Sample records for affairs healthcare system

  1. Strategic alliances in healthcare: opportunities for the Veterans Affairs healthcare system.

    PubMed

    Halverson, P K; Kaluzny, A D; Young, G J

    1997-01-01

    Strategic alliances are proving to be effective strategies for responding and adapting to changing environments, and as such they offer the U.S. Department of Veterans Affairs (VA) healthcare system valuable opportunities for accomplishing the goals of its major reorganization effort. This article begins with an examination of basic strategic-alliance structures that are employed across many different types of industries. Next, consideration is given to the ways in which these basic alliance structures may be adapted to the unique organizations and individuals that serve as providers, purchasers, and consumers of health services. Finally, this article explores how models of strategic alliance in healthcare can be tailored to the specific needs and constraints of the VA healthcare system through an examination of existing and potential alliance opportunities.

  2. Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System

    PubMed Central

    Zulman, Donna M; Pal Chee, Christine; Wagner, Todd H; Yoon, Jean; Cohen, Danielle M; Holmes, Tyson H; Ritchie, Christine; Asch, Steven M

    2015-01-01

    Objectives To investigate the relationship between multimorbidity and healthcare utilisation patterns among the highest cost patients in a large, integrated healthcare system. Design In this retrospective cross-sectional study of all patients in the U.S. Veterans Affairs (VA) Health Care System, we aggregated costs of individuals’ outpatient and inpatient care, pharmacy services and VA-sponsored contract care received in 2010. We assessed chronic condition prevalence, multimorbidity as measured by comorbidity count, and multisystem multimorbidity (number of body systems affected by chronic conditions) among the 5% highest cost patients. Using multivariate regression, we examined the association between multimorbidity and healthcare utilisation and costs, adjusting for age, sex, race/ethnicity, marital status, homelessness and health insurance status. Setting USA VA Health Care System. Participants 5.2 million VA patients. Measures Annual total costs; absolute and share of costs generated through outpatient, inpatient, pharmacy and VA-sponsored contract care; number of visits to primary, specialty and mental healthcare; number of emergency department visits and hospitalisations. Results The 5% highest cost patients (n=261 699) accounted for 47% of total VA costs. Approximately two-thirds of these patients had chronic conditions affecting ≥3 body systems. Patients with cancer and schizophrenia were less likely to have documented comorbid conditions than other high-cost patients. Multimorbidity was generally associated with greater outpatient and inpatient utilisation. However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (−0.6 percentage points per affected body system, p<0.01). Conclusions Multisystem multimorbidity is common among high-cost VA patients. While some patients might benefit from disease

  3. Hepatitis C Cure Is Associated with Decreased Healthcare Costs in Cirrhotics in Retrospective Veterans Affairs Cohort.

    PubMed

    Maier, Marissa M; Zhou, Xiao-Hua; Chapko, Michael; Leipertz, Steven L; Wang, Xuan; Beste, Lauren A

    2018-06-01

    Approximately 233,898 individuals in the Veterans Affairs healthcare network are hepatitis C virus (HCV)-infected, making the Veterans Affairs the single largest provider of HCV care in the USA. Direct-acting antiviral treatment regimens for HCV offer high cure rates. However, these medications pose an enormous financial burden, and whether HCV cure is associated with decreased healthcare costs is poorly defined. To measure downstream healthcare costs in a national population of HCV-infected patients up to 9 years post-HCV antiviral treatment, to compare downstream healthcare costs between cured and uncured patients, and to assess impact of cirrhosis status on cost differences. This is a retrospective cohort study (2004-2014) of hepatitis C-infected patients who initiated antiviral treatment within the United States Veterans Affairs healthcare system October 2004-September 2013. We measured inpatient, outpatient, and pharmacy costs after HCV treatment. For the entire cohort, cure was associated with mean cumulative cost savings in post-treatment years three-six, but no cost savings by post-treatment year nine. By post-treatment year nine, cure in cirrhosis patients was associated with a mean cumulative cost savings of $9474 (- 32,666 to 51,614) per patient, while cure in non-cirrhotic patients was associated with a mean cumulative cost excess of $2526 (- 12,211 to 7159) per patient. Among patients with cirrhosis at baseline, cure is associated with absolute cost savings up to 9 years post-treatment compared to those without cure. Among patients without cirrhosis, early post-treatment cost savings are counterbalanced by higher costs in later years.

  4. Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System.

    PubMed

    Zulman, Donna M; Pal Chee, Christine; Wagner, Todd H; Yoon, Jean; Cohen, Danielle M; Holmes, Tyson H; Ritchie, Christine; Asch, Steven M

    2015-04-16

    To investigate the relationship between multimorbidity and healthcare utilisation patterns among the highest cost patients in a large, integrated healthcare system. In this retrospective cross-sectional study of all patients in the U.S. Veterans Affairs (VA) Health Care System, we aggregated costs of individuals' outpatient and inpatient care, pharmacy services and VA-sponsored contract care received in 2010. We assessed chronic condition prevalence, multimorbidity as measured by comorbidity count, and multisystem multimorbidity (number of body systems affected by chronic conditions) among the 5% highest cost patients. Using multivariate regression, we examined the association between multimorbidity and healthcare utilisation and costs, adjusting for age, sex, race/ethnicity, marital status, homelessness and health insurance status. USA VA Health Care System. 5.2 million VA patients. Annual total costs; absolute and share of costs generated through outpatient, inpatient, pharmacy and VA-sponsored contract care; number of visits to primary, specialty and mental healthcare; number of emergency department visits and hospitalisations. The 5% highest cost patients (n=261,699) accounted for 47% of total VA costs. Approximately two-thirds of these patients had chronic conditions affecting ≥3 body systems. Patients with cancer and schizophrenia were less likely to have documented comorbid conditions than other high-cost patients. Multimorbidity was generally associated with greater outpatient and inpatient utilisation. However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (-0.6 percentage points per affected body system, p<0.01). Multisystem multimorbidity is common among high-cost VA patients. While some patients might benefit from disease-specific programmes, for most patients with multimorbidity there is a need for

  5. Stress Testing After Percutaneous Coronary Intervention in the Veterans Affairs HealthCare System: Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.

    PubMed

    Bradley, Steven M; Hess, Edward; Winchester, David E; Sussman, Jeremy B; Aggarwal, Vikas; Maddox, Thomas M; Barón, Anna E; Rumsfeld, John S; Ho, P Michael

    2015-09-01

    Stress testing after percutaneous coronary intervention (PCI) in fee-for-service settings is common and rates vary by hospital. Rates of stress testing after PCI within integrated healthcare systems, such as the Veterans Affairs (VA) are unknown. We evaluated all VA patients who underwent PCI from October 2007 through June 2010. To avoid the influence of Medicare eligibility on rates of stress testing use in the VA, we excluded Medicare eligible patients during the follow-up period. Hospital-level variation in risk-standardized rates of stress testing and the association with 1-year mortality and myocardial infarction was determined from Markov chain Monte Carlo methods. Among 10 293 patients undergoing PCI at 55 VA hospitals, 2239 (21.8%) had a stress test performed within 1 year of PCI and 3902 (37.9%) within 2 years. Most stress tests after PCI were performed with nuclear imaging (79.8%). The hospital-level risk-standardized rate of stress testing differed significantly from the average at 14 hospitals, with 8 (14.5%) hospitals significantly below and 6 (10.9%) hospitals significantly above the average stress testing rate. Hospital-level risk-standardized stress testing rates were not significantly correlated with risk-standardized mortality (Spearman ρ=-0.24; P=0.08) or myocardial infarction rates (Spearman ρ=0.20; P=0.14). In the VA, nearly 40% of patients underwent stress testing in the 2 years after PCI, which is a third less than published studies from other healthcare systems. However, stress testing rates varied across VA hospitals, suggesting opportunities to optimize the use of stress testing are still present in integrated healthcare systems. © 2015 American Heart Association, Inc.

  6. The Value That Infectious Diseases Physicians Bring to the Healthcare System.

    PubMed

    McQuillen, Daniel P; MacIntyre, Ann T

    2017-09-15

    While a career in infectious diseases (ID) has always been challenging and exciting, recognition of the value that ID physicians provide to the healthcare system as a whole, over and above the value they provide to individual patients, has been poor in this system. In response to this disparity, the Infectious Diseases Society of America Clinical Affairs Committee has long endeavored to quantify the value of ID physicians to the system, which is challenging in part because of the many avenues through which they influence healthcare. We discuss data showing that ID physicians improve clinical outcomes, positively impact transitions of care, and direct system-level improvements through infection prevention and antimicrobial stewardship. We identify areas where value-based care provides additional future opportunities for ID physicians. A Clinical Affairs Committee-sponsored study of ID physicians' positive impact on patient outcomes shows that few medical specialties are better positioned to positively impact the Triple Aim approach-better health, better care, and lower per capita cost-that is the principle tenet of healthcare system reform. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  7. Health promotion practices as perceived by primary healthcare professionals at the Ministry of National Guard Health Affairs, Saudi Arabia.

    PubMed

    Altamimi, Samar; Alshoshan, Feda; Al Shaman, Ghada; Tawfeeq, Nasser; Alasmary, May; Ahmed, Anwar E

    2016-01-01

    In recent years, several research studies have investigated health promotion practices in Saudi healthcare organizations, yet no published literature exists on health promotion practices of primary healthcare professionals working for the Ministry of National Guard Health Affairs (MNG-HA). A cross-sectional study was conducted in a convenience sample of 206 primary healthcare professionals at the MNG-HA. A self-reporting questionnaire was used to investigate the attitudes, awareness, satisfaction, and methods regarding health promotion practices of primary healthcare professionals. Of the 206 primary healthcare professionals surveyed, 58.1% reported awareness of health promotion programs conducted in the hospitals and 64.6% reported that the health promotion system in the hospitals needs to be improved. Language barriers and cultural beliefs were viewed as obstacles to carrying out effective health promotion by 65% and 64.6% of primary healthcare professionals, respectively. The majority (79.9%) of the primary healthcare professionals perceived themselves as having the necessary skills to promote health and 80.6% believed that printed educational materials are the most prevalent method of health promotion/education, whereas 55.8% reported that counseling was the most preferred method of health promotion. The awareness level of health promotion policies, strategies, and programs conducted in the hospitals was not found to be satisfactory. Therefore, widespread training programs are recommended to improve the health promotion system in the hospitals. These programs include facilitating behavioral change, introducing health promotion policies and strategies in hospitals, mandatory workshops, and systematic reminders.

  8. Variation in prescription use and spending for lipid-lowering and diabetes medications in the Veterans Affairs Healthcare System.

    PubMed

    Gellad, Walid F; Good, Chester B; Lowe, John C; Donohue, Julie M

    2010-10-01

    To examine variation in outpatient prescription use and spending for hyperlipidemia and diabetes mellitus in the Veterans Affairs Healthcare System (VA) and its association with quality measures for these conditions. Cross-sectional. We compared outpatient prescription use, spending, and quality of care across 135 VA medical centers (VAMCs) in fiscal year 2008, including 2.3 million patients dispensed lipid-lowering medications and 981,031 patients dispensed diabetes medications. At each facility, we calculated VAMC-level cost per patient for these medications, the proportion of patients taking brand-name drugs, and Healthcare Effectiveness Data and Information Set (HEDIS) scores for hyperlipidemia (low-density lipoprotein cholesterol level <100 mg/dL) and for diabetes (glycosylated hemoglobin level >9% or not measured). The median cost per patient for lipid-lowering agents in fiscal year 2008 was $49.60 and varied from $39.68 in the least expensive quartile of VAMCs to $69.57 in the most expensive quartile (P < .001). For diabetes agents, the median cost per patient was $158.34 and varied from $123.34 in the least expensive quartile to $198.31 in the most expensive quartile (P < .001). The proportion of patients dispensed brand-name oral drugs among these classes in the most expensive quartile of VAMCs was twice that in the least expensive quartile (P < .001). There was no correlation between VAMC-level prescription spending and performance on HEDIS measures for lipid-lowering drugs (r = 0.12 and r = 0.07) or for diabetes agents (r = -0.10). Despite the existence of a closely managed formulary, significant variation in prescription spending and use of brand-name drugs exists in the VA. Although we could not explicitly risk-adjust, there appears to be no relationship between prescription spending and quality of care.

  9. Entacapone and prostate cancer in Parkinson's disease patients: A large Veterans Affairs healthcare system study.

    PubMed

    Major, Jacqueline M; Dong, Diane; Cunningham, Francesca; By, Kunthel; Hur, Kwan; Shih, David C; Jiang, Rong; Podskalny, Gerald D; Wei, XiangMing; Pinheiro, Simone; Bird, Steven T; Keeton, Stephine; Graham, David J

    2018-05-05

    An increased incidence of prostate cancer was observed in Parkinson's disease (PD) patients treated with entacapone during a pre-approval randomized clinical trial; the relation has not been robustly investigated in the U.S. ambulatory setting. To investigate whether entacapone is associated with prostate cancer and to assess whether the associations are correlated with advanced disease at the time of cancer diagnosis. Using data from the Department of Veterans Affairs healthcare system, new-user cohorts were created of PD patients treated with add-on entacapone or add-on dopamine agonist/monoamine oxidase B inhibitors between January 2000 and December 2014. Patients were followed on-treatment for occurrence of prostate cancer, identified via linkage to the VA cancer registry. Mean follow-up time was 3.1 and 4.0 years in the entacapone and control cohort, respectively. There were 17,666 subjects meeting study criteria (mean age, 74 (SD 8.6) years); the entacapone-treated group comprised 5,257 subjects. Twenty-three prostate cancer cases occurred in the entacapone cohort and ninety-seven in the control cohort. The overall incidence of prostate cancer was 1.8 per 1,000 person-years of risk. There was no difference in risk of prostate cancer between the cohorts for increased duration of entacapone intake (adjusted HR: 1.08; 95% confidence interval: 0.46-2.51 for cumulative exposure of ≥2 years). Time since starting drug therapy and cumulative dose (mg) also do not suggest a difference in prostate cancer risk between cohorts. Prolonged therapy with entacapone was not associated with increased prostate cancer incidence; however, findings suggest a higher severity of prostate cancer. Published by Elsevier Ltd.

  10. Using policy to increase prescribing of smoking cessation medications in the VA healthcare system.

    PubMed

    Smith, Mark W; Chen, Shuo; Siroka, Andrew M; Hamlett-Berry, Kim

    2010-12-01

    Since 2002 the US Veterans Affairs (VA) healthcare system has initiated national policies and programmes to reduce smoking among its patients and to increase evidence-based treatment for smoking. To document changes in dispensing rates of cessation-related medications in VA from 2004 to 2008. Retrospective analysis of VA administrative data. Prescription fills for nicotine replacement therapy (NRT), and for bupropion among NRT users, each grew more than 60% in four years. The increase stemmed primarily from treating more people rather than from filling more prescriptions per person. The results provide strong support for the efficacy of these policies and illustrate how healthcare systems can successfully employ multiple strategies to increase evidence-based smoking-cessation treatment.

  11. Reliability of tonosafe disposable tonometer prisms: clinical implications from the Veterans Affairs Boston Healthcare System Quality Assurance Study.

    PubMed

    Thomas, V; Daly, M K; Cakiner-Egilmez, T; Baker, E

    2011-05-01

    Given the Veterans Affairs Boston Healthcare System's recent introduction of single-use Tonosafe disposable tonometer prisms as an alternative to Goldmann applanation tonometers (GATs), this study had two aims: to conduct a large-scale quality assurance trial to assess the reliability of intraocular pressure (IOP) measurements of the Tonosafe disposable tonometer compared with GAT, particularly at extremes of pressure; to evaluate the suitability of Tonosafe disposable tonometer prisms as an acceptable substitute for GATs and for clinic-wide implementation in an academic tertiary referral setting. Ophthalmology resident physicians measured the IOPs of patients in general and specialty eye clinics with the Tonosafe disposable tonometer and GAT. Tonosafe test-retest reliability data were also collected. A retrospective review of patient charts and data analysis were performed to determine the reliability of measurements. The IOPs of 652 eyes (326 patients) were measured with both GAT and Tonosafe, with a range of 3-34 mm Hg. Linear regression analysis showed R=0.93, slope=0.91, both of which supported the proposed hypothesis, and the y-intercept=-1.05 was significantly different from the hypothesized value. The Tonosafe test-retest repeatability (40 eyes of 40 patients), r=0.977, was very high, which was further supported by linear regression slope=0.993, y-intercept=0.118, and a Tonosafe repeatability coefficient of 2.06, similar to GAT repeatability. The IOP measurements by Tonosafe disposable prisms correlated closely with Goldmann measurements, with similar repeated measurement variability to GAT. This suggests that the Tonosafe is an acceptable substitute for GAT to measure IOP in ophthalmology clinic settings.

  12. Impact of presumed service-connected diagnosis on the Department of Veterans Affairs healthcare utilization patterns of Vietnam-Theater Veterans

    PubMed Central

    Fried, Dennis A.; Rajan, Mangala; Tseng, Chin-lin; Helmer, Drew

    2018-01-01

    Abstract During the Vietnam War, the US military sprayed almost 20 million gallons of Agent Orange (AO), an herbicide contaminated with dioxin, over Vietnam. Approximately, 2.7 million US military personnel may have been exposed to AO during their deployment. Ordinarily, veterans who can demonstrate a nexus between a diagnosed condition and military service are eligible for Department of Veterans Affairs (VA) service-connected disability compensation. Vietnam Veterans have had difficulty, however, establishing a nexus between AO exposure and certain medical conditions that developed many years after the war. In response, VA has designated certain conditions as “presumed service connected” for Vietnam Veterans who were present and possibly exposed. Veterans with any of these designated conditions do not have to document AO exposure, making it easier for them to access the VA disability system. The extent to which VA healthcare utilization patterns reflect easier access afforded those with diagnosed presumptive conditions remains unknown. In this cross-sectional study, we hypothesized that Vietnam Veterans with diagnosed presumptive conditions would be heavier users of the VA healthcare system than those without these conditions. In our analysis of 85,699 Vietnam Veterans, we used binary and cumulative logit multivariable regression to assess associations between diagnosed presumptive conditions and VA healthcare utilization in 2013. We found that diagnosed presumptive conditions were associated with higher odds of 5+ VHA primary care visits (OR = 2.01, 95% CI: 1.93–2.07), 5+ specialty care visits (OR = 2.11, 95% CI: 2.04–2.18), emergency department use (OR = 1.22, 95% CI: 1.11–1.34), and hospitalization (OR = 1.23, 95% CI: 1.17–1.29). Consistent with legislative intent, presumptive policies appear to facilitate greater VA system utilization for Vietnam Veterans who may have been exposed to AO. PMID:29742706

  13. Role of HIS/RIS DICOM interfaces in the integration of imaging into the Department of Veterans Affairs healthcare enterprise

    NASA Astrophysics Data System (ADS)

    Kuzmak, Peter M.; Dayhoff, Ruth E.

    1998-07-01

    The U.S. Department of Veterans Affairs is integrating imaging into the healthcare enterprise using the Digital Imaging and Communication in Medicine (DICOM) standard protocols. Image management is directly integrated into the VistA Hospital Information System (HIS) software and clinical database. Radiology images are acquired via DICOM, and are stored directly in the HIS database. Images can be displayed on low- cost clinician's workstations throughout the medical center. High-resolution diagnostic quality multi-monitor VistA workstations with specialized viewing software can be used for reading radiology images. DICOM has played critical roles in the ability to integrate imaging functionality into the Healthcare Enterprise. Because of its openness, it allows the integration of system components from commercial and non- commercial sources to work together to provide functional cost-effective solutions (see Figure 1). Two approaches are used to acquire and handle images within the radiology department. At some VA Medical Centers, DICOM is used to interface a commercial Picture Archiving and Communications System (PACS) to the VistA HIS. At other medical centers, DICOM is used to interface the image producing modalities directly to the image acquisition and display capabilities of VistA itself. Both of these approaches use a small set of DICOM services that has been implemented by VistA to allow patient and study text data to be transmitted to image producing modalities and the commercial PACS, and to enable images and study data to be transferred back.

  14. Dengue Surveillance in Veterans Affairs Healthcare Facilities, 2007–2010

    PubMed Central

    Schirmer, Patricia L.; Lucero-Obusan, Cynthia A.; Benoit, Stephen R.; Santiago, Luis M.; Stanek, Danielle; Dey, Achintya; Martinez, Mirsonia; Oda, Gina; Holodniy, Mark

    2013-01-01

    Background Although dengue is endemic in Puerto Rico (PR), 2007 and 2010 were recognized as epidemic years. In the continental United States (US), outside of the Texas-Mexico border, there had not been a dengue outbreak since 1946 until dengue re-emerged in Key West, Florida (FL), in 2009–2010. The objective of this study was to use electronic and manual surveillance systems to identify dengue cases in Veterans Affairs (VA) healthcare facilities and then to clinically compare dengue cases in Veterans presenting for care in PR and in FL. Methodology Outpatient encounters from 1/2007–12/2010 and inpatient admissions (only available from 10/2009–12/2010) with dengue diagnostic codes at all VA facilities were identified using VA's Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE). Additional case sources included VA data from Centers for Disease Control and Prevention BioSense and VA infection preventionists. Case reviews were performed. Categorical data was compared using Mantel-Haenszel or Fisher Exact tests and continuous variables using t-tests. Dengue case residence was mapped. Findings Two hundred eighty-eight and 21 PR and FL dengue cases respectively were identified. Of 21 FL cases, 12 were exposed in Key West and 9 were imported. During epidemic years, FL cases had significantly increased dengue testing and intensive care admissions, but lower hospitalization rates and headache or eye pain symptoms compared to PR cases. There were no significant differences in clinical symptoms, laboratory abnormalities or outcomes between epidemic and non-epidemic year cases in FL and PR. Confirmed/probable cases were significantly more likely to be hospitalized and have thrombocytopenia or leukopenia compared to suspected cases. Conclusions Dengue re-introduction in the continental US warrants increased dengue surveillance and education in VA. Throughout VA, under-testing of suspected cases highlights the need to emphasize use

  15. Reliability of tonosafe disposable tonometer prisms: clinical implications from the Veterans Affairs Boston Healthcare System Quality Assurance Study

    PubMed Central

    Thomas, V; Daly, M K; Cakiner-Egilmez, T; Baker, E

    2011-01-01

    Purpose Given the Veterans Affairs Boston Healthcare System's recent introduction of single-use Tonosafe disposable tonometer prisms as an alternative to Goldmann applanation tonometers (GATs), this study had two aims: to conduct a large-scale quality assurance trial to assess the reliability of intraocular pressure (IOP) measurements of the Tonosafe disposable tonometer compared with GAT, particularly at extremes of pressure; to evaluate the suitability of Tonosafe disposable tonometer prisms as an acceptable substitute for GATs and for clinic-wide implementation in an academic tertiary referral setting. Methods Ophthalmology resident physicians measured the IOPs of patients in general and specialty eye clinics with the Tonosafe disposable tonometer and GAT. Tonosafe test–retest reliability data were also collected. A retrospective review of patient charts and data analysis were performed to determine the reliability of measurements. Results The IOPs of 652 eyes (326 patients) were measured with both GAT and Tonosafe, with a range of 3–34 mm Hg. Linear regression analysis showed R=0.93, slope=0.91, both of which supported the proposed hypothesis, and the y-intercept=−1.05 was significantly different from the hypothesized value. The Tonosafe test–retest repeatability (40 eyes of 40 patients), r=0.977, was very high, which was further supported by linear regression slope=0.993, y-intercept=0.118, and a Tonosafe repeatability coefficient of 2.06, similar to GAT repeatability. Conclusions The IOP measurements by Tonosafe disposable prisms correlated closely with Goldmann measurements, with similar repeated measurement variability to GAT. This suggests that the Tonosafe is an acceptable substitute for GAT to measure IOP in ophthalmology clinic settings. PMID:21455241

  16. 38 CFR 17.509 - Authorized disclosure: Non-Department of Veterans Affairs requests.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance Review... agencies upon their written request to permit VA's participation in healthcare programs including healthcare delivery, research, planning, and related activities with the requesting agencies. Any Federal...

  17. 38 CFR 17.509 - Authorized disclosure: Non-Department of Veterans Affairs requests.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance Review... agencies upon their written request to permit VA's participation in healthcare programs including healthcare delivery, research, planning, and related activities with the requesting agencies. Any Federal...

  18. 38 CFR 17.509 - Authorized disclosure: Non-Department of Veterans Affairs requests.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance Review... agencies upon their written request to permit VA's participation in healthcare programs including healthcare delivery, research, planning, and related activities with the requesting agencies. Any Federal...

  19. 38 CFR 17.509 - Authorized disclosure: Non-Department of Veterans Affairs requests.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance Review... agencies upon their written request to permit VA's participation in healthcare programs including healthcare delivery, research, planning, and related activities with the requesting agencies. Any Federal...

  20. 38 CFR 17.509 - Authorized disclosure: Non-Department of Veterans Affairs requests.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance Review... agencies upon their written request to permit VA's participation in healthcare programs including healthcare delivery, research, planning, and related activities with the requesting agencies. Any Federal...

  1. [Establishment of response system to emergency parasitic disease affairs in China].

    PubMed

    Chun-Li, C; Le-Ping, S; Qing-Biao, H; Bian-Li, X U; Bo, Z; Jian-Bing, L; Dan-Dan, L; Shi-Zhu, L I; Oning, X; Xiao-Nong, Z

    2017-08-14

    China's prevention and control of parasitic diseases has made remarkable achievements. However, the prevalence and transmission of parasitic diseases is impacted by the complicated natural and social factors of environment, natural disasters, population movements, and so on. Therefore, there are still the risks of the outbreak of emergency parasitic diseases affairs, which may affect the control effectiveness of parasitic diseases and endanger the social stability seriously. In this article, we aim at the analysis of typical cases of emergency parasitic disease affairs and their impacts on public health security in China in recently years, and we also elaborate the disposal characteristics of emergency parasitic disease affairs, and propose the establishment of response system to emergency parasitic disease affairs in China, including the organizational structure and response flow path, and in addition, point out that, in the future, we should strengthen the system construction and measures of the response system to emergency parasitic disease affairs, so as to control the risk and harm of parasitic disease spread as much as possible and to realize the early intervention and proper disposal of emergency parasitic disease affairs.

  2. Antibiotic resistance rates for Pseudomonas aeruginosa clinical respiratory and bloodstream isolates among the Veterans Affairs Healthcare System from 2009 to 2013.

    PubMed

    Appaneal, Haley J; Caffrey, Aisling R; Jiang, Lan; Dosa, David; Mermel, Leonard A; LaPlante, Kerry L

    2018-04-01

    Pseudomonas aeruginosa is a major cause of healthcare-associated infections and resistance among isolates is an increasing burden. The study purpose was to describe national resistance rates for clinical P. aeruginosa respiratory and bloodstream cultures and the prevalence of multidrug-resistant (MDR) P. aeruginosa within the Veterans Affairs (VA). MDR was defined as non-susceptibility to at least one drug in at least 3 of the following 5 categories: carbapenems, extended-spectrum cephalosporins, aminoglycosides, and piperacillin/tazobactam. We reviewed 24,562 P. aeruginosa respiratory and bloodstream isolates across 126 VA facilities between 2009 and 2013. Most isolates were collected from inpatient settings (82%). Resistance was highest in fluoroquinolones (33%) and exceeded 20% for all classes assessed (carbapenems, extended-spectrum cephalosporins, aminoglycosides, and piperacillin/tazobactam). Resistance was higher in inpatient settings and in respiratory isolates. Prevalence of MDR was 20% overall (22% for inpatient isolates, 11% outpatient, 21% respiratory, 17% bloodstream). Our findings are consistent with previous surveillance reports. Published by Elsevier Inc.

  3. Chronic disease management perspectives of colorectal cancer survivors using the Veterans Affairs healthcare system: a qualitative analysis.

    PubMed

    Zullig, Leah L; Goldstein, Karen M; Bosworth, Hayden B; Andrews, Sara M; Danus, Susanne; Jackson, George L; Provenzale, Dawn; Weinberger, Morris; Kelley, Michael J; Voils, Corrine I

    2018-03-09

    Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the US. CRC survivors may have complex healthcare needs requiring care from both specialists and primary care. Our objective was to understand how CRC survivors perceive their survivorship care, especially management of their cardiovascular-related chronic diseases. We identified patients diagnosed with non-metastatic CRC between 10/1/2007 and 12/31/2015 at Veterans Affairs Medical Centers in North Carolina or Virginia. In 2016, we conducted telephone-based, semi-structured interviews to assess survivors' experiences with cancer survivorship and changes in health priorities. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed, and coded. The 25 participants were, on average, 64 years old and approximately 4 years post-CRC diagnosis at the time of interview; most were white (60%), male (92%), and diagnosed with colon cancer (64%) as opposed to rectal cancer. CRC survivors reported: (1) a shift in focus from surviving cancer to reducing cardiovascular disease risk (e.g., by managing weight); (2) challenges with taking medications for CVD-related conditions; (3) new recognition of the importance of engaging with primary care providers. Experiences with cancer shapes how survivors view their health. Management of cardiovascular-related chronic disease is important to veteran CRC survivors. There is a need to deliver cardiovascular disease risk reduction programs tailored for CRC survivors.

  4. Development of Effective Academic Affairs Administration System in Thai Primary Schools

    ERIC Educational Resources Information Center

    Thongnoi, Niratchakorn; Srisa-ard, Boonchom; Sri-ampai, Anan

    2013-01-01

    This research aimed to: 1) study current situations and problems of academic affairs administration system in Primary Schools. 2) develop an effective academic affairs administration system, and 3) evaluate the implementation of the developed system in the primary school, Thailand. Research and Development (R&D) was employed which consisted of…

  5. Antimicrobial Resistance of Escherichia coli Urinary Isolates in the Veterans Affairs Health Care System.

    PubMed

    Morrill, Haley J; Morton, Jacob B; Caffrey, Aisling R; Jiang, Lan; Dosa, David; Mermel, Leonard A; LaPlante, Kerry L

    2017-05-01

    We reviewed data for almost 300,000 clinical Escherichia coli urinary isolates (collected in 2009 through 2013) from 127 inpatient and outpatient facilities, to assess antibiotic resistance among Veterans Affairs health care system patients using Clinical and Laboratory Standards Institute and Centers for Disease Control and Prevention National Healthcare Safety Network definitions or guidance. Rates of resistance to amoxicillin or ampicillin/β-lactamase inhibitors were approximately 40% and rates of resistance to fluoroquinolones and trimethoprim-sulfamethoxazole approached 30%. Rates of resistance to nitrofurantoin, antipseudomonal penicillin/β-lactamase inhibitors, and carbapenems remained less than 10%. The percentage of isolates that were considered multidrug resistant varied (4% to 37%), depending on the definitions used. Copyright © 2017 American Society for Microbiology.

  6. Antimicrobial Resistance of Escherichia coli Urinary Isolates in the Veterans Affairs Health Care System

    PubMed Central

    Morton, Jacob B.; Caffrey, Aisling R.; Jiang, Lan; Dosa, David; Mermel, Leonard A.; LaPlante, Kerry L.

    2017-01-01

    ABSTRACT We reviewed data for almost 300,000 clinical Escherichia coli urinary isolates (collected in 2009 through 2013) from 127 inpatient and outpatient facilities, to assess antibiotic resistance among Veterans Affairs health care system patients using Clinical and Laboratory Standards Institute and Centers for Disease Control and Prevention National Healthcare Safety Network definitions or guidance. Rates of resistance to amoxicillin or ampicillin/β-lactamase inhibitors were approximately 40% and rates of resistance to fluoroquinolones and trimethoprim-sulfamethoxazole approached 30%. Rates of resistance to nitrofurantoin, antipseudomonal penicillin/β-lactamase inhibitors, and carbapenems remained less than 10%. The percentage of isolates that were considered multidrug resistant varied (4% to 37%), depending on the definitions used. PMID:28193660

  7. Right to Healthcare: The Way Forward

    PubMed Central

    Peer, Rafia F.

    2013-01-01

    From the Bhore Committee Report of 1946 to the present Universal Health Coverage (UHC) 2011, nothing much has changed in terms of health status in India. The overall health status continues to be dismal and disappointing. One factor that is mainly responsible for this state of affairs is that healthcare has not been realized as a right. If healthcare becomes a right, the state will become responsible and accountable to the people, for enhancing their health. If people are invoked into a sense of belonging to the health system and made to look at healthcare as their right, there is a strong possibility of a positive change in the overall health status of the people. The article looks at healthcare from the rights perspective and explores the methods in which it can be translated into reality. It tries to look at the moral basis of the right to healthcare. For healthcare to be achieved as a right, the state can no longer be a mute spectator of the predominant market forces dictating the healthcare delivery system. The article argues that translation of healthcare as a right is only possible if the state takes full responsibility to improve the health status of the people. PMID:24479035

  8. Public satisfaction with the healthcare system performance in South Korea: Universal healthcare system.

    PubMed

    Park, Kisoo; Park, Jumin; Kwon, Young Dae; Kang, Yoonjeong; Noh, Jin-Won

    2016-06-01

    An awareness of the public's level of satisfaction with health professionals is becoming more important as steps are being taken to improve quality, reduce costs, and implement reform. The purpose of this study is to assess public satisfaction with the healthcare system and to examine the relationship between satisfaction and socio-demographic factors in the context of the health care environment in the Republic of Korea. The data were obtained from 1573 adults aged 20-69 in three major areas - Seoul, Gyeonggi, and Busan - by the Ministry of Health and Welfare during June and July 2011 in South Korea. Satisfaction with the healthcare system was evaluated by using 13 items in three sections: access to care, cost of care, and quality of care. A confirmatory factor analysis (CFA) was conducted to examine the validity of satisfaction with a healthcare system performance questionnaire. A structural equation model (SEM) was estimated to assess the relative impact of demographic and socio-economic variables on satisfaction. The study proposed a comprehensive three-factor model of healthcare system performance satisfaction. Among the three factors, the quality of care had the largest impact on satisfaction with the healthcare system, suggesting that is the most important determinant of consumers' satisfaction with their healthcare system. Regarding the relationships between public satisfaction and demographic and socio-economic variables, residence and marital status were significant predictors of the satisfaction level. It is important to be aware of the potential significance of background variables in determining satisfaction with the healthcare system. An understanding of the characteristics of the sample enables healthcare managers and/or policymakers to inform targeted follow-up actions. Copyright © 2016. Published by Elsevier Ireland Ltd.

  9. Success of HIS DICOM interfaces in the integration of the healthcare enterprise at the Department of Veterans Affairs

    NASA Astrophysics Data System (ADS)

    Kuzmak, Peter M.; Dayhoff, Ruth E.

    1999-07-01

    The US Department of Veterans Affairs (VA) is integrating imaging into the healthcare enterprise using the Digital Imaging and Communication in Medicine (DICOM) standard protocols. Image management is directly integrated into the VistA Hospital Information System (HIS) software and the clinical database. Radiology images are acquired via DICOM, and are stored directly in the HIS database. Images can be displayed on low-cost clinician's workstations throughout the medical center. High-resolution diagnostic quality multi-monitor VistA workstations with specialized viewing software can be used for reading radiology images. Two approaches are used to acquire and handle imags within the radiology department. Some sties have a commercial Picture Archiving and Communications System (PACS) interfaced to the VistA HIS, while other sites use the direct image acquisition and integrated diagnostic reading capabilities of VistA itself. A small set of DICOM services have been implemented by VistA to allow patient and study text data to be transmitted to image producing modalities and the commercial PACS, and to enable images and study data to be transferred back. The VistA DICOM capabilities are now used to interface seven different commercial PACS products and over twenty different radiology modalities. The communications capabilities of DICOM and the VA wide area network are begin used to support reading of radiology images form remote sites. DICOM has been the cornerstone in the ability to integrate imaging functionality into the Healthcare Enterprise. Because of its openness, it allows the integration of system component from commercial and non- commercial sources to work together to provide functional cost-effective solutions. As DICOM expands to non-radiology devices, integration must occur with the specialty information subsystems that handle orders and reports, their associated DICOM image capture systems, and the computer- based patient record. The mode and concepts of

  10. Impact of presumed service-connected diagnosis on the Department of Veterans Affairs healthcare utilization patterns of Vietnam-Theater Veterans: A cross-sectional study.

    PubMed

    Fried, Dennis A; Rajan, Mangala; Tseng, Chin-Lin; Helmer, Drew

    2018-05-01

    During the Vietnam War, the US military sprayed almost 20 million gallons of Agent Orange (AO), an herbicide contaminated with dioxin, over Vietnam. Approximately, 2.7 million US military personnel may have been exposed to AO during their deployment. Ordinarily, veterans who can demonstrate a nexus between a diagnosed condition and military service are eligible for Department of Veterans Affairs (VA) service-connected disability compensation. Vietnam Veterans have had difficulty, however, establishing a nexus between AO exposure and certain medical conditions that developed many years after the war. In response, VA has designated certain conditions as "presumed service connected" for Vietnam Veterans who were present and possibly exposed. Veterans with any of these designated conditions do not have to document AO exposure, making it easier for them to access the VA disability system. The extent to which VA healthcare utilization patterns reflect easier access afforded those with diagnosed presumptive conditions remains unknown. In this cross-sectional study, we hypothesized that Vietnam Veterans with diagnosed presumptive conditions would be heavier users of the VA healthcare system than those without these conditions. In our analysis of 85,699 Vietnam Veterans, we used binary and cumulative logit multivariable regression to assess associations between diagnosed presumptive conditions and VA healthcare utilization in 2013. We found that diagnosed presumptive conditions were associated with higher odds of 5+ VHA primary care visits (OR = 2.01, 95% CI: 1.93-2.07), 5+ specialty care visits (OR = 2.11, 95% CI: 2.04-2.18), emergency department use (OR = 1.22, 95% CI: 1.11-1.34), and hospitalization (OR = 1.23, 95% CI: 1.17-1.29). Consistent with legislative intent, presumptive policies appear to facilitate greater VA system utilization for Vietnam Veterans who may have been exposed to AO.

  11. Postcrisis redevelopment of sustainable healthcare systems.

    PubMed

    Kanadanian, Koren V; Haan, Constance K

    2014-01-01

    Research and field experience have identified a global gap in postdisaster rebuilding of healthcare systems due to the current primary focus on returning devastated community infrastructures to predisaster conditions. Disasters, natural or man-made, present an opportunity for communities to rebuild, restructure, and redefine their predisaster states, creating more resilient and sustainable healthcare systems. A model for sustainable postdisaster healthcare rebuilding was developed by bridging identified gaps in the literature on the processes of developing healthcare systems postdisaster and utilizing evidence from the literature on postdisaster community reconstruction. The proposed model-the Sustainable Healthcare Redevelopment Model-is designed to guide communities through the process of recovery, and identifies four stages for rebuilding healthcare systems: (1) response, (2) recovery, (3) redevelopment, and (4) sustainable development. Implementing sustainable healthcare redevelopment involves a bottom-up approach, where community stakeholders have the ability to influence policy decisions. Relationships within internal government agencies and with public-private partnerships are necessary for successful recovery. The Sustainable Healthcare Redevelopment Model can serve as a guideline for delivery of healthcare services following disaster or conflict and use of crisis as a window of opportunity to improve the healthcare delivery system and incorporate resilience into the healthcare infrastructure.

  12. Improving healthcare systems' disclosures of large-scale adverse events: a Department of Veterans Affairs leadership, policymaker, research and stakeholder partnership.

    PubMed

    Elwy, A Rani; Bokhour, Barbara G; Maguire, Elizabeth M; Wagner, Todd H; Asch, Steven M; Gifford, Allen L; Gallagher, Thomas H; Durfee, Janet M; Martinello, Richard A; Schiffner, Susan; Jesse, Robert L

    2014-12-01

    implementation of a large-scale adverse event disclosure toolkit. These toolkit strategies will enable leaders to provide timely and transparent information to patients and families, while reducing the burden on employees and the healthcare system during these events.

  13. National Healthcare in the United States: What Counselors Should Know.

    ERIC Educational Resources Information Center

    Hannon, J. Wade

    Few articles in the professional counseling literature address the healthcare crisis. This paper examines the current state of the United States healthcare affairs. Topics discussed include the problems in healthcare, including an inspection of the uninsured, the underinsured, rising healthcare costs, and the growing inequality in the healthcare…

  14. Guest editorial. Integrated healthcare information systems.

    PubMed

    Li, Ling; Ge, Ri-Li; Zhou, Shang-Ming; Valerdi, Ricardo

    2012-07-01

    The use of integrated information systems for healthcare has been started more than a decade ago. In recent years, rapid advances in information integration methods have spurred tremendous growth in the use of integrated information systems in healthcare delivery. Various techniques have been used for probing such integrated systems. These techniques include service-oriented architecture (SOA), EAI, workflow management, grid computing, and others. Many applications require a combination of these techniques, which gives rise to the emergence of enterprise systems in healthcare. Development of the techniques originated from different disciplines has the potential to significantly improve the performance of enterprise systems in healthcare. This editorial paper briefly introduces the enterprise systems in the perspective of healthcare informatics.

  15. 78 FR 21502 - Proposed Information Collection (Women Veterans Healthcare Barriers Survey)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-10

    ... Veterans Healthcare Barriers Survey) AGENCY: Veterans Health Administration, Department of Veterans Affairs.... 2900-NEW, Women Veterans Healthcare Barriers Survey'' in any correspondence. FOR FURTHER INFORMATION... . Please refer to ``OMB Control No. 2900-NEW, Women Veterans Healthcare Barriers Survey.'' SUPPLEMENTARY...

  16. An academic hospitalist model to improve healthcare worker communication and learner education: Results from a quasi-experimental study at a veterans affairs medical center

    PubMed Central

    Saint, Sanjay; Fowler, Karen E; Krein, Sarah L; Flanders, Scott A; Bodnar, Timothy W; Young, Eric; Moseley, Richard H

    2013-01-01

    BACKGROUND Although hospitalists may improve efficiency and quality of inpatient care, their effect on healthcare-worker communication and education has been less well-studied. OBJECTIVE To test various approaches to improving healthcare-worker communication and learner education within the context of a newly designed academic hospital medicine program. DESIGN Before-and-after design with concurrent control group. SETTING A Midwestern Veterans Affairs medical center. INTERVENTION Multimodal systems redesign of 1 of 4 medical teams (Gold team) that included clinical modifications (change in rounding structure, with inclusion of nurses, a Clinical Care Coordinator, and a pharmacist) and educational interventions (providing explicit expectations of learners and providing a reading list for both learners and attending physicians). MEASUREMENTS Number of admissions, length of stay, readmissions, house officer and medical student ratings of attendings' teaching, medical student internal medicine National Board of Medical Examiners Subject Examination (“shelf” exam) scores, and clinical staff surveys. RESULTS Length of stay was reduced by about 0.3 days on all teams after the initiative began (P = 0.004), with no significant differences between Gold and non-Gold teams. The majority of physicians (83%) and nurses (68%) felt that including nurses during rounds improved healthcare-worker communication; significantly more nurses were satisfied with communication with the Gold team than with the other teams (71% vs 53%; P = 0.02). Gold attendings generally received higher teaching scores compared with non-Gold attendings, and third-year medical students on the Gold team scored significantly higher on the shelf exam compared with non–Gold team students (84 vs 82; P = 0.006). CONCLUSIONS Academic hospitalists working within a systems redesign intervention were able to improve healthcare-worker communication and enhance learner education without increasing

  17. Engineering healthcare as a service system.

    PubMed

    Tien, James M; Goldschmidt-Clermont, Pascal J

    2010-01-01

    Engineering has and will continue to have a critical impact on healthcare; the application of technology-based techniques to biological problems can be defined to be technobiology applications. This paper is primarily focused on applying the technobiology approach of systems engineering to the development of a healthcare service system that is both integrated and adaptive. In general, healthcare services are carried out with knowledge-intensive agents or components which work together as providers and consumers to create or co-produce value. Indeed, the engineering design of a healthcare system must recognize the fact that it is actually a complex integration of human-centered activities that is increasingly dependent on information technology and knowledge. Like any service system, healthcare can be considered to be a combination or recombination of three essential components - people (characterized by behaviors, values, knowledge, etc.), processes (characterized by collaboration, customization, etc.) and products (characterized by software, hardware, infrastructures, etc.). Thus, a healthcare system is an integrated and adaptive set of people, processes and products. It is, in essence, a system of systems which objectives are to enhance its efficiency (leading to greater interdependency) and effectiveness (leading to improved health). Integration occurs over the physical, temporal, organizational and functional dimensions, while adaptation occurs over the monitoring, feedback, cybernetic and learning dimensions. In sum, such service systems as healthcare are indeed complex, especially due to the uncertainties associated with the human-centered aspects of these systems. Moreover, the system complexities can only be dealt with methods that enhance system integration and adaptation.

  18. National Healthcare Reform: Implications for the Military Healthcare System

    DTIC Science & Technology

    2010-05-16

    nominal benefit, but may inject ex- ante moral hazard into the equation through unhealthy lifestyles , in essence substituting healthcare for health.50...onto a tax dollar mandate, addressing the drivers of the escalating healthcare costs is important. It is an especially critical topic in light of...benefit ratio seen in the American healthcare system to be substantially higher than those studies noted. Moving Forward: Addressing Cost Drivers and

  19. Pervasive mobile healthcare systems for chronic disease monitoring.

    PubMed

    Huzooree, Geshwaree; Kumar Khedo, Kavi; Joonas, Noorjehan

    2017-05-01

    Pervasive mobile healthcare system has the potential to improve healthcare and the quality of life of chronic disease patients through continuous monitoring. Recently, many articles related to pervasive mobile healthcare system focusing on health monitoring using wireless technologies have been published. The main aim of this review is to evaluate the state-of-the-art pervasive mobile healthcare systems to identify major technical requirements and design challenges associated with the realization of a pervasive mobile healthcare system. A systematic literature review was conducted over IEEE Xplore Digital Library to evaluate 20 pervasive mobile healthcare systems out of 683 articles from 2011 to 2016. The classification of the pervasive mobile healthcare systems and other important factors are discussed. Potential opportunities and challenges are pointed out for the further deployment of effective pervasive mobile healthcare systems. This article helps researchers in health informatics to have a holistic view toward understanding pervasive mobile healthcare systems and points out new technological trends and design challenges that researchers have to consider when designing such systems for better adoption, usability, and seamless integration.

  20. The Healthcare Administrator's Associate: an experiment in distributed healthcare information systems.

    PubMed Central

    Fowler, J.; Martin, G.

    1997-01-01

    The Healthcare Administrator's Associate is a collection of portable tools designed to support analysis of data retrieved via the Internet from diverse distributed healthcare information systems by means of the InfoSleuth system of distributed software agents. Development of these tools is part of an effort to enhance access to diverse and geographically distributed healthcare data in order to improve the basis upon which administrative and clinical decisions are made. PMID:9357686

  1. [Healthcare value chain: a model for the Brazilian healthcare system].

    PubMed

    Pedroso, Marcelo Caldeira; Malik, Ana Maria

    2012-10-01

    This article presents a model of the healthcare value chain which consists of a schematic representation of the Brazilian healthcare system. The proposed model is adapted for the Brazilian reality and has the scope and flexibility for use in academic activities and analysis of the healthcare sector in Brazil. It places emphasis on three components: the main activities of the value chain, grouped in vertical and horizontal links; the mission of each link and the main value chain flows. The proposed model consists of six vertical and three horizontal links, amounting to nine. These are: knowledge development; supply of products and technologies; healthcare services; financial intermediation; healthcare financing; healthcare consumption; regulation; distribution of healthcare products; and complementary and support services. Four flows can be used to analyze the value chain: knowledge and innovation; products and services; financial; and information.

  2. The Research of Spatial-Temporal Analysis and Decision-Making Assistant System for Disabled Person Affairs Based on Mapworld

    NASA Astrophysics Data System (ADS)

    Zhang, J. H.; Yang, J.; Sun, Y. S.

    2015-06-01

    This system combines the Mapworld platform and informationization of disabled person affairs, uses the basic information of disabled person as center frame. Based on the disabled person population database, the affairs management system and the statistical account system, the data were effectively integrated and the united information resource database was built. Though the data analysis and mining, the system provides powerful data support to the decision making, the affairs managing and the public serving. It finally realizes the rationalization, normalization and scientization of disabled person affairs management. It also makes significant contributions to the great-leap-forward development of the informationization of China Disabled Person's Federation.

  3. Overview of healthcare system in the Czech Republic

    PubMed Central

    2012-01-01

    The healthcare system in the Czech Republic underwent and still is undergoing dramatic changes since the Velvet revolution in 1989. History of the Czech healthcare system, main healthcare laws, and the current status of healthcare documented in the main healthcare indicators is described based on the several main sources as well as delivery of health services and the role of the main actors in healthcare system. The material is based mainly on Czech Health Statistics 2009, and HiT Summary, Health Care Systems in Translation, 2005, public information of Ministry of Health CR. PMID:22738178

  4. Patient-centredness in integrated healthcare delivery systems - needs, expectations and priorities for organised healthcare systems.

    PubMed

    Juhnke, Christin; Mühlbacher, Axel C

    2013-01-01

    Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser-Meyer-Olkin of 0.914 for the patients (experts: 38.427%, Kaiser-Meyer-Olkin = 0.797). Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

  5. Healthcare costs and resource utilization of patients with binge-eating disorder and eating disorder not otherwise specified in the Department of Veterans Affairs.

    PubMed

    Bellows, Brandon K; DuVall, Scott L; Kamauu, Aaron W C; Supina, Dylan; Babcock, Thomas; LaFleur, Joanne

    2015-12-01

    The objective of this study was to compare the one-year healthcare costs and utilization of patients with binge-eating disorder (BED) to patients with eating disorder not otherwise specified without BED (EDNOS-only) and to matched patients without an eating disorder (NED). A natural language processing (NLP) algorithm identified adults with BED from clinical notes in the Department of Veterans Affairs (VA) electronic health record database from 2000 to 2011. Patients with EDNOS-only were identified using ICD-9 code (307.50) and those with NLP-identified BED were excluded. First diagnosis date defined the index date for both groups. Patients with NED were randomly matched 4:1, as available, to patients with BED on age, sex, BMI, depression diagnosis, and index month. Patients with cost data (2005-2011) were included. Total healthcare, inpatient, outpatient, and pharmacy costs were examined. Generalized linear models were used to compare total one-year healthcare costs while adjusting for baseline patient characteristics. There were 257 BED, 743 EDNOS-only, and 823 matched NED patients identified. The mean (SD) total unadjusted one-year costs, in 2011 US dollars, were $33,716 ($38,928) for BED, $37,052 ($40,719) for EDNOS-only, and $19,548 ($35,780) for NED patients. When adjusting for patient characteristics, BED patients had one-year total healthcare costs $5,589 higher than EDNOS-only (p = 0.06) and $18,152 higher than matched NED patients (p < 0.001). This study is the first to use NLP to identify BED patients and quantify their healthcare costs and utilization. Patients with BED had similar one-year total healthcare costs to EDNOS-only patients, but significantly higher costs than patients with NED. © 2015 Wiley Periodicals, Inc.

  6. Outcomes of cataract surgery with residents as primary surgeons in the Veterans Affairs Healthcare System.

    PubMed

    Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Chen, Xi; Cakiner-Egilmez, Tulay; Chomsky, Amy; Baze, Elizabeth; Vollman, David; Lawrence, Mary G; Daly, Mary K

    2016-03-01

    To explore visual outcomes, functional visual improvement, and events in resident-operated cataract surgery cases. Veterans Affairs Ophthalmic Surgery Outcomes Database Project across 5 Veterans Affairs Medical Centers. Retrospective data analysis of deidentified data. Cataract surgery cases with residents as primary surgeons were analyzed for logMAR corrected distance visual acuity (CDVA) and vision-related quality of life (VRQL) measured by the modified National Eye Institute Vision Function Questionnaire and 30 intraoperative and postoperative events. In some analyses, cases without events (Group A) were compared with cases with events (Group B). The study included 4221 cataract surgery cases. Preoperative to postoperative CDVA improved significantly in both groups (P < .0001), although the level of improvement was less in Group B (P = .03). A CDVA of 20/40 or better was achieved in 96.64% in Group A and 88.25% in Group B (P < .0001); however, Group B had a higher prevalence of preoperative ocular comorbidities (P < .0001). Cases with 1 or more events were associated with a higher likelihood of a postoperative CDVA worse than 20/40 (odds ratio, 3.82; 95% confidence interval, 2.92-5.05; P < .0001) than those who did not experience an event. Both groups had a significant increase in VRQL from preoperative levels (both P < .0001); however, the level of preoperative to postoperative VRQL improvement was significantly less in Group B (P < .0001). Resident-operated cases with and without events had an overall significant improvement in visual acuity and visual function compared with preoperatively, although this improvement was less marked in those that had an event. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  7. Patient-centredness in integrated healthcare delivery systems - needs, expectations and priorities for organised healthcare systems

    PubMed Central

    Juhnke, Christin; Mühlbacher, Axel C.

    2013-01-01

    Introduction Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. Methods A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Results Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser–Meyer–Olkin of 0.914 for the patients (experts: 38.427%, Kaiser–Meyer–Olkin = 0.797). Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. Conclusion and Discussion The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes. PMID:24363639

  8. HIGH PREVALENCE OF AGENT ORANGE EXPOSURE AMONG THYROID CANCER PATIENTS IN THE NATIONAL VA HEALTHCARE SYSTEM.

    PubMed

    Le, Karen T; Sawicki, Mark P; Wang, Marilene B; Hershman, Jerome M; Leung, Angela M

    2016-06-01

    Thyroid cancer is the most common endocrine malignancy and the most rapidly increasing cancer in the U.S. Little is known regarding the epidemiology and characteristics of patients with thyroid cancer within the national Veterans Health Administration (VHA) integrated healthcare system. The aim of this study was to further understand the characteristics of thyroid cancer patients in the VHA population, particularly in relation to Agent Orange exposure. This is a descriptive analysis of the VA (Veterans Affairs) Corporate Data Warehouse database from all U.S. VHA healthcare sites from October1, 1999, to December 31, 2013. Information was extracted for all thyroid cancer patients based on International Classification of Diseases-ninth revision diagnosis codes; histologic subtypes of thyroid cancer were not available. There were 19,592 patients (86% men, 76% white, 58% married, 42% Vietnam-era Veteran) in the VHA system with a diagnosis of thyroid cancer within this 14-year study period. The gender-stratified prevalence rates of thyroid cancer among the Veteran population during the study period were 1:1,114 (women) and 1:1,023 (men), which were lower for women but similar for men, when compared to the U.S. general population in 2011 (1:350 for women and 1:1,219 for men). There was a significantly higher proportion of self-reported Agent Orange exposure among thyroid cancer patients (10.0%), compared to the general VHA population (6.2%) (P<.0001). Thyroid cancer patients, in this sample, have a higher prevalence of self-reported Agent Orange exposure compared to the overall national VA patient population. T4 = thyroxine TCDD = 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin TSH = thyroid-stimulating hormone VA = Veterans Affairs VHA = Veterans Health Administration.

  9. A wearable context aware system for ubiquitous healthcare.

    PubMed

    Kang, Dong-Oh; Lee, Hyung-Jik; Ko, Eun-Jung; Kang, Kyuchang; Lee, Jeunwoo

    2006-01-01

    Recent developments of information technologies are leading the advent of the era of ubiquitous healthcare, which means healthcare services at any time and at any places. The ubiquitous healthcare service needs a wearable system for more continual measurement of biological signals of a user, which gives information of the user from wearable sensors. In this paper, we propose a wearable context aware system for ubiquitous healthcare, and its systematic design process of a ubiquitous healthcare service. Some wearable sensor systems are introduced with Zigbee communication. We develop a context aware framework to send information from wearable sensors to healthcare service entities as a middleware to solve the interoperability problem between sensor makers and healthcare service providers. And, we propose a systematic process of design of ubiquitous healthcare services with the context aware framework. In order to show the feasibility of the proposed system, some application examples are given, which are applied to remote monitoring, and a self check service.

  10. Awareness of the healthcare system and rights to healthcare in the Colombian population.

    PubMed

    Delgado Gallego, María Eugenia; Vázquez-Navarrete, María Luisa

    2013-01-01

    To analyze changes in users' awareness of the healthcare system and of their rights to healthcare in Colombia in the last 10 years, as well as the factors that influence users' awareness. We carried out a descriptive study to compare the results of two cross-sectional studies based on two surveys of users of the Colombian healthcare system. The first survey was performed in 2000 and the second in 2010. The municipalities of Tuluá (urban area) and Palmira (rural area) were surveyed. In both surveys, a stratified, multistage probability sample was selected. There were 1497 users in the first sample and 1405 in the second. Changes in awareness of the healthcare system and associated factors in each year were assessed through multivariate logistic regressions. Users' awareness of the healthcare system was limited in 2000 and was significantly lower in 2010, except for that relating to health insurers and providers. In contrast, more than 90% of users in both surveys perceived themselves as having healthcare rights. The factors consistently associated with greater awareness were belonging to a high socioeconomic stratum and having higher education. The most underprivileged users were less likely to be aware of the healthcare system, hampering their ability to make informed decisions and to exercise their health rights. To correct this situation, health institutions and the government should act decisively to reduce social inequalities. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

  11. Healthcare Utilization Monitoring System in Korea

    PubMed Central

    Shin, Hyun Chul; Lee, Youn Tae; Jo, Emmanuel C.

    2015-01-01

    Objectives It is important to monitor the healthcare utilization of patients at the national level to make evidence-based policy decisions and manage the nation's healthcare sector. The Health Insurance Review & Assessment Service (HIRA) has run a Healthcare Utilization Monitoring System (HUMS) since 2008. The objective of this paper is to introduce HIRA's HUMS. Methods This study described the HUMS's system structure, capacity, functionalities, and output formats run by HIRA in the Republic of Korea. Regarding output formats, this study extracted diabetes related health insurance claims through the HUMS from August 1, 2014 to May 31, 2015. Results The HUMS has kept records of health insurance claim data for 4 years. It has a 14-terabyte hardware capacity and employs several easy-to-use programs for maintenance of the system, such as MSTR, SAS, etc. Regarding functionalities, users should input diseases codes, target periods, facility types, and types of attributes, such as the number of healthcare utilizations or healthcare costs. It also has a functionality to predict healthcare utilization and costs. When this study extracted diabetes related data, it was found that the trend of healthcare costs for the treatment of diabetes and the number of patients with diabetes were increasing. Conclusions HIRA's HUMS works well to monitor healthcare utilization of patients at the national level. The HUMS has a high-capacity hardware infrastructure and several operational programs that allows easy access to summaries as well as details to identify contributing factors for abnormality, but it has a limitation in that there is often a time lag between the provision of healthcare to patients and the filing of health claims. PMID:26279955

  12. Behavioral Reference Model for Pervasive Healthcare Systems.

    PubMed

    Tahmasbi, Arezoo; Adabi, Sahar; Rezaee, Ali

    2016-12-01

    The emergence of mobile healthcare systems is an important outcome of application of pervasive computing concepts for medical care purposes. These systems provide the facilities and infrastructure required for automatic and ubiquitous sharing of medical information. Healthcare systems have a dynamic structure and configuration, therefore having an architecture is essential for future development of these systems. The need for increased response rate, problem limited storage, accelerated processing and etc. the tendency toward creating a new generation of healthcare system architecture highlight the need for further focus on cloud-based solutions for transfer data and data processing challenges. Integrity and reliability of healthcare systems are of critical importance, as even the slightest error may put the patients' lives in danger; therefore acquiring a behavioral model for these systems and developing the tools required to model their behaviors are of significant importance. The high-level designs may contain some flaws, therefor the system must be fully examined for different scenarios and conditions. This paper presents a software architecture for development of healthcare systems based on pervasive computing concepts, and then models the behavior of described system. A set of solutions are then proposed to improve the design's qualitative characteristics including, availability, interoperability and performance.

  13. Department of Defense Healthcare Management System Modernization (DHMSM)

    DTIC Science & Technology

    2016-03-01

    2016 Major Automated Information System Annual Report Department of Defense Healthcare Management System Modernization (DHMSM) Defense...DSN Fax: Date Assigned: November 16, 2015 Program Information Program Name Department of Defense Healthcare Management System Modernization...DHMSM) DoD Component DoD The acquiring DoD Component is Program Executive Office (PEO) Department of Defense (DoD) Healthcare Management Systems (DHMS

  14. The secure authorization model for healthcare information system.

    PubMed

    Hsu, Wen-Shin; Pan, Jiann-I

    2013-10-01

    Exploring healthcare system for assisting medical services or transmitting patients' personal health information in web application has been widely investigated. Information and communication technologies have been applied to the medical services and healthcare area for a number of years to resolve problems in medical management. In the healthcare system, not all users are allowed to access all the information. Several authorization models for restricting users to access specific information at specific permissions have been proposed. However, as the number of users and the amount of information grows, the difficulties for administrating user authorization will increase. The critical problem limits the widespread usage of the healthcare system. This paper proposes an approach for role-based and extends it to deal with the information for authorizations in the healthcare system. We propose the role-based authorization model which supports authorizations for different kinds of objects, and a new authorization domain. Based on this model, we discuss the issues and requirements of security in the healthcare systems. The security issues for services shared between different healthcare industries will also be discussed.

  15. The Integration of Two Healthcare Systems: A Common Healthcare Problem.

    PubMed

    Cassatly, Hannah; Cassatly, Michael

    2015-01-01

    The change in reimbursement mandated by the Affordable Care Act is causing a rapid consolidation of the marketplace as well as the delivery of clinical care in a team-based model. This case report examines the successful joining of two clinical teams concurrent with the merger of two healthcare organizations and discusses some of the difficulties encountered. A subsequent discussion focuses on the resolution: the need for physicians to embrace the team concept of healthcare delivery and for healthcare systems to facilitate this transition with team and leadership coaching.

  16. United States National Healthcare Policies 2015: An Analysis with Implications for the Future of Medicine

    PubMed Central

    2016-01-01

    There is little doubt that the tenure of President Barack Obama and implementation of the Affordable Care Act has had a profound effect on the United States healthcare delivery system in terms of the organization, finances, and clinical aspects of medical practice. As we enter the 2016 presidential election, looming issues of health affairs include 1) Is affordability achievable and can it be achieved without sacrificing the physician-patient relationship? and 2) Does practice consolidation and control by insurance providers cast physicians in a role as technicians? In countries such as the United Kingdom, policies seeking to increase healthcare affordability without sacrificing the quality of care have been implemented, as manifested through not only socialized medicine but also a general goal of cost cutting without sacrificing patient care. In addition, although done more as a tactical move with little impact on the overall budget, the healthcare benefits of political leaders in the United Kingdom are being trimmed in order to increase citizen buy-in in the healthcare model. This article compares recent healthcare policy changes in the United States to those of some constitutional democracies. The attitudes of healthcare stakeholders, including patients, physicians, and political leaders, are also analyzed. It is argued that the evolution of health affairs internationally is driven largely by efficacious political and economic factors, and that it behooves United States healthcare policy makers to note the impact of these international changes and to integrate the necessary changes in order to enhance patient care. PMID:26918219

  17. United States National Healthcare Policies 2015: An Analysis with Implications for the Future of Medicine.

    PubMed

    Birk, Harjus S

    2016-01-07

    There is little doubt that the tenure of President Barack Obama and implementation of the Affordable Care Act has had a profound effect on the United States healthcare delivery system in terms of the organization, finances, and clinical aspects of medical practice. As we enter the 2016 presidential election, looming issues of health affairs include 1) Is affordability achievable and can it be achieved without sacrificing the physician-patient relationship? and 2) Does practice consolidation and control by insurance providers cast physicians in a role as technicians? In countries such as the United Kingdom, policies seeking to increase healthcare affordability without sacrificing the quality of care have been implemented, as manifested through not only socialized medicine but also a general goal of cost cutting without sacrificing patient care. In addition, although done more as a tactical move with little impact on the overall budget, the healthcare benefits of political leaders in the United Kingdom are being trimmed in order to increase citizen buy-in in the healthcare model. This article compares recent healthcare policy changes in the United States to those of some constitutional democracies. The attitudes of healthcare stakeholders, including patients, physicians, and political leaders, are also analyzed. It is argued that the evolution of health affairs internationally is driven largely by efficacious political and economic factors, and that it behooves United States healthcare policy makers to note the impact of these international changes and to integrate the necessary changes in order to enhance patient care.

  18. An evolving systems-based methodology for healthcare planning.

    PubMed

    Warwick, Jon; Bell, Gary

    2007-01-01

    Healthcare planning seems beset with problems at all hierarchical levels. These are caused by the 'soft' nature of many of the issues present in healthcare planning and the high levels of complexity inherent in healthcare services. There has, in recent years, been a move to utilize systems thinking ideas in an effort to gain a better understanding of the forces at work within the healthcare environment and these have had some success. This paper argues that systems-based methodologies can be further enhanced by metrication and modeling which assist in exploring the changed emergent behavior of a system resulting from management intervention. The paper describes the Holon Framework as an evolving systems-based approach that has been used to help clients understand complex systems (in the education domain) that would have application in the analysis of healthcare problems.

  19. Some perspectives on affordable healthcare systems in China.

    PubMed

    Zhang, Y T; Yan, Y S; Poon, C C Y

    2007-01-01

    Consistent with the global population trend, China is becoming an aging society. Over one-fifth of the world's elderly population (aged 65 and over) lives in China. Statistics show that the elderly populace in China constitutes 8% of the total population in 2006 and the percentage will be tripled to become 24% in 2050. As a result, there is inevitably an increase in the prevalence of chronic disease that accounted for almost 80% of all deaths in China in 2005. On the other hand, from 1978 to 2003, the total expenditure on healthcare in China increased from 11.02 billion RMB up to 658.41 billion RMB, and in terms of GDP, it is an increase from 3.04% to 5.62%. The annual average increase (12.1%) in healthcare investment is therefore even higher than the annual rate of GDP increase (9.38%) during the last two decades. Meeting the long-term healthcare needs of this growing elderly population and escalating healthcare expenditure pose a grim challenge to the current Chinese healthcare system and the solvency of state budgets. In fact, the healthcare services in China have become less accessible since the early 1980s when its costs soared up. The rising costs have prevented many Chinese people from seeking early medical care. The phenomenon has created a wide disparity in seeking healthcare between urban and rural areas. These trends are of particular concern to the elderly, who have higher healthcare needs yet lesser means to afford the services. Furthermore, according to the 3rd National Health Service Survey, 79.1% of rural residents and 44.8% of urban citizens did not have any form of medical insurance. Such a low percentage of coverage of medical insurance indicates that many people may not be able to afford medical services when they suffer from severe diseases. Therefore, there is a great need of a more effective and low-cost healthcare system. A new system that can allow multi-level, multi-dimensional and standardized healthcare services for urban and rural

  20. Comparing Catheter-Associated Urinary Tract Infection Prevention Programs Between Veterans Affairs Nursing Homes and Non-Veterans Affairs Nursing Homes.

    PubMed

    Mody, Lona; Greene, M Todd; Saint, Sanjay; Meddings, Jennifer; Trautner, Barbara W; Wald, Heidi L; Crnich, Christopher; Banaszak-Holl, Jane; McNamara, Sara E; King, Beth J; Hogikyan, Robert; Edson, Barbara S; Krein, Sarah L

    2017-03-01

    OBJECTIVE The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that US Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non-VA nursing homes. SETTING VA and non-VA nursing homes participating in the AHRQ Safety Program for Long-Term Care collaborative. METHODS Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention via a needs assessment questionnaire. RESULTS A total of 353 of 494 nursing homes from 41 states (71%; 47 VA and 306 non-VA facilities) responded. VA nursing homes reported more hours per week devoted to infection prevention-related activities (31 vs 12 hours; P<.001) and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs 66%; P<.001), sharing CAUTI data with leadership (94% vs 70%; P=.014) and with nursing personnel (85% vs 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs 81%; P=.004) and catheter insertion (83% vs 94%; P=.004). CONCLUSIONS Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems. Infect Control Hosp Epidemiol 2017;38:287-293.

  1. Examining quality and efficiency of the U.S. healthcare system.

    PubMed

    Kumar, Sameer; Ghildayal, Neha S; Shah, Ronak N

    2011-01-01

    The fundamental concern of this research study is to learn the quality and efficiency of U.S. healthcare services. It seeks to examine the impact of quality and efficiency on various stakeholders to achieve the best value for each dollar spent for healthcare. The study aims to offer insights on quality reformation efforts, contemporary healthcare policy and a forthcoming change shaped by the Federal healthcare fiscal policy and to recommend the improvement objective by comparing the U.S. healthcare system with those of other developed nations. The US healthcare system is examined utilizing various data on recent trends in: spending, budgetary implications, economic indicators, i.e., GDP, inflation, wage and population growth. Process maps, cause and effect diagrams and descriptive data statistics are utilized to understand the various drivers that influence the rising healthcare cost. A proposed cause and effect diagram is presented to offer potential solutions, for significant improvement in U.S. healthcare. At present, the US healthcare system is of vital interest to the nation's economy and government policy (spending). The U.S. healthcare system is characterized as the world's most expensive yet least effective compared with other nations. Growing healthcare costs have made millions of citizens vulnerable. Major drivers of the healthcare costs are institutionalized medical practices and reimbursement policies, technology-induced costs and consumer behavior. Reviewing many articles, congressional reports, internet websites and related material, a simplified process map of the US healthcare system is presented. The financial process map is also created to further understand the overall process that connects the stakeholders in the healthcare system. Factors impacting healthcare are presented by a cause and effect diagram to further simplify the complexities of healthcare. This tool can also be used as a guide to improve efficiency by removing the "waste" from the

  2. Trends in hysterectomy rates among women veterans in the US Department of Veterans Affairs.

    PubMed

    Katon, Jodie G; Gray, Kristen; Callegari, Lisa; Gardella, Carolyn; Gibson, Carolyn; Ma, Erica; Lynch, Kristine E; Zephyrin, Laurie

    2017-10-01

    Prior studies demonstrate a higher prevalence of hysterectomy among veterans compared with nonveterans. While studies identify overall decreasing hysterectomy rates in the United States, none report rates of hysterectomy among women veterans. Given the increasing numbers of women veterans using Veterans Affairs health care, there is an ongoing need to ensure high-quality gynecology care. Therefore, it is important to examine current hysterectomy trends, including proportion of minimally invasive surgeries, among veterans using Veterans Affairs health care. Our objective was to describe hysterectomy trends and utilization of minimally invasive hysterectomy in the Veterans Affairs healthcare system. This longitudinal study used Veterans Affairs clinical and administrative data from fiscal year 2008 to 2014 to identify hysterectomies provided or paid for by Veterans Affairs. Crude and age-adjusted hysterectomy rates were calculated by indication (benign or malignant), mode (abdominal, laparoscopic, vaginal, robotic assisted, unspecified), and source of care (provided vs paid for by Veterans Affairs). Mode and indication for hysterectomy were classified using International Classification of Diseases, ninth revision, codes. The distribution of hysterectomy mode in each year was calculated by indication and source of care. Between fiscal year 2008 and fiscal year 2014, the total hysterectomy rate decreased from 4.0 per 1000 to 2.6 per 1000 unique women veteran Veterans Affairs users. Age-adjusted rates of abdominal hysterectomy for benign indications decreased over the study period from 1.54 per 1000 (95% confidence interval, 1.40-1.69) to 0.77 per 1000 (95% confidence interval, 0.69-0.85) for procedures provided by Veterans Affairs and 0.77 per 1,000 (95% confidence interval, 0.69-0.85) to 0.29 per 1,000 (95% confidence interval, 0.23-0.34) for those paid for by Veterans Affairs. Among hysterectomies for benign indications provided by (n = 5296) or paid for (n = 2610

  3. The development of professional identity and the formation of teams in the Veterans Affairs Connecticut Healthcare System's Center of Excellence in Primary Care Education Program (CoEPCE).

    PubMed

    Meyer, Emily M; Zapatka, Susan; Brienza, Rebecca S

    2015-06-01

    The United States Department of Veterans Affairs Connecticut Healthcare System (VACHS) is one of five Centers of Excellence in Primary Care Education (CoEPCE) pilot sites. The overall goal of the CoEPCE program, which is funded by the Office of Academic Affiliations, is to develop and implement innovative approaches for training future health care providers in postgraduate education programs to function effectively in teams to provide exceptional patient care. This longitudinal study employs theoretically grounded qualitative methods to understand the effect of a combined nursing and medical training model on professional identity and team development at the VACHS CoEPCE site. The authors used qualitative approaches to understand trainees' experiences, expectations, and impressions of the program. From September 2011 to August 2012, they conducted 28 interviews of 18 trainees (internal medicine [IM] residents and nurse practitioners [NPs]) and subjected data to three stages of open, iterative coding. Major themes illuminate both the evolution of individual professional identity within both types of trainees and the dynamic process of group identity development. Results suggest that initially IM residents struggled to understand NPs' roles and responsibilities, whereas NP trainees doubted their ability to work alongside physicians. At the end of one academic year, these uncertainties disappeared, and what was originally artificial had transformed into an organic interprofessional team of health providers who shared a strong sense of understanding and trust. This study provides early evidence of successful interprofessional collaboration among NPs and IM residents in a primary care training program.

  4. Measuring healthcare productivity - from unit to system level.

    PubMed

    Kämäräinen, Vesa Johannes; Peltokorpi, Antti; Torkki, Paulus; Tallbacka, Kaj

    2016-04-18

    Purpose - Healthcare productivity is a growing issue in most Western countries where healthcare expenditure is rapidly increasing. Therefore, accurate productivity metrics are essential to avoid sub-optimization within a healthcare system. The purpose of this paper is to focus on healthcare production system productivity measurement. Design/methodology/approach - Traditionally, healthcare productivity has been studied and measured independently at the unit, organization and system level. Suggesting that productivity measurement should be done in different levels, while simultaneously linking productivity measurement to incentives, this study presents the challenges of productivity measurement at the different levels. The study introduces different methods to measure productivity in healthcare. In addition, it provides background information on the methods used to measure productivity and the parameters used in these methods. A pilot investigation of productivity measurement is used to illustrate the challenges of measurement, to test the developed measures and to prove the practical information for managers. Findings - The study introduces different approaches and methods to measure productivity in healthcare. Practical implications - A pilot investigation of productivity measurement is used to illustrate the challenges of measurement, to test the developed measures and to prove the practical benefits for managers. Originality/value - The authors focus on the measurement of the whole healthcare production system and try to avoid sub-optimization. Additionally considering an individual patient approach, productivity measurement is examined at the unit level, the organizational level and the system level.

  5. Systems Architecture for a Nationwide Healthcare System.

    PubMed

    Abin, Jorge; Nemeth, Horacio; Friedmann, Ignacio

    2015-01-01

    From a national level to give Internet technology support, the Nationwide Integrated Healthcare System in Uruguay requires a model of Information Systems Architecture. This system has multiple healthcare providers (public and private), and a strong component of supplementary services. Thus, the data processing system should have an architecture that considers this fact, while integrating the central services provided by the Ministry of Public Health. The national electronic health record, as well as other related data processing systems, should be based on this architecture. The architecture model described here conceptualizes a federated framework of electronic health record systems, according to the IHE affinity model, HL7 standards, local standards on interoperability and security, as well as technical advice provided by AGESIC. It is the outcome of the research done by AGESIC and Systems Integration Laboratory (LINS) on the development and use of the e-Government Platform since 2008, as well as the research done by the team Salud.uy since 2013.

  6. Primary healthcare information system--the cornerstone for the next generation healthcare sector in Republic of Croatia.

    PubMed

    Koncar, Miroslav; Gvozdanović, Darko

    2006-01-01

    At no time in the history of medicine has the growth in knowledge and technologies been so profound [Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine (IOM), 2001. ISBN 0-309-07280-8]. However, healthcare delivery systems today are not able to keep up with the pace. Studies have shown that it takes an average of about 17 years for new knowledge generated by randomized trials to be incorporated into practice [B. Andrew, S. Boren, Managing clinical knowledge for health care improvement, in: Yearbook of Medical Informatics, National Library of Medicine, Bethesda, MD, 2000, pp. 65-70]. It is safe to say that today healthcare systems "have the data, but not information". In order to provide highest quality patient care, Republic of Croatia has started the process of introducing enterprise information systems to support business processes in the healthcare domain. Two major requirements are in focus: to provide efficient healthcare related data management in support of decision-making processes; and to support continuous process of healthcare resources spending optimization. The first initiated project refers to Primary Healthcare Information System (PHCIS) that provides domain of primary care with state-of-the-art enterprise information system that connects General Practitioners, Pediatricians and Gynecologists offices with the Croatian Institute for Health Insurance and Public Health Institute. In the years to come, PHCIS will serve as the main integration platform for connecting all other stakeholders and levels of healthcare (e.g. hospitals, pharmacies, laboratories) into single enterprise healthcare network. This article gives an overview of PHCIS, explains challenges that were faced in designing and implementing the system, and elaborates PHCIS role as the cornerstone for the next generation healthcare provisioning in Republic of Croatia.

  7. Privacy Impact Assessment for the Mailing System for the Office of Public Affairs

    EPA Pesticide Factsheets

    The Mailing System for the Office of Public Affairs collects contact and geographic information. Learn how this data will be collected in the system, how it will be used, access to the data, the purpose of data collection, and record retention policies.

  8. Consumer response to a report card comparing healthcare systems.

    PubMed

    Braun, Barbara L; Kind, Elizabeth A; Fowles, Jinnet B; Suarez, Walter G

    2002-06-01

    Report cards to date have focused on quality of care in health plans rather than within healthcare delivery systems. The purpose of this study was to evaluate consumer response to the first healthcare system-level report card. Qualitative assessment of consumer response. We conducted 5 focus groups of community members to evaluate consumer response to the report card; 2 included community club members, 3 included community-dwelling retired persons. Discussions were audiotaped and transcribed; comments were categorized by topic area from the script, and common themes identified. Focus group participants, in general, were unaware of the current emphasis on medical quality improvement initiatives. However, they believed that the opinion that the descriptive clinic information and patient survey data contained in the report card would be most useful mainly for choosing a healthcare system if they were dissatisfied with current medical care, if their healthcare options changed, or if they were in poor health. Personal experience was considered a more trustworthy measure of healthcare quality than were patient survey results. Trustworthiness was perceived to be higher if the report card sponsor was not affiliated with the healthcare systems being evaluated. Participants also believed care system administrators should use the data to enact positive clinic-level and physician-level changes. Healthcare consumers appreciated the attention to patient experiences and supported healthcare quality improvement initiatives. Report cards were considered important for choosing a healthcare system in certain circumstances and for guiding quality improvement efforts at all levels.

  9. Human factors systems approach to healthcare quality and patient safety

    PubMed Central

    Carayon, Pascale; Wetterneck, Tosha B.; Rivera-Rodriguez, A. Joy; Hundt, Ann Schoofs; Hoonakker, Peter; Holden, Richard; Gurses, Ayse P.

    2013-01-01

    Human factors systems approaches are critical for improving healthcare quality and patient safety. The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is a human factors systems approach that has been successfully applied in healthcare research and practice. Several research and practical applications of the SEIPS model are described. Important implications of the SEIPS model for healthcare system and process redesign are highlighted. Principles for redesigning healthcare systems using the SEIPS model are described. Balancing the work system and encouraging the active and adaptive role of workers are key principles for improving healthcare quality and patient safety. PMID:23845724

  10. Healthcare and healthcare systems: inspiring progress and future prospects

    PubMed Central

    2016-01-01

    Background Healthcare systems globally have experienced intensive changes, reforms, developments, and improvement over the past 30 years. Multiple actors (governmental and non-governmental) and countries have played their part in the reformation of the global healthcare system. New opportunities are presenting themselves while multiple challenges still remain especially in developing countries. Better way to proceed would be to learn from historical patterns while we plan for the future in a technology-driven society with dynamic demographic, epidemiological and economic uncertainties. Methods A structured review of both peer-reviewed and gray literature on the topic was carried out. Results On the whole, people are healthier, doing better financially and live longer today than 30 years ago. The number of under-5 mortality worldwide has declined from 12.7 million in 1990 to 6.3 million in 2013. Infant and maternal mortality rates have also been reduced. However, both rates are still considered high in Africa and some Asian countries. The world’s population nearly doubled in these 30 years, from 4.8 billion in 1985 to 7.2 billion in 2015. The majority of the increasing population was coming from the least developed countries, i.e., 3.66 to 5.33 billion. The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. Health care expenditures among countries also show sharp differences. In high income countries, per person health expenditure is over USD 3,000 on average, while in poor countries, it is as low as USD 12, WHO estimate of minimum spending per person per year needed to provide basic, life-saving services is USD 44. The challenges faced by the global health system over the past 30 years have been increased in population and urbanization, behavioral changes, rise in chronic diseases, traumatic injuries, infectious diseases, specific regional conflicts and healthcare delivery security. Over the next 30 years

  11. Healthcare and healthcare systems: inspiring progress and future prospects.

    PubMed

    Durrani, Hammad

    2016-01-01

    Healthcare systems globally have experienced intensive changes, reforms, developments, and improvement over the past 30 years. Multiple actors (governmental and non-governmental) and countries have played their part in the reformation of the global healthcare system. New opportunities are presenting themselves while multiple challenges still remain especially in developing countries. Better way to proceed would be to learn from historical patterns while we plan for the future in a technology-driven society with dynamic demographic, epidemiological and economic uncertainties. A structured review of both peer-reviewed and gray literature on the topic was carried out. On the whole, people are healthier, doing better financially and live longer today than 30 years ago. The number of under-5 mortality worldwide has declined from 12.7 million in 1990 to 6.3 million in 2013. Infant and maternal mortality rates have also been reduced. However, both rates are still considered high in Africa and some Asian countries. The world's population nearly doubled in these 30 years, from 4.8 billion in 1985 to 7.2 billion in 2015. The majority of the increasing population was coming from the least developed countries, i.e., 3.66 to 5.33 billion. The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. Health care expenditures among countries also show sharp differences. In high income countries, per person health expenditure is over USD 3,000 on average, while in poor countries, it is as low as USD 12, WHO estimate of minimum spending per person per year needed to provide basic, life-saving services is USD 44. The challenges faced by the global health system over the past 30 years have been increased in population and urbanization, behavioral changes, rise in chronic diseases, traumatic injuries, infectious diseases, specific regional conflicts and healthcare delivery security. Over the next 30 years, most of the world population

  12. Mapping healthcare systems: a policy relevant analytic tool

    PubMed Central

    Sekhri Feachem, Neelam; Afshar, Ariana; Pruett, Cristina; Avanceña, Anton L.V.

    2017-01-01

    Abstract Background In the past decade, an international consensus on the value of well-functioning systems has driven considerable health systems research. This research falls into two broad categories. The first provides conceptual frameworks that take complex healthcare systems and create simplified constructs of interactions and functions. The second focuses on granular inputs and outputs. This paper presents a novel translational mapping tool – the University of California, San Francisco mapping tool (the Tool) - which bridges the gap between these two areas of research, creating a platform for multi-country comparative analysis. Methods Using the Murray-Frenk framework, we create a macro-level representation of a country's structure, focusing on how it finances and delivers healthcare. The map visually depicts the fundamental policy questions in healthcare system design: funding sources and amount spent through each source, purchasers, populations covered, provider categories; and the relationship between these entities. Results We use the Tool to provide a macro-level comparative analysis of the structure of India's and Thailand's healthcare systems. Conclusions As part of the systems strengthening arsenal, the Tool can stimulate debate about the merits and consequences of different healthcare systems structural designs, using a common framework that fosters multi-country comparative analyses. PMID:28541518

  13. Mapping healthcare systems: a policy relevant analytic tool.

    PubMed

    Sekhri Feachem, Neelam; Afshar, Ariana; Pruett, Cristina; Avanceña, Anton L V

    2017-07-01

    In the past decade, an international consensus on the value of well-functioning systems has driven considerable health systems research. This research falls into two broad categories. The first provides conceptual frameworks that take complex healthcare systems and create simplified constructs of interactions and functions. The second focuses on granular inputs and outputs. This paper presents a novel translational mapping tool - the University of California, San Francisco mapping tool (the Tool) - which bridges the gap between these two areas of research, creating a platform for multi-country comparative analysis. Using the Murray-Frenk framework, we create a macro-level representation of a country's structure, focusing on how it finances and delivers healthcare. The map visually depicts the fundamental policy questions in healthcare system design: funding sources and amount spent through each source, purchasers, populations covered, provider categories; and the relationship between these entities. We use the Tool to provide a macro-level comparative analysis of the structure of India's and Thailand's healthcare systems. As part of the systems strengthening arsenal, the Tool can stimulate debate about the merits and consequences of different healthcare systems structural designs, using a common framework that fosters multi-country comparative analyses. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

  14. A novel web-enabled healthcare solution on health vault system.

    PubMed

    Liao, Lingxia; Chen, Min; Rodrigues, Joel J P C; Lai, Xiaorong; Vuong, Son

    2012-06-01

    Complicated Electronic Medical Records (EMR) systems have created problems in systems regarding an easy implementation and interoperability for a Web-enabled Healthcare Solution, which is normally provided by an independent healthcare giver with limited IT knowledge and interests. An EMR system with well-designed and user-friendly interface, such as Microsoft HealthVault System used as the back-end platform of a Web-enabled healthcare application will be an approach to deal with these problems. This paper analyzes the patient oriented Web-enabled healthcare service application as the new trend to delivery healthcare from hospital/clinic-centric to patient-centric, the current e-healthcare applications, and the main backend EMR systems. Then, we present a novel web-enabled healthcare solution based on Microsoft HealthVault EMR system to meet customers' needs, such as, low total cost, easily development and maintenance, and good interoperability. A sample system is given to show how the solution can be fulfilled, evaluated, and validated. We expect that this paper will provide a deep understanding of the available EMR systems, leading to insights for new solutions and approaches driven to next generation EMR systems.

  15. Orthopedic and trauma services in the healthcare system of Serbia.

    PubMed

    Vukasinović, Zoran; Zivković, Zorica; Spasovski, Dusko

    2008-01-01

    Our aim has been to present the functioning of orthopaedic and trauma services in the healthcare system of Serbia. In the introduction, we present geographic, demographic, political and economic elements, which define more closely the position of Serbia in the Southeastern Europe. Further, the healthcare system of Serbia, organized in four levels, is presented: self-care, primary healthcare, secondary healthcare and tertiary healthcare, as well as the schedule of 20,157 physicians engaged in healthcare. In addition, we point out numerous problems, which the system is faced with. Special attention is paid to orthopaedic and trauma services active within the system, its development, current condition and personnel education. We have concluded that, despite this being a middle-income country, the healthcare system is well developed. With 524 orthopaedic surgeons, working in 56 specialized departments, musculoskeletal diseases and trauma management are covered at all three healthcare levels. Nevertheless, the authors also underline weaknesses that are mostly of technical nature. Measures for their elimination and improvement of the entire service are also suggested.

  16. [History of the French healthcare insurance system].

    PubMed

    Milhaud, Gérard; Lagrave, Michel

    2010-06-01

    At a time when the French healthcare system was going through its most serious crisis, in terms of both organisation and funding, the board of governors of the National Academy of Medicine decided, at its meeting of May 26, 2003, to set up a workgroup on the future of the health insurance system. The workgroup revisited the concept of health insurance, taking economic constraints into account. Medical care covered by the national health insurance system is considered as "'free" by both national insurance contributors (patients) and doctors, who are the primary "spenders". The Academy was the first organization to examine the reasons for the budget deficit, which is largely due to State with nothings. In 2008, the Academy created a healthcare insurance committee. Deficits piled up, amplifying the debt, which eventually may spiral out of control. The French population finally became concerned at the situation. In 2010, France's social security budget deficit will reach some 30.5 billion euros, including 14.5 billion for healthcare insurance alone, a figure which is increasing by 5 billion euros each year. The French President recently announced the creation of a workgroup to examine healthcare expenditure. The Academy's healthcare insurance committee is convinced that reform is necessary and feasible, while preserving the underlying principles of our present system, namely humanism, freedom of choice, responsibility and solidarity.

  17. Healthcare system-wide implementation of opioid-safety guideline recommendations: the case of urine drug screening and opioid-patient suicide- and overdose-related events in the Veterans Health Administration.

    PubMed

    Brennan, Penny L; Del Re, Aaron C; Henderson, Patricia T; Trafton, Jodie A

    2016-12-01

    This study provides an example of how healthcare system-wide progress in implementation of opioid-therapy guideline recommendations can be longitudinally assessed and then related to subsequent opioid-prescribed patient health and safety outcomes. Using longitudinal linear mixed effects analyses, we determined that in the Department of Veterans Affairs (VA) healthcare system (n = 141 facilities), over the 4-year interval from 2010 to 2013, a key opioid therapy guideline recommendation, urine drug screening (UDS), increased from 29 to 42 %, with an average within-facility increase rate of 4.5 % per year. Higher levels of UDS implementation from 2010 to 2013 were associated with lower risk of suicide and drug overdose events among VA opioid-prescribed patients in 2013, even after adjusting for patients' 2012 demographic characteristics and medical and mental health comorbidities. Findings suggest that VA clinicians and healthcare policymakers have been responsive to the 2010 VA/Department of Defense (DOD) UDS treatment guideline recommendation, resulting in improved patient safety for VA opioid-prescribed patients.

  18. The healthcare system and provision of oral healthcare in European Union member states. Part 4: Greece.

    PubMed

    Damaskinos, P; Koletsi-Kounari, H; Economou, C; Eaton, K A; Widström, E

    2016-03-11

    This paper presents a description of the healthcare system and how oral healthcare is organised and provided in Greece, a country in a deep economic and social crisis. The national health system is underfunded, with severe gaps in staffing levels and the country has a large private healthcare sector. Oral healthcare has been largely provided in the private sector. Most people are struggling to survive and have no money to spend on general and oral healthcare. Unemployment is rising and access to healthcare services is more difficult than ever. Additionally, there has been an overproduction of dentists and no development of team dentistry. This has led to under or unemployment of dentists in Greece and their migration to other European Union member states, such as the United Kingdom, where over 600 Greek dentists are currently working.

  19. Knowledge management systems success in healthcare: Leadership matters.

    PubMed

    Ali, Nor'ashikin; Tretiakov, Alexei; Whiddett, Dick; Hunter, Inga

    2017-01-01

    To deliver high-quality healthcare doctors need to access, interpret, and share appropriate and localised medical knowledge. Information technology is widely used to facilitate the management of this knowledge in healthcare organisations. The purpose of this study is to develop a knowledge management systems success model for healthcare organisations. A model was formulated by extending an existing generic knowledge management systems success model by including organisational and system factors relevant to healthcare. It was tested by using data obtained from 263 doctors working within two district health boards in New Zealand. Of the system factors, knowledge content quality was found to be particularly important for knowledge management systems success. Of the organisational factors, leadership was the most important, and more important than incentives. Leadership promoted knowledge management systems success primarily by positively affecting knowledge content quality. Leadership also promoted knowledge management use for retrieval, which should lead to the use of that better quality knowledge by the doctors, ultimately resulting in better outcomes for patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Cyberterrorism: is the U.S. healthcare system safe?

    PubMed

    Harries, David; Yellowlees, Peter M

    2013-01-01

    The Internet has brought with it many benefits; key among them has been its ability to allow the expansion of communication and transfer of all kinds of information throughout the U.S. healthcare system. As a consequence, healthcare has become increasingly dependent on the activities carried out in that environment. It is this very dependence that increases the likelihood of individuals or organizations conducting activities through the Internet that will cause physical and/or psychological harm. These activities have become known by the term "cyberterrorism." In the healthcare landscape this can appear in a variety of forms, such as bringing down a hospital computer system or publicly revealing private medical records. Whatever shape it takes, the general effects are the same: patient care is compromised, and trust in the health system is diminished. Fortunately no significant cyber attack has been successfully launched against a U.S. healthcare organization to date. However, there is evidence to suggest that cyber threats are increasing and that much of the U.S. healthcare system is ill equipped to deal with them. Securing cyberspace is not an easy proposition as the threats are constantly changing, and recognizing that cyberterrorism should be part of a broader information technology risk management strategy, there are several"best practices" that can be adopted by healthcare organizations to protect themselves against cyber attacks.

  1. Technology and the healthcare system: implications for patient adherence.

    PubMed

    Beni, Juliet B

    2011-01-01

    Patient nonadherence is a growing and costly problem in the healthcare system, especially for patients with chronic illness. Between 25% and 40% of patients are nonadherent to treatment, and estimated costs directly associated with patient nonadherence in the US healthcare system are $290 billion a year. Nonadherence to preventive and treatment regimens is correlated to negative consequences for patients; however, many barriers to the promotion of successful adherence remain. Some such barriers include financial constraints, physical disability, side effects, forgetfulness, age and complex multi-drug regimens. The implementation of technology in healthcare systems is changing the way in which healthcare providers and patients must approach adherence. The following review applies a framework, the Information-Motivation-Strategy Model?, developed by DiMatteo and colleagues, to the field to conceptualise the changing factors affecting patient adherence as global healthcare moves toward increasingly technology-based systems of care.

  2. The secret art of managing healthcare expenses: investigating implicit rationing and autonomy in public healthcare systems.

    PubMed

    Lauridsen, S M R; Norup, M S; Rossel, P J H

    2007-12-01

    Rationing healthcare is a difficult task, which includes preventing patients from accessing potentially beneficial treatments. Proponents of implicit rationing argue that politicians cannot resist pressure from strong patient groups for treatments and conclude that physicians should ration without informing patients or the public. The authors subdivide this specific programme of implicit rationing, or "hidden rationing", into local hidden rationing, unsophisticated global hidden rationing and sophisticated global hidden rationing. They evaluate the appropriateness of these methods of rationing from the perspectives of individual and political autonomy and conclude that local hidden rationing and unsophisticated global hidden rationing clearly violate patients' individual autonomy, that is, their right to participate in medical decision-making. While sophisticated global hidden rationing avoids this charge, the authors point out that it nonetheless violates the political autonomy of patients, that is, their right to engage in public affairs as citizens. A defence of any of the forms of hidden rationing is therefore considered to be incompatible with a defence of autonomy.

  3. Healthcare system responsiveness in Jiangsu Province, China.

    PubMed

    Chao, Jianqian; Lu, Boyang; Zhang, Hua; Zhu, Liguo; Jin, Hui; Liu, Pei

    2017-01-13

    The perceived responsiveness of a healthcare system reflects its ability to satisfy reasonable expectations of the public with respect to non-medical services. Recently, there has been increasing attention paid to responsiveness in evaluating the performance of a healthcare system in a variety of service settings. However, the factors that affect the responsiveness have been inconclusive so far and measures of improved responsiveness have not always thoroughly considered the factors. The aim of this study was to evaluate both the responsiveness of the healthcare system in Jiangsu Province, China, the factors that influence responsiveness and the measures of improved responsiveness considering it, as determined by a responsiveness survey. A multistage, stratified random sampling method was used to select 1938 adult residents of Jiangsu Province in 2011. Face-to-face interviews were conducted using a self-designed questionnaire modeled on the World Health Organization proposal. The final analysis was based on 1783 (92%) valid questionnaires. Canonical correlation analysis was used to assess the factors that affect responsiveness. The average score of all responsiveness-related domains in the surveyed healthcare system was satisfactory (7.50 out of a maximum 10.0). The two highest scoring domains were dignity and confidentiality, and the two lowest scoring domains choice and prompt attention. The factors affecting responsiveness were age, regional economic development level, and geographic area (urban vs. rural). The responsiveness regarding basic amenities was rated worse by the elderly than by younger respondents. Responsiveness ranked better by those with a poorer economic status. Choice in cities was better than in rural regions. The responsiveness of the Jiangsu healthcare system was considered to be satisfactory but could be improved by offering greater choice and providing more prompt attention. Perceptions of healthcare system responsiveness differ with age

  4. Design principles for achieving integrated healthcare information systems.

    PubMed

    Jensen, Tina Blegind

    2013-03-01

    Achieving integrated healthcare information systems has become a common goal for many countries in their pursuit of obtaining coordinated and comprehensive healthcare services. This article focuses on how a small local project termed 'Standardized pull of patient data' expanded and is now used on a large scale providing a majority of hospitals, general practitioners and citizens across Denmark with the possibility of accessing healthcare data from different electronic patient record systems and other systems. I build on design theory for information infrastructures, as presented by Hanseth and Lyytinen, to examine the design principles that facilitated this smallscale project to expand and become widespread. As a result of my findings, I outline three lessons learned that emphasize: (i) principles of flexibility, (ii) expansion from the installed base through modular strategies and (iii) identification of key healthcare actors to provide them with immediate benefits.

  5. A privacy-strengthened scheme for E-Healthcare monitoring system.

    PubMed

    Huang, Chanying; Lee, Hwaseong; Lee, Dong Hoon

    2012-10-01

    Recent Advances in Wireless Body Area Networks (WBANs) offer unprecedented opportunities and challenges to the development of pervasive electronic healthcare (E-Healthcare) monitoring system. In E-Healthcare system, the processed data are patients' sensitive health data that are directly related to individuals' privacy. For this reason, privacy concern is of great importance for E-Healthcare system. Current existing systems for E-Healthcare services, however, have not yet provided sufficient privacy protection for patients. In order to offer adequate security and privacy, in this paper, we propose a privacy-enhanced scheme for patients' physical condition monitoring, which achieves dual effects: (1) providing unlinkability of health records and individual identity, and (2) supporting anonymous authentication and authorized data access. We also conduct a simulation experiment to evaluate the performance of the proposed scheme. The experimental results demonstrate that the proposed scheme achieves better performance in terms of computational complexity, communication overheads and querying efficiency compared with previous results.

  6. Coherent exchange of healthcare knowledge in open systems.

    PubMed

    Buchan, I; Hanka, R

    1997-01-01

    This paper outlines design philosophies and methods for healthcare knowledge systems. Clinical priorities for knowledge are discussed in terms of temporal and individual needs. Book centred organisation of healthcare knowledge, which has proven effective in clinical practice, is proposed as the basis of virtual libraries available at the point of care for target groups of healthcare professionals.

  7. Comparative effectiveness: its role in the healthcare system.

    PubMed

    Brown, Melissa M; Luo, Betsy; Brown, Heidi C; Brown, Gary C

    2009-05-01

    To describe comparative effectiveness and assess its role in crafting new healthcare policy. Senate Bill S.3408 would establish a nongovernment-affiliated Healthcare Comparative Effectiveness Research Institute that would work with healthcare experts and stakeholders in healthcare to prioritize interventions and services to be studied. A value-based medicine system of standardized comparative effectiveness and cost-effectiveness data using utilities would allow physicians to assess the total value (improvement in quality of life and/or length of life) conferred by interventions. Standardized comparativeness and cost-effectiveness data will give physicians an information system to identify the interventions that confer the greatest value to patients, and thus deliver higher quality care than possible with evidence-based data alone while allowing the most cost-effective care.

  8. Understanding how orthopaedic surgery practices generate value for healthcare systems.

    PubMed

    Olson, Steven A; Mather, Richard C

    2013-06-01

    Orthopaedic surgery practices can provide substantial value to healthcare systems. Increasingly, healthcare administrators are speaking of the need for alignment between physicians and healthcare systems. However, physicians often do not understand what healthcare administrators value and therefore have difficulty articulating the value they create in discussions with their hospital or healthcare organization. Many health systems and hospitals use service lines as an organizational structure to track the relevant data and manage the resources associated with a particular type of care, such as musculoskeletal care. Understanding service lines and their management can be useful for orthopaedic surgeons interested in interacting with their hospital systems. We provide an overview of two basic types of value orthopaedic surgeons create for healthcare systems: financial or volume-driven benefits and nonfinancial quality or value-driven patient care benefits. We performed a search of PubMed from 1965 to 2012 using the term "service line." Of the 351 citations identified, 18 citations specifically involved the use of service lines to improve patient care in both nursing and medical journals. A service line is a structure used in healthcare organizations to enable management of a subset of activities or resources in a focused area of patient care delivery. There is not a consistent definition of what resources are managed within a service line from hospital to hospital. Physicians can positively impact patient care through engaging in service line management. There is increasing pressure for healthcare systems and hospitals to partner with orthopaedic surgeons. The peer-reviewed literature demonstrates there are limited resources for physicians to understand the value they create when attempting to negotiate with their hospital or healthcare organization. To effectively negotiate for resources to provide the best care for patients, orthopaedic surgeons need to claim and

  9. Socioeconomic Status and Satisfaction with Public Healthcare System in Iran.

    PubMed

    Maharlouei, Najmeh; Akbari, Mojtaba; Akbari, Maryam; Lankarani, Kamran B

    2017-01-01

    The users' satisfaction is a method for evaluating the efficacy of healthcare system. We aimed to evaluate the association between the users' socioeconomic status (SES) and satisfaction with the healthcare system in Shiraz, Iran. This cross-sectional study was conducted from December, 2013 to March, 2014, in Shiraz, Iran. 3400 households were recruited by multi-stage cluster random sampling. Information about demographic, insurance status, and users' satisfaction was derived from face-to-face interviews. Satisfaction with healthcare system was assessed by using 5-point Likert scale statements, which ranged from "very dissatisfied" to "very satisfied". All statistical analyses were performed using SPSS-21. Overall, 1.6% (55) of the respondents were very satisfied, while 6% (203) were very dissatisfied with healthcare system. Participants were classified into high SES (26.3%), middle SES (47.9%) and low SES (25.8%). It was discovered that the better the SES, the more frequent were the respondents dissatisfied with healthcare system (P<0.001). Also, dissatisfied respondents were significantly older (P=0.036). Moreover, women were more dissatisfied with healthcare system (P=0.005). Also, dissatisfied respondents had significantly a higher level of education than satisfied ones (P<0.001). Furthermore, logistic regression revealed that age (P=0.04), marital status (P=0.01), insurance status (P<0.001), SES (P<0.001), and having supplemental insurance (P=0.02) were determinant factors of satisfaction with healthcare system. This study demonstrated that users' sex, age, educational level, and SES were related to dissatisfaction with healthcare system. Meanwhile, clients' age, SES, insurance status and marital status were recognized as determinant factors.

  10. Intelligent scheduling of execution for customized physical fitness and healthcare system.

    PubMed

    Huang, Chung-Chi; Liu, Hsiao-Man; Huang, Chung-Lin

    2015-01-01

    Physical fitness and health of white collar business person is getting worse and worse in recent years. Therefore, it is necessary to develop a system which can enhance physical fitness and health for people. Although the exercise prescription can be generated after diagnosing for customized physical fitness and healthcare. It is hard to meet individual execution needs for general scheduling of physical fitness and healthcare system. So the main purpose of this research is to develop an intelligent scheduling of execution for customized physical fitness and healthcare system. The results of diagnosis and prescription for customized physical fitness and healthcare system will be generated by fuzzy logic Inference. Then the results of diagnosis and prescription for customized physical fitness and healthcare system will be scheduled and executed by intelligent computing. The scheduling of execution is generated by using genetic algorithm method. It will improve traditional scheduling of exercise prescription for physical fitness and healthcare. Finally, we will demonstrate the advantages of the intelligent scheduling of execution for customized physical fitness and healthcare system.

  11. Systems modelling approaches to the design of safe healthcare delivery: ease of use and usefulness perceived by healthcare workers.

    PubMed

    Jun, Gyuchan Thomas; Ward, James; Clarkson, P John

    2010-07-01

    The UK health service, which had been diagnosed to be seriously out of step with good design practice, has been recommended to obtain knowledge of design and risk management practice from other safety-critical industries. While these other industries have benefited from a broad range of systems modelling approaches, healthcare remains a long way behind. In order to investigate the healthcare-specific applicability of systems modelling approaches, this study identified 10 distinct methods through meta-model analysis. Healthcare workers' perception on 'ease of use' and 'usefulness' was then evaluated. The characterisation of the systems modelling methods showed that each method had particular capabilities to describe specific aspects of a complex system. However, the healthcare workers found that some of the methods, although potentially very useful, would be difficult to understand, particularly without prior experience. This study provides valuable insights into a better use of the systems modelling methods in healthcare. STATEMENT OF RELEVANCE: The findings in this study provide insights into how to make a better use of various systems modelling approaches to the design and risk management of healthcare delivery systems, which have been a growing research interest among ergonomists and human factor professionals.

  12. Determinants of healthcare system's efficiency in OECD countries.

    PubMed

    Hadad, Sharon; Hadad, Yossi; Simon-Tuval, Tzahit

    2013-04-01

    Firstly, to compare healthcare systems' efficiency (HSE) using two models: one incorporating mostly inputs that are considered to be within the discretionary control of the healthcare system (i.e., physicians' density, inpatient bed density, and health expenditure), and another, including mostly inputs beyond healthcare systems' control (i.e., GDP, fruit and vegetables consumption, and health expenditure). Secondly, analyze whether institutional arrangements, population behavior, and socioeconomic or environmental determinants are associated with HSE. Data envelopment analysis (DEA) was utilized to calculate OECD countries' HSE. Life expectancy and infant survival rate were considered as outputs in both models. Healthcare systems' rankings according to the super-efficiency and the cross-efficiency ranking methods were used to analyze determinants associated with efficiency. (1) Healthcare systems in nine countries with large and stable economies were defined as efficient in model I, but were found to be inefficient in model II; (2) Gatekeeping and the presence of multiple insurers were associated with a lower efficiency; and (3) The association between socioeconomic and environmental indicators was found to be ambiguous. Countries striving to improve their HSE should aim to impact population behavior and welfare rather than only ensure adequate medical care. In addition, they may consider avoiding specific institutional arrangements, namely gatekeeping and the presence of multiple insurers. Finally, the ambiguous association found between socioeconomic and environmental indicators, and a country's HSE necessitates caution when interpreting different ranking techniques in a cross-country efficiency evaluation and needs further exploration.

  13. Predictors of Healthcare System and Physician Distrust In Hospitalized Cardiac Patients

    PubMed Central

    Gupta, Charu; Bell, Susan P.; Schildcrout, Jonathan S.; Fletcher, Sarah; Goggins, Kathryn M.; Kripalani, Sunil

    2015-01-01

    A trusting relationship between patients, physicians, and the healthcare system is important in encouraging self-care behaviors in cardiovascular patients. The study aimed to assess the prevalence of healthcare system and physician distrust in this population, compare the two forms of distrust, and describe the demographic, socioeconomic, and psycho-social predictors of high distrust. 1232 hospitalized adults with acute coronary syndrome or heart failure were enrolled in a prospective, observational study assessing both healthcare system and physician distrust. High healthcare system distrust (35%) was observed across the population, with lower levels of interpersonal physician distrust (16%). In a multivariate analysis, poor social support and coping skills were strong predictors of both healthcare system (p = 0.026, p = 0.003) and physician distrust (p <0.001, p = 0.006). Individuals with low or marginal health literacy had a higher likelihood of physician distrust (p <0.001), but no relationship was found between health literacy and healthcare system distrust. In conclusion, distrust is common among acutely ill cardiac patients. Those with low social support and low coping skills are more distrusting of physicians and the healthcare system. PMID:25315583

  14. A review of the Australian healthcare system: A policy perspective.

    PubMed

    Dixit, Sunil K; Sambasivan, Murali

    2018-01-01

    This article seeks to review the Australian healthcare system and compare it to similar systems in other countries to highlight the main issues and problems. A literature search for articles relating to the Australian and other developed countries' healthcare systems was conducted by using Google and the library of Victoria University, Melbourne. Data from the websites of the Commonwealth of Australia, the Australian Institute of Health and Welfare, the Australian Productivity Commission, the Organisation for Economic Co-operation and Development and the World Bank have also been used. Although care within the Australian healthcare system is among the best in the world, there is a need to change the paradigm currently being used to measure the outcomes and allocate resources. The Australian healthcare system is potentially dealing with two main problems: (a) resource allocation, and (b) performance and patient outcomes improvements. An interdisciplinary research approach in the areas of performance measurement, quality and patient outcomes improvement could be adopted to discover new insights, by using the policy implementation error/efficiency and bureaucratic capacity. Hospital managers, executives and healthcare management practitioners could use an interdisciplinary approach to design new performance measurement models, in which financial performance, quality, healthcare and patient outcomes are blended in, for resource allocation and performance improvement. This article recommends that public policy implementation error and the bureaucratic capacity models be applied to healthcare to optimise the outcomes for the healthcare system in Australia. In addition, it highlights the need for evaluation of the current reimbursement method, freedom of choice to patients and a regular scrutiny of the appropriateness of care.

  15. Information systems in healthcare - state and steps towards sustainability.

    PubMed

    Lenz, R

    2009-01-01

    To identify core challenges and first steps on the way to sustainable information systems in healthcare. Recent articles on healthcare information technology and related articles from Medical Informatics and Computer Science were reviewed and analyzed. Core challenges that couldn't be solved over the years are identified. The two core problem areas are process integration, meaning to effectively embed IT-systems into routine workflows, and systems integration, meaning to reduce the effort for interconnecting independently developed IT-components. Standards for systems integration have improved a lot, but their usefulness is limited where system evolution is needed. Sustainable Healthcare Information Systems should be based on system architectures that support system evolution and avoid costly system replacements every five to ten years. Some basic principles for the design of such systems are separation of concerns, loose coupling, deferred systems design, and service oriented architectures.

  16. Healthcare Systems and Motivation

    PubMed Central

    Loewy, Erich H.

    2007-01-01

    Despite the fact that most American physicians, at least until around the 1970s, stood in the way of developing a universal healthcare system, most are generally not happy with the current state of healthcare – or its lack thereof – today. The primary reasons for this general unhappiness are that insurance companies and managed care have successfully conspired to remove much of the physician's autonomy (via imposed time constraints, burdensome paperwork, the time-consuming chore of having to defend going against stringent treatment algorithms that are often inappropriate for some patients) and the satisfaction of knowing their patients. Few physicians in managed care organizations (MCOs) are able to practice without constant and blindly algorithmic interference concerning the diagnostic tests and therapeutic interventions they order. As copayments have increased, they often find that patients, even though “covered,” cannot afford the therapy they deem necessary. While physicians expect to earn sufficient to pay back their not insignificant educational debts, provide their children with help through college, and assure retirements sufficient for themselves and their spouses, these should not be considered unreasonable expectations. Most physicians today do favor universal healthcare – to the point of having included such language in their various professional codes of ethics (which, perversely enough, bioethicists as a group have failed to do). Contrary to the claims of our colleagues, Altom and Churchill, physicians seem to be genuinely frustrated as to what else they can do to change the current inequitable system. PMID:17435646

  17. Enhancing Health-Care Services with Mixed Reality Systems

    NASA Astrophysics Data System (ADS)

    Stantchev, Vladimir

    This work presents a development approach for mixed reality systems in health care. Although health-care service costs account for 5-15% of GDP in developed countries the sector has been remarkably resistant to the introduction of technology-supported optimizations. Digitalization of data storing and processing in the form of electronic patient records (EPR) and hospital information systems (HIS) is a first necessary step. Contrary to typical business functions (e.g., accounting or CRM) a health-care service is characterized by a knowledge intensive decision process and usage of specialized devices ranging from stethoscopes to complex surgical systems. Mixed reality systems can help fill the gap between highly patient-specific health-care services that need a variety of technical resources on the one side and the streamlined process flow that typical process supporting information systems expect on the other side. To achieve this task, we present a development approach that includes an evaluation of existing tasks and processes within the health-care service and the information systems that currently support the service, as well as identification of decision paths and actions that can benefit from mixed reality systems. The result is a mixed reality system that allows a clinician to monitor the elements of the physical world and to blend them with virtual information provided by the systems. He or she can also plan and schedule treatments and operations in the digital world depending on status information from this mixed reality.

  18. Process-driven selection of information systems for healthcare

    NASA Astrophysics Data System (ADS)

    Mills, Stephen F.; Yeh, Raymond T.; Giroir, Brett P.; Tanik, Murat M.

    1995-05-01

    Integration of networking and data management technologies such as PACS, RIS and HIS into a healthcare enterprise in a clinically acceptable manner is a difficult problem. Data within such a facility are generally managed via a combination of manual hardcopy systems and proprietary, special-purpose data processing systems. Process modeling techniques have been successfully applied to engineering and manufacturing enterprises, but have not generally been applied to service-based enterprises such as healthcare facilities. The use of process modeling techniques can provide guidance for the placement, configuration and usage of PACS and other informatics technologies within the healthcare enterprise, and thus improve the quality of healthcare. Initial process modeling activities conducted within the Pediatric ICU at Children's Medical Center in Dallas, Texas are described. The ongoing development of a full enterprise- level model for the Pediatric ICU is also described.

  19. Possible Courses for News and Public Affairs

    ERIC Educational Resources Information Center

    Wald, Richard C.

    1978-01-01

    Live programming, regular daily news programs, and documentary series, which are suggested as solutions to the limited scope of news and public affairs air time, would enable PBS to increase its coverage of news and public affairs. Some suggestions are also made for restructuring the functions of stations within the system to facilitate this…

  20. Public trust in the healthcare system in a developing country.

    PubMed

    Peters, Dexnell; Youssef, Farid F

    2016-04-01

    Broadly defined, trust in the healthcare system is concerned with how the public perceives the system and the actors therein as it pertains to their ability to both deliver services and seek the best interests of their clientele. Trust is important because it impacts upon a range of health behaviors including compliance and ultimately affects the ability of the healthcare system to meet its goals. While several studies exist on public trust within the developed world, few studies have explored this issue in developing countries. This paper therefore assesses public trust in the healthcare system of a developing small island nation, Trinidad and Tobago. A cross-sectional survey of adults was conducted using a questionnaire that has been successfully used across Europe. We report that trust levels in the healthcare system in Trinidad and Tobago are relatively low with less than 50% of persons indicating fair trust in the healthcare system. In addition, individual health professionals also did not score highly with lowest scores found for nurses and complementary therapists. Results on four out of five dimensions of trust also demonstrated scores significantly lower than those reported in more developed nations. Open-ended comments supported these findings with the majority of persons indicating a lack of confidence in the healthcare system. These results may reflect the reality in the wider developing world, and we suggest that bolstering trust is a needed area of focus in the delivery of healthcare services throughout the nation. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

  1. A review of the Australian healthcare system: A policy perspective

    PubMed Central

    Sambasivan, Murali

    2018-01-01

    This article seeks to review the Australian healthcare system and compare it to similar systems in other countries to highlight the main issues and problems. A literature search for articles relating to the Australian and other developed countries’ healthcare systems was conducted by using Google and the library of Victoria University, Melbourne. Data from the websites of the Commonwealth of Australia, the Australian Institute of Health and Welfare, the Australian Productivity Commission, the Organisation for Economic Co-operation and Development and the World Bank have also been used. Although care within the Australian healthcare system is among the best in the world, there is a need to change the paradigm currently being used to measure the outcomes and allocate resources. The Australian healthcare system is potentially dealing with two main problems: (a) resource allocation, and (b) performance and patient outcomes improvements. An interdisciplinary research approach in the areas of performance measurement, quality and patient outcomes improvement could be adopted to discover new insights, by using the policy implementation error/efficiency and bureaucratic capacity. Hospital managers, executives and healthcare management practitioners could use an interdisciplinary approach to design new performance measurement models, in which financial performance, quality, healthcare and patient outcomes are blended in, for resource allocation and performance improvement. This article recommends that public policy implementation error and the bureaucratic capacity models be applied to healthcare to optimise the outcomes for the healthcare system in Australia. In addition, it highlights the need for evaluation of the current reimbursement method, freedom of choice to patients and a regular scrutiny of the appropriateness of care. PMID:29686869

  2. [Interpretation in the Danish health-care system].

    PubMed

    Lund Hansen, Marianne Taulo; Nielsen, Signe Smith

    2013-03-04

    Communication between health professional and patient is central for treatment and patient safety in the health-care system. This systematic review examines the last ten years of specialist literature concerning interpretation in the Danish health-care system. Structural search in two databases, screening of references and recommended literature from two scientists led to identification of seven relevant articles. The review showed that professional interpreters were not used consistently when needed. Family members were also used as interpreters. These results were supported by international investigations.

  3. A bill to redesignate the Department of Veterans Affairs Healthcare System located at 10000 Bay Pines Boulevard in Bay Pines, Florida, as the "C.W. Bill Young Department of Veterans Affairs Medical Center".

    THOMAS, 113th Congress

    Sen. Nelson, Bill [D-FL

    2013-10-28

    Senate - 10/30/2013 Committee on Veterans' Affairs. Hearings held. Hearings printed: S.Hrg. 113-280. (All Actions) Notes: For further action, see H.R.3302, which became Public Law 113-49 on 11/13/2013. Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  4. Unix becoming healthcare's standard operating system.

    PubMed

    Gardner, E

    1991-02-11

    An unfamiliar buzzword is making its way into healthcare executives' vocabulary, as well as their computer systems. Unix is being touted by many industry observers as the most likely candidate to be a standard operating system for minicomputers, mainframes and computer networks.

  5. Healthcare Systems in Comparative Perspective: Classification, Convergence, Institutions, Inequalities, and Five Missed Turns

    PubMed Central

    Beckfield, Jason; Olafsdottir, Sigrun; Sosnaud, Benjamin

    2017-01-01

    This essay reviews and evaluates recent comparative social science scholarship on healthcare systems. We focus on four of the strongest themes in current research: (1) the development of typologies of healthcare systems, (2) assessment of convergence among healthcare systems, (3) problematization of the shifting boundaries of healthcare systems, and (4) the relationship between healthcare systems and social inequalities. Our discussion seeks to highlight the central debates that animate current scholarship and identify unresolved questions and new opportunities for research. We also identify five currents in contemporary sociology that have not been incorporated as deeply as they might into research on healthcare systems. These five “missed turns” include an emphasis on social relations, culture, postnational theory, institutions, and causal mechanisms. We conclude by highlighting some key challenges for comparative research on healthcare systems. PMID:28769148

  6. Utilizing Health Information Technology to Support Universal Healthcare Delivery: Experience of a National Healthcare System.

    PubMed

    Syed-Abdul, Shabbir; Hsu, Min-Huei; Iqbal, Usman; Scholl, Jeremiah; Huang, Chih-Wei; Nguyen, Phung Anh; Lee, Peisan; García-Romero, Maria Teresa; Li, Yu-Chuan Jack; Jian, Wen-Shan

    2015-09-01

    Recent discussions have focused on using health information technology (HIT) to support goals related to universal healthcare delivery. These discussions have generally not reflected on the experience of countries with a large amount of experience using HIT to support universal healthcare on a national level. HIT was compared globally by using data from the Ministry of the Interior, Republic of China (Taiwan). Taiwan has been providing universal healthcare since 1995 and began to strategically implement HIT on a national level at that time. Today the national-level HIT system is more extensive in Taiwan than in many other countries and is used to aid administration, clinical care, and public health. The experience of Taiwan thus can provide an illustration of how HIT can be used to support universal healthcare delivery. In this article we present an overview of some key historical developments and successes in the adoption of HIT in Taiwan over a 17-year period, as well as some more recent developments. We use this experience to offer some strategic perspectives on how it can aid in the adoption of large-scale HIT systems and on how HIT can be used to support universal healthcare delivery.

  7. Implementing standards for the interoperability among healthcare providers in the public regionalized Healthcare Information System of the Lombardy Region.

    PubMed

    Barbarito, Fulvio; Pinciroli, Francesco; Mason, John; Marceglia, Sara; Mazzola, Luca; Bonacina, Stefano

    2012-08-01

    Information technologies (ITs) have now entered the everyday workflow in a variety of healthcare providers with a certain degree of independence. This independence may be the cause of difficulty in interoperability between information systems and it can be overcome through the implementation and adoption of standards. Here we present the case of the Lombardy Region, in Italy, that has been able, in the last 10 years, to set up the Regional Social and Healthcare Information System, connecting all the healthcare providers within the region, and providing full access to clinical and health-related documents independently from the healthcare organization that generated the document itself. This goal, in a region with almost 10 millions citizens, was achieved through a twofold approach: first, the political and operative push towards the adoption of the Health Level 7 (HL7) standard within single hospitals and, second, providing a technological infrastructure for data sharing based on interoperability specifications recognized at the regional level for messages transmitted from healthcare providers to the central domain. The adoption of such regional interoperability specifications enabled the communication among heterogeneous systems placed in different hospitals in Lombardy. Integrating the Healthcare Enterprise (IHE) integration profiles which refer to HL7 standards are adopted within hospitals for message exchange and for the definition of integration scenarios. The IHE patient administration management (PAM) profile with its different workflows is adopted for patient management, whereas the Scheduled Workflow (SWF), the Laboratory Testing Workflow (LTW), and the Ambulatory Testing Workflow (ATW) are adopted for order management. At present, the system manages 4,700,000 pharmacological e-prescriptions, and 1,700,000 e-prescriptions for laboratory exams per month. It produces, monthly, 490,000 laboratory medical reports, 180,000 radiology medical reports, 180

  8. Integrating hospital information systems in healthcare institutions: a mediation architecture.

    PubMed

    El Azami, Ikram; Cherkaoui Malki, Mohammed Ouçamah; Tahon, Christian

    2012-10-01

    Many studies have examined the integration of information systems into healthcare institutions, leading to several standards in the healthcare domain (CORBAmed: Common Object Request Broker Architecture in Medicine; HL7: Health Level Seven International; DICOM: Digital Imaging and Communications in Medicine; and IHE: Integrating the Healthcare Enterprise). Due to the existence of a wide diversity of heterogeneous systems, three essential factors are necessary to fully integrate a system: data, functions and workflow. However, most of the previous studies have dealt with only one or two of these factors and this makes the system integration unsatisfactory. In this paper, we propose a flexible, scalable architecture for Hospital Information Systems (HIS). Our main purpose is to provide a practical solution to insure HIS interoperability so that healthcare institutions can communicate without being obliged to change their local information systems and without altering the tasks of the healthcare professionals. Our architecture is a mediation architecture with 3 levels: 1) a database level, 2) a middleware level and 3) a user interface level. The mediation is based on two central components: the Mediator and the Adapter. Using the XML format allows us to establish a structured, secured exchange of healthcare data. The notion of medical ontology is introduced to solve semantic conflicts and to unify the language used for the exchange. Our mediation architecture provides an effective, promising model that promotes the integration of hospital information systems that are autonomous, heterogeneous, semantically interoperable and platform-independent.

  9. WISH: a Wireless Mobile Multimedia Information System in Healthcare using RFID.

    PubMed

    Yu, Weider D; Ray, Pradeep; Motoc, Tiberiu

    2008-05-01

    It is important to improve the efficiency of healthcare-related operations and the associated costs. Healthcare organizations are constantly under increased pressure to streamline operations and provide enhanced services to their patients. Wireless mobile computing technology has the potential to provide the desired benefits and would be a critical part of today's healthcare information system. In this paper, a system is presented to better facilitate the functions of physicians and medical staff in healthcare by using modern wireless mobile technology, Radio Frequency Identification (RFID) tools, and multimedia streaming. The paper includes a case study of the development of such a system in the context of healthcare in the United States. The results of the study show how wireless mobile multimedia systems can be developed for the improvement of the quality and efficiency in healthcare for other nations as well. Our testing data show a time reduction of more than 50% in the daily activities of hospital staff.

  10. [Restructuring the healthcare system: redesigning based on needs].

    PubMed

    Szentes, Tamás; Vályi-Nagy, István

    2015-01-18

    The main task of a healthcare system is the provision of the healthcare services demanded by the population. These needs are mostly defined by the epidemiological status, which has been significantly changed during the last century. Due to development of medical science and technology, the main health problems in modern industrial societies are related to chronic diseases rather than infectious diseases occurring at the beginning of the 20th century. However, healthcare services provided by health institutions are still reactive, formed as reactions to current conditions, and they are hardly suited to requirements related to chronic diseases. This paper outlines international and national healthcare models and their shortcomings, and it traces novel paths of a future solution. The structure of the optimal model is suited to systematically produce the services which are needed by the population, decisively in the case of chronic, non communicable diseases. This can significantly relieve the expensive, technology-based reactive care system, nevertheless, it can provide efficient services in case of tertiary prevention. The configuration of this system is cheap, there is no need of significant infrastructure, but needs massive human resource, so that it can be rationally designed in parallel with the constriction of the reactive care system.

  11. Legislative Affairs Media Contact - Public Affairs - NOAA's National

    Science.gov Websites

    Media Contacts -NWS Media Contacts -NOAA Media Contacts -Legislative Affairs Media Tools -Archived News Media Contact Matthew R. Borgia Congressional Affairs Specialist - All National Weather Service issues (202)482-1939 Back Top Home | Mission | Strategic Plan | NWS Media Contacts | NOAA Media Contacts US

  12. Accountability in the UK Healthcare System: An Overview

    PubMed Central

    Peckham, Stephen

    2014-01-01

    Recent changes in the English National Health Service (NHS) have introduced new complexities into the accountability arrangements for healthcare services. This commentary describes how the new organizational structures have challenged the traditional centralized accountability structures by creating a more dispersed system of governance for local health-care commissioners. It sets the context of discussions about accountability in the UK NHS and then describes the key changes in England following the implementation of the NHS reforms in April 2013. The commentary concludes that while there is increased complexity of accountability within a more decentralized and fragmented healthcare system, the government's goal of achieving increased local autonomy and greater control by general practitioners (GPs) will probably not be realized. In particular, the system will continue to have strongly centralized aspects, with increased regulation and central political responsibility. PMID:25305399

  13. Web-based healthcare hand drawing management system.

    PubMed

    Hsieh, Sheau-Ling; Weng, Yung-Ching; Chen, Chi-Huang; Hsu, Kai-Ping; Lin, Jeng-Wei; Lai, Feipei

    2010-01-01

    The paper addresses Medical Hand Drawing Management System architecture and implementation. In the system, we developed four modules: hand drawing management module; patient medical records query module; hand drawing editing and upload module; hand drawing query module. The system adapts windows-based applications and encompasses web pages by ASP.NET hosting mechanism under web services platforms. The hand drawings implemented as files are stored in a FTP server. The file names with associated data, e.g. patient identification, drawing physician, access rights, etc. are reposited in a database. The modules can be conveniently embedded, integrated into any system. Therefore, the system possesses the hand drawing features to support daily medical operations, effectively improve healthcare qualities as well. Moreover, the system includes the printing capability to achieve a complete, computerized medical document process. In summary, the system allows web-based applications to facilitate the graphic processes for healthcare operations.

  14. Information security requirements in patient-centred healthcare support systems.

    PubMed

    Alsalamah, Shada; Gray, W Alex; Hilton, Jeremy; Alsalamah, Hessah

    2013-01-01

    Enabling Patient-Centred (PC) care in modern healthcare requires the flow of medical information with the patient between different healthcare providers as they follow the patient's treatment plan. However, PC care threatens the stability of the balance of information security in the support systems since legacy systems fall short of attaining a security balance when sharing their information due to compromises made between its availability, integrity, and confidentiality. Results show that the main reason for this is that information security implementation in discrete legacy systems focused mainly on information confidentiality and integrity leaving availability a challenge in collaboration. Through an empirical study using domain analysis, observations, and interviews, this paper identifies a need for six information security requirements in legacy systems to cope with this situation in order to attain the security balance in systems supporting PC care implementation in modern healthcare.

  15. The healthcare experiences of Arab Israeli women in a reformed healthcare system.

    PubMed

    Elnekave, Eldad; Gross, Revital

    2004-07-01

    Arab Israeli women are subject to unique social stresses deriving from their status as part of an ethno-political minority and from their position as women in a patriarchal community. Collectively, their health profiles rate poorly in comparison to Jewish Israeli women or to women in the vast majority of developed countries. To examine the experiences of Arab Israeli women in the contemporary Israeli healthcare system, following implementation of the National Health Insurance Law (NHIL). The study combined quantitative and qualitative research methodologies. A telephone survey utilizing a structured questionnaire was conducted during August-September 1998 among a random national sample of 849 women, with a response rate of 83%. Between the months of January and July of 2000, qualitative data was attained via participant-observation, long and short semi-structured interviews, and focus groups in one large Muslim Arab Israeli village. Arab Israeli women in the national survey reported poorer self-assessed health, lower rates of care by a woman primary care physician, lower satisfaction ratings for primary care physicians and more frequently foregoing medical care than did native or immigrant Jewish Israeli women. Three major factors contributing to Arab Israeli women's healthcare experiences were elucidated by the qualitative study: (1) the threat of physical and social exposure (2) difficulties in communicating with male physicians and (3) the stifling effect of family politics and surveillance on healthcare. We discuss our findings in relation to structural changes associated with the recent reform of the Israeli health care system. We conclude by suggesting policy measures for better adapting primary care services to the needs of Arab Israeli women, and note the relevance to other systems that aim to provide service to cultural and ethno-political minorities, in which healthcare delivery is shaped by unique local circumstances.

  16. National quality improvement policies and strategies in European healthcare systems.

    PubMed

    Spencer, E; Walshe, K

    2009-02-01

    This survey provides an overview of the development of policies and strategies for quality improvement in European healthcare systems, by mapping quality improvement policies and strategies, progress in their implementation, and early indications of their impact. A survey of quality improvement policies and strategies in healthcare systems of the European Union was conducted in 2005 for the first phase of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project. The survey, completed by 68 key experts in quality improvement from 24 European Union member states, represents their views and accounts of quality improvement policies and strategies in their healthcare systems. There are substantial international and intra-national variations in the development of healthcare quality improvement. Legal requirements for quality improvement strategies are an important driver of progress, along with the activities of national governments and professional associations and societies. Patient and service user organisations appear to have less influence on quality improvement. Wide variation in voluntary and mandatory coverage of quality improvement policies and strategies across sectors can potentially lead to varying levels of progress in implementation. Many healthcare organisations lack basic infrastructure for quality improvement. Some convergence can be observed in policies on quality improvement in healthcare. Nevertheless, the growth of patient mobility across borders, along with the implications of free market provisions for the organisation and funding of healthcare systems in European Union member states, require policies for cooperation and learning transfer.

  17. Cartographic Encounters at the Bureau of Indian Affairs Geographic Information System Center of Calculation

    ERIC Educational Resources Information Center

    Palmer, Mark H.

    2012-01-01

    The centering processes of geographic information system (GIS) development at the United States Bureau of Indian Affairs (BIA) was an extension of past cartographic encounters with American Indians through the central control of geospatial technologies, uneven development of geographic information resources, and extension of technically dependent…

  18. Student Affairs Capitalism and Early-Career Student Affairs Professionals

    ERIC Educational Resources Information Center

    Lee, Jenny J.; Helm, Matthew

    2013-01-01

    This study explores student affairs capitalism as the alteration of professional practice towards the financial interests of institutions. Student affairs capitalism has the potential to create dynamics in which the interests of students become secondary to the institution's economic needs. This study examined this phenomenon from the perspectives…

  19. Patient satisfaction with the healthcare system: Assessing the impact of socio-economic and healthcare provision factors.

    PubMed

    Xesfingi, Sofia; Vozikis, Athanassios

    2016-03-15

    Patient satisfaction is an important measure of healthcare quality as it offers information on the provider's success at meeting clients' expectations and is a key determinant of patients' perspective behavioral intention. The aim of this paper is first to assess the degree of patient satisfaction, and second, to study the relationship between patient satisfaction of healthcare system and a set of socio-economic and healthcare provision indicators. This empirical analysis covers 31 countries for the years 2007, 2008, 2009 and 2012. The dependent variable, the satisfaction index, is defined as the patient satisfaction of their country's health system. We first construct an index of patient satisfaction and then, at a second stage, this index is related to socio-economic and healthcare provision variables. Our findings support that there is a strong positive association between patient satisfaction level and healthcare provision indicators, such as nurses and physicians per 100,000 habitants, with the latter being the most important contributor, and a negative association between patient satisfaction level and number of hospital beds. Among the socio-economic variables, public health expenditures greatly shape and positive relate to patient satisfaction, while private spending on health relates negatively. Finally, the elder a patient is, the more satisfied with a country's healthcare system appears to be. We conclude that there is a strong positive association between patient satisfaction and public health expenditures, number of physicians and nurses, and the age of the patient, while there is a negative evidence for private health spending and number of hospital beds.

  20. House Committee on Veterans' Affairs

    MedlinePlus

    ... Phil Roe, M.D. Visit Chairman Roe's Website Twitter Updates Follow @HouseVetAffairs HouseVetAffairs @HouseVetAffairs a minute ago ... FRI 11/17) at 2pm ET for a Twitter Q&A. Ask questions using #askVBA . h… HouseVetAffairs @ ...

  1. Systems healthcare: a holistic paradigm for tomorrow.

    PubMed

    Fiandaca, Massimo S; Mapstone, Mark; Connors, Elenora; Jacobson, Mireille; Monuki, Edwin S; Malik, Shaista; Macciardi, Fabio; Federoff, Howard J

    2017-12-19

    Systems healthcare is a holistic approach to health premised on systems biology and medicine. The approach integrates data from molecules, cells, organs, the individual, families, communities, and the natural and man-made environment. Both extrinsic and intrinsic influences constantly challenge the biological networks associated with wellness. Such influences may dysregulate networks and allow pathobiology to evolve, resulting in early clinical presentation that requires astute assessment and timely intervention for successful mitigation. Herein, we describe the components of relevant biological systems and the nature of progression from at-risk to manifest disease. We illustrate the systems approach by examining two relevant clinical examples: Alzheimer's and cardiovascular diseases. The implications of systems healthcare management are examined through the lens of economics, ethics, policy and the law. Finally, we propose the need to develop new educational paradigms to enhance the training of the health professional in an era of systems medicine.

  2. The healthcare system and the provision of oral healthcare in European Union member states. Part 8: Italy.

    PubMed

    Bindi, M; Paganelli, C; Eaton, K A; Widström, E

    2017-05-26

    In Italy healthcare is provided for all Italian citizens and residents and it is delivered mainly by public providers, with some private or private-public entities. Italy's public healthcare system - the Servizio Sanitario Nazionale (SSN) - is organised by the Ministry of Health and administered on a devolved regional basis. It is financed by general taxation that provides universal coverage, largely free of charge at the point of service. The central government establishes the basic national health benefits package, which must be uniformly provided throughout the country, through services guaranteed under the NHS provision called LEA - (Livelli Essenziali di Assistenza [Essential Level of Assistance]) and allocates national funds to the regions. The regions, through their regional health departments, are responsible for organising, administering and delivering primary, secondary and tertiary healthcare services as well as preventive and health promotion services. Regions are allowed a large degree of autonomy in how they perform this role and regarding decisions about the local structure of the system. Complementary and supplementary private health insurance is also available. However, as in most other Mediterranean European countries, in Italy oral healthcare is mainly provided under private arrangements. The public healthcare system provides only 5-8% of oral healthcare services and this percentage varies from region to region. Oral healthcare is included in the Legislation on Essential levels of care (LEAs) for specific populations such as children, vulnerable people (medically compromised and those on low income) and individuals who need oral healthcare in some urgent/emergency cases. For other people, oral healthcare is generally not covered. Apart from the national benefits package, regions may also carry out their own initiatives autonomously, but must finance these themselves. The number of dentists working in Italy has grown rapidly in the last few years

  3. Oral healthcare systems in the extended European union.

    PubMed

    Widström, Eeva; Eaton, Kenneth A

    2004-01-01

    This article reports a survey of the systems for the provision of oral healthcare in the 28 member and accession states of the EU/EEA in 2003. Descriptions of the systems were collected from the principal dental advisers to governments in the individual states. In many states these were the Chief Dental Officers (CDOs). In states without a CDO, descriptions were gathered from CDO equivalents or senior academics. A template (model description) was used to guide all respondents. Additional statistical information on oral healthcare costs and workforce was collected from the Council of European Chief Dental Officers, WHO and World Bank websites. The study showed that in broad terms there were six patterns (Beveridgian, Bismarkian, The Eastern European (in transition), Nordic, Southern European and Hybrid) for the administration and financing of oral healthcare in the expanding EU. The extent and nature of government involvement in planning and coordinating oral healthcare services and the numbers and pay of the oral healthcare workforce varied between the different models. The biggest recent changes in European oral healthcare were found to have occurred in Eastern Europe, where there has been wide scale privatization of the previously public dental services. However, most of the EU accession (Eastern European) states seemed to be slowly developing insurance systems to cover oral health treatment costs. In the existing EU/EEA, the public dental services such as those in the Nordic countries still have strong political support and some expansion has occurred. In Southern Europe public dental services seemed to have gained some acceptance for the treatment of children and special needs groups. In UK, which has a unique public dental service system, there are plans to make big changes in the delivery, commissioning and remuneration of dental services in the near future. Some EU member states which operate the Bismarkian system with health insurances offering wide

  4. Building China's municipal healthcare performance evaluation system: a Tuscan perspective.

    PubMed

    Li, Hao; Barsanti, Sara; Bonini, Anna

    2012-08-01

    Regional healthcare performance evaluation systems can help optimize healthcare resources on regional basis and improve the performance of healthcare services provided. The Tuscany region in Italy is a good example of an institution which meets these requirements. China has yet to build such a system based on international experience. In this paper, based on comparative studies between Tuscany and China, we propose that the managing institutions in China's experimental cities can select and commission a third-party agency to, respectively, evaluate the performance of their affiliated hospitals and community health service centers. Following some features of the Tuscan experience, the Chinese municipal healthcare performance evaluation system can be built by focusing on the selection of an appropriate performance evaluation agency, the design of an adequate performance evaluation mechanism and the formulation of a complete set of laws, rules and regulations. When a performance evaluation system at city level is formed, the provincial government can extend the successful experience to other cities.

  5. Intelligent diagnosis and prescription for a customized physical fitness and healthcare system.

    PubMed

    Huang, Chung-Chi; Liu, Hsiao-Man; Huang, Chung-Lin

    2015-01-01

    With the advent of the era of global high-tech industry and commerce and its associated sedentary lifestyle, opportunities for physical activity are reduced. People's physical fitness and health is deteriorating. Therefore, it is necessary to develop a system that can enhance people's physical fitness and health. However, it is difficult for general physical fitness and healthcare systems to meet individualized needs. The main purpose of this research is to develop a method of intelligent diagnosis and prescription for a customized physical fitness and healthcare system. The proposed system records all processes of the physical fitness and healthcare system via a wireless sensor network and the results of the diagnosis and prescription will be generated by fuzzy logic inference. It will improve individualized physical fitness and healthcare. Finally, we demonstrate the advantages of intelligent diagnosis and prescription for a customized physical fitness and healthcare system.

  6. The healthcare system and the provision of oral healthcare in European Union member states. Part 1: Germany.

    PubMed

    Ziller, S; Eaton, K E; Widström, E

    2015-02-01

    Germany is the largest member state of the EU, both in terms of population and number of dentists and dental team members, with 80.5 million inhabitants and 69,236 active dentists, 182,000 dental nurses and 54,000 dental technicians in 2012. General dental practitioners in private practice provide almost all oral healthcare under a health insurance scheme. The tradition of compulsory health insurance goes back to the nineteenth century when it was introduced by Bismarck. Today, the majority of the German population (86%) are members of a statutory sick fund which reimburses a legally prescribed standard oral healthcare package provided by dentists in contract with the health insurance system. A smaller number are privately insured. Access to oral healthcare is excellent and 80% of adults visited a dentist in 2013. Healthcare expenditure in Germany has long been considered high. This has led to several reforms in recent years. This paper outlines the system for the provision of oral healthcare in Germany and explains and discusses the latest changes.

  7. Impact of data governance on a nation's healthcare system building blocks.

    PubMed

    Hovenga, Evelyn J S

    2013-01-01

    This chapter gives an overview of a nation's healthcare system, particularly for those who are familiar with IT but not healthcare or for those working in one area of healthcare who may not be familiar with the system and data requirements across the care continuum. The structure of this chapter uses the World Health Organisation's (WHO) Health systems framework with a focus on the need for data and information governance to achieve a sustainable health system delivering improved health for all, responsively and equitably meeting genuine demands for health services, with social and financial risk protection and overall improved efficiency. It is argued that there is a need to gather the right data and to process these data in a manner that provides good information in order to more fully understand how the health system is working and where and when it isn't working well. This needs to be achieved in the most cost effective manner that doesn't detract from the allocation of resources to healthcare or the clinical workflow required to achieve quality healthcare.

  8. UNIX and healthcare systems: a good marriage.

    PubMed

    Wieners, W

    1992-08-01

    Powerful and versatile, UNIX makes open systems affordable in today's complex healthcare marketplace. As more emphasis is placed on combining the best systems for the least money, UNIX plays an important role. How many hospitals are using it already?

  9. Quality of the ophthalmological service to outpatients of the public and private healthcare systems.

    PubMed

    Hercos, Benigno Vicente Santos; Berezovsky, Adriana

    2017-01-01

    To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

  10. A scalable healthcare information system based on a service-oriented architecture.

    PubMed

    Yang, Tzu-Hsiang; Sun, Yeali S; Lai, Feipei

    2011-06-01

    Many existing healthcare information systems are composed of a number of heterogeneous systems and face the important issue of system scalability. This paper first describes the comprehensive healthcare information systems used in National Taiwan University Hospital (NTUH) and then presents a service-oriented architecture (SOA)-based healthcare information system (HIS) based on the service standard HL7. The proposed architecture focuses on system scalability, in terms of both hardware and software. Moreover, we describe how scalability is implemented in rightsizing, service groups, databases, and hardware scalability. Although SOA-based systems sometimes display poor performance, through a performance evaluation of our HIS based on SOA, the average response time for outpatient, inpatient, and emergency HL7Central systems are 0.035, 0.04, and 0.036 s, respectively. The outpatient, inpatient, and emergency WebUI average response times are 0.79, 1.25, and 0.82 s. The scalability of the rightsizing project and our evaluation results show that the SOA HIS we propose provides evidence that SOA can provide system scalability and sustainability in a highly demanding healthcare information system.

  11. Bureau of Indian Affairs Schools: New Facilities Management Information System Promising, but Improved Data Accuracy Needed.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC.

    A General Accounting Office (GAO) study evaluated the Bureau of Indian Affairs' (BIA) new facilities management information system (FMIS). Specifically, the study examined whether the new FMIS addresses the old system's weaknesses and meets BIA's management needs, whether BIA has finished validating the accuracy of data transferred from the old…

  12. Using HFACS-Healthcare to Identify Systemic Vulnerabilities During Surgery.

    PubMed

    Cohen, Tara N; Francis, Sarah E; Wiegmann, Douglas A; Shappell, Scott A; Gewertz, Bruce L

    2018-03-01

    The Human Factors Analysis and Classification System for Healthcare (HFACS-Healthcare) was used to classify surgical near miss events reported via a hospital's event reporting system over the course of 1 year. Two trained analysts identified causal factors within each event narrative and subsequently categorized the events using HFACS-Healthcare. Of 910 original events, 592 could be analyzed further using HFACS-Healthcare, resulting in the identification of 726 causal factors. Most issues (n = 436, 60.00%) involved preconditions for unsafe acts, followed by unsafe acts (n = 257, 35.39%), organizational influences (n = 27, 3.72%), and supervisory factors (n = 6, 0.82%). These findings go beyond the traditional methods of trending incident data that typically focus on documenting the frequency of their occurrence. Analyzing near misses based on their underlying contributing human factors affords a greater opportunity to develop process improvements to reduce reoccurrence and better provide patient safety approaches.

  13. Intersectionality in Student Affairs: Perspective from a Senior Student Affairs Officer

    ERIC Educational Resources Information Center

    Moneta, Larry

    2017-01-01

    The author draws upon over four decades of experience in student affairs administration to investigate how senior student affairs officers can incorporate intersectionality into comprehensive and targeted decision-making processes, strategic planning, and organizational considerations.

  14. The implementation of mindfulness in healthcare systems: a theoretical analysis.

    PubMed

    Demarzo, M M P; Cebolla, A; Garcia-Campayo, J

    2015-01-01

    Evidence regarding the efficacy of mindfulness-based interventions (MBIs) is increasing exponentially; however, there are still challenges to their integration in healthcare systems. Our goal is to provide a conceptual framework that addresses these challenges in order to bring about scholarly dialog and support health managers and practitioners with the implementation of MBIs in healthcare. This is an opinative narrative review based on theoretical and empirical data that address key issues in the implementation of mindfulness in healthcare systems, such as the training of professionals, funding and costs of interventions, cost effectiveness and innovative delivery models. We show that even in the United Kingdom, where mindfulness has a high level of implementation, there is a high variability in the access to MBIs. In addition, we discuss innovative approaches based on "complex interventions," "stepped-care" and "low intensity-high volume" concepts that may prove fruitful in the development and implementation of MBIs in national healthcare systems, particularly in Primary Care. In order to better understand barriers and opportunities for mindfulness implementation in healthcare systems, it is necessary to be aware that MBIs are "complex interventions," which require innovative approaches and delivery models to implement these interventions in a cost-effective and accessible way. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. ERP (enterprise resource planning) systems can streamline healthcare business functions.

    PubMed

    Jenkins, E K; Christenson, E

    2001-05-01

    Enterprise resource planning (ERP) software applications are designed to facilitate the systemwide integration of complex processes and functions across a large enterprise consisting of many internal and external constituents. Although most currently available ERP applications generally are tailored to the needs of the manufacturing industry, many large healthcare systems are investigating these applications. Due to the significant differences between manufacturing and patient care, ERP-based systems do not easily translate to the healthcare setting. In particular, the lack of clinical standardization impedes the use of ERP systems for clinical integration. Nonetheless, an ERP-based system can help a healthcare organization integrate many functions, including patient scheduling, human resources management, workload forecasting, and management of workflow, that are not directly dependent on clinical decision making.

  16. Creation and Execution of a Novel Anesthesia Perioperative Care Service at a Veterans Affairs Hospital.

    PubMed

    Alvis, Bret D; King, Adam B; Pandharipande, Pratik P; Weavind, Liza M; Avila, Katelin; Leisy, Philip J; Ajmal, Muhammad; McHugh, Michael; Keegan, Kirk A; Baker, David A; Walia, Ann; Hughes, Christopher G

    2017-11-01

    Physician-led perioperative surgical home models are developing as a method for improving the American health care system. These models are novel, team-based approaches that help to provide continuity of care throughout the perioperative period. Another avenue for improving care for surgical patients is the use of enhanced recovery after surgery pathways. These are well-described methods that have shown to improve perioperative outcomes. An established perioperative surgical home model can help implementation, efficiency, and adherence to enhanced recovery after surgery pathways. For these reasons, the Tennessee Valley Healthcare System, Nashville Veterans Affairs Medical Center created an Anesthesiology Perioperative Care Service that provides comprehensive care to surgical patients from their preoperative period through the continuum of their hospital course and postdischarge follow-up. In this brief report, we describe the development, implementation, and preliminary outcomes of the service.

  17. A healthcare management system for Turkey based on a service-oriented architecture.

    PubMed

    Herand, Deniz; Gürder, Filiz; Taşkin, Harun; Yuksel, Emre Nuri

    2013-09-01

    The current Turkish healthcare management system has a structure that is extremely inordinate, cumbersome and inflexible. Furthermore, this structure has no common point of view and thus has no interoperability and responds slowly to innovations. The purpose of this study is to show that using which methods can the Turkish healthcare management system provide a structure that could be more modern, more flexible and more quick to respond to innovations and changes taking advantage of the benefits given by a service-oriented architecture (SOA). In this paper, the Turkish healthcare management system is chosen to be examined since Turkey is considered as one of the Third World countries and the information architecture of the existing healthcare management system of Turkey has not yet been configured with SOA, which is a contemporary innovative approach and should provide the base architecture of the new solution. The innovation of this study is the symbiosis of two main integration approaches, SOA and Health Level 7 (HL7), for integrating divergent healthcare information systems. A model is developed which is based on SOA and enables obtaining a healthcare management system having the SSF standards (HSSP Service Specification Framework) developed by the framework of the HSSP (Healthcare Services Specification Project) under the leadership of HL7 and the Object Management Group.

  18. Who pays for providing spiritual care in healthcare settings? The ethical dilemma of taxpayers funding holistic healthcare and the first amendment requirement for separation of church and state.

    PubMed

    Warnock, Carla Jean Pease

    2009-12-01

    All US governmental, public, and private healthcare facilities and their staff fall under some form of regulatory requirement to provide opportunities for spiritual health assessment and care as a component of holistic healthcare. As often the case with regulations, these facilities face the predicament of funding un-reimbursable care. However, chaplains and nurses who provide most patient spiritual care are paid using funds the facility obtains from patients, private, and public sources. Furthermore, Veteran healthcare services, under the United States Department of Veterans Affairs (VA), are provided with taxpayer funds from local, state, and federal governments. With the recent legal action by the Freedom From Religion Foundation, Inc. (FFRF) against the Veterans Administration, the ethical dilemma surfaces between taxpayers funding holistic healthcare and the first amendment requirement for separation of church and state.

  19. Navigating the health-care system in community: Perspectives from Asian immigrant parents of children with special health-care needs.

    PubMed

    Son, Esther; Moring, Nechama Sammet; Igdalsky, Leah; Parish, Susan L

    2018-06-01

    Children with special health-care needs (CSHCNs) face notable barriers to health-care access and to receiving quality and family-centered care, despite higher health-care utilization rates. Within the population of CSHCNs, there are significant inequities in health-care quality impacting immigrants who have migrated to the United States. However, little is known about the experiences and needs of Asian immigrant families who have CSHCNs. This study aimed to explore how Asian immigrant parents of CSHCNs view their child's health-care access, quality, and utilization. We conducted semi-structured qualitative interviews with 22 Vietnamese- and Cantonese-speaking parents of CSHCNs. Participants were recruited through community partners. Interviews were transcribed, translated, and coded using content analysis. Participants were generally satisfied with their children's care and had strong relationships with their primary care doctors who were often culturally 'matched'. However, participants experienced several important and culturally specific barriers, including gaps in their understanding of the health-care system, language barriers, and a sense of alienation. Parents frequently turned to informal and community supports for assistance in navigating the US health-care system. Further research to understand the drivers of health disparities and policy level solutions is warranted.

  20. An enhanced mobile-healthcare emergency system based on extended chaotic maps.

    PubMed

    Lee, Cheng-Chi; Hsu, Che-Wei; Lai, Yan-Ming; Vasilakos, Athanasios

    2013-10-01

    Mobile Healthcare (m-Healthcare) systems, namely smartphone applications of pervasive computing that utilize wireless body sensor networks (BSNs), have recently been proposed to provide smartphone users with health monitoring services and received great attentions. An m-Healthcare system with flaws, however, may leak out the smartphone user's personal information and cause security, privacy preservation, or user anonymity problems. In 2012, Lu et al. proposed a secure and privacy-preserving opportunistic computing (SPOC) framework for mobile-Healthcare emergency. The brilliant SPOC framework can opportunistically gather resources on the smartphone such as computing power and energy to process the computing-intensive personal health information (PHI) in case of an m-Healthcare emergency with minimal privacy disclosure. To balance between the hazard of PHI privacy disclosure and the necessity of PHI processing and transmission in m-Healthcare emergency, in their SPOC framework, Lu et al. introduced an efficient user-centric privacy access control system which they built on the basis of an attribute-based access control mechanism and a new privacy-preserving scalar product computation (PPSPC) technique. However, we found out that Lu et al.'s protocol still has some secure flaws such as user anonymity and mutual authentication. To fix those problems and further enhance the computation efficiency of Lu et al.'s protocol, in this article, the authors will present an improved mobile-Healthcare emergency system based on extended chaotic maps. The new system is capable of not only providing flawless user anonymity and mutual authentication but also reducing the computation cost.

  1. ICT use for information management in healthcare system for chronic disease patient

    NASA Astrophysics Data System (ADS)

    Wawrzyniak, Zbigniew M.; Lisiecka-Biełanowicz, Mira

    2013-10-01

    Modern healthcare systems are designed to fulfill needs of the patient, his system environment and other determinants of the treatment with proper support of technical aids. A whole system of care is compatible to the technical solutions and organizational framework based on legal rules. The purpose of this study is to present how can we use Information and Communication Technology (ICT) systemic tools in a new model of patient-oriented care, improving the effectiveness of healthcare for patients with chronic diseases. The study material is the long-term process of healthcare for patients with chronic illness. Basing on the knowledge of the whole circumstances of patient's ecosystem and his needs allow us to build a new ICT model of long term care. The method used is construction, modeling and constant improvement the efficient ICT layer for the patient-centered healthcare model. We present a new constructive approach to systemic process how to use ICT for information management in healthcare system for chronic disease patient. The use of ICT tools in the model for chronic disease can improve all aspects of data management and communication, and the effectiveness of long-term complex healthcare. In conclusion: ICT based model of healthcare can be constructed basing on the interactions of ecosystem's functional parts through information feedback and the provision of services and models as well as the knowledge of the patient itself. Systematic approach to the model of long term healthcare assisted functionally by ICT tools and data management methods will increase the effectiveness of patient care and organizational efficiency.

  2. Integrating Social impacts on Health and Health-Care Systems in Systemic Seismic Vulnerability Analysis

    NASA Astrophysics Data System (ADS)

    Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.

    2012-04-01

    This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to

  3. Effects of an incinerator project on a healthcare-waste management system.

    PubMed

    Khammaneechan, Patthanasak; Okanurak, Kamolnetr; Sithisarankul, Pornchai; Tantrakarnapa, Kraichat; Norramit, Poonsup

    2011-10-01

    This evaluative research study aimed to assess the effects of the central healthcare incinerator project on waste management in Yala Province. The study data were collected twice: at baseline and during the operational phase. A combination of structured interview and observation were used during data collection. The study covered 127 healthcare facilities: government hospitals, healthcare centres, and private clinics. The results showed 63% of healthcare risk waste (HCRW) handlers attended the HCRW management training. Improvements in each stage of the HCRW management system were observed in all groups of facilities. The total cost of the HCRW management system did not change, however; the costs for hospitals decreased, whereas those for clinics increased significantly. It was concluded that the central healthcare waste incinerator project positively affected HCRW management in the area, although the costs of management might increase for a particular group. However, the benefits of changing to a more appropriately managed HCRW system will outweigh the increased costs.

  4. Modelling healthcare systems with phase-type distributions.

    PubMed

    Fackrell, Mark

    2009-03-01

    Phase-type distributions constitute a very versatile class of distributions. They have been used in a wide range of stochastic modelling applications in areas as diverse as telecommunications, finance, biostatistics, queueing theory, drug kinetics, and survival analysis. Their use in modelling systems in the healthcare industry, however, has so far been limited. In this paper we introduce phase-type distributions, give a survey of where they have been used in the healthcare industry, and propose some ideas on how they could be further utilized.

  5. Caring letters for suicide prevention: implementation of a multi-site randomized clinical trial in the U.S. military and Veteran Affairs healthcare systems.

    PubMed

    Luxton, David D; Thomas, Elissa K; Chipps, Joan; Relova, Rona M; Brown, Daphne; McLay, Robert; Lee, Tina T; Nakama, Helenna; Smolenski, Derek J

    2014-03-01

    Caring letters is a suicide prevention intervention that entails the sending of brief messages that espouse caring concern to patients following discharge from treatment. First tested more than four decades ago, this intervention is one of the only interventions shown in a randomized controlled trial to reduce suicide mortality rates. Due to elevated suicide risk among patients following psychiatric hospitalization and the steady increase in suicide rates among the U.S. military personnel, it is imperative to test interventions that may help prevent suicide among high-risk military personnel and veterans. This paper describes the design, methods, study protocol, and regulatory implementation processes for a multi-site randomized controlled trial that aims to evaluate the effectiveness of a caring emails intervention for suicide prevention in the military and VA healthcare systems. The primary outcome is suicide mortality rates to be determined 24 months post-discharge from index hospital stay. Healthcare re-utilization rates will also be evaluated and comprehensive data will be collected regarding suicide risk factors. Recommendations for navigating the military and VA research regulatory processes and implementing a multi-site clinical trial at military and VA hospitals are discussed. Published by Elsevier Inc.

  6. Enhancing security and improving interoperability in healthcare information systems.

    PubMed

    Gritzalis, D A

    1998-01-01

    Security is a key issue in healthcare information systems, since most aspects of security become of considerable or even critical importance when handling healthcare information. In addition, the intense need for information exchange has revealed interoperability of systems and applications as another key issue. Standardization can play an important role towards both these issues. In this paper, relevant standardization activities are briefly presented, and existing and emerging healthcare information security standards are identified and critically analysed. The analysis is based on a framework which has been developed for this reason. Therefore, the identification of gaps and inconsistencies in current standardization, the description of the conflicts of standards with legislation, and the analysis of implications of these standards to user organizations, are the main results of this paper.

  7. An Attribute Based Access Control Framework for Healthcare System

    NASA Astrophysics Data System (ADS)

    Afshar, Majid; Samet, Saeed; Hu, Ting

    2018-01-01

    Nowadays, access control is an indispensable part of the Personal Health Record and supplies for its confidentiality by enforcing policies and rules to ensure that only authorized users gain access to requested resources in the system. In other words, the access control means protecting patient privacy in healthcare systems. Attribute-Based Access Control (ABAC) is a new access control model that can be used instead of other traditional types of access control such as Discretionary Access Control, Mandatory Access Control, and Role-Based Access Control. During last five years ABAC has shown some applications in both recent academic fields and industry purposes. ABAC by using user’s attributes and resources, makes a decision according to an access request. In this paper, we propose an ABAC framework for healthcare system. We use the engine of ABAC for rendering and enforcing healthcare policies. Moreover, we handle emergency situations in this framework.

  8. The tidal waves of connected health devices with healthcare applications: consequences on privacy and care management in European healthcare systems.

    PubMed

    Allaert, Francois-André; Mazen, Noël-Jean; Legrand, Louis; Quantin, Catherine

    2017-01-17

    The market for Connected Health Devices (CHD) with healthcare applications is growing fast and should be worth several billion euros in turnover in the coming years. Their development will completely transform the organisation of our healthcare system, profoundly change the way patients are managed and revolutionizes disease prevention. The CHD with healthcare applications is a tidal wave that has societal impact calling into question the privacy of patients' personal and healthcare information and its protection in secure systems. Rather than trying to stop the use of CHD, we must channel the wave by clearly examining the advantages versus the risks and threats to the patients, and find counter-measures for implementation. The main difficulty is channeling the wave in a way that is acceptable to CHD developers who otherwise will bypass the rules, even if they can be sued for it. Therefore, it appears necessary to implement guidelines that can be used by all developers, defining the minimum requirement for assuring the security of patient privacy and healthcare management. In European Healthcare Systems, there is an imperative need for establishing security guidelines that CHD producers could use to ensure compliance, so that patient privacy and healthcare management is safeguarded. The aim would be to implement the guidelines a posteriori rather than a priori control so as not to hamper innovation.

  9. Software engineering principles applied to large healthcare information systems--a case report.

    PubMed

    Nardon, Fabiane Bizinella; de A Moura, Lincoln

    2007-01-01

    São Paulo is the largest city in Brazil and one of the largest cities in the world. In 2004, São Paulo City Department of Health decided to implement a Healthcare Information System to support managing healthcare services and provide an ambulatory health record. The resulting information system is one of the largest public healthcare information systems ever built, with more than 2 million lines of code. Although statistics shows that most software projects fail, and the risks for the São Paulo initiative were enormous, the information system was completed on-time and on-budget. In this paper, we discuss the software engineering principles adopted that allowed to accomplish that project's goals, hoping that sharing the experience of this project will help other healthcare information systems initiatives to succeed.

  10. Architecture and implementation for a system enabling smartphones to access smart card based healthcare records.

    PubMed

    Karampelas, Vasilios; Pallikarakis, Nicholas; Mantas, John

    2013-01-01

    The healthcare researchers', academics' and practitioners' interest concerning the development of Healthcare Information Systems has been on a steady rise for the last decades. Fueling this steady rise has been the healthcare professional need of quality information, in every healthcare provision incident, whenever and wherever this incident may take place. In order to address this need a truly mobile health care system is required, one that will be able to provide a healthcare provider with accurate patient-related information regardless of the time and place that healthcare is provided. In order to fulfill this role the present study proposes the architecture for a Healthcare Smartcard system, which provides authenticated healthcare professionals with remote mobile access to a Patient's Healthcare Record, through their Smartphone. Furthermore the research proceeds to develop a working prototype system.

  11. 48 CFR 852.203-71 - Display of Department of Veterans Affairs hotline poster.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Veterans Affairs hotline poster. 852.203-71 Section 852.203-71 Federal Acquisition Regulations System... Provisions and Clauses 852.203-71 Display of Department of Veterans Affairs hotline poster. As prescribed in 803.7001, insert the following clause: Display of Department of Veterans Affairs Hotline Poster (DEC...

  12. 48 CFR 852.203-71 - Display of Department of Veterans Affairs hotline poster.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Veterans Affairs hotline poster. 852.203-71 Section 852.203-71 Federal Acquisition Regulations System... Provisions and Clauses 852.203-71 Display of Department of Veterans Affairs hotline poster. As prescribed in 803.7001, insert the following clause: Display of Department of Veterans Affairs Hotline Poster (DEC...

  13. 48 CFR 852.203-71 - Display of Department of Veterans Affairs hotline poster.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Veterans Affairs hotline poster. 852.203-71 Section 852.203-71 Federal Acquisition Regulations System... Provisions and Clauses 852.203-71 Display of Department of Veterans Affairs hotline poster. As prescribed in 803.7001, insert the following clause: Display of Department of Veterans Affairs Hotline Poster (DEC...

  14. 48 CFR 852.203-71 - Display of Department of Veterans Affairs hotline poster.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Veterans Affairs hotline poster. 852.203-71 Section 852.203-71 Federal Acquisition Regulations System... Provisions and Clauses 852.203-71 Display of Department of Veterans Affairs hotline poster. As prescribed in 803.7001, insert the following clause: Display of Department of Veterans Affairs Hotline Poster (DEC...

  15. 48 CFR 852.203-71 - Display of Department of Veterans Affairs hotline poster.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Veterans Affairs hotline poster. 852.203-71 Section 852.203-71 Federal Acquisition Regulations System... Provisions and Clauses 852.203-71 Display of Department of Veterans Affairs hotline poster. As prescribed in 803.7001, insert the following clause: Display of Department of Veterans Affairs Hotline Poster (DEC...

  16. Interorganisational Integration: Healthcare Professionals’ Perspectives on Barriers and Facilitators within the Danish Healthcare System

    PubMed Central

    Godtfredsen, Nina Skavlan; Frølich, Anne

    2016-01-01

    Introduction: Despite many initiatives to improve coordination of patient pathways and intersectoral cooperation, Danish health care is still fragmented, lacking intra- and interorganisational integration. This study explores barriers to and facilitators of interorganisational integration as perceived by healthcare professionals caring for patients with chronic obstructive pulmonary disease within the Danish healthcare system. Methods: Seven focus groups were conducted in January through July 2014 with 21 informants from general practice, local healthcare centres and a pulmonary department at a university hospital in the Capital Region of Denmark. Results and discussion: Our results can be grouped into five influencing areas for interorganisational integration: communication/information transfer, committed leadership, patient engagement, the role and competencies of the general practitioner and organisational culture. Proposed solutions to barriers in each area hold the potential to improve care integration as experienced by individuals responsible for supporting and facilitating it. Barriers and facilitators to integrating care relate to clinical, professional, functional and normative integration. Especially, clinical, functional and normative integration seems fundamental to developing integrated care in practice from the perspective of healthcare professionals. PMID:27616948

  17. On-Location Public Affairs Reach-Back System

    DTIC Science & Technology

    2017-03-01

    benefit of this study was to provide a required capability to Commander Naval Air Forces Atlantic (CNAL) Public Affairs Office (PAO). The required...of research are possible, including, but not limited to • Feasibility studies and cost - benefit analyses of upgrading a given ship to MEO from GEO...identified by Stephens and Adams (2016). • A cost - benefit analysis of providing MEO SATCOM to a geographical area (e.g., CENTCOM area of responsibility

  18. Student Affairs Committee.

    ERIC Educational Resources Information Center

    Goodale, Thomas G.

    1984-01-01

    The agenda, structure, and responsibilities of a board of trustees standing committee--the campus student affairs committee--are discussed. The size, selection, and rotation of student affairs committee members will vary with the traditions and policies of the individual institution. If possible, the committee should include students among its…

  19. Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil

    PubMed Central

    Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; Ferreira da Silva, Maria Rejane; Unger, Jean-Pierre; Vázquez, María-Luisa

    2016-01-01

    Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel’ perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive–interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives

  20. CMOS Enabled Microfluidic Systems for Healthcare Based Applications.

    PubMed

    Khan, Sherjeel M; Gumus, Abdurrahman; Nassar, Joanna M; Hussain, Muhammad M

    2018-04-01

    With the increased global population, it is more important than ever to expand accessibility to affordable personalized healthcare. In this context, a seamless integration of microfluidic technology for bioanalysis and drug delivery and complementary metal oxide semiconductor (CMOS) technology enabled data-management circuitry is critical. Therefore, here, the fundamentals, integration aspects, and applications of CMOS-enabled microfluidic systems for affordable personalized healthcare systems are presented. Critical components, like sensors, actuators, and their fabrication and packaging, are discussed and reviewed in detail. With the emergence of the Internet-of-Things and the upcoming Internet-of-Everything for a people-process-data-device connected world, now is the time to take CMOS-enabled microfluidics technology to as many people as possible. There is enormous potential for microfluidic technologies in affordable healthcare for everyone, and CMOS technology will play a major role in making that happen. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  1. The orthopaedist's role in healthcare system governance.

    PubMed

    Probe, Robert A

    2013-06-01

    Historically, physicians as participants in healthcare governance were shunned because of perceived potential for conflict of interest. This maxim is being revisited as health systems begin to appreciate the value presented by physician leaders. This overview of the orthopaedist's role in healthcare governance will be addressed in three sections: first to identify the need for change in American healthcare, second to examine the role that physicians should play in governing over this inevitable change, and third to outline strategies for effective participation for those physicians wishing to play a role in healthcare governance. The PubMed data set was queried applying the search commands "governance AND (healthcare OR hospital) AND (doctor OR physician OR surgeon)" for the time period 1969 to 2012. In addition, the bibliographies of relevant articles were reviewed. This search strategy returned 404 titles. Abstract and article review identified 19 relevant to the topic. Bibliographic review identified five more articles of relevance forming the foundation for this review. The delivery of American health care will require change to face current economic realities. Organizations that embrace this change guided by the insight of physician governors are well positioned to recognize the simultaneous improvement in value and quality. Although few physicians are formally trained for these roles, multiple paths to becoming effective governors are available. In this environment of rapid change in healthcare delivery, the medical insight of physician leadership will prove invaluable. Governing bodies should reach out to talented physicians and administratively talented physicians should rise to this challenge.

  2. Understanding healthcare innovation systems: the Stockholm region case.

    PubMed

    Larisch, Lisa-Marie; Amer-Wåhlin, Isis; Hidefjäll, Patrik

    2016-11-21

    Purpose There is an increasing interest in understanding how innovation processes can address current challenges in healthcare. The purpose of this paper is to analyze the wider socio-economic context and conditions for such innovation processes in the Stockholm region, using the functional dynamics approach to innovation systems (ISs). Design/methodology/approach The analysis is based on triangulation using data from 16 in-depth interviews, two workshops, and additional documents. Using the functional dynamics approach, critical structural and functional components of the healthcare IS were analyzed. Findings The analysis revealed several mechanisms blocking innovation processes such as fragmentation, lack of clear leadership, as well as insufficient involvement of patients and healthcare professionals. Furthermore, innovation is expected to occur linearly as a result of research. Restrictive rules for collaboration with industry, reimbursement, and procurement mechanisms limit entrepreneurial experimentation, commercialization, and spread of innovations. Research limitations/implications In this study, the authors analyzed how certain functions of the functional dynamics approach to ISs related to each other. The authors grouped knowledge creation, resource mobilization, and legitimacy as they jointly constitute conditions for needs articulation and entrepreneurial experimentation. The economic effects of entrepreneurial experimentation and needs articulation are mainly determined by the stage of market formation and existence of positive externalities. Social implications Stronger user involvement; a joint innovation strategy for healthcare, academia, and industry; and institutional reform are necessary to remove blocking mechanisms that today prevent innovation from occurring. Originality/value This study is the first to provide an analysis of the system of innovation in healthcare using a functional dynamics approach, which has evolved as a tool for public

  3. THE DESIGN OF PERFORMANCE MONITORING SYSTEMS IN HEALTHCARE ORGANIZATIONS: A STAKEHOLDER PERSPECTIVE.

    PubMed

    Rouhana, Rima E; Van Caillie, Didier

    2016-01-01

    Monitoring hospitals performance is evolving over time in search of more efficiency by integrating additional levels of care, reducing costs and keeping staff up-to-date. To fulfill these three potentially divergent aspects and to monitor performance, healthcare administrators are using dissimilar management control tools. To explain why, we suggest to go beyond traditional contingent factors to assess the role of the different stakeholders that are at the heart of any healthcare organization. We rely first on seminal studies to appraise the role of the main healthcare players and their influence on some organizational attributes. We then consider the managerial awareness and the perception of a suitable management system to promote a strategy-focused organization. Our methodology is based on a qualitative approach of twenty-two case studies, led in two heterogeneous environments (Belgium and Lebanon), comparing the managerial choice of a management system within three different healthcare organizational structures. Our findings allow us to illustrate, for each healthcare player, his positioning within the healthcare systems. Thus, we define how his role, perception and responsiveness manipulate the organization's internal climate and shape the design of the performance monitoring systems. In particular, we highlight the managerial role and influence on the choice of an adequate management system.

  4. [Current legislation in the healthcare system 2015/2016].

    PubMed

    Martenstein, I; Wienke, A

    2016-05-01

    The energy of the legislator in the healthcare system was barely stoppable in 2015. Many new laws have been brought into force and legal initiatives have also been implemented. The Hospital Structure Act, the Treatment Enhancement Act, amendments of the official medical fee schedules for physicians, the Prevention Act, the E-Health Act, the Anti-corruption Act, the hospital admission guidelines and amendments of the model specialty training regulations are just some of the essential alterations that lie ahead of the medical community. This article gives a review of the most important new legislative regulations in the healthcare system and presents the fundamental consequences for the practice.

  5. [Current legislation in the healthcare system 2015/2016].

    PubMed

    Martenstein, I; Wienke, A

    2016-03-01

    The energy of the legislator in the healthcare system was barely stoppable in 2015. Many new laws have been brought into force and legal initiatives have also been implemented. The Hospital Structure Act, the Treatment Enhancement Act, amendments of the official medical fee schedules for physicians, the Prevention Act, the E-Health Act, the Anti-corruption Act, the hospital admission guidelines and amendments of the model specialty training regulations are just some of the essential alterations that lie ahead of the medical community. This article gives a review of the most important new legislative regulations in the healthcare system and presents the fundamental consequences for the practice.

  6. Health-care process improvement decisions: a systems perspective.

    PubMed

    Walley, Paul; Silvester, Kate; Mountford, Shaun

    2006-01-01

    The paper seeks to investigate decision-making processes within hospital improvement activity, to understand how performance measurement systems influence decisions and potentially lead to unsuccessful or unsustainable process changes. A longitudinal study over a 33-month period investigates key events, decisions and outcomes at one medium-sized hospital in the UK. Process improvement events are monitored using process control methods and by direct observation. The authors took a systems perspective of the health-care processes, ensuring that the impacts of decisions across the health-care supply chain were appropriately interpreted. The research uncovers the ways in which measurement systems disguise failed decisions and encourage managers to take a low-risk approach of "symptomatic relief" when trying to improve performance metrics. This prevents many managers from trying higher risk, sustainable process improvement changes. The behaviour of the health-care system is not understood by many managers and this leads to poor analysis of problem situations. Measurement using time-series methodologies, such as statistical process control are vital for a better understanding of the systems impact of changes. Senior managers must also be aware of the behavioural influence of similar performance measurement systems that discourage sustainable improvement. There is a risk that such experiences will tarnish the reputation of performance management as a discipline. Recommends process control measures as a way of creating an organization memory of how decisions affect performance--something that is currently lacking.

  7. Hospital Systems, Convenient Care Strategies, and Healthcare Reform.

    PubMed

    Kaissi, Amer; Shay, Patrick; Roscoe, Christina

    2016-01-01

    Retail clinics (RCs) and urgent care centers (UCCs) are convenient care models that emerged on the healthcare scene in the past 10 to 15 years. Characterized as disruptive innovations, these models of healthcare delivery seem to follow a slightly different path from each other. Hospital systems, the very organizations that were originally threatened by convenient care models, are developing them and partnering with existing models. We posit that legislative changes such as the Affordable Care Act created challenges for hospital systems that accelerated their adoption of these models. In this study, we analyze 117 hospital systems in six states and report on their convenient care strategies. Our data suggest that UCCs are more prevalent than RCs among hospital systems, and that large and unexplained state-by-state variations exist in the adoption of these strategies. We also postulate about the future role of hospital systems in leading these innovations.

  8. Office Automation in Student Affairs.

    ERIC Educational Resources Information Center

    Johnson, Sharon L.; Hamrick, Florence A.

    1987-01-01

    Offers recommendations to assist in introducing or expanding computer assistance in student affairs. Describes need for automation and considers areas of choosing hardware and software, funding and competitive bidding, installation and training, and system management. Cites greater efficiency in handling tasks and data and increased levels of…

  9. E-health and healthcare enterprise information system leveraging service-oriented architecture.

    PubMed

    Hsieh, Sung-Huai; Hsieh, Sheau-Ling; Cheng, Po-Hsun; Lai, Feipei

    2012-04-01

    To present the successful experiences of an integrated, collaborative, distributed, large-scale enterprise healthcare information system over a wired and wireless infrastructure in National Taiwan University Hospital (NTUH). In order to smoothly and sequentially transfer from the complex relations among the old (legacy) systems to the new-generation enterprise healthcare information system, we adopted the multitier framework based on service-oriented architecture to integrate the heterogeneous systems as well as to interoperate among many other components and multiple databases. We also present mechanisms of a logical layer reusability approach and data (message) exchange flow via Health Level 7 (HL7) middleware, DICOM standard, and the Integrating the Healthcare Enterprise workflow. The architecture and protocols of the NTUH enterprise healthcare information system, especially in the Inpatient Information System (IIS), are discussed in detail. The NTUH Inpatient Healthcare Information System is designed and deployed on service-oriented architecture middleware frameworks. The mechanisms of integration as well as interoperability among the components and the multiple databases apply the HL7 standards for data exchanges, which are embedded in XML formats, and Microsoft .NET Web services to integrate heterogeneous platforms. The preliminary performance of the current operation IIS is evaluated and analyzed to verify the efficiency and effectiveness of the designed architecture; it shows reliability and robustness in the highly demanding traffic environment of NTUH. The newly developed NTUH IIS provides an open and flexible environment not only to share medical information easily among other branch hospitals, but also to reduce the cost of maintenance. The HL7 message standard is widely adopted to cover all data exchanges in the system. All services are independent modules that enable the system to be deployed and configured to the highest degree of flexibility

  10. Flexible solution for interoperable cloud healthcare systems.

    PubMed

    Vida, Mihaela Marcella; Lupşe, Oana Sorina; Stoicu-Tivadar, Lăcrămioara; Bernad, Elena

    2012-01-01

    It is extremely important for the healthcare domain to have a standardized communication because will improve the quality of information and in the end the resulting benefits will improve the quality of patients' life. The standards proposed to be used are: HL7 CDA and CCD. For a better access to the medical data a solution based on cloud computing (CC) is investigated. CC is a technology that supports flexibility, seamless care, and reduced costs of the medical act. To ensure interoperability between healthcare information systems a solution creating a Web Custom Control is presented. The control shows the database tables and fields used to configure the two standards. This control will facilitate the work of the medical staff and hospital administrators, because they can configure the local system easily and prepare it for communication with other systems. The resulted information will have a higher quality and will provide knowledge that will support better patient management and diagnosis.

  11. Student Affairs and Academic Affairs Collaborations in the Community College Setting

    ERIC Educational Resources Information Center

    Gulley, Needham Yancey; Mullendore, Richard H.

    2014-01-01

    The relationship between academic affairs and student affairs units in higher education settings has traditionally and historically been troubled by the divergent understandings of each other's institutional role and the systematic division of labor between the two. However, for a variety of reasons, not the least of which is a desire to…

  12. Establishing values-based leadership and value systems in healthcare organizations.

    PubMed

    Graber, David R; Kilpatrick, Anne Osborne

    2008-01-01

    The importance of values in organizations is often discussed in management literature. Possessing strong or inspiring values is increasingly considered to be a key quality of successful leaders. Another common theme is that organizational values contribute to the culture and ultimate success of organizations. These conceptions or expectations are clearly applicable to healthcare organizations in the United States. However, healthcare organizations have unique structures and are subject to societal expectations that must be accommodated within an organizational values system. This article describes theoretical literature on organizational values. Cultural and religious influences on Americans and how they may influence expectations from healthcare providers are discussed. Organizational cultures and the training and socialization of the numerous professional groups in healthcare also add to the considerable heterogeneity of value systems within healthcare organizations. These contribute to another challenge confronting healthcare managers--competing or conflicting values within a unit or the entire organization. Organizations often fail to reward members who uphold or enact the organization's values, which can lead to lack of motivation and commitment to the organization. Four key elements of values-based leadership are presented for healthcare managers who seek to develop as values-based leaders. 1) Recognize your personal and professional values, 2) Determine what you expect from the larger organization and what you can implement within your sphere of influence, 3) Understand and incorporate the values of internal stakeholders, and 4) Commit to values-based leadership.

  13. Mobile healthcare applications: system design review, critical issues and challenges.

    PubMed

    Baig, Mirza Mansoor; GholamHosseini, Hamid; Connolly, Martin J

    2015-03-01

    Mobile phones are becoming increasingly important in monitoring and delivery of healthcare interventions. They are often considered as pocket computers, due to their advanced computing features, enhanced preferences and diverse capabilities. Their sophisticated sensors and complex software applications make the mobile healthcare (m-health) based applications more feasible and innovative. In a number of scenarios user-friendliness, convenience and effectiveness of these systems have been acknowledged by both patients as well as healthcare providers. M-health technology employs advanced concepts and techniques from multidisciplinary fields of electrical engineering, computer science, biomedical engineering and medicine which benefit the innovations of these fields towards healthcare systems. This paper deals with two important aspects of current mobile phone based sensor applications in healthcare. Firstly, critical review of advanced applications such as; vital sign monitoring, blood glucose monitoring and in-built camera based smartphone sensor applications. Secondly, investigating challenges and critical issues related to the use of smartphones in healthcare including; reliability, efficiency, mobile phone platform variability, cost effectiveness, energy usage, user interface, quality of medical data, and security and privacy. It was found that the mobile based applications have been widely developed in recent years with fast growing deployment by healthcare professionals and patients. However, despite the advantages of smartphones in patient monitoring, education, and management there are some critical issues and challenges related to security and privacy of data, acceptability, reliability and cost that need to be addressed.

  14. [Public health stewardship and governance regarding the Colombian healthcare system, 2012-2013].

    PubMed

    Roth-Deubel, André N; Molina-Marín, Gloria

    2013-01-01

    Analysing decision-making concerning public health issues regarding the Colombian healthcare system from a market economy-based approach. This study involved applying Glaser and Strauss's grounded theory in six Colombian cities during 2012: Bogotá, Barranquilla, Bucaramanga, Leticia, Medellin and Pasto. 120 individual interviews were conducted with professionals involved in decision-making, running public healthcare programmes and making policy within public and private institutions. Fourteen focus groups were held with community organisation leaders. The findings suggested national and municipal health authorities' weak stewardship and ineffective governance regarding public healthcare policy and programmes, related to a lack of staff trained in public health management issues. In turn, this was related to political parties' interference and private insurers' particular interests and the structural fragmentation of functions and actors within the health system, thereby limiting public health development. A new axiology is necessary for achieving effective governance (I.e. cooperation between Colombian Healthcare Social Security System actors) to overcome current incompetence and financial self-interest predominating within the Colombian healthcare system.

  15. Korean Affairs Report, Number 295

    DTIC Science & Technology

    1983-07-18

    Third World was followed by a keynote report of Carlos Perez Herrera , foreign affairs advisor to the Panamanian president. The head of the Korean...first of all a vigorous struggle to estab- lish an ideological system of chuche in its organisations, regarding this as its cardinal task, thus

  16. A systems-based partnership learning model for strengthening primary healthcare

    PubMed Central

    2013-01-01

    Background Strengthening primary healthcare systems is vital to improving health outcomes and reducing inequity. However, there are few tools and models available in published literature showing how primary care system strengthening can be achieved on a large scale. Challenges to strengthening primary healthcare (PHC) systems include the dispersion, diversity and relative independence of primary care providers; the scope and complexity of PHC; limited infrastructure available to support population health approaches; and the generally poor and fragmented state of PHC information systems. Drawing on concepts of comprehensive PHC, integrated quality improvement (IQI) methods, system-based research networks, and system-based participatory action research, we describe a learning model for strengthening PHC that addresses these challenges. We describe the evolution of this model within the Australian Aboriginal and Torres Strait Islander primary healthcare context, successes and challenges in its application, and key issues for further research. Discussion IQI approaches combined with system-based participatory action research and system-based research networks offer potential to support program implementation and ongoing learning across a wide scope of primary healthcare practice and on a large scale. The Partnership Learning Model (PLM) can be seen as an integrated model for large-scale knowledge translation across the scope of priority aspects of PHC. With appropriate engagement of relevant stakeholders, the model may be applicable to a wide range of settings. In IQI, and in the PLM specifically, there is a clear role for research in contributing to refining and evaluating existing tools and processes, and in developing and trialling innovations. Achieving an appropriate balance between funding IQI activity as part of routine service delivery and funding IQI related research will be vital to developing and sustaining this type of PLM. Summary This paper draws together

  17. Asan medical information system for healthcare quality improvement.

    PubMed

    Ryu, Hyeon Jeong; Kim, Woo Sung; Lee, Jae Ho; Min, Sung Woo; Kim, Sun Ja; Lee, Yong Su; Lee, Young Ha; Nam, Sang Woo; Eo, Gi Seung; Seo, Sook Gyoung; Nam, Mi Hyun

    2010-09-01

    This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. AMIS CONSISTED OF SEVERAL DISTINCTIVE SYSTEMS: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.

  18. Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil.

    PubMed

    Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; Ferreira da Silva, Maria Rejane; Unger, Jean-Pierre; Vázquez, María-Luisa

    2016-07-01

    Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen

  19. Applying analytic hierarchy process to assess healthcare-oriented cloud computing service systems.

    PubMed

    Liao, Wen-Hwa; Qiu, Wan-Li

    2016-01-01

    Numerous differences exist between the healthcare industry and other industries. Difficulties in the business operation of the healthcare industry have continually increased because of the volatility and importance of health care, changes to and requirements of health insurance policies, and the statuses of healthcare providers, which are typically considered not-for-profit organizations. Moreover, because of the financial risks associated with constant changes in healthcare payment methods and constantly evolving information technology, healthcare organizations must continually adjust their business operation objectives; therefore, cloud computing presents both a challenge and an opportunity. As a response to aging populations and the prevalence of the Internet in fast-paced contemporary societies, cloud computing can be used to facilitate the task of balancing the quality and costs of health care. To evaluate cloud computing service systems for use in health care, providing decision makers with a comprehensive assessment method for prioritizing decision-making factors is highly beneficial. Hence, this study applied the analytic hierarchy process, compared items related to cloud computing and health care, executed a questionnaire survey, and then classified the critical factors influencing healthcare cloud computing service systems on the basis of statistical analyses of the questionnaire results. The results indicate that the primary factor affecting the design or implementation of optimal cloud computing healthcare service systems is cost effectiveness, with the secondary factors being practical considerations such as software design and system architecture.

  20. Teratology Public Affairs Committee position paper: maternal obesity and pregnancy.

    PubMed

    Scialli, Anthony R

    2006-02-01

    Compared to normal-weight women, obese women have an increased risk of infertility and pregnancy complications. The most consistently described pregnancy complications are hypertensive disorders, gestational diabetes mellitus, thromboembolic events, and cesarean section. Fetal and neonatal complications may include congenital malformations, macrosomia, and shoulder dystocia. The literature suggests that women with a body mass index (BMI) >or=30 have approximately double the risk of having a child with a neural tube defect (NTD) compared to normal-weight women, and the increased risk associated with higher maternal body weight does not appear to be modified by folic acid supplementation. The Public Affairs Committee of the Teratology Society supports the public health initiatives identified by the U.S. Food and Drug Administration in 2004 and the research initiatives identified by the National Institutes of Health in 2004. The Public Affairs Committee recommends that clinicians counsel women about appropriate caloric intake and exercise and that health-care providers educate parents about appropriate childhood nutrition. Breast-feeding should be encouraged based on evidence of a protective effect against childhood obesity, as well as other health advantages. Birth Defects Research (Part A), 2006. (c) 2006 Wiley-Liss, Inc.

  1. Is public health ready to participate in the transformation of the healthcare system?

    PubMed

    Millar, John; Bruce, Ted; Cheng, Siu Mee; Masse, Richard; McKeown, David

    2013-01-01

    The healthcare system in Canada is undergoing significant transformation in response to three major interrelated pressures: the overall burden of illness is rising, patients are getting poor quality of care and healthcare costs are inexorably rising. One idea to guide this change is to transform the primary care system into a community-based primary healthcare (CBPH) system. This paper discusses, in particular, the readiness of public health to participate in the transformation to a CBPH system. Copyright © 2013 Longwoods Publishing.

  2. Using ESB and BPEL for Evolving Healthcare Systems Towards Pervasive, Grid-Enabled SOA

    NASA Astrophysics Data System (ADS)

    Koufi, V.; Malamateniou, F.; Papakonstantinou, D.; Vassilacopoulos, G.

    Healthcare organizations often face the challenge of integrating diverse and geographically disparate information technology systems to respond to changing requirements and to exploit the capabilities of modern technologies. Hence, systems evolution, through modification and extension of the existing information technology infrastructure, becomes a necessity. Moreover, the availability of these systems at the point of care when needed is a vital issue for the quality of healthcare provided to patients. This chapter takes a process perspective of healthcare delivery within and across organizational boundaries and presents a disciplined approach for evolving healthcare systems towards a pervasive, grid-enabled service-oriented architecture using the enterprise system bus middleware technology for resolving integration issues, the business process execution language for supporting collaboration requirements and grid middleware technology for both addressing common SOA scalability requirements and complementing existing system functionality. In such an environment, appropriate security mechanisms must ensure authorized access to integrated healthcare services and data. To this end, a security framework addressing security aspects such as authorization and access control is also presented.

  3. Improvement of emotional healthcare system with stress detection from ECG signal.

    PubMed

    Tivatansakul, S; Ohkura, M

    2015-01-01

    Our emotional healthcare system is designed to cope with users' negative emotions in daily life. To make the system more intelligent, we integrated emotion recognition by facial expression to provide appropriate services based on user's current emotional state. Our emotion recognition by facial expression has confusion issue to recognize some positive, neutral and negative emotions that make the emotional healthcare system provide a relaxation service even though users don't have negative emotions. Therefore, to increase the effectiveness of the system to provide the relaxation service, we integrate stress detection from ECG signal. The stress detection might be able to address the confusion issue of emotion recognition by facial expression to provide the service. Indeed, our results show that integration of stress detection increases the effectiveness and efficiency of the emotional healthcare system to provide services.

  4. Discourse analysis: A useful methodology for health-care system researches

    PubMed Central

    Yazdannik, Ahmadreza; Yousefy, Alireza; Mohammadi, Sepideh

    2017-01-01

    Discourse analysis (DA) is an interdisciplinary field of inquiry and becoming an increasingly popular research strategy for researchers in various disciplines which has been little employed by health-care researchers. The methodology involves a focus on the sociocultural and political context in which text and talk occur. DA adds a linguistic approach to an understanding of the relationship between language and ideology, exploring the way in which theories of reality and relations of power are encoded in such aspects as the syntax, style, and rhetorical devices used in texts. DA is a useful and productive qualitative methodology but has been underutilized within health-care system research. Without a clear understanding of discourse theory and DA it is difficult to comprehend important research findings and impossible to use DA as a research strategy. To redress this deficiency, in this article, represents an introduction to concepts of discourse and DA, DA history, Philosophical background, DA types and analysis strategy. Finally, we discuss how affect to the ideological dimension of such phenomena discourse in health-care system, health beliefs and intra-disciplinary relationship in health-care system. PMID:29296612

  5. Discourse analysis: A useful methodology for health-care system researches.

    PubMed

    Yazdannik, Ahmadreza; Yousefy, Alireza; Mohammadi, Sepideh

    2017-01-01

    Discourse analysis (DA) is an interdisciplinary field of inquiry and becoming an increasingly popular research strategy for researchers in various disciplines which has been little employed by health-care researchers. The methodology involves a focus on the sociocultural and political context in which text and talk occur. DA adds a linguistic approach to an understanding of the relationship between language and ideology, exploring the way in which theories of reality and relations of power are encoded in such aspects as the syntax, style, and rhetorical devices used in texts. DA is a useful and productive qualitative methodology but has been underutilized within health-care system research. Without a clear understanding of discourse theory and DA it is difficult to comprehend important research findings and impossible to use DA as a research strategy. To redress this deficiency, in this article, represents an introduction to concepts of discourse and DA, DA history, Philosophical background, DA types and analysis strategy. Finally, we discuss how affect to the ideological dimension of such phenomena discourse in health-care system, health beliefs and intra-disciplinary relationship in health-care system.

  6. New context and old challenges in the healthcare system.

    PubMed

    Peiró, Manel; Barrubés, Joan

    2012-07-01

    The economic crisis cannot conceal the need for transformation of the National Health System. The financial difficulties of healthcare systems whose spending is growing at a faster rate than the economy have been well known for years. The development and diffusion of new technologies, increased use of health services, rising drug costs, inflation of prices, and the inefficiency of the system explain the new context. The challenges facing the healthcare system are not new: address the debt, improve funding, review the list of services, transform the governance of the system and provide the institutions with real management autonomy. The gravity of the economic situation can be an opportunity to carry out the long-awaited changes. Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  7. Professionalisation of Student Affairs Educators in China: History, Challenges, and Solutions

    ERIC Educational Resources Information Center

    Li, Youngshan; Fang, Yuanyuan

    2017-01-01

    Student affairs administration in Chinese universities is characterised by a dual-layer system of governance, with student affairs practitioners, i.e. advisors to students, being supervised by either central university administration or by affiliated colleges. In the last decade, government-oriented developments have achieved great success in…

  8. Forging a Frailty-Ready Healthcare System to Meet Population Ageing.

    PubMed

    Lim, Wee Shiong; Wong, Sweet Fun; Leong, Ian; Choo, Philip; Pang, Weng Sun

    2017-11-24

    The beginning of the 21st century has seen health systems worldwide struggling to deliver quality healthcare amidst challenges posed by ageing populations. The increasing prevalence of frailty with older age and accompanying complexities in physical, cognitive, social and psychological dimensions renders the present modus operandi of fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In line with the public health framework for action in the World Health Organization's World Health and Ageing Report, meeting these challenges will require a systemic reform of healthcare delivery that is integrated, patient-centric, team-based, and health-centered. These reforms can be achieved through building partnerships and relationships that engage, empower, and activate patients and their support systems. To meet the challenges of population ageing, Singapore has reorganised its public healthcare into regional healthcare systems (RHSs) aimed at improving population health and the experience of care, and reducing costs. This paper will describe initiatives within the RHS frameworks of the National Health Group (NHG) and the Alexandra Health System (AHS) to forge a frailty-ready healthcare system across the spectrum, which includes the well healthy ("living well"), the well unhealthy ("living with illness"), the unwell unhealthy ("living with frailty"), and the end-of-life (EoL) ("dying well"). For instance, the AHS has adopted a community-centered population health management strategy in older housing estates such as Yishun to build a geographically-based care ecosystem to support the self-management of chronic disease through projects such as "wellness kampungs" and "share-a-pot". A joint initiative by the Lien Foundation and Khoo Teck Puat Hospital aims to launch dementia-friendly communities across the island by building a network comprising community partners, businesses, and members of the public. At the National

  9. How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation.

    PubMed

    Bokhour, Barbara G; Fix, Gemmae M; Mueller, Nora M; Barker, Anna M; Lavela, Sherri L; Hill, Jennifer N; Solomon, Jeffrey L; Lukas, Carol VanDeusen

    2018-03-07

    Healthcare organizations increasingly are focused on providing care which is patient-centered rather than disease-focused. Yet little is known about how best to transform the culture of care in these organizations. We sought to understand key organizational factors for implementing patient-centered care cultural transformation through an examination of efforts in the US Department of Veterans Affairs. We conducted multi-day site visits at four US Department of Veterans Affairs medical centers designated as leaders in providing patient-centered care. We conducted qualitative semi-structured interviews with 108 employees (22 senior leaders, 42 middle managers, 37 front-line providers and 7 staff). Transcripts of audio recordings were analyzed using a priori codes based on the Consolidated Framework for Implementation Research. We used constant comparison analysis to synthesize codes into meaningful domains. Sites described actions taken to foster patient-centered care in seven domains: 1) leadership; 2) patient and family engagement; 3) staff engagement; 4) focus on innovations; 5) alignment of staff roles and priorities; 6) organizational structures and processes; 7) environment of care. Within each domain, we identified multi-faceted strategies for implementing change. These included efforts by all levels of organizational leaders who modeled patient-centered care in their interactions and fostered willingness to try novel approaches to care amongst staff. Alignment and integration of patient centered care within the organization, particularly surrounding roles, priorities and bureaucratic rules, remained major challenges. Transforming healthcare systems to focus on patient-centered care and better serve the "whole" patient is a complex endeavor. Efforts to transform healthcare culture require robust, multi-pronged efforts at all levels of the organization; leadership is only the beginning. Challenges remain for incorporating patient-centered approaches in the

  10. Access to the US Department of Veterans Affairs health system: self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom

    PubMed Central

    2013-01-01

    Background The U.S. Department of Veterans Affairs (VA) implemented the Polytrauma System of Care to meet the health care needs of military and veterans with multiple injuries returning from combat operations in Afghanistan and Iraq. Studies are needed to systematically assess barriers to use of comprehensive and exclusive VA healthcare services from the perspective of veterans with polytrauma and with other complex health outcomes following their service in Afghanistan and Iraq. These perspectives can inform policy with regard to the optimal delivery of care to returning veterans. Methods We studied combat veterans (n = 359) from two polytrauma rehabilitation centers using structured clinical interviews and qualitative open-ended questions, augmented with data collected from electronic health records. Our outcomes included several measures of exclusive utilization of VA care with our primary exposure as reported access barriers to care. Results Nearly two thirds of the veterans reported one or more barriers to their exclusive use of VA healthcare services. These barriers predicted differences in exclusive use of VA healthcare services. Experiencing any barriers doubled the returnees’ odds of not using VA exclusively, the geographic distance to VA barrier resulted in a 7 fold increase in the returnees odds of not using VA, and reporting a wait time barrier doubled the returnee’s odds of not using VA. There were no striking differences in access barriers for veterans with polytrauma compared to other returning veterans, suggesting the barriers may be uniform barriers that predict differences in using the VA exclusively for health care. Conclusions This study provides an initial description of utilization of VA polytrauma rehabilitation and other medical care for veteran returnees from all military services who were involved in combat operations in Afghanistan or Iraq. Our findings indicate that these veterans reported important stigmatization and barriers to

  11. Corruption in health-care systems and its effect on cancer care in Africa.

    PubMed

    Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan

    2015-08-01

    At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Using grey literature to prepare pharmacy students for an evolving healthcare delivery system.

    PubMed

    Happe, Laura E; Walker, Desiree'

    2013-05-13

    To assess the impact of using "grey literature" (information internally produced in print or electronic format by agencies such as hospitals, government, businesses, etc) rather than a textbook in a course on healthcare delivery systems on students' perception of the relevance of healthcare delivery system topics and their ability to identify credible sources of this information. A reading from the grey literature was identified and assigned to the students for each topic in the course. Pre- and post-course survey instruments were used for the assessment. Students reported healthcare delivery systems topics to be moderately relevant to the profession of pharmacy on both the pre- and post-course survey instruments. Students' knowledge of current and credible sources of information on healthcare delivery system topics significantly improved based on self-reports and scores on objective assessments (p<0.05). Assignment of grey literature in a course on healthcare delivery systems can be used to ensure that information in the pharmacy school curriculum is the most current and credible information available.

  13. The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association.

    PubMed

    Maddox, Thomas M; Albert, Nancy M; Borden, William B; Curtis, Lesley H; Ferguson, T Bruce; Kao, David P; Marcus, Gregory M; Peterson, Eric D; Redberg, Rita; Rumsfeld, John S; Shah, Nilay D; Tcheng, James E

    2017-04-04

    The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented. © 2017 American Heart Association, Inc.

  14. An Informatics Blueprint for Healthcare Quality Information Systems

    PubMed Central

    Niland, Joyce C.; Rouse, Layla; Stahl, Douglas C.

    2006-01-01

    There is a critical gap in our nation's ability to accurately measure and manage the quality of medical care. A robust healthcare quality information system (HQIS) has the potential to address this deficiency through the capture, codification, and analysis of information about patient treatments and related outcomes. Because non-technical issues often present the greatest challenges, this paper provides an overview of these socio-technical issues in building a successful HQIS, including the human, organizational, and knowledge management (KM) perspectives. Through an extensive literature review and direct experience in building a practical HQIS (the National Comprehensive Cancer Network Outcomes Research Database system), we have formulated an “informatics blueprint” to guide the development of such systems. While the blueprint was developed to facilitate healthcare quality information collection, management, analysis, and reporting, the concepts and advice provided may be extensible to the development of other types of clinical research information systems. PMID:16622161

  15. Canada's universal health-care system: achieving its potential.

    PubMed

    Martin, Danielle; Miller, Ashley P; Quesnel-Vallée, Amélie; Caron, Nadine R; Vissandjée, Bilkis; Marchildon, Gregory P

    2018-04-28

    Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care. Administration and service delivery are highly decentralised, although coverage is portable across the country. In the setting of geographical and population diversity, long waits for elective care demand the capacity and commitment to scale up effective and sustainable models of care delivery across the country. Profound health inequities experienced by Indigenous populations and some vulnerable groups also require coordinated action on the social determinants of health if these inequities are to be effectively addressed. Achievement of the high aspirations of Medicare's founders requires a renewal of the tripartite social contract between governments, health-care providers, and the public. Expansion of the publicly funded basket of services and coordinated effort to reduce variation in outcomes will hinge on more engaged roles for the federal government and the physician community than have existed in previous decades. Public engagement in system stewardship will also be crucial to achieve a high-quality system grounded in both evidence and the Canadian values of equity and solidarity. Copyright © 2018 Elsevier Ltd. All rights reserved.

  16. The impact of automating laboratory request forms on the quality of healthcare services.

    PubMed

    Dogether, Majed Al; Muallem, Yahya Al; Househ, Mowafa; Saddik, Basema; Khalifa, Mohamed

    In recent decades, healthcare organizations have undergone a significant transformation with the integration of Information and Communication Technologies within healthcare operations to improve healthcare services. Various technologies such as Hospital Information Systems (HIS), Electronic Health Records (EHR) and Laboratory Information Systems (LIS) have been incorporated into healthcare services. The aim of this study is to evaluate the completeness of outpatients' laboratory paper based request forms in comparison with a electronic laboratory request system. This study was carried out in the laboratory department at King Abdulaziz Medical City (KAMC), National Guard Health Affairs, Riyadh, Saudi Arabia. We used a sample size calculator for comparing two proportions. We estimated the sample size to be 228 for each group. Any laboratory requests including paper and electronic forms were included. We categorized the clarity of the forms into understandable, readable, and unclear. A total of 57 incomplete paper forms or 25% were identified as being incomplete. For electronic forms, there were no incomplete fields, as all fields were mandatory, therefore, rendering them complete. The total of understandable paper-based laboratory forms was 11.4%. Additionally, it was found that the total of readable was 33.8% and the total for unclear was 54.8%, while for electronic-based forms, there were no unclear forms. Electronic based laboratory forms provide a more complete, accurate, clear, and understandable format than paper-based laboratory records. Based on these findings, KAMC should move toward the implementation of electronic-based laboratory request forms for the outpatient laboratory department. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  17. The Indiana University Center for Healthcare Innovation and Implementation Science: Bridging healthcare research and delivery to build a learning healthcare system.

    PubMed

    Azar, Jose; Adams, Nadia; Boustani, Malaz

    2015-01-01

    In the United States, it is estimated that 75,000 deaths every year could be averted if the healthcare system implemented high quality care more effectively and efficiently. Patient harm in the hospital occurs as a consequence of inadequate procedures, medications and other therapies, nosocomial infections, diagnostic evaluations and patient falls. Implementation science, a new emerging field in healthcare, is the development and study of methods and tools aimed at enhancing the implementation of new discoveries and evidence into daily healthcare delivery. The Indiana University Center for Healthcare Innovation and Implementation Science (IU-CHIIS) was launched in September 2013 with the mission to use implementation science and innovation to produce great-quality, patient-centered and cost-efficient healthcare delivery solutions for the United States of America. Within the first 24 months of its initiation, the IU-CHIIS successfully scaled up an evidence-based collaborative care model for people with dementia and/or depression, successfully expanded the Accountable Care Unit model positively impacting the efficiency and quality of care, created the first Certificate in Innovation and Implementation Science in the US and secured funding from National Institutes of Health to investigate innovations in dementia care. This article summarizes the establishment of the IU-CHIIS, its impact and outcomes and the lessons learned during the journey. Copyright © 2015. Published by Elsevier GmbH.

  18. Explaining public satisfaction with health-care systems: findings from a nationwide survey in China.

    PubMed

    Munro, Neil; Duckett, Jane

    2016-06-01

    To identify factors associated with health-care system satisfaction in China. Recent research suggests that socio-demographic characteristics, self-reported health, income and insurance, ideological beliefs, health-care utilization, media use and perceptions of services may affect health-care system satisfaction, but the relative importance of these factors is poorly understood. New data from China offer the opportunity to test theories about the sources of health-care system satisfaction. Stratified nationwide survey sample analysed using multilevel logistic regression. 3680 Chinese adults residing in family dwellings between 1 November 2012 and 17 January 2013. Satisfaction with the way the health-care system in China is run. We find only weak associations between satisfaction and socio-demographic characteristics, self-reported health and income. We do, however, find that satisfaction is strongly associated with having insurance and belief in personal responsibility for meeting health-care costs. We also find it is negatively associated with utilization, social media use, perceptions of access as unequal and perceptions of service providers as unethical. To improve satisfaction, Chinese policymakers - and their counterparts in countries with similar health-care system characteristics - should improve insurance coverage and the quality of health services, and tackle unethical medical practices. © 2015 The Authors. Health Expectations published by John Wiley & Sons Ltd.

  19. Real-time locating systems (RTLS) in healthcare: a condensed primer

    PubMed Central

    2012-01-01

    Real-time locating systems (RTLS, also known as real-time location systems) have become an important component of many existing ubiquitous location aware systems. While GPS (global positioning system) has been quite successful as an outdoor real-time locating solution, it fails to repeat this success indoors. A number of RTLS technologies have been used to solve indoor tracking problems. The ability to accurately track the location of assets and individuals indoors has many applications in healthcare. This paper provides a condensed primer of RTLS in healthcare, briefly covering the many options and technologies that are involved, as well as the various possible applications of RTLS in healthcare facilities and their potential benefits, including capital expenditure reduction and workflow and patient throughput improvements. The key to a successful RTLS deployment lies in picking the right RTLS option(s) and solution(s) for the application(s) or problem(s) at hand. Where this application-technology match has not been carefully thought of, any technology will be doomed to failure or to achieving less than optimal results. PMID:22741760

  20. Real-time locating systems (RTLS) in healthcare: a condensed primer.

    PubMed

    Kamel Boulos, Maged N; Berry, Geoff

    2012-06-28

    Real-time locating systems (RTLS, also known as real-time location systems) have become an important component of many existing ubiquitous location aware systems. While GPS (global positioning system) has been quite successful as an outdoor real-time locating solution, it fails to repeat this success indoors. A number of RTLS technologies have been used to solve indoor tracking problems. The ability to accurately track the location of assets and individuals indoors has many applications in healthcare. This paper provides a condensed primer of RTLS in healthcare, briefly covering the many options and technologies that are involved, as well as the various possible applications of RTLS in healthcare facilities and their potential benefits, including capital expenditure reduction and workflow and patient throughput improvements. The key to a successful RTLS deployment lies in picking the right RTLS option(s) and solution(s) for the application(s) or problem(s) at hand. Where this application-technology match has not been carefully thought of, any technology will be doomed to failure or to achieving less than optimal results.

  1. Applying e-procurement system in the healthcare: the EPOS paradigm

    NASA Astrophysics Data System (ADS)

    Ketikidis, Panayiotis H.; Kontogeorgis, Apostolos; Stalidis, George; Kaggelides, Kostis

    2010-03-01

    One of the goals of procurement is to establish a competitive price, while e-procurement utilises electronic commerce to identify potential sources of supply, to purchase goods and services, to exchange contractual information and to interact with suppliers. Extensive academic work has been extensively devoted to e-procurement in diverse industries. However, applying e-procurement in the healthcare sector remains unexplored. It lacks an efficient e-procurement mechanism that will enable hospitals and healthcare suppliers to electronically exchange contractual information, aided by the technologies of optimisation and business rules. The development and deployment of e-procurement requires a major effort in the coordination of complex interorganisational business process. This article presents an e-procurement optimised system (EPOS) for the healthcare marketplace, a complete methodological approach for deploying and operating such system, as piloted in public and private hospitals in three European countries (Greece, Spain and Belgium) and suppliers of healthcare items in the fourth country (Italy). The efficient e-procurement mechanism that EPOS suggests enables hospitals and pharmaceutical and medical equipment suppliers to electronically exchange contractual information.

  2. [The latest reform of the Colombian healthcare-related social security system].

    PubMed

    Franco-Giraldo, Álvaro

    2012-10-01

    This essay was aimed at exploring and analysing the challenges and opportunities arising from reforming Colombian law 1438/2011 dealing with the healthcare-related social security system. Some outstanding issues from the reform introduced by Law 100/1993 were reviewed and then compared to the 2011 regulations; they were also contrasted (in market model conditions) with some public health strategies which were inoperative during the reform stage. This second reform phase was discussed in relation to the scope of the right to health, access and overall equity. Progress regarding important issues such as benefit package equalisation, primary healthcare attention, integrated healthcare service networks was recognised; however, its failure to change core aspects of the system was discussed, i.e. financial sustainability and the economic rationale imposed on the aforementioned strategies which curtailed its responsiveness to keep the model introduced by law 100/1993 intact. The crucial points necessary for major structural reform of the Colombian healthcare system based on the right to health and equity were then outlined.

  3. Five types of OECD healthcare systems: empirical results of a deductive classification.

    PubMed

    Böhm, Katharina; Schmid, Achim; Götze, Ralf; Landwehr, Claudia; Rothgang, Heinz

    2013-12-01

    This article classifies 30 OECD healthcare systems according to a deductively generated typology by Rothgang and Wendt [1]. This typology distinguishes three core dimensions of the healthcare system: regulation, financing, and service provision, and three types of actors: state, societal, and private actors. We argue that there is a hierarchical relationship between the three dimensions, led by regulation, followed by financing and finally service provision, where the superior dimension restricts the nature of the subordinate dimensions. This hierarchy rule limits the number of theoretically plausible types to ten. To test our argument, we classify 30 OECD healthcare systems, mainly using OECD Health Data and WHO country reports. The classification results in five system types: the National Health Service, the National Health Insurance, the Social Health Insurance, the Etatist Social Health Insurance, and the Private Health System. All five types belong to the group of healthcare system types considered theoretically plausible. Merely Slovenia does not comply with our assumption of a hierarchy among dimensions and typical actors due to its singular transformation history. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

  4. Preparing for Fiscal Leadership in Student Affairs: The Senior Student Affairs Officer Voice

    ERIC Educational Resources Information Center

    Stewart, Stephanie C.; Williams, Terry E.

    2010-01-01

    Success within today's challenging economic environment mandates that senior student affairs officers in higher education possess a sophisticated financial and budgetary skill set. Limited research addresses avenues through which professionals might best acquire the financial acumen needed. To address this gap, 19 senior student affairs officers…

  5. Forging a Frailty-Ready Healthcare System to Meet Population Ageing

    PubMed Central

    Lim, Wee Shiong; Wong, Sweet Fun; Leong, Ian; Choo, Philip; Pang, Weng Sun

    2017-01-01

    The beginning of the 21st century has seen health systems worldwide struggling to deliver quality healthcare amidst challenges posed by ageing populations. The increasing prevalence of frailty with older age and accompanying complexities in physical, cognitive, social and psychological dimensions renders the present modus operandi of fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In line with the public health framework for action in the World Health Organization’s World Health and Ageing Report, meeting these challenges will require a systemic reform of healthcare delivery that is integrated, patient-centric, team-based, and health-centered. These reforms can be achieved through building partnerships and relationships that engage, empower, and activate patients and their support systems. To meet the challenges of population ageing, Singapore has reorganised its public healthcare into regional healthcare systems (RHSs) aimed at improving population health and the experience of care, and reducing costs. This paper will describe initiatives within the RHS frameworks of the National Health Group (NHG) and the Alexandra Health System (AHS) to forge a frailty-ready healthcare system across the spectrum, which includes the well healthy (“living well”), the well unhealthy (“living with illness”), the unwell unhealthy (“living with frailty”), and the end-of-life (EoL) (“dying well”). For instance, the AHS has adopted a community-centered population health management strategy in older housing estates such as Yishun to build a geographically-based care ecosystem to support the self-management of chronic disease through projects such as “wellness kampungs” and “share-a-pot”. A joint initiative by the Lien Foundation and Khoo Teck Puat Hospital aims to launch dementia-friendly communities across the island by building a network comprising community partners, businesses, and members of the

  6. Web-based integrated public healthcare information system of Korea: development and performance.

    PubMed

    Ryu, Seewon; Park, Minsu; Lee, Jaegook; Kim, Sung-Soo; Han, Bum Soo; Mo, Kyoung Chun; Lee, Hyung Seok

    2013-12-01

    The Web-based integrated public healthcare information system (PHIS) of Korea was planned and developed from 2005 to 2010, and it is being used in 3,501 regional health organizations. This paper introduces and discusses development and performance of the system. We reviewed and examined documents about the development process and performance of the newly integrated PHIS. The resources we analyzed the national plan for public healthcare, information strategy for PHIS, usage and performance reports of the system. The integrated PHIS included 19 functional business areas, 47 detailed health programs, and 48 inter-organizational tasks. The new PHIS improved the efficiency and effectiveness of the business process and inter-organizational business, and enhanced user satisfaction. Economic benefits were obtained from five categories: labor, health education and monitoring, clinical information management, administration and civil service, and system maintenance. The system was certified by a patent from the Korean Intellectual Property Office and accredited as an ISO 9001. It was also reviewed and received preliminary comments about its originality, advancement, and business applicability from the Patent Cooperation Treaty. It has been found to enhance the quality of policy decision-making about regional healthcare at the self-governing local government level. PHIS, a Web-based integrated system, has contributed to the improvement of regional healthcare services of Korea. However, when it comes to an appropriate evolution, the needs and changing environments of community-level healthcare service and IT infrastructure should be analyzed properly in advance.

  7. Population aging and its impacts: strategies of the health-care system in Taipei.

    PubMed

    Lin, Ming-Hsien; Chou, Ming-Yueh; Liang, Chih-Kuang; Peng, Li-Ning; Chen, Liang-Kung

    2010-11-01

    Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities. Copyright © 2010 Elsevier B.V. All rights reserved.

  8. The Learning Healthcare System: Where are we now? A systematic review.

    PubMed

    Budrionis, Andrius; Bellika, Johan Gustav

    2016-12-01

    The Learning Healthcare System paradigm has attracted the attention of researchers worldwide. The great potential originating from high-scale health data reuse and the inclusion of patient perspectives into care models promises personalized care, lower costs of health services and minimized consumption of resources. The aim of this review is to summarize the attempts to adopt the novel paradigm, putting emphasis on implementations and evaluating the impact on current medical practices. PRISMA methodology was followed for structuring the review process. Three major research databases (PubMed, IEEE Xplore and ACM DL) were queried with the predefined search terms "learning healthcare" and "learning health". Publications containing specific theoretical or empirical results were considered. Three hundred and fifty-eight publications were identified; however, only 32 met the inclusion criteria. Nineteen papers were characterized as theoretical contributions, while the rest presented empirical achievements. Only one paper described the initial estimates of impact and economy. Individualistic communication of studies ignoring popular frameworks for assessing and reporting research achievements prevents the systematic generation of knowledge. Evaluating the impact of the Learning Healthcare System instances where it is implemented could work as a catalyst in reaching higher acceptance and adoption of the proposed ideas by healthcare worldwide; however, it mostly remains described in theory. The review demonstrated the interest of researchers in exploring the Learning Healthcare System ideas. However, it also revealed minimal focus on evaluating the impact of the novel paradigm on both healthcare service delivery and patient outcome. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Multidisciplinary HIS DICOM interfaces at the Department of Veterans Affairs

    NASA Astrophysics Data System (ADS)

    Kuzmak, Peter M.; Dayhoff, Ruth E.

    2000-05-01

    The U.S. Department of Veterans Affairs (VA) is using the Digital Imaging and Communications in Medicine (DICOM) standard to integrate image data objects from multiple systems for use across the healthcare enterprise. DICOM uses a structured representation of image data and a communication mechanism that allows the VA to easily acquire images from multiple sources and store them directly into the online patient record. The VA can obtain both radiology and non- radiology images using DICOM, and can display them on low-cost clinician's color workstations throughout the medical center. High-resolution gray-scale diagnostic quality multi-monitor workstations with specialized viewing software can be used for reading radiology images. The VA's DICOM capabilities can interface six different commercial Picture Archiving and Communication Systems (PACS) and over twenty different image acquisition modalities. The VA is advancing its use of DICOM beyond radiology. New color imaging applications for Gastrointestinal Endoscopy and Ophthalmology using DICOM are under development. These are the first DICOM offerings for the vendors, who are planning to support the recently passed DICOM Visible Light and Structured Reporting service classes. Implementing these in VistA is a challenge because of the different workflow and software support for these disciplines within the VA HIS environment.

  10. Data Privacy in Cloud-assisted Healthcare Systems: State of the Art and Future Challenges.

    PubMed

    Sajid, Anam; Abbas, Haider

    2016-06-01

    The widespread deployment and utility of Wireless Body Area Networks (WBAN's) in healthcare systems required new technologies like Internet of Things (IoT) and cloud computing, that are able to deal with the storage and processing limitations of WBAN's. This amalgamation of WBAN-based healthcare systems to cloud-based healthcare systems gave rise to serious privacy concerns to the sensitive healthcare data. Hence, there is a need for the proactive identification and effective mitigation mechanisms for these patient's data privacy concerns that pose continuous threats to the integrity and stability of the healthcare environment. For this purpose, a systematic literature review has been conducted that presents a clear picture of the privacy concerns of patient's data in cloud-assisted healthcare systems and analyzed the mechanisms that are recently proposed by the research community. The methodology used for conducting the review was based on Kitchenham guidelines. Results from the review show that most of the patient's data privacy techniques do not fully address the privacy concerns and therefore require more efforts. The summary presented in this paper would help in setting research directions for the techniques and mechanisms that are needed to address the patient's data privacy concerns in a balanced and light-weight manner by considering all the aspects and limitations of the cloud-assisted healthcare systems.

  11. Establishment, Present Condition, and Developmental Direction of the New Korean Healthcare Accreditation System

    PubMed Central

    Chang, Hoo-Sun

    2012-01-01

    On July 23rd, 2010 a revised medical law (Article 58) was passed to change existing evaluation system of medical institutions to an accreditation system. The new healthcare accreditation system was introduced to encourage medical institutions to work voluntarily and continuously to improve patient safety and medical service quality. Changes regarding the healthcare accreditation system included the establishment of an accreditation agency, the voluntary participation of medical institutions, accreditation standards centering on the treatment process and patient safety, tracing methodology, and the announcement of comprehensive results concerning accreditation. Despite varying views on the healthcare accreditation system, including some that are critical, it is meaningful that the voluntary nature of the system acknowledges that the medical institutions must be active agents in improving medical service quality. Healthcare quality is not improved instantaneously, but instead gradually through continuous communication within the clinical field. For this accreditation system to be successful, followings are essential: the accreditation agency becomes financially independent and is managed efficiently, the autonomy and regulation surrounding the system are balanced, the professionalism of the system is ensured, and the medical field plays an active role in the operation of the system. PMID:22661873

  12. Patient Relationship Management: What the U.S. Healthcare System Can Learn from Other Industries.

    PubMed

    Poku, Michael K; Behkami, Nima A; Bates, David W

    2017-01-01

    As the U.S. healthcare system moves to value-based care, the importance of engaging patients and families continues to intensify. However, simply engaging patients and families to improve their subjective satisfaction will not be enough for providers who want to maximize value. True optimization entails developing deep and long-term relationships with patients. We suggest that healthcare organizations must build such a discipline of "patient relationship management" (PRM) just as companies in non-healthcare industries have done with the concept of customer relationship management (CRM). Some providers have already made strides in this area, but overall it has been underemphasized or ignored by most healthcare systems to date. As healthcare providers work to develop their dedicated PRM systems, tools, and processes, we suggest they may benefit from emulating companies in other industries who have been able to engage their customers in innovative ways while acknowledging the differences between healthcare and other industries.

  13. Emerging perspectives on transforming the healthcare system: redesign strategies and a call for needed research.

    PubMed

    Doebbeling, Bradley N; Flanagan, Mindy E

    2011-12-01

    U.S. healthcare requires major redesign of its delivery systems, finances, and incentives. Healthcare operations, leadership, and payors are increasingly recognizing the need for community-business-research partnerships to transform healthcare. New models of continuous learning, research, and development should help focus and sustain redesign efforts. This study summarizes suggested strategies for transformational change in healthcare and identifies needed areas for research to inform, spread, and sustain transformational change. We developed these recommendations based on a series of review papers, invited expert discussion, and a subsequent review in the context of a health system transformation research conference (The Regenstrief Biennial Research Conference). The multidisciplinary audience included health systems researchers, clinicians, informaticians, social and engineering scientists, and operational and business leaders. Conference participants and literature reviews identified key strategies for system redesign with the following themes: using the framework of complex adaptive systems; fostering organizational redesign; developing appropriate performance measures and incentives; creating continuous learning organizations; and integrating health information, technology, and communication into practice. Sustained investment in research and development in these areas is crucial. Multiple issues influence the likelihood that healthcare leaders will make transformational changes in their healthcare systems. Healthcare leaders, clinicians, researchers, journals, and academic institutions, in partnership with payors, government and multiple other stakeholders, should apply the recommendations relevant to their own setting to redesign healthcare delivery, improve cognitive support, and sustain transformation. Fostering further research investments in these areas will increase the impact of transformation on the health and healthcare of the public.

  14. A GUIDE TO UNDERSTANDING WORLD AFFAIRS.

    ERIC Educational Resources Information Center

    ROGERS, WILLIAM C.

    WRITTEN IN EVERYDAY ENGLISH, THIS READING BOOK PRESENTS MANY FACTS AND IDEAS ABOUT WORLD AFFAIRS. CHAPTERS COVER INTERNATIONAL LIFE, POWER IN WORLD AFFAIRS, WAR AS INTERNATIONAL CONFLICT, THE MEANS AND VARIETIES OF ARMED CONFLICT, INTERNATIONAL CONFLICT SHORT OF WAR, THE ACCOMMODATION OF CONFLICT IN WORLD AFFAIRS, AND PEACE--WHAT IT IS AND HOW TO…

  15. Getting Started in Student Affairs Development

    ERIC Educational Resources Information Center

    Morgan, Myra F.; Policello, Sharon M.

    2010-01-01

    Student affairs organizations must deal with the reality that if offering high-quality and innovative programs for students is a priority, then identifying and soliciting outside funding sources is essential. If the vice president for student affairs has decided to establish a development office in the division of student affairs in a large public…

  16. Facility-Level Variation in Hospitalization, Mortality, and Costs in the 30 Days After Percutaneous Coronary Intervention: Insights on Short-Term Healthcare Value From the Veterans Affairs Clinical Assessment, Reporting, and Tracking System (VA CART) Program.

    PubMed

    Bradley, Steven M; O'Donnell, Colin I; Grunwald, Gary K; Liu, Chuan-Fen; Hebert, Paul L; Maddox, Thomas M; Jesse, Robert L; Fihn, Stephan D; Rumsfeld, John S; Ho, P Michael

    2015-07-14

    Policies to reduce unnecessary hospitalizations after percutaneous coronary intervention (PCI) are intended to improve healthcare value by reducing costs while maintaining patient outcomes. Whether facility-level hospitalization rates after PCI are associated with cost of care is unknown. We studied 32,080 patients who received PCI at any 1 of 62 Veterans Affairs hospitals from 2008 to 2011. We identified facility outliers for 30-day risk-standardized hospitalization, mortality, and cost. Compared with the risk-standardized average, 2 hospitals (3.2%) had a lower-than-expected hospitalization rate, and 2 hospitals (3.2%) had a higher-than-expected hospitalization rate. We observed no statistically significant variation in facility-level risk-standardized mortality. The facility-level unadjusted median per patient 30-day total cost was $23,820 (interquartile range, $19,604-$29,958). Compared with the risk-standardized average, 17 hospitals (27.4%) had lower-than-expected costs, and 14 hospitals (22.6%) had higher-than-expected costs. At the facility level, the index PCI accounted for 83.1% of the total cost (range, 60.3%-92.2%), whereas hospitalization after PCI accounted for only 5.8% (range, 2.0%-12.7%) of the 30-day total cost. Facilities with higher hospitalization rates were not more expensive (Spearman ρ=0.16; 95% confidence interval, -0.09 to 0.39; P=0.21). In this national study, hospitalizations in the 30 day after PCI accounted for only 5.8% of 30-day cost, and facility-level cost was not correlated with hospitalization rates. This challenges the focus on reducing hospitalizations after PCI as an effective means of improving healthcare value. Opportunities remain to improve PCI value by reducing the variation in total cost of PCI without compromising patient outcomes. © 2015 American Heart Association, Inc.

  17. The implications of e-health system delivery strategies for integrated healthcare: lessons from England.

    PubMed

    Eason, Ken; Waterson, Patrick

    2013-05-01

    This paper explores the implications that different technical strategies for sharing patient information have for healthcare workers and, as a consequence, for the extent to which these systems provide support for integrated care. Four technical strategies were identified and the forms of coupling they made with healthcare agencies were classified. A study was conducted in England to examine the human and organizational implications of systems implemented by these four strategies. Results were used from evaluation reports of two systems delivered as part of the NPfIT (National Programme for Information Technology) and from user responses to systems delivered in two local health communities in England. In the latter study 40 clinical respondents reported the use of systems to support integrated care in six healthcare pathways. The implementation of a detailed care record system (DCRS) in the NPfIT was problematic because it could not meet the diverse needs of all healthcare agencies and it required considerable local customization. The programme evolved to allow different systems to be delivered for each local health community. A national Summary Care Record (SCR) was implemented but many concerns were raised about wide access to confidential patient information. The two technical strategies that required looser forms of coupling and were under local control led to wide user adoption. The systems that enabled data to be transferred between local systems were successfully used to support integrated care in specific healthcare pathways. The portal approach gave many users an opportunity to view patient data held on a number of databases and this system evolved over a number of years as a result of requests from the user community. The UK national strategy to deliver single shared database systems requires tight coupling between many users and has led to poor adoption because of the diverse needs of healthcare agencies. Sharing patient information has been more

  18. An evolutionary approach to the architecture of effective healthcare delivery systems.

    PubMed

    Towill, D R; Christopher, M

    2005-01-01

    Aims to show that material flow concepts developed and successfully applied to commercial products and services can form equally well the architectural infrastructure of effective healthcare delivery systems. The methodology is based on the "power of analogy" which demonstrates that healthcare pipelines may be classified via the Time-Space Matrix. A small number (circa 4) of substantially different healthcare delivery pipelines will cover the vast majority of patient needs and simultaneously create adequate added value from their perspective. The emphasis is firmly placed on total process mapping and analysis via established identification techniques. Healthcare delivery pipelines must be properly engineered and matched to life cycle phase if the service is to be effective. This small family of healthcare delivery pipelines needs to be designed via adherence to very specific-to-purpose principles. These vary from "lean production" through to "agile delivery". The proposition for a strategic approach to healthcare delivery pipeline design is novel and positions much currently isolated research into a comprehensive organisational framework. It therefore provides a synthesis of the needs of global healthcare.

  19. Adoption of PACS by the Department of Veterans Affairs: the past, the present, and future plans

    NASA Astrophysics Data System (ADS)

    Siegel, Eliot L.; Reiner, Bruce I.; Kuzmak, Peter M.

    2000-05-01

    The diffusion of PACS technology within the Department of Veterans Affairs has followed the 'S' curve transition originally described by Ryan and Gross in 1943. They described a paradigm that describes the diffusion of a new technology into the community. However the rate of adoption of filmless radiology by the VA has been much higher than that of the general healthcare system. This is likely due to the fact that the VA and Department of Defense medical systems are somewhat isolated and independent from other health care systems and are subject to a different rate of diffusion of technology. The early introduction and success of PACS in the VA undoubtedly accelerated its acceptance throughout the system. An additional impetus to the growth of PACS in the VA has been the development of an image management system that has been incorporated into the electronic medical record. The universal use of the VISTA HIS and RIS system throughout the VA and the fact that it was developed 'in-house' as well as its extensive support for DICOM functionality have also played a major role in facilitating the acceptance of Picture Archival and Communication Systems throughout the VA.

  20. Web-Based Integrated Public Healthcare Information System of Korea: Development and Performance

    PubMed Central

    Park, Minsu; Lee, Jaegook; Kim, Sung-Soo; Han, Bum Soo; Mo, Kyoung Chun; Lee, Hyung Seok

    2013-01-01

    Objectives The Web-based integrated public healthcare information system (PHIS) of Korea was planned and developed from 2005 to 2010, and it is being used in 3,501 regional health organizations. This paper introduces and discusses development and performance of the system. Methods We reviewed and examined documents about the development process and performance of the newly integrated PHIS. The resources we analyzed the national plan for public healthcare, information strategy for PHIS, usage and performance reports of the system. Results The integrated PHIS included 19 functional business areas, 47 detailed health programs, and 48 inter-organizational tasks. The new PHIS improved the efficiency and effectiveness of the business process and inter-organizational business, and enhanced user satisfaction. Economic benefits were obtained from five categories: labor, health education and monitoring, clinical information management, administration and civil service, and system maintenance. The system was certified by a patent from the Korean Intellectual Property Office and accredited as an ISO 9001. It was also reviewed and received preliminary comments about its originality, advancement, and business applicability from the Patent Cooperation Treaty. It has been found to enhance the quality of policy decision-making about regional healthcare at the self-governing local government level. Conclusions PHIS, a Web-based integrated system, has contributed to the improvement of regional healthcare services of Korea. However, when it comes to an appropriate evolution, the needs and changing environments of community-level healthcare service and IT infrastructure should be analyzed properly in advance. PMID:24523997

  1. Healthcare IT system in the midst of and after Great East Japan Earthquake Disaster : Grand design for reconstruction of Tohoku-region healthcare IT system

    NASA Astrophysics Data System (ADS)

    Tanaka, Hiroshi

    In this article, we described what was really going in the disaster medical care at the Great East Japan Earthquake, mainly in Ishinomaki and Kesen-numa areas. As for exchange tools of the disaster information, in contrast to the breakdown of fixed-line and mobile phone, MCA radio system, satellite mobiles and internet, especially SNS, were greatly helpful. Learned from the disaster experiences, we are making the grand design for “disaster-robust” regional healthcare IT systems, which are composed of (1) cloud center storing whole-prefecture medical records, (2) SS-MIX based regional healthcare information systems of “the second medical care zones”, (3) ASP/SaaS typed electronic medical record system for all clinics located at Pacific coastal areas, and (4) wireless communication environment supporting comprehensive care of elderly for daily living activities.

  2. The healthcare system and the provision of oral healthcare in European Union member states: Part 5: Romania.

    PubMed

    Oancea, R; Amariei, C; Eaton, K A; Widström, E

    2016-04-01

    Romania is one of the newest member states of the European Union (EU). It has 13 dental schools, 14,841 dentists and 2,935 dental technicians providing oral health care for a population, at 31 December 2014, of 21.3 million. The shift from a communist system to a democratic or capitalist society has contributed to an enormous change in the proportion of public and private sector oral health services. The lack of public funds during the post-communist years has contributed to a dependency on private oral healthcare rather than the government financed public provision. Affordability and social awareness have together established a mixed economy for oral health care costs and oral healthcare is growing slowly compared with other developed EU member states. At the same time, there has been overproduction of new dentists (currently 1500 graduate annually). This has led to un and under-employment and emigration of dentists to other EU member states. This paper explains the current oral healthcare system in Romania and changes in recent years.

  3. IHE: integrating the healthcare enterprise, towards complete integration of healthcare information systems.

    PubMed

    Bernardini, Antonio; Alonzi, Mauro; Campioni, Paolo; Vecchioli, Amorino; Marano, Pasquale

    2003-01-01

    Information systems of a modern hospital govern extremely important functions as patient management, control of work flows, administration etc. However a great variety of recommended standards are used while in most cases no effective coordination and intercommunication is possible. Some years ago to simplify and resolve this problem IHE was created; it is a technical framework which identifies a number of components of the healthcare enterprise (the "actors") whose interactions are defined in terms of "transactions", that should be implemented according to HL7 and DICOM standards. Attempting an in-depth understanding of IHE structure and its principles of function, those transactions that can occur among the various actors, which of these are supported and which require specific actors, are analyzed. IHE is continuously evolving, therefore open to the factual contribution of all health professionals who can point out the main instances that emerge daily from their activity in the field. While its origin was specific for the field of radiology, the true soul and driving force of the project lay on the type of approach used: to get together medical specialists and information technology professionals in order to identify and solve the difficulties which hindered an effective and functional integration of healthcare information systems.

  4. Embracing uncertainty, managing complexity: applying complexity thinking principles to transformation efforts in healthcare systems.

    PubMed

    Khan, Sobia; Vandermorris, Ashley; Shepherd, John; Begun, James W; Lanham, Holly Jordan; Uhl-Bien, Mary; Berta, Whitney

    2018-03-21

    Complexity thinking is increasingly being embraced in healthcare, which is often described as a complex adaptive system (CAS). Applying CAS to healthcare as an explanatory model for understanding the nature of the system, and to stimulate changes and transformations within the system, is valuable. A seminar series on systems and complexity thinking hosted at the University of Toronto in 2016 offered a number of insights on applications of CAS perspectives to healthcare that we explore here. We synthesized topics from this series into a set of six insights on how complexity thinking fosters a deeper understanding of accepted ideas in healthcare, applications of CAS to actors within the system, and paradoxes in applications of complexity thinking that may require further debate: 1) a complexity lens helps us better understand the nebulous term "context"; 2) concepts of CAS may be applied differently when actors are cognizant of the system in which they operate; 3) actor responses to uncertainty within a CAS is a mechanism for emergent and intentional adaptation; 4) acknowledging complexity supports patient-centred intersectional approaches to patient care; 5) complexity perspectives can support ways that leaders manage change (and transformation) in healthcare; and 6) complexity demands different ways of implementing ideas and assessing the system. To enhance our exploration of key insights, we augmented the knowledge gleaned from the series with key articles on complexity in the literature. Ultimately, complexity thinking acknowledges the "messiness" that we seek to control in healthcare and encourages us to embrace it. This means seeing challenges as opportunities for adaptation, stimulating innovative solutions to ensure positive adaptation, leveraging the social system to enable ideas to emerge and spread across the system, and even more important, acknowledging that these adaptive actions are part of system behaviour just as much as periods of stability are. By

  5. Utilisation of the healthcare system for authentic early experience placements.

    PubMed

    Hays, Richard B

    2013-01-01

    Authentic early experience in clinical contexts adds interest and relevance to basic medical education, and is regarded positively by both learners and teachers. However, with the recent expansion of medical education, the healthcare system appears close to reaching its capacity for student supervision. This study explores the utilisation of the healthcare system for early clinical placements. A secondary analysis was conducted of data from the Medical Schools Outcomes Database, collected from the 2010 annual questionnaire, focusing on the timing, duration and location of clinical placements during 2009 within the first half of basic medical education programs in Australia. Data was received for 67% of Australian medical students, reporting a total of 16 812 early clinical placements that occupied 97 319 days of supervised time in a wide variety of hospital, general practice and Indigenous health contexts, both urban and rural, across the Australian healthcare system. These early placements occupied about 16% of total clinical placement time for all students in all training years during 2009. The majority of these placements were for only a few hours or days; exceptions were longitudinal placements in regional and rural communities at a minority of schools. Early clinical placements may pose significant resource costs for placement providers, particularly supervision time and expertise. As medical education expands and the teaching capacity of the Australian healthcare system appears to reach its limits, it may be necessary to allocate placements according to their specific learning outcomes, prioritise more acute settings for more senior students, and increase capacity in less acute health and social care settings.

  6. Academic Affairs and Student Affairs Partnerships Promoting Diversity Initiatives on Campus: A Grounded Theory

    ERIC Educational Resources Information Center

    LePeau, Lucy Anne

    2012-01-01

    Higher education research suggests student affairs and academic affairs partner to address challenges on campus, such as building inclusive environments for diverse students and staff, but evidence about "how" partnerships form is lacking in the literature. The purpose of this constructivist grounded theory was to understand…

  7. The impact of healthcare-associated methicillin-resistant Staphylococcus aureus infections on post-discharge healthcare costs and utilization.

    PubMed

    Nelson, Richard E; Jones, Makoto; Liu, Chuan-Fen; Samore, Matthew H; Evans, Martin E; Graves, Nicholas; Lee, Bruce; Rubin, Michael A

    2015-05-01

    Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections are a major cause of morbidity, mortality, and cost among hospitalized patients. Little is known about their impact on post-discharge resource utilization. The purpose of this study was to estimate post-discharge healthcare costs and utilization attributable to positive MRSA cultures during a hospitalization. Our study cohort consisted of patients with an inpatient admission lasting longer than 48 hours within the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. Of these patients, we identified those with a positive MRSA culture from microbiology reports in the VA electronic medical record. We used propensity score matching and multivariable regression models to assess the impact of positive culture on post-discharge outpatient, inpatient, and pharmacy costs and utilization in the 365 days following discharge. Our full cohort included 369,743 inpatients, of whom, 3,599 (1.0%) had positive MRSA cultures. Our final analysis sample included 3,592 matched patients with and without positive cultures. We found that, in the 12 months following hospital discharge, having a positive culture resulted in increases in post-discharge pharmacy costs ($776, P<.0001) and inpatient costs ($12,167, P<.0001). Likewise, having a positive culture increased the risk of a readmission (odds ratio [OR]=1.396, P<.0001), the number of prescriptions (incidence rate ratio [IRR], 1.138; P<.0001) and the number of inpatient days (IRR, 1.204; P<.0001,) but decreased the number of subsequent outpatient encounters (IRR, 0.941; P<.008). The results of this study indicate that MRSA infections are associated with higher levels of post-discharge healthcare cost and utilization. These findings indicate that financial benefits resulting from infection prevention efforts may extend beyond the initial hospital stay.

  8. Student Affairs and Service Learning: Promoting Student Engagement

    ERIC Educational Resources Information Center

    Caruso, Robert; Bowen, Glenn; Adams-Dunford, Jane

    2006-01-01

    Why should service learning be placed within student affairs? What special skills can student affairs professionals bring to service-learning program implementation? How can administrators use this program to promote strong student affairs-academic affairs collaboration? This article discusses a "best practices" model that is working…

  9. Physician density planning in a public healthcare system: Complexities, threats and opportunities-The case of the Israeli healthcare system.

    PubMed

    Gamzu, Ronni; Kaidar, Nir; Afek, Arnon; Horev, Tuvia

    2016-08-01

    Human-resource planning in healthcare is one of the most significant challenges that healthcare systems worldwide face. Among all healthcare professions, the planning of physician supply is the most complex of all due to physicians' lengthy training and many specialties. Forecasts showing a disturbing downward trend in the ratio of physicians to population in Israel prompted the Israeli Government in 2010 to establish a committee mandated to predict demand for physicians and recommend steps to adjust supply to it. The committee analyzed numerous variables that affect physician supply and demand and recommended measures that in greater part were implemented. The article discusses the methodology of the committee, its recommendations, and their implementation such as a 52% increase in the number of first-year medical students between 2010 and 2012. Its analysis of the current situation shows that the implementation of the recommendations successfully stemmed the decrease in physician density and attained the committee's other long-term objectives: physician density of 2.9 per 1000 of population and an increase (32.5%) in the number of physicians who began training in targeted specialties. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Why screening rates vary between Korea and Japan--differences between two national healthcare systems.

    PubMed

    Goto, Rei; Hamashima, Chisato; Mun, Sunghyun; Lee, Won-Chul

    2015-01-01

    Both Japan and Korea provide population-based screening programs. However, screening rates are much higher in Korea than in Japan. To clarify the possible factors explaining the differences between these two countries, we analyzed the current status of the cancer screening and background healthcare systems. Population- based cancer screening in Korea is coordinated well with social health insurance under a unified insurer system. In Japan, there are over 3,000 insurers and coordinating a comprehensive strategy for cancer screening promotion has been very difficult. The public healthcare system also has influence over cancer screening. In Korea, public healthcare does not cover a wide range of services. Almost free cancer screening and subsidization for medical cost for cancers detected in population-screening provides high incentive to participation. In Japan, on the other hand, a larger coverage of medical services, low co-payment, and a lenient medical audit enables people to have cancer screening under public health insurance as well as the broad range of cancer screening. The implementation of evidence-based cancer screening programs may be largely dependent on the background healthcare system. It is important to understand the impacts of each healthcare system as a whole and to match the characteristics of a particular health system when designing an efficient cancer screening system.

  11. Visionary leadership and the future of VA health system.

    PubMed

    Bezold, C; Mayer, E; Dighe, A

    1997-01-01

    As the U.S. Department of Veterans Affairs (VA) makes the change over to Veterans Integrated Service Network (VISNs) the need for new and better leadership is warranted if VA wants to not only survive, but thrive in the emerging twenty-first century healthcare system. VA can prepare for the future and meet the challenges facing them by adopting a system of visionary leadership. The use of scenarios and vision techniques are explained as they relate to VA's efforts to move toward their new system of VISNs. The four scenarios provide snapshots of possible futures for the U.S. healthcare system as well as the possible future role and mission of VA--from VA disappearing to its becoming a premier virtual organization.

  12. How healthcare systems evaluate their advance care planning initiatives: Results from a systematic review.

    PubMed

    Biondo, Patricia D; Lee, Lydia D; Davison, Sara N; Simon, Jessica E

    2016-09-01

    Advance care planning initiatives are being implemented across healthcare systems around the world, but how best to evaluate their implementation is unknown. To identify gaps and/or redundancies in current evaluative strategies to help healthcare systems develop future evaluative frameworks for ACP. Systematic review. Peer-reviewed and gray literature searches were conducted till February 2015 to answer: "What methods have healthcare systems used to evaluate implementation of advance care planning initiatives?" A PICOS framework was developed to identify articles describing the implementation and evaluation of a health system-level advance care planning initiative. Outcome measures were mapped onto a conceptual quality indicator framework based on the Institute of Medicine and Donabedian models of healthcare quality. A total of 46 studies met inclusion criteria for analysis. Most articles reported on single parts of a healthcare system (e.g. continuing care). The most common outcome measures pertained to document completion, followed by healthcare resource use. Patient-, family-, or healthcare provider-reported outcomes were less commonly measured. Concordance measures (e.g. dying in place of choice) were reported by only 26% of studies. The conceptual quality indicator framework identified gaps and redundancies in measurement and is presented as a potential foundation from which to develop a comprehensive advance care planning evaluation framework. Document completion is frequently used to evaluate advance care planning program implementation; capturing the quality of care appears to be more difficult. This systematic review provides health system administrators with a comprehensive summary of measures used to evaluate advance care planning and may identify gaps in evaluation within their local context. © The Author(s) 2016.

  13. Implications of climate change (global warming) for the healthcare system.

    PubMed

    Raffa, R B; Eltoukhy, N S; Raffa, K F

    2012-10-01

    Temperature-sensitive pathogenic species and their vectors and hosts are emerging in previously colder regions as a consequence of several factors, including global warming. As a result, an increasing number of people will be exposed to pathogens against which they have not previously needed defences. We illustrate this with a specific example of recent emergence of Cryptococcus gattii infections in more temperate climates. The outbreaks in more temperate climates of the highly virulent--but usually tropically restricted--C. gattii is illustrative of an anticipated growing challenge for the healthcare system. There is a need for preparedness by healthcare professionals in anticipation and for management of such outbreaks, including other infections whose recent increased prevalence in temperate climates can be at least partly associated with global warming. (Re)emergence of temperature-sensitive pathogenic species in more temperate climates will present new challenges for healthcare systems. Preparation for outbreaks should precede their occurrence. © 2012 Blackwell Publishing Ltd.

  14. MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH-CARE USE

    PubMed Central

    ROBBINS, JACOB A.

    2015-01-01

    The rapid growth of Medicare managed care over the past decade has the potential to increase the efficiency of health-care delivery. Improvements in care management for some may improve efficiency system-wide, with implications for optimal payment policy in public insurance programs. These system-level effects may depend on local health-care market structure and vary based on patient characteristics. We use exogenous variation in the Medicare payment schedule to isolate the effects of market-level managed care enrollment on the quantity and quality of care delivered. We find that in areas with greater enrollment of Medicare beneficiaries in managed care, the non–managed care beneficiaries have fewer days in the hospital but more outpatient visits, consistent with a substitution of less expensive outpatient care for more expensive inpatient care, particularly at high levels of managed care. We find no evidence that care is of lower quality. Optimal payment policies for Medicare managed care enrollees that account for system-level spillovers may thus be higher than those that do not. PMID:27042687

  15. Specific factors influencing information system/information and communication technology sourcing strategies in healthcare facilities.

    PubMed

    Potančok, Martin; Voříšek, Jiří

    2016-09-01

    Healthcare facilities use a number of information system/information and communication technologies. Each healthcare facility faces a need to choose sourcing strategies most suitable to ensure provision of information system/information and communication technology services, processes and resources. Currently, it is possible to observe an expansion of sourcing possibilities in healthcare informatics, which creates new requirements for sourcing strategies. Thus, the aim of this article is to identify factors influencing information system/information and communication technology sourcing strategies in healthcare facilities. The identification was based on qualitative research, namely, a case study. This study provides a set of internal and external factors with their impact levels. The findings also show that not enough attention is paid to these factors during decision-making. © The Author(s) 2015.

  16. [The quality of the German health-care system in an international comparison - a systematic review].

    PubMed

    Lauerer, M; Emmert, M; Schöffski, O

    2013-08-01

    Studies assessing the quality of the German health-care system in an international comparison come to different results. Therefore, this review aims to investigate how the German health-care system is evaluated in comparison to other health-care systems by reviewing international publications. Results show starting points for ways to improve the German health-care system, to maintain and expand its strengths as well as to derive strategies for solving identified problems. A systematic review searching different databases [library catalogues, WorldCat (including MEDLINE and OAIster-search), German National Library, Google Scholar and others]. Search requests were addressed to English or German language publications for the time period 2000-2010 (an informal search was conducted in October 2011 for an update). Results of the identified studies were aggregated and main statements derived. In total, 13 publications assessing the German health-care system in an international comparison were identified. These comparisons are based on 377 measures. After aggregation, 244 substantially different indicators remained, which were dedicated to 14 categories. It became apparent that the German health-care system can be characterised by a high level of expenses, a well-developed health-care infrastructure as well as a high availability of personal and material resources. Outcome measures demonstrate heterogeneous results. It can be stated that, particularly in this field, there is potential for further improvement. The utilisation of health-care services is high, the access is mostly not regulated and out of pocket payments can pose a barrier for patients. Waiting times are not regarded as a major weakness. Although civic satisfaction seems to be acceptable, a large portion of the citizens calls for elementary modifications. Especially, more patient-centred health-care delivery should be addressed as well as management of information and the adoption of meaningful electronic

  17. Incentives for vertical integration in healthcare: the effect of reimbursement systems.

    PubMed

    Byrne, M M; Ashton, C M

    1999-01-01

    In the United States, many healthcare organizations are being transformed into large integrated delivery systems, even though currently available empirical evidence does not provide strong or unequivocal support for or against vertical integration. Unfortunately, the manager cannot delay organizational changes until further research has been completed, especially when further research is not likely to reveal a single, correct solution for the diverse healthcare systems in existence. Managers must therefore carefully evaluate the expected effects of integration on their individual organizations. Vertical integration may be appropriate if conditions facing the healthcare organization provide opportunities for efficiency gains through reorganization strategies. Managers must consider (1) how changes in the healthcare market have affected the dynamics of production efficiency and transaction costs; (2) the likelihood that integration strategies will achieve increases in efficiency or reductions in transaction costs; and (3) how vertical integration will affect other costs, and whether the benefits gained will outweigh additional costs and efficiency losses. This article presents reimbursement systems as an example of how recent changes in the industry may have changed the dynamics and efficiency of production. Evaluation of the effects of vertical integration should allow for reasonable adjustment time, but obviously unsuccessful strategies should not be followed or maintained.

  18. Designing a Safer Interactive Healthcare System - The Impact of Authentic User Participation

    NASA Astrophysics Data System (ADS)

    Went, Kathryn L.; Gregor, Peter; Ricketts, Ian W.

    Information technology has been widely promoted in the healthcare sector to improve current practice and patient safety. However, end users are seldom involved extensively in the design and development of healthcare systems, with lip service often paid to the idea of true user involvement. In this case study the impact of sustained authentic user participation was explored using an interdisciplinary team, consisting of experts both in interaction and healthcare design and consultant anaesthetists, nurses, and pharmacists, to create an electronic prescribing and administration system. This paper details the interface that was created and provides examples of the way in which the design evolved in response to the sustained authentic user participation methods. The working prototype both reduced the opportunity for user error and was preferred by its users to the existing manual system.

  19. Seeking perfection in healthcare. A case study in adopting Toyota Production System methods.

    PubMed

    Kaplan, Gary S; Patterson, Sarah H

    2008-01-01

    Virginia Mason Health System's vision to be the quality leader in healthcare means continually adopting new ways of thinking. One change has been shifting from believing defects are to be expected to believing zero defects in healthcare is not only possible, but also necessary. Generally, healthcare has advanced in technology and understanding of disease, but its business and management systems have changed little since the 1950s. Virginia Mason realized it needed a management method to help make real and measurable improvements in safety, quality, service and staff satisfaction.

  20. 78 FR 13897 - Bureau of International Labor Affairs; Office of Trade and Labor Affairs; Labor Affairs Council...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-01

    ...Pursuant to Article 19.5 of the U.S.-Korea Free Trade Agreement (KORUS FTA), the International Labor Affairs Bureau (ILAB) of the U.S. Department of Labor gives notice of the public session of the meeting of the Labor Affairs Council (``Council'' or ``LAC''). The LAC public session will be held the morning of March 19, 2013. The purpose of the public session is to provide an opportunity for the Council to meet with the public to discuss matters related to the implementation of Chapter 19 (the Labor Chapter) of the KORUS FTA, including activities of the Labor Cooperation Mechanism established under Article 19.6 of the FTA.

  1. Managing the Judicial Function in Student Affairs.

    ERIC Educational Resources Information Center

    Steele, Brenton H.; And Others

    1984-01-01

    Surveyed chief student affairs officers at 264 colleges and universities regarding the administration of judicial affairs and judicial policies and procedures. Results showed 88 percent of the schools did not have a judicial affairs office. Over half felt no change in judicial programs was needed. (JAC)

  2. Private investment in hospitals: a comparison of three healthcare systems and possible implications for real estate strategies.

    PubMed

    van der Zwart, Johan; van der Voordt, Theo; Jonge, Hans de

    2010-01-01

    This article explores lessons to be learned from three different healthcare systems and the possible implications for the management of healthcare real estate, in particular in connection to the Dutch system. It discusses similarities and differences among the different systems, in search of possible consequences on cost, financing, and design innovation. To keep healthcare affordable in the future, the Dutch government is currently in the process of changing legislation to move from a centrally directed system to a so-called regulated market system. The deregulation of real estate investment that accompanies the new healthcare delivery system offers healthcare organizations new opportunities, but also more responsibility and greater risk in return on investment. Consequently, healthcare organizations must find new methods of financing. Private investment is one of the options. Three healthcare systems were analyzed on the basis of a literature review and document analysis, then schematized to show similarities and dissimilarities with regard to private investment in hospitals. Observations are based on a selection of recently published articles on private-sector financing and its implications for healthcare real estate decision making in the Netherlands, the United Kingdom, and Germany. The strengths and weaknesses of three healthcare systems with differing proportions of private and public investment in hospitals were explored. Research revealed a gap between intended effects and actual effects with regard to quality and cost. Costly private finance does not necessarily lead to "value for money." Transferring real estate decisions to private investors decreases the influence of the healthcare organization on future costs and quality. The three healthcare systems show substantial differences between public and private responsibilities. Less governmental involvement affords both opportunities and risks for hospitals. Private investment may lead to innovation

  3. Lean healthcare.

    PubMed

    Weinstock, Donna

    2008-01-01

    As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

  4. Views of the United States healthcare system: Findings from documentary analysis of an interprofessional education course.

    PubMed

    Bultas, Margaret W; Ruebling, Irma; Breitbach, Anthony; Carlson, Judy

    2016-11-01

    As the healthcare system of the United States becomes more complex, collaboration among health professionals is becoming an essential aspect in improving the health of individuals and populations. An interprofessional education course entitled "Health Care System and Health Promotion" was developed to allow health profession students to work and learn together about issues related to healthcare delivery, health promotion, and the effect of policy issues on key stakeholders in the system. A qualitative document analysis research design was used to evaluate the effect of this interprofessional course on students' views of the current healthcare system of the United States. Fifty-nine student articles were analysed using document analysis. Health professions represented in the sample included occupational therapy, physical therapy, athletic training, nursing, and radiation therapy, nuclear medicine technology, and magnetic resonance imaging. Eight themes were identified including: increased personal awareness, the need for a system change, concern for access, affordability of healthcare, vision for future practice role, need for quality care, the value of interprofessional collaboration (IPC), and the importance of disease prevention. The results of the study suggest that healthcare education can benefit from the integration of Interprofessional Education (IPE) courses into their curriculum especially when teaching content common to all healthcare professions such as healthcare systems and health promotion.

  5. China's public health-care system: facing the challenges.

    PubMed Central

    Liu, Yuanli

    2004-01-01

    The severe acute respiratory syndrome (SARS) crisis in China revealed not only the failures of the Chinese health-care system but also some fundamental structural deficiencies. A decentralized and fragmented health system, such as the one found in China, is not well-suited to making a rapid and coordinated response to public health emergencies. The commercial orientation of the health sector on the supply-side and lack of health insurance coverage on the demand-side further exacerbate the problems of the under-provision of public services, such as health surveillance and preventive care. For the past 25 years, the Chinese Government has kept economic development at the top of the policy agenda at the expense of public health, especially in terms of access to health care for the 800 million people living in rural areas. A significant increase in government investment in the public health infrastructure, though long overdue, is not sufficient to solve the problems of the health-care system. China needs to reorganize its public health system by strengthening both the vertical and horizontal connections between its various public health organizations. China's recent policy of establishing a matching-fund financed rural health insurance system presents an exciting opportunity to improve people's access to health care. PMID:15500285

  6. A secure steganography for privacy protection in healthcare system.

    PubMed

    Liu, Jing; Tang, Guangming; Sun, Yifeng

    2013-04-01

    Private data in healthcare system require confidentiality protection while transmitting. Steganography is the art of concealing data into a cover media for conveying messages confidentially. In this paper, we propose a steganographic method which can provide private data in medical system with very secure protection. In our method, a cover image is first mapped into a 1D pixels sequence by Hilbert filling curve and then divided into non-overlapping embedding units with three consecutive pixels. We use adaptive pixel pair match (APPM) method to embed digits in the pixel value differences (PVD) of the three pixels and the base of embedded digits is dependent on the differences among the three pixels. By solving an optimization problem, minimal distortion of the pixel ternaries caused by data embedding can be obtained. The experimental results show our method is more suitable to privacy protection of healthcare system than prior steganographic works.

  7. The Digital Identity of Student Affairs Professionals

    ERIC Educational Resources Information Center

    Ahlquist, Josie

    2016-01-01

    This chapter highlights opportunities in the digital space for student affairs professionals. A blended approach, grounded in the new technology competency recently added in the ACPA and NASPA student affairs professional competencies, is proposed for student affairs professionals' digital identity development. It includes the awareness of one's…

  8. Critical success factors in implementing an e-rostering system in a healthcare organisation.

    PubMed

    Soomro, Zahoor A; Ahmed, Javed; Muhammad, Raza; Hayes, Dawn; Shah, Mahmood H

    2017-01-01

    Effective and efficient staff scheduling has always been a challenging issue, especially in health service organisations. Both the extremes of staff shortage and overage have an adverse impact on the performance of healthcare organisations. In this case, an electronic and systematic staff scheduling (e-rostering) system is the often seen as the best solution. Unless an organisation has an effective implementation of such a system, possible cost savings, efficiency, and benefits could be minimal. This study is aimed to research key success factors for the successful effective implementation of an electronic rostering system, especially at healthcare organisations. A case study research method was used to evaluate critical success factors for effectively implementing an e-rostering system. The data were collected through interviews and observations. The findings indicate that technical support, an effective policy, leadership, clear goals and objectives, gradual change, evidence of the advantages of the new system, senior management support, and effective communication are the critical success factors in implementing an e-rostering system in healthcare organisations. Prior to this study, no such factors were grounded in the current context, so this research would help in bridging the gap towards effective implementation of an e-rostering system in the healthcare sector. This research also suggests future studies in different cultures and contexts.

  9. An integrated healthcare enterprise information portal and healthcare information system framework.

    PubMed

    Hsieh, S L; Lai, Feipei; Cheng, P H; Chen, J L; Lee, H H; Tsai, W N; Weng, Y C; Hsieh, S H; Hsu, K P; Ko, L F; Yang, T H; Chen, C H

    2006-01-01

    The paper presents an integrated, distributed Healthcare Enterprise Information Portal (HEIP) and Hospital Information Systems (HIS) framework over wireless/wired infrastructure at National Taiwan University Hospital (NTUH). A single sign-on solution for the hospital customer relationship management (CRM) in HEIP has been established. The outcomes of the newly developed Outpatient Information Systems (OIS) in HIS are discussed. The future HEIP blueprints with CRM oriented features: e-Learning, Remote Consultation and Diagnosis (RCD), as well as on-Line Vaccination Services are addressed. Finally, the integrated HEIP and HIS architectures based on the middleware technologies are proposed along with the feasible approaches. The preliminary performance of multi-media, time-based data exchanges over the wireless HEIP side is collected to evaluate the efficiency of the architecture.

  10. Clinical pharmacists: The major support to Indian healthcare system in near future

    PubMed Central

    Deshpande, Prasanna R.; Vantipalli, Raghuram; Chaitanya Lakshmi, C. H.; Rao, E. Jagadeswara; Regmi, Bishnu; Ahad, Abdul; Nirojini, P. Sharmila

    2015-01-01

    Pharmacy practice is still in the initial stages of development in India, but launching of Doctor of Pharmacy (PharmD) study program has brought serious discussions about clinical pharmacy in the country. As the profession is in budding stage in the country, the patients, physicians, nurses, other healthcare providers, recruiters in pharmaceutical industries, prospective students, and their parents have numerous questions about this profession and study course. The objective of this article is to create awareness about clinical pharmacy services (CPS) and to introduce the role of clinical pharmacists (CPs). After reading this article, one will know about the usefulness of CPs in the Indian healthcare system against the current flaws in the system. The article describes the role of CPs in the hospitals, in research, in pharmaceutical/contract research companies, in community service and it also tells about the related myths and facts. Prospective job opportunities for CPs, present challenges and the possible solutions are elaborated as well. In conclusion, CPs are going to be the major support to the Indian healthcare system in near future; the reasons being (1) CPS are beneficial in many ways to improve healthcare; CPS have already proved their importance in western countries (2) India was never officially and efficiently exposed to CPS; so launching of CPS shall revolutionize the country's healthcare scenario. PMID:26229349

  11. Variation in costs of cone beam CT examinations among healthcare systems.

    PubMed

    Christell, H; Birch, S; Hedesiu, M; Horner, K; Ivanauskaité, D; Nackaerts, O; Rohlin, M; Lindh, C

    2012-10-01

    To analyse the costs of cone beam CT (CBCT) in different healthcare systems for patients with different clinical conditions. Costs were calculated for CBCT performed in Cluj (Romania), Leuven (Belgium), Malmö (Sweden) and Vilnius (Lithuania) on patients with (i) a maxillary canine with eruption disturbance, (ii) an area with tooth loss prior to implant treatment or (iii) a lower wisdom tooth planned for removal. The costs were calculated using an approach based on the identification, measurement and valuation of all resources used in the delivery of the service that combined direct costs (capital equipment, accommodation, labour) with indirect costs (patients' and accompanying persons' time, "out of pocket" costs for examination fee and visits). The estimates for direct and indirect costs varied among the healthcare systems, being highest in Malmö and lowest in Leuven. Variation in direct costs was mainly owing to different capital costs for the CBCT equipment arising from differences in purchase prices (range €148 000-227 000). Variation in indirect costs were mainly owing to examination fees (range €0-102.02). Cost analysis provides an important input for economic evaluations of diagnostic methods in different healthcare systems and for planning of service delivery. Additionally, it enables decision-makers to separate variations in costs between systems into those due to external influences and those due to policy decisions. A cost evaluation of a dental radiographic method cannot be generalized from one healthcare system to another, but must take into account these specific circumstances.

  12. Variation in costs of cone beam CT examinations among healthcare systems

    PubMed Central

    Christell, H; Birch, S; Hedesiu, M; Horner, K; Ivanauskaité, D; Nackaerts, O; Rohlin, M; Lindh, C

    2012-01-01

    Objectives To analyse the costs of cone beam CT (CBCT) in different healthcare systems for patients with different clinical conditions. Methods Costs were calculated for CBCT performed in Cluj (Romania), Leuven (Belgium), Malmö (Sweden) and Vilnius (Lithuania) on patients with (i) a maxillary canine with eruption disturbance, (ii) an area with tooth loss prior to implant treatment or (iii) a lower wisdom tooth planned for removal. The costs were calculated using an approach based on the identification, measurement and valuation of all resources used in the delivery of the service that combined direct costs (capital equipment, accommodation, labour) with indirect costs (patients' and accompanying persons' time, “out of pocket” costs for examination fee and visits). Results The estimates for direct and indirect costs varied among the healthcare systems, being highest in Malmö and lowest in Leuven. Variation in direct costs was mainly owing to different capital costs for the CBCT equipment arising from differences in purchase prices (range €148 000–227 000). Variation in indirect costs were mainly owing to examination fees (range €0–102.02). Conclusions Cost analysis provides an important input for economic evaluations of diagnostic methods in different healthcare systems and for planning of service delivery. Additionally, it enables decision-makers to separate variations in costs between systems into those due to external influences and those due to policy decisions. A cost evaluation of a dental radiographic method cannot be generalized from one healthcare system to another, but must take into account these specific circumstances. PMID:22499131

  13. Source characterization of nervous system active pharmaceutical ingredients in healthcare wastewaters

    EPA Science Inventory

    Nervous system active pharmaceutical ingredients (APIs), including anti-depressants and opioids, are important clinically administered pharmaceuticals within healthcare facilities. Concentrations and mass loadings of ten nervous system APIs and three nervous system API metaboli...

  14. Healthcare Data Gateways: Found Healthcare Intelligence on Blockchain with Novel Privacy Risk Control.

    PubMed

    Yue, Xiao; Wang, Huiju; Jin, Dawei; Li, Mingqiang; Jiang, Wei

    2016-10-01

    Healthcare data are a valuable source of healthcare intelligence. Sharing of healthcare data is one essential step to make healthcare system smarter and improve the quality of healthcare service. Healthcare data, one personal asset of patient, should be owned and controlled by patient, instead of being scattered in different healthcare systems, which prevents data sharing and puts patient privacy at risks. Blockchain is demonstrated in the financial field that trusted, auditable computing is possible using a decentralized network of peers accompanied by a public ledger. In this paper, we proposed an App (called Healthcare Data Gateway (HGD)) architecture based on blockchain to enable patient to own, control and share their own data easily and securely without violating privacy, which provides a new potential way to improve the intelligence of healthcare systems while keeping patient data private. Our proposed purpose-centric access model ensures patient own and control their healthcare data; simple unified Indicator-Centric Schema (ICS) makes it possible to organize all kinds of personal healthcare data practically and easily. We also point out that MPC (Secure Multi-Party Computing) is one promising solution to enable untrusted third-party to conduct computation over patient data without violating privacy.

  15. A Systems Approach to Healthcare Innovation Using the MIT Hacking Medicine Model.

    PubMed

    Gubin, Tatyana A; Iyer, Hari P; Liew, Shirlene N; Sarma, Aartik; Revelos, Alex; Ribas, João; Movassaghi, Babak; Chu, Zen M; Khalid, Ayesha N; Majmudar, Maulik D; Lee, Christopher Xiang

    2017-07-26

    MIT Hacking Medicine is a student, academic, and community-led organization that uses systems-oriented "healthcare hacking" to address challenges around innovation in healthcare. The group has organized more than 80 events around the world that attract participants with diverse backgrounds. These participants are trained to address clinical needs from the perspective of multiple stakeholders and emphasize utility and implementation viability of proposed solutions. We describe the MIT Hacking Medicine model as a potential method to integrate collaboration and training in rapid innovation techniques into academic medical centers. Built upon a systems approach to healthcare innovation, the time-compressed but expertly guided nature of the events could enable more widely accessible preliminary training in systems-level innovation methodology, as well as creating a structured opportunity for interdisciplinary congregation and collaboration. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. E-Portfolios: Concepts, Designs, and Integration within Student Affairs

    ERIC Educational Resources Information Center

    Garis, Jeff W.

    2007-01-01

    This chapter provides an overview of e-portfolio concepts and designs. It describes a model that outlines an array of dimensions for the categorization of e-portfolio systems, reviews selected systems, and makes observations regarding the importance for student affairs units to understand, collaborate, and include e-portfolio systems within their…

  17. Yoga Therapy in the German Healthcare System.

    PubMed

    Cramer, Holger

    2018-05-09

    An estimated 15.7 million Germans are currently practicing yoga or are at least interested in starting to practice, and they often perceive yoga as a therapeutic approach. From a healthcare system perspective, the situation is less clear. Here, yoga is only recognized as a recreational or preventive activity. When yoga teachers fulfill specific qualifications, their preventive yoga classes are covered by the statutory health insurances. Only those with additional qualifications in medicine or psychotherapy, however, can independently use and promote "yoga therapy." The general perception of yoga in Germany as a preventive practice is reflected in the professional organization of yoga providers. Most providers are considered to be yoga teachers rather than yoga therapists and are organized mainly in yoga teacher associations. Despite the uncertain legal framework, yoga is now considered in a number of medical guidelines; in a number of hospitals, yoga is part of multimodal inpatient treatment programs and is delivered by physical therapists or members of other health professions. An increasing number of yoga therapy clinical trials are conducted in Germany, and efforts are underway to establish yoga therapy as an accepted adjunct treatment approach for selected medical conditions within the German healthcare system.

  18. [The regionalized healthcare network in Santa Catarina State, Brazil, from 2011 to 2015: governance system and oral healthcare].

    PubMed

    Godoi, Heloisa; Andrade, Selma Regina de; Mello, Ana Lúcia Schaefer Ferreira de

    2017-09-28

    : The objective was to describe the governance system used in structuring the regionalized healthcare network in Santa Catarina State, Brazil, based on the Bipartite Inter-Managerial Commission (CIB), with a focus on structuring of oral healthcare. This was a qualitative, exploratory-descriptive documental study, based on the foundations of governance as an analytical tool through identification of the dimensions actors, norms, nodal points, and processes. Secondary data were collected from the minutes of CIB meetings held from January 2011 to December 2015. The analysis shows weaknesses in CIB governance in Santa Catarina in relation to regionalized structuring of oral healthcare from a network perspective. Structuring of oral healthcare occurs in parallel to that of other thematic networks in the state and shows the expansion of dental services, especially those with medium complexity, as an effect of the prevailing governance process. The relations established between administrators and decision-making processes allowed recognizing this network's "prescription", since there is little negotiation and local demand, limited more to following recommendations and incentives from the federal/state sphere, intermediated by staff from the State Health Secretariat. Thus, setting a policy agenda for oral healthcare for the population of Santa Catarina is weakened, with a peripheral position in relation to other health programs.

  19. Information resources assessment of a healthcare integrated delivery system.

    PubMed Central

    Gadd, C. S.; Friedman, C. P.; Douglas, G.; Miller, D. J.

    1999-01-01

    While clinical healthcare systems may have lagged behind computer applications in other fields in the shift from mainframes to client-server architectures, the rapid deployment of newer applications is closing that gap. Organizations considering the transition to client-server must identify and position themselves to provide the resources necessary to implement and support the infrastructure requirements of client-server architectures and to manage the accelerated complexity at the desktop, including hardware and software deployment, training, and maintenance needs. This paper describes an information resources assessment of the recently aligned Pennsylvania regional Veterans Administration Stars and Stripes Health Network (VISN4), in anticipation of the shift from a predominantly mainframe to a client-server information systems architecture in its well-established VistA clinical information system. The multimethod assessment study is described here to demonstrate this approach and its value to regional healthcare networks undergoing organizational integration and/or significant information technology transformations. PMID:10566414

  20. The chief nurse executive role in large healthcare systems.

    PubMed

    Englebright, Jane; Perlin, Jonathan

    2008-01-01

    Community hospitals are most frequently led by nonclinicians. Although some may have employed physician leaders, most often clinical leadership is provided by a chief nurse executive (CNE) or chief nursing officer. Clinical leadership of community hospital and health systems may similarly be provided by a system-level nursing executive or, often, by a council of facility CNEs. The increasingly competitive healthcare environment in which value-based purchasing of healthcare and pay-for-performance programs demand improved clinical performance for financial success has led to reconsideration of whether a council model can provide either the leadership or adequate attention to clinical (and operational) improvement. In turn, community hospitals and health systems look to CNE or chief nursing officer roles at the highest level of the organization as resources that are able to segue between the clinical and operational domains, translating clinical performance demands into operating strategies and tactics. This article explores CNE characteristics required for success in these increasingly responsible and visible roles.

  1. Bringing Big Data to the Forefront of Healthcare Delivery: The Experience of Carolinas HealthCare System.

    PubMed

    Dulin, Michael F; Lovin, Carol A; Wright, Jean A

    2016-01-01

    The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the healthcare system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest healthcare systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA2) group in 2012. DA2 has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.

  2. Bringing Big Data to the Forefront of Healthcare Delivery: The Experience of Carolinas HealthCare System.

    PubMed

    Dulin, Michael F; Lovin, Carol A; Wright, Jean A

    2017-01-01

    The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the health-care system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest health-care systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA) group in 2012. DA has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.

  3. A Strategy Toward Reconstructing the Healthcare System of a Unified Korea

    PubMed Central

    Lee, Yo Han; Kim, Seok Hyang; Shin, Hyun-Woung; Lee, Jin Yong; Kim, Beomsoo; Kim, Young Ae; Yoon, Jangho; Shin, Young Seok

    2013-01-01

    This road map aims to establish a stable and integrated healthcare system for the Korean Peninsula by improving health conditions and building a foundation for healthcare in North Korea through a series of effective healthcare programs. With a basic time frame extending from the present in stages towards unification, the roadmap is composed of four successive phases. The first and second phases, each expected to last five years, respectively, focus on disease treatment and nutritional treatment. These phases would thereby safeguard the health of the most vulnerable populations in North Korea, while fulfilling the basic health needs of other groups by modernizing existing medical facilities. Based on the gains of the first two phases, the third phase, for ten years, would prepare for unification of the Koreas by promoting the health of all the North Korean people and improving basic infrastructural elements such as health workforce capacity and medical institutions. The fourth phase, assuming that unification will take place, provides fundamental principles and directions for establishing an integrated healthcare system across the Korean Peninsula. We are hoping to increase the consistency of the program and overcome several existing concerns of the current program with this roadmap. PMID:23766871

  4. A strategy toward reconstructing the healthcare system of a unified Korea.

    PubMed

    Lee, Yo Han; Yoon, Seok-Jun; Kim, Seok Hyang; Shin, Hyun-Woung; Lee, Jin Yong; Kim, Beomsoo; Kim, Young Ae; Yoon, Jangho; Shin, Young Seok

    2013-05-01

    This road map aims to establish a stable and integrated healthcare system for the Korean Peninsula by improving health conditions and building a foundation for healthcare in North Korea through a series of effective healthcare programs. With a basic time frame extending from the present in stages towards unification, the roadmap is composed of four successive phases. The first and second phases, each expected to last five years, respectively, focus on disease treatment and nutritional treatment. These phases would thereby safeguard the health of the most vulnerable populations in North Korea, while fulfilling the basic health needs of other groups by modernizing existing medical facilities. Based on the gains of the first two phases, the third phase, for ten years, would prepare for unification of the Koreas by promoting the health of all the North Korean people and improving basic infrastructural elements such as health workforce capacity and medical institutions. The fourth phase, assuming that unification will take place, provides fundamental principles and directions for establishing an integrated healthcare system across the Korean Peninsula. We are hoping to increase the consistency of the program and overcome several existing concerns of the current program with this roadmap.

  5. Pathways towards chronic care-focused healthcare systems: evidence from Spain.

    PubMed

    García-Goñi, Manuel; Hernández-Quevedo, Cristina; Nuño-Solinís, Roberto; Paolucci, Francesco

    2012-12-01

    Increasing healthcare expenditure is a matter of concern in many countries, particularly in relation to the underlying drivers of such escalation that include ageing, medical innovation, and changes in the burden of disease, such as the growing prevalence of chronic diseases. Most healthcare systems in developed countries have been designed to 'cure' acute episodes, rather than to 'manage' chronic conditions, and therefore they are not suitably or efficiently organized to respond to the changing needs and preferences of users. New models of chronic care provision have been developed to respond to the changing burden of disease and there is already considerable practical experience in several different countries showing their advantages but also the difficulties associated with their implementation. In this paper, we focus on the Spanish experience in terms of policy changes and pilot studies focused on testing the feasibility of moving towards chronic care models. In particular, we discuss a framework that identifies and analyses ten key prerequisites to achieving high performing chronic care-based healthcare systems and apply it to the current Spanish National Health System (NHS). We find that the design of the Spanish NHS already meets some of these pre-requisites. However, other features are still in their early stages of development or are being applied only in limited geographical and clinical contexts. We outline the policies that are being implemented and the pathway that the Spanish NHS is taking to address the crucial challenge of the transition towards an optimal health system focused on chronic care. Given the current evidence and trends, we expect that the pathway for developing a chronicity strategy being followed by the Spanish NHS will significantly transform its current healthcare delivery model in the next few years. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  6. Putting Descartes before the Horse: Opportunities for Advancing the Student Affairs Link with Academic Affairs.

    ERIC Educational Resources Information Center

    Lamarid, Lucas

    1999-01-01

    Article challenges the division between student and academic affairs and encourages a view of learning and reason in a more holistic and integrated fashion. Outlines the historical factors for the separation of student and academic affairs and offers the programs instituted at Bellarmine College as examples of effective collaboration between…

  7. A post-Bertalanffy Systemics Healthcare Competitive Framework Proposal.

    PubMed

    Fiorini, Rodolfo A; Santacroce, Giulia F

    2014-01-01

    Health Information community can take advantage of a new evolutive categorization cybernetic framework. A systemic concept of principles organizing nature is proposed. It can be used as a multiscaling reference framework to develop successful and competitive antifragile system and new HRO information management strategies in advanced healthcare organization (HO) and high reliability organization (HRO) conveniently. Expected impacts are multifarious and quite articulated at different system scale level: major one is that, for the first time, Biomedical Engineering ideal system categorization levels can be matched exactly to practical system modeling interaction styles, with no paradigmatic operational ambiguity and information loss.

  8. Transitioning from learning healthcare systems to learning health care communities.

    PubMed

    Mullins, C Daniel; Wingate, La'Marcus T; Edwards, Hillary A; Tofade, Toyin; Wutoh, Anthony

    2018-02-26

    The learning healthcare system (LHS) model framework has three core, foundational components. These include an infrastructure for health-related data capture, care improvement targets and a supportive policy environment. Despite progress in advancing and implementing LHS approaches, low levels of participation from patients and the public have hampered the transformational potential of the LHS model. An enhanced vision of a community-engaged LHS redesign would focus on the provision of health care from the patient and community perspective to complement the healthcare system as the entity that provides the environment for care. Addressing the LHS framework implementation challenges and utilizing community levers are requisite components of a learning health care community model, version two of the LHS archetype.

  9. A low-power RFID integrated circuits for intelligent healthcare systems.

    PubMed

    Lee, Shuenn-Yuh; Wang, Liang-Hung; Fang, Qiang

    2010-11-01

    This paper presents low-power radio-frequency identification (RFID) technology for intelligent healthcare systems. With attention to power-efficient communication in the body sensor network, RF power transfer was estimated and the required low-power ICs, which are important in the development of a healthcare system with miniaturization and system integration, are discussed based on the RFID platform. To analyze the power transformation, this paper adopts a 915-MHz industrial, scientific, and medical RF with a radiation power of 70 mW to estimate the power loss under the 1-m communication distance between an RFID reader (bioinformation node) and a transponder (biosignal acquisition nodes). The low-power ICs of the transponder will be implemented in the TSMC 0.18-μm CMOS process. The simulation result reveals that the transponder's IC can fit in with the link budget of the UHF RFID system.

  10. Healthcare system and the wealth-health gradient: a comparative study of older populations in six countries.

    PubMed

    Maskileyson, Dina

    2014-10-01

    The present study provides a comparative analysis of the association between wealth and health in six healthcare systems (Sweden, the United Kingdom, Germany, the Czech Republic, Israel, the United States). National samples of individuals fifty years and over reveal considerable cross-country variations in health outcomes. In all six countries wealth and health are positively associated. The findings also show that state-based healthcare systems produce better population health outcomes than private-based healthcare systems. The results indicate that in five out of the six countries studied, the wealth-health gradients were remarkably similar, despite significant variations in healthcare system type. Only in the United States was the association between wealth and health substantially different from, and much greater than that in the other five countries. The findings suggest that private-based healthcare system in the U.S. is likely to promote stronger positive associations between wealth and health. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. X-PAT: a multiplatform patient referral data management system for small healthcare institution requirements.

    PubMed

    Masseroli, Marco; Marchente, Mario

    2008-07-01

    We present X-PAT, a platform-independent software prototype that is able to manage patient referral multimedia data in an intranet network scenario according to the specific control procedures of a healthcare institution. It is a self-developed storage framework based on a file system, implemented in eXtensible Markup Language (XML) and PHP Hypertext Preprocessor Language, and addressed to the requirements of limited-dimension healthcare entities (small hospitals, private medical centers, outpatient clinics, and laboratories). In X-PAT, healthcare data descriptions, stored in a novel Referral Base Management System (RBMS) according to Health Level 7 Clinical Document Architecture Release 2 (CDA R2) standard, can be easily applied to the specific data and organizational procedures of a particular healthcare working environment thanks also to the use of standard clinical terminology. Managed data, centralized on a server, are structured in the RBMS schema using a flexible patient record and CDA healthcare referral document structures based on XML technology. A novel search engine allows defining and performing queries on stored data, whose rapid execution is ensured by expandable RBMS indexing structures. Healthcare personnel can interface the X-PAT system, according to applied state-of-the-art privacy and security measures, through friendly and intuitive Web pages that facilitate user acceptance.

  12. [The five commandments for preparing the Israeli healthcare system for emergencies].

    PubMed

    Adini, Bruria; Laor, Danny; Cohen, Robert; Lev, Boaz; Israeli, Avi

    2010-07-01

    In the last decade, the Israeli healthcare system dealt with many casualties that resulted from terrorist actions and at the same time maintained preparedness for other potential hazards such as natural disasters, toxicological, chemical, radiological and biological events. There are various models for emergency preparedness that are utilized in different countries. The aim of the article is to present the structure and the methodology of the Israeli healthcare system for emergencies. Assuring emergency preparedness for the different scenarios is based on 5 major components that include: comprehensive contingency planning; control and command of operations; central control of readiness; capacity building; coordination and collaboration among the numerous emergency agencies. CLose working relationships between the military and civilian systems characterize the operations of the emergency system. There is a mutual sharing of information, coordinated operations to achieve risk assessment and determine priorities, and consensual allocation of resources. The ability of the medical system to operate in optimal coordination with interface bodies, including the Israel Defense Forces, is derived from three main elements: the shortage of resources necessitate that all agencies work together to develop an effective response to emergencies; the Israeli society is characterized by transition of personnel from the military to the civilian system which promotes joint operations, whereas in most other countries these systems are completely separated; and also developing mechanisms for continuous and coordinated operation in routine and emergency times, such as the Supreme Health Authority. The Israeli healthcare system was put to the test several times in the Last decade, during the terror wave that occurred between 2001-2006, the 2nd Lebanon War and in operation "Cast Lead". An extensive process of learning lessons, conducted during and following each of these periods, and the

  13. Public Affairs & Strategic Communications (NGB-PA) - Personal Staff - Joint

    Science.gov Websites

    Guard ARNG Media ARNG Public Affairs Family Services Youth Programs Survivor Services Military Funeral General Officer Management Public Affairs Executive Support Services Legislative Liaison Special Staff : Personal Staff : Public Affairs Public Affairs & Strategic Communications (NGB-PA) Mission: Assess

  14. Student Affairs as Formal Educators: When Rhetoric Meets Reality

    ERIC Educational Resources Information Center

    Virkus, Annie J.

    2013-01-01

    The Student Affairs literature contains numerous approaches and strategies for bridging the gap between Student and Academic Affairs on college campuses. The use of student affairs professionals as instructors of credit-bearing courses is one example of such collaborative efforts. The student affairs literature identifies student affairs…

  15. 38 CFR 17.251 - The Subcommittee on Academic Affairs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Academic Affairs. 17.251 Section 17.251 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Grants for Exchange of Information § 17.251 The Subcommittee on Academic Affairs. There is... Subcommittee on Academic Affairs, and the Subcommittee shall advise the Secretary, through the Under Secretary...

  16. 38 CFR 17.251 - The Subcommittee on Academic Affairs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Academic Affairs. 17.251 Section 17.251 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Grants for Exchange of Information § 17.251 The Subcommittee on Academic Affairs. There is... Subcommittee on Academic Affairs, and the Subcommittee shall advise the Secretary, through the Under Secretary...

  17. 38 CFR 17.251 - The Subcommittee on Academic Affairs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Academic Affairs. 17.251 Section 17.251 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Grants for Exchange of Information § 17.251 The Subcommittee on Academic Affairs. There is... Subcommittee on Academic Affairs, and the Subcommittee shall advise the Secretary, through the Under Secretary...

  18. 38 CFR 17.251 - The Subcommittee on Academic Affairs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Academic Affairs. 17.251 Section 17.251 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Grants for Exchange of Information § 17.251 The Subcommittee on Academic Affairs. There is... Subcommittee on Academic Affairs, and the Subcommittee shall advise the Secretary, through the Under Secretary...

  19. 38 CFR 17.251 - The Subcommittee on Academic Affairs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Academic Affairs. 17.251 Section 17.251 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Grants for Exchange of Information § 17.251 The Subcommittee on Academic Affairs. There is... Subcommittee on Academic Affairs, and the Subcommittee shall advise the Secretary, through the Under Secretary...

  20. United States Strategic Plan for International Affairs.

    DTIC Science & Technology

    1998-01-01

    Humanitarian Response 39 Global Issues 41 US Strategic Plan for International Affairs International Affairs Strategic Plan Summary and Introduction...minimize the human costs of conflict and natural disasters. Global Issues : • Secure a sustainable global environment in order to protect the United States...involvement in addressing crises. 40 US Strategic Plan for International Affairs NATIONAL INTEREST: Global Issues The global environment has a

  1. Using Intersectionality in Student Affairs Research

    ERIC Educational Resources Information Center

    Strayhorn, Terrell L.

    2017-01-01

    This chapter presents intersectionality as a useful heuristic for conducting research in higher education and student affairs contexts. Much more than just another theory, intersectionality can powerfully shape student affairs research in both obvious and tacit ways.

  2. IT-based diagnostic instrumentation systems for personalized healthcare services.

    PubMed

    Chun, Honggu; Kang, Jaemin; Kim, Ki-Jung; Park, Kwang Suk; Kim, Hee Chan

    2005-01-01

    This paper describes recent research and development activities on the diagnostic instruments for personalized healthcare services in Seoul National University. Utilizing the state-of-the-art information technologies (IT), various diagnostic medical instruments have been integrated into a personal wearable device and a home telehealthcare system. We developed a wrist-worn integrated health monitoring device (WIHMD) which performs the measurements of non-invasive blood pressure (NIBP), pulse oximetry (SpO2), electrocardiogram (ECG), respiration rate, heart rate, and body surface temperature and the detection of falls to determine the onset of emergency situation. The WIHMD also analyzes the acquired bio-signals and transmits the resultant data to a healthcare service center through a commercial cellular phone. Two different kinds of IT-based blood glucometer have been developed using a cellular phone and PDA(personal digital assistant) as a main unit. A blood glucometer was also integrated within a wrist pressure measurement module which is interfaced with a cellular phone via Telecommunications Technology Association (TTA) standard in order to provide users with easiness in measuring and handling two important health parameters. Non-intrusive bio-signal measurement systems were developed for the ease of home use. One can measure his ECG on a bed while he is sleeping; measure his ECG, body temperature, bodyfat ratio and weight on a toilet seat; measure his ECG on a chair; and estimate the degree of activity by motion analysis using a camera. Another integrated diagnostic system for home telehealthcare services has been developed to include a 12 channels ECG, a pressure meter for NIBP, a blood glucometer, a bodyfat meter and a spirometer. It is an expert system to analyze the measured health data and based on the diagnostic result, the system provides an appropriate medical consultation. The measured data can be either stored on the system or transmitted to the

  3. 41 CFR 105-53.142 - Office of Public Affairs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Office of Public Affairs... Central Offices § 105-53.142 Office of Public Affairs. The Office of Public Affairs, headed by the Associate Administrator for Public Affairs, is responsible for the planning, implementation, and...

  4. Operational experience with DICOM for the clinical specialties in the healthcare enterprise

    NASA Astrophysics Data System (ADS)

    Kuzmak, Peter M.; Dayhoff, Ruth E.

    2004-04-01

    A number of clinical specialties routinely use images in treating patients, for example ophthalmology, dentistry, cardiology, endoscopy, and surgery. These images are captured by a variety of commercial digital image acquisition systems. The US Department of Veterans Affairs has been working for several years on advancing the use of the Digital Imaging and Communications in Medicine (DICOM) Standard in these clinical specialties. This is an effort that has involved several facets: (1) working with the vendors to ensure that they satisfy existing DICOM requirements, (2) developing interface software to the VistA hospital information system (HIS), (3) field testing DICOM systems, (4) deploying these DICOM interfaces nation-wide to all VA medical centers, (5) working with the healthcare providers using the system, and (6) participating in the DICOM working groups to improve the standard. The VA is now beginning to develop clinical applications that make use of the DICOM interfaces in the clinical specialties. The first of these will be in ophthalmology to remotely screen patients for diabetic retinopathy.

  5. The application of the unified modeling language in object-oriented analysis of healthcare information systems.

    PubMed

    Aggarwal, Vinod

    2002-10-01

    This paper concerns itself with the beneficial effects of the Unified Modeling Language (UML), a nonproprietary object modeling standard, in specifying, visualizing, constructing, documenting, and communicating the model of a healthcare information system from the user's perspective. The author outlines the process of object-oriented analysis (OOA) using the UML and illustrates this with healthcare examples to demonstrate the practicality of application of the UML by healthcare personnel to real-world information system problems. The UML will accelerate advanced uses of object-orientation such as reuse technology, resulting in significantly higher software productivity. The UML is also applicable in the context of a component paradigm that promises to enhance the capabilities of healthcare information systems and simplify their management and maintenance.

  6. Productivity changes in OECD healthcare systems: bias-corrected Malmquist productivity approach.

    PubMed

    Kim, Younhee; Oh, Dong-Hyun; Kang, Minah

    2016-10-01

    This study evaluates productivity changes in the healthcare systems of 30 Organization for Economic Co-operation and Development (OECD) countries over the 2002-2012 periods. The bootstrapped Malmquist approach is used to estimate bias-corrected indices of healthcare performance in productivity, efficiency and technology by modifying the original distance functions. Two inputs (health expenditure and school life expectancy) and two outputs (life expectancy at birth and infant mortality rate) are used to calculate productivity growth. There are no perceptible trends in productivity changes over the 2002-2012 periods, but positive productivity improvement has been noticed for most OECD countries. The result also informs considerable variations in annual productivity scores across the countries. Average annual productivity growth is evenly yielded by efficiency and technical changes, but both changes run somewhat differently across the years. The results of this study assert that policy reforms in OECD countries have improved productivity growth in healthcare systems over the past decade. Countries that lag behind in productivity growth should benchmark peer countries' practices to increase performance by prioritizing an achievable trajectory based on socioeconomic conditions. For example, relatively inefficient countries in this study indicate higher income inequality, corresponding to inequality and health outcomes studies. Although income inequality and globalization are not direct measures to estimate healthcare productivity in this study, these issues could be latent factors to explain cross-country healthcare productivity for future research. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  7. Fool-proofing design and crisis management for customized intelligent physical fitness and healthcare system.

    PubMed

    Huang, Chung-Chi; Huang, Chung-Lin; Liu, Hsiao-Man

    2015-01-01

    In recent years, it is quite important to develop a customized system which can enhance physical fitness and health for people. And the system reliability is more important. In the paper, a fool-proofing design and crisis management for customized physical fitness and healthcare system is proposed. It is designed to prevent the failure of the various mechanisms of customized physical fitness and healthcare system, including records, surveillance, assessments, predictions, diagnosis, prescription, and scheduling. It is separated into (1) fool-proofing design module (2) crisis management module. The fool-proofing indexes are set to prevent the failure of the various mechanisms. The states of the various mechanisms are managed by the auto-checked fool-proofing indexes. If mistakes prevention was fail, we have to execute the crisis management for stopping harmful results. The crisis management will find the error level and response the solution by using fuzzy method. By the experiments, we can find the advantages of the fool-proofing design and crisis management for customized physical fitness and healthcare system. And it is effective to prevent the failure of the various mechanisms of intelligent customized physical fitness and healthcare system.

  8. An open system approach to process reengineering in a healthcare operational environment.

    PubMed

    Czuchry, A J; Yasin, M M; Norris, J

    2000-01-01

    The objective of this study is to examine the applicability of process reengineering in a healthcare operational environment. The intake process of a mental healthcare service delivery system is analyzed systematically to identify process-related problems. A methodology which utilizes an open system orientation coupled with process reengineering is utilized to overcome operational and patient related problems associated with the pre-reengineered intake process. The systematic redesign of the intake process resulted in performance improvements in terms of cost, quality, service and timing.

  9. Implementing the incident command system in the healthcare setting.

    PubMed

    Huser, T J

    The author discusses a new requirement in NFPA 99 for healthcare facilities--the implementation of an Incident Command System in the event of a disaster. He offers suggestions on how facilities can change their disaster plans to meet this new standard.

  10. [Barriers to the normalization of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts].

    PubMed

    Roig, Francesc; Saigí, Francesc

    2011-01-01

    Despite the clear political will to promote telemedicine and the large number of initiatives, the incorporation of this modality in clinical practice remains limited. The objective of this study was to identify the barriers perceived by key professionals who actively participate in the design and implementation of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts. We performed a qualitative study based on data from semi-structured interviews with 17 key informants belonging to distinct Catalan health organizations. The barriers identified were grouped in four areas: technological, organizational, human and economic. The main barriers identified were changes in the healthcare model caused by telemedicine, problems with strategic alignment, resistance to change in the (re)definition of roles, responsibilities and new skills, and lack of a business model that incorporates telemedicine in the services portfolio to ensure its sustainability. In addition to suitable management of change and of the necessary strategic alignment, the definitive normalization of telemedicine in a mixed healthcare model based on purchasing of healthcare services using providers' contracts requires a clear and stable business model that incorporates this modality in the services portfolio and allows healthcare organizations to obtain reimbursement from the payer. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

  11. Smart healthcare textile sensor system for unhindered-pervasive health monitoring

    NASA Astrophysics Data System (ADS)

    Rai, Pratyush; Kumar, Prashanth S.; Oh, Sechang; Kwon, Hyeokjun; Mathur, Gyanesh N.; Varadan, Vijay K.; Agarwal, M. P.

    2012-04-01

    Simultaneous monitoring of physiological parameters- multi-lead Electrocardiograph (ECG), Heart rate variability, and blood pressure- is imperative to all forms of medical treatments. Using an array of signal recording devices imply that the patient will have to be confined to a bed. Textiles offer durable platform for embedded sensor and communication systems. The smart healthcare textile, presented here, is a mobile system for remote/wireless data recording and conditioning. The wireless textile system has been designed to monitor a patient in a non-obstructive way. It has a potential for facilitating point of care medicine and streamlining ambulatory medicine. The sensor systems were designed and fabricated with textile based components for easy integration on textile platform. An innovative plethysmographic blood pressure monitoring system was designed and tested as an alternative to inflatable blood pressure sphygmomanometer. Flexible dry electrodes technology was implemented for ECG. The sensor systems were tested and conditioned to daily activities of patients, which is not permissible with halter type systems. The signal quality was assessed for it applicability to medical diagnosis. The results were used to corroborate smart textile sensor system's ability to function as a point of care system that can provide quality healthcare.

  12. Mobile Healthcare System for Health Checkups and Telemedicine in Post-Disaster Situations.

    PubMed

    Hu, Min; Sugimoto, Megumi; Hargrave, Andrew Rebeiro; Nohara, Yasunobu; Moriyama, Michiko; Ahmed, Ashir; Shimizu, Shuji; Nakashima, Naoki

    2015-01-01

    Portable Healthcare Clinic (PHC) is a mobile healthcare system comprising of medical sensors and health assessment criteria. It has been applied in Bangladesh for the last two years as a pilot program to identify non-communicable diseases. In this study, we adapted PHC to fit post-disaster conditions. The PHC health assessment criteria are redesigned to deal with emergency cases and healthcare worker insufficiency. A new algorithm makes an initial assessment of age, symptoms, and whether the person is seeing a doctor. These changes will make the turn-around time shorter and will enable reaching the most affected patients better. We tested the operability and turn-around time of the adapted system at the debris flow disaster shelters in Hiroshima, Japan. Changing the PHC health assessment criteria and other solutions such as a list of medicine preparation makes the PHC system switch into an emergency mode more smoothly following a natural disaster.

  13. Using cost-effectiveness analysis to sharpen formulary decision-making: the example of tiotropium at the Veterans Affairs health care system.

    PubMed

    Onukwugha, Ebere; Mullins, C Daniel; DeLisle, Sylvain

    2008-01-01

    To identify a cost-saving subset of criteria for the use of tiotropium at a Veterans Affairs Medical Center based on a cost-effectiveness analysis with ipratropium as the comparator. Retrospective analysis of electronic medical records for the calendar year 2004 was conducted. The sample was drawn from a population at the Baltimore Veterans Affairs Medical Center that had a confirmed diagnosis of chronic obstructive pulmonary disease (COPD) and had filled prescriptions for ipratropium. The tiotropium sample was based on a modeled cohort of COPD patients who had received tiotropium. The analysis was conducted from the perspective of the Veterans Affairs Health Care System. The outcome was the incremental cost-effectiveness of tiotropium versus ipratropium. The incremental cost-effectiveness ratio (ICER) was $2360 per avoided exacerbation. Tiotropium cost-effectiveness increased with COPD severity and was cost-saving in patients with very severe disease (ICER = $-1818) and in patients with a previous COPD-related hospitalization (ICER = $-4472). The ICER was most sensitive to the relative effectiveness and price of tiotropium. Results identified the levels of treatment effectiveness and price beyond which tiotropium would become cost-saving relative to ipratropium. The results support the existing Veterans Affairs practice of offering tiotropium to patients with COPD-related hospitalizations. Periodic review of the effectiveness data to determine whether tiotropium would be cost-saving in patients with very severe COPD is suggested. Cost-effectiveness analyses that identify practical criteria-for-use should become an integral part of the formulary process.

  14. Accounting Information Systems in Healthcare: A Review of the Literature.

    PubMed

    Hammour, Hadal; Househ, Mowafa; Razzak, Hira Abdul

    2017-01-01

    As information technology progresses in Saudi Arabia, the manual accounting systems have become graduallyinadequate for decision needs. Subsequently, private and public healthcare divisions in Saudi Arabia perceive Computerized accounting information system (CAIS) as a vehicle to safeguard efficient and effective flow of information during the analysis, processes, and recording of financial data. Efficient and effective flow of information improvesthe decision making of staff, thereby improving the capability of health care sectors to reduce cost of the medical services.In this paper, we define computerized accounting systems from the point of view of health informatics. Also, the challenges and benefits of supporting CAIS applications in hospitals of Saudi Arabia. With these elements, we conclude that CAIS in Saudi Arabia can serve as a valuable tool for evaluating and controlling the cost of medical services in healthcare sectors. Supplementary education on the significance of having systems of computerized accounting within hospitals for nurses, doctors, and accountants with other health care staff is warranted in future.

  15. A system dynamics approach for healthcare waste management: a case study in Istanbul Metropolitan City, Turkey.

    PubMed

    Ciplak, Nesli; Barton, John R

    2012-06-01

    Healthcare waste consists of various types of waste materials generated at hospitals, medical research centres, clinics and laboratories. Although 75-90% of this waste is classified as 'domestic' in nature, 20-25% is deemed to be hazardous, which if not disposed of appropriately, poses a risk to healthcare workers, patients, the environment and even the whole community. As long as healthcare waste is mixed with municipal waste and not segregated prior to disposal, costs will increase substantially. In this study, healthcare waste increases along with the potential to decrease the amounts by implementing effective segregation at healthcare facilities are projected to 2040. Our long-term aim is to develop a system to support selection and planning of the future treatment capacity. Istanbul in Turkey was used as the case study area. In order to identify the factors affecting healthcare waste generation in Istanbul, observations were made and interviews conducted in Istanbul over a 3 month period. A system dynamics approach was adopted to build a healthcare waste management model using a software package, Vensim Ple Plus. Based on reported analysis, the non-hazardous municipal fraction co-disposed with healthcare waste is around 65%. Using the projected waste generation flows, reducing a municipal fraction to 30% has the potential to avoid some 8000 t year(-1) of healthcare waste by 2025 and almost 10 000 t year(-1) by 2035. Furthermore, if segregation practices ensured healthcare waste requiring incineration was also selectively managed, 77% of healthcare waste could be diverted to alternative treatment technologies. As the throughput capacity of the only existing healthcare waste treatment facility in Istanbul, Kemerburgaz Incinerator, has already been exceeded, it is evident that improved management could not only reduce overall flows and costs but also permit alternative and cheaper treatment systems (e.g. autoclaving) to be adopted for the healthcare waste.

  16. Healthcare waste management: current practices in selected healthcare facilities, Botswana.

    PubMed

    Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

    2008-01-01

    Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

  17. Performance analysis of multiple Indoor Positioning Systems in a healthcare environment.

    PubMed

    Van Haute, Tom; De Poorter, Eli; Crombez, Pieter; Lemic, Filip; Handziski, Vlado; Wirström, Niklas; Wolisz, Adam; Voigt, Thiemo; Moerman, Ingrid

    2016-02-03

    The combination of an aging population and nursing staff shortages implies the need for more advanced systems in the healthcare industry. Many key enablers for the optimization of healthcare systems require provisioning of location awareness for patients (e.g. with dementia), nurses, doctors, assets, etc. Therefore, many Indoor Positioning Systems (IPSs) will be indispensable in healthcare systems. However, although many IPSs have been proposed in literature, most of these have been evaluated in non-representative environments such as office buildings rather than in a hospital. To remedy this, the paper evaluates the performance of existing IPSs in an operational modern healthcare environment: the "Sint-Jozefs kliniek Izegem" hospital in Belgium. The evaluation (data-collecting and data-processing) is executed using a standardized methodology and evaluates the point accuracy, room accuracy and latency of multiple IPSs. To evaluate the solutions, the position of a stationary device was requested at 73 evaluation locations. By using the same evaluation locations for all IPSs the performance of all systems could objectively be compared. Several trends can be identified such as the fact that Wi-Fi based fingerprinting solutions have the best accuracy result (point accuracy of 1.21 m and room accuracy of 98%) however it requires calibration before use and needs 5.43 s to estimate the location. On the other hand, proximity based solutions (based on sensor nodes) are significantly cheaper to install, do not require calibration and still obtain acceptable room accuracy results. As a conclusion of this paper, Wi-Fi based solutions have the most potential for an indoor positioning service in case when accuracy is the most important metric. Applying the fingerprinting approach with an anchor installed in every two rooms is the preferred solution for a hospital environment.

  18. The Evolution of the Civil Affairs Force

    DTIC Science & Technology

    2013-12-01

    efficiency. The purpose of the analysis is to determine whether the current Civil Affairs structure is the most efficient design , and if not, what changes...sources of data include the Total Army Analysis that was utilized to build the Civil Affairs force, historical Quadrennial Defense Reviews (QDR...efficiency. It addresses the question of whether the current Civil Affairs structure reflects the most efficient design , and if not, what changes are

  19. Real-World Effectiveness of Elbasvir/Grazoprevir in HCV-Infected Patients in the US Veterans Affairs Healthcare System.

    PubMed

    Kramer, Jennifer R; Puenpatom, Amy; Erickson, Kevin; Cao, Yumei; Smith, Donna; El-Serag, Hashem; Kanwal, Fasiha

    2018-05-31

    Elbasvir/grazoprevir (EBR/GZR) is an all-oral direct-acting antiviral agent (DAA) with high sustained virologic response (SVR) in clinical trials. This study's primary objective was to evaluate effectiveness of EBR/GZR among HCV-infected patients in a real-world clinical setting. We conducted a nationwide retrospective observational cohort study of HCV-infected patients in the US Department of Veterans Affairs (VA) using the VA Corporate Data Warehouse. The study population included patients with positive HCV RNA who initiated EBR/GZR from February 1 to August 1, 2016. We calculated the 95% confidence interval for binomial proportions for SVR overall and by demographic subgroups. Clinical and demographic characteristics were also evaluated. We included 2,436 patients in the study cohort. Most were male (96.5%), African-American (57.5%), with mean age of 63.5 (SD=5.9), and 95.4% infected with genotype (GT) 1 [GT1a (34.7%), GT1b (58.6%)]. Other comorbidities included diabetes (53.2%), depression (57.2%), and HIV (3.0%). More than 50% had history of drug or alcohol abuse (53.9% and 60.5%, respectively). 33.2% of the cohort had cirrhosis. A total of 95.6% (2,328/2,436; 95% CI: 94.7%-96.4%) achieved SVR. The SVR rates by subgroups were: male, 95.5% (2245/2350); female, 96.5% (83/86); GT1a, 93.4%, GT1b, 96.6%, GT4, 96.9%, African-American, 95.9% (1,342/1,400); treatment-experienced, 96.3% (310/322); cirrhosis, 95.6% (732/766); stage 4-5 CKD, 96.3% (392/407); and HIV, 98.6% (73/74). SVR rates were high overall and across patient subgroups regardless of gender, race/ethnicity, cirrhosis, renal impairment, or HIV. This study provided important data regarding the effectiveness of EBR/GZR in a large clinical setting. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  20. The Smart Floor: How a Public-Private Partnership co-developed a heterogeneous healthcare technology system.

    PubMed

    Brodersen, Søsser; Lindegaard, Hanne

    2015-01-01

    Currently, a wide variety of healthcare technologies are being implemented in private homes, hospitals, nursing homes, etc. with the triple aim of improving people's health, improving the quality of care, and reducing costs related to healthcare services. In this chapter, we discuss how different actors in a public-private partnership co-developed a heterogeneous system around the Smart Floor to ensure that both new healthcare practices and residents' routines were inscribed into the new healthcare technology. We argue that implementing the Smart Floor was not just a question of buying a technology and integrating it during construction-it required co-development with the healthcare staff. The floor is more than a technology placed under the floor surface in a resident's apartment; rather, it is a heterogeneous network of human and non-human actors communicating with each other. In this chapter, we illustrate how the heterogeneous technological system was co-developed and redesigned during knowledge sharing processes with companies, lead-users, and healthcare staff. We also discuss how care practices have changed as a result of the Smart Floor system. In particular, healthcare staff members no longer feel a need to disturb elderly residents with routine in-person checks. Domesticating the technologies for different groups of actors required not only coordinating communication among sensors, the interface, the portable nurse call (smartphones), and alarms, but also accepting the use of surveillance technology.

  1. The 2017 Academic Emergency Medicine Consensus Conference: Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcomes.

    PubMed

    Bond, William F; Hui, Joshua; Fernandez, Rosemarie

    2018-02-01

    Over the past decade, emergency medicine (EM) took a lead role in healthcare simulation in part due to its demands for successful interprofessional and multidisciplinary collaboration, along with educational needs in a diverse array of cognitive and procedural skills. Simulation-based methodologies have the capacity to support training and research platforms that model micro-, meso-, and macrosystems of healthcare. To fully capitalize on the potential of simulation-based research to improve emergency healthcare delivery will require the application of rigorous methods from engineering, social science, and basic science disciplines. The Academic Emergency Medicine (AEM) Consensus Conference "Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcome" was conceived to foster discussion among experts in EM, engineering, and social sciences, focusing on key barriers and opportunities in simulation-based research. This executive summary describes the overall rationale for the conference, conference planning, and consensus-building approaches and outlines the focus of the eight breakout sessions. The consensus outcomes from each breakout session are summarized in proceedings papers published in this issue of Academic Emergency Medicine. Each paper provides an overview of methodologic and knowledge gaps in simulation research and identifies future research targets aimed at improving the safety and quality of healthcare. © 2017 by the Society for Academic Emergency Medicine.

  2. Physician leadership: a health-care system's investment in the future of quality care.

    PubMed

    Orlando, Rocco; Haytaian, Marcia

    2012-08-01

    The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.

  3. Hand hygiene and healthcare system change within multi-modal promotion: a narrative review.

    PubMed

    Allegranzi, B; Sax, H; Pittet, D

    2013-02-01

    Many factors may influence the level of compliance with hand hygiene recommendations by healthcare workers. Lack of products and facilities as well as their inappropriate and non-ergonomic location represent important barriers. Targeted actions aimed at making hand hygiene practices feasible during healthcare delivery by ensuring that the necessary infrastructure is in place, defined as 'system change', are essential to improve hand hygiene in healthcare. In particular, access to alcohol-based hand rubs (AHRs) enables appropriate and timely hand hygiene performance at the point of care. The feasibility and impact of system change within multi-modal strategies have been demonstrated both at institutional level and on a large scale. The introduction of AHRs overcomes some important barriers to best hand hygiene practices and is associated with higher compliance, especially when integrated within multi-modal strategies. Several studies demonstrated the association between AHR consumption and reduction in healthcare-associated infection, in particular, meticillin-resistant Staphylococcus aureus bacteraemia. Recent reports demonstrate the feasibility and success of system change implementation on a large scale. The World Health Organization and other investigators have reported the challenges and encouraging results of implementing hand hygiene improvement strategies, including AHR introduction, in settings with limited resources. This review summarizes the available evidence demonstrating the need for system change and its importance within multi-modal hand hygiene improvement strategies. This topic is also discussed in a global perspective and highlights some controversial issues. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  4. Decision support systems and the healthcare strategic planning process: a case study.

    PubMed

    Lundquist, D L; Norris, R M

    1991-01-01

    The repertoire of applications that comprises health-care decision support systems (DSS) includes analyses of clinical, financial, and operational activities. As a whole, these applications facilitate developing comprehensive and interrelated business and medical models that support the complex decisions required to successfully manage today's health-care organizations. Kennestone Regional Health Care System's use of DSS to facilitate strategic planning has precipitated marked changes in the organization's method of determining capital allocations. This case study discusses Kennestone's use of DSS in the strategic planning process, including profiles of key DSS modeling components.

  5. A systematic review of Human Factors and Ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety

    PubMed Central

    Xie, Anping; Carayon, Pascale

    2014-01-01

    Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how Human Factors and Ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified twelve projects representing 23 studies and addressing different physical, cognitive and organizational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care. Practitioner Summary Existing evidence shows that HFE-based healthcare system redesign has the potential to improve quality of care and patient safety. Healthcare organizations need to recognize the importance of HFE-based healthcare system redesign to quality of care and patient safety, and invest resources to integrate HFE in healthcare improvement activities. PMID:25323570

  6. Indigenous Affairs = Asuntos Indigenas, 1994-1995.

    ERIC Educational Resources Information Center

    Indigenous Affairs, 1995

    1995-01-01

    This document consists of the eight issues of the IWGIA newsletter "Indigenous Affairs" published during 1994-95. Each issue is published in separate English and Spanish versions. The newsletter is published by the International Work Group for Indigenous Affairs (IWGIA), an organization that supports indigenous peoples in their efforts…

  7. Demand for private healthcare in a universal public healthcare system: empirical evidence from Sri Lanka.

    PubMed

    Pallegedara, Asankha; Grimm, Michael

    2017-11-01

    This paper examines healthcare utilization behaviour in Sri Lanka with special emphasis on the choice between costly private and free public healthcare services. We use a data set that combines nationwide household survey data and district level healthcare supply data. Our findings suggest that even with universal public healthcare policy, richer people tend to use private sector healthcare services rather than public services. We also find significant regional and ethnic discrepancies in healthcare access bearing the risk of social tensions if these are further amplified. Latent class analysis shows in addition that the choice between private and public sector healthcare significantly differs between people with and without chronic diseases. We find in particular that chronically ill people rely for their day-to-day care on the public sector, but for their inpatient care they turn more often than non-chronically ill people to the private sector, implying an additional financial burden for the chronically ill. If the observed trend continues it may not only increase further the health-income gradient in Sri Lanka but also undermine the willingness of the middle class to pay taxes to finance public healthcare. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. A Modified No-fault Malpractice System Can Resolve Multiple Healthcare System Deficiencies

    PubMed Central

    Sacopulos, Michael

    2008-01-01

    Medical professional liability in the United States, as measured by total premiums paid by physicians and healthcare facilities, costs approximately $30 billion a year in direct expenses, less than 2% of the entire annual healthcare expenditures. Only a fraction of those dollars reach patients who are negligently injured. Nonetheless, the tort system has far-reaching effects that create substantial indirect costs. Medical malpractice litigation is pervasive and physicians practice defensively to avoid being named in a suit. Those extra expenditures provide little value to patients. Despite an elaborate existing tort system, patient safety remains a vexing problem. Many injured patients are denied access to timely, reasonable remedies. We propose a no-fault system supplemented by a variation of the traditional tort system whereby physicians are incentivized to follow evidence-based guidelines. The proposed system would guarantee a substantial decrease in, but not elimination of, litigation. The system would lower professional liability premiums. Injured patients would ordinarily be compensated with no-fault disability and life insurance proceeds. To the extent individual physicians pose a recurrent danger, their care would be reviewed on an administrative level. Savings would be invested in health information technology and purchase of insurance coverage for the uninsured. We propose a financial model based on publicly accessible sources. Electronic supplementary material The online version of this article (doi:10.1007/s11999-008-0577-9) contains supplementary material, which is available to authorized users. PMID:18979149

  9. [The origins of the basic healthcare system in Brazil: the District System of Sanitation Administration].

    PubMed

    Campos, Carlos Eduardo Aguilera

    2007-01-01

    There exists an interaction between multiple issues involving policy making, the building of knowledge and the implementation of practices in the health sector, which results in the particular way health services are provided in different historical contexts. The emergence and consolidation of sanitation organization was the result of a political process based on an idea of meeting the needs perceived in a given historical context. The historical course taken by the basic healthcare system in Brazil is analyzed from the perspective of its organizational and welfare principles, its expansion in physical terms, and its function within the public health system between 1918 and 1942. The article seeks to describe in detail the antecedents and initiatives taken in the establishment of a district system of sanitation administration, first in Rio de Janeiro and later across Brazil, which was a precursor of the basic healthcare system in Brazil.

  10. Patient Populations, Clinical Associations, and System Efficiency in Healthcare Delivery System

    NASA Astrophysics Data System (ADS)

    Liu, Yazhuo

    The efforts to improve health care delivery usually involve studies and analysis of patient populations and healthcare systems. In this dissertation, I present the research conducted in the following areas: identifying patient groups, improving treatments for specific conditions by using statistical as well as data mining techniques, and developing new operation research models to increase system efficiency from the health institutes' perspective. The results provide better understanding of high risk patient groups, more accuracy in detecting disease' correlations and practical scheduling tools that consider uncertain operation durations and real-life constraints.

  11. Develop security architecture for both in-house healthcare information systems and electronic patient record

    NASA Astrophysics Data System (ADS)

    Zhang, Jianguo; Chen, Xiaomeng; Zhuang, Jun; Jiang, Jianrong; Zhang, Xiaoyan; Wu, Dongqing; Huang, H. K.

    2003-05-01

    In this paper, we presented a new security approach to provide security measures and features in both healthcare information systems (PACS, RIS/HIS), and electronic patient record (EPR). We introduced two security components, certificate authoring (CA) system and patient record digital signature management (DSPR) system, as well as electronic envelope technology, into the current hospital healthcare information infrastructure to provide security measures and functions such as confidential or privacy, authenticity, integrity, reliability, non-repudiation, and authentication for in-house healthcare information systems daily operating, and EPR exchanging among the hospitals or healthcare administration levels, and the DSPR component manages the all the digital signatures of patient medical records signed through using an-symmetry key encryption technologies. The electronic envelopes used for EPR exchanging are created based on the information of signers, digital signatures, and identifications of patient records stored in CAS and DSMS, as well as the destinations and the remote users. The CAS and DSMS were developed and integrated into a RIS-integrated PACS, and the integration of these new security components is seamless and painless. The electronic envelopes designed for EPR were used successfully in multimedia data transmission.

  12. Medical overuse in the Iranian healthcare system: a systematic review protocol.

    PubMed

    Arab-Zozani, Morteza; Pezeshki, Mohammad Zakaria; Khodayari-Zarnaq, Rahim; Janati, Ali

    2018-04-17

    Lack of resources is one of the main problems of all healthcare systems. Recent studies have shown that reducing the overuse of medical services plays an important role in reducing healthcare system costs. Overuse of medical services is a major problem in the healthcare system, and it threatens the quality of the services, can harm patients and create excess costs for patients. So far, few studies have been conducted in this regard in Iran. The main objective of this systematic review is to perform an inclusive search for studies that report overuse of medical services in the Iranian healthcare system. An extensive search of the literature will be conducted in six databases including PubMed, Embase, Scopus, Web of Science, Cochrane and Scientific Information Database using a comprehensive search strategy to identify studies on overuse of medical care. The search will be done without time limit until the end of 2017, completed by reference tracking, author tracking and expert consultation. The search will be conducted on 1 February 2018. Any study that reports an overuse in a service based on a specific standard will be included in the study. Two reviewers will screen the articles based on the title, abstract and full text, and extract data about type of service, clinical area and overuse rate. Quality appraisal will be assessed using the Joanna Briggs Institute checklist. Potential discrepancies will be resolved by consulting a third author. Recommendations will be made to the Iranian MOHME (Ministry of Health and Medical Education) in order to make better evidence-based decisions about medical services in the future. CRD42017075481. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Embedded sensor systems for health - providing the tools in future healthcare.

    PubMed

    Lindén, Maria; Björkman, Mats

    2014-01-01

    Wearable, embedded sensor systems for health applications are foreseen to be enablers in the future healthcare. They will provide ubiquitous monitoring of multiple parameters without restricting the person to stay at home or in the hospital. By following trend changes in the health status, early deteriorations will be detected and treatment can start earlier. Also health prevention will be supported. Such future healthcare requires technology development, including miniaturized sensors, smart textiles and wireless communication. The tremendous amount of data generated by these systems calls for both signal processing and decision support to guarantee the quality of data and avoid overflow of information. Safe and secure communications have to protect the integrity of the persons monitored.

  14. What really matters to healthcare consumers.

    PubMed

    Jennings, Bonnie Mowinski; Heiner, Stacy L; Loan, Lori A; Hemman, Eileen A; Swanson, Kristen M

    2005-04-01

    Consumer satisfaction with healthcare is an important quality and outcome indicator. Satisfaction may be at the crux of survival for healthcare delivery systems because it creates the competitive edge in healthcare. To better understand patient satisfaction by examining consumer healthcare experiences and expectations, a study was conducted. An important concept identified in the data, MY CARE, refers to a constellation of quality healthcare features that were wished for by all participants and realized by only some of them. The features of MY CARE offer lessons for all healthcare leaders to use when making improvements in care delivery systems-improvements that could create a more patient-centered healthcare system and boost patient satisfaction.

  15. Professional Competencies for Student Affairs Practice

    ERIC Educational Resources Information Center

    Munsch, Patty; Cortez, Lori

    2014-01-01

    The purpose of this chapter is to explore the integration of the ACPA/NASPA Professional Competency Areas for Student Affairs Practitioners (ACPA/NASPA, 2010) on community college campuses. The competencies provide specific skill sets for a broad range of student affairs practice areas that should be met by professionals throughout their careers.…

  16. 3D printing of wearable fractal-based sensor systems for neurocardiology and healthcare

    NASA Astrophysics Data System (ADS)

    Ramasamy, Mouli; Varadan, Vijay K.

    2017-04-01

    Neurocardiology is the pathophysiological interplay of nervous and cardiovascular systems. The communication between the heart and brain has revealed various methodologies in healthcare that could be investigated to study the heart-brain interactions and other cardiovascular and neurological diseases. A textile based wearable nanosensor system in the form of e-bra, e-shirt, e-headband, e-brief, underwear etc, was presented in this SPIE conferences earlier for noninvasive recording of EEG and EKG, and showing the correlation between the brain and heart signals. In this paper, the technology is expanded further using fractal based geometries using 3D printing system for low cost and flexible wearable sensor system for healthcare.

  17. Return Migrants’ Experience of Access to Care in Corrupt Healthcare Systems: The Bosnian Example

    PubMed Central

    Neerup Handlos, Line; Fog Olwig, Karen; Bygbjerg, Ib Christian; Norredam, Marie

    2016-01-01

    Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants’ access to healthcare is affected by corruption is largely unstudied, even though return migrants may be particularly vulnerable to problems related to corruption due to their period of absence from their country of origin. This article investigates how corruption in the healthcare sector affects access to healthcare for refugees who repatriated to Bosnia, a country with a high level of corruption, from Denmark, a country with a low level of corruption. The study is based on 18 semi-structured interviews with 33 refugees who returned after long-term residence in Denmark. We found that the returned refugees faced greater problems with corruption than was the case for those who had not left the country, as doctors considered them to be better endowed financially and therefore demanded larger bribes from them than they did from those who had remained in Bosnia. Moreover, during their stay abroad the returnees had lost the connections that could have helped them sidestep the corruption. Returned refugees are thus particularly vulnerable to the effects of corruption. PMID:27657096

  18. Return Migrants' Experience of Access to Care in Corrupt Healthcare Systems: The Bosnian Example.

    PubMed

    Neerup Handlos, Line; Fog Olwig, Karen; Bygbjerg, Ib Christian; Norredam, Marie

    2016-09-19

    Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants' access to healthcare is affected by corruption is largely unstudied, even though return migrants may be particularly vulnerable to problems related to corruption due to their period of absence from their country of origin. This article investigates how corruption in the healthcare sector affects access to healthcare for refugees who repatriated to Bosnia, a country with a high level of corruption, from Denmark, a country with a low level of corruption. The study is based on 18 semi-structured interviews with 33 refugees who returned after long-term residence in Denmark. We found that the returned refugees faced greater problems with corruption than was the case for those who had not left the country, as doctors considered them to be better endowed financially and therefore demanded larger bribes from them than they did from those who had remained in Bosnia. Moreover, during their stay abroad the returnees had lost the connections that could have helped them sidestep the corruption. Returned refugees are thus particularly vulnerable to the effects of corruption.

  19. Android based self-diagnostic electrocardiogram system for mobile healthcare.

    PubMed

    Choo, Kan-Yeep; Ling, Huo-Chong; Lo, Yew-Chiong; Yap, Zuo-Han; Pua, Jun-Sheng; Phan, Raphael C-W; Goh, Vik-Tor

    2015-01-01

    Cardiovascular diseases are the most common cause of death worldwide and are characterized by arrhythmia (i.e. irregular rhythm of heartbeat). Arrhythmia occasionally happens under certain conditions, such as stress. Therefore, it is difficult to be diagnosed using electrocardiogram (ECG) devices available in hospitals for just a few minutes. Constant diagnosis and monitoring of heartbeat is required to reduce death caused by cardiovascular diseases. Mobile healthcare system has emerged as a potential solution to assist patients in monitoring their own heart condition, especially those who are isolated from the reference hospital. This paper proposes a self-diagnostic electrocardiogram system for mobile healthcare that has the capability to perform a real-time ECG diagnostic. The self-diagnostic capability of a real-time ECG signal is achieved by implementing a detrended fluctuation analysis (DFA) method. The result obtained from DFA is used to display the patient's health condition on a smartphone anytime and anywhere. If the health condition is critical, the system will alert the patient and his medical practitioner for further diagnosis. Experimental results verified the validity of the developed ECG diagnostic application on a smartphone. The proposed system can potentially reduce death caused by cardiovascular diseases by alerting the patient possibly undergoing a heart attack.

  20. How are homeless people treated in the healthcare system and other societal institutions? Study of their experiences and trust.

    PubMed

    Irestig, Robert; Burström, Kristina; Wessel, Maja; Lynöe, Niels

    2010-05-01

    To elucidate the perceived treatment that the homeless have received from the healthcare and other societal organisations and to present homeless persons' trust in the healthcare system and suggestions of necessary changes for improving it. Homeless individuals in special houses and institutions in the County of Stockholm were asked to answer a short version of a public health survey, including added questions about how they experienced the healthcare providers' attitudes towards them and how much trust they had in the healthcare system. A total of 155 homeless persons (123 male and 32 female) were interviewed. Three-quarters of the participants stated that they had fairly or very high trust in healthcare services and also felt that they had been fairly or very well treated. Fewer females than males reported being treated well and they declared a lower degree of trust in the healthcare system. The homeless suggest that extra resources be set aside to organise their healthcare, including a higher level of knowledge of the medical problems prevailing in the group. Those who felt badly treated also asked for less neglect and disrespect from the healthcare staff. Even though a majority experience that they are being well treated within the healthcare system, the study also indicated disadvantages in the treatment of homeless persons in Sweden. The study also reveals an imbalance between the official ethical framework in Sweden and of the specific moral of some individual healthcare providers. One way to facilitate their entry into the healthcare system might be to create special surgeries for the homeless.

  1. JPRS Report, Soviet Union, Political Affairs

    DTIC Science & Technology

    1989-07-27

    member of a committee for investigating personal affairs, without verbal affectation : "Better that I buy a bottle of vodka or bite of sausage with...schlock—Indian junk, "Bingo- Bongo ." saccharin melodramas, and simi- lar nonsense. We currently are standing up for our principles and are attempting...tion conditions force the movie theaters to give prece- dence to "Bingo- Bongo ." Finally, we must confess, the system governing our relations

  2. Task Force 62 Medical Brigade combat healthcare support system in the mature Iraq theater of operations.

    PubMed

    Sargent, Patrick D

    2008-01-01

    Leading a deployed combat healthcare system is a very complex task and requires a command and control structure that is a unique blend of technical and tactical expertise to efficaciously deliver world-class medical care to America's sons and daughters. The medical task force in Iraq has successfully managed the transformation of the medical footprint from a tactically arrayed set of disparate medical units to a nascent integrated healthcare system with many features similar to the best healthcare systems in the United States. The American public demands, and Soldiers, Marines, Sailors, Airmen, and Coast Guardsmen deserve US quality medical care, whether they are being treated at a military medical center in the US, or a US medical facility in Iraq. This article presents an overview of the 62nd Medical Brigade's development of the combat healthcare support system during its tenure leading the US medical task force in Iraq.

  3. Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities.

    PubMed

    Manyazewal, Tsegahun

    2017-01-01

    Acknowledging the health system strengthening agenda, the World Health Organization (WHO) has formulated a health systems framework that describes health systems in terms of six building blocks. This study aimed to determine the current status of the six WHO health system building blocks in public healthcare facilities in Ethiopia. A quantitative, cross-sectional study was conducted in five public hospitals in central Ethiopia which were in a post-reform period. A self-administered, structured questionnaire which covered the WHO's six health system building blocks was used to collect data on healthcare professionals who consented. Data was analyzed using IBM SPSS version 20. The overall performance of the public hospitals was 60% when weighed against the WHO building blocks which, in this procedure, needed a minimum of 80% score. For each building block, performance scores were: information 53%, health workforce 55%, medical products and technologies 58%, leadership and governance 61%, healthcare financing 62%, and service delivery 69%. There existed a significant difference in performance among the hospitals ( p  < .001). The study proved that the WHO's health system building blocks are useful for assessing the process of strengthening health systems in Ethiopia. The six blocks allow identifying different improvement opportunities in each one of the hospitals. There was no contradiction between the indicators of the WHO building blocks and the health sustainable development goal (SDG) objectives. However, such SDG objectives should not be a substitute for strategies to strengthen health systems.

  4. Comparison of metoprolol succinate versus carvedilol in time to cardiovascular admission in a Veterans Affairs healthcare system: An observational study.

    PubMed

    Church, Kara M; Henalt, Robert; Baker, Errol; Smith, Gary L; Brennan, Michael T; Joseph, Jacob

    2015-12-01

    To determine if metoprolol succinate or carvedilol is more effective in delaying the time to first cardiovascular disease hospital admission in systolic heart failure patients. As a secondary objective, to determine the most effective dose of each agent in delaying first cardiovascular disease hospital admission, including but not limited to heart failure exacerbation, myocardial infarction, ischemic heart disease, cardiac arrhythmias, or death. This study was a retrospective chart review of 272 veterans at the VA Boston Healthcare System newly started on metoprolol succinate (n = 157) or carvedilol (n = 115) between January 2000 and December 2008. After an 8-week study medication titration period, subjects were subcategorized into low-, medium-, and high-dose ranging groups and followed until the first cardiovascular disease hospitalization, death, or 365 days. The main outcome measure was time to first cardiovascular hospitalization or death. The mean age (69.9 years vs. 67.9 years) and ejection fraction (26% vs. 25%) were comparable between study arms at baseline. Mean time to first cardiovascular disease hospitalization was significantly different (p = 0.001) between study groups with 330.6 days with in metoprolol succinate group vs. 282.6 days in the carvedilol groups. High-dose carvedilol significantly delayed time to first hospitalization in comparison to medium or low carvedilol doses (p = 0.015, p = 0.005). Low- and high-dose metoprolol succinate were not significantly different (p = 0.509) in time to first event, and both dosing groups fared better compared to medium dose metoprolol succinate (p = 0.046). In this veteran patient population in need of additional heart failure treatments, metoprolol succinate use resulted in a delayed time to first cardiovascular disease hospitalization or death compared to carvedilol. Both low and high doses of metoprolol succinate showed a significant delay of time to first cardiovascular hospitalization compared to

  5. Ignorance is not bliss: The effect of systematic information on immigrants' knowledge of and satisfaction with the Danish healthcare system.

    PubMed

    Jervelund, Signe Smith; Maltesen, Thomas; Wimmelmann, Camilla Lawaetz; Petersen, Jørgen Holm; Krasnik, Allan

    2017-03-01

    Suboptimal healthcare utilisation and lower satisfaction with the patient-doctor encounter among immigrants has been documented. Immigrants' lack of familiarity with the healthcare system has been proposed as an explanation for this. This study investigated whether a systematic delivery of information affected immigrants' knowledge of and satisfaction with the Danish healthcare system. A prospective, randomised intervention study of 1158 adult immigrants attending two language schools in Copenhagen was conducted. Two intervention groups received written information or a 12-hour course on the Danish healthcare system, while a control group received nothing. Survey data included self-assessed knowledge, true/false questions on access and questions relating to satisfaction with the healthcare system. Data were linked to socioeconomic registry data. Logistic regression analyses were performed. The course improved knowledge of who to contact in the event of an accident (odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.56-4.59) but not in the event of illness. Further, it positively affected correct answers for nine out of 11 questions on the healthcare system (varying from OR = 1.87, 95% CI = 1.08-3.24 to OR = 3.11, 95% CI = 1.58-6.11). Written information positively affected correct answers for three out of 11 questions, but negatively affected one out of 11 compared with the control group. Neither intervention affected immigrants' satisfaction with the healthcare system. Knowledge of the healthcare system is necessary for optimal healthcare-seeking behaviour. The results may form the basis of national and international changes in immigrant reception and optimise immigrants' contact with the healthcare system.

  6. Redefining Student Affairs through Digital Technology: A Ten-Year Historiography of Digital Technology Use by Student Affairs Administrators

    ERIC Educational Resources Information Center

    Cabellon, Edmund T.

    2016-01-01

    The student affairs profession is at a crossroads (Torres & Walbert, 2010) given digital technology's growth and the academy's administrative expansion (Bowen, 2013). Student affairs administrators must simultaneously respond to digital technology's implications in students' lives (Kirschner & Karpinski, 2010) and to new state and federal…

  7. Student Affairs Assessment, Strategic Planning, and Accreditation

    ERIC Educational Resources Information Center

    Fallucca, Amber

    2017-01-01

    This chapter illustrates how student affairs units participate in accreditation across regional agency expectations and program-level requirements. Strategies for student affairs units to engage in campus strategic planning processes to further highlight their contributions are also recommended.

  8. Civil Affairs in Unconventional Warfare

    DTIC Science & Technology

    2013-05-23

    goals as Mao Tse -tung states, “Military action is a method used to attain a political goal. While military affairs and political affairs are not...OSS to Green Beret: The Birth at Special Forces (Novato, CA: Presidio Press, 1986), 149-51. 25Mao Tse -tung, On Guerrilla Warfare (New York: Classic...House Books, 2009), 39. 26David Galula, Counterinsurgency Warfare, 4; and Mao Tse -tung, On Guerrilla Warfare, 3-4. 27Ibid., 12-13. 28Ibid

  9. Healthcare information system approaches based on middleware concepts.

    PubMed

    Holena, M; Blobel, B

    1997-01-01

    To meet the challenges for efficient and high-level quality, health care systems must implement the "Shared Care" paradigm of distributed co-operating systems. To this end, both the newly developed and legacy applications must be fully integrated into the care process. These requirements can be fulfilled by information systems based on middleware concepts. In the paper, the middleware approaches HL7, DHE, and CORBA are described. The relevance of those approaches to the healthcare domain is documented. The description presented here is complemented through two other papers in this volume, concentrating on the evaluation of the approaches, and on their security threats and solutions.

  10. Healthcare vulnerabilities to electromagnetic pulse.

    PubMed

    Ross, Lenard H; Mihelic, F Matthew

    2008-01-01

    The U.S. healthcare system is particularly vulnerable to the effects of electromagnetic pulse (EMP) attack because of the system's technological sophistication, but while national defense planners prepare for the considerable threat that EMP poses, there has been little or no recognition of this threat within the US healthcare community, and neither has there been any significant healthcare planning to deal with such an eventuality. Recognition of the risk presented by EMP, and advance institution of appropriate strategies to mitigate its effects on the healthcare system, could enable the preservation of much of that system's function in the face of EMP-related disruptions, and will greatly further all-hazards disaster preparations.

  11. 75 FR 6227 - Advisory Committee on Veterans Business Affairs

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-08

    ... Business Administration. ACTION: Notice of open Federal Advisory Committee meeting. SUMMARY: The SBA is... Committee on Veterans Business Affairs. The meeting will be open to the public. DATES: Thursday, February 18... Affairs. The Advisory Committee on Veterans Business Affairs serves as an independent source of advice and...

  12. Integrating patient voices into health information for self-care and patient-clinician partnerships: Veterans Affairs design recommendations for patient-generated data applications.

    PubMed

    Woods, Susan S; Evans, Neil C; Frisbee, Kathleen L

    2016-05-01

    Electronic health record content is created by clinicians and is driven largely by intermittent and brief encounters with patients. Collecting data directly from patients in the form of patient-generated data (PGD) provides an unprecedented opportunity to capture personal, contextual patient information that can supplement clinical data and enhance patients' self-care. The US Department of Veterans Affairs (VA) is striving to implement the enterprise-wide capability to collect and use PGD in order to partner with patients in their care, improve the patient healthcare experience, and promote shared decision making. Through knowledge gained from Veterans' and healthcare teams' perspectives, VA created a taxonomy and an evolving framework on which to design and develop applications that capture and help physicians utilize PGD. Ten recommendations for effectively collecting and integrating PGD into patient care are discussed, addressing health system culture, data value, architecture, policy, data standards, clinical workflow, data visualization, and analytics and population reach. Published by Oxford University Press on behalf of the American Medical Informatics Association 2016. This work is written by US Government employees and is in the public domain in the US.

  13. Cancer management: the difficulties of a target-driven healthcare system.

    PubMed

    Anderson, Beverley

    This article gives a reflective overview on cancer management from a urological perspective. It is based on anecdotal evidence and observations of local practice, and highlights some of the inherent difficulties of delivering a robust service in a target-driven healthcare system. Cancer is a complex disease. It is crucial that stringent measures are used to ensure those affected by it receive care that is of the highest quality, delivered in a timely manner, and tailored to meet the individual's needs. In 2000, the Government's attempt to increase competition among healthcare providers in the delivery of care, and thereby healthcare quality and efficiency, resulted in a number of healthcare reforms being introduced in the UK. Central to these were the NHS Cancer Waiting Time standards, which were designed to fast-track care delivery in the management of cancer patients. The multidisciplinary teams play a pivotal role in this process and their contribution is imperative to achieving the desired outcomes. It is acknowledged that targets can be beneficial, but there are clear unintended consequences as well. Increases in urgent referrals result in significant screening demands and, consequently, newly diagnosed cancers. This, combined with factors such as patient choice and costs, put added pressure on NHS establishments and health professionals to deliver care within the target specifications.

  14. An effectiveness analysis of healthcare systems using a systems theoretic approach.

    PubMed

    Chuang, Sheuwen; Inder, Kerry

    2009-10-24

    The use of accreditation and quality measurement and reporting to improve healthcare quality and patient safety has been widespread across many countries. A review of the literature reveals no association between the accreditation system and the quality measurement and reporting systems, even when hospital compliance with these systems is satisfactory. Improvement of health care outcomes needs to be based on an appreciation of the whole system that contributes to those outcomes. The research literature currently lacks an appropriate analysis and is fragmented among activities. This paper aims to propose an integrated research model of these two systems and to demonstrate the usefulness of the resulting model for strategic research planning. To achieve these aims, a systematic integration of the healthcare accreditation and quality measurement/reporting systems is structured hierarchically. A holistic systems relationship model of the administration segment is developed to act as an investigation framework. A literature-based empirical study is used to validate the proposed relationships derived from the model. Australian experiences are used as evidence for the system effectiveness analysis and design base for an adaptive-control study proposal to show the usefulness of the system model for guiding strategic research. Three basic relationships were revealed and validated from the research literature. The systemic weaknesses of the accreditation system and quality measurement/reporting system from a system flow perspective were examined. The approach provides a system thinking structure to assist the design of quality improvement strategies. The proposed model discovers a fourth implicit relationship, a feedback between quality performance reporting components and choice of accreditation components that is likely to play an important role in health care outcomes. An example involving accreditation surveyors is developed that provides a systematic search for

  15. Accessing VA Healthcare During Large-Scale Natural Disasters.

    PubMed

    Der-Martirosian, Claudia; Pinnock, Laura; Dobalian, Aram

    2017-01-01

    Natural disasters can lead to the closure of medical facilities including the Veterans Affairs (VA), thus impacting access to healthcare for U.S. military veteran VA users. We examined the characteristics of VA patients who reported having difficulty accessing care if their usual source of VA care was closed because of natural disasters. A total of 2,264 veteran VA users living in the U.S. northeast region participated in a 2015 cross-sectional representative survey. The study used VA administrative data in a complex stratified survey design with a multimode approach. A total of 36% of veteran VA users reported having difficulty accessing care elsewhere, negatively impacting the functionally impaired and lower income VA patients.

  16. 78 FR 34702 - Foreign Affairs Policy Board Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-10

    ... STATE DEPARTMENT [Public Notice 8350] Foreign Affairs Policy Board Meeting Notice Closed Meeting... announces a meeting of the Foreign Affairs Policy Board to take place on July 15, 2013, at the Department of State, Washington, DC. The Foreign Affairs Policy Board reviews and assesses: (1) Global threats and...

  17. Healthcare software assurance.

    PubMed

    Cooper, Jason G; Pauley, Keith A

    2006-01-01

    Software assurance is a rigorous, lifecycle phase-independent set of activities which ensure completeness, safety, and reliability of software processes and products. This is accomplished by guaranteeing conformance to all requirements, standards, procedures, and regulations. These assurance processes are even more important when coupled with healthcare software systems, embedded software in medical instrumentation, and other healthcare-oriented life-critical systems. The current Food and Drug Administration (FDA) regulatory requirements and guidance documentation do not address certain aspects of complete software assurance activities. In addition, the FDA's software oversight processes require enhancement to include increasingly complex healthcare systems such as Hospital Information Systems (HIS). The importance of complete software assurance is introduced, current regulatory requirements and guidance discussed, and the necessity for enhancements to the current processes shall be highlighted.

  18. Healthcare Software Assurance

    PubMed Central

    Cooper, Jason G.; Pauley, Keith A.

    2006-01-01

    Software assurance is a rigorous, lifecycle phase-independent set of activities which ensure completeness, safety, and reliability of software processes and products. This is accomplished by guaranteeing conformance to all requirements, standards, procedures, and regulations. These assurance processes are even more important when coupled with healthcare software systems, embedded software in medical instrumentation, and other healthcare-oriented life-critical systems. The current Food and Drug Administration (FDA) regulatory requirements and guidance documentation do not address certain aspects of complete software assurance activities. In addition, the FDA’s software oversight processes require enhancement to include increasingly complex healthcare systems such as Hospital Information Systems (HIS). The importance of complete software assurance is introduced, current regulatory requirements and guidance discussed, and the necessity for enhancements to the current processes shall be highlighted. PMID:17238324

  19. Exploring the Barriers: A Qualitative Study about the Experiences of Mid-SES Roma Navigating the Spanish Healthcare System.

    PubMed

    Aiello, Emilia; Flecha, Ainhoa; Serradell, Olga

    2018-02-22

    Whereas the topic of the 'cultural sensitivity' of healthcare systems has been addressed extensively in the US and the UK, literature on the subject in most European countries, specifically looking at the situation of Roma, is still scarce. Drawing on qualitative research conducted mainly in the city of Barcelona under the communicative approach with Roma subjects who have stable socioeconomic positions and higher cultural capitals (end-users, professionals of the healthcare system, and key informants of a regional policy oriented to the improvement of Roma living conditions), the present study aims to fill this gap. We explore the barriers that the Roma face in accessing the healthcare system, reflecting on how these barriers are accentuated by the existing anti-Roma prejudices and institutional arrangements that do not account for minority cultures. Our results point out a series of obstacles at two levels, in the interaction with healthcare professionals, and in relation to existing institutional arrangements, which prevent Roma families from having equal access to the healthcare system. Education stands up as a mechanism to contest anti-Roma sentiments among healthcare professionals.

  20. Developing and deploying a community healthcare worker-driven, digitally- enabled integrated care system for municipalities in rural Nepal.

    PubMed

    Citrin, David; Thapa, Poshan; Nirola, Isha; Pandey, Sachit; Kunwar, Lal Bahadur; Tenpa, Jasmine; Acharya, Bibhav; Rayamazi, Hari; Thapa, Aradhana; Maru, Sheela; Raut, Anant; Poudel, Sanjaya; Timilsina, Diwash; Dhungana, Santosh Kumar; Adhikari, Mukesh; Khanal, Mukti Nath; Pratap Kc, Naresh; Acharya, Bhim; Karki, Khem Bahadur; Singh, Dipendra Raman; Bangura, Alex Harsha; Wacksman, Jeremy; Storisteanu, Daniel; Halliday, Scott; Schwarz, Ryan; Schwarz, Dan; Choudhury, Nandini; Kumar, Anirudh; Wu, Wan-Ju; Kalaunee, S P; Chaudhari, Pushpa; Maru, Duncan

    2018-06-04

    Integrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in affordable digital technologies and community healthcare workers offer an opportunity to address this challenge. We describe the development of an integrated care system involving community healthcare worker networks that utilize a home-to-facility electronic health record platform for rural municipalities in Nepal. Key aspects of our approach of relevance to a global audience include: community healthcare workers continuously engaging with populations through household visits every three months; community healthcare workers using digital tools during the routine course of clinical care; individual and population-level data generated routinely being utilized for program improvement; and being responsive to privacy, security, and human rights concerns. We discuss implementation, lessons learned, challenges, and opportunities for future directions in integrated care delivery systems. Copyright © 2018 Elsevier Inc. All rights reserved.

  1. [Development method of healthcare information system integration based on business collaboration model].

    PubMed

    Li, Shasha; Nie, Hongchao; Lu, Xudong; Duan, Huilong

    2015-02-01

    Integration of heterogeneous systems is the key to hospital information construction due to complexity of the healthcare environment. Currently, during the process of healthcare information system integration, people participating in integration project usually communicate by free-format document, which impairs the efficiency and adaptability of integration. A method utilizing business process model and notation (BPMN) to model integration requirement and automatically transforming it to executable integration configuration was proposed in this paper. Based on the method, a tool was developed to model integration requirement and transform it to integration configuration. In addition, an integration case in radiology scenario was used to verify the method.

  2. Faculty and Student Affairs Collaboration in the Corporate University

    ERIC Educational Resources Information Center

    Harrison, Laura M.

    2013-01-01

    Faculty, student affairs professionals, and most importantly, students, are paying the price as institutions of higher education increasingly operate in a top-down manner with an over-emphasis on the bottom line. The corporatization of higher education creates lopsided reward (and punishment) systems for faculty, unreasonably stressful…

  3. Reliable in their failure: an analysis of healthcare reform policies in public systems.

    PubMed

    Contandriopoulos, Damien; Brousselle, Astrid

    2010-05-01

    In this paper, we analyze recommendations of past governmental commissions and their implementation in Quebec as a case to discuss the obstacles that litter the road to healthcare system reform. Our analysis shows that the obstacles to tackling the healthcare system's main problems may have less to do with programmatic (what to do) than with political and governance (how to do it) questions. We then draw on neo-institutional theory to discuss the causes and effects of this situation. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

  4. The role of privacy protection in healthcare information systems adoption.

    PubMed

    Hsu, Chien-Lung; Lee, Ming-Ren; Su, Chien-Hui

    2013-10-01

    Privacy protection is an important issue and challenge in healthcare information systems (HISs). Recently, some privacy-enhanced HISs are proposed. Users' privacy perception, intention, and attitude might affect the adoption of such systems. This paper aims to propose a privacy-enhanced HIS framework and investigate the role of privacy protection in HISs adoption. In the proposed framework, privacy protection, access control, and secure transmission modules are designed to enhance the privacy protection of a HIS. An experimental privacy-enhanced HIS is also implemented. Furthermore, we proposed a research model extending the unified theory of acceptance and use of technology by considering perceived security and information security literacy and then investigate user adoption of a privacy-enhanced HIS. The experimental results and analyses showed that user adoption of a privacy-enhanced HIS is directly affected by social influence, performance expectancy, facilitating conditions, and perceived security. Perceived security has a mediating effect between information security literacy and user adoption. This study proposes several implications for research and practice to improve designing, development, and promotion of a good healthcare information system with privacy protection.

  5. Development of online diary and self-management system on e-Healthcare for asthmatic children in Taiwan.

    PubMed

    Lin, Hsueh-Chun; Chiang, Li-Chi; Wen, Tzu-Ning; Yeh, Kuo-Wei; Huang, Jing-Long

    2014-10-01

    Many regional programs of the countries educate asthmatic children and their families to manage healthcare data. This study aims to establish a Web-based self-management system, eAsthmaCare, to promote the electronic healthcare (e-Healthcare) services for the asthmatic children in Taiwan. The platform can perform real time online functionality based upon a five-tier infrastructure with mutually supportive components to acquire asthma diaries, quality of life assessments and health educations. We have designed five multi-disciplinary portions on the interactive interface functioned with the analytical diagrams: (1) online asthma diary, (2) remote asthma assessment, (3) instantaneous asthma alert, (4) diagrammatical clinic support, and (5) asthma health education. The Internet-based asthma diary and assessment program was developed for patients to process self-management healthcare at home. In addition, the online analytical charts can help healthcare professionals to evaluate multi-domain health information of patients immediately. eAsthmaCare was developed by Java™ Servlet/JSP technology upon Apache Tomcat™ web server and Oracle™ database. Forty-one voluntary asthmatic children (and their parents) were intervened to examine the proposed system. Seven domains of satisfiability assessment by using the system were applied for approving the development. The average scores were scaled in the acceptable range for each domain to ensure feasibility of the proposed system. The study revealed the details of system infrastructure and developed functions that can help asthmatic children in self-management for healthcare to enhance communications between patients and hospital professionals. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Design and implementation of a smart card based healthcare information system.

    PubMed

    Kardas, Geylani; Tunali, E Turhan

    2006-01-01

    Smart cards are used in information technologies as portable integrated devices with data storage and data processing capabilities. As in other fields, smart card use in health systems became popular due to their increased capacity and performance. Their efficient use with easy and fast data access facilities leads to implementation particularly widespread in security systems. In this paper, a smart card based healthcare information system is developed. The system uses smart card for personal identification and transfer of health data and provides data communication via a distributed protocol which is particularly developed for this study. Two smart card software modules are implemented that run on patient and healthcare professional smart cards, respectively. In addition to personal information, general health information about the patient is also loaded to patient smart card. Health care providers use their own smart cards to be authenticated on the system and to access data on patient cards. Encryption keys and digital signature keys stored on smart cards of the system are used for secure and authenticated data communication between clients and database servers over distributed object protocol. System is developed on Java platform by using object oriented architecture and design patterns.

  7. An exploration of the enablers and barriers in access to the Dutch healthcare system among Ghanaians in Amsterdam

    PubMed Central

    2012-01-01

    Background Sub-Saharan African populations are growing in many European countries. Data on the health of these populations are rare. Additionally, many sub-Saharan African migrants are confronted with issues of low socio-economic status, acculturation and language difficulties, which may hamper their access to health care. Despite the identification of some of those barriers, little is known about the enabling factors. Knowledge about the enablers and barriers in access to healthcare experienced is important in addressing their health needs and promoting healthcare access. This study aimed to investigate the enabling factors as well as barriers in access to the Dutch healthcare system among the largest sub-Saharan African migrant group (Ghanaians) living in Amsterdam, the Netherlands. Methods Six focus groups were conducted from November 2009 to February 2010. A semi-structured interview guideline was used. Discussions were conducted in English or Twi (Ghanaian dialect), recorded and transcribed verbatim. Analysis was based on the Andersen model of healthcare utilisation using MAXQDA software. Results Knowledge and perceived quality of the health system, awareness of diseases, family and community support, community initiatives and availability of social support were the main enablers to the healthcare system. Difficulties with the Dutch language and mistrust in health care providers were major barriers in access to healthcare. Conclusions Access to healthcare is facilitated mainly by knowledge of and the perceived efficiency and quality of the Dutch healthcare system. However, poor Dutch language proficiency and mistrust in health care providers appear to be important barriers in accessing healthcare. The enablers and barriers identified by this study provide useful information for promoting healthcare access among this and similar Sub-Saharan African communities. PMID:22443162

  8. An exploration of the enablers and barriers in access to the Dutch healthcare system among Ghanaians in Amsterdam.

    PubMed

    Boateng, Linda; Nicolaou, Mary; Dijkshoorn, Henriëtte; Stronks, Karien; Agyemang, Charles

    2012-03-24

    Sub-Saharan African populations are growing in many European countries. Data on the health of these populations are rare. Additionally, many sub-Saharan African migrants are confronted with issues of low socio-economic status, acculturation and language difficulties, which may hamper their access to health care. Despite the identification of some of those barriers, little is known about the enabling factors. Knowledge about the enablers and barriers in access to healthcare experienced is important in addressing their health needs and promoting healthcare access. This study aimed to investigate the enabling factors as well as barriers in access to the Dutch healthcare system among the largest sub-Saharan African migrant group (Ghanaians) living in Amsterdam, the Netherlands. Six focus groups were conducted from November 2009 to February 2010. A semi-structured interview guideline was used. Discussions were conducted in English or Twi (Ghanaian dialect), recorded and transcribed verbatim. Analysis was based on the Andersen model of healthcare utilisation using MAXQDA software. Knowledge and perceived quality of the health system, awareness of diseases, family and community support, community initiatives and availability of social support were the main enablers to the healthcare system. Difficulties with the Dutch language and mistrust in health care providers were major barriers in access to healthcare. Access to healthcare is facilitated mainly by knowledge of and the perceived efficiency and quality of the Dutch healthcare system. However, poor Dutch language proficiency and mistrust in health care providers appear to be important barriers in accessing healthcare. The enablers and barriers identified by this study provide useful information for promoting healthcare access among this and similar Sub-Saharan African communities.

  9. Public trust in primary care doctors, the medical profession and the healthcare system among Redhill residents in Singapore.

    PubMed

    Lee, Yi Yong; Ng, Choon Ta; Siti Aishah, M Ghazalie; Ngiam, Ju Zheng; Tai, Bee Choo; Lim, Meng Kin; Hughes, Kenneth

    2007-08-01

    There have been few studies on public trust in doctors and healthcare systems and this is the first in Singapore. A cross-sectional survey was carried out in Redhill in January 2005. Citizens or Permanent Residents aged > or =18 years were randomly selected, one per household to avoid cluster bias, and 361 participated (response rate 68.7%). An interview administered questionnaire included 3 questionnaires measuring public trust: "Interpersonal Trust in Physicians Scale" for primary care doctors; "Trust in Physicians Generally Scale" for the medical profession; and "Trust in Healthcare System Scale" for the Healthcare System. Questions were answered on a Likert scale: 1. Strongly Disagree, 2. Disagree, 3. Neutral, 4. Agree, 5. Strongly Agree. Individual transformed scores of trust (range, 0 to 100) were equally divided into 5 categories with their average being the transformed mean. Trust in primary care doctors (mean 59.7) had proportions (prevalence rates) of: very low 0.3%, low 2.5%, neutral 40.4%, high 54.0%, and very high 2.8%. Trust in the medical profession (mean 61.8) had proportions of: very low 1.0%, low 7.7%, neutral 33.7%, high 47.0%, and very high 10.5%. Trust in the healthcare system (mean 61.5) had proportions of: very low 0.5%, low 4.1%, neutral 40.0%, high 48.7%, and very high 6.7%. For areas of the healthcare system, proportions of high/very high trust were: "Healthcare Providers' Expertise" (70.8%), "Quality of Care" (61.5%), "Patient Focus of Providers" (58.7%), "Information Supply and Communication by Care Providers" (52.3%), "Quality of Cooperation" (43.3%), and Policies of the Healthcare System" (24.6%). While low proportions had low/very low trust, the high proportions with neutral trust and the rather low level of trust in "Policies of the Healthcare System" are causes for concern.

  10. Health insurance coverage, income distribution and healthcare quality in local healthcare markets.

    PubMed

    Damianov, Damian S; Pagán, José A

    2013-08-01

    We develop a theoretical model of a local healthcare system in which consumers, health insurance companies, and healthcare providers interact with each other in markets for health insurance and healthcare services. When income and health status are heterogeneous, and healthcare quality is associated with fixed costs, the market equilibrium level of healthcare quality will be underprovided. Thus, healthcare reform provisions and proposals to cover the uninsured can be interpreted as an attempt to correct this market failure. We illustrate with a numerical example that if consumers at the local level clearly understand the linkages between health insurance coverage and the quality of local healthcare services, health insurance coverage proposals are more likely to enjoy public support. Copyright © 2012 John Wiley & Sons, Ltd.

  11. Rural Veteran Access to Healthcare Services: Investigating the Role of Information and Communication Technologies in Overcoming Spatial Barriers

    PubMed Central

    Schooley, Benjamin L; Horan, Thomas A; Lee, Pamela W; West, Priscilla A

    2010-01-01

    This multimethod pilot study examined patient and practitioner perspectives on the influence of spatial barriers to healthcare access and the role of health information technology in overcoming these barriers. The study included a survey administered to patients attending a Department of Veterans Affairs (VA) health visit, and a focus group with VA care providers. Descriptive results and focus group findings are presented. Spatial distance is a significant factor for many rural veterans when seeking healthcare. For this sample of rural veterans, a range of telephone, computer, and Internet technologies may become more important for accessing care as Internet access becomes more ubiquitous and as younger veterans begin using the VA health system. The focus group highlighted the negative impact of distance, economic considerations, geographic barriers, and specific medical conditions on access to care. Lack of adequate technology infrastructure was seen as an obstacle to utilization. This study discusses the need to consider distance, travel modes, age, and information technology infrastructure and adoption when designing health information technology to care for rural patients. PMID:20697468

  12. Geographic variation in cancer-related imaging: Veterans Affairs health care system versus Medicare.

    PubMed

    McWilliams, J Michael; Dalton, Jesse B; Landrum, Mary Beth; Frakt, Austin B; Pizer, Steven D; Keating, Nancy L

    2014-12-02

    Geographic variations in use of medical services have been interpreted as indirect evidence of wasteful care. Less overuse of services, however, may not be reliably associated with less geographic variation. To compare average use and geographic variation in use of cancer-related imaging between fee-for-service Medicare and the Department of Veterans Affairs (VA) health care system. Observational analysis of cancer-related imaging from 2003 to 2005 using Medicare and VA utilization data linked to cancer registry data. Multilevel models, adjusted for sociodemographic and tumor characteristics, were used to estimate mean differences in annual imaging use between cohorts of Medicare and VA patients within geographic areas and variation in use across areas for each cohort. 40 hospital referral regions. Older men with lung, colorectal, or prostate cancer, including 34,475 traditional Medicare beneficiaries (Medicare cohort) and 6835 VA patients (VA cohort). Per-patient count of imaging studies for which lung, colorectal, or prostate cancer was the primary diagnosis (each study weighted by a standardized price), and a direct measure of overuse-advanced imaging for prostate cancer at low risk for metastasis. Adjusted annual use of cancer-related imaging was lower in the VA cohort than in the Medicare cohort (price-weighted count, $197 vs. $379 per patient; P < 0.001), as was annual use of advanced imaging for prostate cancer at low risk for metastasis ($41 vs. $117 per patient; P < 0.001). Geographic variation in cancer-related imaging use was similar in magnitude in the VA and Medicare cohorts. Observational study design. Use of cancer-related imaging was lower in the VA health care system than in fee-for-service Medicare, but lower use was not associated with less geographic variation. Geographic variation in service use may not be a reliable indicator of the extent of overuse. Doris Duke Charitable Foundation and Department of Veterans Affairs Office of Policy and

  13. SOA governance in healthcare organisations.

    PubMed

    Koumaditis, Konstantinos; Themistocleous, Marinos; Vassilakopoulos, Georgios

    2013-01-01

    Service Oriented Architecture (SOA) is increasingly adopted by many sectors, including healthcare. Due to the nature of healthcare systems there is a need to increase SOA adoption success rates as the non integrated nature of healthcare systems is responsible for medical errors that cause the loss of tens of thousands patients per year. Following our previous research [1] we propose that SOA governance is a critical success factor for SOA success in healthcare. Literature reports multiple SOA governance models that have limitations and they are confusing. In addition to this, there is a lack of healthcare specific SOA governance models. This highlights a literature void and thus the purpose of this paper is to proposed a healthcare specific SOA governance framework.

  14. 17 CFR 200.15 - Office of International Affairs.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ORGANIZATION; CONDUCT AND ETHICS; AND INFORMATION AND REQUESTS Organization and Program Management General Organization § 200.15 Office of International Affairs. (a) The Office of International Affairs (“OIA”) is...

  15. A telemedicine system for wireless home healthcare based on Bluetooth and the Internet.

    PubMed

    Zhao, Xiaoming; Fei, Ding-Yu; Doarn, Charles R; Harnett, Brett; Merrell, Ronald

    2004-01-01

    The VitalPoll Telemedicine System (VTS) was designed and developed for wireless home healthcare. The aims of this study were: to design the architecture and communication methods for a telemedicine system; to implement a physiologic routing hub to collect data from different medical devices and sensors; and to evaluate the feasibility of this system for applications in wireless home healthcare. The VTS was built using Bluetooth wireless and Internet technologies with client/server architecture. Several medical devices, which acquire vital signs, such as real-time electrocardiogram signals, heart rate, body temperature, and activity (physical motion), were integrated into the VTS. Medical information and data were transmitted over short-range interface (USB, RS232), wireless communication, and the Internet. The medical results were stored in a database and presented using a web browser. The patient's vital signals can be collected, transmitted, and displayed in real time by the VTS. The experiments verified no data loss during Bluetooth and Internet communication. Bluetooth and the Internet provide enough bandwidth channels to tranmit these vital signs. The experimental results show that VTS may be suitable for a practical telemedicine system in home healthcare.

  16. Designing an architectural style for Pervasive Healthcare systems.

    PubMed

    Rafe, Vahid; Hajvali, Masoumeh

    2013-04-01

    Nowadays, the Pervasive Healthcare (PH) systems are considered as an important research area. These systems have a dynamic structure and configuration. Therefore, an appropriate method for designing such systems is necessary. The Publish/Subscribe Architecture (pub/sub) is one of the convenient architectures to support such systems. PH systems are safety critical; hence, errors can bring disastrous results. To prevent such problems, a powerful analytical tool is required. So using a proper formal language like graph transformation systems for developing of these systems seems necessary. But even if software engineers use such high level methodologies, errors may occur in the system under design. Hence, it should be investigated automatically and formally that whether this model of system satisfies all their requirements or not. In this paper, a dynamic architectural style for developing PH systems is presented. Then, the behavior of these systems is modeled and evaluated using GROOVE toolset. The results of the analysis show its high reliability.

  17. Association Between Statin Use and Risk for Keratinocyte Carcinoma in the Veterans Affairs Topical Tretinoin Chemoprevention Trial

    PubMed Central

    Dore, David D.; Lapane, Kate L.; Trivedi, Amal N.; Mor, Vincent; Weinstock, Martin A.

    2013-01-01

    Background Recent evidence suggests that statins may prevent cancer. Objective To quantify the association between statin use and the occurrence of keratinocyte carcinoma in high-risk veterans. Design Cohort study. Setting 6 Veterans Affairs medical centers. Participants 1037 participants of the Veterans Affairs Topical Tretinoin Chemoprevention Trial, a randomized, multicenter, double-blind, vehicle-controlled trial of topical tretinoin, 0.1%, for prevention of keratinocyte carcinoma conducted from November 1998 to November 2004. Measurements Time to first occurrence of keratinocyte carcinoma on the face or ears. Participants using a statin at randomization, according to the Veterans Affairs Pharmacy Benefits Management database, were considered exposed. Study dermatologists conducted physical examinations at baseline and every 6 months during follow-up. The association between statin use at randomization and the outcome was evaluated by using propensity score matching (n = 608) and Cox proportional hazards regression (n = 1037). Results Among the 1037 participants, 37% used a statin at randomization (n = 397) for a median duration of at least 900 days over a median follow-up of 3.5 years. In the propensity score-matched analysis, statin use at randomization was not associated with keratinocyte carcinoma (rate ratio, 0.92 [95% CI, 0.73 to 1.16]), a finding that was consistent with the estimates derived from the Cox proportional hazards regression (rate ratio, 0.84 [CI, 0.70 to 1.02]). Limitations The extent of residual confounding is unknown, and the confidence bounds around the measures of association were wide. These data may not be generalizable to lower-risk populations. Conclusion These data show no conclusive or consistent relationship between long-term statin use and risk for keratinocyte carcinoma. Funding Department of Veterans Affairs, Agency for Healthcare Research and Quality, American Cancer Society, and National Institutes of Health. PMID:19124815

  18. Developing and Using Dashboard Indicators in Student Affairs Assessment

    ERIC Educational Resources Information Center

    Mitchell, Joshua J.; Ryder, Andrew J.

    2013-01-01

    Dashboard systems are increasingly popular as assessment and performance management tools in higher education. This chapter examines the use of dashboards in student affairs, including examples of key indicators and considerations for developing and implementing these tools. The chapter begins with an overview of the origins of dashboards, from…

  19. Interest in Use of Technology for Healthcare Among Veterans Receiving Treatment for Mental Health.

    PubMed

    Miller, Christopher J; McInnes, D Keith; Stolzmann, Kelly; Bauer, Mark S

    2016-10-01

    There is great interest in leveraging technology, including cell phones and computers, to improve healthcare. A range of e-health applications pertaining to mental health such as messaging for prescription refill or mobile device videoconferencing are becoming more available, but little is known about the mental health patient's interest in using these newer applications. We mailed a survey to 300 patients seen in the general mental health clinic of a local Veterans Affairs Medical Center. Survey questions focused on interest in use of cell phones, tablets, and other computers in patients' interactions with the healthcare system. A total of 74 patients, primarily treated for depression, post-traumatic stress disorder, or anxiety disorders, returned completed surveys. Nearly all reported having a cell phone (72/74, 97%), but fewer than half reported having a smartphone (35/74, 47%). Overall, a substantial majority (64/74, 86%) had access to an Internet-capable device (smartphone or computer, including tablets). Respondents appeared to prefer computers to cell phones for some health-related communications, but did not express differential interest for other tasks (such as receiving appointment reminders). Interest in use was higher among younger veterans. Most veterans with a mental health diagnosis have access to technology (including cell phones and computers) and are interested in using that technology for some types of healthcare-related communications. While there is capacity to utilize information technology for healthcare purposes in this population, interests vary widely, and a substantial minority does not have access to relevant devices. Although interest in using computers for health-related communication was higher than interest in using cell phones, single-platform technology-based interventions may nonetheless exclude crucial segments of the population.

  20. HL7 and DICOM based integration of radiology departments with healthcare enterprise information systems.

    PubMed

    Blazona, Bojan; Koncar, Miroslav

    2007-12-01

    Integration based on open standards, in order to achieve communication and information interoperability, is one of the key aspects of modern health care information systems. However, this requirement represents one of the major challenges for the Information and Communication Technology (ICT) solutions, as systems today use diverse technologies, proprietary protocols and communication standards which are often not interoperable. One of the main producers of clinical information in healthcare settings represent Radiology Information Systems (RIS) that communicate using widely adopted DICOM (Digital Imaging and COmmunications in Medicine) standard, but in very few cases can efficiently integrate information of interest with other systems. In this context we identified HL7 standard as the world's leading medical ICT standard that is envisioned to provide the umbrella for medical data semantic interoperability, which amongst other things represents the cornerstone for the Croatia's National Integrated Healthcare Information System (IHCIS). The aim was to explore the ability to integrate and exchange RIS originated data with Hospital Information Systems based on HL7's CDA (Clinical Document Architecture) standard. We explored the ability of HL7 CDA specifications and methodology to address the need of RIS integration HL7 based healthcare information systems. We introduced the use of WADO service interconnection to IHCIS and finally CDA rendering in widely used Internet explorers. The outcome of our pilot work proves our original assumption of HL7 standard being able to adopt radiology data into the integrated healthcare systems. Uniform DICOM to CDA translation scripts and business processes within IHCIS is desired and cost effective regarding to use of supporting IHCIS services aligned to SOA.

  1. The national response for preventing healthcare-associated infections: system capacity and sustainability for improvement.

    PubMed

    Mendel, Peter; Weinberg, Daniel A; Gall, Elizabeth M; Leuschner, Kristin J; Kahn, Katherine L

    2014-02-01

    Strengthening capacity across the healthcare system for improvement is critical to ensuring that past efforts and investments establish a foundation for sustaining progress in patient safety. The objective of this analysis was to identify key system capacity issues for sustainability from evaluation of the Action Plan to prevent healthcare-associated infections, a major national initiative launched by the US Department of Health and Human Services in 2009. The analysis involves the review and synthesis of results across the components of a 3-year evaluation of the Action Plan, as described in the evaluation framework and detailed in separate analyses elsewhere in this special issue. Data collection methods included interviews with government and private stakeholders, document and literature reviews, and observations of meetings and conferences at multiple time points. Key developments in healthcare-associated infection prevention system capacity were extracted on the basis of "major activities" identified through multiple methods and organized into the level of progress based on perspectives of multiple stakeholders. Activities within each level were then examined and compared according to our evaluation's framework of 4 system functions and 5 system properties. Key system capacity and sustainability issues for the Action Plan to be addressed centered on coordination and alignment (among participating agencies, with other federal initiatives, and across levels of healthcare), infrastructure for data and accountability (including more efficient technologies and unintended consequences), cultural embedding of prevention practices, and uncertainty and variability in resources. Sustainability depends on improvements across system functions and properties and how they reinforce each other. Change is more robust if different system elements support and incentivize behavior in similar directions.

  2. System-Level Shared Governance Structures and Processes in Healthcare Systems With Magnet®-Designated Hospitals: A Descriptive Study.

    PubMed

    Underwood, Carlisa M; Hayne, Arlene N

    The purpose was to identify and describe structures and processes of best practices for system-level shared governance in healthcare systems. Currently, more than 64.6% of US community hospitals are part of a system. System chief nurse executives (SCNEs) are challenged to establish leadership structures and processes that effectively and efficiently disseminate best practices for patients and staff across complex organizations, geographically dispersed locations, and populations. Eleven US healthcare SCNEs from the American Nurses Credentialing Center's repository of Magnet®-designated facilities participated in a 35-multiquestion interview based on Kanter's Theory of Organizational Empowerment. Most SCNEs reported the presence of more than 50% of the empowerment structures and processes in system-level shared governance. Despite the difficulties and complexities of growing health systems, SCNEs have replicated empowerment characteristics of hospital shared governance structures and processes at the system level.

  3. [Data coding in the Israeli healthcare system - do choices provide the answers to our system's needs?].

    PubMed

    Zelingher, Julian; Ash, Nachman

    2013-05-01

    The IsraeLi healthcare system has undergone major processes for the adoption of health information technologies (HIT), and enjoys high Levels of utilization in hospital and ambulatory care. Coding is an essential infrastructure component of HIT, and ts purpose is to represent data in a simplified and common format, enhancing its manipulation by digital systems. Proper coding of data enables efficient identification, storage, retrieval and communication of data. UtiLization of uniform coding systems by different organizations enables data interoperability between them, facilitating communication and integrating data elements originating in different information systems from various organizations. Current needs in Israel for heaLth data coding include recording and reporting of diagnoses for hospitalized patients, outpatients and visitors of the Emergency Department, coding of procedures and operations, coding of pathology findings, reporting of discharge diagnoses and causes of death, billing codes, organizational data warehouses and national registries. New national projects for cLinicaL data integration, obligatory reporting of quality indicators and new Ministry of Health (MOH) requirements for HIT necessitate a high Level of interoperability that can be achieved only through the adoption of uniform coding. Additional pressures were introduced by the USA decision to stop the maintenance of the ICD-9-CM codes that are also used by Israeli healthcare, and the adoption of ICD-10-C and ICD-10-PCS as the main coding system for billing purpose. The USA has also mandated utilization of SNOMED-CT as the coding terminology for the ELectronic Health Record problem list, and for reporting quality indicators to the CMS. Hence, the Israeli MOH has recently decided that discharge diagnoses will be reported using ICD-10-CM codes, and SNOMED-CT will be used to code the cLinical information in the EHR. We reviewed the characteristics, strengths and weaknesses of these two coding

  4. [Perceived quality in hospitals of the Andalusia Healthcare System. The case of neurosurgery departments].

    PubMed

    Cordero Tous, N; Horcajadas Almansa, Á; Bermúdez González, G J; Tous Zamora, D

    2014-01-01

    To analyse the characteristics of the perceived quality in hospitals of the Andalusia healthcare system and compare this with that in Andalusian Neurosurgery departments. Randomised surveys, adjusted for working age, were performed in Andalusia using a telephone questionnaire based on the SERVQUAL model with the appropriate modification, with the subsequent selection of a subgroup associated with neurosurgery. Perceived quality was classified as; technical, functional and infrastructure quality. The overall satisfaction was 76.3%. Frequency analysis found that variables related to the technical quality (good doctors, successful operations, trained staff, etc.) obtained more favourable outcomes. Those related to time (wait, consulting, organizing schedules) obtained worse outcomes. The care of families variables obtained poor results. There was no difference between the overall Andalusian healthcare system and neurosurgery departments. In the mean analysis, women and older people gave more favourable responses, especially for variables related to infrastructure quality. In the "cluster" analysis, there were more favourable responses by elderly people, with no differences in gender (P<.009). There is no difference in perceived quality between the Andalusian healthcare system overall and neurosurgery departments. The perceived quality of the Andalusian healthcare system is higher in the elderly people. The analysis of perceived quality is useful for promoting projects to improve clinical management. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  5. A Review on Methods of Risk Adjustment and their Use in Integrated Healthcare Systems

    PubMed Central

    Juhnke, Christin; Bethge, Susanne

    2016-01-01

    Introduction: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The objective of this review was to obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed. Theory and methods: A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines. Results: In general, several distinctions can be made: in terms of risk horizons, in terms of risk factors or in terms of the combination of indicators included. Within these, another differentiation by three levels seems reasonable: methods based on mortality risks, methods based on morbidity risks as well as those based on information on (self-reported) health status. Conclusions and discussion: After the final examination of different methods of risk adjustment it was shown that the methodology used to adjust risks varies. The models differ greatly in terms of their included morbidity indicators. The findings of this review can be used in the evaluation of integrated healthcare delivery systems and can be integrated into quality- and patient-oriented reimbursement of care providers in the design of healthcare contracts. PMID:28316544

  6. 1996 outlook: systems, for-profit chains, medical groups, religious healthcare, managed care, post-acute care, finance, purchasing, info systems, labor, legal, construction.

    PubMed

    Greene, J; Lutz, S; Jaklevic, M C; Japsen, B; Kertesz, L; Shriver, K; Pallarito, K; Scott, L; Morrissey, J; Moore, J D; Burda, D; Fitzgerald, J

    1996-01-01

    It's put-up-or-shut-up time for healthcare providers in 1996. Two years ago, everyone talked about fixing the healthcare system. Not much happened. Last year, providers and politicians concentrated on squeezing medical costs. According to some of Modern Healthcare's key beat reports, this year it's back to the basics of running a business.

  7. Managing Student Affairs Programs: Methods, Models, Muddles.

    ERIC Educational Resources Information Center

    Deegan, William L.

    Management processes and problems are examined in a variety of student affairs contexts. This book (1) proposes a theoretical framework for the analysis of management functions in colleges and universities, (2) studies the practice of management in several different student affairs contexts to uncover current practices, issues, problems, and…

  8. Technology governance strategies for maximizing healthcare economic value. Developing management systems for IT.

    PubMed

    Langabeer, James; Delgado, Rigoberto; Mikhail, Osama

    2007-01-01

    Based on industry averages, healthcare providers spend from 1.5 percent to 3 percent of their revenues on information technology. That can equate to a million dollars a year for even the smallest hospitals and as much as $50 million or $60 million a year for large health systems. That significant amount of capital must be wisely managed because these investments are long-term assets that can help transform the enterprise and contribute to the organization's strategic goals. Unfortunately, in many hospitals these investments are often made without regard for the actual return on investment that the systems will generate. ROI, or economic value, is difficult to quantify in healthcare because of the complex multi-dimensional processes and perspectives that exist. Administrators and providers often question how a clinical system can be quantified and compared with an ERP, research technology or any other information system. When value can be defined in so many ways - such as improvements in clinical outcomes, improvements in system uptime or reliability, or enhancements in productivity and operational business processes-quantification of economic value becomes much more ambiguous and therefore easy to neglect. However, business value can be created by any combination of shifts in performance. Reductions in waiting lines, improvements in imaging capabilities, increased procedures per labor hour, extensions of system life and higher transaction processing all have potential value. However, ROI cannot be calculated or maximized if underlying key performance indicators are not defined and measured, both pre- and post-implementation. This article will build on solid governance strategies for IT that will help to ensure positive economics and improved productivity in healthcare. It also will discuss specific strategies and methods for extracting the most value out of IT in healthcare.

  9. Mission-Driven Collaboration between Academic and Student Affairs in Community Colleges

    ERIC Educational Resources Information Center

    Gulley, Needham Yancey

    2017-01-01

    The purpose of this study was to understand the nature of collaboration between academic affairs and student affairs units in the community college context from a basic interpretivist qualitative perspective. The aim was to examine the experiences, influences, and perceptions of mid-level and chief student affairs and academic affairs officers…

  10. Systems innovation model: an integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center.

    PubMed

    Eisenberg, Dan; Lohnberg, Jessica A; Kubat, Eric P; Bates, Cheryl C; Greenberg, Lauren M; Frayne, Susan M

    2017-04-01

    Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers. To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey. Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m 2 (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts. Published by

  11. Exploring the Barriers: A Qualitative Study about the Experiences of Mid-SES Roma Navigating the Spanish Healthcare System

    PubMed Central

    2018-01-01

    Whereas the topic of the ‘cultural sensitivity’ of healthcare systems has been addressed extensively in the US and the UK, literature on the subject in most European countries, specifically looking at the situation of Roma, is still scarce. Drawing on qualitative research conducted mainly in the city of Barcelona under the communicative approach with Roma subjects who have stable socioeconomic positions and higher cultural capitals (end-users, professionals of the healthcare system, and key informants of a regional policy oriented to the improvement of Roma living conditions), the present study aims to fill this gap. We explore the barriers that the Roma face in accessing the healthcare system, reflecting on how these barriers are accentuated by the existing anti-Roma prejudices and institutional arrangements that do not account for minority cultures. Our results point out a series of obstacles at two levels, in the interaction with healthcare professionals, and in relation to existing institutional arrangements, which prevent Roma families from having equal access to the healthcare system. Education stands up as a mechanism to contest anti-Roma sentiments among healthcare professionals. PMID:29470450

  12. An efficient and secure certificateless authentication protocol for healthcare system on wireless medical sensor networks.

    PubMed

    Guo, Rui; Wen, Qiaoyan; Jin, Zhengping; Zhang, Hua

    2013-01-01

    Sensor networks have opened up new opportunities in healthcare systems, which can transmit patient's condition to health professional's hand-held devices in time. The patient's physiological signals are very sensitive and the networks are extremely vulnerable to many attacks. It must be ensured that patient's privacy is not exposed to unauthorized entities. Therefore, the control of access to healthcare systems has become a crucial challenge. An efficient and secure authentication protocol will thus be needed in wireless medical sensor networks. In this paper, we propose a certificateless authentication scheme without bilinear pairing while providing patient anonymity. Compared with other related protocols, the proposed scheme needs less computation and communication cost and preserves stronger security. Our performance evaluations show that this protocol is more practical for healthcare system in wireless medical sensor networks.

  13. An Efficient and Secure Certificateless Authentication Protocol for Healthcare System on Wireless Medical Sensor Networks

    PubMed Central

    Guo, Rui; Wen, Qiaoyan; Jin, Zhengping; Zhang, Hua

    2013-01-01

    Sensor networks have opened up new opportunities in healthcare systems, which can transmit patient's condition to health professional's hand-held devices in time. The patient's physiological signals are very sensitive and the networks are extremely vulnerable to many attacks. It must be ensured that patient's privacy is not exposed to unauthorized entities. Therefore, the control of access to healthcare systems has become a crucial challenge. An efficient and secure authentication protocol will thus be needed in wireless medical sensor networks. In this paper, we propose a certificateless authentication scheme without bilinear pairing while providing patient anonymity. Compared with other related protocols, the proposed scheme needs less computation and communication cost and preserves stronger security. Our performance evaluations show that this protocol is more practical for healthcare system in wireless medical sensor networks. PMID:23710147

  14. Conflicts of interests in the area of healthcare products and technology. Current state of affairs and recommendations.

    PubMed

    Demarez, Jean-Paul; Funck-Brentano, Christian; Molimard, Mathieu

    2012-01-01

    The handling of conflicts of interest in the area of healthcare products and technology has become a major issue for all of those involved in healthcare. Round Table N°4 at the Giens Workshops 2011 has put forward concrete proposals to clarify and optimise the handling of conflicts of interest. Conflicts of interest cannot be defined by the individuals consulted or applying for funds since each institution, whether public or private, that puts out a call for projects or that requests advice, analyses or expert testimony in the healthcare field has different degrees of what it defines as a conflict of interest, depending on the context of the proposal or specific request that it puts out. In contrast, each individual has ties of personal interest that can and must be openly disclosed. The ties are much more diverse than what is commonly found in the conflict of interest statements of large institutions operating in the healthcare field and are not limited to financial and operational ties between companies and individuals. In addition, the statements are difficult to manage because of their sheer number. The Round Table recommends that each individual should openly disclose all of his or her ties of personal interest in a Single Statement of Ties of personal Interest (SSTI). The SSTI would be updated regularly and accessible on line. Each institution could then determine whether or not the reported ties represent a conflict in the context of the mission proposed. Each institution could publish in advance the conditions that would give rise to a conflict and, in this way, an individual could refrain from applying for the mission. Other practical approaches to handling conflicts of interest were put forward. © 2012 Société Française de Pharmacologie et de Thérapeutique.

  15. Modeling veterans healthcare administration disclosure processes :

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

    Beyeler, Walter E; DeMenno, Mercy B.; Finley, Patrick D.

    As with other large healthcare organizations, medical adverse events at the Department of Veterans Affairs (VA) facilities can expose patients to unforeseen negative risks. VHA leadership recognizes that properly handled disclosure of adverse events can minimize potential harm to patients and negative consequences for the effective functioning of the organization. The work documented here seeks to help improve the disclosure process by situating it within the broader theoretical framework of issues management, and to identify opportunities for process improvement through modeling disclosure and reactions to disclosure. The computational model will allow a variety of disclosure actions to be tested acrossmore » a range of incident scenarios. Our conceptual model will be refined in collaboration with domain experts, especially by continuing to draw on insights from VA Study of the Communication of Adverse Large-Scale Events (SCALE) project researchers.« less

  16. Healthcare information systems: data mining methods in the creation of a clinical recommender system

    NASA Astrophysics Data System (ADS)

    Duan, L.; Street, W. N.; Xu, E.

    2011-05-01

    Recommender systems have been extensively studied to present items, such as movies, music and books that are likely of interest to the user. Researchers have indicated that integrated medical information systems are becoming an essential part of the modern healthcare systems. Such systems have evolved to an integrated enterprise-wide system. In particular, such systems are considered as a type of enterprise information systems or ERP system addressing healthcare industry sector needs. As part of efforts, nursing care plan recommender systems can provide clinical decision support, nursing education, clinical quality control, and serve as a complement to existing practice guidelines. We propose to use correlations among nursing diagnoses, outcomes and interventions to create a recommender system for constructing nursing care plans. In the current study, we used nursing diagnosis data to develop the methodology. Our system utilises a prefix-tree structure common in itemset mining to construct a ranked list of suggested care plan items based on previously-entered items. Unlike common commercial systems, our system makes sequential recommendations based on user interaction, modifying a ranked list of suggested items at each step in care plan construction. We rank items based on traditional association-rule measures such as support and confidence, as well as a novel measure that anticipates which selections might improve the quality of future rankings. Since the multi-step nature of our recommendations presents problems for traditional evaluation measures, we also present a new evaluation method based on average ranking position and use it to test the effectiveness of different recommendation strategies.

  17. Designing the future of healthcare.

    PubMed

    Fidsa, Gianfranco Zaccai

    2009-01-01

    This paper describes the application of a holistic design process to a variety of problems plaguing current healthcare systems. A design process for addressing complex, multifaceted problems is contrasted with the piecemeal application of technological solutions to specific medical or administrative problems. The goal of this design process is the ideal customer experience, specifically the ideal experience for patients, healthcare providers, and caregivers within a healthcare system. Holistic design is shown to be less expensive and wasteful in the long run because it avoids solving one problem within a complex system at the cost of creating other problems within that system. The article applies this approach to the maintenance of good health throughout life; to the creation of an ideal experience when a person does need medical care; to the maintenance of personal independence as one ages; and to the enjoyment of a comfortable and dignified death. Virginia Mason Medical Center is discussed as an example of a healthcare institution attempting to create ideal patient and caregiver experiences, in this case by applying the principles of the Toyota Production System ("lean manufacturing") to healthcare. The article concludes that healthcare is inherently dedicated to an ideal, that science and technology have brought it closer to that ideal, and that design can bring it closer still.

  18. Geospatial Information System Analysis of Healthcare Need and Telemedicine Delivery in California.

    PubMed

    Kaufman, Taylor; Geraghty, Estella M; Dullet, Navjit; King, Jesse; Kissee, Jamie; Marcin, James P

    2017-05-01

    Geospatial Information Systems (GIS) superimpose data on geographical maps to provide visual representations of data by region. Few studies have used GIS data to investigate if telemedicine services are preferentially provided to communities of greatest need. This study compared the healthcare needs of communities with and without telemedicine services from a university-based telemedicine program. Originating sites for all telemedicine consultations between July 1996 and December 2013 were geocoded using ArcGIS software. ZIP Code Tabulation Areas (ZCTAs) were extracted from the 2010 U.S. Census Bureau's Topologically Integrated Geographic Encoding and Referencing file and assigned a community needs index (CNI) score to reflect the ZCTA community's healthcare needs based on evidence-based barriers to healthcare access. CNI scores were compared across communities with and without active telemedicine services. One hundred ninety-four originating telemedicine clinic sites in California were evaluated. The mean CNI score for ZCTAs with at least one telemedicine clinic was significantly higher (3.32 ± 0.84) than those without a telemedicine site (2.95 ± 0.99) and higher than the mean ZCTAs for all of California (2.99 ± 1.01). Of the 194 telemedicine clinics, 71.4% were located in communities with above average need and 33.2% were located in communities with very high needs. Originating sites receiving telemedicine services from a university-based telemedicine program were located in regions with significantly higher community healthcare needs. Leveraging a geospatial information system to understand community healthcare needs provides an opportunity for payers, hospitals, and patients to be strategic in the allocation of telemedicine services.

  19. Primary healthcare in transition--a qualitative study of how managers perceived a system change.

    PubMed

    Maun, Andy; Nilsson, Kerstin; Furåker, Carina; Thorn, Jörgen

    2013-10-03

    Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work. In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman. The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills. This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager's perspective. This suggests a need for

  20. A study of leading indicators for occupational health and safety management systems in healthcare.

    PubMed

    Almost, Joan M; VanDenKerkhof, Elizabeth G; Strahlendorf, Peter; Caicco Tett, Louise; Noonan, Joanna; Hayes, Thomas; Van Hulle, Henrietta; Adam, Ryan; Holden, Jeremy; Kent-Hillis, Tracy; McDonald, Mike; Paré, Geneviève C; Lachhar, Karanjit; Silva E Silva, Vanessa

    2018-04-23

    In Ontario, Canada, approximately $2.5 billion is spent yearly on occupational injuries in the healthcare sector. The healthcare sector has been ranked second highest for lost-time injury rates among 16 Ontario sectors since 2009 with female healthcare workers ranked the highest among all occupations for lost-time claims. There is a great deal of focus in Ontario's occupational health and safety system on compliance and fines, however despite this increased focus, the injury statistics are not significantly improving. One of the keys to changing this trend is the development of a culture of healthy and safe workplaces including the effective utilization of leading indicators within Occupational Health and Safety Management Systems (OHSMSs). In contrast to lagging indicators, which focus on outcomes retrospectively, a leading indicator is associated with proactive activities and consists of selected OHSMSs program elements. Using leading indicators to measure health and safety has been common practice in high-risk industries; however, this shift has not occurred in healthcare. The aim of this project is to conduct a longitudinal study implementing six elements of the Ontario Safety Association for Community and Healthcare (OSACH) system identified as leading indicators and evaluating the effectiveness of this intervention on improving selected health and safety workplace indicators. A quasi-experimental longitudinal research design will be used within two Ontario acute care hospitals. The first phase of the study will focus on assessing current OHSMSs using the leading indicators, determining potential facilitators and barriers to changing current OHSMSs, and identifying the leading indicators that could be added or changed to the existing OHSMS in place. Phase I will conclude with the development of an intervention designed to support optimizing current OHSMSs in participating hospitals based on identified gaps. Phase II will pilot test and evaluate the tailored

  1. Is a flat-line a good thing? On the privatization of Israel's healthcare system.

    PubMed

    Seidman, Guy I

    2010-01-01

    Israel presents an intriguing conundrum: on the one hand, it provides quality healthcare in a near-universal healthcare system; on the other, it has maintained healthcare costs level at approximately 7.7% of GDP. This comes at a time when all western nations struggle with one or both sides of the equation: how to offer affordable, good quality health care to the population while curbing the sharp rise in health related costs. This paper explains both how Israel has achieved this 'flat line" effect and the social and political costs of this achievement.

  2. How secure is your information system? An investigation into actual healthcare worker password practices.

    PubMed

    Cazier, Joseph A; Medlin, B Dawn

    2006-09-27

    For most healthcare information systems, passwords are the first line of defense in keeping patient and administrative records private and secure. However, this defense is only as strong as the passwords employees chose to use. A weak or easily guessed password is like an open door to the medical records room, allowing unauthorized access to sensitive information. In this paper, we present the results of a study of actual healthcare workers' password practices. In general, the vast majority of these passwords have significant security problems on several dimensions. Implications for healthcare professionals are discussed.

  3. Fraud Detection in Healthcare

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

    Chandola, Varun; Schryver, Jack C; Sukumar, Sreenivas R

    We discuss the problem of fraud detection in healthcare in this chapter. Given the recent scrutiny of the ineciencies in the US healthcare system, identifying fraud has been on the forefront of the eorts towards reducing the healthcare costs. In this chapter we will focus on understanding the issue of healthcare fraud in detail, and review methods that have been proposed in the literature to combat this issue using data driven approach.

  4. 75 FR 53007 - Advisory Committee on Veterans Business Affairs; Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-30

    .... Small Business Administration. ACTION: Notice of open Federal Advisory Committee meeting. SUMMARY: The... the Advisory Committee on Veterans Business Affairs. The meeting will be open to the public. DATES... Affairs. The Advisory Committee on Veterans Business Affairs serves as an independent source of advice and...

  5. Healthcare System Information at Language Schools for Newly Arrived Immigrants: A Pertinent Setting in Times of Austerity

    ERIC Educational Resources Information Center

    Tynell, Lena Lyngholt; Wimmelmann, Camilla Lawaetz; Jervelund, Signe Smith

    2017-01-01

    Objective: In most European countries, immigrants do not systematically learn about the host countries' healthcare system when arriving. This study investigated how newly arrived immigrants perceived the information they received about the Danish healthcare system. Methods: Immigrants attending a language school in Copenhagen in 2012 received…

  6. Sexual Orientation Differences in Satisfaction with Healthcare: Findings from the Behavioral Risk Factor Surveillance System, 2014.

    PubMed

    Blosnich, John R

    2017-06-01

    In the United States, the Affordable Care Act and marriage equality may have eased sexual orientation-based differences in access to healthcare coverage, but limited research has investigated sexual orientation-based differences in healthcare satisfaction. The purpose of this study was to examine whether satisfaction with healthcare varied by sexual orientation in a large population-based sample of adults. Data are from the 2014 Behavioral Risk Factor Surveillance System, including items about sexual orientation and healthcare (n = 113,317). Healthcare coverage included employer-based insurance; individually purchased insurance; Medicare; Medicaid; or TRICARE, VA, or military care. Respondents indicated whether they were "very satisfied, somewhat satisfied, or not at all satisfied" with healthcare. After adjusting for several sociodemographic covariates, lesbian, gay, and bisexual status was associated with lower satisfaction with healthcare with individually purchased insurance (adjusted odds ratio = 1.49, 95% confidence interval = 1.24-1.80). Efforts are needed to examine and reduce sexual orientation differences in satisfaction with healthcare.

  7. Predictors of public and private healthcare utilization and associated health system responsiveness among older adults in Ghana

    PubMed Central

    Awoke, Mamaru Ayenew; Negin, Joel; Moller, Jette; Farell, Penny; Yawson, Alfred E.; Biritwum, Richard Berko; Kowal, Paul

    2017-01-01

    ABSTRACT Background: Previous studies investigating factors associated with healthcare utilization by older Ghanaians lack distinction between public and private health services. The present study examined factors associated with public and private healthcare service use, and the resulting perceived health system responsiveness. Objectives: To identify factors associated with public and private healthcare utilization among older adults aged 50 and older in Ghana; and to compare perceived differences in health system responsiveness between the private and public sectors. Methods: Cross-sectional data was analyzed from the World Health Organization Study on global AGEing and adult health (SAGE) Wave 1 in Ghana. Using Andersen’s conceptual framework, public and private outpatient care utilization was examined using multinomial logistic regression to estimate and identify predictor variables associated with the type of outpatient healthcare facility accessed. Health system responsiveness was compared using chi-square tests. Results: Of 2517 respondents who used outpatient care in the 12 months preceding interview, 51.7% of respondents used a public facility, 17.8% a private facility, and 30.5% used other facilities. Older age group, higher education and higher wealth were associated with the use of private outpatient healthcare services. Using public outpatient care facilities was associated with having health insurance. Respondents with two or more chronic conditions were more likely to use public and private outpatient care than other facilities. Perceived health system responsiveness was better in private for-profit than in public and private not-for-profit healthcare facilities. Conclusions: This study suggested that higher wealth and multimorbidity were significant predictors of public and private outpatient healthcare utilization; however, health insurance was a predictor only for the use of public facilities. Future mixed-method studies could further

  8. An RF-based wearable sensor system for indoor tracking to facilitate efficient healthcare management.

    PubMed

    Yuzhe Ouyang; Shan, Kai; Bui, Francis Minhthang

    2016-08-01

    To understand the utilization of clinical resources and improve the efficiency of healthcare, it is often necessary to accurately locate patients and doctors in a healthcare facility. However, existing tracking methods, such as GPS, Wi-Fi and RFID, have technological drawbacks or impose significant costs, thus limiting their applications in many clinical environments, especially those with indoor enclosures. This paper proposes a low-cost and flexible tracking system that is well suited for operating in an indoor environment. Based on readily available RF transceivers and microcontrollers, our wearable sensor system can facilitate locating users (e.g., patients or doctors) or objects (e.g., medical devices) in a building. The strategic construction of the sensor system, along with a suitably designed tracking algorithm, together provide for reliability and dispatch in localization performance. For demonstration purposes, several simplified experiments, with different configurations of the system, are implemented in two testing rooms to assess the baseline performance. From the obtained results, our system exhibits immense promise in acquiring a user location and corresponding time-stamp, with high accuracy and rapid response. This capability is conducive to both short- and long-term data analytics, which are crucial for improving healthcare management.

  9. Socioeconomic profile of couples seeking the public healthcare system (SUS) for infertility treatment.

    PubMed

    Tavares, Rachel; Cunha, Gisele; Aguiar, Lilian; Duarte, Shaytner Campos; Cardinot, Nilza; Bastos, Elizabeth; Coelho, Francisco

    2016-08-01

    The number of couples seeking assisted reproduction services in pursuit of the dream of conceiving a child is growing. In developing countries 10 to 15% of couples of childbearing age cannot bear a child by natural means and the impossibility of conceiving a child has a significant impact on the health and well-being of the couple. The aim of this study was to evaluate the socioeconomic profile and the main causes of infertility of couples seeking assisted reproduction treatment through the public healthcare system. We analyzed 600 medical records of couples who sought infertility treatment at the public healthcare system, and we divided them into three groups according to age: 35 years, 35 to 39, and 40 years or more. In each group we analyzed the cause of infertility, the number of children of the spouses, the education level and family income. The main cause of infertility was male-related in 34%, followed by tubal factor in 31.5%. We found that 56% of the women were less than 35 years old and 58% of the couples earned less than 3 minimum wages. The profile of the couples was: low-income, low education and less than 35 years of age. The cost of assisted reproductive treatment is still high, being restricted to couples of higher socioeconomic statuses. An effective public healthcare policy could minimize this problem by improving the quality of care for couples seeking infertility treatment at the public healthcare system.

  10. [Fostering LGBT-friendly healthcare services].

    PubMed

    Wei, Han-Ting; Chen, Mu-Hong; Ku, Wen-Wei

    2015-02-01

    LGBT (lesbian, gay, bisexual, transgender) patients suffer from stigma and discrimination when seeking healthcare. A large LGBT healthcare survey revealed that 56% of gay patients and 70% of transgender patients suffered some type of discrimination while seeking healthcare in 2014. The fostering of LGBT-friendly healthcare services is not just an advanced step of gender mainstreaming but also a fulfillment of health equality and equity. Additionally, LGBT-friendly healthcare services are expected to provide new opportunities for healthcare workers. Therefore, proactive government policies, education, research, and clinical practice should all encourage the development of these healthcare services. We look forward to a well-developed LGBT-friendly healthcare system in Taiwan.

  11. The influence of social challenges when implementing information systems in a Swedish health-care organisation.

    PubMed

    Nilsson, Lina; Eriksén, Sara; Borg, Christel

    2016-09-01

    To describe and obtain a deeper understanding of social challenges and their influence on the implementation process when implementing Information systems in a Swedish health-care organisation. Despite positive effects when implementing Information systems in health-care organisations, there are difficulties in the implementation process. Nurses' experiences of being neglected have been dismissed as reasons for setbacks in implementation. An Institutional Ethnography design was used. A deductive content analysis was made influenced by empirically identified social challenges of power, professional identity and encounters. An abstraction was made of the analysis. Nineteen nurses at macro, meso and micro levels were interviewed in focus groups. Organisational levels are lost in different ways in how to control the reformation, how to introduce Information systems as reformation strategies and in how to translate new tools and assumptions that do not fit traditional ways of working in shaping professional identities. Different focus may affect the reformation of health-care organisations and implementation and knowledge processes. An implementation climate is needed where the system standards fit the values of the users. Nursing management needs to be visionary, engaged and work with risk factors in order to reform the hierarchical health-care organisation. © 2016 John Wiley & Sons Ltd.

  12. [Awareness survey of Healthcare Number System pros and cons according to medical doctors in Japan].

    PubMed

    Takahashi, Yoshimitsu; Uryuhara, Yoko; Inoue, Machiko; Okamoto, Shigeru; Kashihara, Hidenori; Kito, Kumiko; Shinohara, Keiko; Mandai, Marie; Morioka, Miho; Tanaka, Shiro; Kawakami, Koji; Nakayama, Takeo

    2015-01-01

    After bills to launch the Social Security and Tax Number System were enacted in 2013, health and political officials have considered the Healthcare Number System (the System). However, little is known about doctors' awareness and concerns about the System. This study aimed to measure how many doctors disagree with the System, examine the doctors' characteristics, and analyze the benefits and harms of the System that they identified. A cross-sectional survey was conducted of doctors via the Internet. The participants were selected from a convenience sample of a panel of doctors based on stratified sampling including four groups: working at a hospital and <45 years; working at a hospital and ≥45 years; working at a clinic and <45 years; and working at a clinic and ≥45 years. The main outcome was how many doctors agreed or disagreed with the System. The prevalence was calculated for each group, and their characteristics were examined using multivariable logistic regression analysis. The responses to open-ended questions concerning the Systems' benefits and harms were analyzed using qualitative content analysis. There were 562 respondents (68%). By group, 16/143 (11%), 25/138 (18%), 31/132 (23%), and 43/149 (29%) doctors, respectively, thought that the System was unnecessary. The variables that correlated with the main outcome were age (per 5 years; odds ratio [95% confidence interval], 1.14 [1.01-1.29]) and type of medical facility (working at a clinic; 1.99 [1.30-3.08]). The doctors identified that unifying information could decrease administrative duties, facilitate inter-facility collaboration, and prevent inappropriate medical consultations. This could result in decreased healthcare costs and personalized healthcare. However, the doctors also identified that integrating information and dealing with big data could increase information leakage and information management, cause over-monitoring of doctors, and enable the inappropriate use of integrated information

  13. JPRS Report, Soviet Union, Political Affairs.

    DTIC Science & Technology

    1989-10-03

    18000602 Moscow PRA VDA in Russian 2 Aug 88 p 3 [Article by I . Zarakhovich and T . Trukhacheva, journal- ists, and Ye. Sokolova, member, Central Council...QTJAUn INSP1CH3B t Soviet Union Political Affairs JPRS-UPA-88-044 CONTENTS 03 OCTOBER 1989 PARTY, STATE AFFAIRS History of Formation of Nagorno...Advocated //. Zarakhovich, T . Trukhacheva; PRAVDA, 2 Aug 88] 86 REGIONAL ISSUES Biologist on Costs of Pollution Control Measures [A. Valentey

  14. The non specialist paediatric training registrar in the healthcare system.

    PubMed

    O'Neill, M B; Kumar, A

    2012-01-01

    This study evaluated the experiences of non Specialist Paediatric Training Registrars (nonSPTR) in the Irish Healthcare system. The survey explored their adaptation to the healthcare system, skill development, perceptions of training and career development inclusive of working conditions. Thirty nine (53%) doctors responded. The time spent in Paediatrics ranged from 3 to 19 years with a mean of 8.9 years. Nineteen (49%) had only worked in non regional hospitals and for 20 (51%) the mean time spent in regional hospitals was 2.6 years. The very positives experiences (likert scores 5/6) included journal appraisal for 19 (49%), clinical skill development for 17 (44%) and consultant feedback for 11 (28%).The very negative experiences were difficulty obtaining desired clinical posts for 16 (43%) doctors and only 5 (13%) were happy with their career progression. Thirty one (79.5%) cited specific barriers to career progression, with only 10 (25%) making an application to the Specialist Paediatrics Registrar (SPR) training programme. Solutions for the non SPTR difficulties include the expansion of the SPR programme and the utilization of a criterion based portfolio system to integrate the nonSPTR into formal training.

  15. Primary care training and the evolving healthcare system.

    PubMed

    Peccoralo, Lauren A; Callahan, Kathryn; Stark, Rachel; DeCherrie, Linda V

    2012-01-01

    With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians. © 2012 Mount Sinai School of Medicine.

  16. Advanced earthquake monitoring system for U.S. Department of Veterans Affairs medical buildings--instrumentation

    USGS Publications Warehouse

    Kalkan, Erol; Banga, Krishna; Ulusoy, Hasan S.; Fletcher, Jon Peter B.; Leith, William S.; Reza, Shahneam; Cheng, Timothy

    2012-01-01

    In collaboration with the U.S. Department of Veterans Affairs (VA), the National Strong Motion Project (NSMP; http://nsmp.wr.usgs.gov/) of the U.S. Geological Survey has been installing sophisticated seismic systems that will monitor the structural integrity of 28 VA hospital buildings located in seismically active regions of the conterminous United States, Alaska, and Puerto Rico during earthquake shaking. These advanced monitoring systems, which combine the use of sensitive accelerometers and real-time computer calculations, are designed to determine the structural health of each hospital building rapidly after an event, helping the VA to ensure the safety of patients and staff. This report presents the instrumentation component of this project by providing details of each hospital building, including a summary of its structural, geotechnical, and seismic hazard information, as well as instrumentation objectives and design. The structural-health monitoring component of the project, including data retrieval and processing, damage detection and localization, automated alerting system, and finally data dissemination, will be presented in a separate report.

  17. Integrating radiology information systems with healthcare delivery environments using DICOM and HL7 standards.

    PubMed

    Blazona, Bojan; Koncar, Miroslav

    2006-01-01

    Integration based on open standards, in order to achieve communication and information interoperability, is one of the key aspects of modern health care information systems. Interoperability presents data and communication layer interchange. In this context we identified the HL7 standard as the world's leading medical Information and communication technology (ICT) standard for the business layer in healthcare information systems and we tried to explore the ability to exchange clinical documents with minimal integrated healthcare information systems (IHCIS) change. We explored HL7 Clinical Document Architecture (CDA) abilities to achieve radiology information system integration (DICOM) to IHCIS (HL7). We introduced the use of WADO service interconnection to IHCIS and finally CDA rendering in widely used Internet explorers.

  18. Is variation management included in regional healthcare governance systems? Some proposals from Italy.

    PubMed

    Nuti, Sabina; Seghieri, Chiara

    2014-01-01

    The Italian National Health System, which follows a Beveridge model, provides universal healthcare coverage through general taxation. Universal coverage provides uniform healthcare access to citizens and is the characteristic usually considered the added value of a welfare system financed by tax revenues. Nonetheless, wide differences in practice patterns, health outcomes and regional usages of resources that cannot be justified by differences in patient needs have been demonstrated to exist. Beginning with the experience of the health care system of the Tuscany region (Italy), this study describes the first steps of a long-term approach to proactively address the issue of geographic variation in healthcare. In particular, the study highlights how the unwarranted variation management has been addressed in a region with a high degree of managerial control over the delivery of health care and a consolidated performance evaluation system, by first, considering it a high priority objective and then by actively integrating it into the regional planning and control mechanism. The implications of this study can be useful to policy makers, professionals and managers, and will contribute to the understanding of how the management of variation can be implemented with performance measurements and financial incentives. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  19. The imminent healthcare and emergency care crisis in Japan.

    PubMed

    Suzuki, Tetsuji; Nishida, Masamichi; Suzuki, Yuriko; Kobayashi, Kunio

    2008-05-01

    Japan has a universal healthcare system, and this paper describes the reality of the healthcare services provided, as well as current issues with the system. Academic, government, and press reports on Japanese healthcare systems and healthcare guidelines were reviewed. The universal healthcare system of Japan is considered internationally to be both low-cost and effective because the Japanese population enjoys good health status with a long life expectancy, while healthcare spending in Japan is below the average given by the Organization for Economic Corporation and Development (OECD). However, in many regions of Japan the existing healthcare resources are seriously inadequate, especially with regard to the number of physicians and other health professionals. Because healthcare is traditionally viewed as "sacred" work in Japan, healthcare professionals are expected to make large personal sacrifices. Also, public attitudes toward medical malpractice have changed in recent decades, and medical professionals are facing legal issues without experienced support of the government or legal professionals. Administrative response to the lack of resources and collaboration among communities are beginning, and more efficient control and management of the healthcare system is under consideration. The Japanese healthcare system needs to adopt an efficient medical control organization to ease the strain on existing healthcare professionals and to increase the number of physicians and other healthcare resources. Rather than continuing to depend on healthcare professionals being able and willing to make personal sacrifices, the government, the public and medical societies must cooperate and support changes in the healthcare system.

  20. Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing.

    PubMed

    Molla, Azaher Ali; Chi, Chunhuei

    2017-09-06

    The relationship between payments towards healthcare and ability to pay is a measure of financial fairness. Analysis of progressivity is important from an equity perspective as well as for macroeconomic and political analysis of healthcare systems. Bangladesh health systems financing is characterized by high out-of-pocket payments (63.3%), which is increasing. Hence, we aimed to see who pays what part of this high out-of-pocket expenditure. To our knowledge, this was the first progressivity analysis of health systems financing in Bangladesh. We used data from Bangladesh Household Income and Expenditure Survey, 2010. This was a cross sectional and nationally representative sample of 12,240 households consisting of 55,580 individuals. For quantification of progressivity, we adopted the 'ability-to-pay' principle developed by O'Donnell, van Doorslaer, Wagstaff, and Lindelow (2008). We used the Kakwani index to measure the magnitude of progressivity. Health systems financing in Bangladesh is regressive. Inequality increases due to healthcare payments. The differences between the Gini coefficient and the Kakwani index for all sources of finance are negative, which indicates regressivity, and that financing is more concentrated among the poor. Income inequality increases due to high out-of-pocket payments. The increase in income inequality caused by out-of-pocket payments is 89% due to negative vertical effect and 11% due to horizontal inequity. Our findings add substantial evidence of health systems financing impact on inequitable financial burden of healthcare and income. The heavy reliance on out-of-pocket payments may affect household living standards. If the government and people of Bangladesh are concerned about equitable financing burden, our study suggests that Bangladesh needs to reform the health systems financing scheme.

  1. Queueing for healthcare.

    PubMed

    Palvannan, R Kannapiran; Teow, Kiok Liang

    2012-04-01

    Patient queues are prevalent in healthcare and wait time is one measure of access to care. We illustrate Queueing Theory-an analytical tool that has provided many insights to service providers when designing new service systems and managing existing ones. This established theory helps us to quantify the appropriate service capacity to meet the patient demand, balancing system utilization and the patient's wait time. It considers four key factors that affect the patient's wait time: average patient demand, average service rate and the variation in both. We illustrate four basic insights that will be useful for managers and doctors who manage healthcare delivery systems, at hospital or department level. Two examples from local hospitals are shown where we have used queueing models to estimate the service capacity and analyze the impact of capacity configurations, while considering the inherent variation in healthcare.

  2. A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety.

    PubMed

    Xie, Anping; Carayon, Pascale

    2015-01-01

    Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified 12 projects representing 23 studies and addressing different physical, cognitive and organisational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.

  3. Status of the Bureau of Indian Affairs Reorganization. Hearing Before the United States Senate Select Committee on Indian Affairs, 95th Congress, 2nd Session on Oversight on the Status of the Reorganization of the Bureau of Indian Affairs.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. Senate Select Committee on Indian Affairs.

    The objective of the August 16, 1978, United States Senate hearing was to determine reorganization plans for the Bureau of Indian Affairs (BIA). The Assistant Secretary of the Interior for Indian Affairs, two Deputy Secretaries, and Mr. Charles Trimble of the United Effort Trust testified before the Select Committee on Indian Affairs. The…

  4. Geographic information system-based healthcare waste management planning for treatment site location and optimal transportation routeing.

    PubMed

    Shanmugasundaram, Jothiganesh; Soulalay, Vongdeuane; Chettiyappan, Visvanathan

    2012-06-01

    In Lao People's Democratic Republic (Lao PDR), a growth of healthcare centres, and the environmental hazards and public health risks typically accompanying them, increased the need for healthcare waste (HCW) management planning. An effective planning of an HCW management system including components such as the treatment plant siting and an optimized routeing system for collection and transportation of waste is deemed important. National government offices at developing countries often lack the proper tools and methodologies because of the high costs usually associated with them. However, this study attempts to demonstrate the use of an inexpensive GIS modelling tool for healthcare waste management in the country. Two areas were designed for this study on HCW management, including: (a) locating centralized treatment plants and designing optimum travel routes for waste collection from nearby healthcare facilities; and (b) utilizing existing hospital incinerators and designing optimum routes for collecting waste from nearby healthcare facilities. Spatial analysis paved the way to understand the spatial distribution of healthcare wastes and to identify hotspots of higher waste generating locations. Optimal route models were designed for collecting and transporting HCW to treatment plants, which also highlights constraints in collecting and transporting waste for treatment and disposal. The proposed model can be used as a decision support tool for the efficient management of hospital wastes by government healthcare waste management authorities and hospitals.

  5. An integrated healthcare system for personalized chronic disease care in home-hospital environments.

    PubMed

    Jeong, Sangjin; Youn, Chan-Hyun; Shim, Eun Bo; Kim, Moonjung; Cho, Young Min; Peng, Limei

    2012-07-01

    Facing the increasing demands and challenges in the area of chronic disease care, various studies on the healthcare system which can, whenever and wherever, extract and process patient data have been conducted. Chronic diseases are the long-term diseases and require the processes of the real-time monitoring, multidimensional quantitative analysis, and the classification of patients' diagnostic information. A healthcare system for chronic diseases is characterized as an at-hospital and at-home service according to a targeted environment. Both services basically aim to provide patients with accurate diagnoses of disease by monitoring a variety of physical states with a number of monitoring methods, but there are differences between home and hospital environments, and the different characteristics should be considered in order to provide more accurate diagnoses for patients, especially, patients having chronic diseases. In this paper, we propose a patient status classification method for effectively identifying and classifying chronic diseases and show the validity of the proposed method. Furthermore, we present a new healthcare system architecture that integrates the at-home and at-hospital environment and discuss the applicability of the architecture using practical target services.

  6. Factors influencing healthcare service quality

    PubMed Central

    Mosadeghrad, Ali Mohammad

    2014-01-01

    Background: The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods: Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results: Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion: This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality. PMID:25114946

  7. A Universal Noninvasive Continuous Blood Pressure Measurement System for Remote Healthcare Monitoring.

    PubMed

    Mukherjee, Ramtanu; Ghosh, Sanchita; Gupta, Bharat; Chakravarty, Tapas

    2018-01-22

    The effectiveness of any remote healthcare monitoring system depends on how much accurate, patient-friendly, versatile, and cost-effective measurement it is delivering. There has always been a huge demand for such a long-term noninvasive remote blood pressure (BP) measurement system, which could be used worldwide in the remote healthcare industry. Thus, noninvasive continuous BP measurement and remote monitoring have become an emerging area in the remote healthcare industry. Photoplethysmography-based (PPG) BP measurement is a continuous, unobtrusive, patient-friendly, and cost-effective solution. However, BP measurements through PPG sensors are not much reliable and accurate due to some major limitations like pressure disturbance, motion artifacts, and variations in human skin tone. A novel reflective PPG sensor has been developed to eliminate the abovementioned pressure disturbance and motion artifacts during the BP measurement. Considering the variations of the human skin tone across demography, a novel algorithm has been developed to make the BP measurement accurate and reliable. The training dataset captured 186 subjects' data and the trial dataset captured another new 102 subjects' data. The overall accuracy achieved by using the proposed method is nearly 98%. Thus, demonstrating the efficacy of the proposed method. The developed BP monitoring system is quite accurate, reliable, cost-effective, handy, and user friendly. It is also expected that this system would be quite useful to monitor the BP of infants, elderly people, patients having wounds, burn injury, or in the intensive care unit environment.

  8. Plants and Human Affairs: Educational Enhancement Via a Computer.

    ERIC Educational Resources Information Center

    Crovello, Theodore J.; Smith, W. Nelson

    To enhance both teaching and learning in an advanced undergraduate elective course on the interrelationships of plants and human affairs, the computer was used for information retrieval, multiple choice course review, and the running of three simulation models--plant related systems (e.g., the rise in world coffee prices after the 1975 freeze in…

  9. How Secure Is Your Information System? An Investigation into Actual Healthcare Worker Password Practices

    PubMed Central

    Cazier, Joseph A; Medlin, B. Dawn

    2006-01-01

    For most healthcare information systems, passwords are the first line of defense in keeping patient and administrative records private and secure. However, this defense is only as strong as the passwords employees chose to use. A weak or easily guessed password is like an open door to the medical records room, allowing unauthorized access to sensitive information. In this paper, we present the results of a study of actual healthcare workers' password practices. In general, the vast majority of these passwords have significant security problems on several dimensions. Implications for healthcare professionals are discussed. PMID:18066366

  10. Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review.

    PubMed

    Brand, Sarah L; Thompson Coon, Jo; Fleming, Lora E; Carroll, Lauren; Bethel, Alison; Wyatt, Katrina

    2017-01-01

    Healthcare professionals throughout the developed world report higher levels of sickness absence, dissatisfaction, distress, and "burnout" at work than staff in other sectors. There is a growing call for the 'triple aim' of healthcare delivery (improving patient experience and outcomes and reducing costs; to include a fourth aim: improving healthcare staff experience of healthcare delivery. A systematic review commissioned by the United Kingdom's (UK) Department of Health reviewed a large number of international healthy workplace interventions and recommended five whole-system changes to improve healthcare staff health and wellbeing: identification and response to local need, engagement of staff at all levels, and the involvement, visible leadership from, and up-skilling of, management and board-level staff. This systematic review aims to identify whole-system healthy workplace interventions in healthcare settings that incorporate (combinations of) these recommendations and determine whether they improve staff health and wellbeing. A comprehensive and systematic search of medical, education, exercise science, and social science databases was undertaken. Studies were included if they reported the results of interventions that included all healthcare staff within a healthcare setting (e.g. whole hospital; whole unit, e.g. ward) in collective activities to improve physical or mental health or promote healthy behaviours. Eleven studies were identified which incorporated at least one of the whole-system recommendations. Interventions that incorporated recommendations to address local need and engage the whole workforce fell in to four broad types: 1) pre-determined (one-size-fits-all) and no choice of activities (two studies); or 2) pre-determined and some choice of activities (one study); 3) A wide choice of a range of activities and some adaptation to local needs (five studies); or, 3) a participatory approach to creating programmes responsive and adaptive to local

  11. A qualitative analysis of interprofessional healthcare team members' perceptions of patient barriers to healthcare engagement.

    PubMed

    Powell, Rhea E; Doty, Amanda; Casten, Robin J; Rovner, Barry W; Rising, Kristin L

    2016-09-20

    Healthcare systems increasingly engage interprofessional healthcare team members such as case managers, social workers, and community health workers to work directly with patients and improve population health. This study elicited perspectives of interprofessional healthcare team members regarding patient barriers to health and suggestions to address these barriers. This is a qualitative study employing focus groups and semi-structured interviews with 39 interprofessional healthcare team members in Philadelphia to elicit perceptions of patients' needs and experiences with the health system, and suggestions for positioning health care systems to better serve patients. Themes were identified using a content analysis approach. Three focus groups and 21 interviews were conducted with 26 hospital-based and 13 ambulatory-based participants. Three domains emerged to characterize barriers to care: social determinants, health system factors, and patient trust in the health system. Social determinants included insurance and financial shortcomings, mental health and substance abuse issues, housing and transportation-related limitations, and unpredictability associated with living in poverty. Suggestions for addressing these barriers included increased financial assistance from the health system, and building a workforce to address these determinants directly. Health care system factors included poor care coordination, inadequate communication of hospital discharge instructions, and difficulty navigating complex systems. Suggestions for addressing these barriers included enhanced communication between care sites, patient-centered scheduling, and improved patient education especially in discharge planning. Finally, factors related to patient trust of the health system emerged. Participants reported that patients are often intimidated by the health system, mistrusting of physicians, and fearful of receiving a serious diagnosis or prognosis. A suggestion for mitigating these

  12. Student Affairs as Perceived Through Abraham Maslow's Hierarchy of Needs.

    ERIC Educational Resources Information Center

    Nowacki, Steven

    The needs of human behavior are explored and correlated to the various departments within Student Affairs in an effort to show how Student Affairs can satisfy those needs. Maslow's Hierarchy of needs is briefly explained and related to the following Student Affairs departments: Financial Aid, Student Management, Career Development and Placement,…

  13. Improving the redistribution of the security lessons in healthcare: An evaluation of the Generic Security Template.

    PubMed

    He, Ying; Johnson, Chris

    2015-11-01

    The recurrence of past security breaches in healthcare showed that lessons had not been effectively learned across different healthcare organisations. Recent studies have identified the need to improve learning from incidents and to share security knowledge to prevent future attacks. Generic Security Templates (GSTs) have been proposed to facilitate this knowledge transfer. The objective of this paper is to evaluate whether potential users in healthcare organisations can exploit the GST technique to share lessons learned from security incidents. We conducted a series of case studies to evaluate GSTs. In particular, we used a GST for a security incident in the US Veterans' Affairs Administration to explore whether security lessons could be applied in a very different Chinese healthcare organisation. The results showed that Chinese security professional accepted the use of GSTs and that cyber security lessons could be transferred to a Chinese healthcare organisation using this approach. The users also identified the weaknesses and strengths of GSTs, providing suggestions for future improvements. Generic Security Templates can be used to redistribute lessons learned from security incidents. Sharing cyber security lessons helps organisations consider their own practices and assess whether applicable security standards address concerns raised in previous breaches in other countries. The experience gained from this study provides the basis for future work in conducting similar studies in other healthcare organisations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. The Student Affairs Committee. Effective Committees. Board Basics.

    ERIC Educational Resources Information Center

    Goodale, Thomas G.

    1997-01-01

    Responsibilities of the college or university governing board's student affairs committee include representing students' interests in all policy decisions, ensuring provision of adequate financial resources to support a comprehensive student affairs program, ensuring that board policies keep pace with students' diverse and changing needs, and…

  15. Socioeconomic profile of couples seeking the public healthcare system (SUS) for infertility treatment

    PubMed Central

    Tavares, Rachel; Cunha, Gisele; Aguiar, Lilian; Duarte, Shaytner Campos; Cardinot, Nilza; Bastos, Elizabeth; Coelho, Francisco

    2016-01-01

    Objective The number of couples seeking assisted reproduction services in pursuit of the dream of conceiving a child is growing. In developing countries 10 to 15% of couples of childbearing age cannot bear a child by natural means and the impossibility of conceiving a child has a significant impact on the health and well-being of the couple. The aim of this study was to evaluate the socioeconomic profile and the main causes of infertility of couples seeking assisted reproduction treatment through the public healthcare system. Methods We analyzed 600 medical records of couples who sought infertility treatment at the public healthcare system, and we divided them into three groups according to age: 35 years, 35 to 39, and 40 years or more. In each group we analyzed the cause of infertility, the number of children of the spouses, the education level and family income. Results The main cause of infertility was male-related in 34%, followed by tubal factor in 31.5%. We found that 56% of the women were less than 35 years old and 58% of the couples earned less than 3 minimum wages. Conclusion The profile of the couples was: low-income, low education and less than 35 years of age. The cost of assisted reproductive treatment is still high, being restricted to couples of higher socioeconomic statuses. An effective public healthcare policy could minimize this problem by improving the quality of care for couples seeking infertility treatment at the public healthcare system. PMID:27584602

  16. [Ophthalmological service quality offered to outpatients of the Public Healthcare System].

    PubMed

    Santos Hercos, Benigno Vicente; Berezovsky, Adriana

    2006-01-01

    To identify the perception of the ophthalmic service quality provided for outpatients of the public healthcare system as well as to detect which actions should be considered necessary and priority in order to improve its quality. A quantitative descriptive study was carried out on 100 outpatients of the public healthcare system which were submitted to ophthalmic tests at Fundação Hilton Rocha--Belo Horizonte-MG, from July 1st-July 30th 2004. Individual interviews were carried out by giving the interviewees two structured questionnaires adapted from the modified SERVQUAL. This scale is in agreement with the reality of the studied institute. The adapted SERVQUAL scale was submitted to statistical validation and it showed a suitable internal consistency index. In general terms, a slight general dissatisfaction was detected regarding ophthalmological service quality. The interviewees cared more about safety and reliability. A higher degree of dissatisfaction was detected mainly concerning fulfillment of procedures at scheduled appointments related to the execution of services within due time-limits. The institute is supposed to plan as well as carry out actions which lead to a general improvement in the patient's satisfaction regarding service quality and mainly reliability. Service quality monitoring through periodic use of the SERVQUAL scale will not only make it possible to plan highly precise and effective intervention strategies in these and in other healthcare services but it will also allow monitoring the responses to these actions. All these actions will contribute to the improvement of the service in the system as a whole.

  17. Public healthcare interests require strict competition enforcement.

    PubMed

    Loozen, Edith M H

    2015-07-01

    Several countries have introduced competition in their health systems in order to maintain the supply of high quality health care in a cost-effective manner. The introduction of competition triggers competition enforcement. Since healthcare is characterized by specific market failures, many favor healthcare-specific competition enforcement in order not only to account for the competition interest, but also for the healthcare interests. The question is whether healthcare systems based on competition can succeed when competition enforcement deviates from standard practice. This paper analyzes whether healthcare-specific competition enforcement is theoretically sound and practically effective. This is exemplified by the Dutch system that is based on regulated competition and thus crucially depends on getting competition enforcement right. Governments are responsible for correcting market failures. Markets are responsible for maximizing the public healthcare interests. By securing sufficient competitive pressure, competition enforcement makes sure they do. When interpreted according to welfare-economics, competition law takes into account both costs and benefits specific market behavior may have for healthcare. Competition agencies and judiciary are not legitimized to deviate from standard evidentiary requirements. Dutch case law shows that healthcare-specific enforcement favors the healthcare undertakings concerned, but to the detriment of public health care. Healthcare-specific competition enforcement is conceptually flawed and counterproductive. In order for healthcare systems based on competition to succeed, competition enforcement should be strict. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care.

    PubMed

    Gvozdanović, Darko; Koncar, Miroslav; Kojundzić, Vinko; Jezidzić, Hrvoje

    2007-01-01

    In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1) to provide efficient healthcare-related data management in support of decision-making processes; (2) to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS) on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories) into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

  19. Just healthcare? The moral failure of single-tier basic healthcare.

    PubMed

    Meadowcroft, John

    2015-04-01

    This article sets out the moral failure of single-tier basic healthcare. Single-tier basic healthcare has been advocated on the grounds that the provision of healthcare should be divorced from ability to pay and unequal access to basic healthcare is morally intolerable. However, single-tier basic healthcare encounters a host of catastrophic moral failings. Given the fact of human pluralism it is impossible to objectively define "basic" healthcare. Attempts to provide single-tier healthcare therefore become political processes in which interest groups compete for control of scarce resources with the most privileged possessing an inherent advantage. The focus on outputs in arguments for single-tier provision neglects the question of justice between individuals when some people provide resources for others without reciprocal benefits. The principle that only healthcare that can be provided to everyone should be provided at all leads to a leveling-down problem in which advocates of single-tier provision must prefer a situation where some individuals are made worse-off without any individual being made better-off compared to plausible multi-tier alternatives. Contemporary single-tier systems require the exclusion of noncitizens, meaning that their universalism is a myth. In the light of these pathologies, it is judged that multi-tier healthcare is morally required. © The Author 2015. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. A Decade Lost: Primary Healthcare Performance Reporting across Canada under the Action Plan for Health System Renewal.

    PubMed

    Johnston, Sharon; Hogel, Matthew

    2016-05-01

    In 2004, Canada's First Ministers committed to reforms that would shape the future of the Canadian healthcare landscape. These agreements included commitments to improved performance reporting within the primary healthcare system. The aim of this paper was to review the state of primary healthcare performance reporting after the public reporting mandate agreed to a decade ago in the Action Plan for Health System Renewal of 2003 expired. A grey literature search was performed to identify reports released by the governmental and independent reporting bodies across Canada. No province, or the federal government, met their performance reporting obligations from the 2004 accords. Although the indicators required to report on in the 2004 Accord no longer reflect the priorities of patients, policy makers and physicians, provinces are also failing to report on these priorities. Canada needs better primary healthcare performance reporting to enable accountability and improvement within and across provinces. Despite the national mandate to improve public health system reporting, an opportunity to learn from the diverse primary healthcare reforms, underway across Canada for the past decade, has already been lost. Copyright © 2016 Longwoods Publishing.

  1. 25 CFR 141.31 - Trade by Indian Affairs employees restricted.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 1 2013-04-01 2013-04-01 false Trade by Indian Affairs employees restricted. 141.31 Section 141.31 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES BUSINESS PRACTICES ON THE NAVAJO, HOPI AND ZUNI RESERVATIONS General Business Practices § 141.31 Trade by Indian Affairs employees restricted. (a) Except as...

  2. Epistemological challenges in contemporary Western healthcare systems exemplified by people's widespread use of complementary and alternative medicine.

    PubMed

    Salamonsen, Anita; Ahlzén, Rolf

    2018-07-01

    Modern Western public healthcare systems offer predominantly publicly subsidized healthcare traditionally based on biomedicine as the most important basis to cure persons who suffer from disorders of somatic or psychiatric nature. To which extent this epistemological position is suitable for this purpose is under scientific debate and challenged by some people's personal understandings of health and illness, their individual illness experiences and their decision-making. Current studies show decreasing levels of patient trust in Western public healthcare and a widespread patient-initiated use of complementary and alternative medicine which is often linked to unmet patient-defined healthcare needs. Patients'/complementary and alternative medicine users' understandings of their afflictions are often based on elements of biomedical knowledge as well as embodied and experience-based knowledge. We believe this points to the need for a phenomenologically and socially based understanding of health and illness. In this article, we analyze challenges in contemporary healthcare systems, exemplified by people's widespread use of complementary and alternative medicine and based on three ways of understanding and relating to unhealth: disease (the biomedical perspective), illness (the phenomenological perspective), and sickness (the social perspective). In public healthcare systems aiming at involving patients in treatment processes, acknowledging the coexistence of differing epistemologies may be of great importance to define and reach goals of treatment and compliance.

  3. System review: a method for investigating medical errors in healthcare settings.

    PubMed

    Alexander, G L; Stone, T T

    2000-01-01

    System analysis is a process of evaluating objectives, resources, structure, and design of businesses. System analysis can be used by leaders to collaboratively identify breakthrough opportunities to improve system processes. In healthcare systems, system analysis can be used to review medical errors (system occurrences) that may place patients at risk for injury, disability, and/or death. This study utilizes a case management approach to identify medical errors. Utilizing an interdisciplinary approach, a System Review Team was developed to identify trends in system occurrences, facilitate communication, and enhance the quality of patient care by reducing medical errors.

  4. The Regional Healthcare Ecosystem Analyst (RHEA): a simulation modeling tool to assist infectious disease control in a health system.

    PubMed

    Lee, Bruce Y; Wong, Kim F; Bartsch, Sarah M; Yilmaz, S Levent; Avery, Taliser R; Brown, Shawn T; Song, Yeohan; Singh, Ashima; Kim, Diane S; Huang, Susan S

    2013-06-01

    As healthcare systems continue to expand and interconnect with each other through patient sharing, administrators, policy makers, infection control specialists, and other decision makers may have to take account of the entire healthcare 'ecosystem' in infection control. We developed a software tool, the Regional Healthcare Ecosystem Analyst (RHEA), that can accept user-inputted data to rapidly create a detailed agent-based simulation model (ABM) of the healthcare ecosystem (ie, all healthcare facilities, their adjoining community, and patient flow among the facilities) of any region to better understand the spread and control of infectious diseases. To demonstrate RHEA's capabilities, we fed extensive data from Orange County, California, USA, into RHEA to create an ABM of a healthcare ecosystem and simulate the spread and control of methicillin-resistant Staphylococcus aureus. Various experiments explored the effects of changing different parameters (eg, degree of transmission, length of stay, and bed capacity). Our model emphasizes how individual healthcare facilities are components of integrated and dynamic networks connected via patient movement and how occurrences in one healthcare facility may affect many other healthcare facilities. A decision maker can utilize RHEA to generate a detailed ABM of any healthcare system of interest, which in turn can serve as a virtual laboratory to test different policies and interventions.

  5. 17 CFR 200.15 - Office of International Affairs.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... responding to international issues and in developing legislative, rulemaking and other initiatives relating... 17 Commodity and Securities Exchanges 2 2013-04-01 2013-04-01 false Office of International... Organization § 200.15 Office of International Affairs. (a) The Office of International Affairs (“OIA”) is...

  6. 17 CFR 200.15 - Office of International Affairs.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... responding to international issues and in developing legislative, rulemaking and other initiatives relating... 17 Commodity and Securities Exchanges 2 2012-04-01 2012-04-01 false Office of International... Organization § 200.15 Office of International Affairs. (a) The Office of International Affairs (“OIA”) is...

  7. 17 CFR 200.15 - Office of International Affairs.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... responding to international issues and in developing legislative, rulemaking and other initiatives relating... 17 Commodity and Securities Exchanges 3 2014-04-01 2014-04-01 false Office of International... Organization § 200.15 Office of International Affairs. (a) The Office of International Affairs (“OIA”) is...

  8. Efficacy of Orientation for New Student Affairs Professionals

    ERIC Educational Resources Information Center

    Dean, Laura A.; Saunders, Sue A.; Thompson, George F.; Cooper, Dianne L.

    2011-01-01

    New staff orientation is a strategy that can positively affect job satisfaction and productivity, especially for those beginning careers in student affairs. In this study, new student affairs professionals were surveyed to determine their perceptions about the content and efficacy of their orientation experiences. Despite literature encouraging…

  9. Contract and Tort Based Ethics in Student Affairs.

    ERIC Educational Resources Information Center

    Barratt, Will

    1996-01-01

    Argues that contract law and tort law are appropriate means for providing enforceable professional ethics in student affairs and that incorporating student affairs ethical codes into contracts with students creates enforceable ethical codes. Believes that providing such codes strengthens risk management programs, as well as encouraging…

  10. Underlying Paradigms in Student Affairs Research and Practice

    ERIC Educational Resources Information Center

    Guido, Florence M.; Chavez, Alicia Fedelina; Lincoln, Yvonna S.

    2010-01-01

    Student affairs professionals benefit from understanding paradigms, worldviews, and ways of being among diverse faculty, staff, and students. It is challenging to understand core differences of paradigms, design student affairs practice and research in congruence with or across specific philosophies, and work effectively with individuals operating…

  11. Depiction of Trends in Administrative Healthcare Data from Hospital Information System.

    PubMed

    Kalankesh, Leila R; Pourasghar, Faramarz; Jafarabadi, Mohammad Asghari; Khanehdan, Negar

    2015-06-01

    administrative healthcare data are among main components of hospital information system. Such data can be analyzed and deployed for a variety of purposes. The principal aim of this research was to depict trends of administrative healthcare data from HIS in a general hospital from March 2011 to March 2014. data set used for this research was extracted from the SQL database of the hospital information system in Razi general hospital located in Marand. The data were saved as CSV (Comma Separated Values) in order to facilitate data cleaning and analysis. The variables of data set included patient's age, gender, final diagnosis, final diagnosis code based on ICD-10 classification system, date of hospitalization, date of discharge, LOS(Length of Stay), ward, and survival status of the patient. Data were analyzed and visualized after applying appropriate cleansing and preparing techniques. morbidity showed a constant trend over three years. Pregnancy, childbirth and the puerperium were the leading category of final diagnosis (about 32.8 %). The diseases of the circulatory system were the second class accounting for 13 percent of the hospitalization cases. The diseases of the digestive system had the third rank (10%). Patients aged between 14 and 44 constituted a higher proportion of total cases. Diseases of the circulatory system was the most common class of diseases among elderly patients (age≥65). The highest rate of mortality was observed among patients with final diagnosis of the circulatory system diseases followed by those with diseases of the respiratory system, and neoplasms. Mortality rate for the ICU and the CCU patients were 62% and 33% respectively. The longest average of LOS (7.3 days) was observed among patients hospitalized in the ICU while patients in the Obstetrics and Gynecology ward had the shortest average of LOS (2.4 days). Multiple regression analysis revealed that LOS was correlated with variables of surgery, gender, and type of payment, ward, the

  12. Primary healthcare in transition – a qualitative study of how managers perceived a system change

    PubMed Central

    2013-01-01

    Background Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work. Methods In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman. Results The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills. Conclusions This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager

  13. Pittsburgh Regional Healthcare Initiative puts new spin on improving healthcare quality.

    PubMed

    2002-11-01

    For nearly 4 years, the Pittsburgh Regional Healthcare Initiative (PRHI) has been working to improve the way healthcare is delivered in southwestern Pennsylvania by combining the voices and resources of hospitals, providers, the business community, insurers, health plans, and federal agencies. As one example of borrowing from business, the PRHI has created a new learning and management system, called Perfecting Patient Care, which is based on the Toyota Production System model and is now being used successfully in hospitals.

  14. Innovative healthcare systems on their way to the market: how to cope with commercialization barriers.

    PubMed

    Hofmann, Isa

    2007-01-01

    Healthcare markets and healthcare systems worldwide will be undergoing tremendous changes in the upcoming 5-10 years. We will experience a paradigm shift in the personal awareness and responsibility of disease prevention and health management. Skyrocketing costs, an ageing population and a variety of technical innovations that enhance the quality of life of patients with chronic diseases or suffering from geriatric ailments will open up new horizons for a variety of partly textile based preventative, therapeutic & diagnostic systems, devices & technologies. Mainly these innovations are geared to optimize the patients comfort and concedes more freedom of mobility. However all partners in the healthcare value distribution chain need to cooperate in vue of the patients empowerment to bring innovations quicker to the market and find viable and cost efficient solutions.

  15. The Integrated Care Team Approach of the Department of Veterans Affairs (VA): Geriatric Primary Care.

    PubMed

    Rasin-Waters, Donna; Abel, Valerie; Kearney, Lisa K; Zeiss, Antonette

    2018-05-01

    Historically, integrated mental and behavioral healthcare in the Department of Veterans Affairs (VA) commenced with initiatives in geriatrics. Innovation and system-wide expansion has occurred over decades and culminated in a unified vision for training and practice in the VA medical home model: Patient Aligned Care Team or PACT approach. In one VA hospital, the integration of neuropsychological services in geriatric primary care is pivotal and increases access for patients, as well as contributing to timely and effective care on an interprofessional team. The development and innovative use of an algorithm to identify problems with cognition, health literacy, and mental and behavioral health has been pragmatic and provides useful information for collaborative treatment planning in GeriPACT, VA geriatric primary care. Use of the algorithm also assists with decision-making regarding brief versus comprehensive neuropsychological assessment in the primary care setting. The model presented here was developed by supervising neuropsychologists as part of a postdoctoral residency program in geropsychology. However, postdoctoral residency programs in neuropsychology, as well as neuropsychological clinics, can also use this model to integrate neuropsychological assessment and interventions in geriatric primary care settings.

  16. Provider, veteran, and family perspectives on family education in Veterans Affairs community-based outpatient facilities.

    PubMed

    Sherman, Michelle D; Fischer, Ellen P

    2012-02-01

    The Veterans Affairs (VA) healthcare system is dedicated to providing high-quality mental health services to all veterans, including the nearly 40% of enrolled veterans living in rural areas. Family education programs regarding mental illness and posttraumatic stress disorder, mandated for delivery in all VA medical centers and some community-based outpatient clinics (CBOCs), have been developed and provided primarily in large, urban medical centers. This qualitative investigation involved interviews with CBOC providers and veterans and families who live in rural areas and/or seek care in CBOCs to ascertain their perceptions of the benefits, feasibility, structural and cultural barriers, and logistical preferences regarding family education. The perspectives and concerns that emerged in these interviews were combined with expert knowledge to identify the resources and considerations a VAMC would want to address when translating and implementing similar programming into CBOCs. Although institutional, logistic, and attitudinal challenges were described, all three stakeholder groups endorsed the need for family education, did not see the barriers as insurmountable, and provided creative solutions. Administrators and CBOC clinicians may benefit by anticipating and problem solving around the key issues raised when developing family programming.

  17. Preserving the History of a Student Affairs Association

    ERIC Educational Resources Information Center

    Mann, B. J.

    2010-01-01

    The following is a brief overview regarding: the history and development of Student Affairs as it pertains to (a) preserving the history of a professional association, (b) value and benefits of a professional Student Affairs association, (c) establishing and assessing goals and (d) organizational development/change within a professional…

  18. Healthcare delivery systems: designing quality into health information systems.

    PubMed

    Joyce, Phil; Green, Rosamund; Winch, Graham

    2007-01-01

    To ensure that quality is 'engineered in' a holistic, integrated and quality approach is required, and Total Quality Management (TQM) principles are the obvious foundations for this. This paper describes a novel approach to viewing the operations of a healthcare provider where electronic means could be used to distribute information (including electronic fund settlements), building around the Full Service Provider core. Specifically, an approach called the "triple pair flow" model is used to provide a view of healthcare delivery that is integrated, yet detailed, and that combines the strategic enterprise view with a business process view.

  19. Editorials and Foreign Affairs in the 1972 Presidential Campaign

    ERIC Educational Resources Information Center

    Myers, David S.

    1974-01-01

    Results support the hypothesis that foreign affairs issues decided the outcome of the 1972 Presidential election and even in papers which endorsed George McGovern the editorials on foreign affairs favored Richard Nixon. (RB)

  20. Ethical issues in healthcare financing.

    PubMed

    Maharaj, S R; Paul, T J

    2011-07-01

    The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice. In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.

  1. Cost-Effective Mobile-Based Healthcare System for Managing Total Joint Arthroplasty Follow-Up.

    PubMed

    Bitsaki, Marina; Koutras, George; Heep, Hansjoerg; Koutras, Christos

    2017-01-01

    Long-term follow-up care after total joint arthroplasty is essential to evaluate hip and knee arthroplasty outcomes, to provide information to physicians and improve arthroplasty performance, and to improve patients' health condition. In this paper, we aim to improve the communication between arthroplasty patients and physicians and to reduce the cost of follow-up controls based on mobile application technologies and cloud computing. We propose a mobile-based healthcare system that provides cost-effective follow-up controls for primary arthroplasty patients through questions about symptoms in the replaced joint, questionnaires (WOMAC and SF-36v2) and the radiological examination of knee or hip joint. We also perform a cost analysis for a set of 423 patients that were treated in the University Clinic for Orthopedics in Essen-Werden. The estimation of healthcare costs shows significant cost savings (a reduction of 63.67% for readmission rate 5%) in both the University Clinic for Orthopedics in Essen-Werden and the state of North Rhine-Westphalia when the mobile-based healthcare system is applied. We propose a mHealth system to reduce the cost of follow-up assessments of arthroplasty patients through evaluation of diagnosis, self-monitoring, and regular review of their health status.

  2. Graph Databases for Large-Scale Healthcare Systems: A Framework for Efficient Data Management and Data Services

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

    Park, Yubin; Shankar, Mallikarjun; Park, Byung H.

    Designing a database system for both efficient data management and data services has been one of the enduring challenges in the healthcare domain. In many healthcare systems, data services and data management are often viewed as two orthogonal tasks; data services refer to retrieval and analytic queries such as search, joins, statistical data extraction, and simple data mining algorithms, while data management refers to building error-tolerant and non-redundant database systems. The gap between service and management has resulted in rigid database systems and schemas that do not support effective analytics. We compose a rich graph structure from an abstracted healthcaremore » RDBMS to illustrate how we can fill this gap in practice. We show how a healthcare graph can be automatically constructed from a normalized relational database using the proposed 3NF Equivalent Graph (3EG) transformation.We discuss a set of real world graph queries such as finding self-referrals, shared providers, and collaborative filtering, and evaluate their performance over a relational database and its 3EG-transformed graph. Experimental results show that the graph representation serves as multiple de-normalized tables, thus reducing complexity in a database and enhancing data accessibility of users. Based on this finding, we propose an ensemble framework of databases for healthcare applications.« less

  3. Rules and Incentives: The Problem with American Healthcare.

    PubMed

    Baum, Neil

    2015-01-01

    There are very few within or outside of the American healthcare system who would argue that the current system of providing healthcare is badly broken and needs fixing. The cost of healthcare has outpaced every other sector of American life. We spend 2.5 times more on healthcare than do most developed countries in the world. Do we have the best healthcare in the world? The average life expectancy is 78.49 years, which ranks us 51st in the world. We spend more on healthcare than any other nation but get less for our hard-earned dollars. This article will provide suggestions for repairing the broken healthcare system with excerpts taken from the book Practical Wisdom, by Dr. Barry Schwartz and Kenneth Sharpe.

  4. The Economics of Healthcare Shape the Practice of Neuropsychology in the Era of Integrated Healthcare.

    PubMed

    Pliskin, Neil H

    2018-05-01

    The healthcare system in the United States is in the midst of a major transformation that has affected all healthcare specialties, including clinical psychology/neuropsychology. If this shift in the economics of healthcare reimbursement continues, it promises to impact clinical practice patterns for neuropsychologists far into the next decade.

  5. Applications of Business Analytics in Healthcare.

    PubMed

    Ward, Michael J; Marsolo, Keith A; Froehle, Craig M

    2014-09-01

    The American healthcare system is at a crossroads, and analytics, as an organizational skill, figures to play a pivotal role in its future. As more healthcare systems capture information electronically and as they begin to collect more novel forms of data, such as human DNA, how will we leverage these resources and use them to improve human health at a manageable cost? In this article, we argue that analytics will play a fundamental role in the transformation of the American healthcare system. However, there are numerous challenges to the application and use of analytics, namely the lack of data standards, barriers to the collection of high-quality data, and a shortage of qualified personnel to conduct such analyses. There are also multiple managerial issues, such as how to get end users of electronic data to employ it consistently for improving healthcare delivery, and how to manage the public reporting and sharing of data. In this article, we explore applications of analytics in healthcare, barriers and facilitators to its widespread adoption, and how analytics can help us achieve the goals of the modern healthcare system: high-quality, responsive, affordable, and efficient care.

  6. Applications of Business Analytics in Healthcare

    PubMed Central

    Ward, Michael J.; Marsolo, Keith A.

    2014-01-01

    The American healthcare system is at a crossroads, and analytics, as an organizational skill, figures to play a pivotal role in its future. As more healthcare systems capture information electronically and as they begin to collect more novel forms of data, such as human DNA, how will we leverage these resources and use them to improve human health at a manageable cost? In this article, we argue that analytics will play a fundamental role in the transformation of the American healthcare system. However, there are numerous challenges to the application and use of analytics, namely the lack of data standards, barriers to the collection of high-quality data, and a shortage of qualified personnel to conduct such analyses. There are also multiple managerial issues, such as how to get end users of electronic data to employ it consistently for improving healthcare delivery, and how to manage the public reporting and sharing of data. In this article, we explore applications of analytics in healthcare, barriers and facilitators to its widespread adoption, and how analytics can help us achieve the goals of the modern healthcare system: high-quality, responsive, affordable, and efficient care. PMID:25429161

  7. Designing Student Affairs Organizational Structures: Perceptions of Senior Student Affairs Officers

    ERIC Educational Resources Information Center

    Kuk, Linda; Banning, James H.

    2009-01-01

    Student affairs organizations have become complex entities and serve as a critical link to student success and the quality of the overall educational experience in collegiate institutions. Over time, new programs and services have been added to the array of existing programs and services with little attention focused on how these organizations…

  8. Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review

    PubMed Central

    Brand, Sarah L.; Thompson Coon, Jo; Fleming, Lora E.; Carroll, Lauren; Bethel, Alison; Wyatt, Katrina

    2017-01-01

    Background Healthcare professionals throughout the developed world report higher levels of sickness absence, dissatisfaction, distress, and “burnout” at work than staff in other sectors. There is a growing call for the ‘triple aim’ of healthcare delivery (improving patient experience and outcomes and reducing costs; to include a fourth aim: improving healthcare staff experience of healthcare delivery. A systematic review commissioned by the United Kingdom’s (UK) Department of Health reviewed a large number of international healthy workplace interventions and recommended five whole-system changes to improve healthcare staff health and wellbeing: identification and response to local need, engagement of staff at all levels, and the involvement, visible leadership from, and up-skilling of, management and board-level staff. Objectives This systematic review aims to identify whole-system healthy workplace interventions in healthcare settings that incorporate (combinations of) these recommendations and determine whether they improve staff health and wellbeing. Methods A comprehensive and systematic search of medical, education, exercise science, and social science databases was undertaken. Studies were included if they reported the results of interventions that included all healthcare staff within a healthcare setting (e.g. whole hospital; whole unit, e.g. ward) in collective activities to improve physical or mental health or promote healthy behaviours. Results Eleven studies were identified which incorporated at least one of the whole-system recommendations. Interventions that incorporated recommendations to address local need and engage the whole workforce fell in to four broad types: 1) pre-determined (one-size-fits-all) and no choice of activities (two studies); or 2) pre-determined and some choice of activities (one study); 3) A wide choice of a range of activities and some adaptation to local needs (five studies); or, 3) a participatory approach to

  9. Dollars for Dreams: Student Affairs Staff as Fundraisers.

    ERIC Educational Resources Information Center

    Penney, Sophie W.; Rose, Barbara B.

    This publication provides an educational tool for student affairs professionals involved in fundraising. It is designed to be easily accessible and understood by those with little experience with fundraising, and it will also serve as a useful resource for student affairs professionals who have partnered with fundraisers to, or who themselves…

  10. College Student Concerns: Perceptions of Student Affairs Practitioners

    ERIC Educational Resources Information Center

    Reynolds, Amy L.

    2013-01-01

    The purpose of this study was to increase awareness of the perceptions of student affairs professionals regarding the most frequent and challenging concerns facing college students today. Using the Delphi method, 159 entry-level and mid-level student affairs administrators from institutions across the country were surveyed about their perceptions…

  11. 17 CFR 200.15 - Office of International Affairs.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Office of International... Organization § 200.15 Office of International Affairs. (a) The Office of International Affairs (“OIA”) is... elements. (b) OIA assists in and facilitates the efforts of the Commission's other divisions and offices in...

  12. A comparative study of contemporary user involvement within healthcare systems across England, Poland and Slovenia.

    PubMed

    Lichon, Mateusz; Kavcic, Matic; Masterson, Daniel

    2015-01-01

    The purpose of this paper is to explore how healthcare-users' engagement is perceived, how it occurs and how these perceptions differ between three European countries: England, Poland and Slovenia, using the concepts of voice, choice and coproduction. This comparative, qualitative study is based on a review of legal documents, academic literature and semi-structured interviews conducted in October and November 2011. A research sample consisted of 21 interviewees representing various stakeholders including healthcare-users, doctors and managers. Primary and secondary data were analysed using theoretical thematic analysis. Emerging themes were identified from the interviews and related to the indicators describing healthcare-users' involvement in the voice, choice and coproduction model. Results of the comparative qualitative research suggest that the healthcare-users' influence is strongly grounded in England where the healthcare system and professionals are prepared to include healthcare-users in the decision-making process. In Slovenia, cultural development of healthcare-users' involvement seems to proceed the institutional development. In Poland, institutions are ready to involve healthcare-users in decision-making process although the cultural desirability of involving users among doctors and patients is lacking. The notion of user involvement is increasingly gaining importance and research attention, yet there is still little known about the way cultural, political, historical differences between various European countries influence it. This paper explores this little known area using the original approach of user involvement (Dent et al., 2011) with input from various stakeholders including patients, healthcare representatives and academics.

  13. e-Healthcare in India: critical success factors for sustainable health systems.

    PubMed

    Taneja, Udita; Sushil

    2007-01-01

    As healthcare enterprises seek to move towards an integrated, sustainable healthcare delivery model an IT-enabled or e-Healthcare strategy is being increasingly adopted. In this study we identified the critical success factors influencing the effectiveness of an e-Healthcare strategy in India. The performance assessment criteria used to measure effectiveness were increasing reach and reducing cost of healthcare delivery. A survey of healthcare providers was conducted. Analytic Hierarchy Process (AHP) and Interpretive Structural Modeling (ISM) were the analytical tools used to determine the relative importance of the critical success factors in influencing effectiveness of e-Healthcare and their interplay with each other. To succeed in e-Healthcare initiatives the critical success factors that need to be in place are appropriate government policies, literacy levels, and telecommunications and power infrastructure in the country. The focus should not be on the IT tools and biomedical engineering technologies as is most often the case. Instead the nontechnology factors such as healthcare provider and consumer mindsets should be addressed to increase acceptance of, and enhance the effectiveness of, sustainable e-Healthcare services.

  14. Cross-Border Healthcare Requests to Publicly Funded Healthcare Insurance: Empirical Analysis.

    PubMed

    Stewart Ferreira, Lydia

    2016-02-01

    Despite the legal authority to confirm, override or modify healthcare insurance decisions made by physicians and government officials, health tribunal decisions have not been empirically analyzed. Using a novel quantitative methodology, all 387 Health Services Appeal and Review Board written and publicly available electronic decisions released over a five-year time period were statistically analyzed with respect to Ontario public health insurance requests for global cross-border healthcare. The statistical results found that patients knew their diagnosis prior to requesting cross-border healthcare, and 84% of patients requested specific northern US facilities for specific treatment. Two specific healthcare facilities in the US were requested for either surgery or assessments. A significant number of patients were seeking cross-border healthcare for pain treatment. This research challenges the assumption that cross-border treatment requests result only from domestic delay when instead patients are seeking specific treatments at specific facilities. This novel quantitative research methodology and data source of written and publicly available electronic Health Services Appeal and Review Board decisions should be used to inform policy decision regarding the utilization and evaluation of Canada's healthcare system and publicly funded healthcare insurance. Copyright © 2016 Longwoods Publishing.

  15. Student Affairs: Moving from Theories and Theorists to Practice and Practitioners

    ERIC Educational Resources Information Center

    Gillett-Karam, Rosemary

    2016-01-01

    Student affairs and student services practices are concepts that can replace traditional models of student development, now emphasizing student identity, student voice, and emancipatory advocacy. A new identity is suggested to replace the title for student affairs professionals and student affairs programs in community colleges: student success…

  16. 77 FR 13383 - Foreign Affairs Policy Board Meeting Notice; Closed Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-06

    ... STATE DEPARTMENT [Public Notice: 7604] Foreign Affairs Policy Board Meeting Notice; Closed Meeting...), the Department of State announces a meeting of the Foreign Affairs Policy Board to take place on March 19, 2012, at the Department of State, Washington, DC. The Foreign Affairs Policy Board reviews and...

  17. Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study

    PubMed Central

    Baillie, Lesley; Gallini, Andrew; Corser, Rachael; Elworthy, Gina; Scotcher, Ann; Barrand, Annabelle

    2014-01-01

    Introduction Frail older people experience frequent care transitions and an integrated healthcare system could reduce barriers to transitions between different settings. The study aimed to investigate care transitions of frail older people from acute hospital wards to community healthcare or community hospital wards, within a system that had vertically integrated acute hospital and community healthcare services. Theory and methods The research design was a multimethod, qualitative case study of one healthcare system in England; four acute hospital wards and two community hospital wards were studied in depth. The data were collected through: interviews with key staff (n = 17); focus groups (n = 9) with ward staff (n = 36); interviews with frail older people (n = 4). The data were analysed using the framework approach. Findings Three themes are presented: Care transitions within a vertically integrated healthcare system, Interprofessional communication and relationships; Patient and family involvement in care transitions. Discussion and conclusions A vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other's roles and build relationships and trust. PMID:24868193

  18. The future of UK healthcare: problems and potential solutions to a system in crisis.

    PubMed

    Montgomery, H E; Haines, A; Marlow, N; Pearson, G; Mythen, M G; Grocott, M P W; Swanton, C

    2017-08-01

    The UK's Health System is in crisis, central funding no longer keeping pace with demand. Traditional responses-spending more, seeking efficiency savings or invoking market forces-are not solutions. The health of our nation demands urgent delivery of a radical new model, negotiated openly between public, policymakers and healthcare professionals. Such a model could focus on disease prevention, modifying health behaviour and implementing change in public policy in fields traditionally considered unrelated to health such as transport, food and advertising. The true cost-effectiveness of healthcare interventions must be balanced against the opportunity cost of their implementation, bolstering the central role of NICE in such decisions. Without such action, the prognosis for our healthcare system-and for the health of the individuals it serves-may be poor. Here, we explore such a new prescription for our national health. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  19. LEAN thinking in Finnish healthcare.

    PubMed

    Jorma, Tapani; Tiirinki, Hanna; Bloigu, Risto; Turkki, Leena

    2016-01-01

    Purpose - The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes. Design/methodology/approach - A mixed-method approach incorporating the Webropol survey was used. Findings - LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN. Originality/value - This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

  20. Efficacy of a New Medical Information system, Ubiquitous Healthcare Service with Voice Inception Technique in Elderly Diabetic Patients.

    PubMed

    Kim, Kyoung Min; Park, Kyeong Seon; Lee, Hyun Ju; Lee, Yun Hee; Bae, Ji Seon; Lee, Young Joon; Choi, Sung Hee; Jang, Hak Chul; Lim, Soo

    2015-12-11

    We have demonstrated previously that an individualized health management system using advanced medical information technology, named ubiquitous (u)-healthcare, was helpful in achieving better glycemic control than routine care. Recently, we generated a new u-healthcare system using a voice inception technique for elderly diabetic patients to communicate information about their glucose control, physical activity, and diet more easily. In a randomized clinical trial, 70 diabetic patients aged 60-85 years were assigned randomly to a standard care group or u-healthcare group for 6 months. The primary end points were the changes in glycated hemoglobin (HbA1c) and glucose fluctuation assessed by the mean amplitude glycemic excursion (MAGE). Changes in body weight, lifestyle, and knowledge about diabetes were also investigated. After 6 months, the HbA1c levels decreased significantly in the u-healthcare group (from 8.6 ± 1.0% to 7.5 ± 0.6%) compared with the standard care group (from 8.7 ± 0.9% to 8.2 ± 1.1%, P < 0.01). The MAGE decreased more in the u-healthcare group than in the standard care group. Systolic blood pressure and body weight decreased and liver functions improved in the u-healthcare group, but not in the standard care group. The u-healthcare system with voice inception technique was effective in achieving glycemic control without hypoglycemia in elderly diabetic patients (Clinicaltrials.gov: NCT01891474).

  1. Healthcare chains - enabling application and data privacy controls for healthcare information systems.

    PubMed

    Omran, Esraa; Grandison, Tyrone; Abu Almaati, Shereef

    2010-01-01

    Healthcare applications that have access control, disclosure management and or privacy enforcement requirements may implement the respective solutions to these issues at the application level or at the database level or in both. Unfortunately, there are technical and non-technical factors that influence what can be done. In this paper we present a flexible, simple and novel approach to seamlessly imbuing current healthcare applications and their supporting infrastructure with security and privacy functionality, while being cognizant of these factors. This approach is called the Chain method. This paper will highlight the smaller design footprint, the increased ease of implementation and use of the Chain method, while demonstrating that it is as powerful and effective as traditional methods.

  2. Disruptive Innovation: Implementation of Electronic Consultations in a Veterans Affairs Health Care System.

    PubMed

    Gupte, Gouri; Vimalananda, Varsha; Simon, Steven R; DeVito, Katerina; Clark, Justice; Orlander, Jay D

    2016-02-12

    Electronic consultations (e-consults) offer rapid access to specialist input without the need for a patient visit. E-consult implementation began in 2011 at VA Boston Healthcare System (VABHS). By early 2013, e-consults were available for all clinical services. In this implementation, the requesting clinician selects the desired consultation within the electronic health record (EHR) ordering menu, which creates an electronic form that is pre-populated with patient demographic information and allows free-text entry of the reason for consult. This triggers a message to the requesting clinician and requested specialty, thereby enabling bidirectional clinician-clinician communication. The aim of this study is to examine the utilization of e-consults in a large Veterans Affairs (VA) health care system. Data from the electronic health record was used to measure frequency of e-consult use by provider type (physician or nurse practitioner (NP) and/or physician assistant), and by the requesting and responding specialty from January 2012 to December 2013. We conducted chart reviews for a purposive sample of e-consults and semi-structured interviews with a purposive sample of clinicians and hospital leaders to better characterize the process, challenges, and usability of e-consults. A total of 7097 e-consults were identified, 1998 from 2012 and 5099 from 2013. More than one quarter (27.56%, 1956/7097) of the e-consult requests originated from VA facilities in New England other than VABHS and were excluded from subsequent analysis. Within the VABHS e-consults (72.44%, 5141/7097), variability in frequency and use of e-consults across provider types and specialties was found. A total of 64 NPs requested 2407 e-consults (median 12.5, range 1-415). In contrast, 448 physicians (including residents and fellows) requested 2349 e-consults (median 2, range 1-116). More than one third (37.35%, 1920/5141) of e-consults were sent from primary care to specialists. While most e

  3. [Nursing and the humanization of the end- of-life care within healthcare systems].

    PubMed

    Gómez Arca, Marina

    2014-01-01

    The reflection upon the humanisation of the end-of-life process within healthcare systems and the implication of healthcare professionals is the main objective of this article. The evolution of the model of care and nurses leadership role at the end-of-life process is evaluated. This analysis starts from the first European references regarding advance wills, made in 1997 at the Oviedo Convention, until the introduction of the idea of advance directives incorporated into Spanish law in 2002. It sets the concept of advance planning in health-related decisions, which establishes a process of voluntary dialogue where every person can clarify values, preferences and wishes regarding the final moments of life, with the support of the healthcare professionals. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  4. RFID sensor-tags feeding a context-aware rule-based healthcare monitoring system.

    PubMed

    Catarinucci, Luca; Colella, Riccardo; Esposito, Alessandra; Tarricone, Luciano; Zappatore, Marco

    2012-12-01

    Along with the growing of the aging population and the necessity of efficient wellness systems, there is a mounting demand for new technological solutions able to support remote and proactive healthcare. An answer to this need could be provided by the joint use of the emerging Radio Frequency Identification (RFID) technologies and advanced software choices. This paper presents a proposal for a context-aware infrastructure for ubiquitous and pervasive monitoring of heterogeneous healthcare-related scenarios, fed by RFID-based wireless sensors nodes. The software framework is based on a general purpose architecture exploiting three key implementation choices: ontology representation, multi-agent paradigm and rule-based logic. From the hardware point of view, the sensing and gathering of context-data is demanded to a new Enhanced RFID Sensor-Tag. This new device, de facto, makes possible the easy integration between RFID and generic sensors, guaranteeing flexibility and preserving the benefits in terms of simplicity of use and low cost of UHF RFID technology. The system is very efficient and versatile and its customization to new scenarios requires a very reduced effort, substantially limited to the update/extension of the ontology codification. Its effectiveness is demonstrated by reporting both customization effort and performance results obtained from validation in two different healthcare monitoring contexts.

  5. Security threats categories in healthcare information systems.

    PubMed

    Samy, Ganthan Narayana; Ahmad, Rabiah; Ismail, Zuraini

    2010-09-01

    This article attempts to investigate the various types of threats that exist in healthcare information systems (HIS). A study has been carried out in one of the government-supported hospitals in Malaysia.The hospital has been equipped with a Total Hospital Information System (THIS). The data collected were from three different departments, namely the Information Technology Department (ITD), the Medical Record Department (MRD), and the X-Ray Department, using in-depth structured interviews. The study identified 22 types of threats according to major threat categories based on ISO/IEC 27002 (ISO 27799:2008). The results show that the most critical threat for the THIS is power failure followed by acts of human error or failure and other technological factors. This research holds significant value in terms of providing a complete taxonomy of threat categories in HIS and also an important component in the risk analysis stage.

  6. Ontology-Driven Knowledge-Based Health-Care System, An Emerging Area - Challenges And Opportunities - Indian Scenario

    NASA Astrophysics Data System (ADS)

    Sunitha, A.; Babu, G. Suresh

    2014-11-01

    Recent studies in the decision making efforts in the area of public healthcare systems have been tremendously inspired and influenced by the entry of ontology. Ontology driven systems results in the effective implementation of healthcare strategies for the policy makers. The central source of knowledge is the ontology containing all the relevant domain concepts such as locations, diseases, environments and their domain sensitive inter-relationships which is the prime objective, concern and the motivation behind this paper. The paper further focuses on the development of a semantic knowledge-base for public healthcare system. This paper describes the approach and methodologies in bringing out a novel conceptual theme in establishing a firm linkage between three different ontologies related to diseases, places and environments in one integrated platform. This platform correlates the real-time mechanisms prevailing within the semantic knowledgebase and establishing their inter-relationships for the first time in India. This is hoped to formulate a strong foundation for establishing a much awaited basic need for a meaningful healthcare decision making system in the country. Introduction through a wide range of best practices facilitate the adoption of this approach for better appreciation, understanding and long term outcomes in the area. The methods and approach illustrated in the paper relate to health mapping methods, reusability of health applications, and interoperability issues based on mapping of the data attributes with ontology concepts in generating semantic integrated data driving an inference engine for user-interfaced semantic queries.

  7. Onward and Upward: Characteristics of African American Senior Student Affairs Officers

    ERIC Educational Resources Information Center

    Hammonds, MarTeze D.

    2012-01-01

    The journey of African American student affairs professionals has evolved throughout the history of higher education and student affairs. This study examined the career profiles of ten African American Senior Student Affairs Officers (SSAOs) at predominately White institutions (PWIs) throughout the United States. By using the curriculum vitae and…

  8. Student Affairs and the Board of Trustees: Representation, Support, and Advocacy

    ERIC Educational Resources Information Center

    Beeny, Claudia K.; Garvey-Nix, Ruth C.; Rhodes, Gale S.; Terrell, Patricia S.

    2008-01-01

    A university governing board's influence on institutional policy is undeniable. Educating board members about student affairs issues is essential to ensuring a well-informed, effective board. This study examined the relationship between student affairs and the board's student affairs committee (SAC). An 89-item survey was developed and…

  9. Creating value-focused healthcare delivery systems: Part three--Core competencies.

    PubMed

    Beveridge, R N

    1997-01-01

    Value is created through the delivery of high-quality, cost--effective healthcare services. The ability to create value from the providers' perspective is facilitated through the development and implementation of essential, customer-focused core competencies. These core competencies include customer relationship management, payer/provider relationship management, disease management, outcomes management, financial/cost management, and information management. Customer relationship management is the foundation upon which all core competencies must be built. All of the core competencies must focus on the needs of the customers, both internal and external. Structuring all processes involved in the core competencies from the perspective of the customer will ensure that value is created throughout the system. Payer/provider relationship management will become a crucial pillar for healthcare providers in the future. As more vertical integration among providers occurs, the management of the relationships among providers and with payers will become more important. Many of the integration strategies being implemented across the country involve the integration of hospitals, physicians, and payers to form accountable health plans. The relationships must be organized to form "win/win" situations, where all parties are focused on a shared vision of creating value and none of the parties benefits at the expense of the others. Disease management in creating value requires that we begin examining the disease process along the entire continuum. Not only must providers be able to provide high-quality acute and chronic care, but they must also begin to focus more heavily on programs of prevention. Value is created throughout the system through reducing the prevalence and incidence of disease. Only through managing the full continuum of health will value be created throughout the healthcare delivery system. Outcomes management ensures that the outcomes are the highest quality at a cost

  10. Systemic opioid elimination after implantation of an intrathecal drug delivery system significantly reduced health-care expenditures.

    PubMed

    Hatheway, John A; Caraway, David; David, Guy; Gunnarsson, Candace; Hinnenthal, Jennifer; Ernst, Amanda R; Saulino, Michael

    2015-04-01

    To compare health-care expenditures over a 12-month horizon for chronic pain patients with implanted intrathecal drug delivery systems (IDDS) who eliminated or continued systemic opioids postimplant. Claims data from commercial and Medicare databases were searched for patients who had an IDDS, used systemic opioids before implant, and had 12 months pre- and 13 months postimplant continuous medical and pharmacy coverage. The number and characteristics of patients who eliminated or continued systemic opioids were determined at four times postimplant: 30 days (allowing a systemic opioid washout period), 120 days, 150 days, and 210 days. Multivariable models evaluated the effect of eliminating opioids on health-care expenditures at each of those times. Three hundred eighty-nine patients met inclusion criteria, and 51% completely eliminated systemic opioids (12% within the 30-day washout and an additional 39% by the end of the one-year horizon). Systemic opioid elimination within 120 to 210 days postimplant was associated with a reduction of $3,388 to $4,465 in inpatient and outpatient expenditures, and $4,689 to $5,571 in inpatient, outpatient, and drug expenditures. Fifty-one percent of patients completely eliminated systemic opioids in the year after IDDS implant. This elimination resulted in a 10% to 17% reduction in yearly inpatient, outpatient, and drug expenditures. © 2015 International Neuromodulation Society.

  11. Sexual Healthcare for Wounded Warriors with Serious Combat-Related Injuries and Disabilities.

    PubMed

    Tepper, Mitchell S

    2014-04-01

    Short of the rich literature on sexuality in men following spinal cord injury, started largely by physicians and mental health professionals within the United States Department of Veterans Affairs (VA) system following earlier wars, little attention has been paid to the sexual healthcare of wounded warriors with other serious combat-related injuries. The recent wars in Iraq and Afghanistan-Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND)-resulted in physical injuries including traumatic brain injuries (TBIs), amputations, and serious burns. There are wounded warriors who are left blind or deaf, and a significant percent of OEF/OIF/OND warriors acquire other "invisible" injuries. While the signature injury of the war in Iraq is said to be TBI, there are a substantial number of service members surviving with posttraumatic stress disorder (PTSD). Many with serious injury are struggling with co-occurring depression. Furthermore, many of our wounded warriors are surviving with polytrauma (multiple traumatic injuries, i.e., amputation plus burns). One specific constellation of injuries seen too frequently among our service members in Afghanistan is referred to as a Dismounted Complex Blast Injury (DCBI) sometimes resulting in orchiectomy and/or penile injury. As with other blast injuries, burns, shrapnel injuries, vision loss, hearing loss, TBI, and PTSD often accompany DCBIs. All of the above injuries have significant sexual, endocrine, psychological, and relationship issues that need to be addressed. This article presents an overview of the effects of serious, combat-related injuries on sexual health and provides medical and other health professionals a framework within which to address comprehensive sexual healthcare using a medical rehabilitation model. Sexual healthcare for persons with combat-related disabilities presents a complex array of biopsychosocial and relational issues that call for a coordinated

  12. [Reembursing health-care service provider networks].

    PubMed

    Binder, A; Braun, G E

    2015-03-01

    Health-care service provider networks are regarded as an important instrument to overcome the widely criticised fragmentation and sectoral partition of the German health-care system. The first part of this paper incorporates health-care service provider networks in the field of health-care research. The system theoretical model and basic functions of health-care research are used for this purpose. Furthermore already established areas of health-care research with strong relations to health-care service provider networks are listed. The second part of this paper introduces some innovative options for reimbursing health-care service provider networks which can be regarded as some results of network-oriented health-care research. The origins are virtual budgets currently used in part to reimburse integrated care according to §§ 140a ff. SGB V. Describing and evaluating this model leads to real budgets (capitation) - a reimbursement scheme repeatedly demanded by SVR-Gesundheit (German governmental health-care advisory board), for example, however barely implemented. As a final step a direct reimbursement of networks by the German sickness fund is discussed. Advantages and challenges are shown. The development of the different reimbursement schemes is partially based on models from the USA. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Macroergonomics in Healthcare Quality and Patient Safety

    PubMed Central

    Carayon, Pascale; Karsh, Ben-Tzion; Gurses, Ayse P.; Holden, Richard; Hoonakker, Peter; Hundt, Ann Schoofs; Montague, Enid; Rodriguez, Joy; Wetterneck, Tosha B.

    2014-01-01

    The US Institute of Medicine and healthcare experts have called for new approaches to manage healthcare quality problems. In this chapter, we focus on macroergonomics, a branch of human factors and ergonomics that is based on the systems approach and considers the organizational and sociotechnical context of work activities and processes. Selected macroergonomic approaches to healthcare quality and patient safety are described such as the SEIPS model of work system and patient safety and the model of healthcare professional performance. Focused reviews on job stress and burnout, workload, interruptions, patient-centered care, health IT and medical devices, violations, and care coordination provide examples of macroergonomics contributions to healthcare quality and patient safety. Healthcare systems and processes clearly need to be systematically redesigned; examples of macroergonomic approaches, principles and methods for healthcare system redesign are described. Further research linking macroergonomics and care processes/patient outcomes is needed. Other needs for macroergonomics research are highlighted, including understanding the link between worker outcomes (e.g., safety and well-being) and patient outcomes (e.g., patient safety), and macroergonomics of patient-centered care and care coordination. PMID:24729777

  14. Managing today's complex healthcare business enterprise: reflections on distinctive requirements of healthcare management education.

    PubMed

    Welton, William E

    2004-01-01

    In early 2001, the community of educational programs offering master's-level education in healthcare management began an odyssey to modernize its approach to the organization and delivery of healthcare management education. The community recognized that cumulative long-term changes within healthcare management practice required a careful examination of healthcare management context and manpower requirements. This article suggests an evidence-based rationale for defining the distinctive elements of healthcare management, thus suggesting a basis for review and transformation of master's-level healthcare management curricula. It also suggests ways to modernize these curricula in a manner that recognizes the distinctiveness of the healthcare business enterprise as well as the changing management roles and careers within these complex organizations and systems. Through such efforts, the healthcare management master's-level education community would be better prepared to meet current and future challenges, to increase its relevance to the management practice community, and to allocate scarce faculty and program resources more effectively.

  15. Developing a ubiquitous health management system with healthy diet control for metabolic syndrome healthcare in Taiwan.

    PubMed

    Kan, Yao-Chiang; Chen, Kai-Hong; Lin, Hsueh-Chun

    2017-06-01

    Self-management in healthcare can allow patients managing their health data anytime and everywhere for prevention of chronic diseases. This study established a prototype of ubiquitous health management system (UHMS) with healthy diet control (HDC) for people who need services of metabolic syndrome healthcare in Taiwan. System infrastructure comprises of three portals and a database tier with mutually supportive components to achieve functionality of diet diaries, nutrition guides, and health risk assessments for self-health management. With the diet, nutrition, and personal health database, the design enables the analytical diagrams on the interactive interface to support a mobile application for diet diary, a Web-based platform for health management, and the modules of research and development for medical care. For database integrity, dietary data can be stored at offline mode prior to transformation between mobile device and server site at online mode. The UHMS-HDC was developed by open source technology for ubiquitous health management with personalized dietary criteria. The system integrates mobile, internet, and electronic healthcare services with the diet diary functions to manage healthy diet behaviors of users. The virtual patients were involved to simulate the self-health management procedure. The assessment functions were approved by capturing the screen snapshots in the procedure. The proposed system development was capable for practical intervention. This approach details the expandable framework with collaborative components regarding the self-developed UHMS-HDC. The multi-disciplinary applications for self-health management can support the healthcare professionals to reduce medical resources and improve healthcare effects for the patient who requires monitoring personal health condition with diet control. The proposed system can be practiced for intervention in the hospital. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Redefining Our Mission: What Does Higher Education Need from Student Affairs?

    ERIC Educational Resources Information Center

    Porterfield, Kent T.; Roper, Larry D.; Whitt, Elizabeth J.

    2011-01-01

    In this article, the authors argue that the relevance of student affairs depends on the will to redefine the mission, structures, and practices to provide the leadership that institutions require. They begin with an overview of challenges to higher education and student affairs, examine the implications of those challenges for student affairs, and…

  17. Developing public affairs counseling skills to support a public participation focus at Fernald

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

    Hoopes, J.

    To provide closer coordination between the Public Affairs Division and environmental restoration management and technical staff, the Fernald Environmental Restoration Management Corporation (FERMCO) matrixed Public Affairs staffers as counselors to project teams within FERMCO. Close coordination between technical staff and public affairs staff is essential for effective public communication in a public participation, environmental risk communication environment. Two-way symmetrical communication (public participation) represents a paradigm shift for public affairs staff who have developed skills primarily in a public information (asymmetrical communication) environment. While there has been much focus in the literature and workshops on management changes needed to support amore » public participation environment, less attention has been paid to identifying and developing the skills needed by public affairs professionals to support public participation. To support the new counseling role of public affairs staffers, FERMCO used a public affairs training consultant to design and deliver a workshop to initiate development of the skills needed for the public affairs counseling role. This paper describes FERMCO`s matrixed counseling program and the training to develop public affairs counseling skills for the public participation environment.« less

  18. The Italian health-care system.

    PubMed

    France, George; Taroni, Francesco; Donatini, Andrea

    2005-09-01

    Italy's national health service is statutorily required to guarantee the uniform provision of comprehensive care throughout the country. However, this is complicated by the fact that, constitutionally, responsibility for health care is shared between the central government and the 20 regions. There are large and growing differences in regional health service organisation and provision. Public health-care expenditure has absorbed a relatively low share of gross domestic product, although in the last 25 years it has consistently exceeded central government forecasts. Changes in payment systems, particularly for hospital care, have helped to encourage organisational appropriateness and may have contributed to containing expenditure. Tax sources used to finance the Servizio Sanitario Nazionale (SSN) have become somewhat more regressive. The limited evidence on vertical equity suggests that the SSN ensures equal access to primary care but lower income groups face barriers to specialist care. The health status of Italians has improved and compares favourably with that in other countries, although regional disparities persist. Copyright (c) 2005 John Wiley & Sons, Ltd.

  19. Automated information systems provide health information management support to veterans' healthcare.

    PubMed

    Lloyd, S S

    1992-06-01

    The Veterans Health Administration has implemented a comprehsnsive DHCP which supports the VA healthcare system at both local and national levels. Numerous clinical and management modules have been developed; an overview was given of selected applications impacting health information managers. Continuing development includes an automated clinical record and expanded electronic data exchange.

  20. Potentiality of Big Data in the Medical Sector: Focus on How to Reshape the Healthcare System

    PubMed Central

    Jee, Kyoungyoung

    2013-01-01

    Objectives The main purpose of this study was to explore whether the use of big data can effectively reduce healthcare concerns, such as the selection of appropriate treatment paths, improvement of healthcare systems, and so on. Methods By providing an overview of the current state of big data applications in the healthcare environment, this study has explored the current challenges that governments and healthcare stakeholders are facing as well as the opportunities presented by big data. Results Insightful consideration of the current state of big data applications could help follower countries or healthcare stakeholders in their plans for deploying big data to resolve healthcare issues. The advantage for such follower countries and healthcare stakeholders is that they can possibly leapfrog the leaders' big data applications by conducting a careful analysis of the leaders' successes and failures and exploiting the expected future opportunities in mobile services. Conclusions First, all big data projects undertaken by leading countries' governments and healthcare industries have similar general common goals. Second, for medical data that cuts across departmental boundaries, a top-down approach is needed to effectively manage and integrate big data. Third, real-time analysis of in-motion big data should be carried out, while protecting privacy and security. PMID:23882412

  1. Potentiality of big data in the medical sector: focus on how to reshape the healthcare system.

    PubMed

    Jee, Kyoungyoung; Kim, Gang-Hoon

    2013-06-01

    The main purpose of this study was to explore whether the use of big data can effectively reduce healthcare concerns, such as the selection of appropriate treatment paths, improvement of healthcare systems, and so on. By providing an overview of the current state of big data applications in the healthcare environment, this study has explored the current challenges that governments and healthcare stakeholders are facing as well as the opportunities presented by big data. Insightful consideration of the current state of big data applications could help follower countries or healthcare stakeholders in their plans for deploying big data to resolve healthcare issues. The advantage for such follower countries and healthcare stakeholders is that they can possibly leapfrog the leaders' big data applications by conducting a careful analysis of the leaders' successes and failures and exploiting the expected future opportunities in mobile services. First, all big data projects undertaken by leading countries' governments and healthcare industries have similar general common goals. Second, for medical data that cuts across departmental boundaries, a top-down approach is needed to effectively manage and integrate big data. Third, real-time analysis of in-motion big data should be carried out, while protecting privacy and security.

  2. Geographic variation in Medicare and the military healthcare system.

    PubMed

    Adesoye, Taiwo; Kimsey, Linda G; Lipsitz, Stuart R; Nguyen, Louis L; Goodney, Philip; Olaiya, Samuel; Weissman, Joel S

    2017-08-01

    To compare geographic variation in healthcare spending and utilization between the Military Health System (MHS) and Medicare across hospital referral regions (HRRs). Retrospective analysis. Data on age-, sex-, and race-adjusted Medicare per capita expenditure and utilization measures by HRR were obtained from the Dartmouth Atlas for 2007 to 2010. Similarly, adjusted data from 2007 and 2010 were obtained from the MHS Data Repository and patients assigned to HRRs. We compared high- and low-spending regions, and computed coefficient of variation (CoV) and correlation coefficients for healthcare spending, hospital inpatient days, hip surgery, and back surgery between MHS and Medicare patients. We found significant variation in spending and utilization across HRRs in both the MHS and Medicare. CoV for spending was higher in the MHS compared with Medicare, (0.24 vs 0.15, respectively) and CoV for inpatient days was 0.36 in the MHS versus 0.19 in Medicare. The CoV for back surgery was also greater in the MHS compared with Medicare (0.47 vs 0.29, respectively). Per capita Medicare spending per HRR was significantly correlated to adjusted MHS spending (r = 0.3; P <.0001). Correlation in inpatient days (r = 0.29; P <.0001) and back surgery (r = 0.52; P <.0001) was also significant. Higher spending markets in both systems were not comparable; lower spending markets were located mostly in the Midwest. In comparing 2 systems with similar pricing schemes, differences in spending likely reflect variation in utilization and the influence of local provider culture.

  3. Personalized biomedical devices & systems for healthcare applications

    NASA Astrophysics Data System (ADS)

    Chen, I.-Ming; Phee, Soo Jay; Luo, Zhiqiang; Lim, Chee Kian

    2011-03-01

    With the advancement in micro- and nanotechnology, electromechanical components and systems are getting smaller and smaller and gradually can be applied to the human as portable, mobile and even wearable devices. Healthcare industry have started to benefit from this technology trend by providing more and more miniature biomedical devices for personalized medical treatments in order to obtain better and more accurate outcome. This article introduces some recent development in non-intrusive and intrusive biomedical devices resulted from the advancement of niche miniature sensors and actuators, namely, wearable biomedical sensors, wearable haptic devices, and ingestible medical capsules. The development of these devices requires carful integration of knowledge and people from many different disciplines like medicine, electronics, mechanics, and design. Furthermore, designing affordable devices and systems to benefit all mankind is a great challenge ahead. The multi-disciplinary nature of the R&D effort in this area provides a new perspective for the future mechanical engineers.

  4. A healthcare Lean Six Sigma System for postanesthesia care unit workflow improvement.

    PubMed

    Kuo, Alex Mu-Hsing; Borycki, Elizabeth; Kushniruk, Andre; Lee, Te-Shu

    2011-01-01

    The aim of this article is to propose a new model called Healthcare Lean Six Sigma System that integrates Lean and Six Sigma methodologies to improve workflow in a postanesthesia care unit. The methodology of the proposed model is fully described. A postanesthesia care unit case study is also used to demonstrate the benefits of using the Healthcare Lean Six Sigma System model by combining Lean and Six Sigma methodologies together. The new model bridges the service gaps between health care providers and patients, balances the requirements of health care managers, and delivers health care services to patients by taking the benefits of the Lean speed and Six Sigma high-quality principles. The full benefits of the new model will be realized when applied at both strategic and operational levels. For further research, we will examine how the proposed model is used in different real-world case studies.

  5. Perceived determinants of cardiovascular risk management in primary care: disconnections between patient behaviours, practice organisation and healthcare system.

    PubMed

    Huntink, E; Wensing, M; Klomp, M A; van Lieshout, J

    2015-12-15

    Although conditions for high quality cardiovascular risk management in primary care in the Netherlands are favourable, there still remains a gap between practice guideline recommendations and practice. The aim of the current study was to identify determinants of cardiovascular primary care in the Netherlands. We performed a qualitative study, using semi-structured interviews with healthcare professionals and patients with established cardiovascular diseases or at high cardiovascular risk. A framework analysis was used to cluster the determinants into seven domains: 1) guideline factors, 2) individual healthcare professional factors, 3) patient factors, 4) professional interaction, 5) incentives and recourses, 6) mandate, authority and accountability, and 7) social, political and legal factors. Twelve healthcare professionals and 16 patients were interviewed. Healthcare professionals and patients mentioned a variety of factors concerning all seven domains. Determinants of practice according to the health care professionals were related to communication between healthcare professionals, patients' lack of knowledge and self-management, time management, market mechanisms in the Dutch healthcare system and motivational interviewing skills of healthcare professionals. Patients mentioned determinants related to their knowledge of risk factors for cardiovascular diseases, medication adherence and self-management as key determinants. A key finding is the mismatch between healthcare professionals' and patients' views on patient's knowledge and self-management. Perceived determinants of cardiovascular risk management were mainly related to patient behaviors and (but only for health professionals) to the healthcare system. Though health care professionals and patients agree upon the importance of patients' knowledge and self-management, their judgment of the current state of knowledge and self-management is entirely different.

  6. Principles for Health System Capacity Planning: Insights for Healthcare Leaders.

    PubMed

    Shaw, James; Wong, Ivy; Griffin, Bailey; Robertson, Michael; Bhatia, R Sacha

    2017-01-01

    Jurisdictions across Canada and around the world face the challenge of planning high-performing and sustainable health systems in response to growing healthcare demands. In this paper, we report on the process of developing principles for health system capacity planning by the Ministry of Health and Long-Term Care in Ontario. Integrating the results of a literature review on health system planning and a symposium with representatives from local health integration networks, we describe the following six principles in detail: (1) develop an aspirational vision, (2) establish clear leadership, (3) commit to stakeholder engagement, (4) engage patients and the public, (5) build analytics infrastructure and (6) revise policy when necessary.

  7. The healthcare system and the provision of oral healthcare in European Union Member States. Part 6: Poland.

    PubMed

    Malkiewicz, K; Malkiewicz, E; Eaton, K A; Widström, E

    2016-10-21

    Poland is one of the largest European countries in terms of area and population. The country's economic situation does not allow for the allocation of sufficient public funds for healthcare in general and oral healthcare in particular. The health policy of the state focuses primarily on prophylaxis and treatment of diseases, directly threatening the health and lives of the inhabitants. Currently, expenditure on oral health accounts for only 2.7% of the public funds allocated to healthcare. In this context, providing oral care financed from public funds at an appropriate level constitutes a challenge for state institutions, centres providing medical and dental services and private practices. Despite difficult financial conditions in Poland, therapeutic and prophylactic programmes are implemented, aimed at improving the oral health of the society, especially children and adolescents, pregnant women and patients with disabilities or developmental disorders such as cleft palate. In Poland, apart from the oral care system financed by the state, there is also an extremely well developed system of private practices and clinics providing clinical services on a commercial basis. In 2014, oral services, financed by the state, were utilised by about 30% of the population of children and youths aged 0-18 years (2,212,792 patients) and about 15% of the adult population (5,026,383 patients). Training of Polish dentists is conducted in ten state-owned universities, from which 700 graduate each year. Dentists work mainly in private practices or medical centres, some of which provide services guaranteed by the public insurer - the National Health Fund. The other dentists find employment in state clinics, hospitals, and universities and their associated clinics. In Poland dentistry is a predominantly female profession and 75% of the just over 40,000 Polish dentists are female. Accession of Poland to the European Union meant that some Polish dentists have taken up employment abroad

  8. TIDE: an intelligent home-based healthcare information & diagnostic environment.

    PubMed

    Abidi, S S

    1999-01-01

    The 21st century promises to usher in an era of Internet based healthcare services--Tele-Healthcare. Such services augur well with the on-going paradigm shift in healthcare delivery patterns, i.e. patient centred services as opposed to provider centred services and wellness maintenance as opposed to illness management. This paper presents a Tele-Healthcare info-structure TIDE--an 'intelligent' wellness-oriented healthcare delivery environment. TIDE incorporates two WWW-based healthcare systems: (1) AIMS (Automated Health Monitoring System) for wellness maintenance and (2) IDEAS (Illness Diagnostic & Advisory System) for illness management. Our proposal comes from an attempt to rethink the sources of possible leverage in improving healthcare; vis-à-vis the provision of a continuum of personalised home-based healthcare services that emphasise the role of the individual in self health maintenance.

  9. 77 FR 52379 - Advisory Committee on Veterans Business Affairs

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-29

    ... SMALL BUSINESS ADMINISTRATION Advisory Committee on Veterans Business Affairs AGENCY: U.S. Small Business Administration. ACTION: Notice of open Federal Advisory Committee meeting. SUMMARY: The SBA is... Committee on Veterans Business Affairs. The meeting will be open to the public. DATES: September 10, 2012...

  10. 78 FR 70088 - Advisory Committee on Veterans Business Affairs

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-22

    ... SMALL BUSINESS ADMINISTRATION Advisory Committee on Veterans Business Affairs AGENCY: U.S. Small Business Administration. ACTION: Notice of open Federal Advisory Committee meeting. SUMMARY: The SBA is... Committee on Veterans Business Affairs. The meeting will be open to the public. DATES: December 5, 2013 from...

  11. 75 FR 22434 - Advisory Committee on Veterans Business Affairs

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-28

    ... SMALL BUSINESS ADMINISTRATION Advisory Committee on Veterans Business Affairs AGENCY: U.S. Small Business Administration. ACTION: Notice of open Federal Advisory Committee Meeting. SUMMARY: The SBA is... Committee on Veterans Business Affairs. The meeting will be open to the public. DATES: Tuesday, May 25, 2010...

  12. A Study to Develop Alternative Approaches for Implementing Product Line Management in the South Texas Veterans Health Care System

    DTIC Science & Technology

    1997-05-01

    Transformation of the Veterans Healthcare System." Department of Veterans Affairs, Washington, D.C., March, 1996. 88 Kotler , Philip . "Managing...time lines are developed so management and staff can begin thinking about business from a different perspective (Manning 1987,29). Philip Lathrop...organized around product lines will the full effects of this approach be known. 86 WORKS CITED Benz, Philip D., and Janet Burnham. "Case Study

  13. Achieving fertility control through woman’s autonomy and access to maternal healthcare: Are we on track? In-depth analysis of PDHS-2012-13

    PubMed Central

    Hassan, Sehar-un-Nisa; Siddiqui, Salma; Mahmood, Ayeshah

    2015-01-01

    Background and Objective: Fertility control preferences and maternal healthcare have recently become a major concern for developing nations with evidence suggesting that low fertility control rates and poor maternal healthcare are among major obstructions in ensuring health and social status for women. Our objective was toanalyze the factors that influence women’s autonomy, access to maternal healthcare, and fertility control preferences in Pakistan. Methods: Data consisted of 11,761 ever-married women of ages 15-49 years from PDHS, 2012-13. Variables included socio-demographics, women’s autonomy, fertility control preferences and access to maternal healthcare. Results: Findings from multivariate analysis showed that women’s younger age, having less than three number of children and independent or joint decision-making (indicators of high autonomy) remained the most significant predictors for access to better quality maternal healthcare and better fertility control preferences when other variables were controlled. Conclusion: Women’s access to good quality maternal health care and fertility control preferences are directly and indirectly influenced by their demographic characteristics and decision-making patterns in domestic affairs. PMID:26870096

  14. Using heterogeneous wireless sensor networks in a telemonitoring system for healthcare.

    PubMed

    Corchado, Juan M; Bajo, Javier; Tapia, Dante I; Abraham, Ajith

    2010-03-01

    Ambient intelligence has acquired great importance in recent years and requires the development of new innovative solutions. This paper presents a distributed telemonitoring system, aimed at improving healthcare and assistance to dependent people at their homes. The system implements a service-oriented architecture based platform, which allows heterogeneous wireless sensor networks to communicate in a distributed way independent of time and location restrictions. This approach provides the system with a higher ability to recover from errors and a better flexibility to change their behavior at execution time. Preliminary results are presented in this paper.

  15. Strategic enterprise resource planning in a health-care system using a multicriteria decision-making model.

    PubMed

    Lee, Chang Won; Kwak, N K

    2011-04-01

    This paper deals with strategic enterprise resource planning (ERP) in a health-care system using a multicriteria decision-making (MCDM) model. The model is developed and analyzed on the basis of the data obtained from a leading patient-oriented provider of health-care services in Korea. Goal criteria and priorities are identified and established via the analytic hierarchy process (AHP). Goal programming (GP) is utilized to derive satisfying solutions for designing, evaluating, and implementing an ERP. The model results are evaluated and sensitivity analyses are conducted in an effort to enhance the model applicability. The case study provides management with valuable insights for planning and controlling health-care activities and services.

  16. Wearable nanosensor systems and their applications in healthcare

    NASA Astrophysics Data System (ADS)

    Ramasamy, Mouli; Kumar, Prashanth S.; Varadan, Vijay K.

    2017-04-01

    The development of intelligent miniaturized nano-bio-and info-tech based sensors capable of wireless communication will fundamentally change the way we monitor and treat patients with chronic disease and after surgery. These new sensors will allow the monitoring of the patients as they maintain their normal daily activities, and provide warning to healthcare workers when critical events arise. This will facilitate early discharge of patients from hospitals as well as providing reassurance to patients and family that potential problems will be detected at an early stage. The use of continuous monitoring allows both transient and progressive abnormalities to be reliably detected thus avoiding the problems of conventional diagnosis and monitoring methods where by data is captured only for a brief period during hospital/clinic visits. We have been working with a printable organic semiconductor and thin film transistor, and have fabricated and tested various biosensors that can measure important physiological signs before and after surgery. Integrated into "smart" fabrics - garments with wireless technology - and independent e-bandaid sensors, nanosensors in tattoos and socks, minimally invasive implantable devices, the sensor systems will be able to monitor a patient's condition in real time and thus provide point-of-care diagnostics to health-care professionals and greater freedom for patients.

  17. Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: a health economic modeling study.

    PubMed

    Lokkerbol, Joran; Adema, Dirk; Cuijpers, Pim; Reynolds, Charles F; Schulz, Richard; Weehuizen, Rifka; Smit, Filip

    2014-03-01

    Depressive disorders are significant causes of disease burden and are associated with substantial economic costs. It is therefore important to design a healthcare system that can effectively manage depression at sustainable costs. This article computes the benefit-to-cost ratio of the current Dutch healthcare system for depression, and investigates whether offering more online preventive interventions improves the cost-effectiveness overall. A health economic (Markov) model was used to synthesize clinical and economic evidence and to compute population-level costs and effects of interventions. The model compared a base case scenario without preventive telemedicine and alternative scenarios with preventive telemedicine. The central outcome was the benefit-to-cost ratio, also known as return-on-investment (ROI). In terms of ROI, a healthcare system with preventive telemedicine for depressive disorders offers better value for money than a healthcare system without Internet-based prevention. Overall, the ROI increases from €1.45 ($1.72) in the base case scenario to €1.76 ($2.09) in the alternative scenario in which preventive telemedicine is offered. In a scenario in which the costs of offering preventive telemedicine are balanced by reducing the expenditures for curative interventions, ROI increases to €1.77 ($2.10), while keeping the healthcare budget constant. For a healthcare system for depressive disorders to remain economically sustainable, its cost-benefit ratio needs to be improved. Offering preventive telemedicine at a large scale is likely to introduce such an improvement. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  18. 75 FR 70343 - Privacy Act; System of Records: Records of the Bureau of Public Affairs

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-17

    ... Department principals to accept a speaking engagement or attend a function; representatives of... employees who have asked the Bureau of Public Affairs to place articles about their achievements in their..., biographies, speaking engagements, interviews and communications of Department Secretaries, principals and...

  19. Student Affairs Case Management: Merging Social Work Theory with Student Affairs Practice

    ERIC Educational Resources Information Center

    Adams, Sharrika D.; Hazelwood, Sherry; Hayden, Bruce

    2014-01-01

    Case management is a functional area in higher education and student affairs that emerged after the mass shootings at Virginia Tech in 2007. Although new to higher education, case management emerged from established social work practice. This article compares social work theory and case management standards with a new case management model for…

  20. Technology and Student Affairs: Redux

    ERIC Educational Resources Information Center

    Moneta, Larry

    2005-01-01

    The author addresses two critical questions related to technology: How has students' use of technology influenced student affairs work? How do we best align our business practices with advances in information technology?