75 FR 41506 - Office of the Citizenship and Immigration Service Ombudsman; Agency Information Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

... DEPARTMENT OF HOMELAND SECURITY Office of the Citizenship and Immigration Service Ombudsman... and Virtual Ombudsman System AGENCY: Office of the Citizenship and Immigration Service Ombudsman, DHS.... SUMMARY: The Department of Homeland Security, Office of the Citizenship and Immigration Service Ombudsman...

Complaints against nursing homes: comparing two sources of complaint information and predictors of complaints.

PubMed

Troyer, Jennifer L; Sause, Wendy L

2011-08-01

Two consumer-derived measures of nursing home quality that have been underutilized by researchers are consumer complaints to the state certification agency between inspections and complaints to the Long-Term Care Ombudsman Program. This article describes these complaints, considers facility-level predictors of complaints, and examines how complaints to the 2 entities are related. This article uses North Carolina complaint data from the state certification agency and Ombudsman from 2002 to 2006. First, we outline the similarities and differences in the 2 complaint sources by considering descriptive statistics and examining the structure of the 2 agencies. Second, we examine the relationship between complaints and facility characteristics that have been predictive of traditional quality measures. Finally, we examine the relationships between the 2 types of complaints. We find that complaints to the 2 agencies exhibit distinct differences in substantiation rates, although the top complaint category for both agencies is quality of care. Having a higher proportion of Medicaid residents is generally not predictive of complaint volume, whereas having a higher proportion of Medicare residents is associated with higher complaint levels. We find a lack of association between complaints to the 2 agencies when examining specific matched categories of complaints in many cases, suggesting that the 2 entities are not duplicating efforts in these categories.

Governmental efforts to improve quality of care for nursing home residents and to protect them from mistreatment: a survey of federal and state laws.

PubMed

Gittler, Josephine

2008-10-01

There are many federal and state laws addressing, directly and indirectly, the quality of care provided to nursing home residents and the protection of residents from mistreatment. They include: (a) state laws that govern the licensing of nursing homes, (b) federal laws that govern the certification of nursing homes for participation in the Medicare and Medicaid programs, (c) elder abuse laws prohibiting mistreatment of older adults in nursing homes and other settings, (d) health care fraud abuse laws that are increasingly being used to combat the provision of substandard care to Medicare and Medicaid beneficiaries in nursing homes, and (e) laws that have established long-term care ombudsman programs to promote the health, safety, well-being, and rights of nursing home residents. While these laws are generally viewed as having improved the care and treatment of nursing home residents, much remains to be done, particularly with respect to the implementation of these laws.

75 FR 22609 - Agency Information Collection Activities; Proposals, Submissions, and Approvals: CIS Ombudsman...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-29

... System AGENCY: Office of the Citizenship and Immigration Service Ombudsman, DHS. ACTION: 60-Day Notice... Department of Homeland Security, Office of the Citizenship and Immigration Service Ombudsman, will submit the... Request should be forwarded to Office of the Citizenship and Immigration Services Ombudsman, DHS, Attn...

16 CFR 1020.3 - What are the qualifications and duties of the Small Business Ombudsman?

Code of Federal Regulations, 2010 CFR

2010-01-01

... Ombudsman? (a) The Chairman will appoint a senior, full-time Commission employee as Small Business Ombudsman. The Ombudsman must: (1) Have a working knowledge of the Commission's statutes and regulations; (2) Be familiar with the industries and products that the Commission regulates; (3) Develop a working knowledge of...

76 FR 61725 - Agency Information Collection Activities: Case Submission Form, Case Assistance Form; (Form DHS...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-05

..., Case Assistance Form; (Form DHS-7001), Online Ombudsman Form DHS-7001 AGENCY: Office of the Citizenship... System'' to ``Online Ombudsman Form DHS-7001''. The instructions have been updated to reflect the... Services Ombudsman--001 Virtual Ombudsman System (March 2010) to reflect the name change to Online...

48 CFR 1852.215-84 - Ombudsman.

Code of Federal Regulations, 2011 CFR

2011-10-01

[email protected]nasa.gov. Please do not contact the ombudsman to request copies of the solicitation, verify offer due... recommendations which cannot be resolved at the installation may be referred to the NASA ombudsman, the Director...

48 CFR 1852.215-84 - Ombudsman.

Code of Federal Regulations, 2010 CFR

2010-10-01

[email protected]nasa.gov. Please do not contact the ombudsman to request copies of the solicitation, verify offer due... recommendations which cannot be resolved at the installation may be referred to the NASA ombudsman, the Director...

Office of the Ombudsman.

ERIC Educational Resources Information Center

Office of Federal Student Aid (ED), Washington, DC.

This pamphlet describes the Federal Student Aid Ombudsman, an impartial resource to help customers resolve student loan concerns when other approaches fail. The ombudsman helps resolve discrepancies in loan balances and payments, and helps customers understand interest and collection charges. The office helps resolve issues related to income tax…

Ombudsman Roles for Social Workers

ERIC Educational Resources Information Center

Payne, James E.

1972-01-01

In Scandinavia the ombudsman has long been respected as a mediator who protects the rights of individual citizens and works to assure governmental agencies' fairness in dealing with them. This article examines the concept and considers various ombudsman roles for social workers in the United States. (Author)

48 CFR 652.206-70 - Competition Advocate/Ombudsman.

Code of Federal Regulations, 2010 CFR

2010-10-01

... contact the contracting activity ombudsman, [insert name], at [insert telephone and fax numbers]. For an.... Concerns, issues, disagreements, and recommendations which cannot be resolved at a contracting activity level may be referred to the Department of State Acquisition Ombudsman at (703) 516-1680, by fax at (703...

48 CFR 652.206-70 - Competition Advocate/Ombudsman.

Code of Federal Regulations, 2011 CFR

2011-10-01

... contact the contracting activity ombudsman, [insert name], at [insert telephone and fax numbers]. For an.... Concerns, issues, disagreements, and recommendations which cannot be resolved at a contracting activity level may be referred to the Department of State Acquisition Ombudsman at (703) 516-1680, by fax at (703...

75 FR 48383 - Submission for Review: Ombudsman Request for Assistance Information Collection, 3206-NEW

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-10

... OFFICE OF PERSONNEL MANAGEMENT Submission for Review: Ombudsman Request for Assistance Information Collection, 3206-NEW AGENCY: U.S. Office of Personnel Management. ACTION: 60-Day Notice and request for comments. SUMMARY: The Executive Secretariat and Ombudsman, Office of Personnel Management (OPM) offers the...

The Ombudsman in Practice.

ERIC Educational Resources Information Center

White, J. Benton

The office of Ombudsman at San Jose State College was created as a response to a series of demonstrations by the black community protesting discrimination experienced on and around campus. The Ombudsman was to "search out and facilitate the removal of discrimination of the basis of race, creed, or national origin" wherever it occurred.…

SFA Ombudsman Serving Students. Interim Report, September 1999 to March 2000.

ERIC Educational Resources Information Center

Department of Education, Washington, DC. Student Financial Assistance.

This 6-page pamphlet shares what the Student Financial Assistance (SFA) Office of the Ombudsman has learned from cases it has handled. An initial section offers information on the case management process, noting that the ombudsman process depends on the case's complexity and that many are revolved quickly. Next, it examines customer-reported case…

The Ombudsman. An Informal Survey of the Implementation of the Ombudsman Concept, Summer, 1968.

ERIC Educational Resources Information Center

Bloland, Paul A.; Nowak, Daniel B.

College and university response to the sense of anomie experienced by students --especially those attending large, complex institutions-- has been to implement several plans for reducing the students' feelings of impersonality and estrangement. In one of these plans, based on the "ombudsman" concept, students register complaints to 1 individual,…

The Ombudsman in Higher Education: Advocate or Subversive Bureaucrat.

ERIC Educational Resources Information Center

Ombudsman Foundation, Los Angeles, CA.

Though the authors in these 13 papers differed in their attitudes toward the concept of an Ombudsman on campus, a majority seemed to agree with the following assumptions: 1) various levels of administration and bureaucracy are capable of abusing the citizenry of the university community; 2) the Ombudsman is a "third party agency" and is not the…

Factors Important to Success in the Volunteer Long-Term Care Ombudsman Role

ERIC Educational Resources Information Center

Nelson, H. Wayne; Hooker, Karen; DeHart, Kimberly N.; Edwards, John A.; Lanning, Kevin

2004-01-01

This study found that the satisfaction of one state's largely older volunteers' altruistic, affiliation, and self-improvement motives corresponded to increased organizational loyalty and better performance across several dimensions. Younger volunteers served for shorter periods and were more highly motivated by the "self-improvement" need.…

42 CFR 483.12 - Admission, transfer and discharge rights.

Code of Federal Regulations, 2014 CFR

2014-10-01

... needs, under paragraph (a)(2)(i) of this section; or (E) A resident has not resided in the facility for... telephone number of the State long term care ombudsman; (vi) For nursing facility residents with... Disabilities Assistance and Bill of Rights Act; and (vii) For nursing facility residents who are mentally ill...

42 CFR 483.12 - Admission, transfer and discharge rights.

Code of Federal Regulations, 2011 CFR

2011-10-01

... needs, under paragraph (a)(2)(i) of this section; or (E) A resident has not resided in the facility for... telephone number of the State long term care ombudsman; (vi) For nursing facility residents with... Disabilities Assistance and Bill of Rights Act; and (vii) For nursing facility residents who are mentally ill...

42 CFR 483.12 - Admission, transfer and discharge rights.

Code of Federal Regulations, 2013 CFR

2013-10-01

... needs, under paragraph (a)(2)(i) of this section; or (E) A resident has not resided in the facility for... telephone number of the State long term care ombudsman; (vi) For nursing facility residents with... Disabilities Assistance and Bill of Rights Act; and (vii) For nursing facility residents who are mentally ill...

42 CFR 483.12 - Admission, transfer and discharge rights.

Code of Federal Regulations, 2012 CFR

2012-10-01

... needs, under paragraph (a)(2)(i) of this section; or (E) A resident has not resided in the facility for... telephone number of the State long term care ombudsman; (vi) For nursing facility residents with... Disabilities Assistance and Bill of Rights Act; and (vii) For nursing facility residents who are mentally ill...

Establishment of Korean Nuclear Ombudsman System Importing Compensation and Insurance Concept for Residents

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

Hyun Seok Ko; Yong Min Kim; Young Wook Lee

2006-07-01

In Korea, the nuclear power generation is grown technically well. Already, 20 nuclear reactors are operated, and approximate they supply the 40% of whole the consumption of electric power. This is the driving force of Korean industrial development. Besides, Korean Standard Nuclear Power Plant that was developed by Korean self-technique with nuclear plant technique independence, Ul-Chin 6 has started the commercial operation. Advanced Korean Standard Nuclear Power Plant, new Gori 1, 2 constructions are commenced. But, past days Korean situation is that intention of residents is neglected in the decision making process of nuclear power plant construction and operation. Inmore » existing decision making process, it is regarded as the role of public opinion is secondary, and the problem of decision making process is that public is persuaded and believed. So, in decision making process, the public opinion is considered restrictively, there is not the actual public participation. Therefore the dissatisfaction of public is increased continuously, and in Korea, bad recognition about nuclear power is getting full. The method of public participation for complement of this problem is public hearing or ombudsman system. The public hearing is ensuring public participation before decision of a case, and ombudsman is the system that elevates the public satisfaction through continuous feedback of public requirement to occur in deciding and performing the matters. In Korean situation, that present 20 nuclear reactors are operated and also the place of radioactive waste repository has been decided, not only the introduction of public hearing to decide the coming matter but also the operation of ombudsman system to continuously correct and collect the public requirements about the matter to already decided and operated is necessary. In Korea, administration type ombudsman is operated now. But, it has operated without basic element at the aspect of organization, function and phase. So it is not established a firm phase as right relief body to be believed by public with lack of independence, authority and specialty. Therefore the establishment of organization that can be the role as special ombudsman organization about sensitive and special matter like nuclear matter is necessary. Definite establishment element of ombudsman system is to introduce of congress type ombudsman element, to be permanent standing system ombudsman, to limit jurisdiction extent and have strong authority, to be able to access easily, to be composed of legal and nuclear specialist. One of important requirements of resident is compensation. So, based on the resident compensation theory about aversion equipment, ombudsman system should be established introducing the insurance theory through risk management as functional background for appropriate compensation. (authors)« less

42 CFR 483.10 - Resident rights.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., to refuse to participate in experimental research, and to formulate an advance directive as specified... advocacy groups such as the State survey and certification agency, the State licensure office, the State ombudsman program, the protection and advocacy network, and the Medicaid fraud control unit; and (iv) A...

42 CFR 483.10 - Resident rights.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., to refuse to participate in experimental research, and to formulate an advance directive as specified... advocacy groups such as the State survey and certification agency, the State licensure office, the State ombudsman program, the protection and advocacy network, and the Medicaid fraud control unit; and (iv) A...

Assessment of DoD Voting Assistance Programs for Calendar Year 2013

DTIC Science & Technology

2014-03-31

Introduction 2 │ DODIG-2014-051 Criteria Federal Guidance 42 U.S.C. Chapter 20 (2012)—Elective Franchise This chapter provides requirements for elections in...Protection Enhancement Act of 2012 requires the Inspector General to designate a Whistleblower Protection Ombudsman to educate agency employees about

76 FR 21371 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-15

... organized marketplace to help consumers and small businesses buy health insurance in a way that permits easy... requests for assistance, and providing an easy-to-use website and written materials that individuals can... establishment of consumer assistance (or ombudsman) programs, starting in FY 2010. Federal grants will support...

Ombuds Office

Science.gov Websites

mission of the Ombuds Office is to enhance communication and mitigate conflict at the Laboratory. Contact alternative for assistance with informal complaint resolution, problem solving, and communication. The Ombuds Ombudsman Association Code of Ethics (pdf) International Ombudsman Association Standards of Practice (pdf

77 FR 35659 - Request for Information Regarding Complaints From Private Education Loan Borrowers

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-14

... Regarding Complaints From Private Education Loan Borrowers AGENCY: Bureau of Consumer Financial Protection... and Consumer Protection Act of 2010 (Dodd-Frank Act) established a Private Education Loan Ombudsman... borrowers of private education loans. Among other things, the Dodd-Frank Act directs the Ombudsman to...

76 FR 7479 - Office of the Ombudsman

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-10

... Ombudsman will not consider matters in litigation, arbitration, or mediation. Several commenters requested... Office of Finance by FHFA that is not subject to appeal or in litigation, arbitration, or mediation. The... mediation, unless there has been a breakdown in the process, may not be appealed. Matters not subject to...

The Use of the Ombudsman's Services for Alleviating International Students' Difficulties

ERIC Educational Resources Information Center

Katsara, Ourania

2015-01-01

This article offers some suggestions regarding the development of a support strategy by ombudsmen in order to alleviate international students' difficulties when studying in host universities. It is also shown how the Organisational Justice Theory can be used as a framework for understanding the role of ombudsman in higher education settings and…

75 FR 18857 - Privacy Act of 1974; Department of Homeland Security Citizenship and Immigration Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-13

... processing of information and to aid the Ombudsman in assisting individuals and employers in making systemic... individuals and employers problems allowing the Ombudsman to make systemic recommendations to USCIS. The... prosecuting a violation or enforcing or implementing a law, rule, regulation, or order, where a record, either...

Elder abuse and dementia: a review of the research and health policy.

PubMed

Dong, XinQi; Chen, Ruijia; Simon, Melissa A

2014-04-01

Older adults with dementia may be at high risk for abuse, but the topic has not been well studied. We conducted a literature review to examine the relationships between elder abuse and dementia. We found that psychological abuse was the most common form of abuse among older adults, with estimates of its prevalence ranging from 27.9 percent to 62.3 percent. Physical abuse was estimated to affect 3.5-23.1 percent of older adults with dementia. We also found that many older adults experienced multiple forms of abuse simultaneously, and the risk of mortality from abuse and self-neglect may be higher in older adults with greater levels of cognitive impairment. We summarize programs and policies related to the abuse of older adults with dementia, including adult protective services, mandatory elder abuse reporting, and the Long-Term Care Ombudsman Program. We also summarize aspects of the National Alzheimer's Project Act, the Older Americans Act, and the Elder Justice Act. In spite of a recent increase in research and policy developments on elder abuse, challenges such as insufficient funding, limited knowledge about elder abuse, a lack of funding for the implementation of federal and state programs relevant to elder abuse and dementia, and a lack of dementia-specific training for front-line health care staff persist. Stronger programs targeting the well-being of older adults with dementia are needed.

Special Report of the Ombudsman for Alberta Re: Complaints of the Lubicon Lake Indian Band.

ERIC Educational Resources Information Center

Alberta Office of the Ombudsman, Edmonton.

The Ombudsman for Alberta investigated five allegations raised by the Lubicon Lake Indian Band: (1) that provincial officials had deliberately allowed fires in the Band's traditional area to rage unchecked; (2) that provincial and oil company workers had been instructed to bulldoze deliberately Indian traplines and to scare game out of the area by…

Innovation in the role of the Office of the Ombudsman of the Unified Health System (SUS) - reflections and potential benefits.

PubMed

Fernandes, Fernando Manuel Bessa; Moreira, Marcelo Rasga; Ribeiro, José Mendes; Ouverney, Assis Mafort; Oliveira, Flávio José Fonseca de; Moro, Maria Francisca Abritta

2016-08-01

This article seeks to reflect on the potential of innovative practices in the design and work of the government bodies that comprise the National System of Offices of the Ombudsman of the Unified Health System. It is divided into two parts, seeking to answer the following question: How to think of and implement innovative practices - which include sustainability - when the people are voicing their urgent demands and these are being heard by the public authorities? These grievances are all the more urgent as they involve the area of Health and can they be promptly discussed, attended and resolved? In the first part, the article discusses the polysemic concept of innovation, focusing on its application in the three spheres of public administration, and highlights the importance of its close correlation with the different notions of information and knowledge in a society such as the one we live in. In the second, it develops a task-force of ideas for the office of the ombudsman and based on this, a draft operational concept of innovation in the role of the office of the ombudsman, considering the context of high speed change and transformations and the complexity inherent to contemporary life and the need for resource management and expertise development in information management.

Monitoring and Protecting Health and Human Rights in Mexico.

PubMed

Gómez-Dantés; Frenk; Zorrilla

1995-01-01

This paper describes a unique system through which health care-related human rights are now being monitored and protected in Mexico. Based on the ombudsman concept, the system focuses on identifying and responding to violations of human rights and dignity which may occur in the context of health care delivery. Experience thus far has been encouraging; the Mexican population has identified and used the National Commission of Human Rights as a forum for a variety of health-related complaints. The Mexican system, while requiring strengthening and expansion, is an effort to integrate the monitoring and protection of health-related human rights into the broader field of human rights work in Mexico.

Duty of care is underpinned by a range of obligations.

PubMed

Griffith, Richard

The courts have long established that nurses are in a duty situation and owe a duty of care to their patients (Kent v Griffiths [2001]). Traditionally, the profession set the standard of care and nurses were required to act in accordance with a practice accepted by a responsible body of their peers (Bolam v Friern HMC [1957]).The introduction of the Human Rights Act 1998 gave rise to a positive obligation on government to ensure that laws, policies and procedures are in place to protect violations of human rights. Nurses must now inform their practice with relevant statute law, common law and professional standards in order to properly discharge their duty of care. Richard Griffith considers the law that now underpins a nurse's duty of care and uses a recent report from the Health Service Ombudsman for England to illustrate the obligations that underpin the nurse-patient relationship.

Patient's rights in Poland against the background of new regulations.

PubMed

Rabiega-Przylecka, Agnieszka

2012-03-01

Patient rights are the specification of general human rights. The rights define the patient position in relation to health institutions or medical professions providing, broadly understood, health services. The protection system of patient rights outlined by international legal and ethical regulations is detailed to specific social, political and economic realities by internal legal systems of individual states. Imperfections of the Polish health care system in relation to achieving adequate protection of patient rights, resulting, inter alia, from the lack of comprehensive regulation of the matter of patient rights, led the legislature to introduce new regulations concerning this aspect to the Polish legal order. The new Act of 6 November 2008 on Patient Rights and the Patient Rights Ombudsman (binding from 5 March 2009) is the first universally binding legal act in the Polish legal system entirely dealing with the matter of patient rights. It regulates the rights of the patient and correlated with them obligations of health care providers (public and non-public) irrespectively of both the legal form providers, as well as the sources of funding of the benefits provided. In particular, the Act states: the patient right to health services, right to obtain information, right to confidentiality of patient-linked information, right to consent to obtain health services, right to respect privacy and dignity of the patients, right to medical records and objecting to the doctor's opinion or decision, right to respect private and family life, right to pastoral care. The new regulations--besides the specification of the catalogue of patient rights--reinforced the institutional protection of patient rights by establishing a new central public administrative body having jurisdiction to protect patient rights--the Patient Rights Ombudsman. Poland, like other European countries, makes an attempt to improve the protection of patient rights. The introduction of the Act entirely devoted to patient rights is undoubtedly an important step towards creating the optimum protection of the patient.

Assisting the High Administrative Court in Restricting Too Broad a Concept of Academic Judgment.

PubMed

Cardao-Pito, Tiago

2016-01-01

I have received substantial monetary compensation and a formal apology from my first doctoral school, and a Ph.D. from another university. This essay describes my personal view on discussing the boundaries of academic judgment and research supervision with the ombudsman agency for higher education, and at the High Administrative Court of England and Wales. The Court's judicial doctrine addresses substantial research accountability matters. It clarifies that although the Court and ombudsman agency must not interfere with academic judgment, not everything done by an academic can be considered as academic judgment. A Ph.D. supervisor can seriously fail to perform his/her duties.

Contact Us about Asbestos

EPA Pesticide Factsheets

How to contact EPA for more information on asbestos, including state and regional contacts, EPA’s Asbestos Abatement/Management Ombudsman and the Toxic Substances Control Act (TSCA) Assistance Information Service (TSCA Hotline).

48 CFR 1352.216-76 - Placement of orders.

Code of Federal Regulations, 2010 CFR

2010-10-01

... price or estimated cost or fee; (4) Delivery or performance date; (5) Place of delivery or performance... contact information for the DOC task and delivery order ombudsman is ____. (End of clause) [75 FR 10570...

Poster: Whistleblower Protection Ombudsman for the EPA OIG

EPA Pesticide Factsheets

The Whistleblower Protection Enhancement Act of 2012 Exit was signed into law on November 27, 2012. The Act strengthens protection for federal employees who blow the whistle on waste, fraud, and abuse in government operations.

75 FR 47495 - Office of the Ombudsman

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-06

... Director concerning the complaint or appeal, and (ii) act as a facilitator and mediator for the resolution... recommendations to the Director concerning the complaint or appeal, and (2) Act as a facilitator and mediator for...

Conflict management in public university hospitals in Turkey: a pilot study.

PubMed

Tengilimoglu, Dilaver; Kisa, Adnan

2005-01-01

By nature, hospitals are extremely complex organizations, combining many different professional groups within an intricate administrative structure. Conflicts therefore expectedly arise between individuals, groups, and departments. It is in the interest of health care administrators to periodically assess the major factors giving rise to these conflicts. In this study, a questionnaire designed to measure sources of conflict in the workplace was completed by 204 staff members at Gazi University Hospital. Of the participants, 30.9% were physicians, and 12.5% were administrators at various levels; 61.5% were female, and 38.5% were male. In terms of work experience, 52.6% of participants had worked less than 5 years at the hospital. The results of the study show that educational differences among the hospital staff were a major barrier to good communication and information flow between groups. Professionals in the same specialties experienced fewer conflicts. Another source of conflict was that resource allocation was considered unfair across departments. Although the hospital management provided an ombudsman for staff concerns, staff rarely resorted to the ombudsman because of the stigma associated with complaining. A lack of opportunity for career advancement was mentioned by 52% of the participants as a source of conflict. At present, job performance and rewards are not closely related in public university hospitals in Turkey because promotions and pay raises are strictly limited by law. Bureaucracy was also perceived to be a source of conflict, with 48.4% of participants saying that their performance was less than optimal because of the presence of multiple supervisors. This pilot study suggests that in Turkey, legislative reform is needed to give public university hospitals more flexibility regarding work incentives, open-door policies at the administrative level, and social interactions to improve teamwork among hospital staff.

CMS gives the RA program a makeover with more changes in store.

PubMed

2016-03-01

CMS has made changes in the scope of work for the Recovery Auditor program and has proposed a number of other changes to be implemented when new RA contracts are issued. CMS has restricted the number of additional documentation requests, has shortened the "look-back" period for patient status reviews, and announced penalties for RAs with high error rates. The new contracts shorten the time RAs have to complete complex reviews, requires RAs to wait 30 days before referring cases to the Medicare Administrative Contractors, and postpones contingency payments to RAs until after the second level of appeals. The Audit and Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) bill, introduced in the Senate in December, revamps the appeals process, adding an Ombudsman for Medicare Reviews to assist in resolving complaints by hospitals that have appealed and those considering appeals, and establishes an Appeals Medicare Magistrate program with attorneys who will handle appeals of denials for $1,500 or less.

A bill to provide for the establishment of a Private Education Loan Ombudsman.

THOMAS, 111th Congress

Sen. Brown, Sherrod [D-OH

2009-11-05

Senate - 11/05/2009 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

48 CFR 316.505 - Ordering.

Code of Federal Regulations, 2011 CFR

2011-10-01

... and delivery-order ombudsman is the Director, Strategic Acquisition Service, PSC. The task-order and... Services HRSA: Associate Administrator, Office of Operations IHS: Director, Office of Management Services... Senior Advisor to the Director (Other than R & D) PSC: Director, Strategic Acquisition Service SAMHSA...

48 CFR 316.505 - Ordering.

Code of Federal Regulations, 2010 CFR

2010-10-01

... CONTRACT TYPES TYPES OF CONTRACTS Indefinite-Delivery Contracts 316.505 Ordering. (b)(5) The HHS task-order and delivery-order ombudsman is the Director, Strategic Acquisition Service, PSC. The task-order and... of Performance Accountability, Resources and Technology ASPR/OAMCG: Chief of Acquisition Policy CDC...

Report: Ombudsman Review of the Marjol Battery Site, Throop, Pennsylvania

EPA Pesticide Factsheets

Report #2004-P-00017, May 18, 2004. Over-excavating the Five Foot Seam and ensuring a reliable noncombustible barrier is established between the Five Foot Seam and the Battery Casing Material will sufficiently ensure the long-term safety of the Site.

77 FR 74544 - Data Collection Available for Public Comments and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-14

... SMALL BUSINESS ADMINISTRATION Data Collection Available for Public Comments and Recommendations... of 1995, this notice announces the Small Business Administration's intentions to request approval on... Jose Mendez, Case Management Specialist, Office of Ombudsman, Small Business Administration, 409 3rd...

Toxic Overload: The Waste Disposal Dilemma.

ERIC Educational Resources Information Center

Knox, Robert J.

1991-01-01

The role of the Environmental Protection Agency as ombudsman concerning waste disposal is examined with respect to both the current options of source reduction and recycling as pollution prevention, and alternative approaches that expand upon these current options, particularly with respect to toxic and medical waste. (JJK)

12 CFR 1213.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Office of Finance, or that represents the interests of a person that has a business relationship with a... Banking FEDERAL HOUSING FINANCE AGENCY ORGANIZATION AND OPERATIONS OFFICE OF THE OMBUDSMAN § 1213.2 Definitions. For purposes of this part, the term: Business relationship means any existing or potential...

12 CFR 1213.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Office of Finance, or that represents the interests of a person that has a business relationship with a... Banking FEDERAL HOUSING FINANCE AGENCY ORGANIZATION AND OPERATIONS OFFICE OF THE OMBUDSMAN § 1213.2 Definitions. For purposes of this part, the term: Business relationship means any existing or potential...

12 CFR 1213.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Office of Finance, or that represents the interests of a person that has a business relationship with a... Banking FEDERAL HOUSING FINANCE AGENCY ORGANIZATION AND OPERATIONS OFFICE OF THE OMBUDSMAN § 1213.2 Definitions. For purposes of this part, the term: Business relationship means any existing or potential...

Legal Rights & Intellectual Disability: A Short Guide.

ERIC Educational Resources Information Center

Hall, Julia, Ed.; And Others

The book examines actions that may be taken to redress wrongs illegally perpetrated against people with intellectual disabilities in New South Wales, Australia. Ten topic areas are addressed (sample subtopics in parentheses): protecting rights (complaints to government departments, use of the ombudsman); discrimination (legal aid); personal…

78 FR 76751 - Safety Zone; Vessel Launch; Menominee River; Marinette, WI

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-19

... Agriculture Regulatory Enforcement Ombudsman and the Regional Small Business Regulatory Fairness Boards. The... consensus standards. 14. Environment We have analyzed this rule under Department of Homeland Security... significant effect on the human environment. This rule involves the establishment of a safety zone and...

32 CFR 246.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... STARS AND STRIPES (S&S) NEWSPAPER AND BUSINESS OPERATIONS § 246.3 Definitions. (a) Adverse Conditions... publisher of the Stars and Stripes produced by that organization. (c) S&S Management Action Group (MAG) and..., involve themselves in Stars and Stripes editorial policies. (d) S&S Ombudsman. A highly qualified...

32 CFR 246.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... STARS AND STRIPES (S&S) NEWSPAPER AND BUSINESS OPERATIONS § 246.3 Definitions. (a) Adverse Conditions... publisher of the Stars and Stripes produced by that organization. (c) S&S Management Action Group (MAG) and..., involve themselves in Stars and Stripes editorial policies. (d) S&S Ombudsman. A highly qualified...

32 CFR 246.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... STARS AND STRIPES (S&S) NEWSPAPER AND BUSINESS OPERATIONS § 246.3 Definitions. (a) Adverse Conditions... publisher of the Stars and Stripes produced by that organization. (c) S&S Management Action Group (MAG) and..., involve themselves in Stars and Stripes editorial policies. (d) S&S Ombudsman. A highly qualified...

12 CFR 1213.5 - Complaints from a person.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Banks and Banking FEDERAL HOUSING FINANCE AGENCY ORGANIZATION AND OPERATIONS OFFICE OF THE OMBUDSMAN § 1213.5 Complaints from a person. (a) General. Any person that has a business relationship with a regulated entity or the Office of Finance may submit a complaint in accordance with procedures established...

12 CFR 1213.5 - Complaints from a person.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Banks and Banking FEDERAL HOUSING FINANCE AGENCY ORGANIZATION AND OPERATIONS OFFICE OF THE OMBUDSMAN § 1213.5 Complaints from a person. (a) General. Any person that has a business relationship with a regulated entity or the Office of Finance may submit a complaint in accordance with procedures established...

26 CFR 301.7811-1 - Taxpayer assistance orders.

Code of Federal Regulations, 2010 CFR

2010-04-01

... behavior of the taxpayer and of the action or inaction of the Internal Revenue Service that causes or is... modification or rescission by one of these designated officials may be elevated by the Ombudsman to the... function seeks modification or rescission of the taxpayer assistance order and the appropriate official...

The Vulnerable Worker? A Labor Law Challenge for WIL and Work Experience

ERIC Educational Resources Information Center

Cameron, Craig

2013-01-01

The Fair Work Act (2009) in Australia deregulates "work" in work-integrated learning (WIL) by distinguishing "vocational placement" from "employee". Following concerns about the legal position of WIL and work experience, the Fair Work Ombudsman (FWO) published a fact sheet and commenced a joint research project into…

Report: Ombudsman Review of Bunker Hill and Coeur d’Alene Basin Superfund Actions

EPA Pesticide Factsheets

Report #2004-P-00009, March 24, 2004. EPA made a logical decision to first do cleanup work in the Bunker Hill Box and then later study areas outside the Box and pursue further cleanup work on specific targeted areas in the Coeur d'Alene Basin.

78 FR 18233 - Medical Devices; Technical Amendment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

... the right column: Section Remove Add 814.20 http://www.fda.gov/ http://www.fda.gov/ cdrh/devadvice.../ PremarketApproval PMA/default.htm. 822.7 http://www.fda.gov/ http://www.fda.gov/ cdrh/ombudsman/ AboutFDA/ dispute.html. CentersOffices/ OfficeofMedicalPr oductsandTobacco/ CDRH/ CDRHOmbudsman/ default.htm. 822.15...

76 FR 26333 - National Federal Regulatory Enforcement Fairness Hearing Region III Regulatory Fairness Board

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-06

... National Ombudsman is issuing this notice to announce the location, date and time of the National Federal... Visual and Performing Arts Center--Smith Theatre, Howard Community College, 10901 Little Patuxent Parkway... regulatory enforcement issues affecting their members. Free parking is available at the college. Anyone...

78 FR 51263 - Annual Meeting of the Regional Small Business Regulatory Fairness Boards Office of the National...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-20

... U.S. SMALL BUSINESS ADMINISTRATION Annual Meeting of the Regional Small Business Regulatory Fairness Boards Office of the National Ombudsman AGENCY: U.S. Small Business Administration (SBA). ACTION: Notice of open meeting of the Regional Small Business Regulatory Fairness Boards. SUMMARY: The SBA...

40 CFR 763.97 - Compliance and enforcement.

Code of Federal Regulations, 2012 CFR

2012-07-01

... CONTROL ACT ASBESTOS Asbestos-Containing Materials in Schools § 763.97 Compliance and enforcement. (a... Title II of the Act should direct the complaint to the Governor of the State or the EPA Asbestos... identified as a citizen complaint pursuant to section 207(d) of Title II of TSCA. The EPA Asbestos Ombudsman...

40 CFR 763.97 - Compliance and enforcement.

Code of Federal Regulations, 2014 CFR

2014-07-01

... CONTROL ACT ASBESTOS Asbestos-Containing Materials in Schools § 763.97 Compliance and enforcement. (a... Title II of the Act should direct the complaint to the Governor of the State or the EPA Asbestos... identified as a citizen complaint pursuant to section 207(d) of Title II of TSCA. The EPA Asbestos Ombudsman...

40 CFR 763.97 - Compliance and enforcement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... CONTROL ACT ASBESTOS Asbestos-Containing Materials in Schools § 763.97 Compliance and enforcement. (a... Title II of the Act should direct the complaint to the Governor of the State or the EPA Asbestos... identified as a citizen complaint pursuant to section 207(d) of Title II of TSCA. The EPA Asbestos Ombudsman...

40 CFR 763.97 - Compliance and enforcement.

Code of Federal Regulations, 2013 CFR

2013-07-01

... CONTROL ACT ASBESTOS Asbestos-Containing Materials in Schools § 763.97 Compliance and enforcement. (a... Title II of the Act should direct the complaint to the Governor of the State or the EPA Asbestos... identified as a citizen complaint pursuant to section 207(d) of Title II of TSCA. The EPA Asbestos Ombudsman...

40 CFR 763.97 - Compliance and enforcement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... CONTROL ACT ASBESTOS Asbestos-Containing Materials in Schools § 763.97 Compliance and enforcement. (a... Title II of the Act should direct the complaint to the Governor of the State or the EPA Asbestos... identified as a citizen complaint pursuant to section 207(d) of Title II of TSCA. The EPA Asbestos Ombudsman...

78 FR 16177 - Safety Zone; M/V XIANG YUN KOU and MODU NOBLE DISCOVERER; Resurrection Bay, Seward, AK

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-14

... and comment. Immediate action is needed to protect human life, property, and the environment from... regulations to the Small Business and Agriculture Regulatory Enforcement Ombudsman and the Regional Small... voluntary consensus standards. 14. Environment We have analyzed this rule under Department of Homeland...

76 FR 9630 - Federal Regulatory Enforcement Fairness Hearing; National Ombudsman and Region VI Regional Small...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-18

... Administration (SBA). ACTION: Notice of open hearing of the Regional (Region VI) Small Business Regulatory... location, date and time of the Regional Small Business Regulatory Fairness hearing. This hearing is open to... Chasse Room, New Orleans, LA 70140. SUPPLEMENTARY INFORMATION: Pursuant to the Small Business Regulatory...

76 FR 58227 - Passenger Vessel Operator Financial Responsibility Requirements for Nonperformance of Transportation

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-20

... through its Ombudsman Service. The CADRS staff is trained to serve as third-party neutrals in a..., services and facilities relating thereto not yet performed. 46 CFR 540.2(i). 3. Customer will deposit on... shall arrange, offer, advertise, or provide passage on a vessel having berth or stateroom accommodations...

Chemical and Biological Training for Army and Marine Corps Units in the Republic of Korea Needs Improvement (REDACTED)

DTIC Science & Technology

2016-02-24

Department of Defense that supports the warfighter; promotes accountability , integrity, and efficiency; advises the Secretary of Defense and Congress; and...remedies against retaliation for protected disclosures . The designated ombudsman is the DoD Hotline Director. For more information on your rights and

Embassy of Ukraine in the United States of America

Science.gov Websites

investment climate in Ukraine Exporters and investors council under the МFA of Ukraine Free trade agreements Relations Office of the National Investment Council of Ukraine Ukraine -United States Trade and Investment Proposals of Ukrainian Companies Ukraine Investment Promotion Office Business Ombudsman Council Scientific

Personal and Social Characteristics of Schoolchildren Involved in Bullying in Primary Education

ERIC Educational Resources Information Center

Sanchez, Consuelo; Cerezo, Fuensanta

2010-01-01

Introduction: According to the latest Ombudsman's report, aggressive behavior happens frequently in our country's schools (Spain), appearing in all its manifestations: insults, threats, physical aggression, social isolation, etc. Now, however, we are witnessing a growing interest in this phenomenon and the possible risk factors that may help us…

The need for an organized approach for Government Medical Insurance Programs in the Commonwealth of Virginia.

PubMed

Edlich, Richard F

2005-01-01

The Commonwealth of Virginia has a disorganized approach to enrolling their retired faculty in Medicare Supplement Insurance Programs. An organized approach to establishing Medicare Supplemental Insurance for retired University faculty should include the following administrative changes to correct this potential health-care crisis for retired state faculty members. First, the ombudsman for human resources for the state universities must receive educational programs that prepare the retired faculty members over the age of 65 to select the corporate insurance policy from Anthem Blue Cross/Blue Shield Insurance Company. Included in this educational program should be a review of the Advantage 65 Member Handbook. Second, they must point out to the faculty member that they are receiving a CORPORATE insurance policy rather than an individual insurance policy from Anthem Blue Cross/Blue Shield Insurance Company. They must provide the telephone numbers of the Anthem Blue Cross/Blue Shield offices in Roanoke, Virginia. Concomitantly, they must send the name and address of the faculty member to the Commonwealth of Virginia Department of Human Resource Management. They should inform the faculty member that the Commonwealth of Virginia Department of Human Resource Management will be sending them newsletters that outline any changes in the corporate insurance policy that they coordinate with the Anthem Blue Cross/Blue Shield Insurance Company. The Commonwealth of Virginia Department of Human Resource Management must take on some new responsibilities in their efforts to coordinate health-care coverage of the retired faculty over the age of 65. First, they must have a computer registry of all corporate health-care policies of the individual faculty members to ensure that newsletters are being sent to them. Ideally, this agency should have a computerized system that allows it to send out its newsletter update by email to those retired faculty members who have computers. They should urge the faculty members to initiate an automatic check payment withdrawal from their bank so that the premiums from their corporate insurance policy can be paid promptly to Anthem Blue Cross/Blue Shield Insurance Company. Whereas the universities and the Commonwealth of Virginia Department of Human Resource Management are making these responsible changes, Anthem Blue Cross/Blue Shield Insurance Company must undertake innovative changes in their corporate health-care policy to assist the retired faculty member. For instance, they must list on the insurance card that the faculty member has a corporate policy. Like the United Health Insurance Company, it would be advisable to offer a 2-5% reduction in the cost of the corporate insurance policy if the faculty member begins an automatic premium payment agreement through their bank. This insurance discount would be an added incentive for the faculty member to do automatic payments through their bank.

With everything exposed: cruelty in post-abortion care in Rosario, Argentina.

PubMed

Steele, Cynthia; Chiarotti, Susana

2004-11-01

At the suggestion of a social worker who witnessed abusive post-abortion care at a public hospital in Rosario, Argentina, two human rights NGOs collaborated to investigate women's experiences seeking treatment for abortion complications at area public hospitals. During the year-long enquiry, more than 300 women took part. Role play was successfully used to surmount women's initial reluctance to reveal pervasive discriminatory and humiliating mistreatment. Thirty-one women later gave personal testimonies about their experiences, which were contained in the report of the research and later dramatised in a public meeting and video. The report, Con Todo al Aire (With Everything Exposed), was disseminated widely, including to the media, and a formal complaint was made to the local Ombudsman, who called for high-level action to resolve the problems. Initial denial by some health professionals that there was a serious problem was replaced by critical self-assessment within the provincial government, hospitals and medical and nursing schools, who made commitments to reform hospital practices and the medical school curriculum. Women participants also gained an understanding of their right to appropriate and humane health care. The findings from Rosario are not isolated. They are now being shored with activists and researchers in other provinces of Argentina and other countries.

Factors That Influence Job Satisfaction of College and University Ombudsmen: A Phenomenological Exploration

ERIC Educational Resources Information Center

Anderson, Bernard E.

2013-01-01

This phenomenological study sought to address the problem of low job satisfaction of college and university ombudsmen as evidenced by predictors of high attrition. Data show that within the next six years, a preponderance of ombudsman practitioners with one to five years of experience plan to depart from the profession. Using Kalleberg's Theory of…

75 FR 79050 - Submission for Review: Ombudsman Request for Assistance Information Collection, 3206-NEW

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-17

... the Federal Register on August 10, 2010 at 75 FR 48383 allowing for a 60-day public comment period. No... comments that: 1. Evaluate whether the proposed collection of information is necessary for the proper..., including the validity of the methodology and assumptions used; 3. Enhance the quality, utility, and clarity...

Violence and Victimization among Schoolchildren. Bullying: Identification and Intervention Based on the Bull-S Test

ERIC Educational Resources Information Center

Cerezio, Fuensanta

2006-01-01

The report by the Ombudsman on violence in schools--bullying--served to highlight that there are instances of abuse and violent behavior among schoolchildren at the majority of educational institutions (AA.VV., 2000). From contacts with experts in teaching, we know that this phenomenon is frequently only made known to the educational community…

Army Warfighter Information NetworkTactical Increment 2 Procurement Quantity Not Supported for Future Army Forces (REDACTED)

DTIC Science & Technology

2016-03-01

organization, working together as one professional team, recognized as leaders in our field. For more information about whistleblower protection, please...USE ONLY FOR OFFICIAL USE ONLY Whistleblower Protection U.S. Department of Defense The Whistleblower Protection Enhancement Act of 2012 requires the...Inspector General to designate a Whistleblower Protection Ombudsman to educate agency employees about prohibitions on retaliation, and rights and

U.S. Army Central did not Implement Controls to Effectively Manage the Shared Cost of Administrative Support Functions in Iraq

DTIC Science & Technology

2016-02-17

diverse organization, working together as one professional team, recognized as leaders in our field. For more information about whistleblower protection...Administrative Support Services SOP Standard Operating Procedures SoS Subscription of Services Whistleblower Protection U.S. Department of Defense The... Whistleblower Protection Enhancement Act of 2012 requires the Inspector General to designate a Whistleblower Protection Ombudsman to educate agency

Ombudsman for a day: a job rotation opportunity at the University Health Network.

PubMed

Rogers, Sharon; Bakas, Vasiliki

2007-01-01

When staff at a major Canadian teaching hospital were asked what they found meaningful and important in the working environment, they responded by identifying four specific areas: recognition, communication, workload management and learning environment. One area that was identified as a particularly good example of a successful "learning environment" strategy was the opportunity to participate in a job rotation in a department other than their own.

Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire.

PubMed

Newdick, Christopher; Danbury, Christopher

2015-12-01

Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be 'all changed, changed utterly'. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions? Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Air Force Personnel Can Improve Compliance With the Berry Amendment and Buy American Act

DTIC Science & Technology

2016-02-24

accountability , integrity, and efficiency; advises the Secretary of Defense and Congress; and informs the public. Vision Our vision is to be a model...of personnel from the DoD OIG’s Quantitative Methods Division. Prior Coverage During the last 5 years, the Government Accountability Office (GAO... disclosures . The designated ombudsman is the DoD Hotline Director. For more information on your rights and remedies against retaliation, visit www.dodig.mil

Enablers and Obstacles to Democratic Consolidation and Civil-Military Relations Reform: A Comparative Analysis of Argentina and Guatemala

DTIC Science & Technology

2014-03-01

the war. Even the Procuraduría de los Derechos Humanos (PDH, or Human Rights Ombudsman), which was established in 1985, was infested with racist...Procuraduría de los Derechos Humanos (PDH)145 The PDH’s purpose was to document human rights abuses in order to promote their reduction and eventual...conditions. In addition to the Madres, the Asamblea Permanente por los Derechos 61 Fagen

[Clinical guidelines for the management of schizophrenia:Aims and limitations (Ι)].

PubMed

Margariti, M; Hadjulis, M; Lazaridou, M; Angelidis, G F; Fotopoulos, V; Markaki, L; Koulouri, F

2017-01-01

The initiative for the development of national treatment guidelines, dates back to the '90s. In Greece, however, National Clinical Guidelines for the management of schizophrenia were first formulated in 2014 when a Working Group was set up for this purpose by the Greek Ministry of Health. The objective of this Working Group was to provide evidence-based recommendations covering the pharmacological and psychosocial treatment of schizophrenia as well as the development of appropriate treatment services. The Working Group utilized the NICE Guideline (National Institute of Clinical Excellence, 2010, 2014) for the management of Psychosis & Schizophrenia as the main guide to develop the Greek National Guidelines , and in addition the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia (APA 2004), the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders (Royal Australian and New Zealand College of Psychiatrists 2005) , as well as other relevant sources. The Working Group also took into consideration the available Greek bibliography as well as the external evaluations of the Greek psychiatric reform programs. A special effort was made to adapt the international experience to the current Greek landscape with the constraints resulting from the uneven dispersion of mental health services, the lack of coordination between services, the incomplete sectorization of mental health services provided as part of the National Health System, the still underdeveloped Primary Care Health Service, and last but not least the difficult economic situation in Greece. After the preparation of the draft guidelines, a thorough consultation followed with the relevant stakeholders, including mental health professionals, user associations and representatives of the Greek Ombudsman. Additionally, the Hellenic Psychiatric Association established an Expert Committee in Spring 2016, that contributed with its observations to the final exercise. This article will be followed by two further publications (incorporating the Hellenic Psychiatric Association comments) which include: (1) the summary recommendations regarding the pharmacological, psychological and psychosocial interventions in the treatment of schizophrenia, and (2) the summary recommendations regarding: (a) the role of primary health care service and the role of the family physician in the treatment of schizophrenia (b) the summary recommendations regarding continuity of care and c) the summary recommendations regarding community interventions with documented effectiveness in the treatment of schizophrenia.

San Antonio MICC and POM Personnel Properly Awarded and Administered the POM UESC, but Improved Procedures and Guidance Are Needed

DTIC Science & Technology

2016-04-08

Defense F r a u d , W a s t e & A b u s e For more information about whistleblower protection, please see the inside back cover. I N T E G R I T Y  E...POM Presidio of Monterey UESC Utility Energy Services Contract U.S.C. United States Code Whistleblower Protection U.S. Department of Defense The... Whistleblower Protection Enhancement Act of 2012 requires the Inspector General to designate a Whistleblower Protection Ombudsman to educate agency

DoD Components Did Not Properly Use the Acquisition and Cross Service Agreement Automated Tracking and Reporting System

DTIC Science & Technology

2016-03-24

field. For more information about whistleblower protection, please see the inside back cover. I N T E G R I T Y  E F F I C I E N C Y  A C C O U N T...Services OIG Office of Inspector General OIR Operation Inherent Resolve Whistleblower Protection U.S. Department of Defense The Whistleblower Protection...Enhancement Act of 2012 requires the Inspector General to designate a Whistleblower Protection Ombudsman to educate agency employees about prohibitions

U.S. Army Military Surface Deployment and Distribution Command Needs to Improve its Oversight of Labor Detention Charges at Military Ocean Terminal Sunny Point

DTIC Science & Technology

2016-03-16

whistleblower protection, please see the inside back cover. I N T E G R I T Y  E F F I C I E N C Y  A C C O U N T A B I L I T Y  E X C E L L...USTRANSCOM United States Transportation Command Whistleblower Protection U.S. Department of Defense The Whistleblower Protection Enhancement Act of...2012 requires the Inspector General to designate a Whistleblower Protection Ombudsman to educate agency employees about prohibitions on retaliation

A bioethical j’accuse: analysis of the discussion around thiomersal in Chile.

PubMed

Kottow, Miguel

2014-03-26

Chilean legislators have voted to ban vaccines preserved with thiomersal, an initiative that the Executive has vetoed. Most scientific evidence has dismissed the alleged toxicity of this substance, in accordance with the formal and publicly expressed opinion of local experts, and yet, medical authorities have issued contradictory statements. Some have argued that the principle of precaution suggests eliminating thiomersal preserved vaccines; others have declared that current vaccines should be maintained to protect the population. From the perspective of bioethics, this polemic is another example of the shortcoming of the deliberation process leading to controversial laws in lieu of including citizens in the discussion of regulations that harbor uncertainties, and respect for individual autonomy to accept or reject public immunization programs. The Chilean legal system has been unwilling to implement participatory democratic procedures like plebiscites or institutions such as the ombudsman. In 2006 a law was enacted that creates a National Commission of Bioethics, but successive governments have failed to create such a commission, which is an efficient social instrument to conduct deliberation on bioethical issues that require a balanced participation of the public, experts, and politicians.

The Health Legislation Amendment Act 2013 (QLD) and Queensland's health assets privatisation dispute.

PubMed

Colton, Caroline; Faunce, Thomas

2014-09-01

'New legislation in Queensland has provided a "pathway" for the privatisation of health assets and services in Queensland, which effectively realigns the health care system to the financial market. This column explores how this legislation contained the antecedents of the Queensland doctors' dispute when doctors roundly rejected new employment contracts in February 2014. It also argues that such legislation and its attendant backlash provides a valuable case study in view of the federal government's 2014 budget offer to the States of extra funding if they sell their health assets to fund new infrastructure. The move to privatise health in Queensland has also resulted in a government assault on the ethical credibility of the opposing medical profession and changes to the health complaints system with the introduction of a Health Ombudsman under ministerial control. The column examines these changes in light of R (Heather) v Leonard Cheshire Foundation [2001] EWHC Admin 429, a case concerning the obligations of a private entity towards publically funded clients in the United Kingdom. In discussing concerns about the impact of privatisation on the medical profession, the column points to a stark conflict between the duty to operate hospitals as a business rather than as a duty to patients.

Good governance and corruption in the health sector: lessons from the Karnataka experience.

PubMed

Huss, R; Green, A; Sudarshan, H; Karpagam, Ss; Ramani, Kv; Tomson, G; Gerein, N

2011-11-01

Strengthening good governance and preventing corruption in health care are universal challenges. The Karnataka Lokayukta (KLA), a public complaints agency in Karnataka state (India), was created in 1986 but played a prominent role controlling systemic corruption only after a change of leadership in 2001 with a new Lokayukta (ombudsman) and Vigilance Director for Health (VDH). This case study of the KLA (2001-06) analysed the:Scope and level of poor governance in the health sector; KLA objectives and its strategy; Factors which affected public health sector governance and the operation of the KLA. We used a participatory and opportunistic evaluation design, examined documents about KLA activities, conducted three site visits, two key informant and 44 semi-structured interviews and used a force field model to analyse the governance findings. The Lokayukta and his VDH were both proactive and economically independent with an extended social network, technical expertise in both jurisdiction and health care, and were widely perceived to be acting for the common good. They mobilized media and the public about governance issues which were affected by factors at the individual, organizational and societal levels. Their investigations revealed systemic corruption within the public health sector at all levels as well as in public/private collaborations and the political and justice systems. However, wider contextual issues limited their effectiveness in intervening. The departure of the Lokayukta, upon completing his term, was due to a lack of continued political support for controlling corruption. Governance in the health sector is affected by positive and negative forces. A key positive factor was the combined social, cultural and symbolic capital of the two leaders which empowered them to challenge corrupt behaviour and promote good governance. Although change was possible, it was precarious and requires continuous political support to be sustained.

The Slovenian Mental Health Act de lege ferenda.

PubMed

Ivanc, Blaz

2008-06-01

This article analyzes the case-law of the Constitutional Court of the Republic of Slovenia relating to the protection of mentally ill persons. In case No. U-I-60/03 the Constitutional Court declared that the provisions of Arts. 70 to 81 of the Non-litigious Civil Procedure Act (a Chapter on involuntary Commitment to the closed wards of psychiatric hospitals) are not in conformity with the Constitution. As an interim measure the Constitutional Court instructed the regular Courts (in the procedure for the involuntary commitment of persons to a mental institution) to ensure the following: an ex officio counsel must be appointed for an involuntarily committed person upon the commencement of proceedings; and the notification of detention that the authorised mental institution is obliged to submit to the court must contain reasons substantiating the necessity of detention. The Legislature's intention is to enact a special Law (Mental Health Act) that will not only deal with the procedural questions, but also with all other constitutional and statutory rights and freedoms of the mentally ill patients. It should also deal with other forms of institutional and non-institutional care for mentally ill persons. The author discusses the Ombudsman's control over the rights and freedoms of involuntary committed in-patients. Finally, the author discusses some of the most problematic issues of the Slovenian Mental Health Actde lege ferenda.

The debate on FDA reform: a view from the U.S. Senate. Food and Drug Administration.

PubMed

Baker, R

1995-09-01

The recently released concept paper on Food and Drug Administration (FDA) reform from Republican Senator, Nancy Kassebaum, is reviewed. Senator Kassebaum chairs the Senate Committee on Labor and Human Resources that will influence the Senate's action on FDA reform. The paper outlines the Senator's priorities for Congressional legislation on FDA reform in the following areas: the FDA mission and its accountability; creation of a Performance Review Panel and Industry Advisory Council; approval and access of products for seriously ill patients; the FDA's responsibility for good manufacturing practices; establishment of an Ombudsman Office for resolving disputes; dissemination of information on unapproved uses of approved products; and approval standards for new drugs.

The loss of midwifery supervision: to mourn or rejoice?

PubMed

Lewis, Paul; Freemantle, Danielle; Ireland, Jilly

2015-03-01

The decision of the NMC to end statutory supervision of midwives comes as no surprise. It had been anticipated since the publication of the Parliamentary and Health Service Ombudsman's (PHSO) report in 2013 (PHSO 2013). This found that midwifery supervision and regulatory arrangements had failed to identify poor midwifery practice at Morecambe Bay NHS Foundation Trust. It concluded that midwifery supervision and regulation should be separated; and that the NMC should be in direct control of regulatory activity. A King's Fund report commissioned by the NMC reached similar conclusions and the dye was cast. The process in many respects has been disappointing but inevitable. This article maps the key events, examines concerns in respect of the process, and asks: what now for midwifery supervision? Our survival as a distinct profession may now rest not with the NMC but in recommendations of the Law Commission's report on the regulation of healthcare professionals in the UK.

[Preventive human rights monitoring in child and adolescent psychiatry and welfare institutions].

PubMed

Berger, Ernst; Paar, Caroline

2017-09-01

Since 1 July 2012 the Austrian Ombudsman Board (AOB) together with its six regional expert commissions form the so called "National Prevention Mechanism" implementing the UN Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). The commissions are mandated to conduct regular, unrestricted and unannounced visits to all types of places in which there is or can be a deprivation or restriction of personal liberty, such as prisons, police stations, but also psychiatric hospitals or residential homes/groups for children and juveniles supervised by youth welfare services. 20 monitoring visits have been held in departments for Child- and Adolescent Psychiatry between 2012 and 2016. In the field of residential groups for young people 40 visiting protocols (out of a total of 176 between 2015 and 2016) have been chosen for this analysis. The following article overviews the legal sources and key issues of the monitoring process in this field as well as the commissions' findings and recommendations.

Development of Palliative Care in China: A Tale of Three Cities.

PubMed

Yin, Zhenyu; Li, Jinxiang; Ma, Ke; Ning, Xiaohong; Chen, Huiping; Fu, Haiyan; Zhang, Haibo; Wang, Chun; Bruera, Eduardo; Hui, David

2017-11-01

China is the most populous country in the world, but access to palliative care is extremely limited. A better understanding of the development of palliative care programs in China and how they overcome the barriers to provide services would inform how we can further integrate palliative care into oncology practices in China. Here, we describe the program development and infrastructure of the palliative care programs at three Chinese institutions, using these as examples to discuss strategies to accelerate palliative care access for cancer patients in China. Case study of three palliative care programs in Chengdu, Kunming, and Beijing. The three examples of palliative care delivery in China ranged from a comprehensive program that includes all major branches of palliative care in Chengdu, a program that is predominantly inpatient-based in Kunming, and a smaller program at an earlier stage of development in Beijing. Despite the numerous challenges related to the limited training opportunities, stigma on death and dying, and lack of resources and policies to support clinical practice, these programs were able to overcome many barriers to offer palliative care services to patients with advanced diseases and to advance this discipline in China through visionary leadership, collaboration with other countries to acquire palliative care expertise, committed staff members, and persistence. Palliative care is limited in China, although a few comprehensive programs exist. Our findings may inform palliative care program development in other Chinese hospitals. With a population of 1.3 billion, China is the most populous country in the world, and cancer is the leading cause of death. However, only 0.7% of hospitals offer palliative care services, which significantly limits palliative care access for Chinese cancer patients. Here, we describe the program development and infrastructure of three palliative care programs in China, using these as examples to discuss how they were able to overcome various barriers to implement palliative care. Lessons from these programs may help to accelerate the progress of palliative cancer care in China. © AlphaMed Press 2017.

A comprehensive palliative care program at a tertiary cancer center in Jordan.

PubMed

Shamieh, Omar; Hui, David

2015-03-01

The palliative care program in King Hussein Cancer Center (KHCC) is growing rapidly to serve the needs of patients with cancer and their families. To describe the KHCC palliative care program and its integration into the oncology care. Narrative review of our palliative care program. Patients with cancer at KHCC have access to an interprofessional palliative care at different settings. In 2012, the inpatient team saw 400 consultations and 979 referrals and admissions. The outpatient clinic had a total of 1133 patient visits. The home care program provided a total of 1501 visits. Our program is a regional center for education and training and actively conducts research. Our palliative care program may be a model for successful delivery of comprehensive cancer care in the Middle East. © The Author(s) 2013.

Disease Management, Case Management, Care Management, and Care Coordination: A Framework and a Brief Manual for Care Programs and Staff.

PubMed

Ahmed, Osman I

2016-01-01

With the changing landscape of health care delivery in the United States since the passage of the Patient Protection and Affordable Care Act in 2010, health care organizations have struggled to keep pace with the evolving paradigm, particularly as it pertains to population health management. New nomenclature emerged to describe components of the new environment, and familiar words were put to use in an entirely different context. This article proposes a working framework for activities performed in case management, disease management, care management, and care coordination. The author offers standard working definitions for some of the most frequently used words in the health care industry with the goal of increasing consistency for their use, especially in the backdrop of the Centers for Medicaid & Medicare Services offering a "chronic case management fee" to primary care providers for managing the sickest, high-cost Medicare patients. Health care organizations performing case management, care management, disease management, and care coordination. Road map for consistency among users, in reporting, comparison, and for success of care management/coordination programs. This article offers a working framework for disease managers, case and care managers, and care coordinators. It suggests standard definitions to use for disease management, case management, care management, and care coordination. Moreover, the use of clear terminology will facilitate comparing, contrasting, and evaluating all care programs and increase consistency. The article can improve understanding of care program components and success factors, estimate program value and effectiveness, heighten awareness of consumer engagement tools, recognize current state and challenges for care programs, understand the role of health information technology solutions in care programs, and use information and knowledge gained to assess and improve care programs to design the "next generation" of programs.

Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers.

PubMed

Hermes, Eric; Burrone, Laura; Perez, Elliottnell; Martino, Steve; Rowe, Michael

2018-05-18

Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems. The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation. The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding. A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age. This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop comprehensive strategies for the implementation of internet-based self-care programs in primary care settings. ©Eric Hermes, Laura Burrone, Elliottnell Perez, Steve Martino, Michael Rowe. Originally published in JMIR Mental Health (http://mental.jmir.org), 18.05.2018.

What influences success in family medicine maternity care education programs? Qualitative exploration.

PubMed

Biringer, Anne; Forte, Milena; Tobin, Anastasia; Shaw, Elizabeth; Tannenbaum, David

2018-05-01

To ascertain how program leaders in family medicine characterize success in family medicine maternity care education and determine which factors influence the success of training programs. Qualitative research using semistructured telephone interviews. Purposive sample of 6 family medicine programs from 5 Canadian provinces. Eighteen departmental leaders and program directors. Semistructured telephone interviews were conducted with program leaders in family medicine maternity care. Departmental leaders identified maternity care programs deemed to be "successful." Interviews were audiorecorded and transcribed verbatim. Team members conducted thematic analysis. Participants considered their education programs to be successful in family medicine maternity care if residents achieved competency in intrapartum care, if graduates planned to include intrapartum care in their practices, and if their education programs were able to recruit and retain family medicine maternity care faculty. Five key factors were deemed to be critical to a program's success in family medicine maternity care: adequate clinical exposure, the presence of strong family medicine role models, a family medicine-friendly hospital environment, support for the education program from multiple sources, and a dedicated and supportive community of family medicine maternity care providers. Training programs wishing to achieve greater success in family medicine maternity care education should employ a multifaceted strategy that considers all 5 of the interdependent factors uncovered in our research. By paying particular attention to the informal processes that connect these factors, program leaders can preserve the possibility that family medicine residents will graduate with the competence and confidence to practise full-scope maternity care. Copyright© the College of Family Physicians of Canada.

Development of Palliative Care in China: A Tale of Three Cities

PubMed Central

Yin, Zhenyu; Li, Jinxiang; Ma, Ke; Ning, Xiaohong; Chen, Huiping; Fu, Haiyan; Zhang, Haibo; Wang, Chun; Bruera, Eduardo

2017-01-01

Abstract Background. China is the most populous country in the world, but access to palliative care is extremely limited. A better understanding of the development of palliative care programs in China and how they overcome the barriers to provide services would inform how we can further integrate palliative care into oncology practices in China. Here, we describe the program development and infrastructure of the palliative care programs at three Chinese institutions, using these as examples to discuss strategies to accelerate palliative care access for cancer patients in China. Methods. Case study of three palliative care programs in Chengdu, Kunming, and Beijing. Results. The three examples of palliative care delivery in China ranged from a comprehensive program that includes all major branches of palliative care in Chengdu, a program that is predominantly inpatient‐based in Kunming, and a smaller program at an earlier stage of development in Beijing. Despite the numerous challenges related to the limited training opportunities, stigma on death and dying, and lack of resources and policies to support clinical practice, these programs were able to overcome many barriers to offer palliative care services to patients with advanced diseases and to advance this discipline in China through visionary leadership, collaboration with other countries to acquire palliative care expertise, committed staff members, and persistence. Conclusion. Palliative care is limited in China, although a few comprehensive programs exist. Our findings may inform palliative care program development in other Chinese hospitals. Implications for Practice. With a population of 1.3 billion, China is the most populous country in the world, and cancer is the leading cause of death. However, only 0.7% of hospitals offer palliative care services, which significantly limits palliative care access for Chinese cancer patients. Here, we describe the program development and infrastructure of three palliative care programs in China, using these as examples to discuss how they were able to overcome various barriers to implement palliative care. Lessons from these programs may help to accelerate the progress of palliative cancer care in China. PMID:28739870

5 CFR 792.203 - Child care subsidy programs; eligibility.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Child care subsidy programs; eligibility... of Appropriated Funds for Child Care Costs for Lower Income Employees § 792.203 Child care subsidy programs; eligibility. (a)(1) An Executive agency may establish a child care subsidy program in which the...

5 CFR 792.203 - Child care subsidy programs; eligibility.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Child care subsidy programs; eligibility... of Appropriated Funds for Child Care Costs for Lower Income Employees § 792.203 Child care subsidy programs; eligibility. (a)(1) An Executive agency may establish a child care subsidy program in which the...

Critical Care Nurses' Reasons for Poor Attendance at a Continuous Professional Development Program.

PubMed

Viljoen, Myra; Coetzee, Isabel; Heyns, Tanya

2016-12-01

Society demands competent and safe health care, which obligates professionals to deliver quality patient care using current knowledge and skills. Participation in continuous professional development programs is a way to ensure quality nursing care. Despite the importance of continuous professional development, however, critical care nurse practitioners' attendance rates at these programs is low. To explore critical care nurses' reasons for their unsatisfactory attendance at a continuous professional development program. A nominal group technique was used as a consensus method to involve the critical care nurses and provide them the opportunity to reflect on their experiences and challenges related to the current continuous professional development program for the critical care units. Participants were 14 critical care nurses from 3 critical care units in 1 private hospital. The consensus was that the central theme relating to the unsatisfactory attendance at the continuous professional development program was attitude. In order of importance, the 4 contributing priorities influencing attitude were communication, continuous professional development, time constraints, and financial implications. Attitude relating to attending a continuous professional development program can be changed if critical care nurses are aware of the program's importance and are involved in the planning and implementation of a program that focuses on the nurses' individual learning needs. ©2016 American Association of Critical-Care Nurses.

What influences success in family medicine maternity care education programs?

PubMed Central

Biringer, Anne; Forte, Milena; Tobin, Anastasia; Shaw, Elizabeth; Tannenbaum, David

2018-01-01

Abstract Objective To ascertain how program leaders in family medicine characterize success in family medicine maternity care education and determine which factors influence the success of training programs. Design Qualitative research using semistructured telephone interviews. Setting Purposive sample of 6 family medicine programs from 5 Canadian provinces. Participants Eighteen departmental leaders and program directors. METHODS Semistructured telephone interviews were conducted with program leaders in family medicine maternity care. Departmental leaders identified maternity care programs deemed to be “successful.” Interviews were audiorecorded and transcribed verbatim. Team members conducted thematic analysis. Main findings Participants considered their education programs to be successful in family medicine maternity care if residents achieved competency in intrapartum care, if graduates planned to include intrapartum care in their practices, and if their education programs were able to recruit and retain family medicine maternity care faculty. Five key factors were deemed to be critical to a program’s success in family medicine maternity care: adequate clinical exposure, the presence of strong family medicine role models, a family medicine–friendly hospital environment, support for the education program from multiple sources, and a dedicated and supportive community of family medicine maternity care providers. Conclusion Training programs wishing to achieve greater success in family medicine maternity care education should employ a multifaceted strategy that considers all 5 of the interdependent factors uncovered in our research. By paying particular attention to the informal processes that connect these factors, program leaders can preserve the possibility that family medicine residents will graduate with the competence and confidence to practise full-scope maternity care. PMID:29760273

7 CFR 250.61 - Child and Adult Care Food Program (CACFP).

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 4 2013-01-01 2013-01-01 false Child and Adult Care Food Program (CACFP). 250.61... National School Lunch Program (NSLP) and Other Child Nutrition Programs § 250.61 Child and Adult Care Food... CACFP to distributing agencies, which provide them to child care and adult care institutions...

7 CFR 250.61 - Child and Adult Care Food Program (CACFP).

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 4 2012-01-01 2012-01-01 false Child and Adult Care Food Program (CACFP). 250.61... National School Lunch Program (NSLP) and Other Child Nutrition Programs § 250.61 Child and Adult Care Food... CACFP to distributing agencies, which provide them to child care and adult care institutions...

7 CFR 250.61 - Child and Adult Care Food Program (CACFP).

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 4 2011-01-01 2011-01-01 false Child and Adult Care Food Program (CACFP). 250.61... National School Lunch Program (NSLP) and Other Child Nutrition Programs § 250.61 Child and Adult Care Food... CACFP to distributing agencies, which provide them to child care and adult care institutions...

7 CFR 250.61 - Child and Adult Care Food Program (CACFP).

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 4 2014-01-01 2014-01-01 false Child and Adult Care Food Program (CACFP). 250.61... National School Lunch Program (NSLP) and Other Child Nutrition Programs § 250.61 Child and Adult Care Food... CACFP to distributing agencies, which provide them to child care and adult care institutions...

45 CFR 263.5 - When do expenditures in State-funded programs count?

Code of Federal Regulations, 2011 CFR

2011-10-01

... Care, or Transitional Child Care programs, then current fiscal year expenditures in this program count... recipients, At-Risk Child Care, or Transitional Child care programs, then countable expenditures are limited... 45 Public Welfare 2 2011-10-01 2011-10-01 false When do expenditures in State-funded programs...

45 CFR 263.5 - When do expenditures in State-funded programs count?

Code of Federal Regulations, 2012 CFR

2012-10-01

... Care, or Transitional Child Care programs, then current fiscal year expenditures in this program count... recipients, At-Risk Child Care, or Transitional Child care programs, then countable expenditures are limited... 45 Public Welfare 2 2012-10-01 2012-10-01 false When do expenditures in State-funded programs...

45 CFR 263.5 - When do expenditures in State-funded programs count?

Code of Federal Regulations, 2010 CFR

2010-10-01

... Care, or Transitional Child Care programs, then current fiscal year expenditures in this program count... recipients, At-Risk Child Care, or Transitional Child care programs, then countable expenditures are limited... 45 Public Welfare 2 2010-10-01 2010-10-01 false When do expenditures in State-funded programs...

75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-03

...] Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting AGENCY: Centers for Medicare... guidance and ask questions about the upcoming Community-based Care Transitions Program. The meeting is open... registration information will be posted on the CMS Care Transitions Web site at http://www.cms.gov/DemoProjects...

A Program Design To Motivate Individuals with SCI for Self-Care.

ERIC Educational Resources Information Center

Scotzin, Martha

The report compares a skin care education program with a standard rehabilitation program to determine whether the program improved the self care motivations of spinal cord injury (SCI) paraplegic and quadriplegic inpatients (N=42). Study findings suggest that the skin care educational program was successful in changing patients' thinking about…

[Relationship between community-based dental health programs and health care costs for the metabolic syndrome].

PubMed

Takeuchi, Noriko; Yamamoto, Tatsuo; Hirai, Aya; Morita, Manabu; Kodera, Ryousei

2010-11-01

Health care costs have been increasing year by year and health programs are needed which will allow reduction in the burden. The present community-based ecological study examined the relationship between implementation of dental health care programs and health care costs for the metabolic syndrome. We calculated the monthly health care cost for the metabolic syndrome per capita for each municipality in Okayama Prefecture (n = 27) using the national health insurance receipts for 1997 and 2007 for diabetes mellitus, hypertension, cardiovascular disorder, cerebral vascular disorder, and atherosclerosis as principal diseases. Information was obtained from each municipality on the implementation of public dental health services consisting of 10 programs, including visits for oral hygiene guidance, health consultation for periodontal disease, preventive long-term care, participation of dental hygienists in public health service, programs for improving oral function in the aged, and etc. The municipalities were divided into two groups based on the implementation/non-implementation of each dental health program. Then, the change in health care cost for metabolic syndrome per capita between 1997 and 2007 was compared between the two groups according to each dental health program. RESULTS Health care costs for metabolic syndrome were reduced in decade in the municipalities which executed dental health care programs such as 'preventive long-term care' or 'health consultation for periodontal disease', being greater in the municipalities which did not. More decrease in health care costs was further observed in the municipalities where the other seven programs were also implemented. Any direct relationship between dental health programs and health care costs for the metabolic syndrome remains unclear. However, our data suggests that costs might be decreased in municipalities which can afford to implement dental health programs. Health care costs for the metabolic syndrome in municipalities which executed dental health care programs tended to decrease in ten years.

76 FR 49458 - TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-10

... Medical Program of the Uniformed Services (CHAMPUS); Fiscal Year 2012 Continued Health Care Benefit... Health Care Benefit Program premiums for Fiscal Year 2012. CHCBP is a premium-based health care program...) set forth rules to implement the Continued Health Care Benefit Program (CHCBP) required by 10 United...

76 FR 57637 - TRICARE; Continued Health Care Benefit Program Expansion

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-16

... TRICARE; Continued Health Care Benefit Program Expansion AGENCY: Office of the Secretary, Department of... Continued Health Care Benefit Program (CHCBP) coverage under certain circumstances that terminate their MHS.... Introduction and Background CHCBP is the program that provides continued health care coverage for eligible...

75 FR 60640 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

... Respiratory Care Services; Medicaid Program: Accreditation for Providers of Inpatient Psychiatric Services... Conditions of Participation for Rehabilitation and Respiratory Care Services; Medicaid Program: Accreditation... Participation for Rehabilitation and Respiratory Care Services; Medicaid Program: Accreditation for Providers of...

Care coordination for children with special needs in Medicaid: lessons from Medicare.

PubMed

Stewart, Kate A; Bradley, Katharine W V; Zickafoose, Joseph S; Hildrich, Rachel; Ireys, Henry T; Brown, Randall S

2018-04-01

To provide actionable recommendations for improving care coordination programs for children with special healthcare needs (CSHCN) in Medicaid managed care.  Literature review and interviews with stakeholders and policy experts to adapt lessons learned from Medicare care coordination programs for CSHCN in Medicaid managed care. We reviewed syntheses of research on Medicare care coordination programs to identify lessons learned from successful programs. We adapted findings from Medicare to CSHCN in Medicaid based on an environmental scan and discussions with experts. The scan focused on Medicaid financing and eligibility for care coordination and how these intersect with Medicaid managed care. The expert discussions included pediatricians, Medicaid policy experts, Medicaid medical directors, and a former managed care executive, all experienced in care coordination for CSHCN. We found 6 elements that are consistently associated with improved outcomes from Medicare care coordination programs and relevant to CSHCN in Medicaid: 1) identifying and targeting high-risk patients, 2) clearly articulating what outcomes programs are likely to improve, 3) encouraging active engagement between care coordinators and primary care providers, 4) requiring some in-person contact between care coordinators and patients, 5) facilitating information sharing among providers, and 6) supplementing care coordinators' expertise with that of other clinical experts. States and Medicaid managed care organizations have many options for designing effective care coordination programs for CSHCN. Their choices should account for the diversity of conditions among CSHCN, families' capacity to coordinate care, and social determinants of health.

Supporting Nutrition in Early Care and Education Settings: The Child and Adult Care Food Program (CACFP)

ERIC Educational Resources Information Center

Stephens, Samuel A.

2016-01-01

Child care centers, Head Start programs, and family child care providers serving young children--as well as after school programs and homeless shelters that reach older children, adults, and families--are supported in providing healthy meals and snacks by reimbursements through the Child and Adult Care Food Program (CACFP). Administered by the…

Primary Care Physicians' Experience with Disease Management Programs

PubMed Central

Fernandez, Alicia; Grumbach, Kevin; Vranizan, Karen; Osmond, Dennis H; Bindman, Andrew B

2001-01-01

OBJECTIVE To examine primary care physicians' perceptions of how disease management programs affect their practices, their relationships with their patients, and overall patient care. DESIGN Cross-sectional mailed survey. SETTING The 13 largest urban counties in California. PARTICIPANTS General internists, general pediatricians, and family physicians. MEASUREMENTS AND MAIN RESULTS Physicians' self-report of the effects of disease management programs on quality of patient care and their own practices. Respondents included 538 (76%) of 708 physicians: 183 (34%) internists, 199 (38%) family practitioners, and 156 (29%) pediatricians. Disease management programs were available 285 to (53%) physicians; 178 had direct experience with the programs. Three quarters of the 178 physicians believed that disease management programs increased the overall quality of patient care and the quality of care for the targeted disease. Eighty-seven percent continued to provide primary care for their patients in these programs, and 70% reported participating in major patient care decisions. Ninety-one percent reported that the programs had no effect on their income, decreased (38%) or had no effect (48%) on their workload, and increased (48%)) their practice satisfaction. CONCLUSIONS Practicing primary care physicians have generally favorable perceptions of the effect of voluntary, primary care-inclusive, disease management programs on their patients and on their own practice satisfaction. PMID:11318911

Program Characteristics and Enrollees' Outcomes in the Program of All-Inclusive Care for the Elderly (PACE)

PubMed Central

Mukamel, Dana B; Peterson, Derick R; Temkin-Greener, Helena; Delavan, Rachel; Gross, Diane; Kunitz, Stephen J; Williams, T Franklin

2007-01-01

The Program of All-Inclusive Care for the Elderly (PACE) is a unique program providing a full spectrum of health care services, from primary to acute to long-term care for frail elderly individuals certified to require nursing home care. The objective of this article is to identify program characteristics associated with better risk-adjusted health outcomes: mortality, functional status, and self-assessed health. The article examines statistical analyses of information combining DataPACE (individual-level clinical data), a survey of direct care staff about team performance, and interviews with management in twenty-three PACE programs. Several program characteristics were associated with better functional outcomes. Fewer were associated with long-term self-assessed health, and only one with mortality. These findings offer strategies that may lead to better care. PMID:17718666

Restructuring VA ambulatory care and medical education: the PACE model of primary care.

PubMed

Cope, D W; Sherman, S; Robbins, A S

1996-07-01

The Veterans Health Administration (VHA) Western Region and associated medical schools formulated a set of recommendations for an improved ambulatory health care delivery system during a 1988 strategic planning conference. As a result, the Department of Veterans Affairs (VA) Medical Center in Sepulveda, California, initiated the Pilot (now Primary) Ambulatory Care and Education (PACE) program in 1990 to implement and evaluate a model program. The PACE program represents a significant departure from traditional VA and non-VA academic medical center care, shifting the focus of care from the inpatient to the outpatient setting. From its inception, the PACE program has used an interdisciplinary team approach with three independent global care firms. Each firm is interdisciplinary in composition, with a matrix management structure that expands role function and empowers team members. Emphasis is on managed primary care, stressing a biopsychosocial approach and cost-effective comprehensive care emphasizing prevention and health maintenance. Information management is provided through a network of personal computers that serve as a front end to the VHA Decentralized Hospital Computer Program (DHCP) mainframe. In addition to providing comprehensive and cost-effective care, the PACE program educates trainees in all health care disciplines, conducts research, and disseminates information about important procedures and outcomes. Undergraduate and graduate trainees from 11 health care disciplines rotate through the PACE program to learn an integrated approach to managed ambulatory care delivery. All trainees are involved in a problem-based approach to learning that emphasizes shared training experiences among health care disciplines. This paper describes the transitional phases of the PACE program (strategic planning, reorganization, and quality improvement) that are relevant for other institutions that are shifting to training programs emphasizing primary and ambulatory care.

The Prenatal Care at School Program

ERIC Educational Resources Information Center

Griswold, Carol H.; Nasso, Jacqueline T.; Swider, Susan; Ellison, Brenda R.; Griswold, Daniel L.; Brooks, Marilyn

2013-01-01

School absenteeism and poor compliance with prenatal appointments are concerns for pregnant teens. The Prenatal Care at School (PAS) program is a new model of prenatal care involving local health care providers and school personnel to reduce the need for students to leave school for prenatal care. The program combines prenatal care and education…

Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

PubMed

Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

2012-09-01

In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

Participation in Training for Depression Care Quality Improvement: A Randomized Trial of Community Engagement or Technical Support.

PubMed

Chung, Bowen; Ngo, Victoria K; Ong, Michael K; Pulido, Esmeralda; Jones, Felica; Gilmore, James; Stoker-Mtume, Norma; Johnson, Megan; Tang, Lingqi; Wells, Kenneth Brooks; Sherbourne, Cathy; Miranda, Jeanne

2015-08-01

Community engagement and planning (CEP) could improve dissemination of depression care quality improvement in underresourced communities, but whether its effects on provider training participation differ from those of standard technical assistance, or resources for services (RS), is unknown. This study compared program- and staff-level participation in depression care quality improvement training among programs enrolled in CEP, which trained networks of health care and social-community agencies jointly, and RS, which provided technical support to individual programs. Matched programs from health care and social-community service sectors in two communities were randomly assigned to RS or CEP. Data were from 1,622 eligible staff members from 95 enrolled programs. Primary outcomes were any staff trained (for programs) and total hours of training (for staff). Secondary staff-level outcomes were hours of training in specific depression collaborative care components. CEP programs were more likely than RS programs to participate in any training (p=.006). Within health care sectors, CEP programs were more likely than RS programs to participate in training (p=.016), but within social-community sectors, there was no difference in training by intervention. Among staff who participated in training, mean training hours were greater among CEP programs versus RS programs for any type of training (p<.001) and for training related to each component of depression care (p<.001) except medication management. CEP may be an effective strategy to promote staff participation in depression care improvement efforts in underresourced communities.

Results of Descriptive Study of Crisis Nursery and Respite Care Programs.

ERIC Educational Resources Information Center

Huntington, Gail S.; And Others

This report describes results of an evaluation of respite care programs and crisis nursery programs for children with disabilities, based on survey forms received from 81 programs and site visits to selected programs across the United States. The survey of crisis nursery programs and the survey of respite care programs gathered data on amount of…

Child Development: Day Care. Administration, Number 7.

ERIC Educational Resources Information Center

Host, Malcolm S.; Heller, Pearl B.

The organizing and administering of day care services are the focus of this handbook. The three parts of the handbook are: (1) Organizing Day Care Services (Starting a Day Care Program, The Board of Directors, and The Staff); (2) Components of Day Care Services (Purpose, Objectives and Evaluation of Day Care Programs; Health and Medical Program;…

An Evaluation of the AirCare Program Based on Cost-Benefit and Cost-Effectiveness Analyses

ERIC Educational Resources Information Center

Bi, Hsiaotao T.; Wang, Dianle

2006-01-01

A cost-benefit analysis of the AirCare program in the province of British Columbia on the basis of emissions cost factors from the literature showed a benefit outweighing the cost. Furthermore, a cost-effectiveness analysis comparing the AirCare program with a hybrid-car rebate program revealed that the AirCare program is more effective in…

Care of the elderly program at the University of Alberta

PubMed Central

Charles, Lesley; Dobbs, Bonnie; Triscott, Jean; McKay, Rhianne

2014-01-01

Abstract Problem addressed The population is aging rapidly and there are implications for health care delivery in the face of few physicians specializing in care of the elderly (COE). Objective of program To train physicians wishing to provide COE services. Program description The COE program at the University of Alberta in Edmonton is an enhanced skills diploma program lasting 6 months to 1 year, with core program requirements including geriatric inpatient care, geriatric psychiatry, ambulatory care, continuing care, and outreach. There is a longitudinal clinic component and a research project requirement. The program is designed to cover the 85 core competencies in the CanMEDS– Family Medicine roles. Conclusion There is a need for COE physicians to provide clinical care as well as fill educational, administrative, and research roles to meet the health care needs of medically complex seniors. These physicians require alternative funding and a departmental home within a university if they are to provide an academic service. PMID:25551143

76 FR 21372 - Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-15

...] Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions Program... interested parties of an opportunity to apply to participate in the Medicare Community-based Care Transitions Program, which was authorized by section 3026 of the Affordable Care Act. DATES: Proposals will be...

32 CFR 199.16 - Supplemental Health Care Program for active duty members.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 2 2014-07-01 2014-07-01 false Supplemental Health Care Program for active duty... (CHAMPUS) § 199.16 Supplemental Health Care Program for active duty members. (a) Purpose and applicability... the supplemental health care program for active duty members of the uniformed services, the provision...

32 CFR 199.16 - Supplemental Health Care Program for active duty members.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Supplemental Health Care Program for active duty... (CHAMPUS) § 199.16 Supplemental Health Care Program for active duty members. (a) Purpose and applicability... the supplemental health care program for active duty members of the uniformed services, the provision...

32 CFR 199.16 - Supplemental Health Care Program for active duty members.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 2 2011-07-01 2011-07-01 false Supplemental Health Care Program for active duty... (CHAMPUS) § 199.16 Supplemental Health Care Program for active duty members. (a) Purpose and applicability... the supplemental health care program for active duty members of the uniformed services, the provision...

32 CFR 199.16 - Supplemental Health Care Program for active duty members.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 2 2013-07-01 2013-07-01 false Supplemental Health Care Program for active duty... (CHAMPUS) § 199.16 Supplemental Health Care Program for active duty members. (a) Purpose and applicability... the supplemental health care program for active duty members of the uniformed services, the provision...

32 CFR 199.16 - Supplemental Health Care Program for active duty members.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 2 2012-07-01 2012-07-01 false Supplemental Health Care Program for active duty... (CHAMPUS) § 199.16 Supplemental Health Care Program for active duty members. (a) Purpose and applicability... the supplemental health care program for active duty members of the uniformed services, the provision...

77 FR 14364 - Comment Sought on Funding Pilot Program Participants Transitioning Out of the Rural Health Care...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-09

... Program Participants Transitioning Out of the Rural Health Care Pilot Program in Funding Year 2012 AGENCY..., the Wireline Competition Bureau seeks comment on whether to fund Rural Health Care Pilot Program... transition them into the permanent Rural Health Care support mechanism (RHC support mechanism). DATES...

Integrated Pest Management: A Curriculum for Early Care and Education Programs

ERIC Educational Resources Information Center

California Childcare Health Program, 2011

2011-01-01

This "Integrated Pest Management Toolkit for Early Care and Education Programs" presents practical information about using integrated pest management (IPM) to prevent and manage pest problems in early care and education programs. This curriculum will help people in early care and education programs learn how to keep pests out of early…

Hospital-Based Comprehensive Care Programs for Children With Special Health Care Needs

PubMed Central

Cohen, Eyal; Jovcevska, Vesna; Kuo, Dennis Z.; Mahant, Sanjay

2014-01-01

Objective To examine the effectiveness of hospital-based comprehensive care programs in improving the quality of care for children with special health care needs. Data Sources A systematic review was conducted using Ovid MEDLINE, CINAHL, EMBASE, PsycINFO, Sociological Abstracts SocioFile, and Web of Science. Study Selection Evaluations of comprehensive care programs for categorical (those with single disease) and noncategorical groups of children with special health care needs were included. Selected articles were reviewed independently by 2 raters. Data Extraction Models of care focused on comprehensive care based at least partially in a hospital setting. The main outcome measures were the proportions of studies demonstrating improvement in the Institute of Medicine’s quality-of-care domains (effectiveness of care, efficiency of care, patient or family centeredness, patient safety, timeliness of care, and equity of care). Data Synthesis Thirty-three unique programs were included, 13 (39%) of which were randomized controlled trials. Improved outcomes most commonly reported were efficiency of care (64% [49 of 76 outcomes]), effectiveness of care (60% [57 of 95 outcomes]), and patient or family centeredness (53% [10 of 19 outcomes). Outcomes less commonly evaluated were patient safety (9% [3 of 33 programs]), timeliness of care (6% [2 of 33 programs]), and equity of care (0%). Randomized controlled trials occurred more frequently in studies evaluating categorical vs noncategorical disease populations (11 of 17 [65%] vs 2 of 16 [17%], P = .008). Conclusions Although positive, the evidence supporting comprehensive hospital-based programs for children with special health care needs is restricted primarily to nonexperimental studies of children with categorical diseases and is limited by inadequate outcome measures. Additional high-quality evidence with appropriate comparative groups and broad outcomes is necessary to justify continued development and growth of programs for broad groups of children with special health care needs. PMID:21646589

7 CFR 226.17 - Child care center provisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 4 2013-01-01 2013-01-01 false Child care center provisions. 226.17 Section 226.17... AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.17 Child care center provisions. (a) Child care centers may participate in the Program either as independent...

7 CFR 226.17 - Child care center provisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 4 2014-01-01 2014-01-01 false Child care center provisions. 226.17 Section 226.17... AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.17 Child care center provisions. (a) Child care centers may participate in the Program either as independent...

7 CFR 226.17 - Child care center provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 4 2012-01-01 2012-01-01 false Child care center provisions. 226.17 Section 226.17... AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.17 Child care center provisions. (a) Child care centers may participate in the Program either as independent...

A national survey of the primary and acute care pediatric nurse practitioner educational preparation.

PubMed

Hawkins-Walsh, Elizabeth; Berg, Mary; Docherty, Sharron; Lindeke, Linda; Gaylord, Nan; Osborn, Kristen

2011-01-01

The past decade has been marked by a gradual expansion of the traditional primary care role of the pediatric nurse practitioner (PNP) into practice arenas that call for more acute and critical care of children. The purpose of the study was to explore the educational programming needs of dual (combined) track PNP programs that prepare graduates to provide care to children and adolescents across the continuum of health and illness. A two-phase, exploratory, mixed method design was utilized. An electronic survey was completed by 65% of PNP program directors in the country. Semi-structured telephone interviews were conducted with hospital-based PNPs who were practicing in roles that met a range of health care needs across the primary and acute care continuum. Primary care and acute care programs have more common than unique elements, and the vast majority of clinical competencies are common to both types of program. Only three competencies appear to be unique to acute care programs. The Association of Faculties of Pediatric Nurse Practitioner Programs should utilize existing evidence and develop guidelines for dual PNP programs that focus on the provision of care to children across a wide continuum of health and illness. Copyright © 2011 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

75 FR 32480 - Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-08

... Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title VI Native American Programs Purpose of Notice: Availability of funding opportunity announcement. Funding Opportunity Title/Program Name: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title...

Program Implementation Approaches to Build and Sustain Health Care Coordination for Type 2 Diabetes.

PubMed

Fitzgerald, Tania M; Williams, Pam A; Dodge, Julia A; Quinn, Martha; Heminger, Christina L; Moultrie, Rebecca; Taylor, Olivia; Nelson, Belinda W; Lewis, Megan A

2017-03-01

As more people enter the U.S. health care system under the Affordable Care Act (ACA), it is increasingly critical to deliver coordinated, high-quality health care. The ACA supports implementation and sustainability of efficient health care models, given expected limits in available resources. This article highlights implementation strategies to build and sustain care coordination, particularly ones consistent with and reinforced by the ACA. It focuses on disease self-management programs to improve the health of patients with type 2 diabetes, exemplified by grantees of the Alliance to Reduce Disparities in Diabetes. We conducted interviews with grantee program representatives throughout their 5-year programs and conducted a qualitative framework analysis of data to identify key themes related to care coordination. The most promising care coordination strategies that grantee programs described included establishing clinic-community collaborations, embedding community health workers within care management teams, and sharing electronic data. Establishing provider buy-in was crucial for these strategies to be effective. This article adds new insights into strategies promoting effective care coordination. The strategies that grantees implemented throughout the program align with ACA requirements, underscoring their relevance to the changing U.S. health care environment and the likelihood of further support for program sustainability.

Tennessee Star-Quality Child Care Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Tennessee's Star-Quality Child Care Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

Oregon Child Care Quality Indicators Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Oregon's Child Care Quality Indicators Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

Cost-effectiveness of a primary care treatment program for depression in low-income women in Santiago, Chile.

PubMed

Araya, Ricardo; Flynn, Terry; Rojas, Graciela; Fritsch, Rosemarie; Simon, Greg

2006-08-01

The authors compared the incremental cost-effectiveness of a stepped-care, multicomponent program with usual care for the treatment of depressed women in primary care in Santiago, Chile. A cost-effectiveness study was conducted of a previous randomized controlled trial involving 240 eligible women with DSM-IV major depression who were selected from a consecutive sample of adult women attending primary care clinics. The patients were randomly allocated to usual care or a multicomponent stepped-care program led by a nonmedical health care worker. Depression-free days and health care costs derived from local sources were assessed after 3 and 6 months. A health service perspective was used in the economic analysis. Complete data were determined for 80% of the randomly assigned patients. After we adjusted for initial severity, women receiving the stepped-care program had a mean of 50 additional depression-free days over 6 months relative to patients allocated to usual care. The stepped-care program was marginally more expensive than usual care (an extra 216 Chilean pesos per depression-free day). There was a 90% probability that the incremental cost of obtaining an extra depression-free day with the intervention would not exceed 300 pesos (1.04 US dollars). The stepped-care program was significantly more effective and marginally more expensive than usual care for the treatment of depressed women in primary care. Small investments to improve depression appear to yield larger gains in poorer environments. Simple and inexpensive treatment programs tested in developing countries might provide good study models for developed countries.

38 CFR 52.61 - General requirements for adult day health care program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... adult day health care program. 52.61 Section 52.61 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.61 General requirements for adult day health care program. Adult day health care must be a...

7 CFR 226.19a - Adult day care center provisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 4 2013-01-01 2013-01-01 false Adult day care center provisions. 226.19a Section 226..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.19a Adult day care center provisions. (a) Adult day care centers may participate in the Program...

38 CFR 52.61 - General requirements for adult day health care program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... adult day health care program. 52.61 Section 52.61 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.61 General requirements for adult day health care program. Adult day health care must be a...

7 CFR 226.19a - Adult day care center provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 4 2012-01-01 2012-01-01 false Adult day care center provisions. 226.19a Section 226..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.19a Adult day care center provisions. (a) Adult day care centers may participate in the Program...

7 CFR 226.19a - Adult day care center provisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 4 2014-01-01 2014-01-01 false Adult day care center provisions. 226.19a Section 226..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.19a Adult day care center provisions. (a) Adult day care centers may participate in the Program...

38 CFR 52.61 - General requirements for adult day health care program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... adult day health care program. 52.61 Section 52.61 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.61 General requirements for adult day health care program. Adult day health care must be a...

38 CFR 52.61 - General requirements for adult day health care program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... adult day health care program. 52.61 Section 52.61 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.61 General requirements for adult day health care program. Adult day health care must be a...

38 CFR 52.61 - General requirements for adult day health care program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... adult day health care program. 52.61 Section 52.61 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.61 General requirements for adult day health care program. Adult day health care must be a...

[Achievement and Future Direction of the PEACE Project - A National Education Project for Palliative Care Education].

PubMed

Kizawa, Yoshiyuki; Yamamoto, Ryo

2017-07-01

Although palliative care is assuming an increasingly important role in patient care, most physicians did not learn to provide palliative care during their medical training. To address these serious deficiencies in physician training in palliative care, government decided to provide basic palliative education program for all practicing cancer doctors as a national policy namely Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education(PEACE). The program was 2-days workshop based on adult learning theory and focusing on symptom management and communication. In this 9 years, 4,888 educational workshop has been held, and 93,250 physicians were trained. In prospective observational study, both knowledges and difficulties practicing palliative care were significantly improved. In 2017, the new palliative care education program will be launched including combined program of e-learning and workshop to provide tailor made education based on learner's readiness and educational needs in palliative care.

The effect of Medicaid wage pass-through programs on the wages of direct care workers.

PubMed

Baughman, Reagan A; Smith, Kristin

2010-05-01

Despite growing demand for nursing and home health care as the US population ages, compensation levels in the low-skill nursing labor market that provides the bulk of long-term care remain quite low. The challenge facing providers of long-term care is that Medicaid reimbursement rates for nursing home and home health care severely restrict the wage growth that is necessary to attract workers, resulting in high turnover and labor shortages. Almost half of US states have responded by enacting "pass-through" provisions in their Medicaid programs, channeling additional long-term care funding directly to compensation of lower-skill nursing workers. We test the effect of Medicaid wage pass-through programs on hourly wages for direct care workers. We estimate several specifications of wage models using employment data from the 1996 and 2001 panels of the Survey of Income and Program Participation for nursing, home health, and personal care aides. The effect of pass-through programs is identified by an indicator variable for states with programs; 20 states adopted pass-throughs during the sample period. Workers in states with pass-through programs earn as much as 12% more per hour than workers in other states after those programs are implemented. Medicaid wage pass-through programs appear to be a viable policy option for raising compensation levels of direct care workers, with an eye toward improving recruitment and retention in long-term care settings.

Goals of care conversation teaching in residency - a cross-sectional survey of postgraduate program directors.

PubMed

Roze des Ordons, Amanda; Kassam, Aliya; Simon, Jessica

2017-01-06

Residents are commonly involved in establishing goals of care for hospitalized patients. While education can improve the quality of these conversations, whether and how postgraduate training programs integrate such teaching into their curricula is not well established. The objective of this study was to characterize perceptions of current teaching and assessment of goals of care conversations, and program director interest in associated curricular integration. An electronic survey was sent to all postgraduate program directors at the University of Calgary. Quantitative data was analyzed using descriptive statistics and qualitative comments were analyzed using thematic analysis. The survey response rate was 34% (22/64). Formal goals of care conversation teaching is incorporated into 63% of responding programs, and most commonly involves lectures. Informal teaching occurs in 86% of programs, involving discussion, direct observation and role modeling in the clinical setting. Seventy-three percent of programs assess goals of care conversation skills, mostly in the clinical setting through feedback. Program directors believe that over two-thirds of clinical faculty are prepared to teach goals of care conversations, and are interested in resources to teach and assess goals of care conversations. Themes that emerged include 1) general perceptions, 2) need for teaching, 3) ideas for teaching, and 4) assessment of goals of care conversations. The majority of residency training programs at the University of Calgary incorporate some goals of care conversation teaching and assessment into their curricula. Program directors are interested in resources to improve teaching and assessment of goals of care conversations.

Association of Group Prenatal Care in US Family Medicine Residencies With Maternity Care Practice: A CERA Secondary Data Analysis.

PubMed

Barr, Wendy B; Tong, Sebastian T; LeFevre, Nicholas M

2017-03-01

Group prenatal care has been shown to improve both maternal and neonatal outcomes. With increasing adaption of group prenatal care by family medicine residencies, this model may serve as a potential method to increase exposure to and interest in maternity care among trainees. This study aims to describe the penetration, regional and program variations, and potential impacts on future maternity care practice of group prenatal care in US family medicine residencies. The CAFM Educational Research Alliance (CERA) conducted a survey of all US family medicine residency program directors in 2013 containing questions about maternity care training. A secondary data analysis was completed to examine relevant data on group prenatal care in US family medicine residencies and maternity care practice patterns. 23.1% of family medicine residency programs report provision of group prenatal care. Programs with group prenatal care reported increased number of vaginal deliveries per resident. Controlling for average number of vaginal deliveries per resident, programs with group prenatal care had a 2.35 higher odds of having more than 10% of graduates practice obstetrics and a 2.93 higher odds of having at least one graduate in the past 5 years enter an obstetrics fellowship. Residency programs with group prenatal care models report more graduates entering OB fellowships and practicing maternity care. Implementing group prenatal care in residency training can be one method in a multifaceted approach to increasing maternity care practice among US family physicians.

Effects of enhanced foster care on the long-term physical and mental health of foster care alumni.

PubMed

Kessler, Ronald C; Pecora, Peter J; Williams, Jason; Hiripi, Eva; O'Brien, Kirk; English, Diana; White, James; Zerbe, Richard; Downs, A Chris; Plotnick, Robert; Hwang, Irving; Sampson, Nancy A

2008-06-01

Child maltreatment is a significant risk factor for adult mental disorders and physical illnesses. Although the child welfare system routinely places severely abused and/or neglected children in foster care, no controlled studies exist to determine the effectiveness of this intervention in improving the long-term health of maltreated youth. To present results of the first quasi-experimental study, to our knowledge, to evaluate the effects of expanded foster care treatment on the mental and physical health of adult foster care alumni. We used a quasi-experimental design to compare adult outcomes of alumni of a model private foster care program and 2 public programs. The latter alumni were eligible for but not selected by the private program because of limited openings. Propensity score weights based on intake records were adjusted for preplacement between-sample differences. Personal interviews administered 1 to 13 years after leaving foster care assessed the mental and physical health of alumni. A representative sample of 479 adult foster care alumni who were placed in foster care as adolescents (14-18 years of age) between January 1, 1989, and September 30, 1998, in private (n = 111) or public (n = 368) foster care programs in Oregon and Washington. More than 80% of alumni were traced, and 92.2% of those traced were interviewed. Caseworkers in the model program had higher levels of education and salaries, lower caseloads, and access to a wider range of ancillary services (eg, mental health counseling, tutoring, and summer camps) than caseworkers in the public programs. Youth in the model program were in foster care more than 2 years longer than those in the public programs. Private program alumni had significantly fewer mental disorders (major depression, anxiety disorders, and substance use disorders), ulcers, and cardiometabolic disorders, but more respiratory disorders, than did public program alumni. Public sector investment in higher-quality foster care services could substantially improve the long-term mental and physical health of foster care alumni.

Effect of a Novel Interdisciplinary Teaching Program in the Care-continuum on Medical Student Knowledge and Self-Efficacy.

PubMed

Lathia, Amanda; Rothberg, Michael; Heflin, Mitchell; Nottingham, Kelly; Messinger-Rapport, Barbara

2015-10-01

Medical students report that they receive inadequate training in different levels of care, including care transitions to and from post-acute (PA) and long-term care (LTC). The authors implemented the Medical Students as Teachers in Extended Care (MedTEC) program as an educational innovation at the Cleveland Clinic to address training in the care-continuum, as well as the new medical student and physician competencies in PA/LTC. MedTEC is a 7-hour interactive program that supplements standard geriatric didactics during the medical student primary care rotation. This study evaluated the performance of the program in improving medical student knowledge and attitudes on levels and transitions of care. The program occurs in a community facility that includes subacute/skilled nursing, assisted living, and nursing home care. Five to 8 students completing their primary care rotation at the Cleveland Clinic are required to participate in the MedTEC program each month. The program includes up to 3 hours of interactive discussion and opportunities to meet facility staff, residents, and patients. The highlight of the program is a student-led in-service for facility staff. With institutional review board approval as an exempt educational research project, pre- and postactivity surveys assessed self-efficacy and knowledge regarding levels of care for students who participated in the program and a student comparison group. The post-program knowledge test also was administered to hospital medicine staff, and test performance was compared with medical students who participated in the MedTEC program. Between October 2011 and December 2013, approximately 100 students participated in 20 sessions of MedTEC. All students reported improved self-efficacy and attitudes regarding care of older adults and care transition management. Mean percentage correct on the knowledge test increased significantly from 59.8% to 71.2% (P = .004) for the MedTEC participants but not for the comparison group students (63.1%-58.3%, P = .47). There was no significant difference in mean percentage correct on the post-program knowledge test between MedTEC medical students and hospitalists (71.0% versus 70.3%, P = .86). Students led 8 in-service sessions for facility staff on various topics relating to the care of older adults in PA/LTC. The MedTEC program appears to be a successful innovation in medical student education on levels of care. It could serve as a model for building competency of health professionals on managing care transitions and determining appropriate levels of care for older adults. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

7 CFR 240.9 - Use of funds.

Code of Federal Regulations, 2011 CFR

2011-01-01

... school food authorities (for program schools), service institutions and nonresidential child care... foods for use in their food service under the National School Lunch Program, Child Care Food Program, or... school food authorities (for program schools), service institutions and nonresidential child care...

7 CFR 240.9 - Use of funds.

Code of Federal Regulations, 2010 CFR

2010-01-01

... school food authorities (for program schools), service institutions and nonresidential child care... foods for use in their food service under the National School Lunch Program, Child Care Food Program, or... school food authorities (for program schools), service institutions and nonresidential child care...

7 CFR 240.9 - Use of funds.

Code of Federal Regulations, 2012 CFR

2012-01-01

... school food authorities (for program schools), service institutions and nonresidential child care... foods for use in their food service under the National School Lunch Program, Child Care Food Program, or... school food authorities (for program schools), service institutions and nonresidential child care...

7 CFR 240.9 - Use of funds.

Code of Federal Regulations, 2014 CFR

2014-01-01

... school food authorities (for program schools), service institutions and nonresidential child care... foods for use in their food service under the National School Lunch Program, Child Care Food Program, or... school food authorities (for program schools), service institutions and nonresidential child care...

7 CFR 240.9 - Use of funds.

Code of Federal Regulations, 2013 CFR

2013-01-01

... school food authorities (for program schools), service institutions and nonresidential child care... foods for use in their food service under the National School Lunch Program, Child Care Food Program, or... school food authorities (for program schools), service institutions and nonresidential child care...

Relation Between the Level of American Indian and Alaska Native Diabetes Education Program Services and Quality-of-Care Indicators

PubMed Central

Noonan, Carolyn; Goldberg, Jack H.; Valdez, S. Lorraine; Brown, Tammy L.; Manson, Spero M.; Acton, Kelly

2008-01-01

Objectives. We examined the relation between the level of diabetes education program services in the Indian Health Service (IHS) and indicators of the quality of diabetes care to determine if more-comprehensive diabetes services were associated with better quality of diabetes care. Methods. In this cross-sectional study, we used the IHS Integrated Diabetes Education Recognition Program to rank program services into 1 of 3 levels of comprehensiveness, ranging from lowest (developmental) to highest (integrated). We compared quality-of-care indicators among programs of differing levels with the 2001 IHS Diabetes Care and Outcomes Audit. Quality indicators included patients having recommended yearly examinations, education, and laboratory tests and achieving recommended levels of intermediate outcomes of care. Results. Most of the 86 participating programs were classified at or below the developmental level; only 9 programs (11%) were ranked at higher levels. After adjusting for patient characteristics, program factors, and correlation of patients within programs, we associated programs that were more comprehensive with higher completion rates of yearly lipid and hemoglobin A1C tests (P < .05). Conclusions. System-wide improvements in diabetes education are associated with better diabetes care. The results can help inform the development of diabetes education programs. PMID:18511737

Measuring outcomes of community aged care programs: challenges, opportunities and the Australian Community Outcomes Measurement ACCOM tool.

PubMed

Cardona, Beatriz

2018-05-29

Measuring health and wellbeing outcomes of community aged care programs is a complex task given the diverse settings in which care takes place and the intersection of numerous factors affecting an individual's quality of life outcomes. Knowledge of a strong causal relationship between services provided and the final outcome enables confidence in assuming the care provided was largely responsible for the outcome achieved (Courtney et al., Aust J Adv Nurs 26:49-57, 2009). The Department of Health has recently reported on the findings of The National Aged Care Quality Indicator Program - Home Care Pilot (KPMG, National Aged Care Quality Indicator Program - Home Care Pilot, 2017). The Program sought to test various tools to measure quality of life outcomes of their community aged care programs. Some of the key issues raised in the study reiterate the findings from The Australian Community Care Outcome Measurement (ACCOM) pilot study (Cardona et al., Australas J Ageing 36: 69-71, 2017), including the value of the ASCOT SCT4 tool (Adult Social care Outcomes Toolkit, http://www.pssru.ac.uk/ascot/downloads/questionnaires/sct4.pdf ) to measure social care related quality of life (SCRQoL) in community aged care programs in the Australian context, the collection of additional data to map the relationship of various variables such as functional ability, demographic characteristics and quality of life scores and the governance and administration of measurement tools for the purpose of quality reporting and consumer choice.

Military Lesbian, Gay, Bisexual, and Transgender (LGBT) Awareness Training for Health Care Providers Within the Military Health System [Formula: see text].

PubMed

Shrader, Angela; Casero, Kellie; Casper, Bethany; Kelley, Mary; Lewis, Laura; Calohan, Jess

Lesbian, gay, bisexual, and transgender (LGBT) individuals serving within the U.S. military and their beneficiaries have unique health care requirements. Department of Defense Directive 1304.26 "Don't Ask, Don't Tell" created a barrier for service members to speak candidly with their health care providers, which left specific health care needs unaddressed. There are no standardized cultural education programs to assist Military Health System (MHS) health care providers in delivering care to LGBT patients and their beneficiaries. The purpose of this project was to develop, implement, and evaluate the effectiveness of an LGBT educational program for health care providers within the MHS to increase cultural awareness in caring for this special population. This multisite educational program was conducted at Travis Air Force Base and Joint Base Lewis-McChord from November 15, 2014, to January 30, 2015. A 15-question multiple-choice questionnaire was developed based on the education program and was administered before and after the education program. A total of 51 individuals completed the program. Overall posttest scores improved compared to pretest scores. This program was designed to begin the process of educating health care providers about the unique health care issues of military LGBT Service Members and their beneficiaries. This program was the first to address the disparities in LGBT health care needs within the Department of Defense. It also provided a platform for facilitating open communication among providers regarding LGBT population health needs in the military.

78 FR 54069 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, and Eligibility...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-30

... Parts 147, 153, 155, et al. Patient Protection and Affordable Care Act; Program Integrity: Exchange... 147, 153, 155, and 156 [CMS-9957-F] RIN 0938-AR82 Patient Protection and Affordable Care Act; Program... Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as...

Non-Technical Medical Care: An In-Home Care Program.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Human Services, Oklahoma City.

This document describes the Non-Technical Medical Care (NTMC) program, a personal care service offered by the Oklahoma Department of Human Services to eligible persons in their own homes. These NTMC program goals are listed: to provide personal care services to frail elderly and disabled persons, allowing them to remain in their homes; and to…

Training Programs for Family Child Care Providers: An Analysis of Ten Curricula. Second Edition.

ERIC Educational Resources Information Center

Modigliani, Kathy

This report analyzes the following 10 curricula for training programs for family child care providers: (1) Child Care, a family day home care provider program developed by Texas A&M's Agricultural Extension Service; (2) the Family Day Care Education Series, a coordinated resource manual and independent study course, the Active Learning Series,…

Evaluation of Hospital-Based Palliative Care Programs.

PubMed

Hall, Karen Lynn; Rafalson, Lisa; Mariano, Kathleen; Michalek, Arthur

2016-02-01

This study evaluated current hospital-based palliative care programs using recommendations from the Center to Advance Palliative Care (CAPC) as a framework. Seven hospitals located in Buffalo, New York were included based on the existence of a hospital-based palliative care program. Data was collected from August through October of 2013 by means of key informant interviews with nine staff members from these hospitals using a guide comprised of questions based on CAPC's recommendations. A gap analysis was conducted to analyze the current state of each hospital's program based upon CAPC's definition of a quality palliative care program. The findings identify challenges facing both existing/evolving palliative care programs, and establish a foundation for strategies to attain best practices not yet implemented. This study affirms the growing availability of palliative care services among these selected hospitals along with opportunities to improve the scope of services in line with national recommendations. © The Author(s) 2014.

Improving Health Care Management in Primary Care for Homeless People: A Literature Review.

PubMed

Jego, Maeva; Abcaya, Julien; Ștefan, Diana-Elena; Calvet-Montredon, Céline; Gentile, Stéphanie

2018-02-10

Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. We performed a literature review that included articles which described and evaluated primary care programs for homeless people. Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community's health. Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model.

ASQ Program Observation Instrument: A Tool for Assessing School-Age Child Care Quality.

ERIC Educational Resources Information Center

O'Connor, Susan; And Others

ASQ (Assessing School-Aged Child Care Quality) is a system for determining the quality of school-age child care programs. The ASQ Program Observation Instrument is a ten-step, self assessment process to guide program improvement. This instrument does not work well in full-day programs that have a single focus, but works well in programs that offer…

A Comprehensive Child Development Program; Title XX, Final Report.

ERIC Educational Resources Information Center

Whatley, Juanita T.

This booklet describes the Comprehensive Child Day Care Program for the Atlanta Public School System, a Title XX Program. This program provided day care services for children of clients in various categories. The program goals for 1975-76 were geared toward providing comprehensive day care to encompass social services to the family and…

45 CFR 263.5 - When do expenditures in State-funded programs count?

Code of Federal Regulations, 2014 CFR

2014-10-01

..., or Transitional Child Care programs, then current fiscal year expenditures in this program count in... recipients, At-Risk Child Care, or Transitional Child care programs, then countable expenditures are limited... 45 Public Welfare 2 2014-10-01 2012-10-01 true When do expenditures in State-funded programs count...

45 CFR 263.5 - When do expenditures in State-funded programs count?

Code of Federal Regulations, 2013 CFR

2013-10-01

..., or Transitional Child Care programs, then current fiscal year expenditures in this program count in... recipients, At-Risk Child Care, or Transitional Child care programs, then countable expenditures are limited... 45 Public Welfare 2 2013-10-01 2012-10-01 true When do expenditures in State-funded programs count...

A Survey to Evaluate Facilitators and Barriers to Quality Measurement and Improvement: Adapting Tools for Implementation Research in Palliative Care Programs.

PubMed

Dy, Sydney M; Al Hamayel, Nebras Abu; Hannum, Susan M; Sharma, Ritu; Isenberg, Sarina R; Kuchinad, Kamini; Zhu, Junya; Smith, Katherine; Lorenz, Karl A; Kamal, Arif H; Walling, Anne M; Weaver, Sallie J

2017-12-01

Although critical for improving patient outcomes, palliative care quality indicators are not yet widely used. Better understanding of facilitators and barriers to palliative care quality measurement and improvement might improve their use and program quality. Development of a survey tool to assess palliative care team perspectives on facilitators and barriers to quality measurement and improvement in palliative care programs. We used the adapted Consolidated Framework for Implementation Research to define domains and constructs to select instruments. We assembled a draft survey and assessed content validity through pilot testing and cognitive interviews with experts and frontline practitioners for key items. We analyzed responses using a constant comparative process to assess survey item issues and potential solutions. We developed a final survey using these results. The survey includes five published instruments and two additional item sets. Domains include organizational characteristics, individual and team characteristics, intervention characteristics, and process of implementation. Survey modules include Quality Improvement in Palliative Care, Implementing Quality Improvement in the Palliative Care Program, Teamwork and Communication, Measuring the Quality of Palliative Care, and Palliative Care Quality in Your Program. Key refinements from cognitive interviews included item wording on palliative care team members, programs, and quality issues. This novel, adaptable instrument assesses palliative care team perspectives on barriers and facilitators for quality measurement and improvement in palliative care programs. Next steps include evaluation of the survey's construct validity and how survey results correlate with findings from program quality initiatives. Copyright © 2017 American Academy of Hospice and Palliative Medicine. All rights reserved.

Short and long term improvements in quality of chronic care delivery predict program sustainability.

PubMed

Cramm, Jane Murray; Nieboer, Anna Petra

2014-01-01

Empirical evidence on sustainability of programs that improve the quality of care delivery over time is lacking. Therefore, this study aims to identify the predictive role of short and long term improvements in quality of chronic care delivery on program sustainability. In this longitudinal study, professionals [2010 (T0): n=218, 55% response rate; 2011 (T1): n=300, 68% response rate; 2012 (T2): n=265, 63% response rate] from 22 Dutch disease-management programs completed surveys assessing quality of care and program sustainability. Our study findings indicated that quality of chronic care delivery improved significantly in the first 2 years after implementation of the disease-management programs. At T1, overall quality, self-management support, delivery system design, and integration of chronic care components, as well as health care delivery and clinical information systems and decision support, had improved. At T2, overall quality again improved significantly, as did community linkages, delivery system design, clinical information systems, decision support and integration of chronic care components, and self-management support. Multilevel regression analysis revealed that quality of chronic care delivery at T0 (p<0.001) and quality changes in the first (p<0.001) and second (p<0.01) years predicted program sustainability. In conclusion this study showed that disease-management programs based on the chronic care model improved the quality of chronic care delivery over time and that short and long term changes in the quality of chronic care delivery predicted the sustainability of the projects. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

42 CFR 1001.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (other than the Federal Employees Health Benefits Program), or any State health care program as defined... Department of Health and Human Services. Patient means any individual who is receiving health care items or... primary care services to Federal or State health care program beneficiaries within a defined service area...

42 CFR 1001.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... (other than the Federal Employees Health Benefits Program), or any State health care program as defined... Department of Health and Human Services. Patient means any individual who is receiving health care items or... primary care services to Federal or State health care program beneficiaries within a defined service area...

42 CFR 1001.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (other than the Federal Employees Health Benefits Program), or any State health care program as defined... Department of Health and Human Services. Patient means any individual who is receiving health care items or... primary care services to Federal or State health care program beneficiaries within a defined service area...

42 CFR 1001.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (other than the Federal Employees Health Benefits Program), or any State health care program as defined... Department of Health and Human Services. Patient means any individual who is receiving health care items or... primary care services to Federal or State health care program beneficiaries within a defined service area...

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-02

... Community Care Network NP Nurse Practitioner NPI National Provider Identifier NQF National Quality Forum OIG...: Accountable Care Organizations; Final Rule #0;#0;Federal Register / Vol. 76 , No. 212 / Wednesday, November 2... Savings Program: Accountable Care Organizations AGENCY: Centers for Medicare & Medicaid Services (CMS...

Two Programs for Primary Care Practitioners: Family Medicine Training in an Affiliated University Hospital Program and Primary Care Graduate Training in an Urban Private Medical Center

ERIC Educational Resources Information Center

Farley, Eugene S.; Piemme, Thomas E.

1975-01-01

Eugene Farley describes the University of Rochester and Highland Hospital Family Medicine Program for teaching of primary care internists, primary care pediatricians, and family doctors. Thomas Piemme presents the George Washington University School of Medicine alternative, a 2-year program in an ambulatory setting leading to broad eligibility in…

Wiisokotaatiwin: development and evaluation of a community-based palliative care program in Naotkamegwanning First Nation.

PubMed

Nadin, Shevaun; Crow, Maxine; Prince, Holly; Kelley, Mary Lou

2018-04-01

Approximately 474 000 Indigenous people live in 617 First Nations communities across Canada; 125 of those communities are located in Ontario, primarily in rural and remote areas. Common rural health challenges, including for palliative care, involve quality and access. The need for culturally relevant palliative care programs in First Nations communities is urgent because the population is aging with a high burden of chronic and terminal disease. Because local palliative care is lacking, most First Nations people now leave their culture, family and community to receive care in distant hospitals or long-term care homes. Due to jurisdictional issues, a policy gap exists where neither federal nor provincial governments takes responsibility for funding palliative care in First Nations communities. Further, no Canadian program models existed for how different levels of government can collaborate to fund and deliver palliative care in First Nations communities. This article describes an innovative, community-based palliative care program (Wiisokotaatiwin) developed in rural Naotkamegwanning, and presents the results of a process evaluation of its pilot implementation. The evaluation aimed to (i) document the program's pilot implementation, (ii) assess progress toward intended program outcomes and (iii) assess the perceived value of the program. The Wiisokotaatiwin Program was developed and implemented over 5 years using participatory action research (http://www.eolfn.lakeheadu.ca). A mixed-method evaluation approach was adopted. Descriptive data were extracted from program documents (eg client registration forms). Client tracking forms documented service provision data for a 4-month sample period. Quantitative and qualitative data were collected through client and family member questionnaires (n=7) and healthcare provider questionnaires (n=22). A focus group was conducted with the program leadership team responsible for program development. Quantitative data were summarized using descriptive statistics. An inductive approach was used to identify themes in the qualitative data related to the evaluation questions. The findings demonstrated the program was implemented as intended, and that there was a need for the program, with six clients on the 10-month pilot. The findings also indicated achievement of program-level outcomes and progress toward system-level outcomes. Clients/families and healthcare providers were satisfied with the program and perceived it to be meeting its objectives. The program model was also perceived to be transferrable to other First Nations communities. The results demonstrate how a rural First Nations community can build capacity and develop a palliative care program tailored to their unique culture and context that builds upon and is integrated into existing services. The Wiisokotaatiwin Program allowed community members to receive their palliative care at home, improved client experience and enhanced service integration. This article provides a First Nations specific model for a palliative care program that overcomes jurisdictional issues at the local level, and a methodology for developing and evaluating community-based palliative care programs in rural First Nations communities. The article demonstrates how local, federal and provincial healthcare providers and organizations collaborated to build capacity, fund and deliver community-based palliative care. The described process of developing the program has applicability in other First Nations (Indigenous) communities and for healthcare decisionmakers.

Iowa Child Care Quality Rating System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Iowa's Child Care Quality Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile is divided into the following categories: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family Child Care Programs;…

"In Our Corner": A Qualitative Descriptive Study of Patient Engagement in a Community-Based Care Coordination Program.

PubMed

Sefcik, Justine S; Petrovsky, Darina; Streur, Megan; Toles, Mark; O'Connor, Melissa; Ulrich, Connie M; Marcantonio, Sherry; Coburn, Ken; Naylor, Mary D; Moriarty, Helene

2018-03-01

The purpose of this study was to explore participants' experience in the Health Quality Partners (HQP) Care Coordination Program that contributed to their continued engagement. Older adults with multiple chronic conditions often have limited engagement in health care services and face fragmented health care delivery. This can lead to increased risk for disability, mortality, poor quality of life, and increased health care utilization. A qualitative descriptive design with two focus groups was conducted with a total of 20 older adults enrolled in HQP's Care Coordination Program. Conventional content analysis was the analytical technique. The overarching theme resulting from the analysis was "in our corner," with subthemes "opportunities to learn and socialize" and "dedicated nurses," suggesting that these are the primary contributing factors to engagement in HQP's Care Coordination Program. Study findings suggest that nurses play an integral role in patient engagement among older adults enrolled in a care coordination program.

Challenges of Providing End-of-Life Care for Homeless Veterans.

PubMed

Hutt, Evelyn; Whitfield, Emily; Min, Sung-Joon; Jones, Jacqueline; Weber, Mary; Albright, Karen; Levy, Cari; O'Toole, Thomas

2016-05-01

To describe challenges of caring for homeless veterans at end of life (EOL) as perceived by Veterans Affairs Medical Center (VAMC) homeless and EOL care staff. E-mail survey. Homelessness and EOL programs at VAMCs. Programs and their ratings of personal, structural, and clinical care challenges were described statistically. Homelessness and EOL program responses were compared in unadjusted analyses and using multivariable models. Of 152 VAMCs, 50 (33%) completed the survey. The VAMCs treated an average of 6.5 homeless veterans at EOL annually. Lack of appropriate housing was the most critical challenge. The EOL programs expressed somewhat more concern about lack of appropriate care site and care coordination than did homelessness programs. Personal, clinical, and structural challenges face care providers for veterans who are homeless at EOL. Deeper understanding of these challenges will require qualitative study of homeless veterans and care providers. © The Author(s) 2015.

Coordination of palliative cancer care in the community: "unfinished business".

PubMed

Brazil, Kevin; Bainbridge, Daryl; Sussman, Jonathan; Whelan, Tim; O'Brien, Mary Ann; Pyette, Nancy

2009-07-01

This study assessed the degree to which services in south-central Ontario, Canada, were coordinated to meet the supportive care needs of palliative cancer patients and their families. Programs within the region that were identified as providing supportive care to palliative cancer patients and their families were eligible to participate in the study. Program administrators participated in a semi-structured interview and direct-care providers completed a survey instrument. Administrators from 37 (97%) of 38 eligible programs and 109 direct-care providers representing 26 (70%) programs participated in the study. Most administrator and direct-care respondents felt that existing services in the community were responsive to palliative care patients' individual needs. However, at a system level, most respondents in both groups felt that required services were not available and that resources were inadequate. The most frequently reported unmet supportive care need identified by both respondent groups was psychological/social support. Most administrator (69%) and direct-care (64%) respondents felt that palliative care services were not available when needed. The majority of administrator and direct-care respondents were satisfied with the exchange of patient information within and between programs, although direct-care staff identified a deficit in information transferred on palliative care patients' social/psychological status. The study demonstrated the value of a theory-based approach to evaluate the coordination of palliative cancer care services. The findings revealed that service programs faced significant challenges in their efforts to provide coordinated care.

Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice.

PubMed

Wiler, Jennifer L; Granovsky, Michael; Cantrill, Stephen V; Newell, Richard; Venkatesh, Arjun K; Schuur, Jeremiah D

2016-03-01

In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician's to focus on quality of care measures and report quality performance for the first time. Initially termed "The Physician Voluntary Reporting Program," various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the "traditional PQRS" reporting program and the newer "Value Modifier" program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.

Early Childhood Program Participation, Results from the National Household Education Surveys Program of 2016. First Look. NCES 2017-101

ERIC Educational Resources Information Center

Corcoran, Lisa; Steinley, Katrina

2017-01-01

This report presents findings from the Early Childhood Program Participation Survey of the National Household Education Surveys Program of 2016 (NHES:2016). The Early Childhood Program Participation Survey collected data on children's participation in relative care, nonrelative care, and center-based care arrangements. It also collected…

42 CFR 460.6 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Basis... enrolled in a PACE program. PACE stands for programs of all-inclusive care for the elderly. PACE center is... care for the elderly that is operated by an approved PACE organization and that provides comprehensive...

42 CFR 460.6 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Basis... enrolled in a PACE program. PACE stands for programs of all-inclusive care for the elderly. PACE center is... care for the elderly that is operated by an approved PACE organization and that provides comprehensive...

75 FR 72682 - Health Care Eligibility Under the Secretarial Designee Program and Related Special Authorities

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-26

... 0790-AI52 Health Care Eligibility Under the Secretarial Designee Program and Related Special... assigns responsibilities for health care eligibility under the Secretarial Designee Program. It also implements the requirement that the United States receive reimbursement for inpatient health care provided in...

78 FR 58291 - TRICARE; Fiscal Year 2014 Continued Health Care Benefit Program Premium Update

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-23

... DEPARTMENT OF DEFENSE Office of the Secretary TRICARE; Fiscal Year 2014 Continued Health Care... Health Care Benefit Program Premiums for Fiscal Year 2014. SUMMARY: This notice provides the updated Continued Health Care Benefit Program Premiums for Fiscal Year 2014. DATES: The Fiscal Year 2014 rates...

Illinois: Child Care Collaboration Program

ERIC Educational Resources Information Center

Center for Law and Social Policy, Inc. (CLASP), 2012

2012-01-01

The Illinois Child Care Collaboration Program promotes collaboration between child care and other early care and education providers, including Early Head Start (EHS), by creating policies to ease blending of funds to extend the day or year of existing services. While no funding is provided through the initiative, participating programs may take…

Stability of Subsidy Participation and Continuity of Care in the Child Care Assistance Program in Minnesota. Minnesota Child Care Choices Research Brief Series. Publication #2014-55

ERIC Educational Resources Information Center

Davis, Elizabeth E.; Krafft, Caroline; Tout, Kathryn

2014-01-01

The Minnesota Child Care Assistance Program (CCAP) provides subsidies to help low-income families pay for child care while parents are working, looking for work, or attending school. The program can help make quality child care affordable and is intended both to support employment for low-income families and to support the development and…

Drug-usage evaluation and the patient-care pharmacist: a synergistic combination.

PubMed

Gayman, J; Tapley, D J

1991-07-01

The Joint Commission requires a continuous monitoring program to assure quality pharmaceutical care. The only way to achieve compliance with this standard is to enlist the help of the patient-care pharmacists. Equally important to the pharmacy manager is the way a DUE program can benefit the patient-care pharmacists. The key to an effective program is to assist the patient-care pharmacists in taking responsibility for the quality of drug therapy provided to their patients. Through education, encouragement, and recognition, the DUE Coordinator can elevate the practice of the patient-care pharmacists. The outcome is a synergistic program that enriches the practice of the patient-care pharmacists who, in turn, enrich the quality of pharmaceutical care received by their patients.

Defining pediatric inpatient cardiology care delivery models: A survey of pediatric cardiology programs in the USA and Canada.

PubMed

Mott, Antonio R; Neish, Steven R; Challman, Melissa; Feltes, Timothy F

2017-05-01

The treatment of children with cardiac disease is one of the most prevalent and costly pediatric inpatient conditions. The design of inpatient medical services for children admitted to and discharged from noncritical cardiology care units, however, is undefined. North American Pediatric Cardiology Programs were surveyed to define noncritical cardiac care unit models in current practice. An online survey that explored institutional and functional domains for noncritical cardiac care unit was crafted. All questions were multi-choice with comment boxes for further explanation. The survey was distributed by email four times over a 5-month period. Most programs (n = 45, 60%) exist in free-standing children's hospitals. Most programs cohort cardiac patients on noncritical cardiac care units that are restricted to cardiac patients in 39 (54%) programs or restricted to cardiac and other subspecialty patients in 23 (32%) programs. The most common frontline providers are categorical pediatric residents (n = 58, 81%) and nurse practitioners (n = 48, 67%). However, nurse practitioners are autonomous providers in only 21 (29%) programs. Only 33% of programs use a postoperative fast-track protocol. When transitioning care to referring physicians, most programs (n = 53, 72%) use facsimile to deliver pertinent patient information. Twenty-two programs (31%) use email to transition care, and eighteen (25%) programs use verbal communication. Most programs exist in free-standing children's hospitals in which the noncritical cardiac care units are in some form restricted to cardiac patients. While nurse practitioners are used on most noncritical cardiac care units, they rarely function as autonomous providers. The majority of programs in this survey do not incorporate any postoperative fast-track protocols in their practice. Given the current era of focused handoffs within hospital systems, relatively few programs utilize verbal handoffs to the referring pediatric cardiologist/pediatrician. © 2016 Wiley Periodicals, Inc.

Residents' Perceptions of Primary Care versus Traditional Internal Medicine Programs.

ERIC Educational Resources Information Center

Wilson, Howard K.; And Others

1983-01-01

Two internal medicine residency programs at Baylor College of Medicine are discussed. The traditional program emphasizes experience in the care of acute problems within a hospital inpatient environment. The primary care residency program emphasizes training in the outpatient environment and in noninternal medicine disciplines. (MLW)

Pediatric Specialty Care Model for Management of Chronic Respiratory Failure: Cost and Savings Implications and Misalignment With Payment Models.

PubMed

Graham, Robert J; McManus, Michael L; Rodday, Angie Mae; Weidner, Ruth Ann; Parsons, Susan K

2018-05-01

To describe program design, costs, and savings implications of a critical care-based care coordination model for medically complex children with chronic respiratory failure. All program activities and resultant clinical outcomes were tracked over 4 years using an adapted version of the Care Coordination Measurement Tool. Patient characteristics, program activity, and acute care resource utilization were prospectively documented in the adapted version of the Care Coordination Measurement Tool and retrospectively cross-validated with hospital billing data. Impact on total costs of care was then estimated based on program outcomes and nationally representative administrative data. Tertiary children's hospital. Critical Care, Anesthesia, Perioperative Extension and Home Ventilation Program enrollees. None. The program provided care for 346 patients and families over the study period. Median age at enrollment was 6 years with more than half deriving secondary respiratory failure from a primary neuromuscular disease. There were 11,960 encounters over the study period, including 1,202 home visits, 673 clinic visits, and 4,970 telephone or telemedicine encounters. Half (n = 5,853) of all encounters involved a physician and 45% included at least one care coordination activity. Overall, we estimated that program interventions were responsible for averting 556 emergency department visits and 107 hospitalizations. Conservative monetization of these alone accounted for annual savings of $1.2-2 million or $407/pt/mo net of program costs. Innovative models, such as extension of critical care services, for high-risk, high-cost patients can result in immediate cost savings. Evaluation of financial implications of comprehensive care for high-risk patients is necessary to complement clinical and patient-centered outcomes for alternative care models. When year-to-year cost variability is high and cost persistence is low, these savings can be estimated from documentation within care coordination management tools. Means of financial sustainability, scalability, and equal access of such care models need to be established.

What do practitioners think? A qualitative study of a shared care mental health and nutrition primary care program

PubMed Central

Paquette-Warren, Jann; Vingilis, Evelyn; Greenslade, Jaimi; Newnam, Sharon

2006-01-01

Abstract Objective To develop an in-depth understanding of a shared care model from primary mental health and nutrition care practitioners with a focus on program goals, strengths, challenges and target population benefits. Design Qualitative method of focus groups. Setting/Participants The study involved fifty-three practitioners from the Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. Method Six focus groups were conducted to obtain the perspective of practitioners belonging to various disciplines or health care teams. A qualitative approach using both an editing and template organization styles was taken followed by a basic content analysis. Main findings Themes revealed accessibility, interdisciplinary care, and complex care as the main goals of the program. Major program strengths included flexibility, communication/collaboration, educational opportunities, access to patient information, continuity of care, and maintenance of practitioner and patient satisfaction. Shared care was described as highly dependent on communication style, skill and expertise, availability, and attitudes toward shared care. Time constraint with respect to collaboration was noted as the main challenge. Conclusion Despite some challenges and variability among practices, the program was perceived as providing better patient care by the most appropriate practitioner in an accessible and comfortable setting. PMID:17041680

Design and implementation of population-based specialty care programs.

PubMed

Botts, Sheila R; Gee, Michael T; Chang, Christopher C; Young, Iris; Saito, Logan; Lyman, Alfred E

2017-09-15

The development, implementation, and scaling of 3 population-based specialty care programs in a large integrated healthcare system are reviewed, and the role of clinical pharmacy services in ensuring safe, effective, and affordable care is highlighted. The Kaiser Permanente (KP) integrated healthcare delivery model allows for rapid development and expansion of innovative population management programs involving pharmacy services. Clinical pharmacists have assumed integral roles in improving the safety and effectiveness of high-complexity, high-cost care for specialty populations. These roles require an appropriate practice scope and are supported by an advanced electronic health record with disease registries and electronic surveillance tools for care-gap identification. The 3 specialty population programs described were implemented to address variation or unrecognized gaps in care for at-risk specialty populations. The Home Phototherapy Program has leveraged internal partnerships with clinical pharmacists to improve access to cost-effective nonpharmacologic interventions for psoriasis and other skin disorders. The Multiple Sclerosis Care Program has incorporated clinical pharmacists into neurology care in order to apply clinical guidelines in a systematic manner. The KP SureNet program has used clinical pharmacists and data analytics to identify opportunities to prevent drug-related adverse outcomes and ensure timely follow-up. Specialty care programs improve quality, cost outcomes, and the patient experience by appropriating resources to provide systematic and targeted care to high-risk patients. KP leverages an integration of people, processes, and technology to develop and scale population-based specialty care. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Educational technology integration and distance learning in respiratory care: practices and attitudes.

PubMed

Hopper, Keith B; Johns, Carol L

2007-11-01

Educational technologies have had an important role in respiratory care. Distance learning via postal correspondence has been used extensively in respiratory care, and Internet-based distance learning is now used in the training of respiratory therapists (RTs), clinical continuing education, and in baccalaureate degree and higher programs for RTs and educators. To describe the current scope of respiratory care educational technology integration, including distance learning. To investigate online research potential in respiratory care. A probabilistic online survey of United States respiratory care program directors was conducted on educational technology practices and attitudes, including distance learning. A parallel exploratory study of United States respiratory care managers was conducted. One-hundred seventy-seven (53%) program directors participated. One-hundred twenty-eight respiratory care managers participated. For instructional purposes, the respiratory care programs heavily use office-productivity software, the Internet, e-mail, and commercial respiratory care content-based computer-based instruction. The programs use, or would use, online resources provided by text publishers, but there is a paucity. Many program directors reported that their faculty use personal digital assistants (PDAs), often in instructional roles. 74.6% of the programs offer no fully online courses, but 61.0% reported at least one course delivered partially online. The managers considered continuing education via online technologies appropriate, but one third reported that they have not/will not hire RTs trained via distance learning. Neither group considered fully online courses a good match for RT training, nor did they consider training via distance learning of comparable quality to on-campus programs. Both groups rated baccalaureate and higher degrees via distance learning higher if the program included face-to-face instruction. Online distance-learning participatory experience generally improved attitudes toward distance learning. There was a good match between manager RT expectations in office-productivity software and program instructional practices. Educational technologies have an important role in respiratory care. Online distance learning for baccalaureate and higher degrees in respiratory care is promising. Online distance learning in respiratory care must include face-to-face instruction. Distance-learning deployment in respiratory care will require resources. A follow-up probabilistic survey of United States respiratory care managers is needed. Online surveys conducted for respiratory care are promising, but neither less expensive nor easier than conventional means.

Implementing the Namaste Care Program for residents with advanced dementia: exploring the perceptions of families and staff in UK care homes.

PubMed

Stacpoole, Min; Hockley, Jo; Thompsell, Amanda; Simard, Joyce; Volicer, Ladislav

2017-10-01

Increasing numbers of older people with advanced dementia are cared for in care homes. No cure is available, so research focused on improving quality of life and quality of care for people with dementia is needed to support them to live and die well. The Namaste Care programme is a multi-dimensional care program with sensory, psycho-social and spiritual components intended to enhance quality of life and quality of care for people with advanced dementia. The aim of the study was to establish whether the Namaste Care program can be implemented in UK care homes; and what effect Namaste Care has on the quality of life of residents with advanced dementia, their families and staff. This article explores the qualitative findings of the study, reporting the effect of the programme on the families of people with advanced dementia and care home staff, and presenting their perceptions of change in care. An organisational action research methodology was used. Focus groups and interviews were undertaken pre/post implementation of the Namaste Care program. The researcher kept a reflective diary recording data on the process of change. A comments book was available to staff and relatives in each care home. Data was analysed thematically within each care home and then across all care homes. Six care homes were recruited in south London: one withdrew before the study was underway. Of the five remaining care homes, four achieved a full Namaste Care program. One care home did not achieve the full program during the study, and another discontinued Namaste Care when the study ended. Every home experienced management disruption during the study. Namaste Care challenged normal routinised care for older people with advanced dementia. The characteristics of care uncovered before Namaste was implemented were: chaos and confusion, rushing around, lack of trust, and rewarding care. After the programme was implemented these perceptions were transformed, and themes of calmness, reaching out to each other, seeing the person, and, enhanced well-being, emerged. Namaste Care can enrich the quality of life of older people with advanced dementia in care homes. The program was welcomed by care home staff and families, and was achieved with only modest expenditure and no change in staffing levels. The positive impact on residents quality of life influenced the well-being of family carers. Care staff found the changes in care enjoyable and rewarding. Namaste Care was valued for the benefits seen in residents; the improvement in relationships; and the shift towards a person-centred, relationship-based culture of care brought about by introducing the program. Namaste Care deserves further exploration and investigation including a randomised controlled trial.

The Cost and Threshold Analysis of Retention in Care (RiC): A Multi-Site National HIV Care Program.

PubMed

Maulsby, Catherine; Jain, Kriti M; Weir, Brian W; Enobun, Blessing; Riordan, Maura; Charles, Vignetta E; Holtgrave, David R

2017-03-01

Persons diagnosed with HIV but not retained in HIV medical care accounted for the majority of HIV transmissions in 2009 in the United States (US). There is an urgent need to implement and disseminate HIV retention in care programs; however little is known about the costs associated with implementing retention in care programs. We assessed the costs and cost-saving thresholds for seven Retention in Care (RiC) programs implemented in the US using standard methods recommended by the US Panel on Cost-effectiveness in Health and Medicine. Data were gathered from accounting and program implementation records, entered into a standardized RiC economic analysis spreadsheet, and standardized to a 12 month time frame. Total program costs for from the societal perspective ranged from $47,919 to $423,913 per year or $146 to $2,752 per participant. Cost-saving thresholds ranged from 0.13 HIV transmissions averted to 1.18 HIV transmission averted per year. We estimated that these cost-saving thresholds could be achieved through 1 to 16 additional person-years of viral suppression. Across a range of program models, retention in care interventions had highly achievable cost-saving thresholds, suggesting that retention in care programs are a judicious use of resources.

Outcome evaluation of the Palliative care Emphasis program on symptom management and Assessment for Continuous Medical Education: nationwide physician education project for primary palliative care in Japan.

PubMed

Yamamoto, Ryo; Kizawa, Yoshiyuki; Nakazawa, Yoko; Ohde, Sachiko; Tetsumi, Sato; Miyashita, Mitsunori

2015-01-01

Palliative care is an essential part of medicine, but most physicians have had no formal opportunity to acquire basic skills in palliative care. In Japan, the Palliative care Emphasis program on symptom management and Assessment for Continuous Medical Education (PEACE) was launched to provide formal primary palliative care education for all physicians engaged in cancer care. This study sought to determine whether PEACE could improve physicians' knowledge of, practices in, and difficulties with palliative care. In 2011, we conducted questionnaire-based surveys before, just after, and 2 months after completion of the PEACE program in physicians participating in the program at each of 15 designated cancer hospitals in Japan. Knowledge was measured using the palliative care knowledge questionnaire for PEACE (PEACE-Q). Practices and difficulties were evaluated using the Palliative Care self-reported Practice Scale (PCPS) and the Palliative Care Difficulties Scale (PCDS), respectively. Among 223 physicians participating in the program, 85 (38%) answered the follow-up survey. Significant improvements were noted on the PEACE-Q compared with baseline immediately after completion of the program, and this progress was maintained at 2 months (21.7 ± 5.56 versus 29.5 ± 2.10 versus 28.7 ± 3.28, respectively; p < 0.0001). Similarly, significant improvements were noted for total scores on both the PCPS and the PCDS at 2 months after completion of the program (62.1 ± 13.9 versus 69.6 ± 9.94 [p < 0.0001] for the PCPS; 44.4 ± 9.96 versus 39.4 ± 10.7 [p < 0.0001] for the PCDS). The PEACE education program improved physicians' knowledge of, practices in, and difficulties with palliative care.

Provision of Oral Health Care to Children under Seven Covered by Bolsa Família Program. Is This a Reality?

PubMed

Petrola, Krishna Andréia Feitosa; Bezerra, Ítalo Barroso; de Menezes, Érico Alexandro Vasconcelos; Calvasina, Paola; Saintrain, Maria Vieira de Lima; Pimentel G F Vieira-Meyer, Anya

2016-01-01

Over the last decade, there has been a great improvement in the oral health of Brazilians. However, such a trend was not observed among five-year-old children. Dental caries are determined by the interplay between biological and behavioral factors that are shaped by broader socioeconomic determinants. It is well established that dental disease is concentrated in socially disadvantaged populations. To reduce social and health inequalities, the Brazilian government created Family Health Program (ESF), and the Bolsa Família Program, the Brazilian conditional cash transfer program (Bolsa Família Program). The aim of this study was to examine the oral health care and promotion provided by the Family Health Teams to children and caregivers covered by the Bolsa Família Program. Data was collected through interviews with three groups of participants: 1) dentists working for the Family Health Program; 2) Family Health Program professionals supervising the Bolsa Família Program health conditionalities (Bolsa Família Program supervisors); and 3) parents/caregivers of children covered by the Bolsa Família Program. A pretested questionnaire included sociodemographic, Bolsa Família Program, oral health promotion, dental prevention and dental treatment questions. The results showed that most dentists performed no systematic efforts to promote oral health care to children covered by the Bolsa Família Program (93.3%; n = 69) or to their parents/caregivers (74.3%; n = 55). Many dentists (33.8%) did not provide oral health care to children covered by the Bolsa Família Program because they felt it was beyond their responsibilities. Nearly all Bolsa Família Program supervisors (97.3%; n = 72) supported the inclusion of oral health care in the health conditionality of the Bolsa Família Program, but 82.4% (n = 61) stated they did not promote oral health activities to children covered by the Bolsa Família Program. Children in the routine care setting were more often referred to dentists than children covered by the Bolsa Familia Program (p≤0.001). Parents/caregivers (99.2%; n = 381) agreed that oral health care is important and 99.5% (n = 382) would like their children to be seen regularly. No collaboration was observed between the Bolsa Família Program and the Family Health Program with regard to the provision of oral health care. Making oral health care a Bolsa Família Program conditionality may reduce oral health care inequalities for extreme poor children under seven in Brazil.

Provision of Oral Health Care to Children under Seven Covered by Bolsa Família Program. Is This a Reality?

PubMed Central

Petrola, Krishna Andréia Feitosa; Bezerra, Ítalo Barroso; de Menezes, Érico Alexandro Vasconcelos; Calvasina, Paola; Saintrain, Maria Vieira de Lima; Pimentel G. F. Vieira-Meyer, Anya

2016-01-01

Over the last decade, there has been a great improvement in the oral health of Brazilians. However, such a trend was not observed among five-year-old children. Dental caries are determined by the interplay between biological and behavioral factors that are shaped by broader socioeconomic determinants. It is well established that dental disease is concentrated in socially disadvantaged populations. To reduce social and health inequalities, the Brazilian government created Family Health Program (ESF), and the Bolsa Família Program, the Brazilian conditional cash transfer program (Bolsa Família Program). The aim of this study was to examine the oral health care and promotion provided by the Family Health Teams to children and caregivers covered by the Bolsa Família Program. Data was collected through interviews with three groups of participants: 1) dentists working for the Family Health Program; 2) Family Health Program professionals supervising the Bolsa Família Program health conditionalities (Bolsa Família Program supervisors); and 3) parents/caregivers of children covered by the Bolsa Família Program. A pretested questionnaire included sociodemographic, Bolsa Família Program, oral health promotion, dental prevention and dental treatment questions. The results showed that most dentists performed no systematic efforts to promote oral health care to children covered by the Bolsa Família Program (93.3%; n = 69) or to their parents/caregivers (74.3%; n = 55). Many dentists (33.8%) did not provide oral health care to children covered by the Bolsa Família Program because they felt it was beyond their responsibilities. Nearly all Bolsa Família Program supervisors (97.3%; n = 72) supported the inclusion of oral health care in the health conditionality of the Bolsa Família Program, but 82.4% (n = 61) stated they did not promote oral health activities to children covered by the Bolsa Família Program. Children in the routine care setting were more often referred to dentists than children covered by the Bolsa Familia Program (p≤0.001). Parents/caregivers (99.2%; n = 381) agreed that oral health care is important and 99.5% (n = 382) would like their children to be seen regularly. Conclusions: No collaboration was observed between the Bolsa Família Program and the Family Health Program with regard to the provision of oral health care. Making oral health care a Bolsa Família Program conditionality may reduce oral health care inequalities for extreme poor children under seven in Brazil. PMID:27537330

The cycle of caring.

PubMed

Simons, Marj

2004-01-01

This article discusses areas where nurse leaders may make conscious and deliberate efforts to impact the organization's culture for caring. Leaders must first care for caregivers and have a commitment to their well-being. It is essential that we develop and engage in programs and activities that help staff with their personal struggles and propel them forward on the journey to being their best selves. We must seek to give them the skills and competencies necessary to work in a caring environment. Nurse leaders must facilitate the development and implementation of programs that foster a caring and compassionate culture. The author shares 2 programs that nourish the soul during difficult times for patients and their loved ones in the hospital setting-End-of-Life program and Massage Therapy program. Just as we care for those within our walls, we must also plan and deliver programs that promote health and well-being of our community. Such programs are an integral part of fulfilling our organization's mission of caring for the community. New and proven technologies advance our profession and contribute in invaluable ways to a healing environment; however, it is critical that we retain the art of caring, fundamental from the past and that helped to shape the profession of nursing.

A tertiary care-primary care partnership model for medically complex and fragile children and youth with special health care needs.

PubMed

Gordon, John B; Colby, Holly H; Bartelt, Tera; Jablonski, Debra; Krauthoefer, Mary L; Havens, Peter

2007-10-01

To evaluate the impact of a tertiary care center special needs program that partners with families and primary care physicians to ensure seamless inpatient and outpatient care and assist in providing medical homes. Up to 3 years of preenrollment and postenrollment data were compared for patients in the special needs program from July 1, 2002, through June 30, 2005. A tertiary care center pediatric hospital and medical school serving urban and rural patients. A total of 227 of 230 medically complex and fragile children and youth with special needs who had a wide range of chronic disorders and were enrolled in the special needs program. Care coordination provided by a special needs program pediatric nurse case manager with or without a special needs program physician. Preenrollment and postenrollment tertiary care center resource utilization, charges, and payments. A statistically significant decrease was found in the number of hospitalizations, number of hospital days, and tertiary care center charges and payments, and an increase was found in the use of outpatient services. Aggregate data revealed a decrease in hospital days from 7926 to 3831, an increase in clinic visits from 3150 to 5420, and a decrease in tertiary care center payments of $10.7 million. The special needs program budget for fiscal year 2005 had a deficit of $400,000. This tertiary care-primary care partnership model improved health care and reduced costs with relatively modest institutional support.

42 CFR 1001.1801 - Waivers of exclusions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES PROGRAM INTEGRITY-MEDICARE AND STATE HEALTH CARE PROGRAMS Waivers and Effect of Exclusion § 1001... health care program that an exclusion from that program be waived with respect to an individual or entity...

The need for hospital-based neonatal palliative care programs in Saudi Arabia

PubMed Central

Al-Alaiyan, Saleh; Al-Hazzani, Fahad

2009-01-01

The terms palliative care, supportive care, and comfort care are used to describe individualized care that can provide a dying person the best quality of life until the end. The term “end-of-life care” is also used in a general sense to refer to all aspects of care of a patient with a potentially fatal condition. While the concept of palliative care is not new, it has only recently been applied to the neonatal population. To the best of our knowledge, none of the neonatal intensive care units (NICUs) in Saudi Arabia have adopted a neonatal program for palliative care. We believe the main reason is lack of knowledge of such programs and the fear of being accused of being heartless and cruel by providing comfort care for dying babies. Comfort care begins with the diagnosis of a life-threatening/terminal condition, and continues throughout the course of illness regardless of the outcome. In this perspective, our aim is to introduce these programs for caregivers in the NICUs in Saudi Arabia. For this purpose, we have reviewed the current recommendations in establishing neonatal palliative care programs and discussed some of the social and religious aspects pertaining to this issue. PMID:19700889

Improving Health Care Management in Primary Care for Homeless People: A Literature Review

PubMed Central

Abcaya, Julien; Ștefan, Diana-Elena; Calvet-Montredon, Céline; Gentile, Stéphanie

2018-01-01

Background: Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. Methods: We performed a literature review that included articles which described and evaluated primary care programs for homeless people. Results: Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions: Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model. PMID:29439403

Study protocol: translating and implementing psychosocial interventions in aged home care the lifestyle engagement activity program (LEAP) for life

PubMed Central

2013-01-01

Background Tailored psychosocial activity-based interventions have been shown to improve mood, behaviour and quality of life for nursing home residents. Occupational therapist delivered activity programs have shown benefits when delivered in home care settings for people with dementia. The primary aim of this study is to evaluate the effect of LEAP (Lifestyle Engagement Activity Program) for Life, a training and practice change program on the engagement of home care clients by care workers. Secondary aims are to evaluate the impact of the program on changes in client mood and behaviour. Methods/design The 12 month LEAP program has three components: 1) engaging site management and care staff in the program; 2) employing a LEAP champion one day a week to support program activities; 3) delivering an evidence-based training program to care staff. Specifically, case managers will be trained and supported to set meaningful social or recreational goals with clients and incorporate these into care plans. Care workers will be trained in and encouraged to practise good communication, promote client independence and choice, and tailor meaningful activities using Montessori principles, reminiscence, music, physical activity and play. LEAP Champions will be given information about theories of organisational change and trained in interpersonal skills required for their role. LEAP will be evaluated in five home care sites including two that service ethnic minority groups. A quasi experimental design will be used with evaluation data collected four times: 6-months prior to program commencement; at the start of the program; and then after 6 and 12 months. Mixed effect models will enable comparison of change in outcomes for the periods before and during the program. The primary outcome measure is client engagement. Secondary outcomes for clients are satisfaction with care, dysphoria/depression, loneliness, apathy and agitation; and work satisfaction for care workers. A process evaluation will also be undertaken. Discussion LEAP for Life may prove a cost-effective way to improve client engagement and other outcomes in the community setting. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612001064897. PMID:24238067

Medicaid Home Care Services and Survival in New York City

ERIC Educational Resources Information Center

Albert, Steven M.; Simone, Bridget; Brassard, Andrea; Stern, Yaakov; Mayeux, Richard

2005-01-01

Purpose: New York City's Medicaid Home Care Services Program provides an integrated program of housekeeping and personal assistance care along with regular nursing assessments. We sought to determine if this program of supportive care offers a survival benefit to older adults. Design and Methods: Administrative data from New York City's Medicaid…

Goals and Characteristics of Long-Term Care Programs: An Analytic Model.

ERIC Educational Resources Information Center

Braun, Kathryn L.; Rose, Charles L.

1989-01-01

Used medico-social analytic model to compare five long-term care programs: Skilled Nursing Facility-Intermediate Care Facility (SNF-ICF) homes, ICF homes, foster homes, day hospitals, and home care. Identified similarities and differences among programs. Preliminary findings suggest that model is useful in the evaluation and design of long-term…

78 FR 26036 - Medicare and Medicaid Programs: Application From the Accreditation Commission for Health Care for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

...] Medicare and Medicaid Programs: Application From the Accreditation Commission for Health Care for Continued... from the Accreditation Commission for Health Care (ACHC) for continued recognition as a national... program every 6 years or as determined by CMS. The Accreditation Commission for Health Care's (ACHC's...

76 FR 624 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-05

... Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program) Activity: Comment Request... Form 10-0476).'' SUPPLEMENTARY INFORMATION: Title: Patient Satisfaction Survey Michael E. DeBakey Home... satisfaction with the quality of services/care provided by home care program staff. An agency may not conduct...

75 FR 62635 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-12

... Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program) Activity: Comment Request... determine patients' satisfaction with services provided by or through the Michael E. DeBakey Home Care...: Patient Satisfaction Survey Michael E. DeBakey Home Care Program, VA Form 10-0476. OMB Control Number...

Medicaid.gov

MedlinePlus

... Monitoring Review Plans Program Integrity National Correct Coding Initiative Affordable Care Act Program Integrity Provisions Cost Sharing ... to Care Living Well Quality of Care Improvement Initiatives Medicaid Managed Care Performance Measurement Releases & Announcements Enrollment ...

Medicaid Benefits

MedlinePlus

... Monitoring Review Plans Program Integrity National Correct Coding Initiative Affordable Care Act Program Integrity Provisions Cost Sharing ... to Care Living Well Quality of Care Improvement Initiatives Medicaid Managed Care Performance Measurement Releases & Announcements Enrollment ...

Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice

PubMed Central

Wiler, Jennifer L.; Granovsky, Michael; Cantrill, Stephen V.; Newell, Richard; Venkatesh, Arjun K.; Schuur, Jeremiah D.

2016-01-01

In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians. PMID:26973757

77 FR 56631 - TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-13

... Medical Program of the Uniformed Services; Fiscal Year 2013 Continued Health Care Benefit Program Premium Update AGENCY: Office of the Secretary, DoD. ACTION: Notice of updated continued health care benefit program premiums for fiscal year 2013. SUMMARY: This notice provides the updated Continued Health Care...

Evaluation of a Research Mentorship Program in Community Care

ERIC Educational Resources Information Center

Ploeg, Jenny; de Witt, Lorna; Hutchison, Brian; Hayward, Lynda; Grayson, Kim

2008-01-01

This article describes the results of a qualitative case study evaluating a research mentorship program in community care settings in Ontario, Canada. The purpose of the program was to build evaluation and research capacity among staff of community care agencies through a mentorship program. Data were collected through in-depth, semi-structured…

Caring Wisely: A Program to Support Frontline Clinicians and Staff in Improving Healthcare Delivery and Reducing Costs.

PubMed

Gonzales, Ralph; Moriates, Christopher; Lau, Catherine; Valencia, Victoria; Imershein, Sarah; Rajkomar, Alvin; Prasad, Priya; Boscardin, Christy; Grady, Deborah; Johnston, S

2017-08-01

We describe a program called "Caring Wisely"®, developed by the University of California, San Francisco's (UCSF), Center for Healthcare Value, to increase the value of services provided at UCSF Health. The overarching goal of the Caring Wisely® program is to catalyze and advance delivery system redesign and innovations that reduce costs, enhance healthcare quality, and improve health outcomes. The program is designed to engage frontline clinicians and staff-aided by experienced implementation scientists-to develop and implement interventions specifically designed to address overuse, underuse, or misuse of services. Financial savings of the program are intended to cover the program costs. The theoretical underpinnings for the design of the Caring Wisely® program emphasize the importance of stakeholder engagement, behavior change theory, market (target audience) segmentation, and process measurement and feedback. The Caring Wisely® program provides an institutional model for using crowdsourcing to identify "hot spot" areas of low-value care, inefficiency and waste, and for implementing robust interventions to address these areas. © 2017 Society of Hospital Medicine.

The critical role of social workers in home-based primary care.

PubMed

Reckrey, Jennifer M; Gettenberg, Gabrielle; Ross, Helena; Kopke, Victoria; Soriano, Theresa; Ornstein, Katherine

2014-01-01

The growing homebound population has many complex biomedical and psychosocial needs and requires a team-based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The Mount Sinai Visiting Doctors Program (MSVD), a large interdisciplinary home-based primary care program in New York City, has a vibrant social work program that is integrated into the routine care of homebound patients. We describe the assessment process used by MSVD social workers, highlight examples of successful social work care, and discuss why social workers' individualized care plans are essential for keeping patients with chronic illness living safely in the community. Despite barriers to widespread implementation, such social work involvement within similar home-based clinical programs is essential in the interdisciplinary care of our most needy patients.

42 CFR 460.30 - Program agreement requirement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.30 Program agreement requirement. (a) A PACE organization must...

42 CFR 460.30 - Program agreement requirement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.30 Program agreement requirement. (a) A PACE organization must...

42 CFR 460.52 - Transitional care during termination.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Sanctions, Enforcement Actions, and Termination § 460.52 Transitional care...

42 CFR 460.52 - Transitional care during termination.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Sanctions, Enforcement Actions, and Termination § 460.52 Transitional care...

The intersection of need and opportunity: assessing and capitalizing on opportunities to expand hospital-based palliative care services.

PubMed

Rabow, Michael W; Pantilat, Steven Z; Kerr, Kathleen; Enguidanos, Susan; Ferrell, Bruce; Goldstein, Rebecca; Pankratz, Charles; Picchi, Tina; Rosenfeld, Kenneth E; Stone, Susan C

2010-10-01

To develop and grow most effectively, palliative care programs must consider how best to align their mission with that of their institution. To do so, programs must identify their institutional mission and needs, what palliative care can do to address those needs given available resources, and how the palliative care team can measure and document its value. Such an approach encourages the palliative care team to think strategically and to see themselves and their service as a solution to issues and concerns within the institution. It also helps a palliative care team decide which, among many potential opportunities and possible initiatives, is the one most likely to be supported by the institution and have a recognized and significant impact. We present five case studies to demonstrate how successful programs identify and address institutional needs to create opportunities for palliative care program growth. These case studies can serve as models for other programs seeking to develop or expand their palliative care services.

Opening the door to coordination of care through teachable moments.

PubMed

Berg, Gregory D; Korn, Allan M; Thomas, Eileen; Klemka-Walden, Linda; Bigony, Marysanta D; Newman, John F

2007-10-01

The challenge for care coordination is to identify members at a moment in time when they are receptive to intervention and provide the appropriate care management services. This manuscript describes a pilot program using inbound nurse advice calls from members to engage them in a care management program including disease management (DM). Annual medical claims diagnoses were used to identify members and their associated disease conditions. For each condition group for each year, nurse advice call data were used to calculate inbound nurse advice service call rates for each group. A pilot program was set up to engage inbound nurse advice callers in a broader discussion of their health concerns and refer them to a care management program. Among the program results, both the call rate by condition group and the correlation between average costs and call rates show that higher cost groups of members call the nurse advice service disproportionately more than lower cost members. Members who entered the DM programs through the nurse advice service were more likely to stay in the program than those who participated in the standard opt-in program. The results of this pilot program suggest that members who voluntarily call in to the nurse advice service for triage are at a "teachable moment" and highly motivated to participate in appropriate care management programs. The implication is that the nurse advice service may well be an innovative and effective way to enhance participation in a variety of care management programs including DM.

78 FR 6851 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-31

... (Patient Satisfaction Survey Michael E. DeBakey Home Care Program) Activity: Comment Request AGENCY... Satisfaction Survey Michael E. DeBakey Home Care Program, VA Form 10-0476. OMB Control Number: 2900-0775. Type... gather feedback from patients regarding their satisfaction with the quality of services/care provided by...

The effect of implementing a care coordination program on team dynamics and the patient experience.

PubMed

Di Capua, Paul; Clarke, Robin; Tseng, Chi-Hong; Wilhalme, Holly; Sednew, Renee; McDonald, Kathryn M; Skootsky, Samuel A; Wenger, Neil

2017-08-01

Care coordination programs are frequently implemented in the redesign of primary care systems, focused on improving patient outcomes and reducing utilization. However, redesign can be disruptive, affect patient experiences, and undermine elements in the patient-centered medical home, such as team-based care. Case-controlled study with difference-in-differences (DID) and cross-sectional analyses. The phased implementation of a care coordination program permitted evaluation of a natural experiment to compare measures of patient experience and teamwork in practices with and without care coordinators. Patient experience scores were compared before and after the introduction of care coordinators, using DID analyses. Cross-sectional data were used to compare teamwork, based on the relational coordination survey, and physician-perceived barriers to coordinated care between clinics with and without care coordinators. We evaluated survey responses from 459 staff and physicians and 13,441 patients in 26 primary care practices. Practices with care coordinators did not have significantly different relational coordination scores compared with practices without care coordinators, and physicians in these practices did not report reduced barriers to coordinated care. After implementation of the program, patients in practices with care coordinators reported a more positive experience with staff over time (DID, 2.6 percentage points; P = .0009). A flexible program that incorporates care coordinators into the existing care team was minimally disruptive to existing team dynamics, and the embedded care coordinators were associated with a small increase in patient ratings that reflected a more positive experience with staff.

5 CFR 792.216 - Are Federal employees with children who are enrolled in summer programs and part-time programs...

Code of Federal Regulations, 2012 CFR

2012-01-01

... are enrolled in summer programs and part-time programs eligible for the child care subsidy program... summer programs and part-time programs eligible for the child care subsidy program? Federal employees... enrolled in daytime summer programs and part-time programs such as before and after school programs are...

5 CFR 792.216 - Are Federal employees with children who are enrolled in summer programs and part-time programs...

Code of Federal Regulations, 2011 CFR

2011-01-01

... are enrolled in summer programs and part-time programs eligible for the child care subsidy program... summer programs and part-time programs eligible for the child care subsidy program? Federal employees... enrolled in daytime summer programs and part-time programs such as before and after school programs are...

5 CFR 792.216 - Are Federal employees with children who are enrolled in summer programs and part-time programs...

Code of Federal Regulations, 2010 CFR

2010-01-01

... are enrolled in summer programs and part-time programs eligible for the child care subsidy program... summer programs and part-time programs eligible for the child care subsidy program? Federal employees... enrolled in daytime summer programs and part-time programs such as before and after school programs are...

Emergency Medicine Resources within the Clinical Translational Science Institutes: A Cross-Sectional Study

PubMed Central

Meurer, William J.; Quinn, James; Lindsell, Christopher; Schneider, Sandra; Newgard, Craig D.

2016-01-01

Background The Clinical and Translational Science Award (CTSA) program aims to strengthen and support translational research by accelerating the process of translating laboratory discoveries into treatments for patients, training a new generation of clinical and translational researchers, and engaging communities in clinical research efforts. Yet, little is known about how emergency care researchers have interacted with and utilized the resources of academic institutions with CTSAs. Objective The purpose of this survey was to describe how emergency care researchers use local CTSA resources, to ascertain what proportion of CTSA consortium members have active emergency care research programs, and to solicit participation in a national CTSA-associated emergency care translational research network. Methods Survey of all emergency departments affiliated with a CTSA. Results Of the 65 CTSA consortium members, three had no emergency care research program and we obtained responses from 46 of the remaining 62 (74% response rate). The interactions with and resources used by emergency care researchers varied widely. Methodology and biostatistics support was most frequently accessed (77%), followed closely by education and training programs (60%). Several emergency care research programs (76%) had submitted for funding through CTSAs, with 71% receiving awards. Most CTSA consortium members had an active emergency care research infrastructure: 21 (46%) had 24/7 availability to recruit and screen for research, 21 (46%) had less than 24/7 research recruitment. A number of emergency care research programs participated in NIH research networks with the Neurological Emergencies Treatment Trials network most highly represented with 23 (59%) sites. Most emergency care research programs (96%) were interested in participating in a CTSA-based emergency care translational research network. Conclusions Despite little initial involvement in development of the CTSA program, there has been moderate interaction between CTSAs and emergency care. There is considerable interest in participating in a CTSA consortium based emergency care translational research network. PMID:26826059

Results of the Medicare Health Support disease-management pilot program.

PubMed

McCall, Nancy; Cromwell, Jerry

2011-11-03

In the Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services to test the commercial disease-management model in the Medicare fee-for-service program. The Medicare Health Support Pilot Program was a large, randomized study of eight commercial programs for disease management that used nurse-based call centers. We randomly assigned patients with heart failure, diabetes, or both to the intervention or to usual care (control) and compared them with the use of a difference-in-differences method to evaluate the effects of the commercial programs on the quality of clinical care, acute care utilization, and Medicare expenditures for Medicare fee-for-service beneficiaries. The study included 242,417 patients (163,107 in the intervention group and 79,310 in the control group). The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits, as compared with usual care. We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures. In this large study, commercial disease-management programs using nurse-based call centers achieved only modest improvements in quality-of-care measures, with no demonstrable reduction in the utilization of acute care or the costs of care.

Impact of the Medicare Chronic Disease Management program on the conduct of Australian dietitians' private practices.

PubMed

Jansen, Sarah; Ball, Lauren; Lowe, Catherine

2015-04-01

This study explored private practice dietitians' perceptions of the impact of the Australian Chronic Disease Management (CDM) program on the conduct of their private practice, and the care provided to patients. Twenty-five accredited practising dietitians working in primary care participated in an individual semistructured telephone interview. Interview questions focussed on dietitians' perceptions of the proportion of patients receiving care through the CDM program, fee structures, adhering to reporting requirements and auditing. Transcript data were thematically analysed using a process of open coding. Half of the dietitians (12/25) reported that most of their patients (>75%) received care through the CDM program. Many dietitians (19/25) reported providing identical care to patients using the CDM program and private patients, but most (17/25) described spending substantially longer on administrative tasks for CDM patients. Dietitians experienced pressure from doctors and patients to keep their fees low or to bulk-bill patients using the CDM program. One-third of interviewed dietitians (8/25) expressed concern about the potential to be audited by Medicare. Recommendations to improve the CDM program included increasing the consultation length and subsequent rebate available for dietetic consultations, and increasing the number of consultations to align with dietetic best-practice guidelines. The CDM program creates challenges for dietitians working in primary care, including how to sustain the quality of patient-centred care and yet maintain equitable business practices. To ensure the CDM program appropriately assists patients to receive optimal care, further review of the CDM program within the scope of dietetics is required.

Description of a multi-university education and collaborative care child psychiatry access program: New York State's CAP PC.

PubMed

Kaye, D L; Fornari, V; Scharf, M; Fremont, W; Zuckerbrot, R; Foley, C; Hargrave, T; Smith, B A; Wallace, J; Blakeslee, G; Petras, J; Sengupta, S; Singarayer, J; Cogswell, A; Bhatia, I; Jensen, P

2017-09-01

Although, child mental health problems are widespread, few get adequate treatment, and there is a severe shortage of child psychiatrists. To address this public health need many states have adopted collaborative care programs to assist primary care to better assess and manage pediatric mental health concerns. This report adds to the small literature on collaborative care programs and describes one large program that covers most of New York state. CAP PC, a component program of New York State's Office of Mental Health (OMH) Project TEACH, has provided education and consultation support to primary care providers covering most of New York state since 2010. The program is uniquely a five medical school collaboration with hubs at each that share one toll free number and work together to provide education and consultation support services to PCPs. The program developed a clinical communications record to track information about all consultations which forms the basis of much of this report. 2-week surveys following consultations, annual surveys, and pre- and post-educational program evaluations have also been used to measure the success of the program. CAP PC has grown over the 6years of the program and has provided 8013 phone consultations to over 1500 PCPs. The program synergistically provided 17,523 CME credits of educational programming to 1200 PCPs. PCP users of the program report very high levels of satisfaction and self reported growth in confidence. CAP PC demonstrates that large-scale collaborative consultation models for primary care are feasible to implement, popular with PCPs, and can be sustained. The program supports increased access to child mental health services in primary care and provides child psychiatric expertise for patients who would otherwise have none. Copyright © 2017. Published by Elsevier Inc.

Evaluation of a community transition to professional practice program for graduate registered nurses in Australia.

PubMed

Aggar, Christina; Gordon, Christopher J; Thomas, Tamsin H T; Wadsworth, Linda; Bloomfield, Jacqueline

2018-03-26

Australia has an increasing demand for a sustainable primary health care registered nursing workforce. Targeting graduate registered nurses who typically begin their nursing career in acute-care hospital settings is a potential workforce development strategy. We evaluated a graduate registered nurse Community Transition to Professional Practice Program which was designed specifically to develop and foster skills required for primary health care. The aims of this study were to evaluate graduates' intention to remain in the primary health care nursing workforce, and graduate competency, confidence and experiences of program support; these were compared with graduates undertaking the conventional acute-care transition program. Preceptor ratings of graduate competence were also measured. All of the 25 graduates (n = 12 community, n = 13 acute-care) who completed the questionnaire at 6 and 12 months intended to remain in nursing, and 55% (n = 6) of graduates in the Community Transition Program intended to remain in the primary health care nursing workforce. There were no differences in graduate experiences, including level of competence, or preceptors' perceptions of graduate competence, between acute-care and Community Transition Programs. The Community Transition to Professional Practice program represents a substantial step towards developing the primary health care health workforce by facilitating graduate nurse employment in this area. Copyright © 2018 Elsevier Ltd. All rights reserved.

42 CFR 460.34 - Duration of PACE program agreement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.34 Duration of PACE program agreement. An agreement is...

42 CFR 460.34 - Duration of PACE program agreement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.34 Duration of PACE program agreement. An agreement is...

Care and Respect for Elders in Emergencies program: a preliminary report of a volunteer approach to enhance care in the emergency department.

PubMed

Sanon, Martine; Baumlin, Kevin M; Kaplan, Shari Sirkin; Grudzen, Corita R

2014-02-01

Older adults who present to an emergency department (ED) generally have more-complex medical conditions with complicated care needs and are at high risk for preventable adverse outcomes during their ED visit. The Care and Respect for Elders with Emergencies (CARE) volunteer initiative is a geriatric-focused volunteer program developed to help prevent avoidable complications such as falls, delirium and use of restraints, and functional decline in vulnerable elders in the ED. The CARE program consists of bedside volunteer interventions ranging from conversation to various short activities designed to engage and reorient high-risk, older, unaccompanied individuals in the ED. This article describes the development and characteristics of the CARE program, the services provided, the experiences of the elderly patients and their volunteers, and the growth of the program over time. CARE volunteers provide elders with the additional attention needed in an often chaotic, unfamiliar environment by enhancing their care, improving satisfaction, and preventing potential decline. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

42 CFR 460.71 - Oversight of direct participant care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Administrative Requirements § 460.71 Oversight of direct participant care...

Palliative Care Training in Surgical Oncology and Hepatobiliary Fellowships: A National Survey of Program Directors.

PubMed

Larrieux, Gregory; Wachi, Blake I; Miura, John T; Turaga, Kiran K; Christians, Kathleen K; Gamblin, T Clark; Peltier, Wendy L; Weissman, David E; Nattinger, Ann B; Johnston, Fabian M

2015-12-01

Despite previous literature affirming the importance of palliative care training in surgery, there is scarce literature about the readiness of Surgical Oncology and hepatopancreaticobiliary (HPB) fellows to provide such care. We performed the first nationally representative study of surgical fellowship program directors' assessment of palliative care education. The aim was to capture attitudes about the perception of palliative care and disparity between technical/clinical education and palliative care training. A survey originally used to assess surgical oncology and HPB surgery fellows' training in palliative care, was modified and sent to Program Directors of respective fellowships. The final survey consisted of 22 items and was completed online. Surveys were completed by 28 fellowship programs (70 % response rate). Only 60 % offered any formal teaching in pain management, delivering bad news or discussion about prognosis. Fifty-eight percent offered formal training in basic communication skills and 43 % training in conducting family conferences. Resources were available, with 100 % of the programs having a palliative care consultation service, 42 % having a faculty member with recognized clinical interest/expertise in palliative care, and 35 % having a faculty member board-certified in Hospice and Palliative Medicine. Our data shows HPB and surgical oncology fellowship programs are providing insufficient education and assessment in palliative care. This is not due to a shortage of faculty, palliative care resources, or teaching opportunities. Greater focus one valuation and development of strategies for teaching palliative care in surgical fellowships are needed.

Continuing professional development for volunteers working in palliative care in a tertiary care cancer institute in India: a cross-sectional observational study of educational needs.

PubMed

Deodhar, Jayita Kedar; Muckaden, Mary Ann

2015-01-01

Training programs for volunteers prior to their working in palliative care are well-established in India. However, few studies report on continuing professional development programs for this group. To conduct a preliminary assessment of educational needs of volunteers working in palliative care for developing a structured formal continuing professional development program for this group. Cross-sectional observational study conducted in the Department of Palliative Medicine of a tertiary care cancer institute in India. Participant volunteers completed a questionnaire, noting previous training, years of experience, and a comprehensive list of topics for inclusion in this program, rated in order of importance according to them. Descriptive statistics for overall data and Chi-square tests for categorical variables for group comparisons were applied using Statistical Package for Social Sciences version 18. Fourteen out of 17 volunteers completed the questionnaire, seven having 5-10-years experience in working in palliative care. A need for continuing professional development program was felt by all participants. Communication skills, more for children and elderly specific issues were given highest priority. Spiritual-existential aspects and self-care were rated lower in importance than psychological, physical, and social aspects in palliative care. More experienced volunteers (>5 years of experience) felt the need for self-care as a topic in the program than those with less (<5-years experience) (P < 0.05). Understanding palliative care volunteers' educational needs is essential for developing a structured formal continuing professional development program and should include self-care as a significant component.

Accountability for the Quality of Care Provided to People with Serious Illness

PubMed Central

Hudson Scholle, Sarah; Briefer French, Jessica

2018-01-01

Abstract Background: Care for patients with serious illness is an emerging practice area that has gained attention as value-based purchasing has increased. While the number of programs is growing, their impact on care quality and outcomes is unknown. Objective: With support from the Gordon and Betty Moore Foundation, the National Committee for Quality Assurance (NCQA) is assessing the feasibility of creating an accountability program focused on serious illness care. Methods: This article describes the process of developing an accountability program, findings from our initial work, and our plans to develop measures for a serious illness care accountability program. We focused on three questions: 1. What patient populations should be targeted for measurement?2. What entities have accountability for ensuring high-quality care for serious illness?3. What structures, processes, and outcomes should be evaluated in an accountability program for serious illness care? Results: Our environmental scan showed that the evidence base for specific patient populations or care models is not sufficiently mature to justify traditional structure and process measures. In visits to serious illness care programs, we observed different staffing models, care models, care settings, and payment structures. We found a gap between recommended inclusion criteria and services when compared to inclusion criteria and services offered by existing programs. Conclusions: To address the challenges, NCQA intends to develop outcome measures driven by patient and family priorities. Structure and process measures will focus on building organizations' capacity to measure outcomes, including patient engagement and outcomes, linked to patient goals. PMID:29313755

Putting out the welcome mat-targeting outreach efforts under the Affordable Care Act: Evidence from the Minnesota Community Application Agent Program.

PubMed

Dybdal, Kristin; Blewett, Lynn A; Pintor, Jessie Kemmick; Johnson, Kelli

2015-01-01

An evaluation of the Minnesota Community Application Agent (MNCAA) Program was conducted for the MN Minnesota Department of Human Services and funded by the Health Resources and Services Administration's State Health Access Program grant. The MNCAA evaluation assessed effectiveness in reaching disparate populations, explored overall program value, and sought lessons applicable to the Navigator programs required under the Affordable Care Act. Mixed-methods approach using quantitative analysis of tracking and payment data and interviews with key informants to elicit "lessons learned" about the MNCAA program. The MNCAA program offers incentive payments and technical assistance to community partner organizations that assist individuals in applying for public health care coverage. A total of 140 unique community organizations participated in the MNCAA program in 2008 to 2012. Outreach staff and directors from participating MNCAAs and state/local government officials were interviewed. The article highlights a strategy for targeting outreach to individuals eligible for Medicaid coverage or subsidies under the Affordable Care Act by presenting evaluation findings from a unique outreach program to increase access to care for vulnerable populations in Minnesota. Almost two-thirds of applicants were successfully enrolled but lengthy waiting periods persisted. Seventy percent of applications came from health care organizations. Only 13% of applicants assisted by MNCAAs were new to public health care programs. Most MNCAAs believed that the incentive payment-$25 per successful enrollee-was insufficient. Significant expertise in enrolling individuals in public health care programs exists within a core group of community organizations. Incentives to leverage the capacity of community organizations must be accompanied by recruiting and training. Outreach providers and navigators also need timely access to client information. More investment in financial incentives will be required.

A systematic review of integrative oncology programs

PubMed Central

Seely, D.M.; Weeks, L.C.; Young, S.

2012-01-01

Objective This systematic review set out to summarize the research literature describing integrative oncology programs. Methods Searches were conducted of 9 electronic databases, relevant journals (hand searched), and conference abstracts, and experts were contacted. Two investigators independently screened titles and abstracts for reports describing examples of programs that combine complementary and conventional cancer care. English-, French-, and German-language articles were included, with no date restriction. From the articles located, descriptive data were extracted according to 6 concepts: description of article, description of clinic, components of care, administrative structure, process of care, and measurable outcomes used. Results Of the 29 programs included, most were situated in the United States (n = 12, 41%) and England (n = 10, 34%). More than half (n = 16, 55%) operate within a hospital, and 7 (24%) are community-based. Clients come through patient self-referral (n = 15, 52%) and by referral from conventional health care providers (n = 9, 31%) and from cancer agencies (n = 7, 24%). In 12 programs (41%), conventional care is provided onsite; 7 programs (24%) collaborate with conventional centres to provide integrative care. Programs are supported financially through donations (n = 10, 34%), cancer agencies or hospitals (n = 7, 24%), private foundations (n = 6, 21%), and public funds (n = 3, 10%). Nearly two thirds of the programs maintain a research (n = 18, 62%) or evaluation (n = 15, 52%) program. Conclusions The research literature documents a growing number of integrative oncology programs. These programs share a common vision to provide whole-person, patient-centred care, but each program is unique in terms of its structure and operational model. PMID:23300368

Latch Key: Developing Child Care Programs Through Community Education.

ERIC Educational Resources Information Center

Cramer, James P.; And Others

This guide to the Latch Key program for after-school day care explores rationale and methods for developing Latch Key programs in the public schools to provide low cost after-school care for children (grades 1-6) of working or student parents. (Some programs have been provided for kindergarten children and some have been expanded to full time…

Building a patient-centered and interprofessional training program with patients, students and care professionals: study protocol of a participatory design and evaluation study.

PubMed

Vijn, Thomas W; Wollersheim, Hub; Faber, Marjan J; Fluit, Cornelia R M G; Kremer, Jan A M

2018-05-30

A common approach to enhance patient-centered care is training care professionals. Additional training of patients has been shown to significantly improve patient-centeredness of care. In this participatory design and evaluation study, patient education and medical education will be combined by co-creating a patient-centered and interprofessional training program, wherein patients, students and care professionals learn together to improve patient-centeredness of care. In the design phase, scientific literature regarding interventions and effects of student-run patient education will be synthesized in a scoping review. In addition, focus group studies will be performed on the preferences of patients, students, care professionals and education professionals regarding the structure and content of the training program. Subsequently, an intervention plan of the training program will be constructed by combining these building blocks. In the evaluation phase, patients with a chronic disease, that is rheumatoid arthritis, diabetes and hypertension, and patients with an oncologic condition, that is colonic cancer and breast cancer, will learn together with medical students, nursing students and care professionals in training program cycles of three months. Process and effect evaluation will be performed using the plan-do-study-act (PDSA) method to evaluate and optimize the training program in care practice and medical education. A modified control design will be used in PDSA-cycles to ensure that students who act as control will also benefit from participating in the program. Our participatory design and evaluation study provides an innovative approach in designing and evaluating an intervention by involving participants in all stages of the design and evaluation process. The approach is expected to enhance the effectiveness of the training program by assessing and meeting participants' needs and preferences. Moreover, by using fast PDSA cycles and a modified control design in evaluating the training program, the training program is expected to be efficiently and rapidly implemented into and adjusted to care practice and medical education.

[Family Health Program and children palliative care: listening the relatives of technology dependent children].

PubMed

Rabello, Cláudia Azevedo Ferreira Guimarães; Rodrigues, Paulo Henrique de Almeida

2010-03-01

This study discusses the creation of a new children palliative care program based on the Family Health Program, considering the level of care at home and yielding to family requests. The study focused on eighteen members of nine families of technology dependent children (TDC) who were hospital patients at Instituto Fernandes Figueira (IFF): four who are being assisted by its palliative care program Programa de Assistência Domiciliar Interdisciplinar (PADI); three who were inpatients waiting for inclusion in the Program, and finally two inpatients already included in PADI. PADI was chosen because it is the only child palliative care program in Brazil. The results are positive in regards to the connection established between the families and the health care team, the reception of the children, the explanation to the family concerning the disease, and the functional dynamics between the PADI and IFF. As negative points, difficulties arose as a result of the implementation of the program, from its continuity to the worsening or illness of the entire family. In conclusion, although the PADI is the IFF's way of discharging patients, the domiciliary cares taken by the Family Health Program, well articulated with the healthcare system, would be ideal for being the adequate assistance for such.

What Do High-Risk Patients Value? Perspectives on a Care Management Program.

PubMed

Ganguli, Ishani; Orav, E John; Weil, Eric; Ferris, Timothy G; Vogeli, Christine

2018-01-01

There is growing interest in coordinating care for high-risk patients through care management programs despite inconsistent results on cost reduction. Early evidence suggests patient-centered benefits, but we know little about how participants engage with the programs and what aspects they value. To explore care management program participants' awareness and perceived utility of program offerings. Cross-sectional telephone survey administered December 2015-January 2016. Patients enrolled in a Boston-area primary care-based care management program. Our main outcome was the number of topics in which patients reported having "very helpful" interactions with their care team in the past year. We analyzed awareness of one's care manager as an intermediate outcome, and then as a primary predictor of the main outcome, along with patient demographics, years in the program, attitudes, and worries as secondary predictors. The survey response rate was 45.8% (n = 1220); non-respondents were similar to respondents. More respondents reported worrying about family (72.8%) or financial issues (52.5%) than about their own health (41.6%). Seventy-four percent reported care manager awareness, particularly women (OR 1.33, 95% CI 1.01-1.77) and those with more years in the program (OR 1.16, 95% CI 1.03-1.30). While interaction rates ranged from 19.8% to 72.4% across topics, 81.3% rated at least one interaction as very helpful. Those who were aware of their care manager reported very helpful interactions on more topics (OR 2.77, 95% CI 2.15-3.56), as did women (OR 1.25, 95% CI 1.00-1.55), younger respondents (OR 0.98 for older age, 95% CI 0.97-0.99), and those with higher risk scores (OR 1.04, 95% CI 1.02-1.06), preference for deferring treatment decisions to doctors (OR 2.00, 95% CI 1.60-2.50), and reported control over their health (OR 1.67, 95% CI 1.33-2.10). High-risk patients reported helpful interactions with their care team around medical and social determinants of health, particularly those who knew their care manager. Promoting care manager awareness may help participants make better use of the program.

[Development and effect of a web-based child health care program for the staff at child daycare centers].

PubMed

Kim, Ji Soo

2010-04-01

The purpose of the study is to develop a web-based program on child health care, and to identify the effect of the program on knowledge of, attitudes towards child health care, and health care practice in staff of daycare centers. The program was developed through the processes of needs analysis, contents construction, design, development, and evaluation. After the program was developed, it was revised through feedback from 30 experts. To identify the effect of developed program, onegroup pretest-posttest design study was conducted with 64 staff members from 12 daycare centers in Korea. The program was developed based on users' needs and consisted of five parts: health promotion, disease and symptoms management, oral health, injury and safety, sheets and forms. This study showed that the total score of staff who used the program was significantly higher in terms of knowledge, attitudes, and their health care practice compared with pretest score (p<.05). These results suggest that this Web-based program can contribute to the child health promotion as well as can provide the staff with the insightful child health information. Therefore, it is expected that this program will be applied to staff of other child care settings for children's health.

A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial

PubMed Central

Rojas, Graciela; Guajardo, Viviana; Castro, Ariel; Fritsch, Rosemarie; Moessner, Markus; Bauer, Stephanie

2018-01-01

Background In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. Objective The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. Methods In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. Results Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). Conclusions Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management of depressive patients. Future cost-effectiveness studies are needed. Trial Registration Clinicaltrials.gov NCT02200367; https://clinicaltrials.gov/ct2/show/NCT02200367 (Archived by WebCite at http://www.webcitation.org/6xtZ7OijZ) PMID:29712627

CARES/LIFE Ceramics Analysis and Reliability Evaluation of Structures Life Prediction Program

NASA Technical Reports Server (NTRS)

Nemeth, Noel N.; Powers, Lynn M.; Janosik, Lesley A.; Gyekenyesi, John P.

2003-01-01

This manual describes the Ceramics Analysis and Reliability Evaluation of Structures Life Prediction (CARES/LIFE) computer program. The program calculates the time-dependent reliability of monolithic ceramic components subjected to thermomechanical and/or proof test loading. CARES/LIFE is an extension of the CARES (Ceramic Analysis and Reliability Evaluation of Structures) computer program. The program uses results from MSC/NASTRAN, ABAQUS, and ANSYS finite element analysis programs to evaluate component reliability due to inherent surface and/or volume type flaws. CARES/LIFE accounts for the phenomenon of subcritical crack growth (SCG) by utilizing the power law, Paris law, or Walker law. The two-parameter Weibull cumulative distribution function is used to characterize the variation in component strength. The effects of multiaxial stresses are modeled by using either the principle of independent action (PIA), the Weibull normal stress averaging method (NSA), or the Batdorf theory. Inert strength and fatigue parameters are estimated from rupture strength data of naturally flawed specimens loaded in static, dynamic, or cyclic fatigue. The probabilistic time-dependent theories used in CARES/LIFE, along with the input and output for CARES/LIFE, are described. Example problems to demonstrate various features of the program are also included.

Making care affordable.

PubMed

Solomon, S

1999-01-01

The YRG Centre for AIDS Research and Education (CARE) in Chennai, India runs an integrated care program ensuring appropriate and affordable care to everyone who needs it. The program includes both voluntary counseling/testing and hospital/home-based care. YRG CARE developed several strategies for the care program, which include 1) different fees for an HIV test, 2) free counseling service, 3) different charges for other care services, 4) a subsidized pharmacy (involving purchasing drugs directly from manufacturers and wholesalers, ordering free samples from manufacturers, and acquiring drugs through the drug component of its clinical research projects, from overseas hospitals, and from YRG CARE hospital and community-based patients who have not used them), and 5) subsidized meals.

[The German program for disease management guidelines: evaluation by use of quality indicators].

PubMed

Kopp, Ina B; Geraedts, Max; Jäckel, Wilfried H; Altenhofen, Lutz; Thomeczek, Christian; Ollenschläger, Günter

2007-08-15

The Program for National Disease Management Guidelines (German DM-CPG Program) in Germany aims at the implementation of best-practice recommendations for prevention, acute care, rehabilitation and chronic care in the setting of disease management programs and integrated health-care systems. Like other guidelines, DM-CPG need to be assessed regarding their influence on structures, processes and outcomes of care. However, quality assessment in integrated health-care systems is challenging. On the one hand, a multitude of potential domains for measurement, actors and perspectives need to be considered. On the other hand, measures need to be identified that assess the function of the diagnostic and therapeutic chain in terms of cooperation and coordination of care. The article reviews methods and use of quality indicators in the context of the German DM-CPG Program.

Impact of Provider Incentives on Quality and Value of Health Care.

PubMed

Doran, Tim; Maurer, Kristin A; Ryan, Andrew M

2017-03-20

The use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital Value-Based Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success.

The Breathmobile Program: structure, implementation, and evolution of a large-scale, urban, pediatric asthma disease management program.

PubMed

Jones, Craig A; Clement, Loran T; Hanley-Lopez, Jean; Morphew, Tricia; Kwong, Kenny Yat Choi; Lifson, Francene; Opas, Lawrence; Guterman, Jeffrey J

2005-08-01

Despite more than a decade of education and research-oriented intervention programs, inner city children with asthma continue to engage in episodic "rescue" patterns of healthcare and experience a disproportionate level of morbidity. The aim of this study was to establish and evaluate a sustainable community-wide pediatric asthma disease management program designed to shift inner city children in Los Angeles from acute episodic care to regular preventive care in accordance with national standards. In 1995 the Southern California Chapter of the Asthma and Allergy Foundation of America (AAFA), the Los Angeles County Department of Health Services (LAC DHS), and the Los Angeles Unified School District (LAUSD) established an agreement to initiate and sustain the Breathmobile Program. This program includes automated case identification, mobile school-based clinics, and highly structured clinical encounters supported by an advanced information technology solution. Interdisciplinary teams of asthma care specialists provide regular and ongoing care to children at school and county clinic sites over a wide geographic area of urban Los Angeles. Each team operates in a specially equipped mobile clinic (Breathmobile), efficiently moving a structured healthcare process to school and county clinic sites with large numbers of children. Demographic, clinical, and participation data is tracked carefully in an electronic medical record system. Program operations, clinical oversight, and patient tracking are centralized at a care coordination center. Clinical operations and methods have been replicated in fixed specialty clinic sites at the Los Angeles County + University of Southern California Medical Center. Clinical and process measures are regularly evaluated to assure quality, plan iterative improvement, and support evidence-based care. Four Breathmobiles deliver ongoing care at more than 90 school sites. The program has engaged over five thousand patients and their families in a continuity care model that has demonstrated efficacy over usual episodic care. More than 90% of patients in all asthma severity categories achieved clinical control of asthma with significant reductions in inpatient (IP) and emergency department (ED) use. On February 14, 2002, the program became the first program in the United States to receive the award of disease-specific care certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Proper design and resource allocation can sustain a school-based community-wide pediatric asthma disease management program and shift a population of inner city children from acute episodic care to routine preventive care in accordance with national standards. An evidence-based approach to evaluating and maintaining quality, coupled with stratified care delivery, can assure the efficient use of safety net healthcare resources.

42 CFR 460.32 - Content and terms of PACE program agreement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Program Agreement § 460.32 Content and terms of PACE program agreement. (a...

Space age health care delivery

NASA Technical Reports Server (NTRS)

Jones, W. L.

1977-01-01

Space age health care delivery is being delivered to both NASA astronauts and employees with primary emphasis on preventive medicine. The program relies heavily on comprehensive health physical exams, health education, screening programs and physical fitness programs. Medical data from the program is stored in a computer bank so epidemiological significance can be established and better procedures can be obtained. Besides health care delivery to the NASA population, NASA is working with HEW on a telemedicine project STARPAHC, applying space technology to provide health care delivery to remotely located populations.

Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials.

PubMed

Peikes, Deborah; Chen, Arnold; Schore, Jennifer; Brown, Randall

2009-02-11

Medicare expenditures of patients with chronic illnesses might be reduced through improvements in care, patient adherence, and communication. To determine whether care coordination programs reduced hospitalizations and Medicare expenditures and improved quality of care for chronically ill Medicare beneficiaries. Eligible fee-for-service Medicare patients (primarily with congestive heart failure, coronary artery disease, and diabetes) who volunteered to participate between April 2002 and June 2005 in 15 care coordination programs (each received a negotiated monthly fee per patient from Medicare) were randomly assigned to treatment or control (usual care) status. Hospitalizations, costs, and some quality-of-care outcomes were measured with claims data for 18 309 patients (n = 178 to 2657 per program) from patients' enrollment through June 2006. A patient survey 7 to 12 months after enrollment provided additional quality-of-care measures. Nurses provided patient education and monitoring (mostly via telephone) to improve adherence and ability to communicate with physicians. Patients were contacted twice per month on average; frequency varied widely. Hospitalizations, monthly Medicare expenditures, patient-reported and care process indicators. Thirteen of the 15 programs showed no significant (P<.05) differences in hospitalizations; however, Mercy had 0.168 fewer hospitalizations per person per year (90% confidence interval [CI], -0.283 to -0.054; 17% less than the control group mean, P=.02) and Charlestown had 0.118 more hospitalizations per person per year (90% CI, 0.025-0.210; 19% more than the control group mean, P=.04). None of the 15 programs generated net savings. Treatment group members in 3 programs (Health Quality Partners [HQP], Georgetown, Mercy) had monthly Medicare expenditures less than the control group by 9% to 14% (-$84; 90% CI, -$171 to $4; P=.12; -$358; 90% CI, -$934 to $218; P=.31; and -$112; 90% CI, -$231 to $8; P=.12; respectively). Savings offset fees for HQP and Georgetown but not for Mercy; Georgetown was too small to be sustainable. These programs had favorable effects on none of the adherence measures and only a few of many quality of care indicators examined. Viable care coordination programs without a strong transitional care component are unlikely to yield net Medicare savings. Programs with substantial in-person contact that target moderate to severe patients can be cost-neutral and improve some aspects of care. clinicaltrials.gov Identifier: NCT00627029.

Managing a palliative oncology program: the role of a business plan.

PubMed

Walsh, D; Gombeski, W R; Goldstein, P; Hayes, D; Armour, M

1994-02-01

Today's health-care environment demands that palliative-care programs operate in a businesslike manner. This report summarizes the business plan and the process followed to develop the Palliative Care Program at the Cleveland Clinic Foundation (CCF). The benefits generated from this effort and the lessons learned that may be helpful to other program managers are described. By disciplining itself to focus on financial, marketing, and operational issues, the Palliative Care Program is in a better position to advance its clinical services within the organization and in its market area, and can thereby serve its patients more effectively.

The UCLA Alzheimer’s and Dementia Care Program for Comprehensive, Coordinated, Patient-centered Care: Preliminary Data

PubMed Central

Reuben, David B.; Evertson, Leslie Chang; Wenger, Neil S.; Serrano, Katherine; Chodosh, Joshua; Ercoli, Linda; Tan, Zaldy S.

2013-01-01

Dementia is a chronic disease that requires both medical and social services to provide high quality of care and prevent complications. As a result of time constraints in practice, lack of systems-based approaches, and poor integration of community-based organizations (CBOs), the quality of care for dementia is poor compared to other diseases that affect older persons. The UCLA Alzheimer’s and Dementia Care (UCLA ADC) program partners with CBOs to provide comprehensive, coordinated, patient-centered care for patients with Alzheimer’s disease and other dementias. The goals of the program are to maximize patient function, independence and dignity, minimize caregiver strain and burnout and reduce unnecessary costs. The UCLA ADC program consists of five key components: patient recruitment and a dementia registry, structured needs assessments of patients in the registry and their caregivers, creation and implementation of individualized dementia care plans based on needs assessments and input from the primary care physicians, monitoring and revising care plans, as needed, and access 24/7, 365 days a year for assistance and advice. The program uses a co-management model with a nurse practitioner Dementia Care Manager working with primary care physicians and CBOs. Based on the first 150 patients served, the most common recommendations in the initial care plans were referrals to support groups (73%), Alzheimer’s Association Safe Return (73%), caregiver training (45%), and medication adjustment (41%). The program will be evaluated on its ability to achieve the triple aim of better care for individuals, better health for populations, and lower costs. PMID:24329821

Developing and marketing a community pharmacy-based asthma management program.

PubMed

Rupp, M T; McCallian, D J; Sheth, K K

1997-01-01

To develop a community pharmacy-based asthma management program and successfully market the program to a managed care organization. Community-based ambulatory care. Independent community pharmacy. Development of a structured, stepwise approach to creating, testing, delivering, and marketing a community pharmacy-based disease management program. Peak expiratory flow rates, quality of life, use of health care services, HMO contract renewal. A pharmacy-based asthma management program was developed, pilot tested, and successfully marketed to a local HMO. During the first full year of the program, HMO patients experienced significant improvements in quality of life and decreases in use of health care services, including a 77% decrease in hospitalization, a 78% decrease in emergency room visits, and a 25% decrease in urgent care visits. A contract that pays the pharmacy a flat fee for each patient admitted to the program has recently been renewed for a third year. The program has proved to be an effective, practical, and profitable addition to the portfolio of services offered by the pharmacy.

A disease management program for families of persons in Hong Kong with dementia.

PubMed

Chien, Wai Tong; Lee, Yuet Ming

2008-04-01

This study tested the effectiveness of a dementia care management program for Chinese families of relatives with dementia on caregivers' and patients' health outcomes over a 12-month follow-up period. The dementia care management program is an educational and supportive group for caregivers that lasts six months. A controlled trial was conducted with 88 primary caregivers of persons with dementia in two dementia care centers in Hong Kong. Family members were assigned randomly to either the dementia care program or standard care. The two groups were compared for patients' symptoms and institutionalization rates and caregivers' quality of life, burden, and social support upon recruitment and six and 12 months after group assignment. Over the 12-month follow-up period, patients with family members in the dementia care program showed significantly greater improvements in symptoms and institutionalization rates and their caregivers reported significantly greater improvements in quality of life and burden compared with the control group. The findings provide evidence that the dementia care management program can improve the psychosocial functioning of Chinese persons with dementia and their caregivers.

Challenges of postgraduate critical care nursing program in Iran.

PubMed

Dehghan Nayeri, Nahid; Shariat, Esmaeil; Tayebi, Zahra; Ghorbanzadeh, Majid

2017-01-01

Background: The main philosophy of postgraduate preparation for working in critical care units is to ensure the safety and quality of patients' care. Increasing the complexity of technology, decision-making challenges and the high demand for advanced communication skills necessitate the need to educate learners. Within this aim, a master's degree in critical care nursing has been established in Iran. Current study was designed to collect critical care nursing students' experiences as well as their feedback to the field critical care nursing. Methods: This study used qualitative content analysis through in-depth semi-structured interviews. Graneheim and Lundman method was used for data analysis. Results: The results of the total 15 interviews were classified in the following domains: The vision of hope and illusion; shades of grey attitude; inefficient program and planning; inadequacy to run the program; and multiple outcomes: Far from the effectiveness. Overall findings indicated the necessity to review the curriculum and the way the program is implemented. Conclusion: The findings of this study provided valuable information to improve the critical care-nursing program. It also facilitated the next review of the program by the authorities.

Home-based intermediate care program vs hospitalization: Cost comparison study.

PubMed

Armstrong, Catherine Deri; Hogg, William E; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S; Saginur, Raphael

2008-01-01

To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. Single-arm study with historical controls. Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P < .001), used more community care services following discharge (coefficient $729, P = .007), and were more likely to be readmitted to hospital within 3 months of discharge (coefficient 17%, P = .012) than patients treated in hospital. Total substituted costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs.

A Comparison of Patient Outcomes and Quality of Life in Persons With Neurogenic Bowel: Standard Bowel Care Program Vs Colostomy

PubMed Central

Luther, Stephen L; Nelson, Audrey L; Harrow, Jeffrey J; Chen, Fangfei; Goetz, Lance L

2005-01-01

Background/Objective: The purpose of this study was to compare patient outcomes and quality of life for people with neurogenic bowel using either a standard bowel care program or colostomy. Methods: We analyzed survey data from a national sample, comparing outcomes between veterans with spinal cord injury (SCI) who perform bowel care programs vs individuals with colostomies. This study is part of a larger study to evaluate clinical practice guideline implementation in SCI. The sample included 1,503 veterans with SCI. The response rate was 58.4%. For comparison, we matched the respondents with colostomies to matched controls from the remainder of the survey cohort. A total of 74 veterans with SCI and colostomies were matched with 296 controls, using propensity scores. Seven items were designed to elicit information about the respondent's satisfaction with their bowel care program, whereas 7 other items were designed to measure bowel-related quality of life. Results: No statistically significant differences in satisfaction or quality of life were found between the responses from veterans with colostomies and those with traditional bowel care programs. Both respondents with colostomies and those without colostomies indicated that they had received training for their bowel care program, that they experienced relatively few complications, such as falls as a result of their bowel care program, and that their quality of life related to bowel care was generally good. However, large numbers of respondents with colostomies (n = 39; 55.7%) and without colostomies (n = 113; 41.7%) reported that they were very unsatisfied with their bowel care program. Conclusion: Satisfaction with bowel care is a major problem for veterans with SCI. PMID:16869085

Cost-effectiveness of a multicomponent primary care program targeting frail elderly people.

PubMed

Ruikes, Franca G H; Adang, Eddy M; Assendelft, Willem J J; Schers, Henk J; Koopmans, Raymond T C M; Zuidema, Sytse U

2018-05-16

Over the last 20 years, integrated care programs for frail elderly people aimed to prevent functional dependence and reduce hospitalization and institutionalization. However, results have been inconsistent and merely modest. To date, evidence on the cost-effectiveness of these programs is scarce. We evaluated the cost-effectiveness of the CareWell program, a multicomponent integrated care program for frail elderly people. Economic evaluation from a healthcare perspective embedded in a cluster controlled trial of 12 months in 12 general practices in (the region of) Nijmegen. Two hundred and four frail elderly from 6 general practices in the intervention group received care according to the CareWell program, consisting of multidisciplinary team meetings, proactive care planning, case management, and medication reviews; 165 frail elderly from 6 general practices in the control group received usual care. In cost-effectiveness analyses, we related costs to daily functioning (Katz-15 change score i.e. follow up score minus baseline score) and quality adjusted life years (EQ-5D-3 L). Adjusted mean costs directly related to the intervention were €456 per person. Adjusted mean total costs, i.e. intervention costs plus healthcare utilization costs, were €1583 (95% CI -4647 to 1481) higher in the intervention group than in the control group. Incremental Net Monetary Benefits did not show significant differences between groups, but on average tended to favour usual care. The CareWell primary program was not cost-effective after 12 months. From a cost-effectiveness perspective, widespread implementation of the program in its current form cannot be recommended. The study was registered in the ClinicalTrials.govProtocol Registration System: ( NCT01499797 ; December 26, 2011). Retrospectively registered.

A national long-term care program for the United States. A caring vision. The Working Group on Long-term Care Program Design, Physicians for a National Health Program.

PubMed

Harrington, C; Cassel, C; Estes, C L; Woolhandler, S; Himmelstein, D U

1991-12-04

The financing and delivery of long-term care (LTC) need substantial reform. Many cannot afford essential services; age restrictions often arbitrarily limit access for the nonelderly, although more than a third of those needing care are under 65 years old; Medicaid, the principal third-party payer for LTC, is biased toward nursing home care and discourages independent living; informal care provided by relatives and friends, the only assistance used by 70% of those needing LTC, is neither supported nor encouraged; and insurance coverage often excludes critically important services that fall outside narrow definitions of medically necessary care. We describe an LTC program designed as an integral component of the national health program advanced by Physicians for a National Health Program. Everyone would be covered for all medically and socially necessary services under a single public plan, federally mandated and funded but administered locally. An LTC payment board in each state would contract directly with providers through a network of local public agencies responsible for eligibility determination and care coordination. Nursing homes, home care agencies, and other institutional providers would be paid a global budget to cover all operating costs and would not bill on a per-patient basis. Alternatively, integrated provider organizations could receive a capitation fee to cover a broad range of LTC and acute care services. Individual practitioners could continue to be paid on a fee-for-service basis or could receive salaries from institutional providers. Support for innovation, training of LTC personnel, and monitoring of the quality of care would be greatly augmented. For-profit providers would be compensated for past investments and phased out. Our program would add between $18 billion and $23.5 billion annually to current spending on LTC. Polls indicate that a majority of Americans want such a program and are willing to pay earmarked taxes to support it.

Care in the country: a historical case study of long-term sustainability in 4 rural health centers.

PubMed

Wright, D Brad

2009-09-01

From 1978 to 1983, researchers at the University of North Carolina conducted a National Evaluation of Rural Primary Care Programs. Thirty years later, many of the programs they studied have closed, but the challenges of providing rural health care have persisted. I explored the histories of 4 surviving rural primary care programs and identified factors that contributed to their sustainability. These included physician advocates, innovative practices, organizational flexibility, and community integration. As rural health programs look ahead, identifying future generations of physician advocates is a crucial next step in developing the rural primary care workforce. It is also important for these programs to find ways to cope with high rates of staff turnover.

A randomized controlled trial of an activity specific exercise program for individuals with Alzheimer disease in long-term care settings.

PubMed

Roach, Kathryn E; Tappen, Ruth M; Kirk-Sanchez, Neva; Williams, Christine L; Loewenstein, David

2011-01-01

To determine whether an activity specific exercise program could improve ability to perform basic mobility activities in long-term care residents with Alzheimer disease (AD). Randomized, controlled, single-blinded clinical trial. Residents of 7 long-term care facilities. Eighty-two long-term care residents with mild to severe AD. An activity specific exercise program was compared to a walking program and to an attention control. Ability to perform bed mobility and transfers was assessed using the subscales of the Acute Care Index of Function; functional mobility was measured using the 6-Minute Walk test. Subjects receiving the activity specific exercise program improved in ability to perform transfers, whereas subjects in the other 2 groups declined.

Measuring Success in Health Care Value-Based Purchasing Programs

PubMed Central

Damberg, Cheryl L.; Sorbero, Melony E.; Lovejoy, Susan L.; Martsolf, Grant R.; Raaen, Laura; Mandel, Daniel

2014-01-01

Abstract Value-based purchasing (VBP) refers to a broad set of performance-based payment strategies that link financial incentives to health care providers' performance on a set of defined measures in an effort to achieve better value. The U.S. Department of Health and Human Services is advancing the implementation of VBP across an array of health care settings in the Medicare program in response to requirements in the 2010 Patient Protection and Affordable Care Act, and policymakers are grappling with many decisions about how best to design and implement VBP programs so that they are successful in achieving stated goals. This article summarizes the current state of knowledge about VBP based on a review of the published literature, a review of publicly available documentation from VBP programs, and discussions with an expert panel composed of VBP program sponsors, health care providers and health systems, and academic researchers with VBP evaluation expertise. Three types of VBP models were the focus of the review: (1) pay-for-performance programs, (2) accountable care organizations, and (3) bundled payment programs. The authors report on VBP program goals and what constitutes success; the evidence on the impact of these programs; factors that characterize high– and low–performing providers in VBP programs; the measures, incentive structures, and benchmarks used by VBP programs; evidence on spillover effects and unintended consequences; and gaps in the knowledge base. PMID:28083347

Delivery of oral health care through the Ryan White CARE Act to people infected with HIV.

PubMed

Schneider, D A; Hardwick, K S; Marconi, K M; Niemcryk, S J; Bowen, G S

1993-01-01

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 was passed by Congress "to improve the quality and availability of care for individuals and families with HIV disease." The act targets those individuals infected with HIV who lack financial resources to pay for care. While provision of oral health care is not mandated by the legislation, many oral health services are supported through five different programs receiving CARE Act funding. Legislative mandates, program guidance materials, grant applications, and other related materials were reviewed to analyze oral health care services supported or proposed through the CARE Act. In fiscal year 1991, an estimated $5.8 million of the total CARE Act funds ($229.6 million) were used for oral health care, and there is evidence that oral health concerns will receive increasing attention by grantees in future years. Opportunities exist for local oral health professionals to become involved in CARE Act programs and in the priority development process. It is possible that CARE Act grantees will serve as catalysts for the development of partnerships between private practitioners and public sector programs--relationships that could lead to improved access and quality of care for people with HIV infection.

Managing high-risk patients: the Mass General care management programme

PubMed Central

Kodner, Dennis L.

2015-01-01

The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO). The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program includes the staffing structure, standards of practice, collaborative approach to care transitions and information technology tools that were used in the original demonstration project. PMID:26417211

Wellness Programs: Preventive Medicine to Reduce Health Care Costs.

ERIC Educational Resources Information Center

Martini, Gilbert R., Jr.

1991-01-01

A wellness program is a formalized approach to preventive health care that can positively affect employee lifestyle and reduce future health-care costs. Describes programs for health education, smoking cessation, early detection, employee assistance, and fitness, citing industry success figures. (eight references) (MLF)

Wound care specialization: a proposal for a comprehensive fellowship program.

PubMed

Ennis, William J; Valdes, Wesley; Meneses, Patricio

2004-01-01

This article represents a process paper describing the development, at our facility, of a wound care fellowship that was scheduled to begin in July of 2003. The proposed program is in no way a finished product or our statement of how the program must be. This article is presented as a call to wound care professionals for input, criticism, guidance, and--we hope--adoption and acceptance of wound care fellowships in some format in the future. After many years of work in this field, it has become apparent that without medical specialization wound care will never rise from its current status of part-time avocation to full-time occupation. After a brief background and description of the present status of wound care education, an initial curriculum, program objectives, and clinical rotation schedule are presented. We look forward to the day when this program will have been replaced with a fully accredited, readily accepted, board-certifiable fellowship program with all the rights and responsibilities afforded the other medical specialties.

Making it local: Beacon Communities use health information technology to optimize care management.

PubMed

Allen, Amy; Des Jardins, Terrisca R; Heider, Arvela; Kanger, Chatrian R; Lobach, David F; McWilliams, Lee; Polello, Jennifer M; Rein, Alison L; Schachter, Abigail A; Singh, Ranjit; Sorondo, Barbara; Tulikangas, Megan C; Turske, Scott A

2014-06-01

Care management aims to provide cost-effective, coordinated, non-duplicative care to improve care quality, population health, and reduce costs. The 17 communities receiving funding from the Office of the National Coordinator for Health Information Technology through the Beacon Community Cooperative Agreement Program are leaders in building and strengthening their health information technology (health IT) infrastructure to provide more effective and efficient care management. This article profiles 6 Beacon Communities' health IT-enabled care management programs, highlighting the influence of local context on program strategy and design, and describing challenges, lessons learned, and policy implications for care delivery and payment reform. The unique needs (eg, disease burden, demographics), community partnerships, and existing resources and infrastructure all exerted significant influence on the overall priorities and design of each community's care management program. Though each Beacon Community needed to engage in a similar set of care management tasks--including patient identification, stratification, and prioritization; intervention; patient engagement; and evaluation--the contextual factors helped shape the specific strategies and tools used to carry out these tasks and achieve their objectives. Although providers across the country are striving to deliver standardized, high-quality care, the diverse contexts in which this care is delivered significantly influence the priorities, strategies, and design of community-based care management interventions. Gaps and challenges in implementing effective community-based care management programs include: optimizing allocation of care management services; lack of available technology tailored to care management needs; lack of standards and interoperability; integrating care management into care settings; evaluating impact; and funding and sustainability.

A Guide to Dental Care for the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) Under Medicaid.

ERIC Educational Resources Information Center

Lindahl, Roy L.; Young, Wesley O.

This guide has been developed to assist administrators, providers of dental care, and others involved in carrying out the dental care provisions of the EPSDT program (Early and Periodic Screening, Diagnosis, and Treatment Program). It is intended to assist in the development of programs concerned with the unique characteristics of dental diseases…

Evaluating the Impact of Dental Care on Housing Intervention Program Outcomes Among Homeless Veterans

PubMed Central

Nunez, Elizabeth; Gibson, Gretchen; Jones, Judith A.; Schinka, John A.

2013-01-01

Objectives. In this retrospective longitudinal cohort study, we examined the impact of dental care on outcomes among homeless veterans discharged from a Department of Veterans Affairs (VA) transitional housing intervention program. Methods. Our sample consisted of 9870 veterans who were admitted into a VA homeless intervention program during 2008 and 2009, 4482 of whom received dental care during treatment and 5388 of whom did not. Primary outcomes of interest were program completion, employment or stable financial status on discharge, and transition to permanent housing. We calculated descriptive statistics and compared the 2 study groups with respect to demographic characteristics, medical and psychiatric history (including alcohol and substance use), work and financial support, and treatment outcomes. Results. Veterans who received dental care were 30% more likely than those who did not to complete the program, 14% more likely to be employed or financially stable, and 15% more likely to have obtained residential housing. Conclusions. Provision of dental care has a substantial positive impact on outcomes among homeless veterans participating in housing intervention programs. This suggests that homeless programs need to weigh the benefits and cost of dental care in program planning and implementation. PMID:23678921

Incorporating shared savings programs into primary care: from theory to practice.

PubMed

Hayen, Arthur P; van den Berg, Michael J; Meijboom, Bert R; Struijs, Jeroen N; Westert, Gert P

2015-12-30

In several countries, health care policies gear toward strengthening the position of primary care physicians. Primary care physicians are increasingly expected to take accountability for overall spending and quality. Yet traditional models of paying physicians do not provide adequate incentives for taking on this new role. Under a so-called shared savings program physicians are instead incentivized to take accountability for spending and quality, as the program lets them share in cost savings when quality targets are met. We provide a structured approach to designing a shared savings program for primary care, and apply this approach to the design of a shared savings program for a Dutch chain of primary care providers, which is currently being piloted. Based on the literature, we defined five building blocks of shared savings models that encompass the definition of the scope of the program, the calculation of health care expenditures, the construction of a savings benchmark, the assessment of savings and the rules and conditions under which savings are shared. We apply insights from a variety of literatures to assess the relative merits of alternative design choices within these building blocks. The shared savings program uses an econometric model of provider expenditures as an input to calculating a casemix-corrected benchmark. The minimization of risk and uncertainty for both payer and provider is pertinent to the design of a shared savings program. In that respect, the primary care setting provides a number of unique opportunities for achieving cost and quality targets. Accountability can more readily be assumed due to the relatively long-lasting relationships between primary care physicians and patients. A stable population furthermore improves the confidence with which savings can be attributed to changes in population management. Challenges arise from the institutional context. The Dutch health care system has a fragmented structure and providers are typically small in size. Shared savings programs fit the concept of enhanced primary care. Incorporating a shared savings program into existing payment models could therefore contribute to the financial sustainability of this organizational form.

A national clinical quality program for Veterans Affairs catheterization laboratories (from the Veterans Affairs clinical assessment, reporting, and tracking program).

PubMed

Maddox, Thomas M; Plomondon, Mary E; Petrich, Megan; Tsai, Thomas T; Gethoffer, Hans; Noonan, Gregory; Gillespie, Brian; Box, Tamara; Fihn, Stephen D; Jesse, Robert L; Rumsfeld, John S

2014-12-01

A "learning health care system", as outlined in a recent Institute of Medicine report, harnesses real-time clinical data to continuously measure and improve clinical care. However, most current efforts to understand and improve the quality of care rely on retrospective chart abstractions complied long after the provision of clinical care. To align more closely with the goals of a learning health care system, we present the novel design and initial results of the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) program-a national clinical quality program for VA cardiac catheterization laboratories that harnesses real-time clinical data to support clinical care and quality-monitoring efforts. Integrated within the VA electronic health record, the CART program uses a specialized software platform to collect real-time patient and procedural data for all VA patients undergoing coronary procedures in VA catheterization laboratories. The program began in 2005 and currently contains data on 434,967 catheterization laboratory procedures, including 272,097 coronary angiograms and 86,481 percutaneous coronary interventions, performed by 801 clinicians on 246,967 patients. We present the initial data from the CART program and describe 3 quality-monitoring programs that use its unique characteristics-procedural and complications feedback to individual labs, coronary device surveillance, and major adverse event peer review. The VA CART program is a novel approach to electronic health record design that supports clinical care, quality, and safety in VA catheterization laboratories. Its approach holds promise in achieving the goals of a learning health care system. Published by Elsevier Inc.

Welfare Policies and Adolescents: Exploring the Roles of Sibling Care, Maternal Work Schedules, and Economic Resources

PubMed Central

Hsueh, JoAnn; Gennetian, Lisa A.

2011-01-01

This study uses data from three longitudinal experimental evaluations of US state welfare reform programs to examine whether program-induced changes in families’ reliance on sibling care are linked with the effects of welfare programs on selected schooling outcomes of high risk, low-income adolescents. The findings from two of the welfare programs indicate that increased reliance on sibling care was concomitant with unfavorable effects of the programs on adolescent schooling outcomes. In the third welfare program examined, the program did not yield any increases in the use of sibling care or unfavorable effects on adolescent schooling outcomes, suggesting that sibling care is one likely contributor to the negative effects of welfare programs on adolescent schooling outcomes. These findings are discussed in terms of the pattern of the programs’ effects on families’ income, as well as maternal work on nonstandard schedules, aside from the programs’ effects on maternal employment, which play contributory roles in shaping the extent to which welfare programs led to less favorable effects on the schooling outcomes of adolescents with younger siblings. PMID:21347556

Early Careerist Interest and Participation in Health Care Leadership Development Programs.

PubMed

Thompson, Jon M; Temple, April

2015-01-01

Health care organizations are increasingly embracing leadership development programs. These programs include a variety of specific activities, such as formally structured leadership development, as well as mentoring, personal development and coaching, 360-degree feedback, and job enlargement, in order to increase the leadership skills of managers and high-potential staff. However, there is a lack of information on how early careerists in health care management view these programs and the degree to which they participate. This article reports on a study undertaken to determine how early careerists working in health care organizations view leadership development programs and their participation in such programs offered by their employers. Study findings are based on a survey of 126 early careerists who are graduates of an undergraduate health services administration program. We found varying levels of interest and participation in specific leadership development activities. In addition, we found that respondents with graduate degrees and those with higher compensation were more likely to participate in selected leadership development program activities. Implications of study findings for health care organizations and early careerists in the offering of, and participation in, leadership development programs are discussed.

Better Respiratory Education and Treatment Help Empower (BREATHE) study: Methodology and baseline characteristics of a randomized controlled trial testing a transitional care program to improve patient-centered care delivery among chronic obstructive pulmonary disease patients.

PubMed

Aboumatar, H; Naqibuddin, M; Chung, S; Adebowale, H; Bone, L; Brown, T; Cooper, L A; Gurses, A P; Knowlton, A; Kurtz, D; Piet, L; Putcha, N; Rand, C; Roter, D; Shattuck, E; Sylvester, C; Urteaga-Fuentes, A; Wise, R; Wolff, J L; Yang, T; Hibbard, J; Howell, E; Myers, M; Shea, K; Sullivan, J; Syron, L; Wang, Nae-Yuh; Pronovost, P

2017-11-01

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of hospitalizations. Interventional studies focusing on the hospital-to-home transition for COPD patients are few. In the BREATHE (Better Respiratory Education and Treatment Help Empower) study, we developed and tested a patient and family-centered transitional care program that helps prepare hospitalized COPD patients and their family caregivers to manage COPD at home. In the study's initial phase, we co-developed the BREATHE transitional care program with COPD patients, family-caregivers, and stakeholders. The program offers tailored services to address individual patients' needs and priorities at the hospital and for 3months post discharge. We tested the program in a single-blinded RCT with 240 COPD patients who were randomized to receive the program or 'usual care'. Program participants were offered the opportunity to invite a family caregiver, if available, to enroll with them into the study. The primary outcomes were the combined number of COPD-related hospitalizations and Emergency Department (ED) visits per participant at 6months post discharge, and the change in health-related quality of life over the 6months study period. Other measures include 'all cause' hospitalizations and ED visits; patient activation; self-efficacy; and, self-care behaviors. Unlike 1month transitional care programs that focus on patients' post-acute care needs, the BREATHE program helps hospitalized COPD patients manage the post discharge period as well as prepare them for long term self-management of COPD. If proven effective, this program may offer a timely solution for hospitals in their attempts to reduce COPD rehospitalizations. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of a Patient Incentive Program on Receipt of Preventive Care

PubMed Central

Mehrotra, Ateev; An, Ruopeng; Patel, Deepak N.; Sturm, Roland

2014-01-01

Objectives Patient financial incentives are being promoted as a mechanism to increase receipt of preventive care, encourage healthy behavior, and improve chronic disease management. However, few empirical evaluations have assessed such incentive programs. Study Design In South Africa, a private health plan has introduced a voluntary incentive program which costs enrollees approximately $20 per month. In the program, enrollees earn points when they receive preventive care. These points translate into discounts on retail goods such as airline tickets, movie tickets, or cell phones. Methods We compared the change in 8 preventive care services over the years 2005–11 between those who entered the incentive program and those that did not. We used multivariate regression models with individual random effects to try to address selection bias. Results Of the 4,186,047 unique individuals enrolled in the health plan, 65.5% (2,742,268) voluntarily enrolled in the incentive program. Joining the incentive program was associated with a statistically higher odds of receiving all 8 preventive care services. The odds ratio and estimated percentage point increase for receipt of cholesterol testing was 2.70 (8.9%), glucose testing 1.51 (4.7%), glaucoma screening 1.34 (3.9%), dental exam 1.64 (6.3%), HIV test 3.47 (2.6%), prostate specific antigen testing 1.39 (5.6%), Papanicolaou screening 2.17 (7.0%), and mammogram 1.90 (3.1%) (p<0.001 for all eight services). However, preventive care rates among those in the incentive program was still low. Conclusions Voluntary participation in a patient incentive program was associated with a significantly higher likelihood of receiving preventive care, though receipt of preventive care among those in the program was still lower than ideal. PMID:25180436

Pedagogical Implications of Partnerships Between Psychiatry and Obstetrics-Gynecology in Caring for Patients with Major Mental Disorders.

PubMed

Coverdale, John; Roberts, Laura Weiss; Balon, Richard; Beresin, Eugene V

2015-08-01

Because there are no formal reviews, the authors set out to identify and describe programs that serve female patients with major mental disorders by integrating mental health care with services in obstetrics and gynecology and to describe the pedagogical implications of those programs. The authors searched PubMed for all articles describing a program in which psychiatry was formally integrated with obstetric or gynecological services, other than standard consultation-liaison programs, in the care of patients with major mental disorders. The search terms used included interdisciplinary, interprofessional, integrated, collaborative care, psychiatry, and obstetrics-gynecology or psychosomatic obstetrics-gynecology. The authors found six distinct integrated programs. These included family planning clinics that were integrated into inpatient psychiatry services; inpatient and outpatient psychiatry services for pregnant mentally ill women in close collaboration with obstetric services; a day hospital for pregnant women with psychiatric disorders in an obstetric setting; an interdisciplinary training site providing care for predominantly depressed, low-income, and minority women; a primary care HIV service for women integrated with departments of obstetrics-gynecology and psychiatry; and an obstetrics-gynecology clinic-based collaborative depression care intervention for socially disadvantaged women. Residents' involvement was described in four of the programs. These innovative and integrated programs potentially enhance the care of vulnerable and culturally diverse women with major mental disorders. The authors discuss how these programs may contribute to the education of residents in psychiatry and obstetrics-gynecology.

Team Performance and Risk-Adjusted Health Outcomes in the Program of All-Inclusive Care for the Elderly (PACE)

ERIC Educational Resources Information Center

Mukamel, Dana B.; Temkin-Greener, Helena; Delavan, Rachel; Peterson, Derick R.; Gross, Diane; Kunitz, Stephen; Williams, T. Franklin

2006-01-01

Purpose: The Program of All-Inclusive Care for the Elderly (PACE) is a community-based program providing primary, acute, and long-term care to frail elderly individuals. A central component of the PACE model is the interdisciplinary care team, which includes both professionals and non-professionals. The purpose of this study was to examine the…

Risk Factors Associated with Children Lost to Care in a State Early Childhood Intervention Program

ERIC Educational Resources Information Center

Giannoni, Peggy P.; Kass, Philip H.

2010-01-01

A retrospective cohort study was conducted to identify risk factors associated with children lost to care, and their families, compared to those not lost to care within the California Early Start Program. The cohort included data on 8987 children enrolled in the Early Start Program in 1998. This cohort consisted of 2443 children lost to care, 6363…

Characteristics of private-sector managed care for mental health and substance abuse treatment.

PubMed

Garnick, D W; Hendricks, A M; Dulski, J D; Thorpe, K E; Horgan, C

1994-12-01

This study examined diversity during the late 1980s in managed care programs for mental health, alcohol abuse, and drug abuse to identify ways in which research can generate more meaningful data on the effectiveness of utilization review programs. Telephone interviews were conducted with representatives of utilization review programs for employee health insurance plans in 31 firms that employed 2.1 million people in 1990. Questions addressed qualifications of personnel, clinical criteria to authorize care, integration with employee assistance plans, penalties for not complying with utilization review procedures, outpatient review, and carve out of mental health and substance abuse review. Large variations in utilization review programs were found. Programs employed a range of review personnel and used a variety of clinical criteria to authorize care. More than two-thirds did not carve out mental health and substance abuse review from medical-surgical review. Some firms' employee assistance plans were integrated with utilization review programs, while others remained unintegrated. Penalties for not following program procedures varied widely, as did review of outpatient services. Because of trends toward even more diversity in utilization review programs in the 1990s, research that identifies the specific features of managed care programs that hold most promise for controlling costs while maintaining quality of care will increasingly be needed.

The Michigan Surgical Home and Optimization Program is a scalable model to improve care and reduce costs.

PubMed

Englesbe, Michael J; Grenda, Dane R; Sullivan, June A; Derstine, Brian A; Kenney, Brooke N; Sheetz, Kyle H; Palazzolo, William C; Wang, Nicholas C; Goulson, Rebecca L; Lee, Jay S; Wang, Stewart C

2017-06-01

The Michigan Surgical Home and Optimization Program is a structured, home-based, preoperative training program targeting physical, nutritional, and psychological guidance. The purpose of this study was to determine if participation in this program was associated with reduced hospital duration of stay and health care costs. We conducted a retrospective, single center, cohort study evaluating patients who participated in the Michigan Surgical Home and Optimization Program and subsequently underwent major elective general and thoracic operative care between June 2014 and December 2015. Propensity score matching was used to match program participants to a control group who underwent operative care prior to program implementation. Primary outcome measures were hospital duration of stay and payer costs. Multivariate regression was used to determine the covariate-adjusted effect of program participation. A total of 641 patients participated in the program; 82% were actively engaged in the program, recording physical activity at least 3 times per week for the majority of the program; 182 patients were propensity matched to patients who underwent operative care prior to program implementation. Multivariate analysis demonstrated that participation in the Michigan Surgical Home and Optimization Program was associated with a 31% reduction in hospital duration of stay (P < .001) and 28% lower total costs (P < .001) after adjusting for covariates. A home-based, preoperative training program decreased hospital duration of stay, lowered costs of care, and was well accepted by patients. Further efforts will focus on broader implementation and linking participation to postoperative complications and rigorous patient-reported outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Development and validation of an online interactive, multimedia wound care algorithms program.

PubMed

Beitz, Janice M; van Rijswijk, Lia

2012-01-01

To provide education based on evidence-based and validated wound care algorithms we designed and implemented an interactive, Web-based learning program for teaching wound care. A mixed methods quantitative pilot study design with qualitative components was used to test and ascertain the ease of use, validity, and reliability of the online program. A convenience sample of 56 RN wound experts (formally educated, certified in wound care, or both) participated. The interactive, online program consists of a user introduction, interactive assessment of 15 acute and chronic wound photos, user feedback about the percentage correct, partially correct, or incorrect algorithm and dressing choices and a user survey. After giving consent, participants accessed the online program, provided answers to the demographic survey, and completed the assessment module and photographic test, along with a posttest survey. The construct validity of the online interactive program was strong. Eighty-five percent (85%) of algorithm and 87% of dressing choices were fully correct even though some programming design issues were identified. Online study results were consistently better than previously conducted comparable paper-pencil study results. Using a 5-point Likert-type scale, participants rated the program's value and ease of use as 3.88 (valuable to very valuable) and 3.97 (easy to very easy), respectively. Similarly the research process was described qualitatively as "enjoyable" and "exciting." This digital program was well received indicating its "perceived benefits" for nonexpert users, which may help reduce barriers to implementing safe, evidence-based care. Ongoing research using larger sample sizes may help refine the program or algorithms while identifying clinician educational needs. Initial design imperfections and programming problems identified also underscored the importance of testing all paper and Web-based programs designed to educate health care professionals or guide patient care.

Transitional care programs improve outcomes for heart failure patients: an integrative review.

PubMed

Stamp, Kelly D; Machado, Monique A; Allen, Nancy A

2014-01-01

Individuals with heart failure are frequently rehospitalized owing to a lack of knowledge concerning how to perform their self-care and when to inform their healthcare provider of worsening symptoms. Because there are an overwhelming number of hospital readmissions for individuals with heart failure, efforts are underway to discover how they can be supported and educated during their hospitalization and subsequently followed by a nurse after discharge for continued education and support. The purpose of this integrative review was to critically examine the interventions, quality of life, and readmission rates of individuals with heart failure who are enrolled in a transitional care program. The second aim was to examine the cost-effectiveness of nurse-led transitional care programs. The results of this integrative review (n = 20) showed that transitional care programs for individuals with heart failure can increase a patient's quality of life and decrease the number of readmissions and the overall cost of care. The types of interventions that were most successful in decreasing readmissions used home visits alone or in combination with telephone calls. There is a need for nurse researchers to address gaps in transitional care for heart failure patients by performing studies with larger randomized clinical trials and measuring outcomes such as readmissions at regular intervals over the study period. The Patient Protection and Affordable Care Act will change reimbursement for heart failure readmissions and presents opportunities for healthcare teams to build transitional care programs for patients with conditions such as heart failure. This integrative review can be used to determine effective intervention strategies for transitional care programs and highlights the gaps in research. Healthcare teams that use these programs within their practice may increase continuity of care and quality of life and decrease readmissions and healthcare costs for individuals with heart failure.

"Talkin' about a revolution": How electronic health records can facilitate the scale-up of HIV care and treatment and catalyze primary care in resource-constrained settings.

PubMed

Braitstein, Paula; Einterz, Robert M; Sidle, John E; Kimaiyo, Sylvester; Tierney, William

2009-11-01

Health care for patients with HIV infection in developing countries has increased substantially in response to major international funding. Scaling up treatment programs requires timely data on the type, quantity, and quality of care being provided. Increasingly, such programs are turning to electronic health records (EHRs) to provide these data. We describe how a medical school in the United States and another in Kenya collaborated to develop and implement an EHR in a large HIV/AIDS care program in western Kenya. These data were used to manage patients, providers, and the program itself as it grew to encompass 18 sites serving more than 90,000 patients. Lessons learned have been applicable beyond HIV/AIDS to include primary care, chronic disease management, and community-based health screening and disease prevention programs. EHRs will be key to providing the highest possible quality of care for the funds developing countries can commit to health care. Public, private, and academic partnerships can facilitate the development and implementation of EHRs in resource-constrained settings.

The Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care.

PubMed

Ouslander, Joseph G; Bonner, Alice; Herndon, Laurie; Shutes, Jill

2014-03-01

Interventions to Reduce Acute Care Transfers (INTERACT) is a publicly available quality improvement program that focuses on improving the identification, evaluation, and management of acute changes in condition of nursing home residents. Effective implementation has been associated with substantial reductions in hospitalization of nursing home residents. Familiarity with and support of program implementation by medical directors and primary care clinicians in the nursing home setting are essential to effectiveness and sustainability of the program over time. In addition to helping nursing homes prevent unnecessary hospitalizations and their related complications and costs, and thereby continuing to be or becoming attractive partners for hospitals, health care systems, managed care plans, and accountable care organizations, effective INTERACT implementation will assist nursing homes in meeting the new requirement for a robust quality assurance performance improvement program, which is being rolled out by the federal government over the next year. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

42 CFR 1001.301 - Conviction relating to obstruction of an investigation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... investigation. 1001.301 Section 1001.301 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES PROGRAM INTEGRITY-MEDICARE AND STATE HEALTH CARE PROGRAMS... the Medicare, Medicaid or other Federal health care programs; (iii) The interference or obstruction...

42 CFR 1001.301 - Conviction relating to obstruction of an investigation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... investigation. 1001.301 Section 1001.301 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES PROGRAM INTEGRITY-MEDICARE AND STATE HEALTH CARE PROGRAMS... the Medicare, Medicaid or other Federal health care programs; (iii) The interference or obstruction...

42 CFR 1001.301 - Conviction relating to obstruction of an investigation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... investigation. 1001.301 Section 1001.301 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES PROGRAM INTEGRITY-MEDICARE AND STATE HEALTH CARE PROGRAMS... the Medicare, Medicaid or other Federal health care programs; (iii) The interference or obstruction...

42 CFR 1001.301 - Conviction relating to obstruction of an investigation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... investigation. 1001.301 Section 1001.301 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES PROGRAM INTEGRITY-MEDICARE AND STATE HEALTH CARE PROGRAMS... the Medicare, Medicaid or other Federal health care programs; (iii) The interference or obstruction...

76 FR 40741 - Federal Housing Administration (FHA) Mortgage Insurance Premiums for Multifamily Housing Programs...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-11

... Administration (FHA) Mortgage Insurance Premiums for Multifamily Housing Programs, Health Care Facilities and... mortgage insurance premiums (MIPs) for FHA Multifamily Housing, Health Care Facilities, and Hospital... implement any premium changes for FY 2011 for the multifamily mortgage insurance programs, health care...

Employer Child Care Resources: A Guide to Developing Effective Child Care Programs and Policies.

ERIC Educational Resources Information Center

Women's Bureau (DOL), Washington, DC.

Increasing numbers of employers are responding to employee child care needs by revising their benefit packages, work schedules, and recruitment plans to include child care options. This guide details ways to develop effective child care programs and policies. Section 1 of the guide describes employees' growing child care needs and employers'…

Family Day Care Training Curriculum (Lao).

ERIC Educational Resources Information Center

Nakatsu, Gail

California's Family Day Care Training Program was designed to recruit and train, in 7 weeks, Lao, Vietnamese, and Chinese refugees to establish their own state-licensed, family day care homes. Topics in the program's curriculum include an introduction to family day care, state licenses for family day care, state licensing requirements for family…

Family Day Care Training Curriculum.

ERIC Educational Resources Information Center

Nakatsu, Gail

California's Family Day Care Training Program was designed to recruit and train in 7 weeks, Lao, Vietnamese, and Chinese refugees to establish their own state-licensed, family day care homes. Topics in the program's curriculum include an introduction to family day care, state licenses for family day care, state licensing requirements for family…

Supporting Mentoring Relationships of Youth in Foster Care: Do Program Practices Predict Match Length?

PubMed

Stelter, Rebecca L; Kupersmidt, Janis B; Stump, Kathryn N

2018-04-15

Implementation of research- and safety-based program practices enhance the longevity of mentoring relationships, in general; however, little is known about how mentoring programs might support the relationships of mentees in foster care. Benchmark program practices and Standards in the Elements of Effective Practice for Mentoring, 3rd Edition (MENTOR, 2009) were assessed in the current study as predictors of match longevity. Secondary data analyses were conducted on a national agency information management database from 216 Big Brothers Big Sisters agencies serving 641 youth in foster care and 70,067 youth not in care from across the United States (Mean = 11.59 years old at the beginning of their matches) in one-to-one, community-based (55.06%) and school- or site-based (44.94%) matches. Mentees in foster care had shorter matches and matches that were more likely to close prematurely than mentees who were not in foster care. Agency leaders from 32 programs completed a web-based survey describing their policies and practices. The sum total numbers of Benchmark program practices and Standards were associated with match length for 208 mentees in foster care; however, neither predicted premature match closure. Results are discussed in terms of how mentoring programs and their staff can support the mentoring relationships of high-risk youth in foster care. © Society for Community Research and Action 2018.

The Association of Shelter Veterinarians' 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs.

PubMed

Griffin, Brenda; Bushby, Philip A; McCobb, Emily; White, Sara C; Rigdon-Brestle, Y Karla; Appel, Leslie D; Makolinski, Kathleen V; Wilford, Christine L; Bohling, Mark W; Eddlestone, Susan M; Farrell, Kelly A; Ferguson, Nancy; Harrison, Kelly; Howe, Lisa M; Isaza, Natalie M; Levy, Julie K; Looney, Andrea; Moyer, Michael R; Robertson, Sheilah Ann; Tyson, Kathy

2016-07-15

As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs.

76 FR 22603 - Geographic Preference Option for the Procurement of Unprocessed Agricultural Products in Child...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-22

... Program, Special Milk Program for Children, Child and Adult Care Food Program and Summer Food Service... Program, Fresh Fruit and Vegetable Program, Special Milk Program, Child and Adult Care Food Program and... and 10.553, respectively. The Special Milk Program is listed under No. 10.556. The Child and Adult...

Palliative care in Japan: a review focusing on care delivery system.

PubMed

Morita, Tatsuya; Kizawa, Yoshiyuki

2013-06-01

Providing palliative care in Japan is one of the most important health issues. Understanding palliative care delivery systems of other countries is useful when developing and modifying palliative care systems worldwide. This review summarizes the current status of palliative care in Japan, focusing on the structure and process development. Palliative care units and hospital palliative care consultation teams are the two main specialized palliative care services in Japan. The number of palliative care units is 215 (involved in 8.4% of all cancer deaths), and there are approximately 500 hospital palliative care teams. Conversely, specialized home care services are one of the most undeveloped areas in Japan. However, the government has been trying to develop more efficient home care services through modifying laws, healthcare systems, and multiple educational and cooperative projects. The numbers of palliative care specialists are increasing across all disciplines: cancer pain nurses (1365), palliative care nurses (1100), palliative care physicians (646), and palliative care pharmacists (238). Postgraduate education for physicians is performed via the special nationwide efforts of the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education (PEACE) project - a 2-day program adopting a trainer-trainee strategy. Over 30,000 physicians have participated in the PEACE program. A total of 1298 and 544 physicians have completed a trainer course for palliative medicine and psycho-oncology, respectively. Multiple structure and process evaluation, bereaved family surveys in palliative care units, and patient and family evaluation in the regional palliative care program indicate many improvements. Palliative care in Japan has progressed rapidly, and the Cancer Control Act has played a very important role in developing palliative medicine. Challenges include developing a structure for palliative care in the community or regional palliative care programs, establishing a method to measure and improve the quality of palliative care at a national level, developing evidence-based medicine and policy making, and palliative care for the noncancerous population.

Enhancing the role of case managers with specialty populations: development and evaluation of a palliative care education program.

PubMed

Howell, Doris; Prestwich, Catherine; Laughlin, Emmy; Giga, Nasreen

2004-01-01

Palliative home care is an important component of the care system for patients at the end of life and case management is considered an essential element of the Canadian home care system. Case managers play a critical role in allocating resources, thus influencing the costs and the viability of palliative home care. Case management education programs focused on care coordination with specialty palliative care populations are nonexistent. An education program targeted at improving the knowledge and skills of case managers in allocating resources to palliative care populations was developed and pilot-tested in a metropolitan Canadian city home care program. Core curriculum was based on an initial learning needs assessment and used case-based problem solving to enhance case-management skills. An improvement in knowledge was noted on posttests and case managers described increased comfort and confidence in their role as case managers to this patient population. Home care organizations caring for palliative care populations must ensure case managers are prepared for case management roles with specialty populations if the home is to be rendered an appropriate and viable care setting for patients at the end of life.

Evaluating Training Programs for Primary Care Providers in Child/Adolescent Mental Health in Canada: A Systematic Review.

PubMed

Gotovac, Sandra; Espinet, Stacey; Naqvi, Reza; Lingard, Lorelei; Steele, Margaret

2018-04-01

The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families.

Evaluation of a caring education program for Taiwanese nursing students: a quasi-experiment with before and after comparison.

PubMed

Wu, Li-Min; Chin, Chi-Chun; Chen, Chung-Hey

2009-11-01

Caring is an essential component in nursing curricula. However, how caring can be accomplished effectively has rarely been taught to nursing students. To examine acceptability and preliminary efficacy of a caring education program for nursing students in Taiwan. Students were recruited to participate in a pre-post-test quasi-experimental study. Students self-selected into a control group (n=33) or an experimental group (n=35). The experimental group registered for a 13-week caring education program based on Watson's 10 creative factors through multiple teaching strategies. The Caring Behaviors Assessment (CBA) was used to collect data at weeks 1 and 13. Content analysis was used to reach the main descriptions of caring education from an experimental group of nursing students. The experimental group reported a significantly higher score of caring behaviors after participating in the education program (t=3.4, p=.00). The score of each CBA subscale in the experimental group was significantly enhanced from week 1 to week 13, except in the existential/phenomenological/spiritual dimension. Qualitative results supported that a caring education could help nursing students by building caring behaviors which could be adapted to clinical situations. The findings support the credibility of caring-focused teaching strategies and such focused caring programs are acceptable and show efficacy for nursing students.

Trends in acute mental health care: comparing psychiatric and substance abuse treatment programs.

PubMed

Timko, Christine; Lesar, Michelle; Calvi, Noël J; Moos, Rudolf H

2003-01-01

This study compared psychiatric and substance abuse acute care programs, within both inpatient and residential modalities of care, on organization and staffing, clinical management practices and policies, and services and activities. A total of 412 (95% of those eligible) Department of Veterans Affairs' programs were surveyed nationwide. Some 40% to 50% of patients in psychiatric and substance abuse programs, in both inpatient and residential venues of care, had dual diagnoses. Even though psychiatric programs had a sicker patient population, they provided fewer services, including basic components of integrated programs, than substance abuse programs did. Findings also showed that there is a strong emphasis on the use of clinical practice guidelines, performance monitoring, and obtaining client satisfaction and outcome data in mental health programs. The author's suggest how psychiatric programs might better meet the needs of acutely ill and dually diagnosed patients (e.g., by incorporating former patients as role models and mutual help groups, as substance abuse programs do; and by having policies that balance patient choice with program demand).

Difficult relationships--interactions between family members and staff in long-term care.

PubMed

Norris, S

2000-01-01

Staff of long-term care facilities and family members have a common responsibility to ensure the best course of treatment and everyday care for residents who often cannot speak for themselves. Understanding the difference between instrumental and preservative care, and who the proper agent is to provide care in each category will not only improve staff/family interactions, but residential care in general. The Resident Enrichment and Activity Program improves the family/staff relationship obliquely by involving family in social activities; the Family Involvement in Care program, and the Patterns in Caregiving program directly target the relationship and involve the facility's administration to effect policy change.

Education in care and technology, a facilitator of interdisciplinary research and development.

PubMed

Willems, Charles G; Sponselee, Anne-Mie; Verkerke, Margreet Michel; Sirkka, Andrew; Saarni, Lea; Castello Branco, Miguel; de Witte, Luc

2015-01-01

Application of technology in care is hindered by two factors; a critical attitude of care professionals towards the use of technology as part of care delivery and a lack of knowledge of care practice by technology developers. Technological developments may provide adequate solutions to support care provision. The principles of user centred design and development, traditionally used in the development of assistive technology, may provide powerful tools to support care provision. Interdisciplinary research will be needed to take full benefit. Educational programs to support this development are lacking. Main content of this paper: Six organisations of higher education have taken the initiative to organize a training program to support professionals active in the care or in the technology domain that enables them to become involved in interdisciplinary research and development. a European program to educate a professional master in Care and Technology has been developed and is described in this paper. Accreditation of the program is initiated. Alumni of such a program may form a European network of professionals that are active in developing new solutions to support people with special needs and contribute to the generation of new business.

Redesigning care at the Flinders Medical Centre: clinical process redesign using "lean thinking".

PubMed

Ben-Tovim, David I; Bassham, Jane E; Bennett, Denise M; Dougherty, Melissa L; Martin, Margaret A; O'Neill, Susan J; Sincock, Jackie L; Szwarcbord, Michael G

2008-03-17

*The Flinders Medical Centre (FMC) Redesigning Care program began in November 2003; it is a hospital-wide process improvement program applying an approach called "lean thinking" (developed in the manufacturing sector) to health care. *To date, the FMC has involved hundreds of staff from all areas of the hospital in a wide variety of process redesign activities. *The initial focus of the program was on improving the flow of patients through the emergency department, but the program quickly spread to involve the redesign of managing medical and surgical patients throughout the hospital, and to improving major support services. *The program has fallen into three main phases, each of which is described in this article: "getting the knowledge"; "stabilising high-volume flows"; and "standardising and sustaining". *Results to date show that the Redesigning Care program has enabled the hospital to provide safer and more accessible care during a period of growth in demand.

Abortion-care education in Japanese nurse practitioner and midwifery programs: a national survey.

PubMed

Mizuno, Maki

2014-01-01

While various reports have been published concerning ethical dilemmas in nursing and midwifery, and while many nurses and midwives struggle with the conflict between personal feelings raised by abortion and the duties of their position, few studies investigate the extent and conditions of abortion-care education for registered nurses (RNs) and certified nurse-midwives (CNMs) in Japan. To describe Japanese abortion-care education programs and to investigate program directors' or other relevant persons' perceptions of abortion-care education. Descriptive study was used to determine the extent of abortion-care education programs and the respondents' perceptions of abortion-care education. All 228 Japanese nursing and/or midwifery schools were invited to participate in the study. The response rate was 33.8% (n=77). Response rate varied by program type: 18.4% (n=45) for nursing programs and 29.0% (n=32) for midwifery programs. A confidential survey requesting information about curricular coverage of ten reproductive health topics related to abortion was mailed to program directors. The results show that the majority of CNM and RN programs surveyed offer didactic exposure to instruction in family planning and contraception, emergency contraception, legal considerations, and possible medical complications. However, few programs offer clinical exposure to all 10 topics. Of the respondents, 36% reported that lack of time and the low priority given to abortion-care education were issues of curriculum priority. As for educational materials, few textbooks or guidebooks exist on abortion care in Japan, and most educators use general nursing textbooks to cover this topic. Regardless of interest in or intention to provide abortion services as part of their practice, all providers of abortion-care education need to be knowledgeable about the full range of reproductive health options, including family planning and abortion, and to be able to convey this information to clients. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Boston Health Care for the Homeless Program: a public health framework.

PubMed

O'Connell, James J; Oppenheimer, Sarah C; Judge, Christine M; Taube, Robert L; Blanchfield, Bonnie B; Swain, Stacy E; Koh, Howard K

2010-08-01

During the past 25 years, the Boston Health Care for the Homeless Program has evolved into a service model embodying the core functions and essential services of public health. Each year the program provides integrated medical, behavioral, and oral health care, as well as preventive services, to more than 11 000 homeless people. Services are delivered in clinics located in 2 teaching hospitals, 80 shelters and soup kitchens, and an innovative 104-bed medical respite unit. We explain the program's principles of care, describe the public health framework that undergirds the program, and offer lessons for the elimination of health disparities suffered by this vulnerable population.

The palliative care knowledge questionnaire for PEACE: reliability and validity of an instrument to measure palliative care knowledge among physicians.

PubMed

Yamamoto, Ryo; Kizawa, Yoshiyuki; Nakazawa, Yoko; Morita, Tatsuya

2013-11-01

In Japan, a nationwide palliative care education program for primary palliative care (the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education: PEACE) was established in 2008. Effective delivery of such programs relies on adequate evaluations of program efficacy; however, such an instrument does not exist. This study aimed to develop and validate a measurement tool to quantify knowledge level of physicians about broader areas of palliative care, by which the effect of an education program could be measured. We conducted a cross-sectional, anonymous, self-administered questionnaire survey with a group of 801 conveniently sampled physicians in October 2010. To examine the test-retest reliability of items and domains, the questionnaire was reissued two weeks after the first survey was completed. This study used psychometric methods, including item response theory, intraclass correlation coefficients, and known-group validity. The response rate was 54% (n=434). We included 33 items across the following 9 domains: (1) philosophy of palliative care, (2) cancer pain, (3) side effects of opioids, (4) dyspnea, (5) nausea and vomiting, (6) psychological distress, (7) delirium, (8) communication regarding palliative care, and (9) community-based palliative care. For these items, the intraclass correlation was 0.84 and the Kuder-Richardson Formula 20 (KR-20) test of internal consistency was 0.87. There was a significant difference in the scores between palliative care specialists and other physicians. We successfully validated a newly developed palliative care knowledge questionnaire to evaluate PEACE effectiveness (PEACE-Q). The PEACE-Q could be useful for evaluating both palliative care knowledge among physicians and education programs in primary palliative care.

School-Age Ideas and Activities for After School Programs.

ERIC Educational Resources Information Center

Haas-Foletta, Karen; Cogley, Michele

This guide describes activities for school-age children in after-school day care programs. These activities may also be used in other settings. An introductory section discusses program philosophy, room arrangement, multicultural curriculum, program scheduling, summer programs and holiday care, field trips and special programs, age grouping,…

Restructuring Military Medical Care

DTIC Science & Technology

1995-07-01

providers, perhaps under an approach such as the Federal Employees Health Benefits (FEHB) program , discussed later in this chapter. Effects on DoD’s...CARE July 1995 Military Family Association, would give beneficiaries access to care through the Federal Employees Health Benefits program as well as...enrollment levels and BOX 6. THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM The Federal Employees Health Benefits (FEHB) program is the source of health

77 FR 70783 - Medicare and Medicaid Programs; Approval of the Accreditation Association for Ambulatory Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-27

...] Medicare and Medicaid Programs; Approval of the Accreditation Association for Ambulatory Health Care (AAAHC... announces our decision to approve the Accreditation Association for Ambulatory Health Care (AAAHC) for... Ambulatory Health Care's (AAAHC) current term of approval for their ASC accreditation program expires on...

77 FR 74381 - Medicaid Program; Payments for Services Furnished by Certain Primary Care Physicians and Charges...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-14

... Primary Care Physicians and Charges for Vaccine Administration Under the Vaccines for Children Program... Primary Care Physicians and Charges for Vaccine Administration under the Vaccines for Children Program... the administration of pediatric vaccines. SUPPLEMENTARY INFORMATION: I. Background In FR Doc. 2012...

[Family health and infant palliative care: listening the relatives of technology dependent children].

PubMed

Rabello, Claudia Azevedo Ferreira Guimarães; Rodrigues, Paulo Henrique de Almeida

2010-10-01

This study discusses the creation of a new child palliative care program based on the Family Health Program, considering the level of care at home and yielding to family requests. Eighteen members of nine families of technology dependent children (TDC) who were hospital patients in the Instituto Fernandes Figueira (IFF) participated on the study. From those four were being assisted by its palliative care program Programa de Assistência Domiciliar Interdisciplinar (PADI); three were inpatients waiting for inclusion in the program, and finally two inpatients already included in PADI. PADI was chosen because it is the only child palliative care program in Brazil. The results are positive in regards to the connection established between the families and the health care team, the reception of the children, the explanation to the family concerning the disease, and the functional dynamics between the PADI and the IFF. As negative points, difficulties arose as a result of the implementation of the program, from its continuity to the worsening or illness of the entire family. In conclusion, although the PADI is the IFF's way of discharging patients, the domiciliary care provided by the Family Health Program, well articulated with the healthcare system, would be ideal for being the adequate assistance for it.

A web-based nutrition program reduces health care costs in employees with cardiac risk factors: before and after cost analysis.

PubMed

Sacks, Naomi; Cabral, Howard; Kazis, Lewis E; Jarrett, Kelli M; Vetter, Delia; Richmond, Russell; Moore, Thomas J

2009-10-23

Rising health insurance premiums represent a rapidly increasing burden on employer-sponsors of health insurance and their employees. Some employers have become proactive in managing health care costs by providing tools to encourage employees to directly manage their health and prevent disease. One example of such a tool is DASH for Health, an Internet-based nutrition and exercise behavior modification program. This program was offered as a free, opt-in benefit to US-based employees of the EMC Corporation. The aim was to determine whether an employer-sponsored, Internet-based diet and exercise program has an effect on health care costs. There were 15,237 total employees and spouses who were included in our analyses, of whom 1967 enrolled in the DASH for Health program (DASH participants). Using a retrospective, quasi-experimental design, study year health care costs among DASH participants and non-participants were compared, controlling for baseline year costs, risk, and demographic variables. The relationship between how often a subject visited the DASH website and health care costs also was examined. These relationships were examined among all study subjects and among a subgroup of 735 subjects with cardiovascular conditions (diabetes, hypertension, hyperlipidemia). Multiple linear regression analysis examined the relationship of program use to health care costs, comparing study year costs among DASH participants and non-participants and then examining the effects of increased website use on health care costs. Analyses were repeated among the cardiovascular condition subgroups. Overall, program use was not associated with changes in health care costs. However, among the cardiovascular risk study subjects, health care costs were US$827 lower, on average, during the study year (P= .05; t(729) = 1.95). Among 1028 program users, increased website use was significantly associated with lower health care costs among those who visited the website at least nine times during the study year (US$14 decrease per visit; P = .04; t(1022) = 2.05), with annual savings highest among 80 program users with targeted conditions (US$55 decrease per visit; P < .001; t(74) = 2.71). An employer-sponsored, Internet-based diet and exercise program shows promise as a low-cost benefit that contributes to lower health care costs among persons at higher risk for above-average health care costs and utilization.

A Web-Based Nutrition Program Reduces Health Care Costs in Employees With Cardiac Risk Factors: Before and After Cost Analysis

PubMed Central

Cabral, Howard; Kazis, Lewis E; Jarrett, Kelli M; Vetter, Delia; Richmond, Russell; Moore, Thomas J

2009-01-01

Background Rising health insurance premiums represent a rapidly increasing burden on employer-sponsors of health insurance and their employees. Some employers have become proactive in managing health care costs by providing tools to encourage employees to directly manage their health and prevent disease. One example of such a tool is DASH for Health, an Internet-based nutrition and exercise behavior modification program. This program was offered as a free, opt-in benefit to US-based employees of the EMC Corporation. Objective The aim was to determine whether an employer-sponsored, Internet-based diet and exercise program has an effect on health care costs. Methods There were 15,237 total employees and spouses who were included in our analyses, of whom 1967 enrolled in the DASH for Health program (DASH participants). Using a retrospective, quasi-experimental design, study year health care costs among DASH participants and non-participants were compared, controlling for baseline year costs, risk, and demographic variables. The relationship between how often a subject visited the DASH website and health care costs also was examined. These relationships were examined among all study subjects and among a subgroup of 735 subjects with cardiovascular conditions (diabetes, hypertension, hyperlipidemia). Multiple linear regression analysis examined the relationship of program use to health care costs, comparing study year costs among DASH participants and non-participants and then examining the effects of increased website use on health care costs. Analyses were repeated among the cardiovascular condition subgroups. Results Overall, program use was not associated with changes in health care costs. However, among the cardiovascular risk study subjects, health care costs were US$827 lower, on average, during the study year (P = .05; t 729 = 1.95). Among 1028 program users, increased website use was significantly associated with lower health care costs among those who visited the website at least nine times during the study year (US$14 decrease per visit; P = .04; t 1022 = 2.05), with annual savings highest among 80 program users with targeted conditions (US$55 decrease per visit; P < .001; t 74 = 2.71). Conclusions An employer-sponsored, Internet-based diet and exercise program shows promise as a low-cost benefit that contributes to lower health care costs among persons at higher risk for above-average health care costs and utilization. PMID:19861297

Development of an inter-professional educational program for home care professionals: Evaluation of short-term effects in suburban areas.

PubMed

Tsuchiya, Rumiko; Yoshie, Satoru; Kawagoe, Shohei; Hirahara, Satoshi; Onishi, Hirotaka; Murayama, Hiroshi; Nishinaga, Masanori; Iijima, Katsuya; Tsuji, Tetsuo

2017-01-01

Objective　To examine the short-term effects of an inter-professional educational program developed for physicians and other home care specialists to promote home care in the community.Methods　From March 2012 to January 2013, an inter-professional educational program (IEP) was held four times in three suburban areas (Kashiwa city and Matsudo city in the Chiba prefecture, and Omori district in the Ota ward). This program aimed to motivate physicians to increase the number of home visits and to encourage home care professionals to work together in the same community areas by promoting inter-professional work (IPW). The participants were physicians, home-visit nurses, and other home care professionals recommended by community-level professional associations. The participants attended a 1.5-day multi-professional IEP. Pre- and post-program questionnaires were used to collect information on home care knowledge and practical skills (26 indexes, 1-4 scale), attitudes toward home care practice (4 indexes, 1-6 scale), and IPW (13 indexes, 1-4 scale). Data from all of the participants without labels about the type of professionals were excluded, and both pre-test and post-test responses were used in the analysis. A Wilcoxon signed-rank test and a paired t-test were conducted to compare pre- and post-program questionnaire responses stratified for physicians and other professionals, and the effect size was calculated.Results　The total number of participants for the four programs was 256, and data from 162 (63.3%) were analyzed. The physicians numbered 19 (11.7%), while other professionals numbered 143 (88.3%). Attending this program helped participants obtain home care knowledge of IPW and a practical view of home care. Furthermore, indexes about IPW consisted of two factors: cooperation and interaction; non-physician home care professionals increased their interactions with physicians, other professionals increased their cooperation with other professionals, and physicians increased their cooperation with other physicians.Conclusion　Short-term effects to motivate physicians to increase home visits were limited. However, physicians obtained a practical view of home care by attending the IEP. Also, the participation of physicians and other home care professionals in this program triggered the beginning of IPW in suburban areas. This program is feasible when adapted for regional differences.

Organizational determinants of efficiency and effectiveness in mental health partial care programs.

PubMed Central

Schinnar, A P; Kamis-Gould, E; Delucia, N; Rothbard, A B

1990-01-01

The use of partial care as a treatment modality for mentally ill patients, particularly the chronically mentally ill, has greatly increased. However, research into what constitutes a "good" program has been scant. This article reports on an evaluation study of staff productivity, cost efficiency, and service effectiveness of adult partial care programs carried out in New Jersey in fiscal year 1984/1985. Five program performance indexes are developed based on comparisons of multiple measures of resources, service activities, and client outcomes. These are used to test various hypotheses regarding the effect of organizational and fiscal variables on partial care program efficiency and effectiveness. The four issues explored are: auspices, organizational complexity, service mix, and fiscal control by the state. These were found to explain about half of the variance in program performance. In addition, partial care programs demonstrating midlevel performance with regard to productivity and efficiency were observed to be the most effective, implying a possible optimal level of efficiency at which effectiveness is maximized. PMID:2113046

PERCEIVED FEASIBILITY OF ESTABLISHING DEDICATED ELDER ABUSE PROGRAMS OF CARE AT HOSPITAL-BASED SEXUAL ASSAULT/DOMESTIC VIOLENCE TREATMENT CENTETR.

PubMed

Du Mont, Janice; Mirzaei, Aftab; Macdonald, Sheila; White, Meghan; Kosa, Daisy; Reimer, Linda

2014-12-01

Elder abuse is an increasingly important issue that must be addressed in a systematic and coordinated way. Our objective was to evaluate the perceived feasibility of establishing an elder abuse care program at hospital-based sexual assault and domestic violence treatment centers in Ontario, Canada. In July 2012, a questionnaire focused on elder abuse care was distributed to all of Ontario's Sexual Assault/Domestic Violence Treatment Centre (SA/DVTC) Program Coordinators/Managers. We found that the majority of Program Coordinators/ Managers favored expansion of their program mandates to include an elder abuse care program. However, these respondents viewed collaboration with a large network of well trained professionals and available services in the community that address elder abuse as integral to responding in a coordinated manner. The expansion of health services to address the needs of abused older adults in a comprehensive and integrated manner should be considered as an important next step for hospital-based violence care programs worldwide.

Effectiveness of a transitional home care program in reducing acute hospital utilization: a quasi-experimental study.

PubMed

Low, Lian Leng; Vasanwala, Farhad Fakhrudin; Ng, Lee Beng; Chen, Cynthia; Lee, Kheng Hock; Tan, Shu Yun

2015-03-14

Improving healthcare utilization is essential as health systems around the world grapple with the escalating demands for acute hospital resources. Evidence suggests that transitional care programs are effective to improve utilization of healthcare. However, the evidence for transitional care programs that enhance the home medical care model and provide multi-disciplinary patient-centered care is not well established. We evaluated if a transitional home care program operated by the Singapore General Hospital was effective in reducing acute hospital utilization. We performed a quasi-experimental study using a pre-post design to evaluate the effectiveness of a transitional home care program in reducing hospital admissions and emergency department attendances of medically complex patients enrolled into the program in a tertiary hospital in Singapore. Patients received a comprehensive needs assessment performed by the physician and a nurse case manager in the home setting, followed by an individualized care plan that included medical and nursing care, patient education and coordination of care with hospital specialists and community services. Primary study outcomes were emergency department attendances and hospital admissions to all hospitals. These were extracted from hospital administrative data and national health records. Wilcoxon Signed Ranks Test was used for assess differences in pre and post continuous data. Overall, 262 patients were enrolled into the program and 259 were analyzed. Patients had a 51.6% and 52.8% reduction in hospital admissions in the three-month and six-month post enrollment, respectively. Similarly, a 47.1% and 48.2% reduction was observed for emergency department attendances in the three and six months post enrollment, respectively. The average difference in per patient hospital bed days in the pre- and post-enrollment periods were 12.05 days and 20.03 days at the 3-month and 6-month periods, respectively. Patients enrolled in the transitional home care program had significantly lower acute hospital utilization through the reduction of emergency department attendances and hospital admissions. A comprehensive assessment of patients' medical and social needs in the home setting and formulation of an individualized care plan optimized post-discharge care for medically complex patients.

Long term care needs and personal care services under Medicaid: a survey of administrators.

PubMed

Palley, H A; Oktay, J S

1991-01-01

Home and community based care services constitute a public initiative in the development of a long term care service network. One such home based initiative is the personal care service program of Medicaid. The authors conducted a national survey of administrators of this program. They received a response from 16 administrators of such programs in 1987-1988. The responses raise significant issues regarding training, access to and equity of services, quality of services, administrative oversight and the coordination of home-based care in a network of available services. Based on administrator responses, the authors draw several conclusions.

Results of the 2013 National Resident Matching Program: family medicine.

PubMed

Biggs, Wendy S; Crosley, Philip W; Kozakowski, Stanley M

2013-10-01

The percentage of US seniors who chose primary care careers remains well below the nation's future workforce needs. Entrants into family medicine residency programs, along with their colleagues entering other primary care-designated residencies, will compose the primary care workforce of the future. Data in this article are collected from the 2013 National Resident Matching Program (NRMP) Main Residency Match and the 2013 American Academy of Family Physicians (AAFP) Medical Education Residency Census. The information provided includes the number of applicants to graduate medical education programs for the 2013--2014 academic year, specialty choice, and trends in specialty selection. Family medicine residency programs experienced a modest increase in both the overall fill rate as well as the number of positions filled with US seniors through the NRMP in 2013 in comparison to 2012. Other primary care fields, primary care internal medicine positions, pediatrics-primary care, and internal medicine-pediatrics programs also experienced modest increases in 2013. The 2013 NRMP results show a small increase in medical students choosing primary care careers for the fourth year in a row. Changes in the NRMP Match process in 2013 make a comparison to prior years' Match results difficult. Medical school admission changes, loan repayment, and improved primary care reimbursement may help increase the number of students pursuing family medicine.

The Impact of a Primary Care Education Program Regarding Cancer Survivorship Care Plans: Results from an Engineering, Primary Care, and Oncology Collaborative for Survivorship Health.

PubMed

Donohue, SarahMaria; Haine, James E; Li, Zhanhai; Trowbridge, Elizabeth R; Kamnetz, Sandra A; Feldstein, David A; Sosman, James M; Wilke, Lee G; Sesto, Mary E; Tevaarwerk, Amye J

2017-09-20

Survivorship care plans (SCPs) have been recommended as tools to improve care coordination and outcomes for cancer survivors. SCPs are increasingly being provided to survivors and their primary care providers. However, most primary care providers remain unaware of SCPs, limiting their potential benefit. Best practices for educating primary care providers regarding SCP existence and content are needed. We developed an education program to inform primary care providers of the existence, content, and potential uses for SCPs. The education program consisted of a 15-min presentation highlighting SCP basics presented at mandatory primary care faculty meetings. An anonymous survey was electronically administered via email (n = 287 addresses) to evaluate experience with and basic knowledge of SCPs pre- and post-education. A total of 101 primary care advanced practice providers (APPs) and physicians (35% response rate) completed the baseline survey with only 23% reporting prior receipt of a SCP. Only 9% could identify the SCP location within the electronic health record (EHR). Following the education program, primary care physicians and APPs demonstrated a significant improvement in SCP knowledge, including improvement in their ability to locate one within the EHR (9 vs 59%, p < 0.0001). A brief educational program containing information about SCP existence, content, and location in the EHR increased primary care physician and APP knowledge in these areas, which are prerequisites for using SCP in clinical practice.

Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital

PubMed Central

van der Knaap, Ronald; Bouhannouch, Fatiha; Borgsteede, Sander D.; Janssen, Marjo J. A.; Siegert, Carl E. H.; Egberts, Toine C. G.; van den Bemt, Patricia M. L. A.; van Wier, Marieke F.; Bosmans, Judith E.

2017-01-01

Background To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective. Methods A controlled clinical trial was performed at the Internal Medicine department of a general teaching hospital. All admitted patients using at least one prescription drug were included. The COACH program consisted of medication reconciliation, patient counselling at discharge, and communication to healthcare providers in primary care. The primary outcome was the proportion of patients with an unplanned rehospitalisation within three months after discharge. Also, the number of quality-adjusted life-years (QALYs) was assessed. Cost data were collected using cost diaries. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios between the groups was estimated by bootstrapping. Results In the COACH program, 168 patients were included and in usual care 151 patients. There was no significant difference in the proportion of patients with unplanned rehospitalisations (mean difference 0.17%, 95% CI -8.85;8.51), and in QALYs (mean difference -0.0085, 95% CI -0.0170;0.0001). Total costs for the COACH program were non-significantly lower than usual care (-€1160, 95% CI -3168;847). Cost-effectiveness planes showed that the program was not cost-effective compared with usual care for unplanned rehospitalisations and QALYs gained. Conclusion The COACH program was not cost-effective in comparison with usual care. Future studies should focus on high risk patients and include other outcomes (e.g. adverse drug events) as this may increase the chances of a cost-effective intervention. Dutch trial register NTR1519 PMID:28445474

Making It Local: Beacon Communities Use Health Information Technology to Optimize Care Management

PubMed Central

Allen, Amy; Des Jardins, Terrisca R.; Heider, Arvela; Kanger, Chatrian R.; Lobach, David F.; McWilliams, Lee; Polello, Jennifer M.; Schachter, Abigail A.; Singh, Ranjit; Sorondo, Barbara; Tulikangas, Megan C.; Turske, Scott A.

2014-01-01

Abstract Care management aims to provide cost-effective, coordinated, non-duplicative care to improve care quality, population health, and reduce costs. The 17 communities receiving funding from the Office of the National Coordinator for Health Information Technology through the Beacon Community Cooperative Agreement Program are leaders in building and strengthening their health information technology (health IT) infrastructure to provide more effective and efficient care management. This article profiles 6 Beacon Communities' health IT-enabled care management programs, highlighting the influence of local context on program strategy and design, and describing challenges, lessons learned, and policy implications for care delivery and payment reform. The unique needs (eg, disease burden, demographics), community partnerships, and existing resources and infrastructure all exerted significant influence on the overall priorities and design of each community's care management program. Though each Beacon Community needed to engage in a similar set of care management tasks—including patient identification, stratification, and prioritization; intervention; patient engagement; and evaluation—the contextual factors helped shape the specific strategies and tools used to carry out these tasks and achieve their objectives. Although providers across the country are striving to deliver standardized, high-quality care, the diverse contexts in which this care is delivered significantly influence the priorities, strategies, and design of community-based care management interventions. Gaps and challenges in implementing effective community-based care management programs include: optimizing allocation of care management services; lack of available technology tailored to care management needs; lack of standards and interoperability; integrating care management into care settings; evaluating impact; and funding and sustainability. (Population Health Management 2014;17:149–158) PMID:24476558

Setting Standards at the Forefront of Delivery System Reform: Aligning Care Coordination Quality Measures for Multiple Chronic Conditions

PubMed Central

DuGoff, Eva H.; Dy, Sydney; Giovannetti, Erin R.; Leff, Bruce; Boyd, Cynthia M.

2015-01-01

The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for health care providers and policymakers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs. PMID:24004040

Day Care: A Program in Search of a Policy.

ERIC Educational Resources Information Center

Bikales, Gerda

This report examines current issues relating to day care and challenges many of the policy assumptions that underlie a major public program of subsidized day care for children. A historical perspective of day care is presented and various types of day care are described. The costs and benefits of day care are examined and the relation of day care…

Parent Experiences with State Child Care Subsidy Systems and Their Perceptions of Choice and Quality in Care Selected

ERIC Educational Resources Information Center

Raikes, Helen; Torquati, Julia; Wang, Cixin; Shjegstad, Brinn

2012-01-01

Research Findings: This study investigated parents' experiences using Child Care and Development Fund and other state-dispersed child care subsidies, reasons for choosing their current child care program, and perceptions of the quality of child care received from their current program. A telephone survey of 659 parents receiving child care…

A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial.

PubMed

Rojas, Graciela; Guajardo, Viviana; Martínez, Pablo; Castro, Ariel; Fritsch, Rosemarie; Moessner, Markus; Bauer, Stephanie

2018-04-30

In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management of depressive patients. Future cost-effectiveness studies are needed. Clinicaltrials.gov NCT02200367; https://clinicaltrials.gov/ct2/show/NCT02200367 (Archived by WebCite at http://www.webcitation.org/6xtZ7OijZ). ©Graciela Rojas, Viviana Guajardo, Pablo Martínez, Ariel Castro, Rosemarie Fritsch, Markus Moessner, Stephanie Bauer. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.04.2018.

An Insurer's Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs.

PubMed

Polinski, Jennifer M; Moore, Janice M; Kyrychenko, Pavlo; Gagnon, Michael; Matlin, Olga S; Fredell, Joshua W; Brennan, Troyen A; Shrank, William H

2016-07-01

Adverse drug events and the challenges of clarifying and adhering to complex medication regimens are central drivers of hospital readmissions. Medication reconciliation programs can reduce the incidence of adverse drug events after discharge, but evidence regarding the impact of medication reconciliation on readmission rates and health care costs is less clear. We studied an insurer-initiated care transition program based on medication reconciliation delivered by pharmacists via home visits and telephone and explored its effects on high-risk patients. We examined whether voluntary program participation was associated with improved medication use, reduced readmissions, and savings net of program costs. Program participants had a 50 percent reduced relative risk of readmission within thirty days of discharge and an absolute risk reduction of 11.1 percent. The program saved $2 for every $1 spent. These results represent real-world evidence that insurer-initiated, pharmacist-led care transition programs, focused on but not limited to medication reconciliation, have the potential to both improve clinical outcomes and reduce total costs of care. Project HOPE—The People-to-People Health Foundation, Inc.

Two steps forward, one step back: changes in palliative care consultation services in California hospitals from 2007 to 2011.

PubMed

Pantilat, Steven Z; O'Riordan, David L; Bruno, Kelly A

2014-11-01

The number of palliative care consultation services is growing, yet little is known about how program characteristics change over time. Compare changes in the characteristics of palliative care programs and palliative care consultation services in 2007 and 2011. We surveyed all hospitals in California in 2011 and compared palliative care program and palliative care consultation service characteristics with survey results from 2007. There were 41 new palliative care programs since 2007; 17 programs closed between 2007 and 2011. Hospital characteristics associated with the closure of a palliative care program included a hospital size of 1-149 beds versus 150 or more (p=0.03), for-profit status (p=0.001), and having no system affiliation (p=0.0001). The prevalence of palliative care consultation services was 33% in 2007 and 37% in 2011 (p=0.3). At both time periods nearly all palliative care consultation services (98%) were available onsite during weekday business hours and only half were available at other times (p=0.4). There was an increase (p=0.002) in nurse/physician full-time equivalent (FTE; 2007, mean=1.5; 95% confidence interval [CI]=1.3-1.7; 2011, mean=1.9; 95% CI=1.6-2.2) but fewer teams reported having social workers (58% versus 80%, p=0.002) and chaplains (58% versus 77%, p=0.0001) in 2011. Over half of the palliative care consultation services reported seeing less than 50% of patients who would benefit from a consultation (2007: 59%, 2011=50%, p=0.2), yet most also reported struggling to cope with patient volume (2007: 62%; 2011: 66%, p=0.5). Fewer than half of hospitals in California offer a palliative care program and many close over time. Making palliative care consultation services a condition of participation by insurers could make hospital palliative care consultation services universal. Mechanisms need to be established to improve staffing levels, maintain the interdisciplinary nature of palliative care consultation services, and accommodate demand for services.

32 CFR 536.155 - Claims payable involving tortfeasors other than nonappropriated fund employees.

Code of Federal Regulations, 2014 CFR

2014-07-01

... particular NAF activity. (2) Family child care providers, authorized members of the provider's household and approved substitute providers while care under the family child care program is being provided in the... to, or death of, children receiving care under the family child care program that are caused by the...

32 CFR 536.155 - Claims payable involving tortfeasors other than nonappropriated fund employees.

Code of Federal Regulations, 2012 CFR

2012-07-01

... particular NAF activity. (2) Family child care providers, authorized members of the provider's household and approved substitute providers while care under the family child care program is being provided in the... to, or death of, children receiving care under the family child care program that are caused by the...

32 CFR 536.155 - Claims payable involving tortfeasors other than nonappropriated fund employees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... particular NAF activity. (2) Family child care providers, authorized members of the provider's household and approved substitute providers while care under the family child care program is being provided in the... to, or death of, children receiving care under the family child care program that are caused by the...

32 CFR 536.155 - Claims payable involving tortfeasors other than nonappropriated fund employees.

Code of Federal Regulations, 2013 CFR

2013-07-01

... particular NAF activity. (2) Family child care providers, authorized members of the provider's household and approved substitute providers while care under the family child care program is being provided in the... to, or death of, children receiving care under the family child care program that are caused by the...

32 CFR 536.155 - Claims payable involving tortfeasors other than nonappropriated fund employees.

Code of Federal Regulations, 2011 CFR

2011-07-01

... particular NAF activity. (2) Family child care providers, authorized members of the provider's household and approved substitute providers while care under the family child care program is being provided in the... to, or death of, children receiving care under the family child care program that are caused by the...

76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012...

5 CFR 792.200 - What are the benefits of the child care subsidy program law?

Code of Federal Regulations, 2010 CFR

2010-01-01

... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES' HEALTH AND COUNSELING PROGRAMS Agency... at Federal child care centers, non-Federal child care centers, and in family child care homes for... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What are the benefits of the child care...

Teacher Perspectives on the Practice of Continuity of Care

ERIC Educational Resources Information Center

Longstreth, Sascha; Garrity, Sarah; Ritblatt, Shulamit N.; Olson, Kelsey; Virgilio, Ashley; Dinh, Hilary; Padamada, Shane

2016-01-01

This study aims to address gaps in the literature on continuity of care through focus group interviews with teachers at public early care and education programs in San Diego County, California, USA. To better understand various perspectives on continuity of care, focus groups were conducted at programs that currently practice continuity of care,…

78 FR 45176 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-26

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2013 Through June 30, 2014...

76 FR 43254 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012...

Center to Advance Palliative Care palliative care clinical care and customer satisfaction metrics consensus recommendations.

PubMed

Weissman, David E; Morrison, R Sean; Meier, Diane E

2010-02-01

Data collection and analysis are vital for strategic planning, quality improvement, and demonstration of palliative care program impact to hospital administrators, private funders and policymakers. Since 2000, the Center to Advance Palliative Care (CAPC) has provided technical assistance to hospitals, health systems and hospices working to start, sustain, and grow nonhospice palliative care programs. CAPC convened a consensus panel in 2008 to develop recommendations for specific clinical and customer metrics that programs should track. The panel agreed on four key domains of clinical metrics and two domains of customer metrics. Clinical metrics include: daily assessment of physical/psychological/spiritual symptoms by a symptom assessment tool; establishment of patient-centered goals of care; support to patient/family caregivers; and management of transitions across care sites. For customer metrics, consensus was reached on two domains that should be tracked to assess satisfaction: patient/family satisfaction, and referring clinician satisfaction. In an effort to ensure access to reliably high-quality palliative care data throughout the nation, hospital palliative care programs are encouraged to collect and report outcomes for each of the metric domains described here.

Kansas Primary Care Weighs In: A Pilot Randomized Trial of a Chronic Care Model Program for Obesity in 3 Rural Kansas Primary Care Practices

ERIC Educational Resources Information Center

Ely, Andrea C.; Banitt, Angela; Befort, Christie; Hou, Qing; Rhode, Paula C.; Grund, Chrysanne; Greiner, Allen; Jeffries, Shawn; Ellerbeck, Edward

2008-01-01

Context: Obesity is a chronic disease of epidemic proportions in the United States. Primary care providers are critical to timely diagnosis and treatment of obesity, and need better tools to deliver effective obesity care. Purpose: To conduct a pilot randomized trial of a chronic care model (CCM) program for obesity care in rural Kansas primary…

A Palliative Cancer Care Flexible Education Program for Australian Community Pharmacists

PubMed Central

Marriott, Jennifer L.; Beattie, Jill; Nation, Roger L.; Dooley, Michael J.

2010-01-01

Objective To implement and evaluate a flexible palliative care education program for Australian community pharmacists. Design After identifying pharmacists' education needs, the program content and format were developed. This included identifying expert writers to create modules, assigning education and palliative care specialists to review content, and designing Web hosting of materials. The program was comprised of 11 modules and 79 activities. Assessment An average of 28 responses was posted for each of the 20 noticeboard activities. Of the 60 pharmacists who began the program, 15 contributed to the discussion group, with an average of 3 posts each. Participants' responses to an online questionnaire indicated the program addressed their education needs and improved their knowledge and confidence in providing palliative cancer care. Conclusion A program that pharmacists could access at a time and place convenient to them via the Internet was developed. Pharmacists indicated the program positively impacted their practice. PMID:20414437

A palliative cancer care flexible education program for Australian community pharmacists.

PubMed

Hussainy, Safeera Yasmeen; Marriott, Jennifer L; Beattie, Jill; Nation, Roger L; Dooley, Michael J

2010-03-10

To implement and evaluate a flexible palliative care education program for Australian community pharmacists. After identifying pharmacists' education needs, the program content and format were developed. This included identifying expert writers to create modules, assigning education and palliative care specialists to review content, and designing Web hosting of materials. The program was comprised of 11 modules and 79 activities. An average of 28 responses was posted for each of the 20 noticeboard activities. Of the 60 pharmacists who began the program, 15 contributed to the discussion group, with an average of 3 posts each. Participants' responses to an online questionnaire indicated the program addressed their education needs and improved their knowledge and confidence in providing palliative cancer care. A program that pharmacists could access at a time and place convenient to them via the Internet was developed. Pharmacists indicated the program positively impacted their practice.

Evaluation of a program to strengthen general practice care for patients with chronic disease in Germany.

PubMed

Wensing, Michel; Szecsenyi, Joachim; Stock, Christian; Kaufmann Kolle, Petra; Laux, Gunter

2017-01-21

A program to strengthen general practice care for patients with chronic disease was offered in Germany. Enrollment was a free individual choice for both patients and physicians. This study aimed to examine the long-term impact of this program. Two comparative evaluations were done, at 4 and 5 years (T1 and T2) after start of the program. In each year, patients in the program were compared with patients in usual care. Measures were based on routinely collected data and concerned 11 aspects of primary care and hospital care. Study groups were compared, using regression analysis adjusted for confounders and clustering. Data on 1.187.597 and 1.591.017 eligible patients were available for the analysis for T1 and T2, respectively. Compared to usual care, the program was associated with more visits to the GP per patient (adjusted difference at T2: +1.98), more drugs prescribed per patient (+0.071), lower percentage of drugs that should be avoided (-0.699), and lower yearly medication costs per patient (-85.39 euro). The number of referrals to ambulatory specialists, either with or without referral from GP, was reduced at T2. In hospital care, the program was associated with fewer hospital admissions per patient per year (-0.017) and fewer avoidable hospital admissions of all admissions (-1.165%). Total hospital costs were slightly higher in T1, but lower in T2. Days in hospital and number of readmissions were lower at T2 only. The program has increased the role of general practice in healthcare for patients who chose to be included in the program of intensified general practice care.

A Needs Assessment of Brain Death Education in Pediatric Critical Care Medicine Fellowships.

PubMed

Ausmus, Andrew M; Simpson, Pippa M; Zhang, Liyun; Petersen, Tara L

2018-04-12

To assess the current training in brain death examination provided during pediatric critical care medicine fellowship. Internet-based survey. United States pediatric critical care medicine fellowship programs. Sixty-four pediatric critical care medicine fellowship program directors and 230 current pediatric critical care medicine fellows/recent graduates were invited to participate. Participants were asked demographic questions related to their fellowship programs, training currently provided at their fellowship programs, previous experience with brain death examinations (fellows/graduates), and perceptions regarding the adequacy of current training. Twenty-nine program directors (45%) and 91 current fellows/graduates (40%) responded. Third-year fellows reported having performed a median of five examinations (interquartile range, 3-6). On a five-point Likert scale, 93% of program directors responded they "agree" or "strongly agree" that their fellows receive enough instruction on performing brain death examinations compared with 67% of fellows and graduates (p = 0.007). The responses were similar when asked about opportunity to practice brain death examinations (90% vs 54%; p < 0.001). In a regression tree analysis, number of brain death examinations performed was the strongest predictor of trainee satisfaction. Both fellows and program directors preferred bedside demonstration or simulation as educational modalities to add to the fellowship curriculum. Pediatric critical care medicine fellows overall perform relatively few brain death examinations during their training. Pediatric critical care medicine fellows and program directors disagree in their perceptions of the current training in brain death examination, with fellows perceiving a need for increased training. Both program directors and fellows prefer additional training using bedside demonstration or simulation. Since clinical exposure to brain death examinations is variable, adding simulated brain death examinations to the pediatric critical care medicine fellowship curriculum could help standardize the experience.

Commentary: Medicaid reform issues affecting the Indian health care system.

PubMed Central

Wellever, A; Hill, G; Casey, M

1998-01-01

Substantial numbers of Indian people rely on Medicaid for their primary health insurance coverage. When state Medicaid programs enroll Indians in managed care programs, several unintended consequences may ensue. This paper identifies some of the perverse consequences of Medicaid reform for Indians and the Indian health care system and suggests strategies for overcoming them. It discusses the desire of Indian people to receive culturally appropriate services, the need to maintain or improve Indian health care system funding, and the duty of state governments to respect tribal sovereignty. Because of their relatively small numbers, Indians may be treated differently under Medicaid managed care systems without significantly endangering anticipated program savings. Failure of Medicaid programs to recognize the uniqueness of Indian people, however, may severely weaken the Indian health care system. PMID:9491006

A holistic approach to supporting staff in a pediatric hospital setting.

PubMed

Schwerman, Nichole; Stellmacher, Judy

2012-09-01

Health care professionals experience significant stress in the workplace. Building opportunities for health care professionals to manage stress is essential. Children's Hospital of Wisconsin designed a holistic set of programs called the R&R Series to support the emotional, cognitive, and spiritual health of staff and assist staff in using self-care strategies to build resiliency. Six hundred seventy program evaluations were collected during a 1-year pilot series. Program participants were from a wide variety of departments throughout the health care system. Staff reported feeling more supported, being better able to manage work and life stress, and practicing the self-care techniques they learned. Programs such as the R&R Series are one way to promote the overall health and resiliency of health care professionals. Copyright 2012, SLACK Incorporated.

Implementation and maintenance of patient navigation programs linking primary care with community-based health and social services: a scoping literature review.

PubMed

Valaitis, Ruta K; Carter, Nancy; Lam, Annie; Nicholl, Jennifer; Feather, Janice; Cleghorn, Laura

2017-02-06

Since the early 90s, patient navigation programs were introduced in the United States to address inequitable access to cancer care. Programs have since expanded internationally and in scope. The goals of patient navigation programs are to: a) link patients and families to primary care services, specialist care, and community-based health and social services (CBHSS); b) provide more holistic patient-centred care; and, c) identify and resolve patient barriers to care. This paper fills a gap in knowledge to reveal what is known about motivators and factors influencing implementation and maintenance of patient navigation programs in primary care that link patients to CBHSS. It also reports on outcomes from these studies to help identify gaps in research that can inform future studies. This scoping literature review involved: i) electronic database searches; ii) a web site search; iii) a search of reference lists from literature reviews; and, iv) author follow up. It included papers from Canada, the United States, the United Kingdom, Australia, New Zealand, and/or Western Europe published between January 1990 and June 2013 if they discussed navigators or navigation programs in primary care settings that linked patients to CBHSS. Of 34 papers, most originated in the United States (n = 29) while the remainder were from the United Kingdom, Canada and Australia. Motivators for initiating navigation programs were to: a) improve delivery of health and social care services; b) support and manage specific health needs or specific population needs, and; c) improve quality of life and wellbeing of patients. Eleven factors were found to influence implementation and maintenance of these patient navigation programs. These factors closely aligned with the Diffusion of Innovation in Service Organizations model, thus providing a theoretical foundation to support them. Various positive outcomes were reported for patients, providers and navigators, as well as the health and social care system, although they need to be considered with caution since the majority of studies were descriptive. This study contributes new knowledge that can inform the initiation and maintenance of primary care patient navigation programs that link patients with CBHSS. It also provides directions for future research.

78 FR 23702 - Copayment for Extended Care Services

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-22

... Administrative practice and procedure, Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse, Government contracts, Grant programs--health, Grant programs--veterans, Health care, Health facilities... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AO59 Copayment for Extended Care Services...

78 FR 70863 - Copayment for Extended Care Services

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-27

... procedure, Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse, Government contracts, Grant programs-health, Grant programs-veterans, Health care, Health facilities, Health professions... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AO59 Copayment for Extended Care Services...

Initiating a Reiki or CAM program in a healthcare organization--developing a business plan.

PubMed

Vitale, Anne

2014-01-01

Complementary and alternative medicine (CAM) services, such as Reiki, continue to be offered to consumers in many hospitals and other health care organizations. There is growing interest among nurses, doctors, and other health care providers for the integration of CAM therapies into traditional settings. Health care organizations are responding to this need but may not know how to start CAM programs. Starting a Reiki program in a health care setting must be envisioned in a business model approach. This article introduces nurses and other health care providers to the basic concepts of business plan development and important steps to follow when starting a Reiki or CAM program.

Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study.

PubMed

Allen, Suzanne M; Ballweg, Ruth A; Cosgrove, Ellen M; Engle, Kellie A; Robinson, Lawrence R; Rosenblatt, Roger A; Skillman, Susan M; Wenrich, Marjorie D

2013-12-01

The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions.

PubMed

Isenberg, Sarina R; Lu, Chunhua; McQuade, John; Chan, Kelvin K W; Gill, Natasha; Cardamone, Michael; Torto, Deirdre; Langbaum, Terry; Razzak, Rab; Smith, Thomas J

2017-05-01

Palliative care inpatient units (PCUs) can improve symptoms, family perception of care, and lower per-diem costs compared with usual care. In March 2013, Johns Hopkins Medical Institutions (JHMI) added a PCU to the palliative care (PC) program. We studied the financial impact of the PC program on JHMI from March 2013 to March 2014. This study considered three components of the PC program: PCU, PC consultations, and professional fees. Using 13 months of admissions data, the team calculated the per-day variable cost pre-PCU (ie, in another hospital unit) and after transfer to the PCU. These fees were multiplied by the number of patients transferred to the PCU and by the average length of stay in the PCU. Consultation savings were estimated using established methods. Professional fees assumed a collection rate of 50%. The total positive financial impact of the PC program was $3,488,863.17. There were 153 transfers to the PCU, 60% with cancer, and an average length of stay of 5.11 days. The daily loss pretransfer to the PCU of $1,797.67 was reduced to $1,345.34 in the PCU (-25%). The PCU saved JHMI $353,645.17 in variable costs, or $452.33 per transfer. Cost savings for PC consultations in the hospital, 60% with cancer, were estimated at $2,765,218. $370,000 was collected in professional fees savings. The PCU and PC program had a favorable impact on JHMI while providing expert patient-centered care. As JHMI moves to an accountable care organization model, value-based patient-centered care and increased intensive care unit availability are desirable.

Effect of the California Tobacco Control Program on Personal Health Care Expenditures

PubMed Central

Lightwood, James M; Dinno, Alexis; Glantz, Stanton A

2008-01-01

Background Large state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California's large-scale tobacco control program on aggregate personal health care expenditures in the state. Methods and Findings Cointegrating regressions were used to predict (1) the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2) the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures between the control states and California between 1980 and 2004. Between 1989 (when it started) and 2004, the California program was associated with $86 billion (2004 US dollars) (95% confidence interval [CI] $28 billion to $151 billion) lower health care expenditures than would have been expected without the program. This reduction grew over time, reaching 7.3% (95% CI 2.7%–12.1%) of total health care expenditures in 2004. Conclusions A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures. PMID:18752344

Interdisciplinary treatment of diabetes mellitus in a military treatment facility.

PubMed

Earles, J E; Hartung, G H; Dickert, J M; Moriyama, H H; Coll, K J; Aiello, L M; Jackson, R; Polonsky, W

2001-10-01

The American Diabetes Association emphasizes interdisciplinary management as the standard of care for patients with diabetes. Many times, however, interdisciplinary means various health care professionals treating a patient but not necessarily interacting with each other regarding the patient's care. Recently, Tripler Army Medical Center replicated the Joslin Diabetes Center's diabetes outpatient intensive treatment program as part of a Joslin Diabetes Center/Department of Defense/Veteran's Administration research collaboration. Tripler Army Medical Center named this interdisciplinary program Holopono, which is Hawaiian for success. Holopono is a team of health care professionals providing integrated care and education to a group of diabetes patients over 3.5 days. Individual care management, aided by an Internet-based telemedicine system, then continues for 1 year after entry into the program. This article describes the Holopono program, the role of each team member, and how the team functions together to provide comprehensive diabetes care.

Crisis Nursery and Respite Care Programs: Site Visit Results of Staff and Family Interviews (Winter and Spring of 1991).

ERIC Educational Resources Information Center

Huntington, Gail S.; And Others

Visits were made to selected respite care and crisis nursery programs in order to describe the programs and services they offered to families of young children with special needs and to learn more about the families who used the services and the staff who provided them. The visits to 10 crisis nurseries and 24 respite care programs resulted in…

Awareness of the Food and Drug Administration's Bad Ad Program and Education Regarding Pharmaceutical Advertising: A National Survey of Prescribers in Ambulatory Care Settings.

PubMed

O'Donoghue, Amie C; Boudewyns, Vanessa; Aikin, Kathryn J; Geisen, Emily; Betts, Kevin R; Southwell, Brian G

2015-01-01

The U.S. Food and Drug Administration's Bad Ad program educates health care professionals about false or misleading advertising and marketing and provides a pathway to report suspect materials. To assess familiarity with this program and the extent of training about pharmaceutical marketing, a sample of 2,008 health care professionals, weighted to be nationally representative, responded to an online survey. Approximately equal numbers of primary care physicians, specialists, physician assistants, and nurse practitioners answered questions concerning Bad Ad program awareness and its usefulness, as well as their likelihood of reporting false or misleading advertising, confidence in identifying such advertising, and training about pharmaceutical marketing. Results showed that fewer than a quarter reported any awareness of the Bad Ad program. Nonetheless, a substantial percentage (43%) thought it seemed useful and 50% reported being at least somewhat likely to report false or misleading advertising in the future. Nurse practitioners and physician assistants expressed more openness to the program and reported receiving more training about pharmaceutical marketing. Bad Ad program awareness is low, but opportunity exists to solicit assistance from health care professionals and to help health care professionals recognize false and misleading advertising. Nurse practitioners and physician assistants are perhaps the most likely contributors to the program.

"Doing the heavy lifting: health care workers take back their backs".

PubMed

Morse, Tim; Fekieta, Renee; Rubenstein, Harriet; Warren, Nick; Alexander, Darryl; Wawzyniecki, Patricia

2008-01-01

Health care workers have the highest musculoskeletal disorder prevalence and incidence of any occupational/industry group, and patient handling tasks are so biomechanically demanding that they cannot be made safe through the commonly used, technique-oriented methods such as "back school" training programs. Although there is standard-setting activity for "no-lift" programs in some states, there is still no federal standard. Health care worker unions and nurses' associations have begun to take action through training members in equipment need, use, and acceptance in programs to encourage adoption of no-lifting programs. Acceptance of lifting equipment is increasing due to recognition of the high human and economic costs of MSD, consistent documentation of cost savings from no-lift programs, major improvements in lifting equipment, and shortages of health care staff. An action-oriented training program for health care workers is described that provides knowledge about the 1) Scope of the current problem of back injuries in health care, 2) Costs of injuries, both to workers and to the hospital, 3) Elements of a safe patient-handling program, and 4) Success stories. The program also builds skills through: 1) Hands-on experience with safe lifting equipment, and 2) Assessing organizational and union readiness and planning for action at the workplace.

Setting standards at the forefront of delivery system reform: aligning care coordination quality measures for multiple chronic conditions.

PubMed

DuGoff, Eva H; Dy, Sydney; Giovannetti, Erin R; Leff, Bruce; Boyd, Cynthia M

2013-01-01

The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-Based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for healthcare providers and policy makers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs. © 2013 National Association for Healthcare Quality.

The impact of care management information technology model on quality of care after percutaneous coronary intervention: "Bridging the Divides".

PubMed

Weintraub, William S; Fanari, Zaher; Elliott, Daniel; Ostertag-Stretch, Jennifer; Muther, Ann; Lynahan, Margaret; Kerzner, Roger; Salam, Tabassum; Scherrer, Herbert; Anderson, Sharon; Russo, Carla A; Kolm, Paul; Steinberg, Terri H

2017-07-03

Reducing readmissions and improving metrics of care are a national priority. Supplementing traditional care with care management may improve outcomes. The Bridges program was an initial evaluation of a care management platform (CareLinkHub), supported by information technology (IT) developed to improve the quality and transition of care from hospital to home after percutaneous coronary intervention (PCI) and reduce readmissions. CareLink is comprised of care managers, patient navigators, pharmacists and physicians. Information to guide care management is guided by a middleware layer to gather information, PLR (ColdLight Solutions, LLC) and presented to CareLink staff on a care management platform, Aerial™ (Medecision). An additional analytic engine [Neuron™ (ColdLight Solutions, LLC)] helps, evaluates and guide care. The "Bridges" program enrolled a total of 2054 PCI patients with 2835 admission from April, 1st 2013 through March 1st, 2015. The data of the program was compared with those of 3691 PCI patients with 4414 admissions in the 3years prior to the program. No impact was seen with respect to inpatient and observation readmission, or emergency department visits. Similarly no change was noticed in LDL control. There was minimal improvement in BP control and only in the CTM-3 and SAQ-7 physical limitation scores in the patients' reported outcomes. Patient follow-up with physicians within 1week of discharge improved during the Bridges years. The CareLink hub platform was successfully implemented. Little or no impact on outcome metrics was seen in the short follow-up time. The Bridges program suggests that population health management must be a long-term goal, improving preventive care in the community. Copyright © 2017 Elsevier Inc. All rights reserved.

Geriatric Foot Care: A Model Educational Program for Mid-Level Practitioners.

ERIC Educational Resources Information Center

Suggs, Patricia K.; Krissak, Ruth; Caruso, Frank; Teasdall, Robert

2002-01-01

An educational program on geriatric foot care was completed by 59 nurse practitioners, 12 physicians' assistants, and 1 physician. The 3 1/2 day program included interactive sessions, observation, and hands-on patient care. Posttest results and 6-month follow-up showed significant knowledge increases and incorporation of learning into practice.…

42 CFR 1001.201 - Conviction relating to program or health care fraud.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Conviction relating to program or health care fraud... Permissive Exclusions § 1001.201 Conviction relating to program or health care fraud. (a) Circumstance for... misdemeanor relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial...

42 CFR 1001.201 - Conviction relating to program or health care fraud.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Conviction relating to program or health care fraud... Permissive Exclusions § 1001.201 Conviction relating to program or health care fraud. (a) Circumstance for... misdemeanor relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial...

Peer Mentoring in Long-Term Care: Rational, Design, and Retention

ERIC Educational Resources Information Center

Hegeman, Carol; Hoskinson, Debi; Munro, Heather; Maiden, Patricia; Pillemer, Karl

2007-01-01

This article describes two successful peer-mentoring programs designed to improve the quality of care in nursing homes and retention rates among direct care staff. The first program, "Growing Strong Roots," examined CNA retention rates and the second program, "Peer Mentoring for Long Term Charge Nurses," examined RN and LPN retention rates. These…

Evaluation of Access, a Primary Care Program for Indigent Patients: Inpatient and Emergency Room Utilization.

ERIC Educational Resources Information Center

Davidson, Richard A.; Giancola, Angela; Gast, Andrea; Ho, Janice; Waddell, Rhondda

2003-01-01

Evaluated the impact of Accessing Community Care through Eastside Social Services (ACCESS), a program that provided indigent patients with free primary care, on inpatient admissions, emergency room (ER) visits, and subsequent charges. Data on 19 people before and after program enrollment showed significant decreases in ER visits following…

75 FR 69452 - Solicitation of Information and Recommendations for Supplementing the Guidance Provided in the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-12

... Effect of Exclusion from Participation in Federal Health Care Programs AGENCY: Office of Inspector... from Participation in Federal Health Care Programs (64 FR 52791; September 30, 1999) and solicits input... Federal Health Care Programs. Please assist us by referencing the file code OIG-115-N. Inspection of...

Child Care and Child Nutrition

ERIC Educational Resources Information Center

Karolak, Eric

2009-01-01

The weak economy is challenging the child care program budget. Fluctuations in enrollment come up against rising costs making every penny count. So for many reasons a federal program that helps defray the costs of snacks and meals in child care programs is particularly important and timely. In this article, the author pushes for the…

75 FR 54898 - Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-09

... Intervention Services Grant Under the Ryan White HIV/AIDS Program AGENCY: Health Resources and Services... Part C funds under The Ryan White HIV/AIDS Program to support comprehensive primary care services for persons living with HIV/AIDS, including primary medical care, laboratory testing, oral health care...

77 FR 69550 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-19

... (Patient Satisfaction Survey Michael E. DeBakey Home Care Program) Activity: Comment Request AGENCY... information needed to determine patients' satisfaction with services provided by or through the Michael E...: Patient Satisfaction Survey Michael E. DeBakey Home Care Program, VA Form 10-0476. OMB Control Number...

The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia.

PubMed

Ahmad Sharoni, Siti Khuzaimah; Abdul Rahman, Hejar; Minhat, Halimatus Sakdiah; Shariff-Ghazali, Sazlina; Azman Ong, Mohd Hanafi

2018-01-01

Self-care behaviour is essential in preventing diabetes foot problems. This study aimed to evaluate the effectiveness of health education programs based on the self-efficacy theory on foot self-care behaviour for older adults with diabetes. A randomised controlled trial was conducted for 12 weeks among older adults with diabetes in elderly care facility in Peninsular Malaysia. Six elderly care facility were randomly allocated by an independent person into two groups (intervention and control). The intervention group (three elderly care facility) received a health education program on foot self-care behaviour while the control group (three elderly care facility) received standard care. Participants were assessed at baseline, and at week-4 and week-12 follow-ups. The primary outcome was foot-self-care behaviour. Foot care self-efficacy (efficacy expectation), foot care outcome expectation, knowledge of foot care and quality of life were the secondary outcomes. Data were analysed with Mixed Design Analysis of Variance using the Statistical Package for the Social Sciences version 22.0. 184 respondents were recruited but only 76 met the selection criteria and were included in the analysis. Foot self-care behaviour, foot care self-efficacy (efficacy expectation), foot care outcome expectation and knowledge of foot care improved in the intervention group compared to the control group (p < 0.05). However, some of these improvements did not significantly differ compared to the control group for QoL physical symptoms and QoL psychosocial functioning (p > 0.05). The self-efficacy enhancing program improved foot self-care behaviour with respect to the delivered program. It is expected that in the future, the self-efficacy theory can be incorporated into diabetes education to enhance foot self-care behaviour for elderly with diabetes living in other institutional care facilities. Australian New Zealand Clinical Trial Registry ACTRN12616000210471.

The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia

PubMed Central

Abdul Rahman, Hejar; Minhat, Halimatus Sakdiah; Shariff-Ghazali, Sazlina; Azman Ong, Mohd Hanafi

2018-01-01

Background Self-care behaviour is essential in preventing diabetes foot problems. This study aimed to evaluate the effectiveness of health education programs based on the self-efficacy theory on foot self-care behaviour for older adults with diabetes. Methods A randomised controlled trial was conducted for 12 weeks among older adults with diabetes in elderly care facility in Peninsular Malaysia. Six elderly care facility were randomly allocated by an independent person into two groups (intervention and control). The intervention group (three elderly care facility) received a health education program on foot self-care behaviour while the control group (three elderly care facility) received standard care. Participants were assessed at baseline, and at week-4 and week-12 follow-ups. The primary outcome was foot-self-care behaviour. Foot care self-efficacy (efficacy expectation), foot care outcome expectation, knowledge of foot care and quality of life were the secondary outcomes. Data were analysed with Mixed Design Analysis of Variance using the Statistical Package for the Social Sciences version 22.0. Results 184 respondents were recruited but only 76 met the selection criteria and were included in the analysis. Foot self-care behaviour, foot care self-efficacy (efficacy expectation), foot care outcome expectation and knowledge of foot care improved in the intervention group compared to the control group (p < 0.05). However, some of these improvements did not significantly differ compared to the control group for QoL physical symptoms and QoL psychosocial functioning (p > 0.05). Conclusion The self-efficacy enhancing program improved foot self-care behaviour with respect to the delivered program. It is expected that in the future, the self-efficacy theory can be incorporated into diabetes education to enhance foot self-care behaviour for elderly with diabetes living in other institutional care facilities. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12616000210471 PMID:29534070

Validation of Quality Rating and Improvement Systems for Early Care and Education and School-Age Care. Research-to-Policy, Research-to-Practice Brief. OPRE 2012-29

ERIC Educational Resources Information Center

Zellman, Gail L.; Fiene, Richard

2012-01-01

Quality Rating and Improvement Systems (QRIS) for early care and education and school age care programs are designed to collect information about quality and to use that information to produce program-level ratings, which are the foundation of a QRIS. The ratings are intended to make program quality transparent for parents and other stakeholders…

Improving HIV outcomes in resource-limited countries: the importance of quality indicators.

PubMed

Ahonkhai, Aima A; Bassett, Ingrid V; Ferris, Timothy G; Freedberg, Kenneth A

2012-11-24

Resource-limited countries increasingly depend on quality indicators to improve outcomes within HIV treatment programs, but indicators of program performance suitable for use at the local program level remain underdeveloped. Using the existing literature as a guide, we applied standard quality improvement (QI) concepts to the continuum of HIV care from HIV diagnosis, to enrollment and retention in care, and highlighted critical service delivery process steps to identify opportunities for performance indicator development. We then identified existing indicators to measure program performance, citing examples used by pivotal donor agencies, and assessed their feasibility for use in surveying local program performance. Clinical delivery steps without existing performance measures were identified as opportunities for measure development. Using National Quality Forum (NQF) criteria as a guide, we developed measurement concepts suitable for use at the local program level that address existing gaps in program performance assessment. This analysis of the HIV continuum of care identified seven critical process steps providing numerous opportunities for performance measurement. Analysis of care delivery process steps and the application of NQF criteria identified 24 new measure concepts that are potentially useful for improving operational performance in HIV care at the local level. An evidence-based set of program-level quality indicators is critical for the improvement of HIV care in resource-limited settings. These performance indicators should be utilized as treatment programs continue to grow.

Comprehensive programs for preventing pressure ulcers: a review of the literature.

PubMed

Niederhauser, Andrea; VanDeusen Lukas, Carol; Parker, Victoria; Ayello, Elizabeth A; Zulkowski, Karen; Berlowitz, Dan

2012-04-01

The objective of this study was to examine the evidence supporting the combined use of interventions to prevent pressure ulcers (PrUs) in acute care and long-term-care facilities. A systematic review of the literature describing multifaceted PrU prevention programs was performed. Articles were included if they described an intervention implemented in acute care settings or long-term-care facilities, incorporated more than 1 intervention component, involved a multidisciplinary team, and included information about outcomes related to the intervention. Twenty-four studies were identified. Recurring components used in the development and implementation of PrU prevention programs included preparations prior to the start of a program, PrU prevention best practices, staff education, clinical monitoring and feedback, skin care champions, and cues to action. Ten studies reported PrU prevalence rates; 9 of them reported decreased prevalence rates at the end of their programs. Of the 6 studies reporting PrU incidence rates, 5 reported a decrease in incidence rates. Four studies measured care processes: 1 study reported an overall improvement; 2 studies reported improvement on some, but not all, measures; and 1 study reported no change. There is a growing literature describing multipronged, multidisciplinary interventions to prevent PrUs in acute care settings and long-term-care facilities. Outcomes reported in these studies suggest that such programs can be successful in reducing PrU prevalence or incidence rates. However, to strengthen the level of evidence, sites should be encouraged to rigorously evaluate their programs and to publish their results.

Neurocritical care education during neurology residency: AAN survey of US program directors.

PubMed

Sheth, K N; Drogan, O; Manno, E; Geocadin, R G; Ziai, W

2012-05-29

Limited information is available regarding the current state of neurocritical care education for neurology residents. The goal of our survey was to assess the need and current state of neurocritical care training for neurology residents. A survey instrument was developed and, with the support of the American Academy of Neurology, distributed to residency program directors of 132 accredited neurology programs in the United States in 2011. A response rate of 74% (98 of 132) was achieved. A dedicated neuroscience intensive care unit (neuro-ICU) existed in 64%. Fifty-six percent of residency programs offer a dedicated rotation in the neuro-ICU, lasting 4 weeks on average. Where available, the neuro-ICU rotation was required in the vast majority (91%) of programs. Neurology residents' exposure to the fundamental principles of neurocritical care was obtained through a variety of mechanisms. Of program directors, 37% indicated that residents would be interested in performing away rotations in a neuro-ICU. From 2005 to 2010, the number of programs sending at least one resident into a neuro-ICU fellowship increased from 14% to 35%. Despite the expansion of neurocritical care, large proportions of US neurology residents have limited exposure to a neuro-ICU and neurointensivists. Formal training in the principles of neurocritical care may be highly variable. The results of this survey suggest a charge to address the variability of resident education and to develop standardized curricula in neurocritical care for neurology residents.

24 CFR 242.3 - Encouragement of certain programs.

Code of Federal Regulations, 2010 CFR

2010-04-01

... programs that are undertaken to provide essential health care services to all residents of a community... provision of comprehensive health care, including outpatient and preventive care as well as hospitalization...

A Randomized Controlled Trial of an Activity Specific Exercise Program for Individuals With Alzheimer Disease in Long-term Care Settings

PubMed Central

Roach, Kathryn E.; Tappen, Ruth M.; Kirk-Sanchez, Neva; Williams, Christine L.; Loewenstein, David

2011-01-01

Objective To determine whether an activity specific exercise program could improve ability to perform basic mobility activities in long-term care residents with Alzheimer disease (AD). Design Randomized, controlled, single-blinded clinical trial. Setting Residents of 7 long-term care facilities. Participants Eighty-two long-term care residents with mild to severe AD. Intervention An activity specific exercise program was compared to a walking program and to an attention control. Measurements Ability to perform bed mobility and transfers were assessed using the subscales of the Acute Care Index of Function; functional mobility was measured using the 6-Minute Walk test. Results Subjects receiving the activity specific exercise program improved in ability to perform transfers, whereas subjects in the other 2 groups declined. PMID:21937893

Ceramic material life prediction: A program to translate ANSYS results to CARES/LIFE reliability analysis

NASA Technical Reports Server (NTRS)

Vonhermann, Pieter; Pintz, Adam

1994-01-01

This manual describes the use of the ANSCARES program to prepare a neutral file of FEM stress results taken from ANSYS Release 5.0, in the format needed by CARES/LIFE ceramics reliability program. It is intended for use by experienced users of ANSYS and CARES. Knowledge of compiling and linking FORTRAN programs is also required. Maximum use is made of existing routines (from other CARES interface programs and ANSYS routines) to extract the finite element results and prepare the neutral file for input to the reliability analysis. FORTRAN and machine language routines as described are used to read the ANSYS results file. Sub-element stresses are computed and written to a neutral file using FORTRAN subroutines which are nearly identical to those used in the NASCARES (MSC/NASTRAN to CARES) interface.

Evaluating Training Programs for Primary Care Providers in Child/Adolescent Mental Health in Canada: A Systematic Review

PubMed Central

Espinet, Stacey; Naqvi, Reza; Lingard, Lorelei; Steele, Margaret

2018-01-01

Introduction The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. Methods A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Results Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Discussion Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Conclusion Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families. PMID:29662521

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

PubMed

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

2014-12-01

Increasing concerns about quality of care and workforce shortages have motivated health care organizations and educational institutions to partner to create career ladders for frontline health care workers. Career ladders reward workers for gains in skills and knowledge and may reduce the costs associated with turnover, improve patient care, and/or address projected shortages of certain nursing and allied health professions. This study examines partnerships between health care and educational organizations in the United States during the design and implementation of career ladder training programs for low-skill workers in health care settings, referred to as frontline health care workers. Mixed methods data from 291 frontline health care workers and 347 key informants (e.g., administrators, instructors, managers) collected between 2007 and 2010 were analyzed using both regression and fuzzy-set qualitative comparative analysis (QCA). Results suggest that different combinations of partner characteristics, including having an education leader, employer leader, frontline management support, partnership history, community need, and educational policies, were necessary for high worker career self-efficacy and program satisfaction. Whether a worker received a wage increase, however, was primarily dependent on leadership within the health care organization, including having an employer leader and employer implementation policies. Findings suggest that strong partnerships between health care and educational organizations can contribute to the successful implementation of career ladder programs, but workers' ability to earn monetary rewards for program participation depends on the strength of leadership support within the health care organization. Copyright © 2014 Elsevier Ltd. All rights reserved.

Incorporating human rights into reproductive health care provider education programs in Nicaragua and El Salvador.

PubMed

Reyes, H Luz McNaughton; Zuniga, Karen Padilla; Billings, Deborah L; Blandon, Marta Maria

2013-07-01

Health care providers play a central role in the promotion and protection of human rights in patient care. Consequently, the World Medical Association, among others, has called on medical and nursing schools to incorporate human rights education into their training programs. This report describes the efforts of one Central American nongovernmental organization to include human rights - related content into reproductive health care provider training programs in Nicaragua and El Salvador. Baseline findings suggest that health care providers are not being adequately prepared to fulfill their duty to protect and promote human rights in patient care. Medical and nursing school administrators, faculty, and students recognize the need to strengthen training in this area and are enthusiastic about incorporating human rights content into their education programs. Evaluation findings suggest that exposure to educational materials and methodologies that emphasize the relationship between human rights and reproductive health may lead to changes in health care provider attitudes and behaviors that help promote and safeguard human rights in patient care.

The Boston Health Care for the Homeless Program: A Public Health Framework

PubMed Central

Oppenheimer, Sarah C.; Judge, Christine M.; Taube, Robert L.; Blanchfield, Bonnie B.; Swain, Stacy E.; Koh, Howard K.

2010-01-01

During the past 25 years, the Boston Health Care for the Homeless Program has evolved into a service model embodying the core functions and essential services of public health. Each year the program provides integrated medical, behavioral, and oral health care, as well as preventive services, to more than 11 000 homeless people. Services are delivered in clinics located in 2 teaching hospitals, 80 shelters and soup kitchens, and an innovative 104-bed medical respite unit. We explain the program's principles of care, describe the public health framework that undergirds the program, and offer lessons for the elimination of health disparities suffered by this vulnerable population. PMID:20558804

Development of a hospital reiki training program: training volunteers to provide reiki to patients, families, and staff in the acute care setting.

PubMed

Hahn, Julie; Reilly, Patricia M; Buchanan, Teresa M

2014-01-01

Creating a healing and healthy environment for patients, families, and staff is an ongoing challenge. As part of our hospital's Integrative Care Program, a Reiki Volunteer Program has helped to foster a caring and healing environment, providing a means for patients, family, and staff to reduce pain and anxiety and improve their ability to relax and be present. Because direct care providers manage multiple and competing needs at any given time, they may not be available to provide Reiki when it is needed. This program demonstrates that a volunteer-based program can successfully support nurses in meeting patient, family, and staff demand for Reiki services.

Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model.

PubMed

Wallace, Cara L

2016-08-01

This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.

The Influence of Setting on Care Coordination for Childhood Asthma.

PubMed

Kelly, R Patrick; Stoll, Shelley C; Bryant-Stephens, Tyra; Janevic, Mary R; Lara, Marielena; Ohadike, Yvonne U; Persky, Victoria; Ramos-Valencia, Gilberto; Uyeda, Kimberly; Malveaux, Floyd J

2015-11-01

Asthma affects 7.1 million children in the United States, disproportionately burdening African American and Latino children. Barriers to asthma control include insufficient patient education and fragmented care. Care coordination represents a compelling approach to improve quality of care and address disparities in asthma. The sites of The Merck Childhood Asthma Network Care Coordination Programs implemented different models of care coordination to suit specific settings-school district, clinic or health care system, and community-and organizational structures. A variety of qualitative data sources were analyzed to determine the role setting played in the manifestation of care coordination at each site. There were inherent strengths and challenges of implementing care coordination in each of the settings, and each site used unique strategies to deliver their programs. The relationship between the lead implementing unit and entities that provided (1) access to the priority population and (2) clinical services to program participants played a critical role in the structure of the programs. The level of support and infrastructure provided by these entities to the lead implementing unit influenced how participants were identified and how asthma care coordinators were integrated into the clinical care team. © 2015 Society for Public Health Education.

Coordinated Care Management For Dementia In A Large, Academic Health System

PubMed Central

Tan, Zaldy S.; Jennings, Lee; Reuben, David

2014-01-01

Alzheimer’s disease and other dementias are chronic, incurable diseases that require coordinated care that addresses the medical, behavioral, and social aspects of the disease. With funding from the Center for Medicare and Medicaid Innovation (the Innovation Center), we launched a dementia care program in which a nurse practitioner acting as a dementia care manager worked with primary care physicians to develop and implement a dementia care plan that offers training and support to caregivers, manages care transitions, and facilitates access to community-based services. Post-visit surveys showed high levels of caregiver satisfaction. As program enrollment grows, outcomes will be tracked based on the triple aim developed by the Institute for Healthcare Improvement and adopted by the Centers for Medicare and Medicaid Services: better care, better health, and lower cost and utilization. The program, if successful at achieving the triple aim, may serve as a national model for how dementia and other chronic diseases can be managed in partnership with primary care practices. The program may also inform policy and reimbursement decisions for the recently released transitional care management codes and the complex chronic care management codes to be released by Medicare in 2015. PMID:24711323

The Influence of Setting on Care Coordination for Childhood Asthma

PubMed Central

Kelly, R. Patrick; Stoll, Shelley C.; Bryant-Stephens, Tyra; Janevic, Mary R.; Lara, Marielena; Ohadike, Yvonne U.; Persky, Victoria; Ramos-Valencia, Gilberto; Uyeda, Kimberly; Malveaux, Floyd J.

2015-01-01

Asthma affects 7.1 million children in the United States, disproportionately burdening African American and Latino children. Barriers to asthma control include insufficient patient education and fragmented care. Care coordination represents a compelling approach to improve quality of care and address disparities in asthma. The sites of The Merck Childhood Asthma Network Care Coordination Programs implemented different models of care coordination to suit specific settings—school district, clinic or health care system, and community—and organizational structures. A variety of qualitative data sources were analyzed to determine the role setting played in the manifestation of care coordination at each site. There were inherent strengths and challenges of implementing care coordination in each of the settings, and each site used unique strategies to deliver their programs. The relationship between the lead implementing unit and entities that provided (1) access to the priority population and (2) clinical services to program participants played a critical role in the structure of the programs. The level of support and infrastructure provided by these entities to the lead implementing unit influenced how participants were identified and how asthma care coordinators were integrated into the clinical care team. PMID:26232778

Health financing for the poor produces promising short-term effects on utilization and out-of-pocket expenditure: evidence from Vietnam

PubMed Central

Axelson, Henrik; Bales, Sarah; Minh, Pham Duc; Ekman, Björn; Gerdtham, Ulf-G

2009-01-01

Background Vietnam introduced the Health Care Fund for the Poor in 2002 to increase access to health care and reduce the financial burden of health expenditure faced by the poor and ethnic minorities. It is often argued that effects of financing reforms take a long time to materialize. This study evaluates the short-term impact of the program to determine if pro-poor financing programs can achieve immediate effects on health care utilization and out-of-pocket expenditure. Method Considering that the program is a non-random policy initiative rolled out nationally, we apply propensity score matching with both single differences and double differences to data from the Vietnam Household Living Standards Surveys 2002 (pre-program data) and 2004 (first post-program data). Results We find a small, positive impact on overall health care utilization. We find evidence of two substitution effects: from private to public providers and from primary to secondary and tertiary level care. Finally, we find a strong negative impact on out-of-pocket health expenditure. Conclusion The results indicate that the Health Care Fund for the Poor is meeting its objectives of increasing utilization and reducing out-of-pocket expenditure for the program's target population, despite numerous administrative problems resulting in delayed and only partial implementation in most provinces. The main lessons for low and middle-income countries from Vietnam's early experiences with the Health Care Fund for the Poor are that it managed to achieve positive outcomes in a short time-period, the need to ensure adequate and sustained funding for targeted programs, including marginal administrative costs, develop effective targeting mechanisms and systems for informing beneficiaries and providers about the program, respond to the increased demand for health care generated by the program, address indirect costs of health care utilization, and establish and maintain routine and systematic monitoring and evaluation mechanisms. PMID:19473518

The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial.

PubMed

Jeon, Yun-Hee; Simpson, Judy M; Chenoweth, Lynn; Cunich, Michelle; Kendig, Hal

2013-10-25

A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care--CLiAC) was developed to improve managers' leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster-level analysis. The overall costs and benefits of the program will also be assessed. The outcomes of the trial have the potential to inform actions to enhance leadership and management capabilities of the aged care workforce, address pressing issues about workforce shortages, and increase the quality of aged care services. Australian New Zealand Clinical Trials Registry (ACTRN12611001070921).

HIV provider and patient perspectives on the Development of a Health Department "Data to Care" Program: a qualitative study.

PubMed

Dombrowski, Julia C; Carey, James W; Pitts, Nicole; Craw, Jason; Freeman, Arin; Golden, Matthew R; Bertolli, Jeanne

2016-06-10

U.S. health departments have not historically used HIV surveillance data for disease control interventions with individuals, but advances in HIV treatment and surveillance are changing public health practice. Many U.S. health departments are in the early stages of implementing "Data to Care" programs to assists persons living with HIV (PLWH) with engaging in care, based on information collected for HIV surveillance. Stakeholder engagement is a critical first step for development of these programs. In Seattle-King County, Washington, the health department conducted interviews with HIV medical care providers and PLWH to inform its Data to Care program. This paper describes the key themes of these interviews and traces the evolution of the resulting program. Disease intervention specialists conducted individual, semi-structured qualitative interviews with 20 PLWH randomly selected from HIV surveillance who had HIV RNA levels >10,000 copies/mL in 2009-2010. A physician investigator conducted key informant interviews with 15 HIV medical care providers. Investigators analyzed de-identified interview transcripts, developed a codebook of themes, independently coded the interviews, and identified codes used most frequently as well as illustrative quotes for these key themes. We also trace the evolution of the program from 2010 to 2015. PLWH generally accepted the idea of the health department helping PLWH engage in care, and described how hearing about the treatment experiences of HIV seropositive peers would assist them with engagement in care. Although many physicians were supportive of the Data to Care concept, others expressed concern about potential health department intrusion on patient privacy and the patient-physician relationship. Providers emphasized the need for the health department to coordinate with existing efforts to improve patient engagement. As a result of the interviews, the Data to Care program in Seattle-King County was designed to incorporate an HIV-positive peer component and to ensure coordination with HIV care providers in the process of relinking patients to care. Health departments can build support for Data to Care efforts by gathering input of key stakeholders, such as HIV medical and social service providers, and coordinating with clinic-based efforts to re-engage patients in care.

Home-based intermediate care program vs hospitalization

PubMed Central

Armstrong, Catherine Deri; Hogg, William E.; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S.; Saginur, Raphael

2008-01-01

OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN Single-arm study with historical controls. SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P < .001), used more community care services following discharge (coefficient $729, P = .007), and were more likely to be readmitted to hospital within 3 months of discharge (coefficient 17%, P = .012) than patients treated in hospital. Total substituted costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs. PMID:18208958

Development of an interprofessional program for cardiovascular prevention in primary care: A participatory research approach

PubMed Central

Goudreau, Johanne; Hudon, Éveline; Lussier, Marie-Thérèse; Bareil, Céline; Duhamel, Fabie; Lévesque, Lise; Turcotte, Alain; Lalonde, Gilles

2014-01-01

Background: The chronic care model provides a framework for improving the management of chronic diseases. Participatory research could be useful in developing a chronic care model–based program of interventions, but no one has as yet offered a description of precisely how to apply the approach. Objectives: An innovative, structured, multi-step participatory process was applied to select and develop (1) chronic care model–based interventions program to improve cardiovascular disease prevention that can be adapted to a particular regional context and (2) a set of indicators to monitor its implementation. Methods: Primary care clinicians (n = 16), administrative staff (n = 2), patients and family members (n = 4), decision makers (n = 5), researchers, and a research coordinator (n = 7) took part in the process. Additional primary care actors (n = 26) validated the program. Results: The program targets multimorbid patients at high or moderate risk of cardiovascular disease with uncontrolled hypertension, dyslipidemia or diabetes. It comprises interprofessional follow-up coordinated by case-management nurses, in which motivated patients are referred in a timely fashion to appropriate clinical and community resources. The program is supported by clinical tools and includes training in motivational interviewing. A set of 89 process and clinical indicators were defined. Conclusion: Through a participatory process, a contextualized interventions program to optimize cardiovascular disease prevention and a set of quality indicators to monitor its implementation were developed. Similar approach might be used to develop other health programs in primary care if program developers are open to building on community strengths and priorities. PMID:26770705

Lessons Learned from Home Visiting with Home-Based Child Care Providers

ERIC Educational Resources Information Center

McCabe, Lisa A.; Peterson, Shira M.; Baker, Amy C.; Dumka, Marsha; Brach, Mary Jo; Webb, Diana

2011-01-01

Caring for Quality and Partners in Family Child Care are home visiting programs designed to improve the quality of home-based child care. This article describes the experiences of two different home visitors to demonstrate how programs such as these can help providers improve the overall quality of care, increase children's development, and lead…

Implementing a successful senior/geriatric health care program for veterinarians, veterinary technicians, and office managers.

PubMed

Fortney, William D

2012-07-01

Geriatrics and gerontology have emerged as one of the fastest growing portions of a progressive small animal practice. A critical component of geriatric medicine is a senior/geriatric health care program with senior profiling. Fifty percent of small animal practices have some form of senior/geriatric health care program and the percentage is growing. Armed with the knowledge gleaned from a successful health care program, the progressive veterinarian is better positioned to prevent and/or manage problems in the earliest stages, increasing the options available plus improving the overall outcome.

Quality Details: A Close-Up Look at Child Care Program Strengths and Weaknesses.

ERIC Educational Resources Information Center

Cryer, Debby; Phillipsen, Leslie

1997-01-01

Examined quality of infant/toddler and preschool child care centers. Found that although overall program quality was mediocre at best, accredited programs scored better than nonaccredited programs. Preschool classrooms needed improvements in cultural awareness, child privacy, and furnishings for relaxation. For infant/toddler programs,…

Parents-CARE: a suicide prevention program for parents of at-risk youth.

PubMed

Hooven, Carole

2013-02-01

Families play an important role in youth suicide prevention, as both a source of protection and a source of risk, and thus are an important target for adolescent suicide prevention programs. This article describes in detail Parents-CARE, a brief youth suicide prevention program for parents, for which effectiveness has been demonstrated. Engaging parents in preventive intervention can be challenging; therefore, the feasibility, acceptability, and relevance of the program to parents are examined. A total of 289 households participated in Parents-CARE. Parent attendance data and parent and interventionist process data are utilized to demonstrate the positive response by parents to the program. The Parents-CARE program was highly attended, and ratings demonstrate that parents were engaged in the program. Ratings show parents found the program both acceptable and relevant. Hence, the program described is promising for clinicians working with at-risk youth as they seek brief, accessible, and effective interventions that include parents in order to amplify the effects of an individual intervention approach. © 2013 Wiley Periodicals, Inc.

Educational posters and leaflets on leprosy: raising awareness of leprosy for health-care workers in rural South Africa.

PubMed

Ukpe, Idongesit Sunday

2008-01-01

Leprosy is still occurring in the Republic of South Africa, but it has been eliminated as a public health problem. The country's leprosy care and control program is being provided as a primary health-care program within the general health-care services. Maintaining health workers' leprosy knowledge and awareness at the primary health-care level is one of the program's goals. In one of the country's rural areas, the availability of good-quality leprosy poster and leaflets at primary health-care facilities has been shown to contribute significantly to maintaining health workers' leprosy knowledge and awareness.

Current state of high-risk infant follow-up care in the United States: results of a national survey of academic follow-up programs.

PubMed

Kuppala, V S; Tabangin, M; Haberman, B; Steichen, J; Yolton, K

2012-04-01

High-risk infant follow-up programs have the potential to act as multipurpose clinics by providing continuity of clinical care, education of health care trainees and facilitating outcome data research. Currently there are no nationally representative data on high-risk infant follow-up practices in the United States. The objective of this study is to collect information about the composition of high-risk infant follow-up programs associated with academic centers in the United States, with respect to their structure, function, funding resources and developmental assessment practices, and to identify the barriers to establishment of such programs. Staff neonatologists, follow-up program directors and division directors of 170 Neonatal Intensive Care Units (NICU) associated with pediatric residency programs were invited to participate in an anonymous online survey from October 2009 to January 2010. The overall response rate was 84%. Ninety three percent of the respondents have a follow-up program associated with their NICU. Birth weight, gestational age and critical illness in the NICU were the major criteria for follow-up care. Management of nutrition and neurodevelopmental assessments was the most common service provided. Over 70% have health care trainees in the clinic. About 75% of the respondents have the neurodevelopmental outcome data available. Most of the respondents reported multiple funding sources. Lack of personnel and funding were the most common causes for not having a follow-up program. High-risk infant follow-up programs associated with academic centers in the United States are functioning as multidisciplinary programs providing clinical care, trainee education and facilitating outcomes research.

Labor characteristics and program costs of a successful diabetes disease management program.

PubMed

Rothman, Russell L; So, Stephanie A; Shin, John; Malone, Robert M; Bryant, Betsy; Dewalt, Darren A; Pignone, Michael P; Dittus, Robert S

2006-05-01

Organizations have invested in disease management programs to improve quality and to reduce costs, but little is known about the labor characteristics and the program costs necessary to implement a program. To examine the labor characteristics and the program costs of a successful diabetes disease management program. We performed a labor and cost analysis within a randomized controlled trial of a primary care-based diabetes disease management intervention. Participants included 217 patients with type 2 diabetes mellitus and poor glycemic control (glycosylated hemoglobin levels, > or = 8.0%). The intervention group received 12 months of intensive management from clinical pharmacists and a diabetes care coordinator who provided education, applied algorithms for medication management, and addressed barriers to care. The control group attended a single session led by pharmacists, followed by usual care from their primary providers. The process outcomes included the number of patient care-related activities, time spent per patient, and number of drug titrations or additions. The program costs were calculated based on Bureau of Labor Statistics wage data using a sensitivity analysis. The disease management team performed a mean of 4.0 care-related activities for a mean of 38.6 minutes per patient per month for intervention patients and performed a mean of 1.1 care-related activities for a mean of 10.7 minutes per patient per month for control patients (P < .001). Intervention patients had a median of 7 drug titrations or additions during the study. The incremental program cost for the intervention was 36.97 dollars (sensitivity analysis, 6.22 dollars-88.56 dollars) per patient per month. A successful diabetes disease management program can be integrated into an academic clinic for modest labor and cost.

Implementing Dementia Care Models in Primary Care Settings: The Aging Brain Care Medical Home (Special Supplement)

PubMed Central

Callahan, Christopher M.; Boustani, Malaz A.; Weiner, Michael; Beck, Robin A.; Livin, Lee R.; Kellams, Jeffrey J.; Willis, Deanna R.; Hendrie, Hugh C.

2010-01-01

Objectives The purpose of this paper is to describe our experience in implementing a primary care-based dementia and depression care program focused on providing collaborative care for dementia and late-life depression. Methods Capitalizing on the substantial interest in the US on the patient-centered medical home concept, the Aging Brain Care Medical Home targets older adults with dementia and/or late life depression in the primary care setting. We describe a structured set of activities that laid the foundation for a new partnership with the primary care practice and the lessons learned in implementing this new care model. We also provide a description of the core components of this innovative memory care program. Results Findings from three recent randomized clinical trials provided the rationale and basic components for implementing the new memory care program. We used the reflective adaptive process as a relationship building framework that recognizes primary care practices as complex adaptive systems. This framework allows for local adaptation of the protocols and procedures developed in the clinical trials. Tailored care for individual patients is facilitated through a care manager working in collaboration with a primary care physician and supported by specialists in a memory care clinic as well as by information technology resources. Conclusions We have successfully overcome many system-level barriers in implementing a collaborative care program for dementia and depression in primary care. Spontaneous adoption of new models of care is unlikely without specific attention to the complexities and resource constraints of health care systems. PMID:20945236

One third of a million days of care at home, 1959 to 1975.

PubMed Central

Hunt, T. E.; Crichton, R. D.

1977-01-01

Although articles on studies of organized home care programs are numerous, reports of long-term effectiveness of these programs are scanty. While government spokesmen appear to advocate more widespread use of alternatives to hospitalization, there has been serious criticism of the efficiency and accomplishments of home care services. A medically oriented home care program in Saskatoon (population, less than 150 000) has grown steadily over a 16-year period and is now serving a daily average of 200 individuals. All patients have required "hospital-like care" at home and most have not ordinarily been sufficiently mobile during their time in the program to attend hospital outpatient services. Many have required "concentrated care" through daily visits of professional health personnel. The program is designed for the physically ill and disabled and is administered by the major teaching hospital in the city, although it provides services to the whole community. Over one third of the patients referred in recent years had been at home. Almost one half of the patients have undergone satisfactory rehabilitation at home. The program has also proven to be an acceptable alternative to long-term institutional care for the permanently seriously disabled, a large number of whom are elderly. The program has been able to operate at considerably less cost to the public than inpatient (hospital or institutional) services would have entailed. PMID:405089

78 FR 66364 - Medicare & Medicaid Programs: Application From the Accreditation Commission for Health Care for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-05

...] Medicare & Medicaid Programs: Application From the Accreditation Commission for Health Care for Continued... Accreditation Commission for Health Care (ACHC) for continued recognition as a national accrediting organization...) announcing Accreditation Commission for Health Care's request for approval of its hospice accreditation...

Ask Dr. Sue.

ERIC Educational Resources Information Center

Aronson, Susan S.

1989-01-01

Answers child care center directors' questions about effects of new recommendations for measles immunization on child care programs, the process of finding a pediatrician interested in working with child care programs on health promotion, and radon. (BB)

Implementation of an integrated primary care cardiometabolic risk prevention and management network in Montréal: does greater coordination of care with primary care physicians have an impact on health outcomes?

PubMed

Provost, Sylvie; Pineault, Raynald; Grimard, Dominique; Pérez, José; Fournier, Michel; Lévesque, Yves; Desforges, Johanne; Tousignant, Pierre; Borgès Da Silva, Roxane

2017-04-01

Chronic disease management requires substantial services integration. A cardiometabolic risk management program inspired by the Chronic Care Model was implemented in Montréal for patients with diabetes or hypertension. One of this study's objectives was to assess the impact of care coordination between the interdisciplinary teams and physicians on patient participation in the program, lifestyle improvements and disease control. We obtained data on health outcomes from a register of clinical data, questionnaires completed by patients upon entry into the program and at the 12-month mark, and we drew information on the program's characteristics from the implementation analysis. We conducted multiple regression analyses, controlling for patient sociodemographic and health characteristics, to measure the association between interdisciplinary team coordination with primary care physicians and various health outcomes. A total of 1689 patients took part in the study (60.1% participation rate). Approximately 40% of patients withdrew from the program during the first year. At the 12-month follow-up (n = 992), we observed a significant increase in the proportion of patients achieving the various clinical targets. The perception by the interdisciplinary team of greater care coordination with primary care physicians was associated with increased participation in the program and the achievement of better clinical results. Greater coordination of patient services between interdisciplinary teams and primary care physicians translates into benefits for patients.

Palliative Oncologic Care Curricula for Providers in Resource-Limited and Underserved Communities: a Systematic Review.

PubMed

Xu, Melody J; Su, David; Deboer, Rebecca; Garcia, Michael; Tahir, Peggy; Anderson, Wendy; Kinderman, Anne; Braunstein, Steve; Sherertz, Tracy

2017-12-20

Familiarity with principles of palliative care, supportive care, and palliative oncological treatment is essential for providers caring for cancer patients, though this may be challenging in global communities where resources are limited. Herein, we describe the scope of literature on palliative oncological care curricula for providers in resource-limited settings. A systematic literature review was conducted using PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Med Ed Portal databases, and gray literature. All available prospective cohort studies, case reports, and narratives published up to July 2017 were eligible for review. Fourteen articles were identified and referenced palliative care education programs in Argentina, Uganda, Kenya, Australia, Germany, the USA, or multiple countries. The most common teaching strategy was lecture-based, followed by mentorship and experiential learning involving role play and simulation. Education topics included core principles of palliative care, pain and symptom management, and communication skills. Two programs included additional topics specific to the underserved or American Indian/Alaskan Native community. Only one program discussed supportive cancer care, and no program reported educational content on resource-stratified decision-making for palliative oncological treatment. Five programs reported positive participant satisfaction, and three programs described objective metrics of increased educational or research activity. There is scant literature on effective curricula for providers treating cancer patients in resource-limited settings. Emphasizing supportive cancer care and palliative oncologic treatments may help address gaps in education; increased outcome reporting may help define the impact of palliative care curriculum within resource-limited communities.

Results from a national survey on chronic care management by health plans.

PubMed

Mattke, Soeren; Higgins, Aparna; Brook, Robert

2015-05-01

The growing burden of chronic disease necessitates innovative approaches to help patients and to ensure the sustainability of our healthcare system. Health plans have introduced chronic care management models, but systematic data on the type and prevalence of different approaches are lacking. Our goal was to conduct a systematic examination of chronic care management programs offered by health plans in the commercial market (ie, in products sold to employers and individuals. We undertook a national survey of a representative sample of health plans (70 plans, 36% response rate) and 6 case studies on health plans' programs to improve chronic care in the commercial market. The data underwent descriptive and bivariate analyses. All plans, regardless of size, location, and ownership, offer chronic care management programs, which identify eligible members from claims data and match them to interventions based on overall risk and specific care gaps. Plans then report information on care gaps to providers and offer self-management support to their members. While internal evaluations suggest that the interventions improve care and reduce cost, plans report difficulties in engaging members and providers. To overcome those obstacles, plans are integrating their programs into provider work flow, collaborating with providers on care redesign and leveraging patient support technologies. Our study shows that chronic care management programs have become a standard component of the overall approach used by health plans to manage the health of their members.

Population health management in integrated physical and mental health care.

PubMed

Sieck, Cynthia J; Wickizer, Thomas; Geist, Laurel

2014-01-01

Individuals suffering from serious mental illness (SMI) face many challenges of navigating a complex and often fragmented health care system and may die significantly earlier from co-morbid physical health conditions. Integrating mental and physical health care for individuals with SMI is an emerging trend addressing the often-neglected physical health care needs of this population to better coordinate care and improve health outcomes. Population Health Management (PHM) provides a useful friamework for designing integrated care programs for individuals with SMI. This paper examines the structure and evolution of the integrated care program in Missouri in the context of PHM, highlighting particular elements of PHM that facilitate and support development of an integrated mental and physical health care program. As health care reform provides external motivation to provide integrated care, this study can be useful as other states attempt to address this important issue.

The New York City Infant Day Care Study: A Comparative Study of Licensed Group and Family Infant Day Care Programs and the Effects of These Programs on Children and Their Families. Final Report.

ERIC Educational Resources Information Center

New York City Dept. of Health, NY.

This paper describes a longitudinal comparative study of group and family day care for infants in New York City. Approximately 400 infants from low income, predominantly Black or Hispanic families enrolled in publicly or privately funded, community-sponsored day care programs participated in the study from the time they entered the programs…

The Role of Early Head Start Programs in Addressing the Child Care Needs of Low-Income Families with Infants and Toddlers: Influences on Child Care Use and Quality.

ERIC Educational Resources Information Center

Love, John M.; Constantine, Jill; Paulsell, Diane; Boller, Kimberly; Ross, Christine; Raikes, Helen; Brady-Smith, Christy; Brooks-Gunn, Jeanne

2004-01-01

In 1994, the Secretary's Advisory Committee on Services for Families with Infants and Toddlers set forth a vision for Early Head Start programs in declaring that all child care settings used by Early Head Start families, whether or not the program provides the care directly, must meet the high standards of quality embodied in the Head Start…

Military Child Care Programs: Progress Made, More Needed.

DTIC Science & Technology

1982-06-01

AD-A115 281 GENERAL ACCOUNTING OFFICE WASHINGTON DC FEDERAL PURS-ETC F/B 5/11 MILITARY CHILD CARE PROGRAMSI PROGRESS MADE. MORE NEEDED. (U) JUN Ba...provides background information on military child care programs in each of the services and points out some potential problems in the quality of the...programs. It also identifies oppor- tunities to reduce child care costs. This report contains recommendations to you on pages 9, 15, and 19. As you know

Youth perceptions of comprehensive adolescent health services through the Boston HAPPENS program.

PubMed

Rosenfeld, S L; Keenan, P M; Fox, D J; Chase, L H; Melchiono, M W; Woods, E R

2000-01-01

The Boston HAPPENS (HIV Adolescent Provider and Peer Education Network for Services) program is a collaborative network of care made up of 8 organizations that serve youth and provide coordinated care for human immunodeficiency virus (HIV)-positive, homeless, and at-risk youth aged 12 to 24 years. Learning youth perceptions about the program is essential to determine if the program is meeting their needs. In this qualitative evaluation, 18 youth served by the network met in 4 focus groups to provide their view of the program. Services within 5 categories were assessed: (a) medical care, (b) mental health and substance abuse care, (c) HIV prevention and care, (d) case management, and (e) allocation of finances. Boston HAPPENS has achieved name recognition and provides many needed services for youth from a wide variety of backgrounds. The youth were comfortable receiving care and were appreciative of the comprehensive services available. They provided suggestions for how mental health services could be offered as one-on-one counseling as part of "wellness care." Young participants also requested more recreational and support opportunities for young people living with HIV. Qualitative evaluations such as this give a voice to youth to advocate for services they need. By including youth ideas and perspectives during program development and implementation, services can be more attractive to groups of at-risk youth who historically have been less likely to seek care.

Results of the 2017 National Resident Matching Program® and the American Osteopathic Association Intern/Resident Registration Program.

PubMed

Kozakowski, Stanley M; Travis, Alexandra; Marcinek, Julie P; Bentley, Ashley; Fetter, Gerald T

2017-10-01

The purpose of medicine as a profession is to meet the health needs of people and communities. Despite empirical evidence worldwide that an appropriate foundation of primary care in a health care system leads to improved health outcomes, improved experience of health care, a reduction in health disparities, and lower overall cost of care, publicly available data from National Resident Matching Program® (NRMP) and the American Osteopathic Association (AOA) Intern/Resident Registration Program show that PGY-1 family medicine and primary care positions offered in the NRMP Match continue to grow, but are losing ground in comparison to the growth of non-primary care specialties. In ACGME-accredited family medicine programs, DO students have been displacing non-US citizen IMGs while the proportion of US seniors has remained stable over the past decade. The impact of the displacement of non-US citizen IMGs by DO students in ACGME programs is unknown and deserves future research. Continuing trends in the growth of non-primary care specialties should raise great concern that the current primary shortage will be exacerbated, not serving the needs of the population. A major overhaul of the graduate medical education (GME) system is required to align the medical education system with the transformation of the health care system needed to improve quality, population health, and cost control.

Five Fundamentals of Financial Health--Guidelines for Building Financial Strength.

ERIC Educational Resources Information Center

Brower, Mary R.; Sull, Theresa M.

2003-01-01

Identifies five fundamental indicators of good financial management for child care programs. Offers composites of child care program experiences to illustrate these fundamentals: enrollment at capacity with a waiting list, tuition based on full cost of care, family fees paid on time, program's bills and taxes paid on time, and a cash reserve in…

Leadership Program in the Care of Infants and Toddlers: A Training Model. Final Report.

ERIC Educational Resources Information Center

Shigaki, Irene S.; Zorn, Vera

New York University's Leadership Program in the Care of Infants and Toddlers, an interdisciplinary training model, is described in this final report covering the program's three-year grant period from the National Institute of Mental Health. Focusing primarily on training individuals for leadership positions in the area of infant and toddler care,…

Taylor Proposes Five-Year Child-Care Program.

ERIC Educational Resources Information Center

Taylor, Glen

Senator Glen Taylor of Minnesota proposed a five-year child-care program for the purposes of encouraging employer-sponsored child care and increasing by 53,000 the number of children in low-income families who were covered. This report lists central features of the program, which include: (1) tax incentives which employers can use when they build…

Developing Memory Clinics in Primary Care: An Evidence-Based Interprofessional Program of Continuing Professional Development

ERIC Educational Resources Information Center

Lee, Linda; Weston, W. Wayne; Hillier, Loretta M.

2013-01-01

Introduction: Primary care is challenged to meet the needs of patients with dementia. A training program was developed to increase capacity for dementia care through the development of Family Health Team (FHT)-based interprofessional memory clinics. The interprofessional training program consisted of a 2-day workshop, 1-day observership, and 2-day…

Program To Address Sociocultural Barriers to Health Care in Hispanic Communities. National Program Report.

ERIC Educational Resources Information Center

Jackson, Mike; Heroux, Janet

Many members of the Hispanic community are separated from the larger community by language barriers and different cultures and belief systems. These factors can affect Hispanic Americans' ability to seek and gain access to the health care system. The Program To Address Sociocultural Barriers to Health Care in the Hispanic Community, known as…

Health Care Workforce Development in Rural America: When Geriatrics Expertise Is 100 Miles Away

ERIC Educational Resources Information Center

Tumosa, Nina; Horvath, Kathy J.; Huh, Terri; Livote, Elayne E.; Howe, Judith L.; Jones, Lauren Ila; Kramer, B. Josea

2012-01-01

The Geriatric Scholar Program (GSP) is a Department of Veterans Affairs' (VA) workforce development program to infuse geriatrics competencies in primary care. This multimodal educational program is targeted to primary care providers and ancillary staff who work in VA's rural clinics. GSP consists of didactic education and training in geriatrics…

Researching a Best-Practice End-of-Life Care Model for Canada

ERIC Educational Resources Information Center

Wilson, Donna M.; Birch, Stephen; Sheps, Sam; Thomas, Roger; Justice, Christopher; MacLeod, Rod

2008-01-01

The vast majority of the 220,000 Canadians who die each year, principally of old age and progressive ill health, do not have access to specialized hospice or palliative care. Hospice and palliative care programs are unevenly distributed across Canada, with existing programs limited in capacity and services varying considerably across programs.…

An Exploratory Study of the Impacts of an Employer-Supported Child Care Program

ERIC Educational Resources Information Center

Morrissey, Taryn W.; Warner, Mildred E.

2011-01-01

Although employer-sponsored child care programs have become more common, there is little empirical research on whether these programs affect employees' satisfaction with child care or their work-life balance, and if effects vary across employee characteristics. In this exploratory study, we administered a survey to employees with children at one…

Culture and Child Development in Early Childhood Programs: Practices for Quality Education and Care

ERIC Educational Resources Information Center

Howes, Carollee

2009-01-01

Early childhood education programs are expected to provide exemplary care for all children--poor and affluent; children of color and White children--while also adapting care to include children's families and cultures. These two sets of expectations are often difficult for teachers and programs to meet. In this book, Carollee Howes shows how…

Better Federal Program Administration Can Contribute to Improving State Foster Care Programs.

ERIC Educational Resources Information Center

Comptroller General of the U.S., Washington, DC.

The Adoption Assistance and Child Welfare Act of 1980 provides for annual federal incentive payments to states if they improve foster care programs by (1) avoiding unnecessary removal of children from their homes; (2) preventing extended stays in foster care; and (3) reunifying children with their families or placing them for adoption. To be…

National Structural Survey of Veterans Affairs Home-Based Primary Care Programs.

PubMed

Karuza, Jurgis; Gillespie, Suzanne M; Olsan, Tobie; Cai, Xeuya; Dang, Stuti; Intrator, Orna; Li, Jiejin; Gao, Shan; Kinosian, Bruce; Edes, Thomas

2017-12-01

To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

German diabetes management programs improve quality of care and curb costs.

PubMed

Stock, Stephanie; Drabik, Anna; Büscher, Guido; Graf, Christian; Ullrich, Walter; Gerber, Andreas; Lauterbach, Karl W; Lüngen, Markus

2010-12-01

This paper reports the results of a large-scale analysis of a nationwide disease management program in Germany for patients with diabetes mellitus. The German program differs markedly from "classic" disease management in the United States. Although it combines important hallmarks of vendor-based disease management and the Chronic Care Model, the German program is based in primary care practices and carried out by physicians, and it draws on their personal relationships with patients to promote adherence to treatment goals and self-management. After four years of follow-up, overall mortality for patients and drug and hospital costs were all significantly lower for patients who participated in the program compared to other insured patients with similar health profiles who were not in the program. These results suggest that the German disease management program is a successful strategy for improving chronic illness care.

Changing Health Care Professionals' Attitudes Toward Spanking.

PubMed

Burkhart, Kimberly; Knox, Michele; Hunter, Kimberly

2016-10-01

Twenty-two pediatric residents and 31 medical students viewed the Play Nicely program. The Play Nicely program is a multimedia program that teaches health care professionals how to counsel parents to use positive parenting and disciplining strategies in response to early childhood aggression. Health care professionals completed pre- and posttraining questionnaires to assess changes in comfort with counseling, parenting knowledge, and attitudes toward spanking. Results indicated at posttraining that health care professionals were significantly more comfortable with counseling parents, had increased parenting knowledge, and decreased positive attitudes toward spanking. Findings suggest that this program holds promise for educating health care professionals on how to counsel parents on positive parenting strategies and positively change attitudes toward spanking. © The Author(s) 2016.

BARRIERS AND FACILITATORS TO THE IMPLEMENTATION OF A NATIONAL HIV LINKAGE, RE-ENGAGEMENT, AND RETENTION IN CARE PROGRAM

PubMed Central

Maulsby, Cathy; Sacamano, Paul; Jain, Kriti M.; Enobun, Blessing; Brantley, Meredith L.; Kim, Hae-Young; Riordan, Morey; Werner, Melissa; Holtgrave, David R.

2018-01-01

The 2020 National HIV AIDS Strategy (NHAS) sets a target of 90% of diagnosed people living with HIV (PLWH) retained in HIV care. Access to Care (A2C) was a national HIV linkage, re-engagement, and retention in care program funded by AIDS United with support from the Corporation for National and Community Service that aimed to link and retain the most vulnerable PLWH into high-quality HIV care. This study explores the barriers and facilitators of implementing the A2C program from the perspective of program staff. Ninety-eight qualitative interviews were conducted with staff at implementing organizations over the 5 years of the project. Barriers included challenges with recruiting and retaining participants, staffing and administration, harmonizing partnerships, and addressing the basic and psychosocial needs of participants. Facilitators included strong relationships with partner organizations, flexible program models, and the passion and dedication of staff. Findings will inform the development of future programs and policy. PMID:29068718

European Long-Term Care Programs: Lessons for Community Living Assistance Services and Supports?

PubMed Central

Nadash, Pamela; Doty, Pamela; Mahoney, Kevin J; von Schwanenflugel, Matthias

2012-01-01

Objective To uncover lessons from abroad for Community Living Assistance Services and Supports (CLASS), a federally run voluntary public long-term care (LTC) insurance program created under the Accountable Care Act of 2010. Data Sources Program administrators and policy researchers from Austria, England, France, Germany, and the Netherlands. Study Design Qualitative methods focused on key parameters of cash for care: how programs set benefit levels; project expenditures; control administrative costs; regulate the use of benefits; and protect workers. Data Collection/Extraction Methods Structured discussions were conducted during an international conference of LTC experts, followed by personal meetings and individual correspondence. Principal Findings Germany's self-financing mandate and tight targeting of benefits have resulted in a solvent program with low premiums. Black markets for care are likely in the absence of regulation; France addresses this via a unique system ensuing legal payment of workers. Conclusions Programs in the five countries studied have lessons, both positive and negative, relevant to CLASS design. PMID:22091672

Advancing geriatric education: development of an interprofessional program for health care faculty.

PubMed

Ford, Channing R; Brown, Cynthia J; Sawyer, Patricia; Rothrock, Angela G; Ritchie, Christine S

2015-01-01

To improve the health care of older adults, a faculty development program was created to enhance geriatric knowledge. The University of Alabama at Birmingham (UAB) Geriatric Education Center leadership instituted a one-year, 36-hour curriculum focusing on older adults with complex health care needs. Content areas were chosen from the Institute of Medicine Transforming Health Care Quality report and a local needs assessment. Potential preceptors were identified and participant recruitment efforts began by contacting UAB department chairs of health care disciplines. This article describes the development of the program and its implementation over three cohorts of faculty scholars (n = 41) representing 13 disciplines, from nine institutions of higher learning. Formative and summative evaluation showed program success in terms of positive faculty reports of the program, information gained, and expressed intent by each scholar to apply learned content to teaching and/or clinical practice. This article describes the initial framework and strategies guiding the development of a thriving interprofessional geriatric education program.

Health Care Merged With Senior Housing: Description and Evaluation of a Successful Program.

PubMed

Barry, Theresa Teta

2017-01-01

Objective: This article describes and evaluates a successful partnership between a large health care organization and housing for seniors. The program provides on-site, primary care visits by a physician and a nurse in addition to intensive social services to residents in an affordable senior housing apartment building located in Pennsylvania. Per Donabedian's "Structure-Process-Outcome" model, the program demonstrated positive health care outcomes for its participants via a prescribed structure. To provide guidance for replication in similar settings, we qualitatively evaluated the processes by which successful outcomes were obtained. Methods: With program structures in place and outcomes measured, this case study collected and analyzed qualitative information taken from key informant interviews on care processes involved in the program. Themes were extracted from semistructured interviews and used to describe the processes that helped and hindered the program. Results and Discussion: Common processes were identified across respondents; however, the nuanced processes that lead to successful outcomes suggest that defined structures and processes may not be sufficient to produce similar outcomes in other settings. Further research is needed to determine the program's replicability and policy implications.

Early rehabilitation programs after laparoscopic colorectal surgery: Evidence and criticism

PubMed Central

Kim, Duck-Woo; Kang, Sung-Bum; Lee, Soo-Young; Oh, Heung-Kwon; In, Myung-Hoon

2013-01-01

During the past several decades, early rehabilitation programs for the care of patients with colorectal surgery have gained popularity. Several randomized controlled trials and meta-analyses have confirmed that the implementation of these evidence-based detailed perioperative care protocols is useful for early recovery of patients after colorectal resection. Patients cared for based on these protocols had a rapid recovery of bowel movement, shortened length of hospital stay, and fewer complications compared with traditional care programs. However, most of the previous evidence was obtained from studies of early rehabilitation programs adapted to open colonic resection. Currently, limited evidence exists on the effects of early rehabilitation after laparoscopic rectal resection, although this procedure seems to be associated with a higher morbidity than that reported with traditional care. In this article, we review previous studies and guidelines on early rehabilitation programs in patients undergoing rectal surgery. We investigated the status of early rehabilitation programs in rectal surgery and analyzed the limitations of these studies. We also summarized indications and detailed protocol components of current early rehabilitation programs after rectal surgery, focusing on laparoscopic resection. PMID:24379571

A Study in Child Care (Case Study from Volume II-B): "I'm a New Woman Now." Day Care Programs Reprint Series.

ERIC Educational Resources Information Center

Willis, Erline

The Family Day Care Career Program plan of New York City provides day care for approximately 3500 children of public assistance or low income career mothers (working, in school, or in training) in the homes of teacher mothers (day care mothers). The day care homes are administered by 21 sub-centers, which provide support for teacher mothers…

Using the ecological framework to identify barriers and enablers to implementing Namaste Care in Canada's long-term care system.

PubMed

Hunter, Paulette V; Kaasalainen, Sharon; Froggatt, Katherine A; Ploeg, Jenny; Dolovich, Lisa; Simard, Joyce; Salsali, Mahvash

2017-10-01

Higher acuity of care at the time of admission to long-term care (LTC) is resulting in a shorter period to time of death, yet most LTC homes in Canada do not have formalized approaches to palliative care. Namaste Care is a palliative care approach specifically tailored to persons with advanced cognitive impairment who are living in LTC. The purpose of this study was to employ the ecological framework to identify barriers and enablers to an implementation of Namaste Care. Six group interviews were conducted with families, unlicensed staff, and licensed staff at two Canadian LTC homes that were planning to implement Namaste Care. None of the interviewees had prior experience implementing Namaste Care. The resulting qualitative data were analyzed using a template organizing approach. We found that the strongest implementation enablers were positive perceptions of need for the program, benefits of the program, and fit within a resident-centred or palliative approach to care. Barriers included a generally low resource base for LTC, the need to adjust highly developed routines to accommodate the program, and reliance on a casual work force. We conclude that within the Canadian LTC system, positive perceptions of Namaste Care are tempered by concerns about organizational capacity to support new programming.

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program.

PubMed

Anderson, Wendy G; Puntillo, Kathleen; Cimino, Jenica; Noort, Janice; Pearson, Diana; Boyle, Deborah; Grywalski, Michelle; Meyer, Jeannette; O'Neil-Page, Edith; Cain, Julia; Herman, Heather; Barbour, Susan; Turner, Kathleen; Moore, Eric; Liao, Solomon; Ferrell, Bruce; Mitchell, William; Edmonds, Kyle; Fairman, Nathan; Joseph, Denah; MacMillan, John; Milic, Michelle M; Miller, Monica; Nakagawa, Laura; O'Riordan, David L; Pietras, Christopher; Thornberry, Kathryn; Pantilat, Steven Z

2017-09-01

Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care. To implement and evaluate a palliative care professional development program for ICU bedside nurses. From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds. Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P < .01 vs preworkshop). Coaching rounds in each ICU took a mean of 3 hours per month. For 82% of 1110 patients discussed in rounds, bedside nurses identified palliative care needs and created plans to address them. Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs. ©2017 American Association of Critical-Care Nurses.

Responses of Canada's health care management education programs to health care reform initiatives.

PubMed

Angus, D E; Lay, C M

2000-01-01

Canada's provincial health care systems have been experiencing significant changes, mostly through horizontal integration achieved by merging hospitals, and, in a few cases, through vertical integration of public health, long term care, home care and hospital services. The government motivation for forcing these changes seems to have been primarily financial. In a few cases, the integration seems to have resulted in a stable and successful outcome, but, in most others, there has been destabilization, and in some, there has been chaos. The question posed in this research was how the five accredited Canadian graduate programs in health care management were responding to these changes. Two of the programs have recently made major changes in structure and/or delivery processes, following careful examination of their perceived environments. One has rationalized by subdividing courses. Another is repatriating courses from the business school in order to achieve more health-related content. Four of the five programs have added a number of courses in the last few years, or plan to do so in the next year or two, either because of accreditation criteria or student or faculty interest. The program directors viewed the educational requirements for clinicians and non-clinicians as being identical. In spite of the major structural changes, and the resulting destabilization of the health care organizations (and even governments), none of the programs emphasized the changes as factors in their plans for program changes. They expressed some concern about the possibility of fads as opposed to significant changes. It may be that these changes are dealt with in the content of individual courses. This aspect was not examined by the survey nor by interviews with the directors. Each of the programs has emphasized its own niche, with no consensus about changes required.

The costs of HIV antiretroviral therapy adherence programs and impact on health care utilization.

PubMed

Sansom, Stephanie L; Anthony, Monique N; Garland, Wendy H; Squires, Kathleen E; Witt, Mallory D; Kovacs Andrea, A; Larsen, Robert A; Valencia, Rosa; Pals, Sherri L; Hader, Shannon; Weidle, Paul J; Wohl, Amy R

2008-02-01

From a trial comparing interventions to improve adherence to antiretroviral therapy-directly administered antiretroviral therapy (DAART) or an intensive adherence case management (IACM)-to standard of care (SOC), for HIV-infected participants at public HIV clinics in Los Angeles County, California, we examined the cost of adherence programs and associated health care utilization. We assessed differences between DAART, IACM, and SOC in the rate of hospitalizations, hospital days, and outpatient and emergency department visits during an average of 1.7 years from study enrollment, beginning November 2001. We assigned costs to health care utilization and program delivery. We calculated incremental costs of DAART or IACM v SOC, and compared those costs with savings in health care utilization among participants in the adherence programs. IACM participants experienced fewer hospital days compared with SOC (2.3 versus 6.7 days/1000 person-days, incidence rate ratio [IRR]: 0.34, 97.5% confidence interval [CI]: 0.13-0.87). DAART participants had more outpatient visits than SOC (44.2 versus 31.5/1000 person-days, IRR: 1.4; 97.5% CI: 1.01-1.95). Average per-participant health care utilization costs were $13,127, $8,988, and $14,416 for DAART, IACM, and SOC, respectively. Incremental 6-month program costs were $2,120 and $1,653 for DAART and IACM participants, respectively. Subtracting savings in health care utilization from program costs resulted in an average net program cost of $831 per DAART participant; and savings of $3,775 per IACM participant. IACM was associated with a significant decrease in hospital days compared to SOC and was cost saving when program costs were compared to savings in health care utilization.

24/7 in-house intensivist coverage and fellowship education: a cross-sectional survey of academic medical centers in the United States.

PubMed

Diaz-Guzman, Enrique; Colbert, Colleen Y; Mannino, David M; Davenport, Daniel L; Arroliga, Alejandro C

2012-04-01

The objectives of this study were to determine the current staffing models of practice and the frequency of 24/7 coverage in academic medical centers in the United States and to assess the perceptions of critical care trainees and program directors toward these models. A cross-sectional national survey was conducted using an Internet-based survey platform. The survey was distributed to fellows and program directors of 374 critical care training programs in US academic medical centers. We received 518 responses: 138 from program directors (PDs) (37% of 374 programs) and 380 fellow responses. Coverage by a board-certified or board-eligible intensivist physician 24/7 was reported by 33% of PD respondents and was more common among pediatric and surgical critical care programs. Mandatory in-house call for critical care trainees was reported by 48% of the PDs. Mandatory call was also more common among pediatric-critical care programs compared with the rest (P < .001). Advanced nurse practitioners with critical care training were reported available by 27% of the PDs. The majority of respondents believed that 24/7 coverage would be associated with better patient care in the ICU and improved education for the fellows, although 65% of them believed this model would have a negative impact on trainees' autonomy. Intensivist coverage 24/7 was not commonly used in US academic centers responding to our survey. Significant differences in coverage models among critical care medicine specialties appear to exist. Program director and trainee respondents believed that 24/7 coverage was associated with better outcomes and education but also expressed concerns about the impact of this model on fellows' autonomy.

Identifying Patterns in Implementation of Hospital Pressure Ulcer Prevention Programs: A Multisite Qualitative Study.

PubMed

Soban, Lynn M; Finley, Erin P; Miltner, Rebecca S

2016-01-01

To describe the presence or absence of key components of hospital pressure ulcer (PU) prevention programs in 6 acute care hospitals. Multisite comparative case study. Using purposeful selection based on PU rates (high vs low) and hospital size, 6 hospitals within the Veterans Health Administration health care system were invited to participate. Key informant interviews (n = 48) were conducted in each of the 6 participating hospitals among individuals playing key roles in PU prevention: senior nursing leadership (n = 9), nurse manager (n = 7), wound care specialist (n = 6), frontline RNs (n = 26). Qualitative data were collected during face-to-face, semistructured interviews. Interview protocols were tailored to each interviewee's role with a core set of common questions covering 3 major content areas: (1) practice environment (eg, policies and wound care specialists), (2) current prevention practices (eg, conduct of PU risk assessment and skin inspection), and (3) barriers to PU prevention. We conducted structured coding of 5 key components of PU prevention programs and cross-case analysis to identify patterns in operationalization and implementation of program components across hospitals based on facility size and PU rates (low vs high). All hospitals had implemented all PU prevention program components. Component operationalization varied considerably across hospitals. Wound care specialists were integral to the operationalization of the 4 other program components examined; however, staffing levels and work assignments of wound care specialists varied widely. Patterns emerged among hospitals with low and high PU rates with respect to wound care specialist staffing, data monitoring, and staff education. We found hospital-level variations in PU prevention programs. Wound care specialist staffing may represent a potential point of leverage in achieving other PU program components, particularly performance monitoring and staff education.

7 CFR 226.19 - Outside-school-hours care center provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

...-school-hours care centers shall be eligible to serve one or more of the following meal types: breakfasts...-hours care centers to serve Program meals to children on school vacation, including holidays and... care center participating in the Program shall claim only the meal types specified in its approved...

7 CFR 226.19 - Outside-school-hours care center provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

...-school-hours care centers shall be eligible to serve one or more of the following meal types: breakfasts...-hours care centers to serve Program meals to children on school vacation, including holidays and... care center participating in the Program shall claim only the meal types specified in its approved...

76 FR 11338 - Hospital and Outpatient Care for Veterans Released From Incarceration to Transitional Housing

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-02

..., found health care played a key role in the first months of community re-adjustment and reduced... abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse, Foreign relations, Government contracts, Grant programs--health, Grant programs--veterans, Health care, Health facilities, Health professions...

75 FR 18138 - Health Care Eligibility Under the Secretarial Designee Program and Related Special Authorities

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-09

... 0790-AI52] Health Care Eligibility Under the Secretarial Designee Program and Related Special... establish policies and assign responsibilities for health care eligibility under the Secretarial Designee... inpatient health care provided in the United States to foreign military or diplomatic personnel or their...

78 FR 8535 - Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

... develop and test innovative health care payment and service delivery models that show promise of reducing program expenditures, while preserving or enhancing the quality of care for Medicare, Medicaid, and... disease (ESRD). This population has complex health care needs, typically with comorbid conditions and...

Child Care: A Business Investment That Works.

ERIC Educational Resources Information Center

Children's Action Alliance, Phoenix, AZ.

This publication explains to Arizona employers the effect of child care difficulties on the work force and profitablity and describes ways to help employees meet their child care needs. Discussion concerns the benefits of employee child care assistance programs, program options available to employees, and the steps required to implement the…

42 CFR 460.106 - Plan of care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Plan of care. 460.106 Section 460.106 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE...

42 CFR 460.100 - Emergency care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Emergency care. 460.100 Section 460.100 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE...

2 CFR 200.101 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-01-01

... authorized under the Child Care and Development Block Grant Act of 1990, as amended: (i) Child Care and Development Block Grant (42 U.S.C. 9858) (ii) Child Care Mandatory and Matching Funds of the Child Care and... programs: (i) Special Supplemental Nutrition Program for Women, Infants and Children (section 17 of the...

75 FR 68799 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-09

... 0938-AP86 Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services.... SUMMARY: This notice announces the inpatient hospital deductible and the hospital and extended care... extended care services in a skilled nursing facility in a benefit period. DATES: Effective Date: This...

77 FR 60315 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-03

... Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality... entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

Developing a Palliative Care Competency Framework for Health Professionals and Volunteers: The Nova Scotian Experience.

PubMed

McCallum, Meg; Carver, Janet; Dupere, David; Ganong, Sharon; Henderson, J David; McKim, Ann; McNeil-Campbell, Lisa; Richardson, Holly; Simpson, Judy; Tschupruk, Cheryl; Jewers, Heather

2018-05-15

In 2014, Nova Scotia released a provincial palliative care strategy and implementation working groups were established. The Capacity Building and Practice Change Working Group, comprised of health professionals, public advisors, academics, educators, and a volunteer supervisor, was asked to select palliative care education programs for health professionals and volunteers. The first step in achieving this mandate was to establish competencies for health professionals and volunteers caring for patients with life-limiting illness and their families and those specializing in palliative care. In 2015, a literature search for palliative care competencies and an environmental scan of related education programs were conducted. The Irish Palliative Care Competence Framework serves as the foundation of the Nova Scotia Palliative Care Competency Framework. Additional disciplines and competencies were added and any competencies not specific to palliative care were removed. To highlight interprofessional practice, the framework illustrates shared and discipline-specific competencies. Stakeholders were asked to validate the framework and map the competencies to educational programs. Numerous rounds of review refined the framework. The framework includes competencies for 22 disciplines, 9 nursing specialties, and 4 physician specialties. The framework, released in 2017, and the selection and implementation of education programs were a significant undertaking. The framework will support the implementation of the Nova Scotia Integrated Palliative Care Strategy, enhance the interprofessional nature of palliative care, and guide the further implementation of education programs. Other jurisdictions have expressed considerable interest in the framework.

A palliative approach for heart failure end-of-life care

PubMed Central

Maciver, Jane; Ross, Heather J.

2018-01-01

Purpose of review The current review discusses the integration of guideline and evidence-based palliative care into heart failure end-of-life (EOL) care. Recent findings North American and European heart failure societies recommend the integration of palliative care into heart failure programs. Advance care planning, shared decision-making, routine measurement of symptoms and quality of life and specialist palliative care at heart failure EOL are identified as key components to an effective heart failure palliative care program. There is limited evidence to support the effectiveness of the individual elements. However, results from the palliative care in heart failure trial suggest an integrated heart failure palliative care program can significantly improve quality of life for heart failure patients at EOL. Summary Integration of a palliative approach to heart failure EOL care helps to ensure patients receive the care that is congruent with their values, wishes and preferences. Specialist palliative care referrals are limited to those who are truly at heart failure EOL. PMID:29135524

Path toward economic resilience for family caregivers: mitigating household deprivation and the health care talent shortage at the same time.

PubMed

Simon, Melissa A; Gunia, Brian; Martin, Emily J; Foucar, Charles E; Kundu, Tapas; Ragas, Daiva M; Emanuel, Linda L

2013-10-01

Rising costs and a workforce talent shortage are two of the health care industry's most pressing challenges. In particular, serious illnesses often impose significant costs on individuals and their families, which can place families at an increased risk for multigenerational economic deprivation or even an illness-poverty trap. At the same time, family caregivers often acquire a wide variety of health care skills that neither these caregivers nor the health care industry typically use. As these skills are marketable and could be paired with many existing medical certifications, this article describes a possible "path toward economic resilience" (PER) through a program whereby family caregivers could find meaningful employment using their new skills. The proposed program would identify ideal program candidates, assess and supplement their competencies, and connect them to the health care industry. We provide a set of practical steps and recommended tools for implementation, discuss pilot data on the program's appeal and feasibility, and raise several considerations for program development and future research. Our analysis suggests that this PER program could appeal to family caregivers and the health care industry alike, possibly helping to address two of our health care system's most pressing challenges with one solution.

Bending The Spending Curve By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO.

PubMed

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

2017-05-01

Accountable care organizations (ACOs) appear to lower medical spending, but there is little information on how they do so. We examined the impact of patient participation in a Pioneer ACO and its care management program on rates of emergency department (ED) visits and hospitalizations and on Medicare spending. We used data for the period 2009-14, exploiting naturally staggered program entry to create concurrent controls to help isolate the program effects. The care management program (the ACO's primary intervention) targeted beneficiaries with elevated but modifiable risks for future spending. ACO participation had a modest effect on spending, in line with previous estimates. Participation in the care management program was associated with substantial reductions in rates for hospitalizations and both all and nonemergency ED visits, as well as Medicare spending, when compared to preparticipation levels and to rates and spending for a concurrent sample of beneficiaries who were eligible for but had not yet started the program. Rates of ED visits and hospitalizations were reduced by 6 percent and 8 percent, respectively, and Medicare spending was reduced by 6 percent. Targeting beneficiaries with modifiable high risks and shifting care away from the ED represent viable mechanisms for altering spending within ACOs. Project HOPE—The People-to-People Health Foundation, Inc.

The patient perspective: utilizing focus groups to inform care coordination for high-risk medicaid populations.

PubMed

Sheff, Alex; Park, Elyse R; Neagle, Mary; Oreskovic, Nicolas M

2017-07-25

Care coordination programs for high-risk, high-cost patients are a critical component of population health management. These programs aim to improve outcomes and reduce costs and have proliferated over the last decade. Some programs, originally designed for Medicare patients, are now transitioning to also serve Medicaid populations. However, there are still gaps in the understanding of what barriers to care Medicaid patients experience, and what supports will be most effective for providing them care coordination. We conducted two focus groups (n = 13) and thematic analyses to assess the outcomes drivers and programmatic preferences of Medicaid patients enrolled in a high-risk care coordination program at a major academic medical center in Boston, MA. Two focus groups identified areas where care coordination efforts were having a positive impact, as well as areas of unmet needs among the Medicaid population. Six themes emerged from the focus groups that clustered in three groupings: In the first group (1) enrollment in an existing medical care coordination programs, and (2) provider communication largely presented as positive accounts of assistance, and good relationships with providers, though participants also pointed to areas where these efforts fell short. In the second group (3) trauma histories, (4) mental health challenges, and (5) executive function difficulties all presented challenges faced by high-risk Medicaid patients that would likely require redress through additional programmatic supports. Finally, in the third group, (6) peer-to-peer support tendencies among patients suggested an untapped resource for care coordination programs. Programs aimed at high-risk Medicaid patients will want to consider programmatic adjustments to attend to patient needs in five areas: (1) provider connection/care coordination, (2) trauma, (3) mental health, (4) executive function/paperwork and coaching support, and (5) peer-to-peer support.

Development of a chronic care ostomy self-management program.

PubMed

Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C; Wendel, Christopher S; Krouse, Robert

2013-03-01

Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long-term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self-Management Program, which was informed by (1) evidence on published quality-of-life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self-Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies.

Development of a Chronic Care Ostomy Self Management Program

PubMed Central

Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C.; Wendel, Christopher S.; Krouse, Robert

2012-01-01

Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self Management Program, which was informed by (1) evidence on published quality of life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies. PMID:23104143

Khoa Trinh Huan Luyen Giu Tre Ban Ngay Tai Gia (Family Day Care Training Curriculum--Vietnamese).

ERIC Educational Resources Information Center

Nakatsu, Gail

California's Family Day Care Training Program was designed to recruit and train, in 7 weeks, Lao, Vietnamese, and Chinese refugees to establish their own state-licensed, family day care homes. Topics in the program's curriculum include an introduction to family day care, state licenses and licensing requirements for family day care, licensing…

The Quality of Care under a Managed-Care Program for Dual Eligibles

ERIC Educational Resources Information Center

Kane, Robert L.; Homyak, Patricia; Bershadsky, Boris; Lum, Terry; Flood, Shannon; Zhang, Hui

2005-01-01

Purpose: Our objective in this study was to compare the quality of care provided under the Minnesota Senior Health Options (MSHO), a special program designed to serve dually eligible older persons, to care provided to controls who received fee-for-service Medicare and Medicaid managed care. Design and Methods: Two control groups were used; one was…