may claims be decided without trial by jury (the separation of powers and Seventh Amendment issues)? 3. Would pilot programs that require some claims to be pursued in a federal administrative forum while other claimants are left to pursue traditional state tort law remedies be constitutional (the equal protection issue)? The article concludes that a federal compensation system through administrative health courts should be constitutional provided the statute is appropriately drafted and that appropriate factual findings are made concerning the benefits to patients and the public as well as to doctors and their insurers.

  9. [Working conditions, living conditions and physical health problems declared among penitentiary administration personnel in France].

    PubMed

    Goldberg, P; Landre, M F; David, S; Goldberg, M; Dassa, S; Marne, M J

    1996-06-01

    A cross-sectional epidemiological survey was conducted among prison staff in France to investigate the relationships between working conditions and health. The sample included men and women 20 to 64 years old belonging to all categories of prison personnel: prison guards, administrative staff, socioeducational workers, technicians, health care workers, and managers (n = 4587, response rate 45.7%). A mailed self-administered questionnaire was used to assess sociodemographic characteristics, working conditions, and physical and mental disorders. Multiple logistic regression analyses were conducted to determine the effects of working conditions and social relationships on health of prison staff. However, the results reported here only concern 17 health disorders: body mass index, sick leave, medication use, accidents, digestive disorders, lower extremities and back disorders, hypertension, hemorrhoids, arthritis, skin disorders, urinary infections, chronic bronchitis, cholesterol, gastric ulcer, respiratory infections, ocular disorders. The living non professional conditions mostly associated with health disorders were financial difficulties (OR: 1.9 for digestive disorders, 1.8 for gastric ulcer, 1.7 for medication use) and irregularity of meals (OR = 1.5 for digestive disorders, and hypertension). In the occupational environment, the factors most associated with health disorders are seniority (OR = 4.2 for arthritis, 2.3 for cholesterol) and constraints (OR = 1.7 for lower extremities disorders). In spite of some limits associated to this kind of study, relationships between occupational and non occupational factors and physical health conditions were observed; the results also pointed out the protective role of the social relationships for health conditions.

  10. Exploring the link between ambulatory care and avoidable hospitalizations at the Veteran Health Administration.

    PubMed

    Pracht, Etienne E; Bass, Elizabeth

    2011-01-01

    This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable.

  11. Health utilities in people with chronic pain using a population-level survey and linked health care administrative data.

    PubMed

    Hogan, Mary-Ellen; Taddio, Anna; Katz, Joel; Shah, Vibhuti; Krahn, Murray

    2017-03-01

    Health utilities are a preference-based measure of health-related quality of life that facilitates comparison of disease burden across conditions. We estimated utilities using a population-based, matched sample of adolescents and adults with and without chronic pain, controlling for comorbidity. Ontarians aged ≥12 years with and without chronic pain were identified from the Canadian Community Health Survey (CCHS) 2000-2001 and 2009-2010 and linked to their provincial health care administrative data. Individuals with chronic pain were matched to those without using age, sex, survey year, and a propensity score for having chronic pain estimated from a rurality index, income quintile, and comorbidity. The Health Utilities Index Mark 3 instrument, included in the Canadian Community Health Survey, was used. Mean utilities were calculated for each group. Utility decrement for chronic pain was also calculated for each matched pair. A total of 65,246 responses were available for analysis. After matching, there were 12,146 matched pairs with and without pain. In the matched cohort, mean age was 54 years (SD 12); 61% were female. The matched cohort with chronic pain had a mean utility of 0.59 (95% confidence interval 0.58-0.59), and the decrement associated with chronic pain was 0.32 (95% confidence interval 0.31-0.32). Utilities in people with chronic pain were lower than, and decrements larger than, those seen with most other chronic diseases including heart disease, diabetes, and chronic obstructive pulmonary disease. These data will be useful to inform priorities and future strategies for the prevention and control of chronic pain.

  12. The effect of administration family planning policy on maternal and child health.

    PubMed

    Zabin, L S

    1983-09-01

    Several ideologies of the present Administration appear to converge as they impinge upon family planning--themes which are not restricted to reproductive health but which interact in ways particularly threatening to its achievements of the last decade. Most of these ideologies are clear, articulated objectives of the present government such as overall budget reduction and the return of budgetary control to the states. Others are responsive to the influence of the so called "moral mojority." Essentially, the federal government can affect family planning delivery through 4 different routes: through the allocation of funds; through specific legislation; and through regulation or organizational structure (areas in the hands of the executive branch alone). There have been recent and prime examples of all 4 routes, all directed at weakening the federal family planning program which has grown steadily stronger with bipartisan support in the last decades. Major sources of family planning support are reviewed in order to indicate the areas of change or of serious risk to the field. By retaining the categorical funding of Title 10 (half of the federal money in the family planning field has, for some years, come through Title 10 of the Public Health Service Act) in 1981, Congress reasserted the importance it places upon fertility regualtion against Administration pressure to block-grant. Despite an approximately 23% cut, this funding remains the single best hope for the field in these tight money times. In the language of the House Budget Committee report, Congress expressed its intention that an emphasis upon family planning be retained in the Maternal and Child Health block grant. It is no surprise that under the pressure of funding cuts that intention has not been honored. An upsurge in the use of Medicaid funding by family planning providers has increased the proportion of family planning funds from this source. In Title 20 of the Social Security Act (Social Services) it

  13. Social work in the Veterans Health Administration (VA) System: rewards, challenges, roles and interventions.

    PubMed

    Beder, Joan; Postiglione, Paul

    2013-01-01

    For the social worker in the Veterans Health Administration (VA) System, numerous challenges are faced and met while serving the nation's Veterans. As part of the multidisciplinary team, social workers perform a variety of tasks and function in diverse roles. The qualitative survey research reported in this article sought to detail what social workers identified about the impact and rewards of their work and what they saw as the challenges and frustrations. In addition the social workers were asked to clarify their role with the patient and the family. Intervention strategies used in the course of the social workers interaction with the Veterans was also ascertained.

  14. Baldrige-based quality awards: Veterans Health Administration's 3-year experience.

    PubMed

    Shirks, Allan; Weeks, William B; Stein, Annie

    2002-01-01

    This article describes the Veterans Health Administration's (VHA's) 3-year experience with an internal, Baldrige-based quality award. The authors examined scores for Veterans Integrated Service Networks (VISNs), which received site visits, variation in year-to-year survey outcomes for repeat applicants, and variation in survey team reports for a VISN with multiple surveys. Individual VISNs that applied in multiple years had mixed results. Variation in feedback reports was not significant. Although some VISNs increased their scores over time, there was not measurable, systemwide improvement. Three years may be too short a time to significantly affect Baldrige scores in an organization as large as VHA.

  15. Women veterans' preferences for intimate partner violence screening and response procedures within the Veterans Health Administration.

    PubMed

    Iverson, Katherine M; Huang, Kristin; Wells, Stephanie Y; Wright, Jason D; Gerber, Megan R; Wiltsey-Stirman, Shannon

    2014-08-01

    Intimate partner violence (IPV) is a significant health issue faced by women veterans, but little is known about their preferences for IPV-related care. Five focus groups were conducted with 24 women Veterans Health Administration (VHA) patients with and without a lifetime history of IPV to understand their attitudes and preferences regarding IPV screening and responses within VHA. Women veterans wanted disclosure options, follow-up support, transparency in documentation, and VHA and community resources. They supported routine screening for IPV and articulated preferences for procedural aspects of screening. Women suggested that these procedures could be provided most effectively when delivered with sensitivity and connectedness. Findings can inform the development of IPV screening and response programs within VHA and other healthcare settings.

  16. Health care administration in the year 2000: practitioners' views of future issues and job requirements.

    PubMed

    Hudak, R P; Brooke, P P; Finstuen, K; Riley, P

    1993-01-01

    This research identifies the most important domains in health care administration (HCA) from now to the year 2000 and differentiates job skill, knowledge, and ability requirements necessary for successful management. Fellows of the American College of Healthcare Executives from about half of the United States responded to two iterations of a Delphi mail inquiry. Fellows identified 102 issues that were content-analyzed into nine domains by an HCA expert panel. Domains, in order of ranked importance, were cost/finance, leadership, professional staff interactions, health care delivery concepts, accessibility, ethics, quality/risk management, technology, and marketing. In the second Delphi iteration, Fellows reviewed domain results and rated job requirements on required job importance. Results indicated that while a business orientation is needed for organizational survival, an equal emphasis on person-oriented skills, knowledge, and abilities is required.

  17. Self-reported performance improvement strategies of highly successful Veterans Health Administration facilities.

    PubMed

    Craig, Thomas J; Perlin, Jonathan B; Fleming, Barbara B

    2007-01-01

    The Veterans Health Administration (VHA) has achieved considerable success in improving health care through the use of clinical performance measures. This report examines the self-reported strategies used by the most successful facilities in the VHA system. For fiscal year 2002, facilities that scored the highest on any of 24 clinical performance measures were queried as to which strategies they used to achieve their level of performance. The most commonly cited strategies across all performance categories were organizational change (55.6%), clinical reminders (41.4%), audit and feedback to providers (39.6%), and staff education (32.5%). Certain strategies were more likely to be cited for 1 or more specific performance categories (eg, clinical reminders for immunization [61.1%], screening [60.6%]). These findings suggest that successful facilities are generally using evidence-based strategies to achieve high clinical performance. However, some evidence-based implementation strategies were rarely cited (eg, use of clinical champions).

  18. Radon in the Workplace: the Occupational Safety and Health Administration (OSHA) Ionizing Radiation Standard.

    PubMed

    Lewis, Robert K

    2016-10-01

    On 29 December 1970, the Occupational Safety and Health Act of 1970 established the Occupational Safety and Health Administration (OSHA). This article on OSHA, Title 29, Part 1910.1096 Ionizing Radiation standard was written to increase awareness of the employer, the workforce, state and federal governments, and those in the radon industry who perform radon testing and radon mitigation of the existence of these regulations, particularly the radon relevant aspect of the regulations. This review paper was also written to try to explain what can sometimes be complicated regulations. As the author works within the Radon Division of the Pennsylvania Department of Environmental Protection, Bureau of Radiation Protection, the exclusive focus of the article is on radon. The 1910.1096 standard obviously covers many other aspects of radiation and radiation safety in the work place.

  19. Using geographic information system tools to improve access to MS specialty care in Veterans Health Administration.

    PubMed

    Culpepper, William J; Cowper-Ripley, Diane; Litt, Eric R; McDowell, Tzu-Yun; Hoffman, Paul M

    2010-01-01

    Access to appropriate and timely healthcare is critical to the overall health and well-being of patients with chronic diseases. In this study, we used geographic information system (GIS) tools to map Veterans Health Administration (VHA) patients with multiple sclerosis (MS) and their access to MS specialty care. We created six travel-time bands around VHA facilities with MS specialty care and calculated the number of VHA patients with MS who resided in each time band and the number of patients who lived more than 2 hours from the nearest specialty clinic in fiscal year 2007. We demonstrate the utility of using GIS tools in decision-making by providing three examples of how patients' access to care is affected when additional specialty clinics are added. The mapping technique used in this study provides a powerful and valuable tool for policy and planning personnel who are evaluating how to address underserved populations and areas within the VHA healthcare system.

  20. [Preparation of the database and the homepage on chemical accidents relating to health hazard].

    PubMed

    Yamamoto, M; Morita, M; Kaminuma, T

    1998-01-01

    We collected the data on accidents due to chemicals occurred in Japan, and prepared the database. We also set up the World Wide Web homepage containing the explanation on accidents due to chemicals and the retrieval page for the database. We designed the retrieval page so that users can search the data from keywords such as chemicals (e.g. chlorine gas, hydrogen sulfide, pesticides), places (e.g. home, factory, vehicles, tank), causes (e.g. reaction, leakage, exhaust gas) and others (e.g. cleaning, painting, transportation).

  1. The Total Army Injury and Health Outcomes Database (TAIHOD): Uses and Limitations as a Research Tool for Force Health Protection Research

    DTIC Science & Technology

    2004-09-01

    lateral sclerosis , or fibromyalgia associated with Persian Gulf War service? An examination of Department of Defense hospitalization data. Am J...Soldiers (8, 10). The TAIHOD structure and its component databases are described in greater detail later in this report. While initially developed for...DMDC, give specific dates in and out of theater. Many Gulf War health researchers use these files. As we will discuss later in this report, there

  2. Initial Treatment of Men With Newly Diagnosed Lower Urinary Tract Dysfunction in the Veterans Health Administration

    PubMed Central

    Erickson, Bradley A.; Lu, Xin; Vaughan-Sarrazin, Mary; Kreder, Karl J.; Breyer, Benjamin N.; Cram, Peter

    2014-01-01

    OBJECTIVE To examine initial treatments given to men with newly diagnosed lower urinary tract dysfunction (LUTD) within a large integrated health care system in the United States. METHODS We used data from 2003 to 2009 from the Veteran's Health Administration to identify newly diagnosed cases of LUTD using established ICD-9CM codes. Our primary outcome was initial LUTD treatment (3 months), categorized as watchful waiting (WW), medical therapy (MT), or surgical therapy (ST); our secondary outcome was pharmacotherapy class received. We used logistic regression models to examine patient, provider, and health system factors associated with receiving MT or ST when compared with WW. RESULTS There were 393,901 incident cases of LUTD, of which 58.0% initially received WW, 41.8% MT, and 0.2% ST. Of the MT men, 79.8% received an alpha-blocker, 7.7% a 5-alpha reductase inhibitor, 3.3% an anticholinergic, and 7.3% combined therapy (alpha-blocker and 5-alpha reductase inhibitor). In our regression models, we found that age (higher), race (white/black), income (low), region (northeast/south), comorbidities (greater), prostate-specific antigen (lower), and provider (nonurologist) were associated with an increased odds of receiving MT. We found that age (higher), race (white), income (low), region (northeast/south), initial provider (urologist), and prostate-specific antigen (higher) increased the odds of receiving ST. CONCLUSION Most men with newly diagnosed LUTD in the Veteran's Health Administration receive WW, and initial surgical treatment is rare. A large number of men receiving MT were treated with monotherapy, despite evidence that combination therapy is potentially more effective in the long-term, suggesting opportunities for improvement in initial LUTD management within this population. PMID:24286603

  3. Conducting research using the electronic health record across multi-hospital systems: semantic harmonization implications for administrators.

    PubMed

    Bowles, Kathryn H; Potashnik, Sheryl; Ratcliffe, Sarah J; Rosenberg, Melissa; Shih, Nai-Wei; Topaz, Maxim; Holmes, John H; Naylor, Mary D

    2013-06-01

    Administrators play a major role in choosing and managing the use of the electronic health record (EHR). The documentation policies and EHR changes enacted or approved by administrators affect the ability to use clinical data for research. This article illustrates the challenges that can be avoided through awareness of the consequences of customization, variations in documentation policies and quality, and user interface features. Solutions are posed that assist administrators in avoiding these challenges and promoting data harmonization for research and quality improvement.

  4. Veterans Health Administration's MOVE! Weight Management Program: Primary Care Clinicians' Perceptions of Program Implementation.

    PubMed

    Arigo, Danielle; Funderburk, Jennifer; Hooker, Stephanie; Dundon, Margaret; Evans-Hudnall, Gina; Dubbert, Patricia; Dickinson, Eva-Maria; Catanese, Sarah; O'Donohue, Jenny

    2015-10-01

    The Veterans Health Administration's MOVE! Program is the largest health care-delivered weight loss intervention in the United States. As a referring clinician's perceptions and knowledge of health programs may impact implementation, examining perceptions of MOVE! may inform improvements to this and other programs. This study investigated primary care clinician perceptions of MOVE! (n = 754, 50% nurses). Perceived effectiveness ratings were highest for groups with 11 to 25 group members (p < 0.01) and for a combined lecture and support group format (p = 0.026), though session length and several other aspects of delivery were not associated with perceptions of effectiveness. MOVE! staff also rated the program as more effective than did other clinicians (p < 0.01). Many respondents lacked knowledge about program specifics, especially those not involved with MOVE! delivery (vs. those directly involved; p < 0.01). These findings indicate that variety in group size and format is related to perceptions of MOVE! effectiveness. Also, clinicians not involved with MOVE! may lack knowledge about the program and underestimate its effectiveness, which could negatively affect referral likelihood or enthusiasm expressed to referred patients. Findings highlight opportunities for clarifying perceptions of a weight control program among clinicians in a large health care system.

  5. China's laws, rights, and administrative structures in occupational safety and health: a comparison with the United States.

    PubMed

    Sun, Yinling; Xu, Lingzhong; Shao, Hua; Wang, He

    2014-11-01

    China has achieved rapid economic development, but faces tremendous challenges in occupational safety and health (OSH). We describe China's laws, rights, and administrative structures in OSH and in workers' compensation. The article compares these with comparable laws, rights, and administrative structures in the United States. We hope this comparison may provide useful lessons for continued OSH development and improvement in China.

  6. 77 FR 41418 - Statement of Cooperation Between the Food and Drug Administration and the Secretaria of Health of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-13

    ... HUMAN SERVICES Food and Drug Administration Statement of Cooperation Between the Food and Drug Administration and the Secretaria of Health of the United Mexican States: Safety and Sanitary Quality of Fresh and Frozen Molluscan Shellfish Exported From Mexico to the United States AGENCY: Food and...

  7. Implementing International Health Regulation (2005) in the Brazilian legal-administrative system.

    PubMed

    Lima, Yara Oyram Ramos; Costa, Ediná Alves

    2015-06-01

    The scope of this study was to analyze how the International Sanitary Regulation (ISR 2005)has been incorporated into the Brazilian legal-administrative system, in relation to sanitary control measures involving freight, means of transportation and travelers and possible alterations to health surveillance activities, competencies and procedures. This case study has been undertaken using a qualitative approach, of a descriptive and exploratory nature, using institutional data sources and interviews with key-informants involved in implementing ISR (2005). Alterations to the Brazilian legal-administrative system resulting from ISR (2005) were identified, in relation to standards, special competencies and procedures relating to sanitary controls for freight, modes of transportation and travelers. In its present form, the International Sanitary Regulation is an instrument that, in addition to introducing new international and national sanitary control concepts and elements, also helps to clarify questions that are helpful on a national level, relating to the specific competencies and procedures which will, to a certain extent, put pressure on administrative structures in the areas of sanitary control and surveillance.

  8. Building research administration applications for the academic health center: a case study.

    PubMed

    Guard, J Roger; Brueggemann, Ralph F; Highsmith, Robert F; Marine, Stephen A; Riep, Josette R; Schick, Leslie C

    2005-11-01

    The academic health center information environment is saturated with information of varying quality and overwhelming quantity. The most significant challenge is transforming data and information into knowledge. The University of Cincinnati Medical Center's (UCMC) focus is to develop an information architecture comprising data structures, Web services, and user interfaces that enable individuals to manage the information overload so that they can create new knowledge. UCMC has accomplished much of what is reported in this article with the help of a four-year Integrated Advanced Information Management Systems (IAIMS) operation grant awarded by the National Library of Medicine in 2003. In the UCMC vision for knowledge management, individuals have reliable, secure access to information that is filtered, organized, and highly relevant for specific tasks and personal needs. Current applications and tool sets will evolve to become the next generation knowledge management applications or smart digital services. When smart digital services are implemented, silo applications will disappear. A major focus of UCMC's IAIMS grant is research administration. Testing and building out existing and new research administration applications and digital services is underway. The authors review UCMC's progress and results in developing a software architecture, tools, and services for research administration. Included are sections on the evolution to full integration, the impact of the work at UCMC to date, lessons learned during this research and development process, and future plans and needs.

  9. Relationship between tort claims and patient incident reports in the Veterans Health Administration

    PubMed Central

    Schmidek, J; Weeks, W

    2005-01-01

    Objective: The Veterans Health Administration's patient incident reporting system was established to obtain comprehensive data on adverse events that affect patients and to act as a harbinger for risk management. It maintains a dataset of tort claims that are made against Veterans Administration's employees acting within the scope of employment. In an effort to understand the thoroughness of reporting, we examined the relationship between tort claims and patient incident reports (PIRs). Methods: Using social security and record numbers, we matched 8260 tort claims and 32 207 PIRs from fiscal years 1993–2000. Tort claims and PIRs were considered to be related if the recorded dates of incident were within 1 month of each other. Descriptive statistics, odds ratios, and two sample t tests with unequal variances were used to determine the relationship between PIRs and tort claims. Results: 4.15% of claims had a related PIR. Claim payment (either settlement or judgment for plaintiff) was more likely when associated with a PIR (OR 3.62; 95% CI 2.87 to 4.60). Payment was most likely for medication errors (OR 8.37; 95% CI 2.05 to 73.25) and least likely for suicides (OR 0.25; 95% CI 0.11 to 0.55). Conclusions: Although few tort claims had a related PIR, if a PIR was present the tort claim was more likely to result in a payment; moreover, the payment was likely to be higher. Underreporting of patient incidents that developed into tort claims was evident. Our findings suggest that, in the Veterans Health Administration, there is a higher propensity to both report and settle PIRs with bad outcomes. PMID:15805457

  10. Incidence of Hospitalization for Respiratory Syncytial Virus Infection amongst Children in Ontario, Canada: A Population-Based Study Using Validated Health Administrative Data

    PubMed Central

    Pisesky, Andrea; Benchimol, Eric I.; Wong, Coralie A.; Hui, Charles; Crowe, Megan; Belair, Marc-Andre; Pojsupap, Supichaya; Karnauchow, Tim; O'Hearn, Katie; Yasseen, Abdool S.; McNally, James D.

    2016-01-01

    Importance RSV is a common illness among young children that causes significant morbidity and health care costs. Objective Routinely collected health administrative data can be used to track disease incidence, explore risk factors and conduct health services research. Due to potential for misclassification bias, the accuracy of data-elements should be validated prior to use. The objectives of this study were to validate an algorithm to accurately identify pediatric cases of hospitalized respiratory syncytial virus (RSV) from within Ontario’s health administrative data, estimate annual incidence of hospitalization due to RSV and report the prevalence of major risk factors within hospitalized patients. Study Design and Setting A retrospective chart review was performed to establish a reference-standard cohort of children from the Ottawa region admitted to the Children’s Hospital of Eastern Ontario (CHEO) for RSV-related disease in 2010 and 2011. Chart review data was linked to Ontario’s administrative data and used to evaluate the diagnostic accuracy of algorithms of RSV-related ICD-10 codes within provincial hospitalization and emergency department databases. Age- and sex-standardized incidence was calculated over time, with trends in incidence assessed using Poisson regression. Results From a total of 1411 admissions, chart review identified 327 children hospitalized for laboratory confirmed RSV-related disease. Following linkage to administrative data and restriction to first admissions, there were 289 RSV patients in the reference-standard cohort. The best algorithm, based on hospitalization data, resulted in sensitivity 97.9% (95%CI: 95.5–99.2%), specificity 99.6% (95%CI: 98.2–99.8%), PPV 96.9% (95%CI: 94.2–98.6%), NPV 99.4% (95%CI: 99.4–99.9%). Incidence of hospitalized RSV in Ontario from 2005–2012 was 10.2 per 1000 children under 1 year and 4.8 per 1000 children aged 1 to 3 years. During the surveillance period, there was no identifiable

  11. Integration of structural health monitoring solutions onto commercial aircraft via the Federal Aviation Administration structural health monitoring research program

    NASA Astrophysics Data System (ADS)

    Swindell, Paul; Doyle, Jon; Roach, Dennis

    2017-02-01

    The Federal Aviation Administration (FAA) started a research program in structural health monitoring (SHM) in 2011. The program's goal was to understand the technical gaps of implementing SHM on commercial aircraft and the potential effects on FAA regulations and guidance. The program evolved into a demonstration program consisting of a team from Sandia National Labs Airworthiness Assurance NDI Center (AANC), the Boeing Corporation, Delta Air Lines, Structural Monitoring Systems (SMS), Anodyne Electronics Manufacturing Corp (AEM) and the FAA. This paper will discuss the program from the selection of the inspection problem, the SHM system (Comparative Vacuum Monitoring-CVM) that was selected as the inspection solution and the testing completed to provide sufficient data to gain the first approved use of an SHM system for routine maintenance on commercial US aircraft.

  12. Ensuring Appropriate Care for LGBT Veterans in the Veterans Health Administration.

    PubMed

    Sharpe, Virginia Ashby; Uchendu, Uchenna S

    2014-09-01

    Within health care systems, negative perceptions of lesbian, gay, bisexual, and transgender persons have often translated into denial of services, denial of visitation rights to same-sex partners, reluctance on the part of LGBT patients to share personal information, and failure of workers to assess and recognize the unique health care needs of these patients. Other bureaucratic forms of exclusion have included documents, forms, and policies that fail to acknowledge a patient's valued relationships because of, for example, a narrow definition of "spouse," "parent," or "family." Bureaucratic exclusion has taken a particularly prominent form in the U.S. military. Until its repeal and termination in 2011, the "Don't Ask, Don't Tell" policy had for eighteen years barred openly gay men and lesbians from serving in the military. Among the effects of DADT is a dearth of information about the number and needs of LGBT service members who transition to the Veterans Health Administration for health care at the end of their military service. The long-standing social stigma against LGBT persons, the silence mandated by DADT, and the often unrecognized bias built into the fabric of bureaucratic systems make the task of creating a welcoming culture in the VHA urgent and challenging. The VHA has accepted a commitment to that task. Its Strategic Plan for fiscal years 2013 through 2018 stipulates that "[v]eterans will receive timely, high quality, personalized, safe, effective and equitable health care irrespective of geography, gender, race, age, culture or sexual orientation." To achieve this goal, the VHA undertook a number of coordinated initiatives to create an environment and culture that is informed, welcoming, positive, and empowering for the LGBT veterans and families whom the agency serves.

  13. Database system for management of health physics and industrial hygiene records.

    SciTech Connect

    Murdoch, B. T.; Blomquist, J. A.; Cooke, R. H.; Davis, J. T.; Davis, T. M.; Dolecek, E. H.; Halka-Peel, L.; Johnson, D.; Keto, D. N.; Reyes, L. R.; Schlenker, R. A.; Woodring; J. L.

    1999-10-05

    This paper provides an overview of the Worker Protection System (WPS), a client/server, Windows-based database management system for essential radiological protection and industrial hygiene. Seven operational modules handle records for external dosimetry, bioassay/internal dosimetry, sealed sources, routine radiological surveys, lasers, workplace exposure, and respirators. WPS utilizes the latest hardware and software technologies to provide ready electronic access to a consolidated source of worker protection.

  14. Can You Diagnose Me Now? A Proposal to Modify FDA's Regulation of Smartphone Mobile Health Applications with a Pre-Market Notification and Application Database System.

    PubMed

    McInerney, Stephen

    2015-01-01

    Mobile applications provide limitless possibilities for the future of medical care. Yet these changes have also created concerns about patient safety. Under the Federal Food, Drug, and Cosmetic Act (FDCA), the Food and Drug Administration (FDA) has the authority to regulate a much broader spectrum of products beyond traditional medical devices like stethoscopes or pacemakers. The regulatory question is not if FDA has the statutory. authority to regulate health-related software, but rather how it will exercise its regulatory authority. In September 2013, FDA published guidance on Mobile Medical Applications; in it, the Agency limited its oversight to a small subset of medical-related mobile applications, referred to as "mobile medical applications." For the guidance to be effective, FDA must continue to work directly with all actors--including innovators, doctors, and patients--as the market for mobile health applications continues to develop. This Article argues that FDA should adopt a two-step plan--a pre-market notification program and a mobile medical application database--to aid in the successful implementation of its 2013 guidance. By doing so, FDA will ensure that this burgeoning market can reach its fullest potential.

  15. Using Organization Development Concept to Conduct Administrative Assessment of Health Promoting Schools in Taiwan--A Preliminary Study

    ERIC Educational Resources Information Center

    Huang, Jen-Jen; Yeh, Gwo-Liang; Tseng, Chie-Chien; Chen, Wei William; Hwu, Yin-Jinn; Jiang, Donald Dah-Shyong

    2009-01-01

    The Health Promoting School (HPS) programs in Taiwan were initiated and implemented with funding from Department of Health and Ministry of Education during the initial phase. The purpose of this article was to describe the application of organization development (OD) concept in the administrative assessment of HPS programs and to present results…

  16. Regulations implementing the Federal Coal Mine Health and Safety Act of 1969, as amended. Employment Standards Administration, Labor. Final rule.

    PubMed

    2000-12-20

    On January 22, 1997, the Department issued a proposed rule to amend the regulations implementing the Black Lung Benefits Act. 62 FR 3338-3435 (Jan. 22, 1997). When the comment period closed on August 21, 1997, the Department had received written submissions from almost 200 interested persons, including coal miners, coal mine operators, insurers, physicians, and attorneys. The Department also held hearings in Charleston, West Virginia, and Washington, D.C. at which over 50 people testified. The Department carefully reviewed the testimony and the comments and, on October 8, 1999, issued a second notice of proposed rulemaking. 64 FR 54966-55072 (Oct. 8, 1999). In its second notice, the Department proposed changing several of the most important provisions in its initial proposal. The Department also explained its decision not to alter the original proposal with respect to other key regulations based on the comments received to date. Finally, the Department prepared an initial regulatory flexibility analysis. In order to ensure that small businesses that could be affected by the Department's proposal received appropriate notice of the Department's proposed changes, the Department mailed a copy of the second notice of proposed rulemaking to all coal mine operators contained in the databases maintained by the Mine Safety and Health Administration. The Department initially allowed interested parties until December 7, 1999 to file comments to its second proposal, but extended that period until January 6, 2000. The Department received 37 written submissions before the close of the comment period, from groups representing both coal miners and coal mine operators. The Department also received comments from individual miners, various coal mining and insurance companies, as well as from claims processing organizations, attorneys, and various professional organizations. The Department has carefully reviewed all of the comments, and is issuing its final rule. The rule contains a

  17. Evaluating the Veterans Health Administration's Staffing Methodology Model: A Reliable Approach.

    PubMed

    Taylor, Beth; Yankey, Nicholas; Robinson, Claire; Annis, Ann; Haddock, Kathleen S; Alt-White, Anna; Krein, Sarah L; Sales, Anne

    2015-01-01

    All Veterans Health Administration facilities have been mandated to use a standardized method of determining appropriate direct-care staffing by nursing personnel. A multi-step process was designed to lead to projection of full-time equivalent employees required for safe and effective care across all inpatient units. These projections were intended to develop appropriate budgets for each facility. While staffing levels can be increased, even in facilities subject to budget and personnel caps, doing so requires considerable commitment at all levels of the facility. This commitment must come from front-line nursing personnel to senior leadership, not only in nursing and patient care services, but throughout the hospital. Learning to interpret and rely on data requires a considerable shift in thinking for many facilities, which have relied on historical levels to budget for staffing, but which does not take into account the dynamic character of nursing units and patient need.

  18. Relationship of hospital organizational culture to patient safety climate in the Veterans Health Administration.

    PubMed

    Hartmann, Christine W; Meterko, Mark; Rosen, Amy K; Shibei Zhao; Shokeen, Priti; Singer, Sara; Gaba, David M

    2009-06-01

    Improving safety climate could enhance patient safety, yet little evidence exists regarding the relationship between hospital characteristics and safety climate. This study assessed the relationship between hospitals' organizational culture and safety climate in Veterans Health Administration (VA) hospitals nationally. Data were collected from a sample of employees in a stratified random sample of 30 VA hospitals over a 6-month period (response rate = 50%; n = 4,625). The Patient Safety Climate in Healthcare Organizations (PSCHO) and the Zammuto and Krakower surveys were used to measure safety climate and organizational culture, respectively. Higher levels of safety climate were significantly associated with higher levels of group and entrepreneurial cultures, while lower levels of safety climate were associated with higher levels of hierarchical culture. Hospitals could use these results to design specific interventions aimed at improving safety climate.

  19. Improving perceptions of teamwork climate with the Veterans Health Administration medical team training program.

    PubMed

    Carney, Brian T; West, Priscilla; Neily, Julia B; Mills, Peter D; Bagian, James P

    2011-01-01

    There are differences between nurse and physician perceptions of teamwork. The purpose of this study was to determine whether these differences would be reduced with medical team training (MTT). The Safety Attitudes Questionnaire was administered to nurses and physicians working in the operating rooms of 101 consecutive hospitals before and at the completion of an MTT program. Responses to the 6 teamwork climate items on the Safety Attitudes Questionnaire were analyzed using nonparametric testing. At baseline, physicians had more favorable perceptions on teamwork climate items than nurses. Physicians demonstrated improvement on all 6 teamwork climate items. Nurses demonstrated improvement in perceptions on all teamwork climate items except "Nurse input is well received." Physicians still had a more favorable perception than nurses on all 6 teamwork climate items at follow-up. Despite an improvement in perceptions by physicians and nurses, baseline nurse-physician differences persisted at completion of the Veterans Health Administration MTT Program.

  20. 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

    2016-01-01

    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.

  1. Behavioral Health Services Utilization among Older Adults Identified within a State Abuse Hotline Database

    ERIC Educational Resources Information Center

    Schonfeld, Lawrence; Larsen, Rebecca G.; Stiles, Paul G.

    2006-01-01

    Purpose: This study examined the extent to which older adults identified in a statewide abuse hotline registry utilized behavioral health services. This is important as mental health issues have been identified as a high priority for filling gaps in services for victims of mistreatment. Design and Methods: We compared Medicaid and Medicare claims…

  2. Industrial health hazards due to atmospheric factors. (Latest citations from the NTIS bibliographic database). Published Search

    SciTech Connect

    1995-07-01

    The bibliography contains citations concerning atmospheric health hazards in industrial plants, companies, and corporations. Citations present research reports on evaluation and determination of toxic hazards, and on health and safety issues. References include protective equipment, personal hygiene, ventilation systems, and dust and humidity control. (Contains 50-250 citations and includes a subject term index and title list.)

  3. Linking databases on perinatal health: a review of the literature and current practices in Europe

    PubMed Central

    Szamotulska, K.; Hindori-Mohangoo, A.D.; Blondel, B.; Macfarlane, A.J.; Dattani, N.; Barona, C.; Berrut, S.; Zile, I.; Wood, R.; Sakkeus, L.; Gissler, M.; Zeitlin, J.

    2016-01-01

    Background: International comparisons of perinatal health indicators are complicated by the heterogeneity of data sources on pregnancy, maternal and neonatal outcomes. Record linkage can extend the range of data items available and thus can improve the validity and quality of routine data. We sought to assess the extent to which data are linked routinely for perinatal health research and reporting. Methods: We conducted a systematic review of the literature by searching PubMed for perinatal health studies from 2001 to 2011 based on linkage of routine data (data collected continuously at various time intervals). We also surveyed European health monitoring professionals about use of linkage for national perinatal health surveillance. Results: 516 studies fit our inclusion criteria. Denmark, Finland, Norway and Sweden, the US and the UK contributed 76% of the publications; a further 29 countries contributed at least one publication. Most studies linked vital statistics, hospital records, medical birth registries and cohort data. Other sources were specific registers for: cancer (70), congenital anomalies (56), ART (19), census (19), health professionals (37), insurance (22) prescription (31), and level of education (18). Eighteen of 29 countries (62%) reported linking data for routine perinatal health monitoring. Conclusion: Research using linkage is concentrated in a few countries and is not widely practiced in Europe. Broader adoption of data linkage could yield substantial gains for perinatal health research and surveillance. PMID:26891058

  4. National databases and rheumatology research II: the National Health and Nutrition Examination Surveys.

    PubMed

    Sokka, Tuulikki; Krishnan, Eswar

    2004-11-01

    Three National Health and Nutrition Examination Surveys were conducted in the United States between 1971 and 1994 to provide data on the nutritional and health status of the population and on specific target conditions. This article describes features of the surveys and provides examples of research on musculoskeletal disorders that used the survey data.

  5. Government databases and public health research: facilitating access in the public interest.

    PubMed

    Adams, Carolyn; Allen, Judy

    2014-06-01

    Access to datasets of personal health information held by government agencies is essential to support public health research and to promote evidence-based public health policy development. Privacy legislation in Australia allows the use and disclosure of such information for public health research. However, access is not always forthcoming in a timely manner and the decision-making process undertaken by government data custodians is not always transparent. Given the public benefit in research using these health information datasets, this article suggests that it is time to recognise a right of access for approved research and that the decisions, and decision-making processes, of government data custodians should be subject to increased scrutiny. The article concludes that researchers should have an avenue of external review where access to information has been denied or unduly delayed.

  6. The eradication of smallpox: organizational learning and innovation in international health administration.

    PubMed

    Hopkins, J W

    1988-04-01

    The WHO smallpox eradication campaign represents perhaps the best example of a successful international health administration. In the 1st year of the campaign (1967), the guiding strategy was to vaccinate people en masse over a 2-3 year period in countries where smallpox was epidemic thereby conquering the disease. In Western Nigeria where 90% of the population had been vaccinated, a smallpox outbreak occurred in a religious sect resisting vaccinations and a delay in delivery of supplies forced a change in strategy. Campaign staff learned to rapidly isolate infected persons and swiftly vaccinate the uninfected in an outbreak area in order to break the transmission of smallpox, even where 1/2 the population had been vaccinated. Technological advancements also contributed to the campaign's success. For example, the jet injector vaccinated 1000 people/hour with efficient, reliable, mass produced potent, stable freeze dried vaccines (often produced in target countries) or the less costly and virtually maintenance free bifurcated needle was used. The most significant contribution to the success of the campaign, however, was the flexible mode of management adopted by the campaign staff at WHO which provided an appropriate environment for organizational learning and innovation. Although management was open and flexible, the campaign did depend on careful planning and setting of goals, continual assessment, and rapid response to field requests for assistance or advice. Trends in the incidence of smallpox was chosen as the indicator of success as opposed to the number of vaccinations. The campaign demonstrated the need for cultural adaptations as it operated in each country and region. This evaluation of the success of the smallpox campaign presents conclusions that serve as guidelines to the organization and administration of international programs designed to solve other health problems.

  7. Emerging factors shaping the future of the Veterans' Health Administration: a strategic analysis.

    PubMed

    Rivers, P A; Glover, S H; Agho, A

    2002-02-01

    In response to societal and industry-wide forces, the Veterans' Health Administration (VHA) has undertaken a re-engineering process, changing the operational and management structure from individual, independent, and often competing large hospital centres into 22 integrated service networks or VISNs to provide structural incentives for efficiency, quality and improved access as well as transitioning the system to one that is grounded in ambulatory and primary care (Ashton et al., 1998). This paper presents a framework for evaluating the successes and/or failures of the recent re-organization efforts of the VHA in bringing together this multitude of medical care 'parts' or modules into an integrated, cost-effective healthcare delivery system. In total, this paper attempts to delineate an analytical framework by which the threats and opportunities as well as the strengths and weaknesses of the VHA are identified. More specifically, this paper addresses the external pressures driving reform in the VHA system and how the Veterans' Administration can respond to these pressures. Implications for the future of the VHA if its reform efforts are not successful are examined.

  8. Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis.

    PubMed

    Carey, Evan P; Frank, Joseph W; Kerns, Robert D; Ho, P Michael; Kirsh, Susan R

    2016-01-01

    In 2011, the Veterans Health Administration (VHA) implemented a pilot telementoring program across seven healthcare networks called the Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) for pain management. A VHA healthcare network is a group of hospitals and clinics administratively linked in a geographic area. We created a series of county-level maps in one network displaying (1) the location of Veterans with chronic pain, (2) VHA sites (i.e., coordinating center, other medical centers, outpatient clinics), (3) proportion of Veterans being seen in-person at pain specialty clinics, and (4) proportion of Veterans with access to a primary care provider participating in Pain SCAN-ECHO. We calculated the geodesic distance from Veterans' homes to nearest VHA pain specialty care clinics. We used logistic regression to determine the association between distance and Pain SCAN-ECHO primary care provider participation. Mapping showed counties closer to the Pain SCAN-ECHO coordinating center had a higher rate of Veterans whose providers participated in Pain SCAN-ECHO than those further away. Regression models within networks revealed wide heterogeneity in the reach of Pain SCAN-ECHO to Veterans with low spatial access to pain care. Using geographic information systems can reveal the spatial reach of technology-based healthcare programs and inform future expansion.

  9. Receipt of employment services among Veterans Health Administration users with psychiatric diagnoses.

    PubMed

    Abraham, Kristen M; Ganoczy, Dara; Yosef, Matheos; Resnick, Sandra G; Zivin, Kara

    2014-01-01

    This study examined the population-based reach of Veterans Health Administration (VHA) employment services to VHA patients with psychiatric diagnoses. Reach of services includes the percentage and characteristics of people who accessed services compared with those who did not. Using clinical administrative data, we identified patients with a psychiatric diagnosis among a random sample of all patients who received VHA services in 1 yr. Among VHA patients with psychiatric diagnoses, we examined their likelihood of receiving any VHA employment services and specific types of employment services, including supported employment, transitional work, incentive therapy, and vocational assistance. We identified clinical and demographic characteristics associated with receiving employment services. Results indicated that 4.2% of VHA patients with a psychiatric diagnosis received employment services. After adjusting for clinical and demographic characteristics, VHA patients with schizophrenia and bipolar disorder were more likely to receive any employment services and to receive supported employment than were patients with depression, PTSD, or other anxiety disorders. VHA patients with depression and PTSD were more likely to receive transitional work and vocational assistance than patients with schizophrenia. Future studies should examine system-level barriers to receiving employment services and identify types of employment services most appropriate for Veterans with different psychiatric diagnoses.

  10. Health technology management: a database analysis as support of technology managers in hospitals.

    PubMed

    Miniati, Roberto; Dori, Fabrizio; Iadanza, Ernesto; Fregonara, Mario M; Gentili, Guido Biffi

    2011-01-01

    Technology management in healthcare must continually respond and adapt itself to new improvements in medical equipment. Multidisciplinary approaches which consider the interaction of different technologies, their use and user skills, are necessary in order to improve safety and quality. An easy and sustainable methodology is vital to Clinical Engineering (CE) services in healthcare organizations in order to define criteria regarding technology acquisition and replacement. This article underlines the critical aspects of technology management in hospitals by providing appropriate indicators for benchmarking CE services exclusively referring to the maintenance database from the CE department at the Careggi Hospital in Florence, Italy.

  11. Studies of health outcomes in transit operators: policy implications of the current scientific database.

    PubMed

    Ragland, D R; Krause, N; Greiner, B A; Fisher, J M

    1998-04-01

    Urban transit operators' medical symptoms and conditions exceed other occupational groups, resulting partly from working conditions. Medical outcomes among operators have an impact on the transit system, including on performance, work attendance, and medical costs. This is exacerbated by external economic and political pressures in which expected service often exceeds the system's capacity in a congested, chaotic urban environment. A vicious cycle of poor working environment, reduced health and well-being among operators, and lowered efficiency and increased costs often results. Operator-health policies focusing solely on individuals are not sufficient to address these problems. A broader approach is needed, acknowledging the relationship between health of the system and health of employees, including redesigning the interface between transit systems and the urban environment and organizational change within companies. This comprehensive approach recognizes the dynamic reciprocity among the transit operators, the transit system, and the larger community.

  12. Battlefield acupuncture: Opening the door for acupuncture in Department of Defense/Veteran's Administration health care.

    PubMed

    Walker, Patricia Hinton; Pock, Arnyce; Ling, Catherine G; Kwon, Kyung Nancy; Vaughan, Megan

    2016-01-01

    Battlefield acupuncture is a unique auricular acupuncture procedure which is being used in a number of military medical facilities throughout the Department of Defense (DoD). It has been used with anecdotal published positive impact with warriors experiencing polytrauma, post-traumatic stress disorder, and traumatic brain injury. It has also been effectively used to treat warriors with muscle and back pain from carrying heavy combat equipment in austere environments. This article highlights the history within the DoD related to the need for nonpharmacologic/opioid pain management across the continuum of care from combat situations, during evacuation, and throughout recovery and rehabilitation. The article describes the history of auricular acupuncture and details implementation procedures. Training is necessary and partially funded through DoD and Veteran's Administration (VA) internal Joint Incentive Funds grants between the DoD and the VA for multidisciplinary teams as part of a larger initiative related to the recommendations from the DoD Army Surgeon General's Pain Management Task Force. Finally, Uniformed Services University of the Health Sciences School of Medicine and Graduate School of Nursing faculty members present how this interdisciplinary training is currently being integrated into both schools for physicians and advanced practice nurses at the Uniformed Services University of the Health Sciences. Current and future research challenges and progress related to the use of acupuncture are also presented.

  13. Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care

    PubMed Central

    Brown, George R.; Shipherd, PhD, Jillian C.; Kauth, Michael; Piegari, Rebecca I.; Bossarte, Robert M.

    2013-01-01

    Objectives. We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. Methods. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009–2011) of suicide-related events among all VHA users to examine suicide risk. Results. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. Conclusions. The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care. PMID:23947310

  14. The Role of More Sensitive Helminth Diagnostics in Mass Drug Administration Campaigns: Elimination and Health Impacts.

    PubMed

    Medley, G F; Turner, H C; Baggaley, R F; Holland, C; Hollingsworth, T D

    2016-01-01

    Diagnostics play a crucial role in determining treatment protocols and evaluating success of mass drug administration (MDA) programmes used to control soil-transmitted helminths (STHs). The current diagnostic, Kato-Katz, relies on inexpensive, reusable materials and can be used in the field, but only trained microscopists can read slides. This diagnostic always underestimates the true prevalence of infection, and the accuracy worsens as the true prevalence falls. We investigate how more sensitive diagnostics would impact on the management and life cycle of MDA programmes, including number of mass treatment rounds, health impact, number of unnecessary treatments and probability of elimination. We use an individual-based model of STH transmission within the current World Health Organization (WHO) treatment guidelines which records individual disability-adjusted life years (DALY) lost. We focus on Ascaris lumbricoides due to the availability of high-quality data on existing diagnostics. We show that the effect of improving the sensitivity of diagnostics is principally determined by the precontrol prevalence in the community. Communities at low true prevalence (<30%) and high true prevalence (>70%) do not benefit greatly from improved diagnostics. Communities with intermediate prevalence benefit greatly from increased chemotherapy application, both in terms of reduced DALY loss and increased probability of elimination. Our results suggest that programmes should be extended beyond school-age children, especially in high prevalence communities. Finally, we argue against using apparent or measured prevalence as an uncorrected proxy for true prevalence.

  15. The transformation experience of the Veterans Health Administration and its relevance to Canada.

    PubMed

    Fooks, Cathy; Decter, Michael

    2005-01-01

    Over the past few years, there has been a steady stream of visitors to Canada from the US Veterans Health Administration (VA). Led by the former Under Secretary for Health in the Department of Veterans Affairs, Dr. Ken Kizer, they come to tell the remarkable story of how the VA transformed itself from a hospital-based bureaucracy described as "dangerous, dirty and scandal-ridden" to a healthcare system for veterans recognized for its high-quality, patient-centred care. It is a fascinating story of how a publicly funded healthcare service changed its entire approach to patient care with a quality improvement lens at its core. Fifteen years ago, critics of the VA called for its complete privatization as the only solution to fixing its problems. A team of quality champions set out to prove otherwise. Canada has some lessons to learn. The VA is a compelling role model for Canadian reformers, in large measure, due to its public sector character.

  16. The effects of periparturient administration of flunixin meglumine on the health and production of dairy cattle.

    PubMed

    Newby, N C; Leslie, K E; Dingwell, H D Putnam; Kelton, D F; Weary, D M; Neuder, L; Millman, S T; Duffield, T F

    2017-01-01

    Research on the assessment and management of pain in cows following difficult or assisted calving is still limited, especially on the effects of analgesics intended to mitigate this pain. The purpose of this study was to assess the effects of flunixin meglumine on the health and production of Holstein cows after calving. In total, 34 flunixin-treated and 38 placebo-treated animals were enrolled in a precalving treatment trial. A total of 633 animals given flunixin and 632 animals administered a placebo were enrolled in a postcalving treatment trial. In both cases, animals were randomly assigned to treatment, and researchers were blind to treatment condition until after analysis. A total of 1,265 animal records were analyzed for milk production for the first 14d in milk and health outcomes for the first 30d in milk. Animals treated with flunixin meglumine before calving had a significantly increased risk of stillbirth. Animals treated immediately after calving had increased odds of having a retained placenta and, in turn, increased risk of a high temperature, decreased milk production, and an increased risk of developing metritis. The administration of flunixin meglumine within 24h of parturition is not recommended in dairy cattle.

  17. Paths to partnership: Veterans Health Administration's Journey in pilot testing breast cancer care quality measures.

    PubMed

    Hogg, Lori Hoffman

    2014-01-01

    Prioritizing personalized, proactive, patient-driven health care is among the Veterans Health Administration's (VHA's) transformational initiatives. As one of the largest integrated healthcare systems, the VHA sets standards for performance measures and outcomes achieved in quality of care. Evidence-based practice (EBP) is a hallmark in oncology nursing care. EBP can be linked to positive outcomes and improving quality that can be influenced directly by nursing interventions. VHA oncology nurses had the opportunity to partner with the Oncology Nursing Society (ONS), ONS Foundation, and the Joint Commission in the multiyear development of a comprehensive approach to quality cancer care. Building on a platform of existing measures and refining measurement sets culminated in testing evidence-based, nursing-sensitive quality measures for reliability through the ONS Foundation-supported Breast Cancer Care (BCC) Quality Measures Set. The BCC Measures afforded the VHA to have its many sites collectively assess documentation of the symptoms of patients with breast cancer, the use of colony-stimulating factors, and education about neutropenia precautions provided. Parallel paths of the groups, seeking evidence-based measures, led to the perfect partnership in the VHA's journey in pilot testing the BCC Measures in veterans with breast cancer. This generated further quality assessments and continuous improvement projects for spread and sustainability throughout the VHA.

  18. Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration

    PubMed Central

    Sperber, Nina R.; Andrews, Sara M.; Voils, Corrine I.; Green, Gregory L.; Provenzale, Dawn; Knight, Sara

    2016-01-01

    We examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. We conducted semi-structured interviews with 58 clinicians to understand use of the following genomic services for colorectal care: family health history documentation, molecular and genetic testing, and genetic counseling. Data collection and analysis were informed by two conceptual frameworks, the Greenhalgh Diffusion of Innovation and Andersen Behavioral Model, to allow for concurrent examination of both access and innovation factors. Specialists were more likely than primary care clinicians to obtain family history to investigate hereditary colorectal cancer (CRC), but with limited detail; clinicians suggested templates to facilitate retrieval and documentation of family history according to guidelines. Clinicians identified advantage of molecular tumor analysis prior to genetic testing, but tumor testing was infrequently used due to perceived low disease burden. Support from genetic counselors was regarded as facilitative for considering hereditary basis of CRC diagnosis, but there was variability in awareness of and access to this expertise. Our data suggest the need for tools and policies to establish and disseminate well-defined processes for accessing services and adhering to guidelines. PMID:27136589

  19. Estimation of Apple Intake for the Exposure Assessment of Residual Chemicals Using Korea National Health and Nutrition Examination Survey Database

    PubMed Central

    2016-01-01

    The aims of this study were to develop strategies and algorithms of calculating food commodity intake suitable for exposure assessment of residual chemicals by using the food intake database of Korea National Health and Nutrition Examination Survey (KNHANES). In this study, apples and their processed food products were chosen as a model food for accurate calculation of food commodity intakes uthrough the recently developed Korea food commodity intake calculation (KFCIC) software. The average daily intakes of total apples in Korea Health Statistics were 29.60 g in 2008, 32.40 g in 2009, 34.30 g in 2010, 28.10 g in 2011, and 24.60 g in 2012. The average daily intakes of apples by KFCIC software was 2.65 g higher than that by Korea Health Statistics. The food intake data in Korea Health Statistics might have less reflected the intake of apples from mixed and processed foods than KFCIC software has. These results can affect outcome of risk assessment for residual chemicals in foods. Therefore, the accurate estimation of the average daily intake of food commodities is very important, and more data for food intakes and recipes have to be applied to improve the quality of data. Nevertheless, this study can contribute to the predictive estimation of exposure to possible residual chemicals and subsequent analysis for their potential risks. PMID:27152299

  20. Estimation of Apple Intake for the Exposure Assessment of Residual Chemicals Using Korea National Health and Nutrition Examination Survey Database.

    PubMed

    Kim, Bumsik; Baek, Min-Seok; Lee, Yongmin; Paik, Jean Kyung; Chang, Moon-Ik; Rhee, Gyu-Seek; Ko, Sanghoon

    2016-04-01

    The aims of this study were to develop strategies and algorithms of calculating food commodity intake suitable for exposure assessment of residual chemicals by using the food intake database of Korea National Health and Nutrition Examination Survey (KNHANES). In this study, apples and their processed food products were chosen as a model food for accurate calculation of food commodity intakes uthrough the recently developed Korea food commodity intake calculation (KFCIC) software. The average daily intakes of total apples in Korea Health Statistics were 29.60 g in 2008, 32.40 g in 2009, 34.30 g in 2010, 28.10 g in 2011, and 24.60 g in 2012. The average daily intakes of apples by KFCIC software was 2.65 g higher than that by Korea Health Statistics. The food intake data in Korea Health Statistics might have less reflected the intake of apples from mixed and processed foods than KFCIC software has. These results can affect outcome of risk assessment for residual chemicals in foods. Therefore, the accurate estimation of the average daily intake of food commodities is very important, and more data for food intakes and recipes have to be applied to improve the quality of data. Nevertheless, this study can contribute to the predictive estimation of exposure to possible residual chemicals and subsequent analysis for their potential risks.

  1. Effect of physician specialist alternative payment plans on administrative health data in Calgary: a validation study

    PubMed Central

    Cunningham, Ceara Tess; Jetté, Nathalie; Li, Bing; Dhanoa, Ravneet Robyn; Hemmelgarn, Brenda; Noseworthy, Tom; Beck, Cynthia A.; Dixon, Elijah; Samuel, Susan; Ghali, William A.; DeCoster, Carolyn; Quan, Hude

    2015-01-01

    Background: There are concerns that alternate payment plans for physicians may be associated with erosion of data quality, given that physicians are paid regardless of whether claims are submitted. Our objective was to determine the proportion of claims submitted by physician specialists using fee-for-service and alternative payment plans, and to identify and compare the validity of information coded in physician billing claims submitted by these specialists in Calgary. Methods: We conducted a survey of physician specialists to determine their plan status and obtained consent to use physicians' claims data from 4 acute care hospitals in Calgary. Inpatient and emergency department services were identified from the Discharge Abstract Database for Alberta (Canadian Institute for Health Information) and the Alberta Ambulatory Care Classification System database. We linked services to claims by Alberta physicians from 2002 to 2009 by using unique patient and physician identifiers. After identifying the proportion of claims submitted, we reviewed inpatient charts to determine the completeness of submissions as defined by positive predictive value. Results: Of 182 physicians who responded to the survey, 94 (51.6%) used fee-for-service plans exclusively and 51 (28.0%) used alternative payment plans exclusively. Overall completeness of physician submissions for claims was 91.8% for physicians using fee-for-service plans and 90.0% for physicians using alternative payment plans. Submission rate varied by medical specialty (surgery: 92.4% for fee for service v. 88.6% for alternative payment; internal medicine: 94.1% v. 91.3%; neurology: 95.1% v. 91.0%; and pediatrics: 95.1% v. 89.3%). Among claims submitted, the physician accuracies for billing of medical conditions were 87.8% for fee-for-service and 85.0% for alternative payment. Interpretation: Overall submission rates and accuracy in recording diagnoses by physicians who used both plans were high. These findings show that

  2. Geomasking sensitive health data and privacy protection: an evaluation using an E911 database.

    PubMed

    Allshouse, William B; Fitch, Molly K; Hampton, Kristen H; Gesink, Dionne C; Doherty, Irene A; Leone, Peter A; Serre, Marc L; Miller, William C

    2010-10-01

    Geomasking is used to provide privacy protection for individual address information while maintaining spatial resolution for mapping purposes. Donut geomasking and other random perturbation geomasking algorithms rely on the assumption of a homogeneously distributed population to calculate displacement distances, leading to possible under-protection of individuals when this condition is not met. Using household data from 2007, we evaluated the performance of donut geomasking in Orange County, North Carolina. We calculated the estimated k-anonymity for every household based on the assumption of uniform household distribution. We then determined the actual k-anonymity by revealing household locations contained in the county E911 database. Census block groups in mixed-use areas with high population distribution heterogeneity were the most likely to have privacy protection below selected criteria. For heterogeneous populations, we suggest tripling the minimum displacement area in the donut to protect privacy with a less than 1% error rate.

  3. Oral health and oromotor function in rare diseases--a database study.

    PubMed

    Sjögreen, Lotta; Andersson-Norinder, Jan; Bratel, John

    2015-01-01

    The aim was to study oral health and oromotor function in individuals with rare diseases. A disease is defined as rare when it affects no more than 100 individuals per million population and leads to a marked degree of disability. An affected nervous or musculoskeletal system, cognitive impairment, neuropsychiatric disorders and craniofacial malformations are common in rare diseases and may all be risk factors for oral health and oromotor function. In 1996-2008, 1,703 individuals with 169 rare diseases, aged 3-67 years, answered a questionnaire about general health, oral health and orofacial function and 1,614 participated in a clinical examination. A control group of 135 healthy children, aged 3-14 years, was also included in the study. Oral health was examined by a dentist and oromotor function by a speech-language pathologist. The participants with rare diseases were recruited via family programmes, referrals to the clinic and research projects, while the controls were randomly selected from a Swedish municipality. In the diagnosis group, 40% had moderate or severe problems coping with dental treatment, 43% were receiving specialised dental care. Difficulties related to tooth brushing were common compared with the controls. Approximately two thirds of the study group and the control group were caries free. Frontal open bite, long face and high palate were common in individuals with rare diseases compared with controls. Oromotor impairment was a frequent finding (43%) and was absent among the controls. There was a significant correlation between oromotor impairment and certain structural deviations and oral-health issues. Compared with healthy controls, individuals with rare diseases often have difficulty coping with dental treatment and managing tooth brushing. Dysmorphology and oromotor dysfunction are frequent findings in this population and they often require extra prophylactic dental care and access to specialised dental care in order to prevent oral disease.

  4. Asbestos Exposure Assessment Database

    NASA Technical Reports Server (NTRS)

    Arcot, Divya K.

    2010-01-01

    Exposure to particular hazardous materials in a work environment is dangerous to the employees who work directly with or around the materials as well as those who come in contact with them indirectly. In order to maintain a national standard for safe working environments and protect worker health, the Occupational Safety and Health Administration (OSHA) has set forth numerous precautionary regulations. NASA has been proactive in adhering to these regulations by implementing standards which are often stricter than regulation limits and administering frequent health risk assessments. The primary objective of this project is to create the infrastructure for an Asbestos Exposure Assessment Database specific to NASA Johnson Space Center (JSC) which will compile all of the exposure assessment data into a well-organized, navigable format. The data includes Sample Types, Samples Durations, Crafts of those from whom samples were collected, Job Performance Requirements (JPR) numbers, Phased Contrast Microscopy (PCM) and Transmission Electron Microscopy (TEM) results and qualifiers, Personal Protective Equipment (PPE), and names of industrial hygienists who performed the monitoring. This database will allow NASA to provide OSHA with specific information demonstrating that JSC s work procedures are protective enough to minimize the risk of future disease from the exposures. The data has been collected by the NASA contractors Computer Sciences Corporation (CSC) and Wyle Laboratories. The personal exposure samples were collected from devices worn by laborers working at JSC and by building occupants located in asbestos-containing buildings.

  5. Proceedings of the First Annual Meeting of the American College of Mental Health Administration, September 21-23, 1980, Williamsburg, VA.

    ERIC Educational Resources Information Center

    Feldman, Saul; And Others

    1981-01-01

    Presents three keynote speeches focusing on the topics of leadership development in mental health services administration and ethical dilemmas in the administration of mental health services. Suggests that didactic content and specific skill training activities must be provided for administrators at all levels. (HLM)

  6. Conducting Research Using the Electronic Health Record Across Multi-Hospital Systems: Semantic Harmonization Implications for Administrators

    PubMed Central

    Bowles, Kathryn H.; Potashnik, Sheryl; Ratcliffe, Sarah J.; Rosenberg, Melissa; Shih, Nai-Wei; Topaz, Maxim; Holmes, John H.; Naylor, Mary D.

    2013-01-01

    Administrators play a major role in choosing and managing the use of the electronic health record (EHR). The documentation policies and EHR changes enacted or approved by administrators affect the ability to use clinical data for research. This article illustrates the challenges that can be avoided through awareness of the consequences of customization, variations in documentation policies and quality, and user interface features. Solutions are posed that assist administrators in avoiding these challenges and promoting data harmonization for research and quality improvement. PMID:23708504

  7. The Veterans Health Administration: quality, value, accountability, and information as transforming strategies for patient-centered care.

    PubMed

    Perlin, Jonathan B; Kolodner, Robert M; Roswell, Robert H

    2004-11-01

    The Veterans Health Administration is the United States' largest integrated health system. Once disparaged as a bureaucracy providing mediocre care, the Department of Veterans Affairs (VA) reinvented itself during the past decade through a policy shift mandating structural and organizational change, rationalization of resource allocation, explicit measurement and accountability for quality and value, and development of an information infrastructure supporting the needs of patients, clinicians, and administrators. Today, the VA is recognized for leadership in clinical informatics and performance improvement, cares for more patients with proportionally fewer resources, and sets national benchmarks in patient satisfaction and for 18 indicators of quality in disease prevention and treatment.

  8. The Veterans Health Administration: quality, value, accountability, and information as transforming strategies for patient-centered care.

    PubMed

    Perlin, Johnathan B; Kolodner, Robert M; Roswell, Robert H

    2005-01-01

    The Veterans Health Administration is the United States' largest integrated health system. Once disparaged as a bureaucracy providing mediocre care, the Department of Veterans Affairs (VA) reinvented itself during the past decade through a policy shift mandating structural and organizational change, rationalization of resource allocation, explicit measurement and accountability for quality and value, and development of an information infrastructure supporting the needs of patients, clinicians, and administrators. Today, the VA is recognized for leadership in clinical informatics and performance improvement, cares for more patients with proportionally fewer resources, and sets national benchmarks in patient satisfaction and for 18 indicators of quality in disease prevention and treatment.

  9. [The Health Surveillance database of a large hospital enterprise: a 20-year analysis].

    PubMed

    Talini, Donatella; Baldasseronil, Alberto; Cristaudo, Alfonso; Magnani, Aldo

    2014-01-01

    To evaluate the aging of the working population and its effects, a 20 years observational study was conducted on health surveillance data of a large healthcare company. The data showed a gradual increase in the mean age of workers, especially among subjects with restrictions/requirements regarding their job title. If no preventive/corrective measures are taken, the socio-economnic situation will get worse with economic and social damages.

  10. Quality of sickness certification in primary health care: a retrospective database study

    PubMed Central

    2013-01-01

    Background In the period 2004–2009, national and regional initiatives were developed in Sweden to improve the quality of sickness certificates. Parameters for assessing the quality of sickness certificates in primary health care have been proposed. The aim of this study was to measure the quality of sickness certification in primary health care by means of assessing sickness certificates issued between 2004 and 2009 in Stockholm. Methods This was a retrospective study using data retrieved from sickness certificates contained in the electronic patient records of 21 primary health care centres in Stockholm County covering six consecutive years. A total number of 236 441 certificates were used in the current study. Seven quality parameters were chosen as outcome measures. Descriptive statistics and regression models with time, sex and age group as explanatory variables were used. Results During the study period, the quality of the sickness certification practice improved as the number of days on first certification decreased and the proportion of duly completely and acceptable certificates increased. Assessment of need for vocational rehabilitation and giving a prognosis for return to work were not significantly improved during the same period. Time was the most influential variable. Conclusions The quality of sickness certification practice improved for most of the parameters, although additional efforts to improve the quality of sickness certificates are needed. Measures, such as reminders, compulsory certificate fields and structured guidance, could be useful tools to achieve this objective. PMID:23586694

  11. The Impact of Environment and Occupation on the Health and Safety of Active Duty Air Force Members: Database Development and De-Identification.

    PubMed

    Erich, Roger; Eaton, Melinda; Mayes, Ryan; Pierce, Lamar; Knight, Andrew; Genovesi, Paul; Escobar, James; Mychalczuk, George; Selent, Monica

    2016-08-01

    Preparing data for medical research can be challenging, detail oriented, and time consuming. Transcription errors, missing or nonsensical data, and records not applicable to the study population may hamper progress and, if unaddressed, can lead to erroneous conclusions. In addition, study data may be housed in multiple disparate databases and complex formats. Merging methods may be incomplete to obtain temporally synchronized data elements. We created a comprehensive database to explore the general hypothesis that environmental and occupational factors influence health outcomes and risk-taking behavior among active duty Air Force personnel. Several databases containing demographics, medical records, health survey responses, and safety incident reports were cleaned, validated, and linked to form a comprehensive, relational database. The final step involved removing and transforming personally identifiable information to form a Health Insurance Portability and Accountability Act compliant limited database. Initial data consisted of over 62.8 million records containing 221 variables. When completed, approximately 23.9 million clean and valid records with 214 variables remained. With a clean, robust database, future analysis aims to identify high-risk career fields for targeted interventions or uncover potential protective factors in low-risk career fields.

  12. Implementation and Service error: Veterans Administration health care and the commercial market option.

    PubMed

    Thompson, F J; Campbell, R W

    1981-01-01

    As government has attempted to deal with complex social problems, the inevitability of error has become increasingly apparent to students of public policy and implementation. This essay focuses on errors of service, initially drawing on the experience of the Veterans Administration (VA) medical system to explore problems of defining, detecting and correcting such errors when government directly delivers care. It probes the complex blend of errors of liberality and stringency that appeared to be present in the VA during the 1970s, the formidable barriers to error correction, and the steps taken by the VA in response to the problem. Second, the essay examines whether a commercial market strategy, as embodied by Medicare or Medicaid, offers certain advantages in dealing with service errors similar to those confronted by VA. The experience of Medicare and Medicaid casts doubt on whether a commercial market model yields superior results in coping with these kinds of error. Finally, the study points to some more general implications of the VA's experience for discussions of service problems in the health policy arena.

  13. Not of One Mind: Mental Models of Clinical Practice Guidelines in the Veterans Health Administration

    PubMed Central

    Hysong, Sylvia J; Best, Richard G; Pugh, Jacqueline A; Moore, Frank I

    2005-01-01

    Objective The purpose of this paper is to present differences in mental models of clinical practice guidelines (CPGs) among 15 Veterans Health Administration (VHA) facilities throughout the United States. Data Sources Two hundred and forty-four employees from 15 different VHA facilities across four service networks around the country were invited to participate. Participants were selected from different levels throughout each service setting from primary care personnel to facility leadership. Study Design This qualitative study used purposive sampling, a semistructured interview process for data collection, and grounded theory techniques for analysis. Data Collection A semistructured interview was used to collect information on participants' mental models of CPGs, as well as implementation strategies and barriers in their facility. Findings Analysis of these interviews using grounded theory techniques indicated that there was wide variability in employees' mental models of CPGs. Findings also indicated that high-performing facilities exhibited both (a) a clear, focused shared mental model of guidelines and (b) a tendency to use performance feedback as a learning opportunity, thus suggesting that a shared mental model is a necessary but not sufficient step toward successful guideline implementation. Conclusions We conclude that a clear shared mental model of guidelines, in combination with a learning orientation toward feedback are important components for successful guideline implementation and improved quality of care. PMID:15960693

  14. The epidemiology and burden of Alzheimer’s disease in Taiwan utilizing data from the National Health Insurance Research Database

    PubMed Central

    Hung, Yen-Ni; Kadziola, Zbigniew; Brnabic, Alan JM; Yeh, Ju-Fen; Fuh, Jong-Ling; Hwang, Jen-Ping; Montgomery, William

    2016-01-01

    Purpose The objectives of this study were to estimate the incidence, cumulative incidence, and economic burden of Alzheimer’s disease (AD) in Taiwan, using data from the National Health Insurance Research Database (NHIRD). Materials and methods This was a retrospective, longitudinal, observational study using data from the Longitudinal Health Insurance Database of the NHIRD. Patients were included in this study if they were 50 years of age or older and their records included a primary or secondary diagnosis of AD. New patients who met inclusion criteria were followed up longitudinally from 2005 to 2010. Costs were calculated for the first year following the diagnosis of AD. Results Overall, a higher percentage of women than men were diagnosed with AD (54% vs 46%, respectively). The first AD diagnosis occurred most frequently in the age of 75–84 years. The person-year incidence rate increased from 5.63/1,000 persons (95% CI, 5.32–5.94) in 2005 to 8.17/1,000 persons (95% CI, 7.78–8.57) in 2010. The cumulative incidence rate was 33.54/1,000 persons (95% CI, 32.76–34.33) in 2005–2010. The total mean inflated annual costs per patient in new Taiwan dollars (NT$) in the first year of diagnosis ranged from NT$205,413 (2009) to NT$227,110 (2005), with hospitalization representing the largest component. Conclusion AD represents a substantial burden in Taiwan, and based on the observed increase in incidence rate over time, it is likely that this burden will continue to increase. The findings reported here are consistent with previous research. The NHIRD contains extensive real-world information that can be used to conduct research, allowing us to expand our understanding of the incidence, prevalence, and burden of disease in Taiwan. PMID:27536149

  15. THE AFFORDABLE CARE ACT AND INCENTIVIZED HEALTH WELLNESS PROGRAMS--A TALE OF FEDERALISM AND SHIFTING ADMINISTRATIVE BURDEN.

    PubMed

    Sirpal, Sanjeev

    2014-01-01

    The Patient Protection and Affordable Care Act creates new incentives and builds on existing wellness program policies to promote employer wellness programs and encourage opportunities to support healthier workplaces. The proposed rules are promulgated by the Department of Health and Human Services (HHS), the Department of Labor, and the Treasury Department, and seek to encourage appropriately designed, consumer-protective wellness programs in group health coverage. This legislative landscape raises significant federalism concerns insofar as it largely shifts the responsibility for administration of health incentive programs to the states. Little attention has been paid to the shifting "administrative burden" that would thereby ensue. This paper will address the distribution of power in the American federal system vis-à-vis subnational counterparts in the wake of rampant, recent health care reform efforts. This paper will therefore explore the willingness of the national government to delegate policymaking responsibility to state governments in the context of an important aspect of healthcare reform. This, in turn, can be used to assess the distribution of powers between governmental levels--a subject that has received little systematic inquiry to date. Finally, this paper will explore the degree of administrative burden shifting that may likely occur as a result of these changes in health reform and what potential impacts it may have on individual health.

  16. Health literacy and medication administration performance by caregivers of adults with developmental disabilities

    PubMed Central

    Erickson, Steven R.; LeRoy, Barbara

    2015-01-01

    Objectives To measure health literacy (HL) of caregivers of adults with intellectual/developmental disabilities (IDDs); to determine the association between HL and a medication administration task (MAT) assessment; and to identify caregiver characteristics associated with higher HL and MAT scores. Design Cross-sectional study. Setting Southeastern Michigan. Participants Caregivers, aged 18 years or older, who provided supportive care of adults with IDDs. Interventions Survey and demonstration. Main Outcome Measures Short Test of Functional Health Literacy in Adults (STOFHLA); a MAT assessment consisting of interpretation of five sets of medication instructions followed by demonstration of understanding using a pill box; and a survey of caregivers' demographics, medication-related experiences, education, characteristics of persons for whom they provide care, and care-related activities performed. Results A total of 47 caregivers provided data. Caregivers had a mean age of 45.7 ± 14.6 years; 41 (87.2%) were women and 38 (80.9%) had education beyond high school. Caregivers were involved in obtaining medication from pharmacies, reminded the person with IDD to take medications and/or administered them to the person, documented medication and health information, and accompanied persons with IDD to physician offices. Most did not conduct monitoring procedures. The STOFHLA mean score was 34.5 ± 2.5 (median, 35; range, 22–36), while the MAT mean score was 12.0 ± 2.2 (median, 12; range, 6–15). Compared with family caregivers, direct support staff more frequently had undergone some medication training and had other people with whom they could discuss medication questions, but they had worked with the person with IDD a significantly shorter amount of time. No significant differences in STOFHLA and MAT scores between the family caregivers and direct support staff were observed. Caregiver education was significantly correlated with the STOFHLA score. MAT scores were not

  17. Healthcare usage and economic impact of non-treated obesity in Italy: findings from a retrospective administrative and clinical database analysis

    PubMed Central

    Colao, Annamaria; Lucchese, Marcello; D'Adamo, Monica; Savastano, Silvia; Facchiano, Enrico; Veronesi, Chiara; Blini, Valerio; Degli Esposti, Luca

    2017-01-01

    Objectives Investigate the prevalence of obesity in Italy and examine its resource consumption and economic impact on the Italian national healthcare system (NHS). Design Retrospective, observational and real-life study. Setting Data from three health units from Northern (Bergamo, Lombardy), Central (Grosseto, Tuscany) and Southern (Naples, Campania) Italy. Participants All patients aged ≥18 years with at least one recorded body mass index (BMI) measurement between 1 January 2009 and 31 December 2012 were included. Interventions Information retrieved from the databases included primary care data, medical prescriptions, specialist consultations and hospital discharge records from 2009–2013. Costs associated with these data were also calculated. Data are presented for two time periods (1 year after BMI measurement and study end). Primary and secondary outcome measures Primary—to estimate health resources consumption and the associated economic impact on the Italian NHS. Secondary—the prevalence and characteristics of subjects by BMI category. Results 20 159 adult subjects with at least one documented BMI measurement. Subjects with BMI ≥30 kg/m2 were defined as obese. The prevalence of obesity was 22.2% (N=4471) and increased with age. At the 1-year observation period, obese subjects who did not receive treatment for their obesity experienced longer durations of hospitalisation (median length: 5 days vs 3 days), used more prescription drugs (75.0% vs 57.7%), required more specialised outpatient healthcare (mean number: 5.3 vs 4.4) and were associated with greater costs, primarily owing to prescription drugs and hospital admissions (mean annual cost per year per patient: €460.6 vs €288.0 for drug prescriptions, €422.7 vs € 279.2 for hospitalisations and €283.2 vs €251.7 for outpatient care), compared with normal weight subjects. Similar findings were observed for the period up to data cut-off (mean follow-up of 2.7

  18. Radon gas: Health risks and toxicity. (Latest citations from the NTIS bibliographic database). Published Search

    SciTech Connect

    Not Available

    1993-08-01

    The bibliography contains citations concerning health risks and toxicity associated with indoor and outdoor exposure to radon gas. Citations discuss radon sources from tobacco smoke, fossil fuel combustion, phosphate mining, uranium mining, granitic rocks, building materials, and water supplies. Discussed also are risk assessment, regulations, radon gas monitoring, exposure modeling and control, biological pathways, and occupational exposure. Radionuclides in groundwater, and radon analysis and detection, are examined in separate bibliographies. (Contains a minimum of 125 citations and includes a subject term index and title list.)

  19. Let's reach all of the market for health administration education: design, development, and delivery issues in distance delivery.

    PubMed

    Olmosk, Kurt E; Chandra, Ashish

    2006-01-01

    Web-based distance learning is an up and coming form of education. Web-based education delivered via a Web browser through the Internet has been found to be less expensive, more efficient, and sometimes more effective than classroom training. In the distance learning environment, the traditional "lecture and chalkboard" classroom pedagogy is completely absent. The virtual classroom becomes an "active learning" environment in which students, while utilizing technology, are able to discuss health administration concepts, analyze cases, work exercises, and discuss and share these interactively with both the instructor and fellow classmates. This method of Health Administration Education encourages students to learn from each other and promotes the open exchange of ideas and experiences. It does not require working students to put their careers on hold while they continue their studies. In this paper, we explore the opportunities and challenges of delivering web-based Health Administration courses via the Internet. Included is a discussion of the design, development, and delivery of a distance learning, web-based Health Administration Education system.

  20. TUESDAY: EPA Administrator to Discuss Historic Clean Power Plan to Cut U.S. Carbon Pollution and Protect Public Health

    EPA Pesticide Factsheets

    WASHINGTON - On Tuesday, August 11, EPA Administrator Gina McCarthy will be discussing the Clean Power Plan at the Resources for the Future (RFF) Leadership Forum. The Clean Power Plan will protect public health, spur clean energy investments and st

  1. 75 FR 78997 - Centers for Disease Control and Prevention/Health Resources and Services Administration (CDC/HRSA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-17

    .../Health Resources and Services Administration (CDC/HRSA) Advisory Committee on HIV and STD Prevention and...-463) of October 6, 1972, that the CDC/HRSA Advisory Committee on HIV and STD Prevention and Treatment.... Contact Person for More Information: Kevin Fenton, M.D., PhD, Designated Federal Officer,...

  2. Initial Role Delineation for Entry-Level Health Services Administration Personnel. Comprehensive Report, October 1, 1979-December 31, 1980.

    ERIC Educational Resources Information Center

    Educational Testing Service, Princeton, NJ. Center for Occupational and Professional Assessment.

    Results of a job analysis for the position of entry-level health services administrator (HSA) are presented. The following products of the study are presented: a list of 132 tasks grouped into 10 job dimensions (e.g., policy direction, financial management), ratings of the importance of each task at entry-level, a list of 39 qualifications,…

  3. A database of human exposomes and phenomes from the US National Health and Nutrition Examination Survey

    PubMed Central

    Patel, Chirag J.; Pho, Nam; McDuffie, Michael; Easton-Marks, Jeremy; Kothari, Cartik; Kohane, Isaac S.; Avillach, Paul

    2016-01-01

    The National Health and Nutrition Examination Survey (NHANES) is a population survey implemented by the Centers for Disease Control and Prevention (CDC) to monitor the health of the United States whose data is publicly available in hundreds of files. This Data Descriptor describes a single unified and universally accessible data file, merging across 255 separate files and stitching data across 4 surveys, encompassing 41,474 individuals and 1,191 variables. The variables consist of phenotype and environmental exposure information on each individual, specifically (1) demographic information, physical exam results (e.g., height, body mass index), laboratory results (e.g., cholesterol, glucose, and environmental exposures), and (4) questionnaire items. Second, the data descriptor describes a dictionary to enable analysts find variables by category and human-readable description. The datasets are available on DataDryad and a hands-on analytics tutorial is available on GitHub. Through a new big data platform, BD2K Patient Centered Information Commons (http://pic-sure.org), we provide a new way to browse the dataset via a web browser (https://nhanes.hms.harvard.edu) and provide application programming interface for programmatic access. PMID:27779619

  4. Exploration of Preterm Birth Rates Using the Public Health Exposome Database and Computational Analysis Methods

    PubMed Central

    Kershenbaum, Anne D.; Langston, Michael A.; Levine, Robert S.; Saxton, Arnold M.; Oyana, Tonny J.; Kilbourne, Barbara J.; Rogers, Gary L.; Gittner, Lisaann S.; Baktash, Suzanne H.; Matthews-Juarez, Patricia; Juarez, Paul D.

    2014-01-01

    Recent advances in informatics technology has made it possible to integrate, manipulate, and analyze variables from a wide range of scientific disciplines allowing for the examination of complex social problems such as health disparities. This study used 589 county-level variables to identify and compare geographical variation of high and low preterm birth rates. Data were collected from a number of publically available sources, bringing together natality outcomes with attributes of the natural, built, social, and policy environments. Singleton early premature county birth rate, in counties with population size over 100,000 persons provided the dependent variable. Graph theoretical techniques were used to identify a wide range of predictor variables from various domains, including black proportion, obesity and diabetes, sexually transmitted infection rates, mother’s age, income, marriage rates, pollution and temperature among others. Dense subgraphs (paracliques) representing groups of highly correlated variables were resolved into latent factors, which were then used to build a regression model explaining prematurity (R-squared = 76.7%). Two lists of counties with large positive and large negative residuals, indicating unusual prematurity rates given their circumstances, may serve as a starting point for ways to intervene and reduce health disparities for preterm births. PMID:25464130

  5. Graduate programs in health administration: faculty academic reputation and faculty research reputation by program location and program reputation.

    PubMed

    Nowicki, M

    1995-01-01

    This study used program location and program reputation to describe two important faculty characteristics: academic reputation and research reputation. The study involved 44 graduate programs in health administration representing four program locations: schools of public health, business, medicine/allied health, and graduate/independent. Fourteen programs were identified as ranked programs and the remaining 30 programs were identified as unranked programs. While the study identifies many differences, few are significant, thus adding credence to the argument for diversity in program location and diminishing credence in the argument for program reputation.

  6. [Women's health in violent situations: municipal administrative roles and decision-making in the Brazilian public health system].

    PubMed

    Porto, Madge; McCallum, Cecilia; Scott, Russell Parry; de Morais, Heloísa M Mendonça

    2003-01-01

    The aim of this study was to investigate the role of health management staff concerning the health of women facing violent situations and the impact these roles have on decisions concerning health measures targeting these women. The study employed a qualitative, descriptive methodology including 18 health management staff members from three municipalities classified as having fully autonomous municipal management systems under the Unified National Health System (SUS) in Greater Metropolitan Recife, Pernambuco State, Brazil. Staff members were divided into three distinct groups according to their opinions on women in violent situations and women's health interventions. However, the three groups were convergent with respect to their roles in determining decisions on health actions for these women. The health management staff's commitment to the feminist movement proved to be the most relevant factor. Common issues among staff members, such as the problem of public health and quality of living, or more technically, the cost-benefit issue, did appear as key arguments.

  7. Accessing Data Resources in the Mouse Phenome Database for Genetic Analysis of Murine Life Span and Health Span

    PubMed Central

    Peters, Luanne L.; Paigen, Beverly; Korstanje, Ron; Yuan, Rong; Ackert-Bicknell, Cheryl; Grubb, Stephen C.; Churchill, Gary A.; Chesler, Elissa J.

    2016-01-01

    Understanding the source of genetic variation in aging and using this variation to define the molecular mechanisms of healthy aging require deep and broad quantification of a host of physiological, morphological, and behavioral endpoints. The murine model is a powerful system in which to understand the relations across age-related phenotypes and to identify research models with variation in life span and health span. The Jackson Laboratory Nathan Shock Center of Excellence in the Basic Biology of Aging has performed broad characterization of aging in genetically diverse laboratory mice and has placed these data, along with data from several other major aging initiatives, into the interactive Mouse Phenome Database. The data may be accessed and analyzed by researchers interested in finding mouse models for specific aging processes, age-related health and disease states, and for genetic analysis of aging variation and trait covariation. We expect that by placing these data in the hands of the aging community that there will be (a) accelerated genetic analyses of aging processes, (b) discovery of genetic loci regulating life span, (c) identification of compelling correlations between life span and susceptibility for age-related disorders, and (d) discovery of concordant genomic loci influencing life span and aging phenotypes between mouse and humans. PMID:25533306

  8. What workforce is needed to implement the health information technology agenda? Analysis from the HIMSS analytics database.

    PubMed

    Hersh, William; Wright, Adam

    2008-11-06

    One of the essential ingredients for health information technology implementation is a well trained and competent workforce. However, this workforce has not been quantified or otherwise characterized well. We extracted data from the HIMSS Analytics Database and extrapolated our findings to the US as a whole. We found that there are approximately 108,390 IT professionals in healthcare the US. In addition, the amount of IT staff hired varies by level of EMR adoption, with the rate of IT FTE per bed started at a level of 0.082 FTE per bed at the lowest level of the EMR Adoption Model (Stage0) and increasing to 0.210 FTE bed at higher levels(Stage 4). We can extrapolate nationally to conclude that to move the entire US to higher levels of adoption (Stage 4) will require an additional 40,784 IT professionals. There are limitations to this analysis, including that the data are limited to IT professionals who are mainly in hospitals and do not include those who, for example, work for vendors or in non-clinical settings. Furthermore, data on biomedical informatics professionals are still virtually non-existent. Our analysis adds to data that show there must be increasing attention paid to the workforce that will develop, implement, and evaluate HIT applications. Further research is essential to better characterize all types of workers needed for adoption of health information technology, including their job roles, required competencies, and optimal education.

  9. Preventative care for patients with inflammatory bowel disease in the Veterans Health Administration

    PubMed Central

    Pandey, Nivedita; Herrera, Henry H.; Johnson, Christopher M.; MacCarthy, Andrea A.; Copeland, Laurel A.

    2016-01-01

    Abstract Patients with inflammatory bowel disease (IBD) have underlying immune dysregulation. Immunosuppressive medications put them at risk of infection. This study assessed rates of recommended vaccinations and preventative screening in patients with IBD. Nationwide data on patients diagnosed with IBD in the Veterans Health Administration (VHA) October 2004 to September 2014 were extracted. Variation in vaccination, screenings, and risk of death by demographic factors (age group, gender) were estimated in bivariate and multivariable analyses. During the 10-year study period, 62,002 patients were treated for IBD. Nonmelanoma skin cancer was found in 2.6%, and these patients more commonly accessed dermatology clinic (22.5% vs 15.2%; chi-square = 66.6; df = 1; P < 0.0001). In total, 15% received DEXA scans, especially women (34.7% vs 13.2% men; chi-square = 1415.5; df = 1; P < 0.0001). Eye manifestations were noted in 38.3% yet only 31% were referred to ophthalmology. Abnormal Pap smears were found for 15% of women <65 (compared to 5% among normal patient populations); 34% had no record of Pap smear in VHA data. Vaccination rates were modest: pneumococcal 39%; TDAP 23%; hepatitis B 3%; varicella and PPD <0.5%. In an adjusted logistic regression model, 5-year mortality was lower among those using primary care prior to IBD diagnosis (odds ratio [OR] = 0.61; 95% CI 0.55–0.68). Despite the current IBD guidelines, vaccination and preventative screening rates were unacceptably low among patients diagnosed with IBD. Interventions such as education and increased awareness may be needed to improve these rates. PMID:27399081

  10. Results from the Veterans Health Administration ICD-10-CM/PCS Coding Pilot Study.

    PubMed

    Weems, Shelley; Heller, Pamela; Fenton, Susan H

    2015-01-01

    The Veterans Health Administration (VHA) of the US Department of Veterans Affairs has been preparing for the October 1, 2015, conversion to the International Classification of Diseases, Tenth Revision, Clinical Modification and Procedural Coding System (ICD-10-CM/PCS) for more than four years. The VHA's Office of Informatics and Analytics ICD-10 Program Management Office established an ICD-10 Learning Lab to explore expected operational challenges. This study was conducted to determine the effects of the classification system conversion on coding productivity. ICD codes are integral to VHA business processes and are used for purposes such as clinical studies, performance measurement, workload capture, cost determination, Veterans Equitable Resource Allocation (VERA) determination, morbidity and mortality classification, indexing of hospital records by disease and operations, data storage and retrieval, research purposes, and reimbursement. The data collection for this study occurred in multiple VHA sites across several months using standardized methods. It is commonly accepted that coding productivity will decrease with the implementation of ICD-10-CM/PCS. The findings of this study suggest that the decrease will be more significant for inpatient coding productivity (64.5 percent productivity decrease) than for ambulatory care coding productivity (6.7 percent productivity decrease). This study reveals the following important points regarding ICD-10-CM/PCS coding productivity: 1. Ambulatory care ICD-10-CM coding productivity is not expected to decrease as significantly as inpatient ICD-10-CM/PCS coding productivity. 2. Coder training and type of record (inpatient versus outpatient) affect coding productivity. 3. Inpatient coding productivity is decreased when a procedure requiring ICD-10-PCS coding is present. It is highly recommended that organizations perform their own analyses to determine the effects of ICD-10-CM/PCS implementation on coding productivity.

  11. Chikungunya Fever Cases Identified in the Veterans Health Administration System, 2014

    PubMed Central

    Perti, Tara; Lucero-Obusan, Cynthia A.; Schirmer, Patricia L.; Winters, Mark A.; Holodniy, Mark

    2016-01-01

    Background During December 2013, the first locally transmitted chikungunya virus (CHIKV) infections in the Americas were reported in the Caribbean. Although CHIKV infection is rarely fatal, risk for severe disease increases with age and medical comorbidities. Herein we describe characteristics of Veterans Health Administration (VHA) patients with CHIKV infection and, among those with infections diagnosed in Puerto Rico, investigated risk factors for hospitalization. Methodology We queried VHA’s national electronic medical records to identify patients with CHIKV testing during 2014. Demographics, clinical history, laboratory results, and outcomes were abstracted. We investigated risk factors for hospitalization among patients with laboratory-confirmed CHIKV infection in Puerto Rico. Principal Findings We identified 180 laboratory-confirmed CHIKV infections; 148 (82.2%) were diagnosed in Puerto Rico, and 32 (17.8%) were diagnosed among returning travelers elsewhere in the United States. In Puerto Rico, where more patients were hospitalized (55.4% versus 20.0%) and died (4.1% versus 0%), risk for hospitalization increased with age (relative risk [RR]/each 10-year increase, 1.19; 95% confidence interval [CI], 1.06–1.32) and, adjusted for age, increased among patients with congestive heart failure (RR, 1.58; 95% CI, 1.25–1.99), chronic kidney disease (RR, 1.52; 95% CI, 1.19–1.94), diabetes mellitus (RR, 1.39; 95% CI, 1.06–1.84), or chronic lung disease (RR, 1.37; 95% CI, 1.03–1.82). Conclusions/Significance CHIKV infection is an emerging problem among Veterans residing in or visiting areas with CHIKV transmission. Although overall mortality rates are low, clinicians in affected areas should be aware that older patients and patients with comorbidities may be at increased risk for severe disease. PMID:27144588

  12. The National Aeronautics and Space Administration's Earth Science Applications Program: Exploring Partnerships to Enhance Decision Making in Public Health Practice

    NASA Technical Reports Server (NTRS)

    Vann, Timi S.; Venezia, Robert A.

    2002-01-01

    The National Aeronautics and Space Administration (NASA), Earth Science Enterprise is engaged in applications of NASA Earth science and remote sensing technologies for public health. Efforts are focused on establishing partnerships with those agencies and organizations that have responsibility for protecting the Nation's Health. The program's goal is the integration of NASA's advanced data and technology for enhanced decision support in the areas of disease surveillance and environmental health. A focused applications program, based on understanding partner issues and requirements, has the potential to significantly contribute to more informed decision making in public health practice. This paper intends to provide background information on NASA's investment in public health and is a call for partnership with the larger practice community.

  13. Health Savings Account Balances, Contributions, Distributions, and Other Vital Statistics, 2014: Estimates from the EBRI HSA Database.

    PubMed

    Fronsti, Paul

    2015-07-01

    The Employee Benefit Research Institute (EBRI) maintains a wealth of data collected from various health savings account (HSA) providers. The EBRI HSA Database contains 2.9 million accounts with total assets of $5 billion as of Dec. 31, 2014. This Issue Brief is the second annual report drawing on cross-sectional data from the EBRI HSA Database. It examines account balances, individual and employer contributions, annual distributions, investment accounts, and account-owner demographics for 2014. Enrollment in HSA-eligible health plans is estimated to be about 17 million policyholders and their dependents, and it has also been estimated that there are 13.8 million accounts holding $24.2 billion in assets as of Dec. 31, 2014. Almost 4 in 5 HSAs have been opened since the beginning of 2011. The average HSA balance at the end of 2014 was $1,933, up from $1,408 at the beginning of the year. Average account balances increased with the age of the owner of the account. Account balances averaged $655 for owners under age 25 and $5,016 for owners ages 65 and older. About 6 percent of HSAs had an associated investment account. End-of-year 2014 balance averages were higher in accounts with investment assets. Thirty-seven percent of HSAs with investment assets ended 2014 with a balance of $10,000 or more, whereas only 4 percent of HSAs without investment assets had such a balance. Among HSAs with investment assets, accounts opened in 2014 ended the year with an average balance of $6,544; whereas those opened in 2005 had an average balance of $19,269 at the end of 2014. HSAs with either individual or employer contributions accounted for 70 percent of all accounts and 86 percent of the assets in 2014. Four percent of these accounts ended the year with a zero balance. On a yearly average, individuals who made contributions deposited $2,096 to their account. HSAs receiving employer contributions received $1,021 a year, on average. Four-fifths of HSAs with a contribution also had a

  14. Does language matter? A case study of epidemiological and public health journals, databases and professional education in French, German and Italian

    PubMed Central

    Baussano, Iacopo; Brzoska, Patrick; Fedeli, Ugo; Larouche, Claudia; Razum, Oliver; Fung, Isaac C-H

    2008-01-01

    Epidemiology and public health are usually context-specific. Journals published in different languages and countries play a role both as sources of data and as channels through which evidence is incorporated into local public health practice. Databases in these languages facilitate access to relevant journals, and professional education in these languages facilitates the growth of native expertise in epidemiology and public health. However, as English has become the lingua franca of scientific communication in the era of globalisation, many journals published in non-English languages face the difficult dilemma of either switching to English and competing internationally, or sticking to the native tongue and having a restricted circulation among a local readership. This paper discusses the historical development of epidemiology and the current scene of epidemiological and public health journals, databases and professional education in three Western European languages: French, German and Italian, and examines the dynamics and struggles they have today. PMID:18826570

  15. A Quality System Database

    NASA Technical Reports Server (NTRS)

    Snell, William H.; Turner, Anne M.; Gifford, Luther; Stites, William

    2010-01-01

    A quality system database (QSD), and software to administer the database, were developed to support recording of administrative nonconformance activities that involve requirements for documentation of corrective and/or preventive actions, which can include ISO 9000 internal quality audits and customer complaints.

  16. Administration on Aging

    MedlinePlus

    ... Administration on Aging Administration on Disabilities Center for Integrated Programs Center for Performance and Evaluation National Institute ... Project Aging Statistics Profile of Older Americans AGing Integrated Database (AGID) Census Data & Population Estimates Projected Future ...

  17. Effect of prepartum administration of recombinant bovine somatotropin on health and performance of lactating dairy cows.

    PubMed

    Gohary, K; LeBlanc, S J; Lissemore, K D; Overton, M W; Von Massow, M; Duffield, T F

    2014-10-01

    A double-blind, randomized clinical trial was conducted in 5 commercial dairy herds in southern Ontario with 1,362 cows enrolled to evaluate the effect of prepartum administration of recombinant bovine somatotropin (rbST) on health and performance. Cows were randomly assigned to receive either 325 mg of sometribove zinc suspension (n=680) or a placebo injection (n=682; control) subcutaneously every 14 d until calving. Treatments started 28 to 22 d before expected calving, with a maximum of 3 treatments per cow. Serum samples taken at the time of enrollment, 1 wk before calving, and weekly for 3 wk after calving were analyzed for nonesterified fatty acids (NEFA), β-hydroxybutyrate (BHBA), glucose, aspartate aminotransferase, calcium, and haptoglobin. Diseases were recorded by farm staff. Incidences of clinical ketosis, clinical mastitis, displaced abomasum, metritis, retained placenta, milk fever, and lameness were similar between groups. Body condition score was lower for treated than for control cows at 3 wk after calving (3.13 and 3.17, respectively). Serum NEFA tended to be higher for treated than for control cows by 0.01 mmol/L. Overall BHBA was not different between groups, but BHBA for treated cows was higher in wk 1 after calving (750 and 698 μmol/L, respectively) and tended to be higher in wk 2 after calving (779 and 735 μmol/L, respectively). Incidence of hyperketonemia was similar between groups. Treated cows had higher serum glucose compared with control cows (2.8 and 2.7 mmol/L, respectively). We detected no differences in serum aspartate aminotransferase, calcium, or haptoglobin between groups. Milk yield was recorded daily for each cow for 63 d, and did not differ between groups (37.1 ± 0.5 kg and 36.7 ± 0.5 kg, respectively) but we detected a tendency for treated cows to produce 0.8 kg/d more milk than control cows in wk 1 after calving. We observed no difference between groups in the time from calving to first insemination or the probability of

  18. Linkage between the Danish National Health Service Prescription Database, the Danish Fetal Medicine Database, and other Danish registries as a tool for the study of drug safety in pregnancy

    PubMed Central

    Pedersen, Lars H; Petersen, Olav B; Nørgaard, Mette; Ekelund, Charlotte; Pedersen, Lars; Tabor, Ann; Sørensen, Henrik T

    2016-01-01

    A linked population-based database is being created in Denmark for research on drug safety during pregnancy. It combines information from the Danish National Health Service Prescription Database (with information on all prescriptions reimbursed in Denmark since 2004), the Danish Fetal Medicine Database, the Danish National Registry of Patients, and the Medical Birth Registry. The new linked database will provide validated information on malformations diagnosed both prenatally and postnatally. The cohort from 2008 to 2014 will comprise 589,000 pregnancies with information on 424,000 pregnancies resulting in live-born children, ∼420,000 pregnancies undergoing prenatal ultrasound scans, 65,000 miscarriages, and 92,000 terminations. It will be updated yearly with information on ∼80,000 pregnancies. The cohort will enable identification of drug exposures associated with severe malformations, not only based on malformations diagnosed after birth but also including those having led to termination of pregnancy or miscarriage. Such combined data will provide a unique source of information for research on the safety of medications used during pregnancy. PMID:27274312

  19. 77 FR 54663 - Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-05

    ... International Classification of Diseases, 10th Revision, Clinical Modification (ICD- 10-CM) for diagnosis coding... of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure... health identifier for health care providers for use in the health care system and adopting the...

  20. Using Administrative Health Data to Identify Individuals with Intellectual and Developmental Disabilities: A Comparison of Algorithms

    ERIC Educational Resources Information Center

    Lin, E.; Balogh, R.; Cobigo, V.; Ouellette-Kuntz, H.; Wilton, A. S.; Lunsky, Y.

    2013-01-01

    Background: Individuals with intellectual and developmental disabilities (IDD) experience high rates of physical and mental health problems; yet their health care is often inadequate. Information about their characteristics and health services needs is critical for planning efficient and equitable services. A logical source of such information is…

  1. Study of a rural practice dental hygienist in a public health setting: analysis of an administrative dataset.

    PubMed

    Squillace, Joe

    2012-05-01

    States are grappling with the lack of access to oral health care for their child populations. This study evaluated a unique administrative dataset collected by a hygienist in rural Missouri who started a new clinic and provided services to a two-county population under what is known as unsupervised practice. Results showed 82% of 2-8 year olds presenting at the clinic had no prior visits to other practicing dental providers, indicating the benefits of new oral health providers in an underserved area. School-aged children (ages 6-12 years) were significantly more likely than other age groups to have higher numbers of recall visits and therefore, subsequently to use prevention services of the unsupervised dental hygienist at the rural clinic. The results suggest that improved systematic collection of data from dental hygienists in public health settings is needed to provide evidence that may affect public oral health policies.

  2. The Food and Drug Administration Office of Women's Health: Impact of Science on Regulatory Policy: An Update

    PubMed Central

    Elahi, Merina; Eshera, Noha; Bambata, Nkosazana; Barr, Helen; Lyn-Cook, Beverly; Beitz, Julie; Rios, Maria; Taylor, Deborah R.; Lightfoote, Marilyn; Hanafi, Nada; DeJager, Lowri; Wiesenfeld, Paddy; Scott, Pamela E.; Henderson, Marsha B.

    2016-01-01

    Abstract The U.S. Food and Drug Administration Office of Women's Health (FDA OWH) has supported women's health research for ∼20 years, funding more than 300 studies on women's health issues, including research on diseases/conditions that disproportionately affect women in addition to the evaluation of sex differences in the performance of and response to medical products. These important women's health issues are studied from a regulatory perspective, with a focus on improving and optimizing medical product development and the evaluation of product safety and efficacy in women. These findings have influenced industry direction, labeling, product discontinuation, safety notices, and clinical practice. In addition, OWH-funded research has addressed gaps in the knowledge about diseases and medical conditions that impact women across the life span such as cardiovascular disease, pregnancy, menopause, osteoporosis, and the safe use of numerous medical products. PMID:26871618

  3. The Food and Drug Administration Office of Women's Health: Impact of Science on Regulatory Policy: An Update.

    PubMed

    Elahi, Merina; Eshera, Noha; Bambata, Nkosazana; Barr, Helen; Lyn-Cook, Beverly; Beitz, Julie; Rios, Maria; Taylor, Deborah R; Lightfoote, Marilyn; Hanafi, Nada; DeJager, Lowri; Wiesenfeld, Paddy; Scott, Pamela E; Fadiran, Emmanuel O; Henderson, Marsha B

    2016-03-01

    The U.S. Food and Drug Administration Office of Women's Health (FDA OWH) has supported women's health research for ∼20 years, funding more than 300 studies on women's health issues, including research on diseases/conditions that disproportionately affect women in addition to the evaluation of sex differences in the performance of and response to medical products. These important women's health issues are studied from a regulatory perspective, with a focus on improving and optimizing medical product development and the evaluation of product safety and efficacy in women. These findings have influenced industry direction, labeling, product discontinuation, safety notices, and clinical practice. In addition, OWH-funded research has addressed gaps in the knowledge about diseases and medical conditions that impact women across the life span such as cardiovascular disease, pregnancy, menopause, osteoporosis, and the safe use of numerous medical products.

  4. Clinical and cost outcomes from different hyaluronic acid treatments in patients with knee osteoarthritis: evidence from a US health plan claims database

    PubMed Central

    Dasa, Vinod; DeKoven, Mitch; Sun, Kainan; Scott, Allan; Lim, Sooyeol

    2016-01-01

    Background: Intra-articular injection of hyaluronic acid (HA) for knee osteoarthritis (OA) effectively reduces pain and delays total knee replacement (TKR) surgery; however, little is known about relative differences in clinical and cost outcomes among different HA products. Objective: To compare disease-specific costs and risk of TKR among patients receiving different HA treatments in a commercially insured cohort of patients with knee OA in the USA. Method: Retrospective analyses using IMS Health’s PharMetrics Plus Health Plan Claims Database were conducted by identifying knee OA patients with claims indicating initiation of HA treatment at an ‘index date’ during the selection period (2007–2010). Patients were required to be continuously enrolled in the database for 12 months preindex to 36 months postindex. A generalized linear model (GLM) with a gamma distribution and log-link function was used to model aggregate patient-based changes in disease-specific costs. A Cox proportional hazards model (PHM) was used to model the risk of TKR. Both multivariate models included covariates such as age, gender, comorbidities, and preindex healthcare costs. Results: 50,389 patients with HA treatment for knee OA were identified. 18,217 (36.2%) patients were treated with HA products indicated for five injections per treatment course (Supartz and Hyalgan). The remainder were treated with HA products indicated for fewer than five injections per treatment course, with 20,518 patients (40.7%) receiving Synvisc; 6,263 (12.4%), Euflexxa; and 5,391 (10.7%), Orthovisc. Synvisc- and Orthovisc-injected patients had greater disease-specific costs compared to Supartz/Hyalgan (9.0%, p<0.0001 and 6.8%, p=0.0050, respectively). Hazard ratios (HRs) showed a significantly higher risk of TKR for patients receiving Synvisc compared to Supartz/Hyalgan (HR=1.069, p=0.0009). Patients treated with Supartz/Hyalgan, Euflexxa, and Orthovisc had longer delays to TKR than those treated with

  5. Transforming Administrative and Clinical Practice in a Public Behavioral Health System: An Ethnographic Assessment of the Context of Change

    PubMed Central

    Willging, Cathleen E.; Waitzkin, Howard; Lamphere, Louise

    2010-01-01

    In July 2005, New Mexico placed all publicly funded behavioral health services under the management of one private corporation. This reform emphasized the provision of evidence-based, culturally competent services. Methods Participant observation and semi-structured interviews with 189 administrators, staff, and providers were carried out in 14 behavioral health safety-net institutions (SNIs) during the transition period. Results New administrative requirements led to substantial paperwork demands, payment problems, and financial stress within SNIs. Personnel at the SNIs often lacked knowledge about and training in evidence-based practices and culturally competent care, and viewed the costs of delivering such services as prohibitive. Discussion Policymakers must account for the challenges that SNIs face as the reform continues to unfold. The financial stability of SNIs is of critical importance. Efforts are needed to increase training and development opportunities in evidence-based care and cultural competency; SNIs typically lack resources to pursue these opportunities on their own. PMID:19648713

  6. Pregnancy-Associated Risk Factors of Postpartum Breast Cancer in Korea: A Nationwide Health Insurance Database Study

    PubMed Central

    Kang, Eun Joo; Seo, Jae Hong; Kim, Log Young; Park, Geun U.; Oh, Min-Jeong; Park, Pyoung-Jae; Cho, Geum Joon

    2016-01-01

    Patients with postpartum breast cancer have been reported to have a poor prognosis. The present study aimed to evaluate the pregnancy-related risk factors of postpartum breast cancer in Korea. We collected patient data from the Korea National Health Insurance (KNHI) Claims Database of the Health Insurance Review and Assessment Service (HIRA) for the 2009–2013 period. We evaluated the pregnancy-related risk factors for postpartum breast cancer in two population groups. For Group 1 (women who had given birth during the 2010–2012 period), data on those who were diagnosed with breast cancer from childbirth to 1-year postpartum were extracted. For Group 2, we extracted the data of women who gave birth in 2010 and traced them until December 31, 2013. In Group 1, 1,384,551 deliveries and 317 postpartum breast cancer patients were recorded in Korea between January 1, 2010, and December 31, 2012. Women aged ≥35 years (Odds Ratio [OR], 2.003; 95% Confidence Interval [CI], 1.567–2.560) and those who gave birth via cesarean delivery (OR, 1.237; 95% CI, 0.986–1.553) were considered to be at a higher risk for breast cancer. Lower risk was noted in primiparous women (OR, 0.737; 95% CI, 0.585–0.928). In Group 2, the data of 457,924 women who gave birth in 2010 were traced until December 31, 2013. Among them, 655 patients were diagnosed with breast cancer, and age ≥35 years and cesarean delivery were associated with an higher risk of breast cancer, whereas primiparous status was associated with a lower risk of breast cancer. In conclusion, older age (≥35 years) and cesarean delivery are significant risk factors for postpartum breast cancer, and primiparous women have a lower risk of developing postpartum breast cancer. PMID:27977789

  7. Intranasal Neuropeptide Administration To Target the Human Brain in Health and Disease.

    PubMed

    Spetter, Maartje S; Hallschmid, Manfred

    2015-08-03

    Central nervous system control of metabolic function relies on the input of endocrine messengers from the periphery, including the pancreatic hormone insulin and the adipokine leptin. This concept primarily derives from experiments in animals where substances can be directly applied to the brain. A feasible approach to study the impact of peptidergic messengers on brain function in humans is the intranasal (IN) route of administration, which bypasses the blood-brain barrier and delivers neuropeptides to the brain compartment, but induces considerably less, if any, peripheral uptake than other administration modes. Experimental IN insulin administration has been extensively used to delineate the role of brain insulin signaling in the control of energy homeostasis, but also cognitive function in healthy humans. Clinical pilot studies have found beneficial effects of IN insulin in patients with memory deficits, suggesting that the IN delivery of this and other peptides bears some promise for new, selectively brain-targeted pharmaceutical approaches in the treatment of metabolic and cognitive disorders. More recently, experiments relying on the IN delivery of the hypothalamic hormone oxytocin, which is primarily known for its involvement in psychosocial processes, have provided evidence that oxytocin influences metabolic control in humans. The IN administration of leptin has been successfully tested in animal models but remains to be investigated in the human setting. We briefly summarize the literature on the IN administration of insulin, leptin, and oxytocin, with a particular focus on metabolic effects, and address limitations and perspectives of IN neuropeptide administration.

  8. Use of information on disease diagnoses from databases for animal health economic, welfare and food safety purposes: strengths and limitations of recordings.

    PubMed

    Houe, Hans; Gardner, Ian Andrew; Nielsen, Liza Rosenbaum

    2011-01-01

    Many animal health, welfare and food safety databases include data on clinical and test-based disease diagnoses. However, the circumstances and constraints for establishing the diagnoses vary considerably among databases. Therefore results based on different databases are difficult to compare and compilation of data in order to perform meta-analysis is almost impossible. Nevertheless, diagnostic information collected either routinely or in research projects is valuable in cross comparisons between databases, but there is a need for improved transparency and documentation of the data and the performance characteristics of tests used to establish diagnoses. The objective of this paper is to outline the circumstances and constraints for recording of disease diagnoses in different types of databases, and to discuss these in the context of disease diagnoses when using them for additional purposes, including research. Finally some limitations and recommendations for use of data and for recording of diagnostic information in the future are given. It is concluded that many research questions have such a specific objective that investigators need to collect their own data. However, there are also examples, where a minimal amount of extra information or continued validation could make sufficient improvement of secondary data to be used for other purposes. Regardless, researchers should always carefully evaluate the opportunities and constraints when they decide to use secondary data. If the data in the existing databases are not sufficiently valid, researchers may have to collect their own data, but improved recording of diagnostic data may improve the usefulness of secondary diagnostic data in the future.

  9. Marketers don't wear plaid: marketing and health care administration in the Canadian context.

    PubMed

    Rigby, J M; Backman, A M

    1997-01-01

    Marketing has a bad reputation among Canadian health managers, even though marketing solutions may address many of their problems. This article provides an overview of current understandings of marketing and how they may be applied to health care situations. Marketing should be considered an ongoing process. This is particularly helpful if we understand the root task of health managers as creating and promoting exchanges--with governments, physicians, nurses, other health workers and client groups. Exchanges that are desirable to the health care community will more likely occur if the true costs and benefits of health services are analyzed, understood and imaginatively communicated. The public constantly evaluates the health system. Constant evaluation implies a need for marketing directed internally at staff and those within the health system, and externally at constituents outside the system. Properly understood and practiced, marketing can be part of the innovative solutions health care managers develop and apply as they deal with the difficult challenges facing them in Canada's current health care environment.

  10. Administrative and private searches for smoking articles conducted pursuant to the federal mine safety and health act: Constitutional considerations

    SciTech Connect

    Hardy, D.J.; McCambley, M.E.

    1995-11-01

    Searches conducted to detect the presence of smoking articles are required to fulfill the legitimate, administrative objectives that underlie the Federal Mine Safety and Health Act of 1977. Consequently, such searches may be conducted by government mine safety enforcement officials without benefit of either a warrant based upon probable cause or an administrative warrant. The authority to conduct warrantless administrative searches on mine property is limited by FMSHA, however, and MSHA must either comply with the administrative substitutes for a warrant set forth in that Act or obtain an administrative warrant before entering onto a mine-operator`s property for purposes of conducting a search for smoking articles. Once mine safety enforcement officials properly gain entry onto mine property, no further warrants are required to conduct searches of individual miners. Miners who choose to work in underground mines are put on notice, by the FMSHA, MSHA regulations, and the training they receive, that they will be subject to searches for smoking articles. Thus, miners have no reasonable expectation that they will be free from the type of pat-down and personal effects searches used to detect the presence of smoking articles. The Fourth amendment is simply not implicated by such searches. This is true even though the legislative scheme designed to enhance mine safety imposes criminal as well as civil penalties on miners found with smoking articles.

  11. A comparison of academic curricula in the MPH and MHA-type degrees in health administration at the accredited schools of public health.

    PubMed

    Singh, D A; Stoskope, C H; Ciesla, J R

    1996-01-01

    Based on a survey of the departments of health services administration in accredited schools of public health, this study presents (1) a profile of the M.P.H. and M.H.A. (and similar) programs concentrating in health administration, and (2) a comparison of the M.P.H. and M.H.A. degrees. All 27 schools currently accredited by the Council on Education for Public Health (CEPH) are represented in this research. The curriculum from each school was broken down and classified into eight components: (1) epidemiology, (2) statistics, (3) accounting/finance, (4) management theory, (5) management application, (6) public health policy, (7) electives, and (8) other. That the M.H.A. programs compared to the M.P.H. programs, have higher course requirements to furnish skills in business management and quantitative/analytical areas is the main hypothesis tested. Statistically significant differences were found in seven of the eight curriculum components for M.P.H. and M.H.A. degrees. Overall, the M.H.A. degree was found to be more rigorous in applied management and analytical courses. Implications and recommendations are discussed.

  12. Native Health Research Database

    MedlinePlus

    ... Lacs Band of Chippewa Mimbres Minnesota Chippewa Tribe Mississippi Band of Choctaw Indians Miwok Mixe Modoc Mogollon ... Nation of Oklahoma Sac and Fox Tribe of Mississippi/Iowa Saginaw Chippewa Salish Salt River Indian Community ...

  13. 77 FR 48007 - Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-10

    ... Spending Projections Through 2020: Economic Recovery and Reform drive faster Spending Growth,'' Health..., ``The achievement of the vision of seamless electronic flow of information in a confidential and...

  14. Breast implant surveillance reports to the U.S. Food and Drug Administration: maternal-child health problems.

    PubMed

    Brown, S Lori; Todd, Joan Ferlo; Cope, Judith U; Sachs, Hari Cheryl

    2006-01-01

    There is continuing concern that women who receive breast implants may be at increased risk for adverse reproductive outcomes or experience problems with breastfeeding. It is unknown whether exposure to biomaterials in breast implants may have teratogenic effects or leach into breast milk causing postnatalproblems. We studied the Food and Drug Administration (FDA) experience by analyzing a case series of adverse event reports received and entered into the FDA's Manufacturer and User Facility Device Experience (MAUDE) database or the Device Experience Network (DEN) database by December 31, 2002 regarding women with breast implants. Reports were critically reviewed for lactation difficulties, reproductive problems (spontaneous abortion, delayed conception) and medical conditions among offspring, including neonatal, infant, and childhood diseases and congenital defects that were attributed to implants. We identified 339 reports that described maternal-child adverse events. Nearly half of these reports (46%) described actual problems with breastfeeding or expressed concern that implants would be unsafe or interfere with breastfeeding. Forty-four percent of reports (n=149) described either nonspecific or specific signs, symptoms, or illnesses in children. An additional 3.5% of reports (n=12) detailed a congenital anomaly believed by the reporter to be caused by breast implants.

  15. Community Needs Assessment for Office Administration and Technology Program: Health Unit Coordinator.

    ERIC Educational Resources Information Center

    Pezzoli, Jean A.; Johnson, Nancy; Lum, Kuuipo

    In order to determine the potential employment demand and skills needed for health unit coordinators and other clerical workers in the medical field, Maui Community College (MCC) in Hawaii conducted a survey of 120 local health care providers in the spring semester of 1998. Forty respondents provided MCC with the following details: (1) 92 percent…

  16. 76 FR 40457 - Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-08

    ... Prescription Drug Programs (NCPDP) Telecommunication standard Version 5.1, which are specified at 45 CFR part... 837 I Health care claims--Institutional. NCPDP D.0 Health care claims--Retail pharmacy drug. ASC X12.... NCPDP D.0 Coordination of Benefits--Retail pharmacy drug. ASC X12 837 D Coordination of...

  17. 5 CFR 5201.105 - Additional rules for Mine Safety and Health Administration employees.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... company or other person engaged in mining activities subject to the Federal Mine Safety and Health Act of 1977 (Mine Safety and Health Act), 30 U.S.C. 801 et seq. A company or other person shall be deemed to... another company or other person engaged in such mining activities. A company or other person shall not...

  18. The Healthcare Administrator’s Desk Reference: A Managed Care and Health Care Contracting Dictionary for the Military Health System

    DTIC Science & Technology

    1998-07-01

    Electrocardiogram ECP Engineering Change Proposal ECT Electroconvulsive Therapy EDI Electronic Data Interchange EEO Equal Employment Opportunity EEOC Equal...Administration OT Occupational Therapy OTC Over the Counter OTR Outpatient Treatment Record OTS Off the Shelf OTSG Office of the Surgeon General OWA...Standards Review Organization PT Physical Therapy PTMPY Per Thousand Members Per Year Desk Reference 85 Pub.Cont.L.J. Public Contract Law Journal PV 1

  19. Patient-centered medical home initiative produced modest economic results for Veterans Health Administration, 2010-12.

    PubMed

    Hebert, Paul L; Liu, Chuan-Fen; Wong, Edwin S; Hernandez, Susan E; Batten, Adam; Lo, Sophie; Lemon, Jaclyn M; Conrad, Douglas A; Grembowski, David; Nelson, Karin; Fihn, Stephan D

    2014-06-01

    In 2010 the Veterans Health Administration (VHA) began a nationwide initiative called Patient Aligned Care Teams (PACT) that reorganized care at all VHA primary care clinics in accordance with the patient-centered medical home model. We analyzed data for fiscal years 2003-12 to assess how trends in health care use and costs changed after the implementation of PACT. We found that PACT was associated with modest increases in primary care visits and with modest decreases in both hospitalizations for ambulatory care-sensitive conditions and outpatient visits with mental health specialists. We estimated that these changes avoided $596 million in costs, compared to the investment in PACT of $774 million, for a potential net loss of $178 million in the study period. Although PACT has not generated a positive return, it is still maturing, and trends in costs and use are favorable. Adopting patient-centered care does not appear to have been a major financial risk for the VHA.

  20. Dietary supplements and their future in health care: commentary on draft guidelines proposed by the Food and Drug Administration.

    PubMed

    Umhau, John C; Garg, Keva; Woodward, Albert M

    2012-03-01

    The Dietary Supplement and Health and Education Act of 1994 gives the U.S. Food and Drug Administration (FDA) responsibility for oversight of the dietary supplement industry. Recent draft guidelines proposed by the FDA to insure the safety of new dietary ingredients would significantly alter the ability of manufacturers to bring new dietary ingredients to market, and may cause many products introduced since 1994 to be discontinued. These changes will have an impact on health care, but with limited research on dietary supplements and how their use affects the health care system, there is no way to predict what their overall effect on health will be. Since the natural raw materials for dietary supplements are often inexpensive and generally cannot be patented, manufactures have little incentive to conduct the research which might otherwise be warranted. Appropriate clinical trials that evaluate the use and efficacy of various supplements may be critical for our health care system. If inexpensive dietary supplements are found to be safe and effective, such research could yield significant cost savings as well as health benefits.

  1. Legal Issues in School Health Services and School Psychology: Guidelines for the Administration of Medication

    ERIC Educational Resources Information Center

    Mazur-Mosiewicz, Anna; Pierson, Eric E.; McIntosh, David E.

    2009-01-01

    The use of psychoactive medications to augment behavioral and psychosocial interventions in schools has significantly increased within the last few decades. Yet, advising, administrating, and supervising the dispensation of medication (including psychostimulants and psychoactive substances) tend to be some of the most risky tasks of school…

  2. The Veterans Administration Experiments in Health Communications on the Applications Technology Satellite (ATS-6). Final Report.

    ERIC Educational Resources Information Center

    Caldwell, Kathryn S.

    Because many of the Veterans Administration hospitals in Appalachia are located great distances from medical teaching facilities, high powered communication satellites have been employed to facilitate quality two-way communication between medical personnel scattered throughout the region. To achieve diagnostic, therapeutic, and educational…

  3. 76 FR 55928 - Food and Drug Administration Health Professional Organizations Conference

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-09

    ... Organizations Conference AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public conference. The... Professional Organizations. Dr. Margaret Hamburg, Commissioner of the Food and Drugs, and Dr. Janet Woodcock... organization, address, and telephone number. There is no registration fee for this conference....

  4. 77 FR 72868 - The Centers for Disease Control (CDC)/Health Resources and Services Administration (HRSA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-06

    ... Resources and Services Administration (HRSA) Advisory Committee on HIV, Viral Hepatitis and STD Prevention... (Pub. L. 92-463) of October 6, 1972, that the CDC/HRSA Advisory Committee on HIV, Viral Hepatitis and...., Designated Federal Officer, CDC/HRSA Advisory Committee on HIV, Viral Hepatitis and STD Prevention...

  5. Sizing up the individual market for health insurance: a comparison of survey and administrative data sources.

    PubMed

    Abraham, Jean M; Karaca-Mandic, Pinar; Boudreaux, Michel

    2013-08-01

    Provisions within the Affordable Care Act, including the introduction of subsidized, Exchange-based coverage for lower income Americans lacking access to employer coverage, are expected to greatly expand the size and importance of the individual market. Using multiple federal surveys and administrative data from the National Association of Insurance Commissioners, we generate national-, regional-, and state-level estimates of the individual market. In 2009, the number of nonelderly persons with individual coverage ranged from 9.55 million in the Medical Expenditure Panel Survey to 25.3 million in the American Community Survey. Notable differences also exist between survey estimates and National Association of Insurance Commissioners administrative counts, an outcome likely driven by variation in the type and measurement of individual coverage considered by surveys relative to administrative data. Future research evaluating the impact of the Affordable Care Act coverage provisions must be mindful of differences across surveys and administrative sources as it relates to the measurement of individual market coverage.

  6. Development of a Risk Index for Serious Prescription Opioid‐Induced Respiratory Depression or Overdose in Veterans’ Health Administration Patients

    PubMed Central

    Xie, Lin; Wang, Li; Joyce, Andrew; Vick, Catherine; Brigham, Janet; Kariburyo, Furaha; Baser, Onur; Murrelle, Lenn

    2015-01-01

    Abstract Objective Develop a risk index to estimate the likelihood of life‐threatening respiratory depression or overdose among medical users of prescription opioids. Subjects, Design, and Methods A case‐control analysis of administrative health care data from the Veterans’ Health Administration identified 1,877,841 patients with a pharmacy record for an opioid prescription between October 1, 2010 and September 30, 2012. Overdose or serious opioid‐induced respiratory depression (OSORD) occurred in 817. Ten controls were selected per case (n = 8,170). Items for an OSORD risk index (RIOSORD) were selected through logistic regression modeling, with point values assigned to each predictor. Modeling of risk index scores produced predicted probabilities of OSORD; risk classes were defined by the predicted probability distribution. Results Fifteen variables most highly associated with OSORD were retained as items, including mental health disorders and pharmacotherapy; impaired drug metabolism or excretion; pulmonary disorders; specific opioid characteristics; and recent hospital visits. The average predicted probability of experiencing OSORD ranged from 3% in the lowest risk decile to 94% in the highest, with excellent agreement between predicted and observed incidence across risk classes. The model's C‐statistic was 0.88 and Hosmer–Lemeshow goodness‐of‐fit statistic 10.8 (P > 0.05). Conclusion RIOSORD performed well in identifying medical users of prescription opioids within the Veterans’ Health Administration at elevated risk of overdose or life‐threatening respiratory depression, those most likely to benefit from preventive interventions. This novel, clinically practical, risk index is intended to provide clinical decision support for safer pain management. It should be assessed, and refined as necessary, in a more generalizable population, and prospectively evaluated. PMID:26077738

  7. Glia Open Access Database (GOAD): A comprehensive gene expression encyclopedia of glia cells in health and disease.

    PubMed

    Holtman, Inge R; Noback, Michiel; Bijlsma, Marieke; Duong, Kim N; van der Geest, Marije A; Ketelaars, Peer T; Brouwer, Nieske; Vainchtein, Ilia D; Eggen, Bart J L; Boddeke, Hendrikus W G M

    2015-09-01

    Recently, the number of genome-wide transcriptome profiles of pure populations of glia cells has drastically increased, resulting in an unprecedented amount of data that offer opportunities to study glia phenotypes and functions in health and disease. To make genome-wide transcriptome data easily accessible, we developed the Glia Open Access Database (GOAD), available via www.goad.education. GOAD contains a collection of previously published and unpublished transcriptome data, including datasets from isolated microglia, astrocytes and oligodendrocytes both at homeostatic and pathological conditions. It contains an intuitive web-based interface that consists of three features that enable searching, browsing, analyzing, and downloading of the data. The first feature is differential gene expression (DE) analysis that provides genes that are significantly up and down-regulated with the associated fold changes and p-values between two conditions of interest. In addition, an interactive Venn diagram is generated to illustrate the overlap and differences between several DE gene lists. The second feature is quantitative gene expression (QE) analysis, to investigate which genes are expressed in a particular glial cell type and to what degree. The third feature is a search utility, which can be used to find a gene of interest and depict its expression in all available expression data sets by generating a gene card. In addition, quality guidelines and relevant concepts for transcriptome analysis are discussed. Finally, GOAD is discussed in relation to several online transcriptome tools developed in neuroscience and immunology. In conclusion, GOAD is a unique platform to facilitate integration of bioinformatics in glia biology.

  8. Surgical Approach and Anesthetic Modality for Carpal Tunnel Release: A Nationwide Database Study With Health Care Cost Implications.

    PubMed

    Foster, Brock D; Sivasundaram, Lakshmanan; Heckmann, Nathanael; Cohen, Jeremiah R; Pannell, William C; Wang, Jeffrey C; Ghiassi, Alidad

    2017-03-01

    Background: Carpal tunnel release (CTR) is commonly performed for carpal tunnel syndrome once conservative treatment has failed. Operative technique and anesthetic modality vary by surgeon preference and patient factors. However, CTR practices and anesthetic trends have, to date, not been described on a nationwide scale in the United States. Methods: The PearlDiver Patient Records Database was used to search Current Procedural Terminology codes for elective CTR from 2007 to 2011. Anesthetic modality (eg, general and regional anesthesia vs local anesthesia) and surgical approach (eg, endoscopic vs open) were recorded for this patient population. Cost analysis, patient demographics, regional variation, and annual changes in CTR surgery were evaluated. Results: We identified 86 687 patients who underwent carpal tunnel surgery during this 5-year time period. In this patient sample, 80.5% of CTR procedures were performed using general or regional anesthesia, compared with 19.5% of procedures performed using local anesthesia; 83.9% of all CTR were performed in an open fashion, and 16.1% were performed using an endoscopic technique. Endoscopic surgery was on average $794 more expensive than open surgery, and general or regional anesthesia was $654 more costly than local anesthesia. Conclusions: In the United States, open CTR under local anesthesia is the most cost-effective way to perform a CTR. However, only a small fraction of elective CTR procedures are performed with this technique, representing a potential area for significant health care cost savings. In addition, regional and age variations exist in procedure and anesthetic type utilized.

  9. Antipsychotic monotherapy among outpatients with schizophrenia treated with olanzapine or risperidone in Japan: a health care database analysis

    PubMed Central

    Ye, Wenyu; Ascher-Svanum, Haya; Tanji, Yuka; Flynn, Jennifer A; Takahashi, Michihiro; Conley, Robert R

    2012-01-01

    Purpose Antipsychotic monotherapy is often recommended over antipsychotic polypharmacy because of fewer adverse events, reduced treatment complexity, and lower medication cost. This study compared the rate and the duration of antipsychotic monotherapy following initiation of olanzapine or risperidone in the treatment of outpatients with schizophrenia in Japan. Methods Outpatients diagnosed with schizophrenia in the Japan Medical Data Center database were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision, diagnosis codes. Patients were between 20 and 65 years old, initiated on olanzapine or risperidone therapy between August 2003 and July 2008, and continuously enrolled during the 6 months prior to and the 12 months following the initiation date. Antipsychotic polypharmacy was defined as concurrent use of two or more antipsychotics. The probability of monotherapy during the 12-month follow-up period was assessed using a propensity score-adjusted generalized estimating equation model. Duration of monotherapy was contrasted using a propensity score-adjusted bootstrapping model. Results After applying all inclusion and exclusion criteria, the final analytic sample consisted of 332 olanzapine- and 496 risperidone-treated outpatients. At treatment initiation, 61.5% of the olanzapine-treated patients and 45.6% of the risperidone-treated patients received antipsychotic monotherapy (P < 0.001). After correcting for background differences, monotherapy was more common among olanzapine-treated patients (P = 0.001). In addition, olanzapine was used as monotherapy for a longer duration (P = 0.006). Conclusion Consistent with prior global research, this retrospective naturalistic study of schizophrenia outpatients in Japan found that olanzapine is more likely to be used as monotherapy and to be used as monotherapy for a longer duration than risperidone. PMID:22745559

  10. Health informatics and analytics - building a program to integrate business analytics across clinical and administrative disciplines.

    PubMed

    Tremblay, Monica Chiarini; Deckard, Gloria J; Klein, Richard

    2016-07-01

    Health care organizations must develop integrated health information systems to respond to the numerous government mandates driving the movement toward reimbursement models emphasizing value-based and accountable care. Success in this transition requires integrated data analytics, supported by the combination of health informatics, interoperability, business process design, and advanced decision support tools. This case study presents the development of a master's level cross- and multidisciplinary informatics program offered through a business school. The program provides students from diverse backgrounds with the knowledge, leadership, and practical application skills of health informatics, information systems, and data analytics that bridge the interests of clinical and nonclinical professionals. This case presents the actions taken and challenges encountered in navigating intra-university politics, specifying curriculum, recruiting the requisite interdisciplinary faculty, innovating the educational format, managing students with diverse educational and professional backgrounds, and balancing multiple accreditation agencies.

  11. 78 FR 14303 - Statement of Delegation of Authority; Health Resources and Services Administration and Centers...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-05

    ... Services under Title III, Part R, Section 399BB, titled ``Autism, Education, Early Detection, and Intervention,'' of the Public Health Service (PHS) Act, as amended, insofar as such authority pertains to...

  12. Maternal and Child Health Block Grant: Program Changes Emerging under State Administration.

    DTIC Science & Technology

    1984-05-07

    services and reducing repeat pregnancies among teen -" agers. From 1981 to 1983, funding for this project declined from about $175,000 to $147,000. As a...Pennsylvania reported 1981 adolescent pregnancy expend- itures as part of its maternal and child health services ex- penditures, comparing 1983...D-R14l 168 MATERNAL AND CHILD HEALTH BLOCK GRANT: PROGRAM CHANGES 112 UN _ EMERGING UNDER STATE ADMINISTRRTION(U) GENERAL R CCOUNTING OFFICE

  13. Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians.

    PubMed

    Erickson, Shari M; Rockwern, Brooke; Koltov, Michelle; McLean, Robert

    2017-03-28

    This American College of Physicians (ACP) position paper, initiated and written by ACP's Medical Practice and Quality Committee and approved by the Board of Regents on 21 January 2017, reports policy recommendations to address the issue of administrative tasks to mitigate or eliminate their adverse effects on physicians, their patients, and the health care system as a whole. The paper outlines a cohesive framework for analyzing administrative tasks through several lenses to better understand any given task that a clinician and his or her staff may be required to perform. In addition, a scoping literature review and environmental scan were done to assess the effects on physician time, practice and system cost, and patient care due to the increase in administrative tasks. The findings from the scoping review, in addition to the framework, provide the backbone of detailed policy recommendations from the ACP to external stakeholders (such as payers, governmental oversight organizations, and vendors) regarding how any given administrative requirement, regulation, or program should be assessed, then potentially revised or removed entirely.

  14. A case study of early experience with implementation of collaborative care in the Veterans Health Administration.

    PubMed

    Tai-Seale, Ming; Kunik, Mark E; Shepherd, Alexandra; Kirchner, JoAnn; Gottumukkala, Aruna

    2010-12-01

    Primary care remains critically important for those who suffer from mental disorders. Although collaborative care, which integrates mental health services into primary care, has been shown to be more effective than usual care, its implementation has been slow and the experience of providers and patients with collaborative care is less well known. The objective of this case study was to examine the effects of collaborative care on patient and primary care provider (PCP) experiences and communication during clinical encounters. Participating physicians completed a self-administered visit reconstruction questionnaire in which they logged details of patient visits and described their perceptions of the visits and the influence of collaborative care. Audio recordings of visits were analyzed to assess the extent of discussion about colocated mental health services and visit time devoted to mental health topics. The main outcome measures were the extent of discussion and recommendation for collaborative care during clinical visits and providers' experiences based on their responses to the visit reconstruction questionnaire. Providers surveyed expressed enthusiasm about collaborative care and cited the time constraint of office visits and lack of specialty support as the main reasons for limiting their discussion of mental health topics with patients. Despite the availability of mental health providers at the same clinic, PCPs missed many opportunities to address mental health issues with their patients. Ongoing education for PCPs regarding how to conduct a "warm handoff" to colocated providers will need to be an integral part of the implementation of collaborative care.

  15. Provider practices in the primary care behavioral health (PCBH) model: an initial examination in the Veterans Health Administration and United States Air Force.

    PubMed

    Funderburk, Jennifer S; Dobmeyer, Anne C; Hunter, Christopher L; Walsh, Christine O; Maisto, Stephen A

    2013-12-01

    The goals of this study were to identify characteristics of both behavioral health providers (BHPs) and the patients seen in a primary care behavioral health (PCBH) model of service delivery using prospective data obtained from BHPs. A secondary objective was to explore similarities and differences between these variables within the Veterans Health Administration (VHA) and United States Air Force (USAF) primary care clinics. A total of 159 VHA and 23 USAF BHPs, representing almost every state in the United States, completed the study, yielding data from 403 patient appointments. BHPs completed a web-based questionnaire that assessed BHP and setting characteristics, and a separate questionnaire after each patient seen on one day of clinical service. Data demonstrated that there are many similarities between the VHA and USAF BHPs and practices. Both systems tend to use well-trained psychologists as BHPs, had systems that support the BHP being in close proximity to the primary care providers, and have seamless operational elements (i.e., shared record, one waiting room, same-day appointments, and administrative support for BHPs). Comorbid anxiety and depression was the most common presenting problem in both systems, but overall rates were higher in VHA clinics, and patients were significantly more likely to meet diagnostic criteria for mental health conditions. This study provides the first systematic, prospective examination of BHPs and practices within a PCBH model of service delivery in two large health systems with well over 5 years of experience with behavioral health integration. Many elements of the PCBH model were implemented in a manner consistent with the model, although some variability exists within both settings. These data can help guide future implementation and training efforts.

  16. An Evaluation of a Quality Assessment Tool for Health Care Administrators at Brooke Army Medical Center

    DTIC Science & Technology

    1986-07-23

    facing the administrator in the assessment of quality of I care is that, in most cases, the assessment must be based on clinical knowledge and judgement ...With that, it becomes clear that the care provided can be divided into two areas, the technical ("science") and the interpersonal ("art") (18). The...34great search." He proposes the interpersonal aspect of the healing encounter be defined and evaluated based on societal values and norms. He also

  17. Djeen (Database for Joomla!’s Extensible Engine): a research information management system for flexible multi-technology project administration

    PubMed Central

    2013-01-01

    Background With the advance of post-genomic technologies, the need for tools to manage large scale data in biology becomes more pressing. This involves annotating and storing data securely, as well as granting permissions flexibly with several technologies (all array types, flow cytometry, proteomics) for collaborative work and data sharing. This task is not easily achieved with most systems available today. Findings We developed Djeen (Database for Joomla!’s Extensible Engine), a new Research Information Management System (RIMS) for collaborative projects. Djeen is a user-friendly application, designed to streamline data storage and annotation collaboratively. Its database model, kept simple, is compliant with most technologies and allows storing and managing of heterogeneous data with the same system. Advanced permissions are managed through different roles. Templates allow Minimum Information (MI) compliance. Conclusion Djeen allows managing project associated with heterogeneous data types while enforcing annotation integrity and minimum information. Projects are managed within a hierarchy and user permissions are finely-grained for each project, user and group. Djeen Component source code (version 1.5.1) and installation documentation are available under CeCILL license from http://sourceforge.net/projects/djeen/files and supplementary material. PMID:23742665

  18. Using the AHRQ PSIs to Detect Post-Discharge Adverse Events in the Veterans Health Administration

    PubMed Central

    Mull, Hillary J.; Borzecki, Ann M.; Chen, Qi; Shin, Marlena H.; Rosen, Amy K.

    2015-01-01

    Background PSIs use inpatient administrative data to flag cases with potentially preventable adverse events (AEs) attributable to hospital care. We explored how many AEs the PSIs identified in the 30 days post-discharge. Methods We ran the PSI software (version 3.1a) on VA 2003–2007 administrative data for ten recently validated PSIs. Among PSI-eligible index hospitalizations not flagged with an AE, we evaluated how many AEs occurred within 1–14 and 15–30 days post-discharge using inpatient and outpatient administrative data. Results Considering all PSI-eligible index hospitalizations, we identified 11,141 post-discharge AEs, compared to 40,578 inpatient-flagged AEs. More than 60% of post-discharge AEs were detected within 14 days of discharge. The majority of post-discharge AEs were decubitus ulcers and postoperative pulmonary embolisms or deep vein thromboses. Conclusions Extending PSI algorithms to the post-discharge period may provide a more complete picture of hospital quality. Future work should use chart review to validate post-discharge PSI events. PMID:23939485

  19. Merging the Military Health System (MHS) and the Veterans Health Administration (VHA) into a Single Governance Structure

    DTIC Science & Technology

    2008-04-07

    Surgery, and Otolaryngology. All CRDAMC’s programs remain fully accredited by the Accreditation Council for Graduate Medical Education (ACGME). 55 The...also develops Military Health System (MHS) initiatives to improve the quality of healthcare across the DoD and prepares the DoD healthcare budget.12...and retention, the Services provide education , leadership development, and other training programs to support MHS needs.15 DoD Healthcare Plan

  20. Administrative Data and the Manitoba Centre for Health Policy: Some Reflections

    PubMed Central

    Roos, Noralou P.; Roos, Leslie L.; Freemantle, Jane

    2011-01-01

    The authors review their 30 years' experience in determining the best research applications for routinely collected data from ministries of health, education and social services. They describe the rich research opportunities afforded by 40 years of data on health – i.e., every patient contact with hospitals, physicians, drugs and more – from the problems encountered in convincing an academic journal that meaningful findings could be culled from information collected on paying bills and tracking patients, through studies on education (enrolment, grades, standardized tests for grades 1 to 12), family characteristics (residential moves, marital formation and breakdown, number and timing of births) and social services (welfare recipients, children taken into care, protection services offered children in the family). They also detail how and why the Manitoba Centre for Health Policy was founded, and how it has continued through multiple ministerial, deputy and government changes. PMID:24933370

  1. The use of databases and registries to enhance colonoscopy quality.

    PubMed

    Logan, Judith R; Lieberman, David A

    2010-10-01

    Administrative databases, registries, and clinical databases are designed for different purposes and therefore have different advantages and disadvantages in providing data for enhancing quality. Administrative databases provide the advantages of size, availability, and generalizability, but are subject to constraints inherent in the coding systems used and from data collection methods optimized for billing. Registries are designed for research and quality reporting but require significant investment from participants for secondary data collection and quality control. Electronic health records contain all of the data needed for quality research and measurement, but that data is too often locked in narrative text and unavailable for analysis. National mandates for electronic health record implementation and functionality will likely change this landscape in the near future.

  2. EPA Administrator Announces New Report on Impacts of Climate Change on Public Health

    EPA Pesticide Factsheets

    Today, on the first day of National Public Health Week, EPA and seven other federal agencies, as well as the White House Office of Science and Technology Policy, are releasing a new report summarizing the growing understanding of how climate change is affe

  3. The Impact of Word Processing on Office Administration in the Medical and Allied Health Professions.

    ERIC Educational Resources Information Center

    Platt, Naomi Dornfeld

    The effect of word processing equipment on the future medical secretarial science curriculum was studied. A literature search focused on word processing and the medical and allied health professions, word processing and business education, and futuring of and changes in the secretarial science curriculum. Questionnaires to identify various aspects…

  4. 78 FR 44574 - Third Annual Food and Drug Administration Health Professional Organizations Conference

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-24

    ... (public/private partnerships), and a FDA Town Hall. The FDA Town Hall will feature FDA senior executives...), Silver Spring, MD 20993-0002. Entrance for the public meeting participants (non-FDA employees) is through... public health mission of the FDA through training, collaboration, and structured discussion...

  5. Guidelines for health surveillance in the NASA (National Aeronautics and Space Administration) workplace

    NASA Technical Reports Server (NTRS)

    1984-01-01

    The adequacy of biomedical data sheets used by the NASA medical staff for NASA employees and contractors was assessed. Procedures for developing medical histories, conducting medical examinations, and collecting toxicity data were reviewed. Recommendations for employee health maintenance and early detection of work-related abnormalities are given.

  6. 75 FR 42105 - Memorandum of Understanding: Food and Drug Administration and the National Institutes of Health...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-20

    ... Toxicology Program; and the National Institutes of Health, National Human Genome Research Institute, National... Program (NTP); and the NIH, National Human Genome Research Institute (NHGRI), NIH Chemical Genomics Center... phylogenetically lower animal species (e.g., fish, worms), as well as high throughput whole genome...

  7. MOVE: weight management program across the veterans health administration: patient- and facility-level predictors of utilization

    PubMed Central

    2013-01-01

    Background Health care systems initiating major behavioral health programs often face challenges with variable implementation and uneven patient engagement. One large health care system, Veterans Health Administration (VHA), recently initiated the MOVE!® Weight Management Program, but it is unclear if veterans most in need of MOVE!® services are accessing them. The purpose of this study was to examine patient and facility factors associated with MOVE!® utilization (defined as 1 or more visits) across all VHA facilities. Methods Using national administrative data in a retrospective cohort study of eligible overweight (25 < = body mass index (BMI) < 30 and at least one obesity associated comorbidity) and obese (BMI > =30) VHA outpatients, we examined variation in and predictors of MOVE!® utilization in fiscal year (FY) 2010 using generalized linear mixed models. Results 4.39% (n = 90,230) of all eligible overweight and obese patients using VHA services utilized MOVE!® services at least once in FY 2010. Facility-level MOVE! Utilization rates ranged from 0.05% to 16%. Veterans were more likely to have at least one MOVE!® visit if they had a higher BMI, were female, unmarried, younger, a minority, or had a psychiatric or obesity-related comorbidity. Conclusions Although substantial variation exists across VHA facilities in MOVE!® utilization rates, Veterans most in need of obesity management services were more likely to access MOVE!®, although at a low level. However, there may still be many Veterans who might benefit but are not accessing these services. More research is needed to examine the barriers and facilitators of MOVE!® utilization, particularly in facilities with unusually high and low reach. PMID:24325730

  8. Strategy for Coordinated EPA/Occupational Safety and Health Administration (OSHA) Implementation of the Chemical Accident Prevention Requirements of the Clean Air Act Amendments of 1990

    EPA Pesticide Factsheets

    EPA and the Occupational Safety and Health Administration (OSHA) share responsibility for prevention: OSHA has the Process Safety Management Standard to protect workers, and EPA the Risk Management Program to protect the general public and environment.

  9. The medical care programs of the Farm Security Administration, 1932 through 1947: a rehearsal for national health insurance?

    PubMed Central

    Grey, M R

    1994-01-01

    At a time of renewed interest in universal health insurance, an examination of earlier periods when society grappled with the link between socioeconomic status and health is fruitful. Between 1935 and 1947, the federal government sponsored a comprehensive medical care program for low-income farmers, sharecroppers, and migrant workers under the auspices of the Farm Security Administration (FSA). Despite the strong opposition of the American Medical Association, humanitarian and economic concerns at the local level often promoted physicians' participation in the program's group prepayment plans. Many FSA leaders clearly saw the program as a model upon which national health insurance might advance. However, in the wake of World War II, the FSA program declined as physicians' income improved, the rural population declined, and traditional ideological objections to federal intervention in medical care resurfaced. The FSA experience illuminates the complex ideological, economic, and humanitarian motivations of American physicians in the face of health care reform. Images p1680-a p1682-a p1684-a PMID:7943497

  10. Rationale, Procedures, and Response Rates for the 2015 Administration of NCI's Health Information National Trends Survey: HINTS-FDA 2015.

    PubMed

    Blake, Kelly D; Portnoy, David B; Kaufman, Annette R; Lin, Chung-Tung Jordan; Lo, Serena C; Backlund, Eric; Cantor, David; Hicks, Lloyd; Lin, Amy; Caporaso, Andrew; Davis, Terisa; Moser, Richard P; Hesse, Bradford W

    2016-12-01

    The National Cancer Institute (NCI) developed the Health Information National Trends Survey (HINTS) to monitor population trends in cancer communication practices, information preferences, health risk behaviors, attitudes, and cancer knowledge. The U.S. Food and Drug Administration (FDA) recognized HINTS as a unique data resource for informing its health communication endeavors and partnered with NCI to field HINTS-FDA 2015. HINTS-FDA 2015 was a self-administered paper instrument sent by mail May 29 to September 8, 2015, using a random probability-based sample of U.S. postal addresses stratified by county-level smoking rates, with an oversampling of high and medium-high smoking strata to increase the yield of current smokers responding to the survey. The response rate for HINTS-FDA 2015 was 33% (N = 3,738). The yield of current smokers (n = 495) was lower than expected, but the sampling strategy achieved the goal of obtaining more former smokers (n = 1,132). Public-use HINTS-FDA 2015 data and supporting documentation have been available for download and secondary data analyses since June 2016 at http://hints.cancer.gov . NCI and FDA encourage the use of HINTS-FDA for health communication research and practice related to tobacco-related communications, public knowledge, and behaviors as well as beliefs and actions related to medical products and dietary supplements.

  11. Information requirements of the National Aeronautics and Space Administration's safety, environmental health, and occupational medicine programs

    NASA Technical Reports Server (NTRS)

    Whyte, A. A.

    1978-01-01

    A survey of the internal and external reporting and recordkeeping procedures of these programs was conducted and the major problems associated with them are outlined. The impact of probable future requirements on existing information systems is evaluated. This report also presents the benefits of combining the safety and health information systems into one computerized system and recommendations for the development and scope of that system.

  12. Medicare and Medicaid; miscellaneous amendments--Health Care Financing Administration. Interim final rules with comment period.

    PubMed

    1982-10-26

    These regulations modify the rules pertaining to compliance with a Life Safety Code, participation of home health agencies (HHA's) in Medicare, and establishment and review of plans of treatment for home health services and outpatient speech pathology services. The changes are necessary to implement several provisions of the Omnibus Reconciliation Act of 1980. The intent of the statutory amendments is (1) to eliminate outdated Life Safety Code requirements imposed on skilled nursing facilities (SNFs); (2) to make it easier for providers of outpatient speech pathology (OSP) services to meet the plan of treatment requirement; (3) to expand the sources of home health services and foster competition; (4) to make it easier for HHAs to meet certification and plan of treatment requirements, while guarding against conflict of interest in the performance of those functions. The amended regulations extend the fire safety code provisions to all hospitals and SNFs under Medicaid as well as Medicare, and to intermediate care facilities (ICFs) under Medicaid. Our purpose is to keep Medicaid rules consistent with the Medicare rules in this area.

  13. Effects of post-partum administration of ketoprofen on sow health and piglet growth.

    PubMed

    Viitasaari, Elina; Hänninen, Laura; Heinonen, Mari; Raekallio, Marja; Orro, Toomas; Peltoniemi, Olli; Valros, Anna

    2013-10-01

    The effect of the non-steroidal anti-inflammatory drug ketoprofen on the post farrowing phase of sows was studied in a randomized, blinded, placebo-controlled trial. Ketoprofen (3mg/kg) was administered intramuscularly to 20 healthy sows for 3 days post-partum (p.p.). The control group (n=20) received a saline placebo. Backfat, number of days of constipation and days before feed refusal were measured. Body condition (BCS) and shoulder sores were scored for 1 week p.p. Changes in BCS, backfat and shoulder sore scores were analysed with ANOVA. Blood was collected on days -1, 0, 5 and 14 with respect to medication. Aspartate aminotransferase (AST), creatinine kinase (CK), haptoglobin and serum amyloid A (SAA) were quantified and analysed with a Mann-Whitney U test. BCS and backfat decreased less following ketoprofen administration than with the placebo (-0.08 ± 0.2 vs. -0.8 ± 0.2, 1.0 ± 0.8mm vs. -2.0 ± 0.9 mm, respectively; P<0.05 for both) during the first 2 weeks of lactation. The shoulder sore score deterioration was milder during days 4-6 p.p. with ketoprofen than placebo (P<0.05). Duration of constipation was shorter with ketoprofen than placebo (5.5 ± 0.3 vs. 6.4 ± 0.3 days p.p.; P<0.05). Incidences of feed refusal occurred later in the ketoprofen group than in the placebos (9.6 ± 0.9 vs. 3.8 ± 0.8 days p.p.; P<0.05). AST and SAA values were higher after ketoprofen administration than placebo on day 5 p.p. (P<0.05). It was concluded that ketoprofen appeared to benefit sows during the first 2 weeks post farrowing, but caused some tissue irritation.

  14. Agreement on nutrient intake between the databases of the First National Health and Nutrition Examination Survey and the ESHA Food Processor.

    PubMed

    Bazzano, Lydia A; He, Jiang; Ogden, Lorraine G; Loria, Catherine M; Vupputuri, Suma; Myers, Leann; Whelton, Paul K

    2002-07-01

    The objective of this study was to assess agreement on nutrient intake between the nutrient database of the First National Health and Nutrition Examination Survey (NHANES I) and an up-to-date (December 1998) nutrient database, the ESHA Food Processor. Analysis was conducted among 11,303 NHANES I participants aged 25-74 years in 1971-1975 who had undergone dietary assessment. A list of all unique foods consumed was obtained from a single 24-hour dietary recall questionnaire administered during the baseline NHANES I visit. Foods on the list were matched to foods in the ESHA Food Processor software. Agreement between participants' nutrient intakes as calculated with the NHANES I and ESHA nutrient databases was assessed using intraclass correlation analysis, linear regression analysis, and graphic methods. Intraclass correlation analysis demonstrated excellent concordance between most nutrient intakes, with coefficients above 0.95 for intakes of energy, carbohydrates, protein, cholesterol, and calcium; coefficients between 0.90 and 0.95 for intakes of total fat, saturated fat, potassium, and vitamin C; and coefficients of approximately 0.85 for intakes of sodium and vitamin A. Graphic methods and regression analyses also showed good-to-excellent correspondence for most nutrients. These findings support the validity of expanding existing nutrient intake databases to explore current hypotheses, provided that food formulation, enrichment, and fortification practices have not changed substantially over time.

  15. Reproducibility, reliability and validity of population-based administrative health data for the assessment of cancer non-related comorbidities

    PubMed Central

    Fowler, Helen

    2017-01-01

    Background Patients with comorbidities do not receive optimal treatment for their cancer, leading to lower cancer survival. Information on individual comorbidities is not straightforward to derive from population-based administrative health datasets. We described the development of a reproducible algorithm to extract the individual Charlson index comorbidities from such data. We illustrated the algorithm with 1,789 laryngeal cancer patients diagnosed in England in 2013. We aimed to clearly set out and advocate the time-related assumptions specified in the algorithm by providing empirical evidence for them. Methods Comorbidities were assessed from hospital records in the ten years preceding cancer diagnosis and internal reliability of the hospital records was checked. Data were right-truncated 6 or 12 months prior to cancer diagnosis to avoid inclusion of potentially cancer-related comorbidities. We tested for collider bias using Cox regression. Results Our administrative data showed weak to moderate internal reliability to identify comorbidities (ICC ranging between 0.1 and 0.6) but a notably high external validity (86.3%). We showed a reverse protective effect of non-cancer related Chronic Obstructive Pulmonary Disease (COPD) when the effect is split into cancer and non-cancer related COPD (Age-adjusted HR: 0.95, 95% CI:0.7–1.28 for non-cancer related comorbidities). Furthermore, we showed that a window of 6 years before diagnosis is an optimal period for the assessment of comorbidities. Conclusion To formulate a robust approach for assessing common comorbidities, it is important that assumptions made are explicitly stated and empirically proven. We provide a transparent and consistent approach useful to researchers looking to assess comorbidities for cancer patients using administrative health data. PMID:28263996

  16. Biofuel Database

    National Institute of Standards and Technology Data Gateway

    Biofuel Database (Web, free access)   This database brings together structural, biological, and thermodynamic data for enzymes that are either in current use or are being considered for use in the production of biofuels.

  17. Moving From Discovery to System-Wide Change: The Role of Research in a Learning Health Care System: Experience from Three Decades of Health Systems Research in the Veterans Health Administration.

    PubMed

    Atkins, David; Kilbourne, Amy M; Shulkin, David

    2017-03-20

    The Veterans Health Administration is unique, functioning as an integrated health care system that provides care to more than six million veterans annually and as a home to an established scientific enterprise that conducts more than $1 billion of research each year. The presence of research, spanning the continuum from basic health services to translational research, has helped the Department of Veterans Affairs (VA) realize the potential of a learning health care system and has contributed to significant improvements in clinical quality over the past two decades. It has also illustrated distinct pathways by which research influences clinical care and policy and has provided lessons on challenges in translating research into practice on a national scale. These lessons are increasingly relevant to other health care systems, as the issues confronting the VA-the need to provide timely access, coordination of care, and consistent high quality across a diverse system-mirror those of the larger US health care system.

  18. Occupational Safety and Health Administration--Access to employee exposure and medical records. Final rule.

    PubMed

    1980-05-23

    This final occupational safety and health standard, promulgated today as a revised 29 CFR 1910.20, provides for employee, designated representative, and OSHA access to employer-maintained exposure and medical records relevant to employees exposed to toxic substances and harmful physical agents. Access is also assured to employer analyses using exposure and medical records. The final standard requires long term preservation of these records, contains provisions concerning informing employees of their rights under the standard, and includes provisions protective of trade secret information.

  19. [Health care reform in the Obama administration: difficulties of reaching a similar agreement in Argentina].

    PubMed

    Belmartino, Susana

    2014-04-01

    This article presents a comparative analysis of the processes leading to health care reform in Argentina and in the USA. The core of the analysis centers on the ideological references utilized by advocates of the reform and the decision-making processes that support or undercut such proposals. The analysis begins with a historical summary of the issue in each country. The political process that led to the sanction of the Obama reform is then described. The text defends a hypothesis aiming to show that deficiencies in the institutional capacities of Argentina's decision-making bodies are a severe obstacle to attaining substantial changes in this area within the country.

  20. Administration of Coagulation-Altering Therapy in the Patient Presenting for Oral Health and Maxillofacial Surgery.

    PubMed

    Halaszynski, Thomas M

    2016-11-01

    Oral health care providers are concerned with how to manage patients prescribed coagulation-altering therapy during the perioperative/periprocedural period for dental and oral surgery interventions. Management and recommendation can be based on medication pharmacology and the clinical relevance of coagulation factor levels/deficiencies. Caution should be used with concurrent use of medications that affect other components of the clotting mechanisms; prompt diagnosis and any necessary intervention to optimize outcome is warranted. However, evidence-based data on management of anticoagulation therapy during oral and maxillofacial surgery/interventions is lacking. Therefore, clinical understanding and judgment are needed along with appropriate guidelines matching patient- and intervention-specific recommendations.

  1. Patient, hospital, and local health system characteristics associated with the use of observation stays in veterans health administration hospitals, 2005 to 2012

    PubMed Central

    Wright, Brad; O'Shea, Amy M.J.; Glasgow, Justin M.; Ayyagari, Padmaja; Vaughan-Sarrazin, Mary

    2016-01-01

    Abstract Recent studies have documented that a significant increase in the use of observation stays along with extensive variation in patterns of use across hospitals. The objective of this longitudinal observational study was to examine the extent to which patient, hospital, and local health system characteristics explain variation in observation stay rates across Veterans Health Administration (VHA) hospitals. Our data came from years 2005 to 2012 of the nationwide VHA Medical SAS inpatient and enrollment files, American Hospital Association Survey, and Area Health Resource File. We used these data to estimate linear regression models of hospitals’ observation stay rates as a function of hospital, patient, and local health system characteristics, while controlling for time trends and Veterans Integrated Service Network level fixed effects. We found that observation stay rates are inversely related to hospital bed size and that hospitals with a greater proportion of younger or rural patients have higher observation stay rates. Observation stay rates were nearly 15 percentage points higher in 2012 than 2005. Although we identify several characteristics associated with variation in VHA hospital observation stay rates, many factors remain unmeasured. PMID:27603391

  2. Measuring Sustainability within the Veterans Administration Mental Health System Redesign Initiative

    PubMed Central

    Ford, James H.; Krahn, Dean; Wise, Meg; Oliver, Karen Anderson

    2011-01-01

    Objective To examine how attributes affecting sustainability differ across VHA organizational components and by staff characteristics. Subjects Surveys of 870 change team members and 50 staff interviews within the VA’s Mental Health System Redesign initiative. Methods A one-way ANOVA with a Tukey post-hoc test examined differences in sustainability by VISN, job classification, and tenure from staff survey data of the Sustainability Index. Qualitative interviews used an iterative process to identify “a priori” and “in vivo” themes. A simple stepwise linear regression explored predictors of sustainability. Results Sustainability differed across VISN and staff tenure. Job classification differences existed for: 1) Benefits and Credibility of the change and 2) staff involvement and attitudes toward change. Sustainability barriers were: staff and institutional resistance, and non-supportive leadership. Facilitators were: commitment to veterans, strong leadership, and use of QI Tools. Sustainability predictors were outcomes tracking, regular reporting, and use of PDSA cycles. Conclusions Creating homogeneous implementation and sustainability processes across a national health system is difficult. Despite the VA’s best evidence-based implementation efforts, there was significant variance. Locally tailored interventions might better support sustainability than “one-size-fits all” approaches. Further research is needed to understand how participation in a QI collaborative affects sustainability. PMID:21971024

  3. Job strain and family well-being among public health nurses in Bangkok metropolitan administration, Thailand.

    PubMed

    Jirapongsuwan, Ann; Likitpornswan, Orawan; Triamchaisri, Somporn K; Chandanasotthi, Pimsupa

    2012-07-01

    This study aimed to examine job strain and family well-being among public health nurses. A total of 239 public health nurses participated in the study. Data were collected using a questionnaire. One-way ANOVA and Pearson's correlation coefficients were used to assess the association of each factor with family well-being. It was found that there was a correlation between job strain and family well-being. Individual and family factors were also associated with family well-being. In all, 67% of nurses had a high rating for family well-being. A large portion of nurses belonged to the category of "active job" (51.5%). More than 50% of nurses were exposed to high "job demand" and 97.5% were in high "job control." The study suggests that nurses should be promoted with the ability to be in authority and display decision-making skills and should receive support and encouragement from supervisors and coworkers in order to improve family well-being.

  4. On the value of environmental stewardship and sustainability in health administration education.

    PubMed

    Verderber, Stephen; Fauerbach, Julia; Walter, Brandon

    2008-01-01

    Global warming, the depletion of the world'snatural resources, and excessive consumer consumption in developed countries are determinants reshaping the way we live our everyday lives. These factors are rapidly giving rise to new ecological paradigms of environmental stewardship and in healthcare environments that express sustainable theories and practices. This has given rise to a systematic system for promoting and assessing the energy performance and efficiency of healthcare facilities known as Leadership in Energy Efficient Environmental Design (LEED), and a parallel certification program, the Green Guide for Heath Care. These developments are examined in direct relation to the functions of managerial ethics. A series of ten sustainability-based ethical dilemmas are presented. Each is examined in relation to the need to inculcate in future healthcare administrators a critical understanding and appreciation of the need to reposition contemporary healthcare organizations at the center--as leading civic participants and role models in relation to the emerging movement towards carbon neutrality in the healthcare industry.

  5. The Online Bioinformatics Resources Collection at the University of Pittsburgh Health Sciences Library System—a one-stop gateway to online bioinformatics databases and software tools

    PubMed Central

    Chen, Yi-Bu; Chattopadhyay, Ansuman; Bergen, Phillip; Gadd, Cynthia; Tannery, Nancy

    2007-01-01

    To bridge the gap between the rising information needs of biological and medical researchers and the rapidly growing number of online bioinformatics resources, we have created the Online Bioinformatics Resources Collection (OBRC) at the Health Sciences Library System (HSLS) at the University of Pittsburgh. The OBRC, containing 1542 major online bioinformatics databases and software tools, was constructed using the HSLS content management system built on the Zope® Web application server. To enhance the output of search results, we further implemented the Vivísimo Clustering Engine®, which automatically organizes the search results into categories created dynamically based on the textual information of the retrieved records. As the largest online collection of its kind and the only one with advanced search results clustering, OBRC is aimed at becoming a one-stop guided information gateway to the major bioinformatics databases and software tools on the Web. OBRC is available at the University of Pittsburgh's HSLS Web site (). PMID:17108360

  6. CKD screening and management in the Veterans Health Administration: the impact of system organization and an innovative electronic record.

    PubMed

    Patel, Thakor G; Pogach, Leonard M; Barth, Robert H

    2009-03-01

    At the beginning of this decade, Healthy People 2010 issued a series of objectives to "reduce the incidence, morbidity, mortality and health care costs of chronic kidney disease." A necessary feature of any program to reduce the burden of kidney disease in the US population must include mechanisms to screen populations at risk and institute early the aspects of management, such as control of blood pressure, management of diabetes, and, in patients with advanced chronic kidney disease (CKD), preparation for dialysis therapy and proper vascular access management, that can retard CKD progression and improve long-term outcome. The Department of Veterans Affairs and the Veterans Health Administration is a broad-based national health care system that is almost uniquely situated to address these issues and has developed a number of effective approaches using evidence-based clinical practice guidelines, performance measures, innovative use of a robust electronic medical record system, and system oversight during the past decade. In this report, we describe the application of this systems approach to the prevention of CKD in veterans through the treatment of risk factors, identification of CKD in veterans, and oversight of predialysis and dialysis care. The lessons learned and applicability to the private sector are discussed.

  7. Will the Occupational Safety and Health Administration's Proposed Standards for Occupational Exposure to Respirable Crystalline Silica Reduce Workplace Risk?

    PubMed

    Dudley, Susan E; Morriss, Andrew P

    2015-07-01

    The Occupational Safety and Health Administration (OSHA) is developing regulations to amend existing standards for occupational exposure to respirable crystalline silica by establishing a new permissible exposure limit as well as a series of ancillary provisions for controlling exposure. This article briefly reviews OSHA's proposed regulatory approach and the statutory authority on which it is based. It then evaluates OSHA's preliminary determination of significant risk and its analysis of the risk reduction achievable by its proposed controls. It recognizes that OSHA faces multiple challenges in devising a regulatory approach that reduces exposures and health risks and meets its statutory goal. However, the greatest challenge to reducing risks associated with silica exposure is not the lack of incentives (for either employers or employees) but rather lack of information, particularly information on the relative toxicity of different forms of silica. The article finds that OSHA's proposed rule would contribute little in the way of new information, particularly since it is largely based on information that is at least a decade old--a significant deficiency, given the rapidly changing conditions observed over the last 45 years. The article concludes with recommendations for alternative approaches that would be more likely to generate information needed to improve worker health outcomes.

  8. [Boundaries of the autonomy of local health administration: innovation, creativity and evidence-based decision-making].

    PubMed

    Silva, Silvio Fernandes da; Souza, Nathan Mendes; Barreto, Jorge Otávio Maia

    2014-11-01

    The scope of this article was to identify the boundaries of the autonomy of local administration in the context of the federal pact in the Brazilian Unified Health System and the importance and potential for promoting innovation, creativity and evidence-based decision-making by local governments. The methodology used was to ask questions that favored dialogue with the specific literature to identify the influence of centrally-formulated policies in spaces of local autonomy and then to identify strategies to foster innovation, creativity and the systematic use of evidence-based research in health policy implementation. A gradual reduction in municipal decision-making autonomy was detected due to increased financial commitment of the municipalities resulting from responsibilities assumed, albeit with the possibility of reverting this trend in the more recent context. Some determinants and challenges for the dissemination of innovative practices were analyzed and some relevant national and international experiences in this respect were presented. The conclusion drawn is that it is possible to make local decision-making more effective provided that initiatives are consolidated to promote this culture and the formulation and implementation of evidence-based health policies.

  9. A Comparison of Mail and Telephone Administration of District-Level Questionnaires for the School Health Policies and Programs Study (SHPPS) 2006: Effects on Estimates and Data Quality

    ERIC Educational Resources Information Center

    Denniston, Maxine; Brener, Nancy

    2010-01-01

    Background: The School Health Policies and Programs Study (SHPPS) is a national study periodically conducted to assess school health policies and programs at the state, district, school, and classroom levels. For SHPPS 2006, district-level questionnaires were designed for telephone administration, but mixed-mode data collection that also used…

  10. Mapping the literature of nursing administration

    PubMed Central

    Galganski, Carol J.

    2006-01-01

    Objectives: As part of Phase I of a project to map the literature of nursing, sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association, this study identifies the core literature cited in nursing administration and the indexing services that provide access to the core journals. The results of this study will assist librarians and end users searching for information related to this nursing discipline, as well as database producers who might consider adding specific titles to their indexing services. Methods: Using the common methodology described in the overview article, five source journals for nursing administration were identified and selected for citation analysis over a three-year period, 1996 to 1998, to identify the most frequently cited titles according to Bradford's Law of Scattering. From this core of most productive journal titles, the bibliographic databases that provide the best access to these titles were identified. Results: Results reveal that nursing administration literature relies most heavily on journal articles and on those titles identified as core nursing administrative titles. When the indexing coverage of nine services is compared, PubMed/MEDLINE and CINAHL provide the most comprehensive coverage of this nursing discipline. Conclusions: No one indexing service adequately covers this nursing discipline. Researchers needing comprehensive coverage in this area must search more than one database to effectively research their projects. While PubMed/MEDLINE and CINAHL provide more coverage for this discipline than the other indexing services, none is sufficiently broad in scope to provide indexing of nursing, health care management, and medical literature in a single file. Nurse administrators using the literature to research current work issues need to review not only the nursing titles covered by CINAHL but should also include the major weekly medical titles, core titles in health care administration, and

  11. Development and applications of the Veterans Health Administration's Stratification Tool for Opioid Risk Mitigation (STORM) to improve opioid safety and prevent overdose and suicide.

    PubMed

    Oliva, Elizabeth M; Bowe, Thomas; Tavakoli, Sara; Martins, Susana; Lewis, Eleanor T; Paik, Meenah; Wiechers, Ilse; Henderson, Patricia; Harvey, Michael; Avoundjian, Tigran; Medhanie, Amanuel; Trafton, Jodie A

    2017-02-01

    Concerns about opioid-related adverse events, including overdose, prompted the Veterans Health Administration (VHA) to launch an Opioid Safety Initiative and Overdose Education and Naloxone Distribution program. To mitigate risks associated with opioid prescribing, a holistic approach that takes into consideration both risk factors (e.g., dose, substance use disorders) and risk mitigation interventions (e.g., urine drug screening, psychosocial treatment) is needed. This article describes the Stratification Tool for Opioid Risk Mitigation (STORM), a tool developed in VHA that reflects this holistic approach and facilitates patient identification and monitoring. STORM prioritizes patients for review and intervention according to their modeled risk for overdose/suicide-related events and displays risk factors and risk mitigation interventions obtained from VHA electronic medical record (EMR)-data extracts. Patients' estimated risk is based on a predictive risk model developed using fiscal year 2010 (FY2010: 10/1/2009-9/30/2010) EMR-data extracts and mortality data among 1,135,601 VHA patients prescribed opioid analgesics to predict risk for an overdose/suicide-related event in FY2011 (2.1% experienced an event). Cross-validation was used to validate the model, with receiver operating characteristic curves for the training and test data sets performing well (>.80 area under the curve). The predictive risk model distinguished patients based on risk for overdose/suicide-related adverse events, allowing for identification of high-risk patients and enrichment of target populations of patients with greater safety concerns for proactive monitoring and application of risk mitigation interventions. Results suggest that clinical informatics can leverage EMR-extracted data to identify patients at-risk for overdose/suicide-related events and provide clinicians with actionable information to mitigate risk. (PsycINFO Database Record

  12. Characterization of Listeria monocytogenes recovered from imported cheese contributed to the National PulseNet Database by the U.S. Food and Drug Administration from 2001 to 2008.

    PubMed

    Timbo, Babgaleh B; Keys, Christine; Klontz, Karl

    2010-08-01

    Imported foods must meet the same U.S. Food and Drug Administration (FDA) standards as domestic foods. The FDA determines whether an imported food is in compliance with the Federal Food, Drug, and Cosmetic Act. Pursuant to its regulatory activities, the FDA conducts compliance surveillance on imported foods offered for entry into the U.S. commerce. The National PulseNet Database is the molecular surveillance network for foodborne infections and is widely used to provide real-time subtyping support to epidemiologic investigations of foodborne diseases. FDA laboratories use pulsed-field gel electrophoresis to subtype foodborne pathogens recovered from imported foods and submit the molecular patterns to the National PulseNet Database at the Centers for Disease Control and Prevention. There were 60 isolates of Listeria monocytogenes in the FDA Field Accomplishment and Compliance Tracking System from 2001 to 2008 due to cheese imported from the following countries: Mexico (n=21 isolates), Italy (19), Israel (9), Portugal (5), Colombia (3), Greece (2), and Spain (1). We observed genetic diversity of L. monocytogenes isolates and genetic relatedness among strains recovered from imported cheese products coming to the United States from different countries. Consistent characterization of L. monocytogenes isolates recovered from imported cheeses, accompanied by epidemiologic investigations to ascertain human illness associated with these strains, could be helpful in the control of listeriosis acquired from imported cheeses.

  13. Mortality associated with lithium and valproate treatment of US Veterans Health Administration patients with mental disorders.

    PubMed

    Smith, Eric G; Austin, Karen L; Kim, Hyungjin Myra; Eisen, Susan V; Kilbourne, Amy M; Miller, Donald R; Zivin, Kara; Hannemann, Claire; Sauer, Brian C; Valenstein, Marcia

    2015-07-01

    BackgroundThe mood stabilisers lithium and valproate might plausibly have differing associations with mortality because of differing effects on mental health and various physiological indicators.AimsTo assess associations between lithium, valproate and non-suicide mortality.MethodIntention-to-treat, propensity score-matched cohort study.ResultsLithium was associated with significantly reduced non-suicide mortality in the intent-to-treat cohort over 0-90 days (hazard ratio (HR) = 0.67, 95% CI 0.51-0.87) but not longer. In secondary analyses, a sizeable reduction in mortality was observed during active treatment with lithium across all time periods studied (for example 365-day HR = 0.62, 95% CI 0.45-0.84), but significantly increased risks were observed among patients discontinuing lithium by 180 days (HR = 1.54, 95% CI 1.01-2.37).ConclusionsPatients initiating lithium had lower non-suicide mortality over 0-90 days than patients initiating valproate and consistently lower non-suicide mortality among patients maintaining treatment, but elevated risk among patients discontinuing treatment by 180 days. Although residual confounding or selection effects cannot be excluded, this study suggests potential benefits to enhancing lithium treatment persistence and the monitoring of patients discontinuing lithium. There is a need for further research.

  14. Integration of an Evidence Base into a Probabilistic Risk Assessment Model. The Integrated Medical Model Database: An Organized Evidence Base for Assessing In-Flight Crew Health Risk and System Design

    NASA Technical Reports Server (NTRS)

    Saile, Lynn; Lopez, Vilma; Bickham, Grandin; FreiredeCarvalho, Mary; Kerstman, Eric; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

    2011-01-01

    This slide presentation reviews the Integrated Medical Model (IMM) database, which is an organized evidence base for assessing in-flight crew health risk. The database is a relational database accessible to many people. The database quantifies the model inputs by a ranking based on the highest value of the data as Level of Evidence (LOE) and the quality of evidence (QOE) score that provides an assessment of the evidence base for each medical condition. The IMM evidence base has already been able to provide invaluable information for designers, and for other uses.

  15. The Relationship Between the Educational Background and Managerial Experience of Senior Navy Medical Service Corps Executives (Health Care Administrators) and their Perceived Current and Required Management Capabilities.

    DTIC Science & Technology

    1994-03-01

    alternatives 20 Develop a Comunicate vision 34 writing effectively 53 Providing feedback 4 Oral prsentatim. 55 Listenng tfeatively 56 Suilding vomk...describes a future of health care delivery in which the present pressures affecting health care administrators will intensify due to "changing demographics...corresponding survey questions are presented in Appendix B. The "Preliminary Analysis of Educational Needs for Navy Health Care Executives" [Ref. 21 provided

  16. From the sidelines to the frontline: how the Substance Abuse and Mental Health Services Administration embraced smoking cessation.

    PubMed

    Santhosh, Lekshmi; Meriwether, Margaret; Saucedo, Catherine; Reyes, Reason; Cheng, Christine; Clark, Brian; Tipperman, Doug; Schroeder, Steven A

    2014-05-01

    Smoking is a major contributor to premature mortality among people with mental illness and substance abuse. Historically, the Substance Abuse and Mental Health Services Administration (SAMHSA) did not include smoking cessation in its mission. We describe the development of a unique partnership between SAMHSA and the University of California, San Francisco's Smoking Cessation Leadership Center. Starting with an educational summit in Virginia in 2007, it progressed to a jointly sponsored "100 Pioneers for Smoking Cessation" campaign that provided grants and technical assistance to organizations promoting cessation. By 2013, the partnership established 7 "Leadership Academies," state-level multidisciplinary collaboratives of organizations focused on cessation. This academic-public partnership increased tobacco quit attempts, improved collaboration across multiple agencies, and raised awareness about tobacco use in vulnerable populations.

  17. Methodological approach and tools for systems thinking in health systems research: technical assistants' support of health administration reform in the Democratic Republic of Congo as an application.

    PubMed

    Ribesse, Nathalie; Bossyns, Paul; Marchal, Bruno; Karemere, Hermes; Burman, Christopher J; Macq, Jean

    2017-03-01

    In the field of development cooperation, interest in systems thinking and complex systems theories as a methodological approach is increasingly recognised. And so it is in health systems research, which informs health development aid interventions. However, practical applications remain scarce to date. The objective of this article is to contribute to the body of knowledge by presenting the tools inspired by systems thinking and complexity theories and methodological lessons learned from their application. These tools were used in a case study. Detailed results of this study are in process for publication in additional articles. Applying a complexity 'lens', the subject of the case study is the role of long-term international technical assistance in supporting health administration reform at the provincial level in the Democratic Republic of Congo. The Methods section presents the guiding principles of systems thinking and complex systems, their relevance and implication for the subject under study, and the existing tools associated with those theories which inspired us in the design of the data collection and analysis process. The tools and their application processes are presented in the results section, and followed in the discussion section by the critical analysis of their innovative potential and emergent challenges. The overall methodology provides a coherent whole, each tool bringing a different and complementary perspective on the system.

  18. Patterns of opioid use for chronic noncancer pain in the Veterans Health Administration from 2009 to 2011.

    PubMed

    Edlund, Mark J; Austen, Mark A; Sullivan, Mark D; Martin, Bradley C; Williams, James S; Fortney, John C; Hudson, Teresa J

    2014-11-01

    Although opioids are frequently prescribed for chronic noncancer pain (CNCP) among Veterans Health Administration (VHA) patients, little has been reported on national opioid prescribing patterns in the VHA. Our objective was to better characterize the dosing and duration of opioid therapy for CNCP in the VHA. We analyzed national VHA administrative and pharmacy data for fiscal years 2009 to 2011. For individuals with CNCP diagnoses and any opioid use in the fiscal year, we calculated the distribution of individual mean daily opioid dose, individual total days covered with opioids in a year, and individual total opioid dose in a year. We also investigated the factors associated with being in the top 5% of individuals for total opioid dose in a year, which we term receipt of high-volume opioids. About half of the patients with CNCP received opioids in a given fiscal year. The median daily dose was 21 mg morphine equivalents. Approximately 4.5% had a mean daily dose higher than 120 mg morphine equivalents. The median days covered in a year was 115 to 120 days in these years for those receiving opioids. Fifty-seven percent had at least 90 days covered with opioids per year. Major depression and posttraumatic stress disorder were positively associated with receiving high-volume opioids, but nonopioid substance use disorders were not. Among VHA patients with CNCP, chronic opioid therapy occurs frequently, but for most patients, the average daily dose is modest. Doses and duration of therapy were unchanged from 2009 to 2011.

  19. Long-term risk of repeat occupational injury or illness incidents among veterans health administration nursing employees.

    PubMed

    Welch, Charles E

    2010-08-01

    This retrospective population-based study assessed the long-term risk of repeat reported occupational injury or illness incidents among Veterans Health Administration (VHA) nursing employees. Using fiscal year (FY) 2002 as the start date for the longitudinal surveillance of incidents, descriptive analyses included all VHA nursing employees (N = 25,697) who reported an initial (index) incident that occurred between FY 2002 and FY 2005. Adjusted for total administrative loss rates (e.g., attrition, disability, retirements), approximately half of the "surviving" index cases reported repeat incidents during an ensuing 3-year period. This total increased to approximately two thirds during a 6-year period. Compared to their nurse counterparts, practical nurses and nursing assistants had higher cumulative probabilities of multiple reported repeat occupational injury or illness incidents. Study findings suggest that reported levels of repeat occupational injury or illness incidents represent a complex interplay between environmental factors (e.g., location) and nursing staff demographics (e.g., level of education).

  20. Use of technology assessment databases to identify the issues associated with adoption of structural health monitoring practices.

    SciTech Connect

    Roach, Dennis Patrick; Smith, Bryce; Neidigk, Stephen

    2010-09-01

    The goal is to create a systematic method and structure to compile, organize, and summarize SHM related data to identify the level of maturity and rate of evolution and have a quick and ongoing evaluation of the current state of SHM among research institutions and industry. Hundreds of technical publication and conference proceedings were read and analyzed to compile the database. Microsoft Excel was used to create a useable interface that could be filtered to compare any of the entered data fields.

  1. National Veterans Health Administration inpatient risk stratification models for hospital-acquired acute kidney injury

    PubMed Central

    Cronin, Robert M; VanHouten, Jacob P; Siew, Edward D; Eden, Svetlana K; Fihn, Stephan D; Nielson, Christopher D; Peterson, Josh F; Baker, Clifton R; Ikizler, T Alp; Speroff, Theodore

    2015-01-01

    Objective Hospital-acquired acute kidney injury (HA-AKI) is a potentially preventable cause of morbidity and mortality. Identifying high-risk patients prior to the onset of kidney injury is a key step towards AKI prevention. Materials and Methods A national retrospective cohort of 1,620,898 patient hospitalizations from 116 Veterans Affairs hospitals was assembled from electronic health record (EHR) data collected from 2003 to 2012. HA-AKI was defined at stage 1+, stage 2+, and dialysis. EHR-based predictors were identified through logistic regression, least absolute shrinkage and selection operator (lasso) regression, and random forests, and pair-wise comparisons between each were made. Calibration and discrimination metrics were calculated using 50 bootstrap iterations. In the final models, we report odds ratios, 95% confidence intervals, and importance rankings for predictor variables to evaluate their significance. Results The area under the receiver operating characteristic curve (AUC) for the different model outcomes ranged from 0.746 to 0.758 in stage 1+, 0.714 to 0.720 in stage 2+, and 0.823 to 0.825 in dialysis. Logistic regression had the best AUC in stage 1+ and dialysis. Random forests had the best AUC in stage 2+ but the least favorable calibration plots. Multiple risk factors were significant in our models, including some nonsteroidal anti-inflammatory drugs, blood pressure medications, antibiotics, and intravenous fluids given during the first 48 h of admission. Conclusions This study demonstrated that, although all the models tested had good discrimination, performance characteristics varied between methods, and the random forests models did not calibrate as well as the lasso or logistic regression models. In addition, novel modifiable risk factors were explored and found to be significant. PMID:26104740

  2. Impact of a Regional Pharmacy Call Center on Telephone Access Metrics Within the Veterans Health Administration

    PubMed Central

    Jones, Marshall R.; Kuester, Melanie K.; Myers, Kelly L.; Schnarr, Barbara A.

    2015-01-01

    Purpose: To establish a cost-effective centralized pharmacy call center to serve the patients of Veterans Integrated Service Network (VISN) 11 that would meet established performance metrics. Methods: A pilot project began in August 2011 with the Indianapolis VA Medical Center (VAMC) and the Health Resource Center (HRC) in Topeka, Kansas. The Indianapolis VAMC used a first-call resolution business model consisting of pharmacy technicians receiving tier 1 phone calls that could be escalated to a tier 2 line that consisted of lead technicians and pharmacists, while the HRC utilized general telephone agents that would transfer unresolved calls to the primary facility. Pre- and post-VISN 11 Pharmacy Call Center performance metrics were compared for each of the 7 facilities in the network with the goals being monthly average abandoned call rate less than 5% and average speed to answer less than 30 seconds. Cost per call was also compared. Results: The average abandoned call rate for the network during the year prior to VISN 11 Pharmacy Call Center implementation (August 2010-July 2011) was 15.66% and decreased to 3% in July 2014. The average abandoned call rate decreased for each individual facility. In fiscal year 2014, the VISN 11 Pharmacy Call Center was operating at a cost of $4.35 per call while providing more services than the HRC, resulting in less workload being transferred back to the individual facilities. Conclusion: A centralized VISN pharmacy call center is a reasonable alternative to individual facility call centers or the HRC. PMID:26405322

  3. A micro case study of the legal and administrative arrangements for river health in the Kangaroo River (NSW).

    PubMed

    Mooney, C; Farrier, D

    2002-01-01

    Kangaroo Valley is a drinking water supply catchment for Kangaroo Valley village, parts of the Southern Highlands and Sydney. It is also a popular recreation area both for swimming and canoeing. Land use has traditionally been dominated by dairy farming but there has been significant and continuing development of land for hobby farms and rural residential subdivision. Dairy industry restructuring has affected the viability of some farms in the Valley and created additional pressure for subdivision. River health is a function of flows, water quality, riparian vegetation, geomorphology and aquatic habitat and riverine biota. River flows in the Kangaroo River are affected by water extraction and storage for urban water supply and extraction by commercial irrigators and riparian land holders which have a significant impact at low flows. Current water quality often does not meet ANZECC Guidelines for primary contact and recreation and the river is a poor source of raw drinking water. Key sources of contaminants are wastewater runoff from agriculture, and poorly performing on-site sewage management systems. Riparian vegetation, which is critical to the maintenance of in-stream ecosystems suffers from uncontrolled stock access and weed infestation. The management of land use and resulting diffuse pollution sources is critical to the long term health of the river. The Healthy Rivers Commission of New South Wales Independent Inquiry into the Shoalhaven River System Final Report July, 1999 found that the longer term protection of the health of the Kangaroo River is contingent upon achievement of patterns of land use that have regard to land capability and also to the capability of the river to withstand the impacts of inappropriate or poorly managed land uses. This micro case study of Kangaroo Valley examines the complex legal and administrative arrangements with particular reference to the management of diffuse pollution for river health. In the past, diffuse pollution has

  4. Publication Bias in Antipsychotic Trials: An Analysis of Efficacy Comparing the Published Literature to the US Food and Drug Administration Database

    PubMed Central

    Turner, Erick H.; Knoepflmacher, Daniel; Shapley, Lee

    2012-01-01

    Background Publication bias compromises the validity of evidence-based medicine, yet a growing body of research shows that this problem is widespread. Efficacy data from drug regulatory agencies, e.g., the US Food and Drug Administration (FDA), can serve as a benchmark or control against which data in journal articles can be checked. Thus one may determine whether publication bias is present and quantify the extent to which it inflates apparent drug efficacy. Methods and Findings FDA Drug Approval Packages for eight second-generation antipsychotics—aripiprazole, iloperidone, olanzapine, paliperidone, quetiapine, risperidone, risperidone long-acting injection (risperidone LAI), and ziprasidone—were used to identify a cohort of 24 FDA-registered premarketing trials. The results of these trials according to the FDA were compared with the results conveyed in corresponding journal articles. The relationship between study outcome and publication status was examined, and effect sizes derived from the two data sources were compared. Among the 24 FDA-registered trials, four (17%) were unpublished. Of these, three failed to show that the study drug had a statistical advantage over placebo, and one showed the study drug was statistically inferior to the active comparator. Among the 20 published trials, the five that were not positive, according to the FDA, showed some evidence of outcome reporting bias. However, the association between trial outcome and publication status did not reach statistical significance. Further, the apparent increase in the effect size point estimate due to publication bias was modest (8%) and not statistically significant. On the other hand, the effect size for unpublished trials (0.23, 95% confidence interval 0.07 to 0.39) was less than half that for the published trials (0.47, 95% confidence interval 0.40 to 0.54), a difference that was significant. Conclusions The magnitude of publication bias found for antipsychotics was less than that found

  5. [Changes in features of diabetes care in Hungary in the period of years 2001-2014. Aims and methods of the database analysis of the National Health Insurance Fund].

    PubMed

    Jermendy, György; Kempler, Péter; Abonyi-Tóth, Zsolt; Rokszin, György; Wittmann, István

    2016-08-01

    In the last couple of years, database analyses have become increasingly popular among clinical-epidemiological investigations. In Hungary, the National Health Insurance Fund serves as central database of all medical attendances in state departments and purchases of drug prescriptions in pharmacies. Data from in- and outpatient departments as well as those from pharmacies are regularly collected in this database which is public and accessible on request. The aim of this retrospective study was to investigate the database of the National Health Insurance Fund in order to analyze the diabetes-associated morbidity and mortality in the period of years 2001-2014. Moreover, data of therapeutic costs, features of hospitalizations and practice of antidiabetic treatment were examined. The authors report now on the method of the database analysis. It is to be hoped that the upcoming results of this investigation will add some new data to recent knowledge about diabetes care in Hungary. Orv. Hetil., 2016, 157(32), 1259-1265.

  6. Response Audit of an Internet Survey of Health Care Providers and Administrators: Implications for Determination of Response Rates

    PubMed Central

    Orchard, Margo C; Golden, Brian; Holowaty, Eric; Paszat, Lawrence; Brown, Adalsteinn D; Sullivan, Terrence

    2008-01-01

    Background Internet survey modalities often compare unfavorably with traditional survey modalities, particularly with respect to response rates. Response to Internet surveys can be affected by the distribution options and response/collection features employed as well as the existence of automated (out-of-office) replies, automated forwarding, server rejection, and organizational or personal spam filters. However, Internet surveys also provide unparalleled opportunities to track study subjects and examine many of the factors influencing the determination of response rates. Tracking data available for Internet surveys provide detailed information and immediate feedback on a significant component of response that other survey modalities cannot match. This paper presents a response audit of a large Internet survey of more than 5000 cancer care providers and administrators in Ontario, Canada. Objective Building upon the CHEcklist for Reporting Results of Internet E-Surveys (CHERRIES), the main objectives of the paper are to (a) assess the impact of a range of factors on the determination of response rates for Internet surveys and (b) recommend steps for improving published descriptions of Internet survey methods. Methods We audited the survey response data, analyzing the factors that affected the numerator and denominator in the ultimate determination of response. We also conducted a sensitivity analysis to account for the inherent uncertainty associated with the impact of some of the factors on the response rates. Results The survey was initially sent out to 5636 health care providers and administrators. The determination of the numerator was influenced by duplicate/unattached responses and response completeness. The numerator varied from a maximum of 2031 crude (unadjusted) responses to 1849 unique views, 1769 participants, and 1616 complete responses. The determination of the denominator was influenced by forwarding of the invitation email to unknown individuals

  7. Utilization and Expenditure of Hospital Admission in Patients with Autism Spectrum Disorder: National Health Insurance Claims Database Analysis

    ERIC Educational Resources Information Center

    Lin, Jin-Ding; Hung, Wen-Jiu; Lin, Lan-Ping; Lai, Chia-Im

    2011-01-01

    There were not many studies to provide information on health access and health utilization of people with autism spectrum disorders (ASD). The present study describes a general profile of hospital admission and the medical cost among people with ASD, and to analyze the determinants of medical cost. A retrospective study was employed to analyze…

  8. Application of Tools and Databases to Community-Level Assessments of Exposure, Health and the Environment with Case Study Examples

    EPA Science Inventory

    The purpose of this report is to assess the application of tools to community-level assessments of exposure, health and the environment. Various tools and datasets provided different types of information, such as on health effects, chemical types and volumes, facility locations a...

  9. The Impact of Environment and Occupation on the Health and Safety of Active Duty Air Force Members - Database Development

    DTIC Science & Technology

    2014-04-01

    abuse, and physical altercations), high-risk sexual behavior (e.g., unprotected sexual intercourse), and physical health issues, such as high blood... sexual activity questions (section 12- reproductive ) PHA Sexually transmitted disease Sponsor ID (SSN), dependent status, DOB, sponsor pay grade...based on encounters and responses. The requested Health Assessment data consisted of specific information relating to tobacco, alcohol, and sexual

  10. The development of an information system and installation of an Internet web database for the purposes of the occupational health and safety management system.

    PubMed

    Mavrikakis, I; Mantas, J; Diomidous, M

    2007-01-01

    This paper is based on the research on the possible structure of an information system for the purposes of occupational health and safety management. We initiated a questionnaire in order to find the possible interest on the part of potential users in the subject of occupational health and safety. The depiction of the potential interest is vital both for the software analysis cycle and development according to previous models. The evaluation of the results tends to create pilot applications among different enterprises. Documentation and process improvements ascertained quality of services, operational support, occupational health and safety advice are the basics of the above applications. Communication and codified information among intersted parts is the other target of the survey regarding health issues. Computer networks can offer such services. The network will consist of certain nodes responsible to inform executives on Occupational Health and Safety. A web database has been installed for inserting and searching documents. The submission of files to a server and the answers to questionnaires through the web help the experts to perform their activities. Based on the requirements of enterprises we have constructed a web file server. We submit files so that users can retrieve the files which they need. The access is limited to authorized users. Digital watermarks authenticate and protect digital objects.

  11. Job Analysis Techniques for Restructuring Health Manpower Education and Training in the Navy Medical Department. Attachment 13. Administrative QPCB Task Sort for Medical/Dental Administration.

    ERIC Educational Resources Information Center

    Technomics, Inc., McLean, VA.

    This publication is Attachment 13 of a set of 16 computer listed QPCB task sorts, by career level, for the entire Hospital Corps and Dental Technician fields. Statistical data are presented in tabular form for a detailed listing of job duties in medical/dental administration. (BT)

  12. The follow-up inspection of selected aspects of the Department of Energy`s administration of post retirement health benefits

    SciTech Connect

    Not Available

    1994-05-05

    In a September 1990 report entitled, ``General Management Inspection of the San Francisco Operations Office,`` we made recommendations to Departmental officials regarding the administration of M&O contractor post retirement health benefits. The majority of these recommendations were directed to the administration of benefits paid by one M&O contractor, the University of California. The purpose of this inspection was to determine what actions Departmental officials have taken in response to the recommendations made in our September 1990 report.

  13. Image Databases.

    ERIC Educational Resources Information Center

    Pettersson, Rune

    Different kinds of pictorial databases are described with respect to aims, user groups, search possibilities, storage, and distribution. Some specific examples are given for databases used for the following purposes: (1) labor markets for artists; (2) document management; (3) telling a story; (4) preservation (archives and museums); (5) research;…

  14. Maize databases

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This chapter is a succinct overview of maize data held in the species-specific database MaizeGDB (the Maize Genomics and Genetics Database), and selected multi-species data repositories, such as Gramene/Ensembl Plants, Phytozome, UniProt and the National Center for Biotechnology Information (NCBI), ...

  15. Medical product safety surveillance: how many databases to use?

    PubMed

    Maro, Judith C; Brown, Jeffrey S; Kulldorff, Martin

    2013-09-01

    Large linked database networks, like the US Food and Drug Administration's Sentinel System, are being built for medical product surveillance. One use of these networks is for "near real-time" sequential database surveillance of prespecified medical product-adverse event pairs, which may result in a "safety signal" when a statistical excess risk is detected. Sequential database surveillance requires the investigator to manage surveillance in both information time (ie, how sample size accrues) and calendar time. Calendar time is important because people external to the surveillance population may be affected by the speed with which a safety signal is detected or ruled out. Optimal design and analysis aspects of sequential database surveillance are not well developed, but are gaining in importance as observational database networks grow. Using information time concepts, we show how to calculate sample sizes when performing sequential database surveillance, illustrating the relationships between statistical power, the time to detect a signal, and the maximum sample size for various true effect sizes. Then, using a vaccine example, we demonstrate a four-step planning process that allows investigators to translate information time into calendar time. Given the calendar time for surveillance, the process focuses on choosing observational database configurations consistent with the investigator's preferences for timeliness and statistical power. Although the planning process emphasizes sample size considerations, the influence of secondary database attributes such as delay times, measurement error, and cost are also discussed. Appropriate planning allows the most efficient use of public health dollars dedicated to medical product surveillance efforts.

  16. Opportunities and Barriers to Rural, Remote and First Nation Health Services Research in Canada: Comparing Access to Administrative Claims Data in Manitoba and British Columbia

    PubMed Central

    Wong, Sabrina; Katz, Alan; Sinclair, Stephanie

    2016-01-01

    Access to geographically disaggregated data is essential for the pursuit of meaningful rural, remote and First Nation health services research. This paper explores the opportunities and challenges associated with undertaking administrative claims data research in the context of two different models of administrative data management: the Manitoba and British Columbia models. We argue that two conditions must be in place to support rural, remote and First Nation health services research: (1) pathways to data access that reconcile the need to protect privacy with the imperative to conduct analyses on disaggregated data; and (2) a trust-based relationship with data providers. PMID:27585026

  17. Veterans Health Administration

    MedlinePlus

    ... for Vets VetSuccess Performance Based Interviewing Clinical Trainees (Academic Affiliations) Employees & Contractors Talent Management System (TMS) VA Learning University (VALU) SimLearn Libraries ( ...

  18. Genome databases

    SciTech Connect

    Courteau, J.

    1991-10-11

    Since the Genome Project began several years ago, a plethora of databases have been developed or are in the works. They range from the massive Genome Data Base at Johns Hopkins University, the central repository of all gene mapping information, to small databases focusing on single chromosomes or organisms. Some are publicly available, others are essentially private electronic lab notebooks. Still others limit access to a consortium of researchers working on, say, a single human chromosome. An increasing number incorporate sophisticated search and analytical software, while others operate as little more than data lists. In consultation with numerous experts in the field, a list has been compiled of some key genome-related databases. The list was not limited to map and sequence databases but also included the tools investigators use to interpret and elucidate genetic data, such as protein sequence and protein structure databases. Because a major goal of the Genome Project is to map and sequence the genomes of several experimental animals, including E. coli, yeast, fruit fly, nematode, and mouse, the available databases for those organisms are listed as well. The author also includes several databases that are still under development - including some ambitious efforts that go beyond data compilation to create what are being called electronic research communities, enabling many users, rather than just one or a few curators, to add or edit the data and tag it as raw or confirmed.

  19. Strategic plan for geriatrics and extended care in the veterans health administration: background, plan, and progress to date.

    PubMed

    Shay, Kenneth; Hyduke, Barbara; Burris, James F

    2013-04-01

    The leaders of Geriatrics and Extended Care (GEC) in the Veterans Health Administration (VHA) undertook a strategic planning process that led to approval in 2009 of a multidisciplinary, evidence-guided strategic plan. This article reviews the four goals contained in that plan and describes VHA's progress in addressing them. The goals included transforming the healthcare system to a veteran-centric approach, achieving universal access to a panel of services, ensuring that the Veterans Affair's (VA) healthcare workforce was adequately prepared to manage the needs of the growing elderly veteran population, and integrating continuous improvement into all care enhancements. There has been substantial progress in addressing all four goals. All VHA health care has undergone an extensive transformation to patient-centered care, has enriched the services it can offer caregivers of dependent veterans, and has instituted models to better integrate VA and non-VA cares and services. A range of successful models of geriatric care described in the professional literature has been adapted to VA environments to gauge suitability for broader implementation. An executive-level task force developed a three-pronged approach for enhancing the VA's geriatric workforce. The VHA's performance measurement approaches increasingly include incentives to enhance the quality of management of vulnerable elderly adults in primary care. The GEC strategic plan was intended to serve as a road map for keeping VHA aligned with an ambitious but important long-term vision for GEC services. Although no discrete set of resources was appropriated for fulfillment of the plan's recommendations, this initial report reflects substantial progress in addressing most of its goals.

  20. National Database of Geriatrics

    PubMed Central

    Kannegaard, Pia Nimann; Vinding, Kirsten L; Hare-Bruun, Helle

    2016-01-01

    Aim of database The aim of the National Database of Geriatrics is to monitor the quality of interdisciplinary diagnostics and treatment of patients admitted to a geriatric hospital unit. Study population The database population consists of patients who were admitted to a geriatric hospital unit. Geriatric patients cannot be defined by specific diagnoses. A geriatric patient is typically a frail multimorbid elderly patient with decreasing functional ability and social challenges. The database includes 14–15,000 admissions per year, and the database completeness has been stable at 90% during the past 5 years. Main variables An important part of the geriatric approach is the interdisciplinary collaboration. Indicators, therefore, reflect the combined efforts directed toward the geriatric patient. The indicators include Barthel index, body mass index, de Morton Mobility Index, Chair Stand, percentage of discharges with a rehabilitation plan, and the part of cases where an interdisciplinary conference has taken place. Data are recorded by doctors, nurses, and therapists in a database and linked to the Danish National Patient Register. Descriptive data Descriptive patient-related data include information about home, mobility aid, need of fall and/or cognitive diagnosing, and categorization of cause (general geriatric, orthogeriatric, or neurogeriatric). Conclusion The National Database of Geriatrics covers ∼90% of geriatric admissions in Danish hospitals and provides valuable information about a large and increasing patient population in the health care system. PMID:27822120

  1. The influence of gender on suicidal ideation following military sexual trauma among Veterans in the Veterans Health Administration.

    PubMed

    Monteith, Lindsey L; Bahraini, Nazanin H; Matarazzo, Bridget B; Gerber, Holly R; Soberay, Kelly A; Forster, Jeri E

    2016-10-30

    No studies have examined whether military sexual trauma, as measured and defined within the Veterans Health Administration (VHA), is associated with suicidal ideation among Veterans in VHA care, when taking prior suicide attempts into account. Research regarding the role of gender in this association is also limited. The present study examined: (1) whether military sexual trauma was associated with the presence of past-week suicidal ideation among 354 Veterans in VHA (310 men, 44 women); (2) whether gender moderated the association between military sexual trauma and suicidal ideation. Information regarding military sexual trauma, suicidal ideation, suicide attempt, and psychiatric diagnoses was obtained from self-report instruments and medical records. Adjusting for age, gender, combat, posttraumatic stress disorder, depressive disorders, negative affect, and lifetime suicide attempt, Veterans with military sexual trauma were significantly more likely to report suicidal ideation, compared to Veterans without military sexual trauma. Furthermore, the association between military sexual trauma and suicidal ideation was stronger for men compared to women. These results contribute to a growing literature identifying military sexual trauma as a risk factor for suicidal thoughts and behaviors among Veterans in VHA care and emphasize the importance of screening for suicidal ideation among survivors of military sexual trauma.

  2. Mass Drug Administration and beyond: how can we strengthen health systems to deliver complex interventions to eliminate neglected tropical diseases?

    PubMed Central

    2015-01-01

    Achieving the 2020 goals for Neglected Tropical Diseases (NTDs) requires scale-up of Mass Drug Administration (MDA) which will require long-term commitment of national and global financing partners, strengthening national capacity and, at the community level, systems to monitor and evaluate activities and impact. For some settings and diseases, MDA is not appropriate and alternative interventions are required. Operational research is necessary to identify how existing MDA networks can deliver this more complex range of interventions equitably. The final stages of the different global programmes to eliminate NTDs require eliminating foci of transmission which are likely to persist in complex and remote rural settings. Operational research is required to identify how current tools and practices might be adapted to locate and eliminate these hard-to-reach foci. Chronic disabilities caused by NTDs will persist after transmission of pathogens ceases. Development and delivery of sustainable services to reduce the NTD-related disability is an urgent public health priority. LSTM and its partners are world leaders in developing and delivering interventions to control vector-borne NTDs and malaria, particularly in hard-to-reach settings in Africa. Our experience, partnerships and research capacity allows us to serve as a hub for developing, supporting, monitoring and evaluating global programmes to eliminate NTDs.

  3. Receipt of Pharmacotherapy for Opioid Use Disorder by Justice-Involved U.S. Veterans Health Administration Patients

    PubMed Central

    Finlay, Andrea K.; Harris, Alex H.S.; Rosenthal, Joel; Blue-Howells, Jessica; Clark, Sean; McGuire, Jim; Timko, Christine; Frayne, Susan M.; Smelson, David; Oliva, Elizabeth; Binswanger, Ingrid

    2016-01-01

    Background Pharmacotherapy – methadone, buprenorphine, or naltrexone – is an evidence-based treatment for opioid use disorder, but little is known about receipt of these medications among veterans involved in the justice system. The current study examines receipt of pharmacotherapy for opioid use disorder among veterans with a history of justice involvement at U.S. Veterans Health Administration (VHA) facilities compared to veterans with no justice involvement. Methods Using national VHA clinical and pharmacy records, we conducted a retrospective cohort study of veterans with an opioid use disorder diagnosis in fiscal year 2012. Using a mixed-effects logistic regression model, we examined receipt of pharmacotherapy in the 1-year period following diagnosis as a function of justice involvement, adjusting for patient and facility characteristics. Results The 1-year rate of receipt for pharmacotherapy for opioid use disorder was 27% for prison-involved veterans, 34% for jail/court-involved veterans, and 33% for veterans not justice-involved. Compared to veterans not justice-involved, those prison-involved had 0.75 lower adjusted odds (95% confidence interval [CI]: 0.65–0.87) of receiving pharmacotherapy whereas jail/court-involved veterans did not have significantly different adjusted odds. Conclusions Targeted efforts to increase receipt of pharmacotherapy for opioid use disorder among veterans exiting prison is needed as they have lower odds of receiving these medications. PMID:26832998

  4. 75 FR 69449 - Draft Guidance for Industry and Food and Drug Administration Staff on Dear Health Care Provider...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-12

    ... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry and Food and Drug Administration...; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug... manufacturer or distributor of a human drug or biologic, or from FDA--intended to alert physicians and...

  5. The effect of a health communication campaign on compliance with mass drug administration for schistosomiasis control in western Kenya--the SCORE project.

    PubMed

    Omedo, Martin; Ogutu, Michael; Awiti, Alphonce; Musuva, Rosemary; Muchiri, Geoffrey; Montgomery, Susan P; Secor, W Evan; Mwinzi, Pauline

    2014-11-01

    Compliance with mass drug administration (MDA) can be affected by rumors and mistrust about the drug. Communication campaigns are an effective way to influence attitudes and health behaviors in diverse public health contexts, but there is very little documentation about experiences using health communications in schistosomiasis control programs. A qualitative study was conducted with community health workers (CHWs) as informants to explore the effect of a health communication campaign on their experiences during subsequent praziquantel MDA for schistosomiasis. Discussions were audio-recorded, transcribed verbatim, translated into English where applicable, and analyzed thematically using ATLAS.ti software. According to the CHWs, exposure to mass media messages improved awareness of the MDA, which in turn, led to better treatment compliance. Our findings suggest that communication campaigns influence health behaviors and create awareness of schistosomiasis control interventions, which may ultimately improve praziquantel MDA.

  6. EPA Regional Administrator and American Indian Environmental Office Director Present Recognition of Innovation to Alaska Native Tribal Health Consortium's LEO Network

    EPA Pesticide Factsheets

    (Anchorage - February 10, 2016) Today, U.S. EPA Region 10 Administrator Dennis McLerran and EPA American Indian Environmental Office National Director JoAnn Chase will present a Recognition of Innovation award to the Alaska Native Tribal Health Consortium'

  7. The Online Bioinformatics Resources Collection at the University of Pittsburgh Health Sciences Library System--a one-stop gateway to online bioinformatics databases and software tools.

    PubMed

    Chen, Yi-Bu; Chattopadhyay, Ansuman; Bergen, Phillip; Gadd, Cynthia; Tannery, Nancy

    2007-01-01

    To bridge the gap between the rising information needs of biological and medical researchers and the rapidly growing number of online bioinformatics resources, we have created the Online Bioinformatics Resources Collection (OBRC) at the Health Sciences Library System (HSLS) at the University of Pittsburgh. The OBRC, containing 1542 major online bioinformatics databases and software tools, was constructed using the HSLS content management system built on the Zope Web application server. To enhance the output of search results, we further implemented the Vivísimo Clustering Engine, which automatically organizes the search results into categories created dynamically based on the textual information of the retrieved records. As the largest online collection of its kind and the only one with advanced search results clustering, OBRC is aimed at becoming a one-stop guided information gateway to the major bioinformatics databases and software tools on the Web. OBRC is available at the University of Pittsburgh's HSLS Web site (http://www.hsls.pitt.edu/guides/genetics/obrc).

  8. Associations of hair cortisol concentration with self-reported measures of stress and mental health-related factors in a pooled database of diverse community samples.

    PubMed

    Wells, Samantha; Tremblay, Paul F; Flynn, Andrea; Russell, Evan; Kennedy, James; Rehm, Jürgen; Van Uum, Stan; Koren, Gideon; Graham, Kathryn

    2014-07-01

    A pooled database from diverse community samples was used to examine the associations of hair cortisol concentration (HCC) with self-reported stress and stress-linked mental health measures, including depression, anxiety, alcohol and drug use, disability and experiences with aggression. As part of innovative research using a mobile laboratory to study community mental health, data were pooled from five sub-studies: a random sample of the general population (n = 70), people who had received treatment for a mental health and/or substance use problem (n = 78), family members of people treated for mental health and/or substance use problems (n = 49), community volunteers who sometimes felt sad or blue or thought they drank too much (n = 83) and young adults in intimate partner relationships (n = 44). All participants completed a computerized questionnaire including standard measures of perceived stress, chronic stress, depression, anxiety, hazardous drinking, tobacco use, prescription drug use, illicit drug use, disability and intimate partner aggression. HCC was significantly associated with use of antidepressants, hazardous drinking, smoking and disability after adjusting for sub-study and potential confounders (sex, body-mass index, use of glucocorticoids and hair dyed). In addition, preliminary analyses suggest a significant curvilinear relationship between HCC and perceived stress; specifically, HCC increased with higher perceived stress but decreased at the highest level of stress. Overall, HCC was associated with mental health-related variables mainly reflecting substance use or experiencing a disability. The relationship between HCC and self-reported stress is unclear and needs further research.

  9. Online Spatial Database of US Army Public Health Command Region-West Mosquito Surveillance Records: 1947-2009

    DTIC Science & Technology

    2011-09-01

    Command Region-West (APHCR-W) area of responsibility, including US Army (9), Army Reserve (2), National Guard (2), US Navy (6) and one from the...to conduct occupational health surveys of Army operated industrial plants , arsenals, and depots. These surveys were aimed at identifying and...military fac il- ities, but this was not always the case. Other locations included National Parks, water and sewage treatment plants , roadside

  10. Food composition databases

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Food composition is the determination of what is in the foods we eat and is the critical bridge between nutrition, health promotion and disease prevention and food production. Compilation of data into useable databases is essential to the development of dietary guidance for individuals and populat...

  11. [THE USE OF OPEN REAL ESTATE DATABASES FOR THE ANALYSIS OF INFLUENCE OF CONCOMITANT FACTORS ON THE STATE OF THE URBAN POPULATION'S HEALTH].

    PubMed

    Zheleznyak, E V; Khripach, L V

    2015-01-01

    There was suggested a new method of the assessment of certain social-lifestyle factors in hygienic health examination of the urban population, based on the work with the open real estate databases on residential areas of the given city. On the example of the Moscow FlatInfo portal for a sample of 140 residents of the city of Moscow there was studied the distribution of such available for analysis factors as a typical design of the building, where studied citizen resides, the year of its construction and the market price of 1m2 of housing space in this house. The latter value is a quantitative integrated assessment of the social and lifestyle quality of housing, depending on the type and technical condition of the building, neighborhood environment, infrastructure of the region and many other factors, and may be a useful supplemental index in hygienic research.

  12. Sex Differences in the Treatment and Outcome of Korean Patients With Acute Myocardial Infarction Using the Korean National Health Insurance Claims Database

    PubMed Central

    Hong, Jae-Seok; Kang, Hee-Chung

    2015-01-01

    Abstract Evidence showing higher acute myocardial infarction (AMI) mortality rates among female compared with male inpatients has stimulated interest in whether this disparity is the result of biological factors or differences in the provision of healthcare services. We investigated the impact of sex on in-hospital mortality rates due to AMI, and evaluated the contribution of differences in the delivery of optimal medical services for AMI. We retrospectively constructed a dataset of 85,329 new patients admitted to Korean hospitals with AMI between 2003 and 2007 from the Korea National Health Insurance Claims Database. We used the claims database to provide information about treatment after admission or death for each patient. Proportionally more female than male patients aged 65 years or older had complications; however, proportionally fewer female patients underwent invasive procedures. Female patients had a higher in-hospital mortality rate than males (21.2% vs 14.6%, odds ratio [OR] 1.58, 95% confidence interval [CI] 1.52–1.64). The probability of death within 30 days after admission remained higher for females than males after adjusting for demographic characteristics and severity (OR 1.08, 95% CI 1.04–1.13). After additionally adjusting for invasive and medical management, the probability of death within 30 days did not differ between males and females (OR 1.04, 95% CI 0.99–1.08). A similar trend was revealed by an additional analysis of patients according to younger (<65 years) and older (≥65 years) age groups. The higher in-hospital mortality rates after AMI in Korean female patients was associated with a lower procedure rate. Evidence indicating that AMI symptoms differ according to sex highlights the need for health policies and public education programs that raise awareness of sex-related differences in early AMI symptoms to increase the incidence of appropriate early treatment in females. PMID:26334894

  13. Health and economic outcomes associated with uncontrolled surgical bleeding: a retrospective analysis of the Premier Perspectives Database

    PubMed Central

    Corral, Mitra; Ferko, Nicole; Hollmann, Sarah; Broder, Michael S; Chang, Eunice

    2015-01-01

    Background Bleeding remains a common occurrence in surgery. Data describing the burden of difficult-to-control bleeding and topical absorbable hemostat use are sparse. This study was conducted to estimate the clinical and economic impact that remains associated with uncontrolled surgical bleeding, even when hemostats are used during surgery. Methods This US retrospective analysis used the Premier Perspectives Database. Hospital discharges from 2012 were used to identify patients treated with hemostats during eight surgery types. Patients were included if they were ≥18 years, had an inpatient hospitalization with one of the eight surgeries, and received a hemostat on the day of surgery. Patients were stratified by procedure and presence or absence of major bleeding (uncontrolled) despite hemostat use. Outcomes were all-cause hospitalization costs, hemostat costs, length of stay, reoperation, and surgery-related complications (eg, mortality). Statistical significance was tested through chi-square or t-tests. Multivariate analyses were conducted for all-cause costs and length of stay using analysis of covariance. Results Among 25,048 procedures, major bleeding events occurred in 14,251 cases. Despite treatment with hemostats, major bleeding occurred in 32%–68% of cases. All-cause costs were significantly higher in patients with uncontrolled bleeding despite hemostat use versus controlled bleeding (US$24,203–$61,323 [uncontrolled], US$14,420–$45,593 [controlled]; P<0.001). Hemostat costs were significantly greater in the uncontrolled bleeding cohort for all surgery types except cystectomy and pancreatic surgery. Reoperation and mortality rates were significantly higher in the uncontrolled bleeding cohort in all surgical procedures except cystectomy and radical hysterectomy. Conclusion Uncontrolled intraoperative bleeding despite hemostat use is prevalent and associated with significantly higher hospital costs and worse clinical outcomes across several surgical

  14. Validating the 8 CPCSSN Case Definitions for Chronic Disease Surveillance in a Primary Care Database of Electronic Health Records

    PubMed Central

    Williamson, Tyler; Green, Michael E.; Birtwhistle, Richard; Khan, Shahriar; Garies, Stephanie; Wong, Sabrina T.; Natarajan, Nandini; Manca, Donna; Drummond, Neil

    2014-01-01

    PURPOSE The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is Canada’s first national chronic disease surveillance system based on electronic health record (EHR) data. The purpose of this study was to develop and validate case definitions and case-finding algorithms used to identify 8 common chronic conditions in primary care: chronic obstructive pulmonary disease (COPD), dementia, depression, diabetes, hypertension, osteoarthritis, parkinsonism, and epilepsy. METHODS Using a cross-sectional data validation study design, regional and local CPCSSN networks from British Columbia, Alberta (2), Ontario, Nova Scotia, and Newfoundland participated in validating EHR case-finding algorithms. A random sample of EHR charts were reviewed, oversampling for patients older than 60 years and for those with epilepsy or parkinsonism. Charts were reviewed by trained research assistants and residents who were blinded to the algorithmic diagnosis. Sensitivity, specificity, and positive and negative predictive values (PPVs, NPVs) were calculated. RESULTS We obtained data from 1,920 charts from 4 different EHR systems (Wolf, Med Access, Nightingale, and PS Suite). For the total sample, sensitivity ranged from 78% (osteoarthritis) to more than 95% (diabetes, epilepsy, and parkinsonism); specificity was greater than 94% for all diseases; PPV ranged from 72% (dementia) to 93% (hypertension); NPV ranged from 86% (hypertension) to greater than 99% (diabetes, dementia, epilepsy, and parkinsonism). CONCLUSIONS The CPCSSN diagnostic algorithms showed excellent sensitivity and specificity for hypertension, diabetes, epilepsy, and parkinsonism and acceptable values for the other conditions. CPCSSN data are appropriate for use in public health surveillance, primary care, and health services research, as well as to inform policy for these diseases. PMID:25024246

  15. Improving Clinical Workflow in Ambulatory Care: Implemented Recommendations in an Innovation Prototype for the Veteran’s Health Administration

    PubMed Central

    Patterson, Emily S.; Lowry, Svetlana Z.; Ramaiah, Mala; Gibbons, Michael C.; Brick, David; Calco, Robert; Matton, Greg; Miller, Anne; Makar, Ellen; Ferrer, Jorge A.

    2015-01-01

    Introduction: Human factors workflow analyses in healthcare settings prior to technology implemented are recommended to improve workflow in ambulatory care settings. In this paper we describe how insights from a workflow analysis conducted by NIST were implemented in a software prototype developed for a Veteran’s Health Administration (VHA) VAi2 innovation project and associated lessons learned. Methods: We organize the original recommendations and associated stages and steps visualized in process maps from NIST and the VA’s lessons learned from implementing the recommendations in the VAi2 prototype according to four stages: 1) before the patient visit, 2) during the visit, 3) discharge, and 4) visit documentation. NIST recommendations to improve workflow in ambulatory care (outpatient) settings and process map representations were based on reflective statements collected during one-hour discussions with three physicians. The development of the VAi2 prototype was conducted initially independently from the NIST recommendations, but at a midpoint in the process development, all of the implementation elements were compared with the NIST recommendations and lessons learned were documented. Findings: Story-based displays and templates with default preliminary order sets were used to support scheduling, time-critical notifications, drafting medication orders, and supporting a diagnosis-based workflow. These templates enabled customization to the level of diagnostic uncertainty. Functionality was designed to support cooperative work across interdisciplinary team members, including shared documentation sessions with tracking of text modifications, medication lists, and patient education features. Displays were customized to the role and included access for consultants and site-defined educator teams. Discussion: Workflow, usability, and patient safety can be enhanced through clinician-centered design of electronic health records. The lessons learned from implementing

  16. Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration

    PubMed Central

    Stetler, Cheryl B; Legro, Marcia W; Rycroft-Malone, Joanne; Bowman, Candice; Curran, Geoffrey; Guihan, Marylou; Hagedorn, Hildi; Pineros, Sandra; Wallace, Carolyn M

    2006-01-01

    Background Facilitation has been identified in the literature as a potentially key component of successful implementation. It has not, however, either been well-defined or well-studied. Significant questions remain about the operational definition of facilitation and about the relationship of facilitation to other interventions, especially to other change agent roles when used in multi-faceted implementation projects. Researchers who are part of the Quality Enhancement Research Initiative (QUERI) are actively exploring various approaches and processes, including facilitation, to enable implementation of best practices in the Veterans Health Administration health care system – the largest integrated healthcare system in the United States. This paper describes a systematic, retrospective evaluation of implementation-related facilitation experiences within QUERI, a quality improvement program developed by the US Department of Veterans Affairs. Methods A post-hoc evaluation was conducted through a series of semi-structured interviews to examine the concept of facilitation across several multi-site QUERI implementation studies. The interview process is based on a technique developed in the field of education, which systematically enhances learning through experience by stimulating recall and reflection regarding past complex activities. An iterative content analysis approach relative to a set of conceptually-based interview questions was used for data analysis. Findings Findings suggest that facilitation, within an implementation study initiated by a central change agency, is a deliberate and valued process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship. Facilitation was described primarily as a distinct role with a number of potentially crucial behaviors and activities. Data further suggest that external facilitators were likely to use or integrate other

  17. Characteristics of Veterans Receiving Buprenorphine vs. Methadone for Opioid Use Disorder Nationally in the Veterans Health Administration

    PubMed Central

    Manhapra, Ajay; Quinones, Lantie; Rosenheck, Robert

    2016-01-01

    BACKGROUND The advent of buprenorphine as an alternative to methadone has dramatically shifted the landscape of opioid agonist therapy (OAT) for opioid use disorder (OUD). However, there is limited US national level data describing the differences between patients who are prescribed these two OAT options. METHODS From veterans with OUD diagnosis who used Veterans Health Administration services in 2012, we identified 3 mutually exclusive groups: those who received (1) buprenorphine only (n=5,670); (2) methadone only (n=6,252); or (3) both buprenorphine and methadone in the same year (n=2513). We calculated the bi-varate effect size differences (risk ratios and Cohen's d) for characteristics that differentiated these groups. Logistic regression analysis was then used to identify factors independently differentiating the groups. RESULTS Ten year increment in age (OR 0.67; 95% CI 0.64-0.70), urban residence (OR 0.26; 95% CI 0.25-0.33), and black race (OR 0.39; 95% CI 0.35-0.43) were strongly and negatively associated with odds of receiving buprenorphine compared to methadone, while medical and psychiatric comorbidities or receipt of other psychiatric medications did not demonstrate substantial differences between groups. CONCLUSIONS Differences between veterans receiving buprenorphine or methadone based OAT seems to be largely shaped by demographic characteristics rather than medical or psychiatric or service use characteristics. A clearer understanding of the reasons for racial differences could be helpful in assuring that black OUD patients are not denied the opportunity to receive buprenorphine if that is their preference. PMID:26804898

  18. Experiment Databases

    NASA Astrophysics Data System (ADS)

    Vanschoren, Joaquin; Blockeel, Hendrik

    Next to running machine learning algorithms based on inductive queries, much can be learned by immediately querying the combined results of many prior studies. Indeed, all around the globe, thousands of machine learning experiments are being executed on a daily basis, generating a constant stream of empirical information on machine learning techniques. While the information contained in these experiments might have many uses beyond their original intent, results are typically described very concisely in papers and discarded afterwards. If we properly store and organize these results in central databases, they can be immediately reused for further analysis, thus boosting future research. In this chapter, we propose the use of experiment databases: databases designed to collect all the necessary details of these experiments, and to intelligently organize them in online repositories to enable fast and thorough analysis of a myriad of collected results. They constitute an additional, queriable source of empirical meta-data based on principled descriptions of algorithm executions, without reimplementing the algorithms in an inductive database. As such, they engender a very dynamic, collaborative approach to experimentation, in which experiments can be freely shared, linked together, and immediately reused by researchers all over the world. They can be set up for personal use, to share results within a lab or to create open, community-wide repositories. Here, we provide a high-level overview of their design, and use an existing experiment database to answer various interesting research questions about machine learning algorithms and to verify a number of recent studies.

  19. Health characteristics and consultation patterns of people with intellectual disability: a cross-sectional database study in English general practice

    PubMed Central

    Carey, Iain M; Shah, Sunil M; Hosking, Fay J; DeWilde, Stephen; Harris, Tess; Beighton, Carole; Cook, Derek G

    2016-01-01

    Background People with intellectual disability (ID) are a group with high levels of healthcare needs; however, comprehensive information on these needs and service use is very limited. Aim To describe chronic disease, comorbidity, disability, and general practice use among people with ID compared with the general population. Design and setting This study is a cross-sectional analysis of a primary care database including 408 English general practices in 2012. Method A total of 14 751 adults with ID, aged 18–84 years, were compared with 86 221 age-, sex- and practice-matched controls. Depending on the outcome, prevalence (PR), risk (RR), or odds (OR) ratios comparing patients with ID with matched controls are shown. Results Patients with ID had a markedly higher prevalence of recorded epilepsy (18.5%, PR 25.33, 95% confidence interval [CI] = 23.29 to 27.57), severe mental illness (8.6%, PR 9.10, 95% CI = 8.34 to 9.92), and dementia (1.1%, PR 7.52, 95% CI = 5.95 to 9.49), as well as moderately increased rates of hypothyroidism and heart failure (PR>2.0). However, recorded prevalence of ischaemic heart disease and cancer was approximately 30% lower than the general population. The average annual number of primary care consultations was 6.29 for patients with ID, compared with 3.89 for matched controls. Patients with ID were less likely to have longer doctor consultations (OR 0.73, 95% CI = 0.69 to 0.77), and had lower continuity of care with the same doctor (OR 0.77, 95% CI = 0.73 to 0.82). Conclusion Compared with the general population, people with ID have generally higher overall levels of chronic disease and greater primary care use. Ensuring access to high-quality chronic disease management, especially for epilepsy and mental illness, will help address these greater healthcare needs. Continuity of care and longer appointment times are important potential improvements in primary care. PMID:26906630

  20. NASA Records Database

    NASA Technical Reports Server (NTRS)

    Callac, Christopher; Lunsford, Michelle

    2005-01-01

    The NASA Records Database, comprising a Web-based application program and a database, is used to administer an archive of paper records at Stennis Space Center. The system begins with an electronic form, into which a user enters information about records that the user is sending to the archive. The form is smart : it provides instructions for entering information correctly and prompts the user to enter all required information. Once complete, the form is digitally signed and submitted to the database. The system determines which storage locations are not in use, assigns the user s boxes of records to some of them, and enters these assignments in the database. Thereafter, the software tracks the boxes and can be used to locate them. By use of search capabilities of the software, specific records can be sought by box storage locations, accession numbers, record dates, submitting organizations, or details of the records themselves. Boxes can be marked with such statuses as checked out, lost, transferred, and destroyed. The system can generate reports showing boxes awaiting destruction or transfer. When boxes are transferred to the National Archives and Records Administration (NARA), the system can automatically fill out NARA records-transfer forms. Currently, several other NASA Centers are considering deploying the NASA Records Database to help automate their records archives.

  1. Solubility Database

    National Institute of Standards and Technology Data Gateway

    SRD 106 IUPAC-NIST Solubility Database (Web, free access)   These solubilities are compiled from 18 volumes (Click here for List) of the International Union for Pure and Applied Chemistry(IUPAC)-NIST Solubility Data Series. The database includes liquid-liquid, solid-liquid, and gas-liquid systems. Typical solvents and solutes include water, seawater, heavy water, inorganic compounds, and a variety of organic compounds such as hydrocarbons, halogenated hydrocarbons, alcohols, acids, esters and nitrogen compounds. There are over 67,500 solubility measurements and over 1800 references.

  2. Comparative analysis of benign prostatic hyperplasia management by urologists and nonurologists: A Korean nationwide health insurance database study

    PubMed Central

    Park, Juhyun; Lee, Young Ju; Lee, Jeong Woo; Yoo, Tag Keun; Chung, Jae Il; Yun, Seok-Joong; Hong, Jun Hyuk; Seo, Seong Il; Cho, Sung Yong

    2015-01-01

    Purpose To compare the current management of benign prostatic hyperplasia (BPH) by urologists and nonurologists by use of Korean nationwide health insurance data. Materials and Methods We obtained patient data from the national health insurance system. New patients diagnosed with BPH in 2009 were divided into two groups depending on whether they were diagnosed by a urologist (U group) or by a nonurologist (NU group). Results A total of 390,767 individuals were newly diagnosed with BPH in 2009. Of these, 240,907 patients (61.7%) were in the U group and 149,860 patients (38.3%) were in the NU group. The rate of all initial evaluation tests, except serum creatinine, was significantly lower in the NU group. The initial prescription rate was higher in the U group, whereas the prescription period was longer in the NU group. Regarding the initial drugs prescribed, the use of alpha-blockers was common in both groups. However, the U group was prescribed combination therapy of an alpha-blocker and 5-alpha-reductase inhibitor as the second choice, whereas the NU group received monotherapy with a 5-alpha-reductase inhibitor. During the 1-year follow-up, the incidence of surgery was significantly different between the U group and the NU group. Conclusions There are distinct differences in the diagnosis and treatment of BPH by urologists and nonurologists in Korea. These differences may have adverse consequences for BPH patients. Urological societies should take a leadership role in the management of BPH and play an educational role for nonurologists as well as urologists. PMID:25763128

  3. Assessing and Improving the Quality of Food Composition Databases for Nutrition and Health Applications in Europe: The Contribution of EuroFIR123

    PubMed Central

    Finglas, Paul M.; Berry, Rachel; Astley, Siân

    2014-01-01

    Food composition databases (FCDBs) form an integral part of nutrition and health research, patient treatment, manufacturing processes, and consumer information. FCDBs have traditionally been compiled at a national level; therefore, until recently, there was limited standardization of procedures across different data sets. Digital technologies now allow FCDB users to access a variety of information from different sources, which has emphasized the need for greater harmonization. The European Food Information Resource (EuroFIR) Network of Excellence and Nexus projects (2005–2013) has been instrumental in addressing differences in FCDBs and in producing standardized protocols and quality schemes to compile and manage them. A formal, recognized European standard for food composition data has been prepared, which will further assist in the production of comparable data. Quality schemes need to address both the composition data, plus the methods of sampling, analysis, and calculation, and the documentation of processes. The EuroFIR data exchange platform provides a wealth of resources for composition compilers and end users and continues to develop new and innovative tools and methodologies. EuroFIR also is working in collaboration with the European Food Safety Authority, and as a partner in several European projects. Through such collaborations, EuroFIR will continue to develop FCDB harmonization and to use new technologies to ensure sustainable future initiatives in the food composition activities that underpin food and health research in Europe. PMID:25469406

  4. Socioeconomic variation in the burden of chronic conditions and health care provision – analyzing administrative individual level data from the Basque Country, Spain

    PubMed Central

    2013-01-01

    Background Chronic diseases are posing an increasing challenge to society, with the associated burden falling disproportionally on more deprived individuals and geographical areas. Although the existence of a socioeconomic health gradient is one of the main concerns of health policy across the world, health information systems commonly do not have reliable data to detect and monitor health inequalities and inequities. The objectives of this study were to measure the level of socioeconomic-related inequality in prevalence of chronic diseases and to investigate the extent and direction of inequities in health care provision. Methods A dataset linking clinical and administrative information of the entire population living in the Basque Country, Spain (over 2 million individuals) was used to measure the prevalence of 52 chronic conditions and to quantify individual health care costs. We used a concentration-index approach to measure the extent and direction of inequality with respect to the deprivation of the area of residence of each individual. Results Most chronic diseases were found to be disproportionally concentrated among individuals living in more deprived areas, but the extent of the imbalance varies by type of disease and sex. Most of the variation in health care utilization was explained by morbidity burden. However, even after accounting for differences in morbidity, pro-poor horizontal inequity was present in specialized outpatient care, emergency department, prescription, and primary health care costs and this fact was more apparent in females than males; inpatient costs exhibited an equitable distribution in both sexes. Conclusions Analyses of comprehensive administrative clinical information at the individual level allow the socioeconomic gradient in chronic diseases and health care provision to be measured to a level of detail not possible using other sources. This frequently updated source of information can be exploited to monitor trends and evaluate

  5. Administrators: Nursing Home Administrator

    ERIC Educational Resources Information Center

    Kahl, Anne

    1976-01-01

    Responsibilities, skills needed, training needed, earnings, employment outlook, and sources of additional information are outlined for the administrator who holds the top management job in a nursing home. (JT)

  6. Administrative Uses of the Microcomputer.

    ERIC Educational Resources Information Center

    Spuck, Dennis W.; Atkinson, Gene

    1983-01-01

    An outline of microcomputer applications for administrative computing in education is followed by discussions of aspects of office automation, database management systems, management information systems, administrative computer systems, and software. Several potential problems relating to administrative computing in education are identified.…

  7. Frequency and pattern of Chinese herbal medicine prescriptions for urticaria in Taiwan during 2009: analysis of the national health insurance database

    PubMed Central

    2013-01-01

    Background Large-scale pharmaco-epidemiological studies of Chinese herbal medicine (CHM) for treatment of urticaria are few, even though clinical trials showed some CHM are effective. The purpose of this study was to explore the frequencies and patterns of CHM prescriptions for urticaria by analysing the population-based CHM database in Taiwan. Methods This study was linked to and processed through the complete traditional CHM database of the National Health Insurance Research Database in Taiwan during 2009. We calculated the frequencies and patterns of CHM prescriptions used for treatment of urticaria, of which the diagnosis was defined as the single ICD-9 Code of 708. Frequent itemset mining, as applied to data mining, was used to analyse co-prescription of CHM for patients with urticaria. Results There were 37,386 subjects who visited traditional Chinese Medicine clinics for urticaria in Taiwan during 2009 and received a total of 95,765 CHM prescriptions. Subjects between 18 and 35 years of age comprised the largest number of those treated (32.76%). In addition, women used CHM for urticaria more frequently than men (female:male = 1.94:1). There was an average of 5.54 items prescribed in the form of either individual Chinese herbs or a formula in a single CHM prescription for urticaria. Bai-Xian-Pi (Dictamnus dasycarpus Turcz) was the most commonly prescribed single Chinese herb while Xiao-Feng San was the most commonly prescribed Chinese herbal formula. The most commonly prescribed CHM drug combination was Xiao-Feng San plus Bai-Xian-Pi while the most commonly prescribed triple drug combination was Xiao-Feng San, Bai-Xian-Pi, and Di-Fu Zi (Kochia scoparia). Conclusions In view of the popularity of CHM such as Xiao-Feng San prescribed for the wind-heat pattern of urticaria in this study, a large-scale, randomized clinical trial is warranted to research their efficacy and safety. PMID:23947955

  8. Factors Associated With Resource Utilization and Coronary Artery Dilation in Refractory Kawasaki Disease (from the Pediatric Health Information System Database).

    PubMed

    Lo, Jennifer Y; Minich, L LuAnn; Tani, Lloyd Y; Wilkes, Jacob; Ding, Qian; Menon, Shaji C

    2016-12-01

    Management guidelines for refractory Kawasaki disease (KD) are vague. We sought to assess practice variation and identify factors associated with large/complex coronary artery aneurysms (LCAA) and resource utilization in refractory KD. This retrospective cohort study identified patients aged ≤18 years with KD (2004 to 2014) using the Pediatric Health Information System. Refractory KD was defined as receiving >1 dose of intravenous immunoglobulin. Demographics, medications, concomitant infections, length of stay (LOS), and charges were collected. Antithrombotic therapy was a surrogate for LCAA. LOS and hospital charges assessed resource utilization. Multivariate regression identified factors associated with LOS, charges, and LCAA. Of 14,194 patients with KD, 2,974 (21%) had refractory KD and 203 of those 2,974 (7%) had LCAA. Additional intravenous immunoglobulin was the sole medication in 77%. Other medications added were steroids (18%), infliximab (2%), and both (3%). Warfarin, low-molecular-weight heparin, tissue plasminogen activator, and clopidogrel were prescribed with equal frequency (2%). Male gender (adjusted relative risk 1.52, 95% confidence interval [CI] 1.08 to 2.16, p <0.01), admission to an intensive care unit (4.79, 95% CI 3.40 to 6.74, p <0.001), arrhythmia (3.00, 95% CI 1.94 to 4.65, p <0.001), and concomitant viral infection (2.29, 95% CI 1.49 to 3.52, p <0.001) were associated with LCAA. Severe illness, race, region, and payer were independently associated with increased charges (p <0.05 for all). In conclusion, treatment for refractory KD varies widely. Concomitant viral infection was associated with a greater risk of LCAA in refractory KD. Better understanding of optimal management may improve outcomes and decrease both variability in management and resource utilization for refractory KD.

  9. Effect of administration of recombinant bovine somatotropin on health and performance of lactating dairy cows diagnosed with hyperketonemia.

    PubMed

    Gohary, K; Leslie, K E; Ford, J; Capel, M; LeBlanc, S J; Duffield, T F

    2015-07-01

    The effect of administering recombinant bovine somatotropin (rbST) to cows with hyperketonemia during the early postpartum period on health, metabolic parameters, milk production, and early reproductive performance was evaluated in a double-blinded clinical trial. Cows from 8 dairy herds in New York State were tested weekly between 3 and 16d in milk for elevated serum β-hydroxybutyrate. Cows were enrolled in the study when blood β-hydroxybutyrate was ≥1.3mmol/L for the first time. Enrolled cows were randomly assigned to a treatment (n=273) or placebo control (n=270) group. Treated cows were given 325mg of rbST subcutaneously on the day of enrollment and again 14d later. Control cows received the same regimen except the syringe contained only the carrier without somatotropin. After enrollment, blood samples were collected weekly for 4wk and submitted to the laboratory to be analyzed for selected metabolites. Risk ratios for clinical diseases subsequent to treatment were calculated using Poisson regression. Continuous data were analyzed using linear mixed models. Time to first insemination was assessed with survival analysis. In the 42d following the first administration of rbST, incidence risks of displaced abomasum, clinical ketosis, metritis, clinical mastitis, and lameness were not different between treatment groups. Cows treated with rbST had a slightly lower body condition score 28d after enrollment compared with control cows. In the 4wk following enrollment, serum nonesterified fatty acids and aspartate amino-transferase were slightly higher for treated than control cows, respectively. Serum glucose, calcium, haptoglobin, and β-hydroxybutyrate were similar between groups. Treatment had no effect on resolution of hyperketonemia in any of the 4wk after enrollment. Milk production in either of the 2-wk periods after each treatment was not different between treated and control cows. Furthermore, milk production was not different between groups from enrollment

  10. The Decline in Hydrocodone/Acetaminophen Prescriptions in Emergency Departments in the Veterans Health Administration Between 2009 to 2015

    PubMed Central

    Grasso, Michael A.; Dezman, Zachary D.W.; Comer, Angela C.; Jerrard, David A.

    2016-01-01

    Introduction The purpose of the study was to measure national prescribing patterns for hydrocodone/acetaminophen among veterans seeking emergency medical care, and to see if patterns have changed since this medication became a Schedule II controlled substance. Methods We conducted a retrospective cohort study of emergency department (ED) visits within the Veterans Health Administration (VA) between January 2009 and June 2015. We looked at demographics, comorbidities, utilization measures, diagnoses, and prescriptions. Results During the study period, 1,709,545 individuals participated in 6,270,742 ED visits and received 471,221 prescriptions for hydrocodone/acetaminophen (7.5% of all visits). The most common diagnosis associated with a prescription was back pain. Prescriptions peaked at 80,776 in 2011 (8.7% of visits), and declined to 35,031 (5.6%) during the first half of 2015 (r=−0.99, p<0.001). The percentage of hydrocodone/acetaminophen prescriptions limited to 12 pills increased from 22% (13,949) in 2009 to 31% (11,026) in the first half of 2015. A prescription was more likely written for patients with a pain score≥7 (OR 3.199, CI [3.192–3.205]), a musculoskeletal (OR 1.622, CI [1.615–1.630]) or soft tissue (OR 1.656, CI [1.649–1.664]) diagnosis, and those below the first quartile for total ED visits (OR 1.282, CI [1.271–1.293]) and total outpatient ICD 9 codes (OR 1.843, CI [1.833–1.853]). Conclusion Hydrocodone/acetaminophen is the most frequently prescribed ED medication in the VA. The rate of prescribing has decreased since 2011, with the rate of decline remaining unchanged after it was classified as a Schedule II controlled substance. The proportion of prescriptions falling within designated guidelines has increased but is not at goal. PMID:27482304

  11. The Department of Veterans Health Administration Office of Nursing Service, "transforming nursing in a national healthcare system: an example of transformation in action".

    PubMed

    Wertenberger, Sydney; Chapman, Kathleen M; Wright-Brown, Salena

    2011-01-01

    The Department of Veterans Health Administration Office of Nursing Service has embarked on a multiyear transformational process, an example of which is the development of an organization-wide nursing handbook. The development of this handbook offered the opportunity to improve collaboration, redefine expectations and behavior, as well as prepare for the future of Nursing within the Veterans Health Administration. The lessons learned from this process have revolved around the themes of leadership skills for managing high-level change often in a virtual environment; constant collaboration; that the practice of nursing will continue to evolve on the basis of new evidence, technology, customer expectations, and resources; and that the process to accomplish this goal is powerful.

  12. 'By papers and pens, you can only do so much': views about accountability and human resource management from Indian government health administrators and workers.

    PubMed

    George, Asha

    2009-01-01

    Although accountability drives in the Indian health sector sporadically highlight egregious behaviour of individual health providers, accountability needs to be understood more broadly. From a managerial perspective, while accountability functions as a control mechanism that involves reviews and sanctions, it also has a constructive side that encourages learning from errors and discretion to support innovation. This points to social relationships: how formal rules and hierarchies combine with informal norms and processes and more fundamentally how power relations are negotiated. Drawing from this conceptual background and based on qualitative research, this article analyses the views of government primary health care administrators and workers from Koppal district, northern Karnataka, India. In particular, the article details how these actors view two management functions concerned with internal accountability: supervision and disciplinary action. A number of disjunctures are revealed. Although extensive information systems exist, they do not guide responsiveness or planning. While supportive supervision efforts are acknowledged and practiced, implicit quid-pro-quo bargains that justify poor service delivery performance are more prevalent. Despite the enactment of numerous disciplinary measures, little discipline is observed. These disjunctures reflect nuanced and layered relationships between health administrators and workers, as well as how power is negotiated through corruption and elected representatives within the broader political economy context of health systems in northern Karnataka, India. These various dimensions of accountability need to be addressed if it is to be used more equitably and effectively.

  13. The challenge of closing the diversity gap: development of Hispanic nursing faculty through a Health Resources and Services Administration Minority Faculty Fellowship Program grant.

    PubMed

    Jacob, Susan R; Sánchez, Zoila V

    2011-01-01

    Underrepresentation of minority faculty in schools of nursing is well reported. Recently, there have been multiple initiatives from both public and private sectors to alleviate the shortage of minority faculty. This article describes how the University of Tennessee Health Science Center (UTHSC) College of Nursing took advantage of one such initiative: the Health Resources and Services Administration (HRSA) Minority Faculty Fellowship Program (MFFP) grant. This program grant provides stipends to enable health professions educational programs to increase the number of faculty who are racial and ethnic minorities underrepresented in the health professions. It enabled the college to recruit a Hispanic nurse and to assist her in preparing for a successful academic career. HRSA provided a stipend in an amount not exceeding 50% of regular faculty salary of the institution for 3 years, to be matched by the institution. Expert faculty mentored the nurse's development in the areas of pedagogy, administration and leadership, design and conduct of research, grant writing and scientific writing for publication in peer-reviewed journals, and cultural competence. Dr. Susan Jacob was the project director of the MFFP grant received by the College of Nursing at UTHSC, and Zoila Sanchez, a Cuban American, was the minority faculty fellow supported by an HRSA MFFP grant. Dr. Sanchez was the first minority faculty fellow selected from the nursing profession. Past fellows represented the other health professions such as medicine and dentistry.

  14. Data Extraction and Management in Networks of Observational Health Care Databases for Scientific Research: A Comparison of EU-ADR, OMOP, Mini-Sentinel and MATRICE Strategies

    PubMed Central

    Gini, Rosa; Schuemie, Martijn; Brown, Jeffrey; Ryan, Patrick; Vacchi, Edoardo; Coppola, Massimo; Cazzola, Walter; Coloma, Preciosa; Berni, Roberto; Diallo, Gayo; Oliveira, José Luis; Avillach, Paul; Trifirò, Gianluca; Rijnbeek, Peter; Bellentani, Mariadonata; van Der Lei, Johan; Klazinga, Niek; Sturkenboom, Miriam

    2016-01-01

    Introduction: We see increased use of existing observational data in order to achieve fast and transparent production of empirical evidence in health care research. Multiple databases are often used to increase power, to assess rare exposures or outcomes, or to study diverse populations. For privacy and sociological reasons, original data on individual subjects can’t be shared, requiring a distributed network approach where data processing is performed prior to data sharing. Case Descriptions and Variation Among Sites: We created a conceptual framework distinguishing three steps in local data processing: (1) data reorganization into a data structure common across the network; (2) derivation of study variables not present in original data; and (3) application of study design to transform longitudinal data into aggregated data sets for statistical analysis. We applied this framework to four case studies to identify similarities and differences in the United States and Europe: Exploring and Understanding Adverse Drug Reactions by Integrative Mining of Clinical Records and Biomedical Knowledge (EU-ADR), Observational Medical Outcomes Partnership (OMOP), the Food and Drug Administration’s (FDA’s) Mini-Sentinel, and the Italian network—the Integration of Content Management Information on the Territory of Patients with Complex Diseases or with Chronic Conditions (MATRICE). Findings: National networks (OMOP, Mini-Sentinel, MATRICE) all adopted shared procedures for local data reorganization. The multinational EU-ADR network needed locally defined procedures to reorganize its heterogeneous data into a common structure. Derivation of new data elements was centrally defined in all networks but the procedure was not shared in EU-ADR. Application of study design was a common and shared procedure in all the case studies. Computer procedures were embodied in different programming languages, including SAS, R, SQL, Java, and C++. Conclusion: Using our conceptual framework

  15. Workplace measurements by the U.S. Occupational Safety and Health Administration since 1979: Descriptive analysis and potential uses for exposure assessment.

    PubMed

    Lavoue, J; Friesen, M C; Burstyn, I

    2013-06-01

    This letter summarizes modifications to the results presented in Lavoué et al. (2012): Lavoué, J., Burstyn, I.,Friesen, M. (2012) Workplace Measurements by the US Occupational Safety and Health Administration since1979: Descriptive Analysis and Potential Uses for Exposure Assessment. Annals of occupational hygiene57(1):77–97. Although several results were altered, the conclusions were not affected by the changes.

  16. Developing quality of care indicators for patients with traumatic and non-traumatic spinal cord injury (SCI): A feasibility study using administrative health data

    PubMed Central

    Parsons, Daria; Craven, B. Catharine; Jaglal, Susan B.; Verrier, Molly

    2015-01-01

    Objectives (1) to inform the development of health system quality indicators for traumatic and non-traumatic spinal cord injury from acute care admission to community care discharge using administrative data, and (2) to examine characteristics and differences in care among type of care facility, and type of pathology using administrative data. Design Retrospective cohort study using administrative health data. Setting Ontario, Canada. Participants Using administrative health data, we used International Classification codes 10th version Canadian Edition to identify incident cases of SCI from April 1, 2006 to March 31, 2012. Results We identified 7,693 cases in our cohort, of whom 1,537 (20.0%) were categorized as traumatic spinal cord (TSCI) and 6,156 (80.0%) as non-traumatic (NTSCI). Of those identified with NTSCI, more than half (54.0%) were diagnosed with either Guillain Barré syndrome and Multiple Sclerosis (n = 3,326). More individuals admitted to a trauma/spine center were seen by an orthopedic surgeon or a neurosurgeon (20.3% compared to 5.6% for NTSCI; 77.7% compared to 24.9% for TSCI). Only 25.7% (n = 724) of the NTSCI cohort were admitted to a rehabilitation facility from a trauma/spine center, compared to 58.9% (n = 754) of those with TSCI. Conclusions Important challenges in data completeness and utility were identified. Province wide processes to flag incomplete data and provision of incentives for comprehensive data are urgently needed to develop quality indicators across the care continuum. Consensus on the coding for NTSCI for the purposes of developing health system indicators is required. PMID:26111282

  17. Veterans Health Administration Office of Nursing Services exploration of positive patient care synergies fueled by consumer demand: care coordination, advanced clinic access, and patient self-management.

    PubMed

    Wertenberger, Sydney; Yerardi, Ruth; Drake, Audrey C; Parlier, Renee

    2006-01-01

    The consumers who utilize the Veterans Health Administration healthcare system are older, and most are learning to live with chronic diseases. Their desires and needs have driven changes within the Veterans Health Administration. Through patient satisfaction initiatives and other feedback sources, consumers have made it clear that they do not want to wait for their care, they want a say in what care is provided to them, and they want to remain as independent as possible. Two interdisciplinary processes/models of healthcare are being implemented on the national level to address these issues: advanced clinic access and care coordination. These programs have a synergistic relationship and are integrated with patient self-management initiatives. Positive outcomes of these programs also meet the needs of our staff. As these new processes and programs are implemented nationwide, skills of both patients and nursing staff who provide their care need to be enhanced to meet the challenges of providing nursing care now and into the 21st century. Veterans Health Administration Office of Nursing Services Strategic Planning Work Group is defining and implementing processes/programs to ensure nurses have the knowledge, information, and skills to meet these patient care demands at all levels within the organization.

  18. Hyaluronic Acid Injections Are Associated with Delay of Total Knee Replacement Surgery in Patients with Knee Osteoarthritis: Evidence from a Large U.S. Health Claims Database

    PubMed Central

    Altman, Roy; Lim, Sooyeol; Steen, R. Grant; Dasa, Vinod

    2015-01-01

    Background The growing prevalence of osteoarthritis (OA) and the medical costs associated with total knee replacement (TKR) surgery for end-stage OA motivate a search for agents that can delay OA progression. We test a hypothesis that hyaluronic acid (HA) injection is associated with delay of TKR in a dose-dependent manner. Methods and Findings We retrospectively evaluated records in an administrative claims database of ~79 million patients, to identify all patients with knee OA who received TKR during a 6-year period. Only patients with continuous plan enrollment from diagnosis until TKR were included, so that complete medical records were available. OA diagnosis was the index event and we evaluated time-to-TKR as a function of the number of HA injections. The database included 182,022 patients with knee OA who had TKR; 50,349 (27.7%) of these patients were classified as HA Users, receiving ≥1 courses of HA prior to TKR, while 131,673 patients (72.3%) were HA Non-users prior to TKR, receiving no HA. Cox proportional hazards modelling shows that TKR risk decreases as a function of the number of HA injection courses, if patient age, gender, and disease comorbidity are used as background covariates. Multiple HA injections are therefore associated with delay of TKR (all, P < 0.0001). Half of HA Non-users had a TKR by 114 days post-diagnosis of knee OA, whereas half of HA Users had a TKR by 484 days post-diagnosis (χ2 = 19,769; p < 0.0001). Patients who received no HA had a mean time-to-TKR of 0.7 years; with one course of HA, the mean time to TKR was 1.4 years (χ2 = 13,725; p < 0.0001); patients who received ≥5 courses delayed TKR by 3.6 years (χ2 = 19,935; p < 0.0001). Conclusions HA injection in patients with knee OA is associated with a dose-dependent increase in time-to-TKR. PMID:26694145

  19. Database for Safety-Oriented Tracking of Chemicals

    NASA Technical Reports Server (NTRS)

    Stump, Jacob; Carr, Sandra; Plumlee, Debrah; Slater, Andy; Samson, Thomas M.; Holowaty, Toby L.; Skeete, Darren; Haenz, Mary Alice; Hershman, Scot; Raviprakash, Pushpa

    2010-01-01

    SafetyChem is a computer program that maintains a relational database for tracking chemicals and associated hazards at Johnson Space Center (JSC) by use of a Web-based graphical user interface. The SafetyChem database is accessible to authorized users via a JSC intranet. All new chemicals pass through a safety office, where information on hazards, required personal protective equipment (PPE), fire-protection warnings, and target organ effects (TOEs) is extracted from material safety data sheets (MSDSs) and recorded in the database. The database facilitates real-time management of inventory with attention to such issues as stability, shelf life, reduction of waste through transfer of unused chemicals to laboratories that need them, quantification of chemical wastes, and identification of chemicals for which disposal is required. Upon searching the database for a chemical, the user receives information on physical properties of the chemical, hazard warnings, required PPE, a link to the MSDS, and references to the applicable International Standards Organization (ISO) 9000 standard work instructions and the applicable job hazard analysis. Also, to reduce the labor hours needed to comply with reporting requirements of the Occupational Safety and Health Administration, the data can be directly exported into the JSC hazardous- materials database.

  20. [PUBLIC ADMINISTRATION OF PERSONNEL POLICY IN REFORMING OF UKRAINIAN HEALTH CARE SYSTEM USING THE EXAMPLE OF DERMATOVENEREOLOGICAL SERVICE].

    PubMed

    Korolenko, V V; Dykun, O P; Isayenko, R M; Remennyk, O I; Avramenko, T P; Stepanenko, V I; Petrova, K I; Volosovets, O P; Lazoryshynets, V V

    2014-01-01

    The health care system, its modernization and optimization are among the most important functions of the modern Ukrainian state. The main goal of the reforms in the field of healthcare is to improve the health of the population, equal and fair access for all to health services of adequate quality. Important place in the health sector reform belongs to optimizing the structure and function of dermatovenereological service. The aim of this work is to address the issue of human resources management of dermatovenereological services during health sector reform in Ukraine, taking into account the real possibility of disengagement dermatovenereological providing care between providers of primary medical care level (general practitioners) and providers of secondary (specialized) and tertiary (high-specialized) medical care (dermatovenerologists and pediatrician dermatovenerologists), and coordinating interaction between these levels. During research has been found, that the major problems of human resources of dermatovenereological service are insufficient staffing and provision of health-care providers;,growth in the number of health workers of retirement age; sectoral and regional disparity of staffing; the problem of improving the skills of medical personnel; regulatory support personnel policy areas and create incentives for staff motivation; problems of rational use of human resources for health care; problems of personnel training for dermatovenereological service. Currently reforming health sector should primarily serve the needs of the population in a fairly effective medical care at all levels, to ensure that there must be sufficient qualitatively trained and motivated health workers. To achieve this goal directed overall work of the Ministry of Health of Uktaine, the National Academy of Medical Sciences of Ukraine, medical universities, regional health authorities, professional medical associations. Therefore Ukrainian dermatovenereological care, in particular