Reproductive health care strategy -- a gender-sensitive approach to family welfare.

PubMed

Anita

1996-01-01

The author advocates a reproductive health care strategy to revitalize India's family welfare program. A major shift in focus is needed in population policy and programs to incorporate a gender-sensitive approach. That shift should help to clear the path toward improved health status for women and female children. Consensus reached at the UN's 1994 International Conference on Population and Development supported a change in population and development policies, affording women's empowerment, gender equality, and equity greater priority for a meaningful policy of human-centered sustainable development. Reproductive health care, reproductive health in practice, the quality of care in reproductive health, gender equality as a human right, and empowering women are discussed.

State CCDBG Plans to Promote Opportunities for Babies and Toddlers in Child Care. Policy Brief

ERIC Educational Resources Information Center

Lim, Teresa; Schumacher, Rachel

2009-01-01

State child care policies--including licensing, subsidy, and quality enhancement strategies--can promote the quality and continuity of early childhood experiences and foster the healthy growth and development of babies and toddlers in child care settings, especially if they are informed by research. One of the policy levers states may use to…

A comparative analysis of early child health and development services and outcomes in countries with different redistributive policies

PubMed Central

2013-01-01

Background The social environment is a fundamental determinant of early child development and, in turn, early child development is a determinant of health, well-being, and learning skills across the life course. Redistributive policies aimed at reducing social inequalities, such as a welfare state and labour market policies, have shown a positive association with selected health indicators. In this study, we investigated the influence of redistributive policies specifically on the social environment of early child development in five countries with different political traditions. The objective of this analysis was to highlight similarities and differences in social and health services between the countries and their associations with other health outcomes that can inform better global early child development policies and improve early child health and development. Methods Four social determinants of early child development were selected to provide a cross-section of key time periods in a child’s life from prenatal to kindergarten. They included: 1) prenatal care, 2) maternal leave, 3) child health care, and 4) child care and early childhood education. We searched international databases and reports (e.g. Organization for Economic Cooperation and Development, World Bank, and UNICEF) to obtain information about early child development policies, services and outcomes. Results Although a comparative analysis cannot claim causation, our analysis suggests that redistributive policies aimed at reducing social inequalities are associated with a positive influence on the social determinants of early child development. Generous redistributive policies are associated with a higher maternal leave allowance and pay and more preventive child healthcare visits. A decreasing trend in infant mortality, low birth weight rate, and under five mortality rate were observed with an increase in redistributive policies. No clear influence of redistributive policies was observed on breastfeeding and immunization rates. In the analysis of child care and early education, the lack of uniform measures of early child development outcomes was apparent. Conclusions This paper provides further support for an association between redistributive policies and early child health and development outcomes, along with the organization of early child health and development services. PMID:24195544

A comparative analysis of early child health and development services and outcomes in countries with different redistributive policies.

PubMed

van den Heuvel, Meta; Hopkins, Jessica; Biscaro, Anne; Srikanthan, Cinntha; Feller, Andrea; Bremberg, Sven; Verkuijl, Nienke; Flapper, Boudien; Ford-Jones, Elizabeth Lee; Williams, Robin

2013-11-06

The social environment is a fundamental determinant of early child development and, in turn, early child development is a determinant of health, well-being, and learning skills across the life course. Redistributive policies aimed at reducing social inequalities, such as a welfare state and labour market policies, have shown a positive association with selected health indicators. In this study, we investigated the influence of redistributive policies specifically on the social environment of early child development in five countries with different political traditions. The objective of this analysis was to highlight similarities and differences in social and health services between the countries and their associations with other health outcomes that can inform better global early child development policies and improve early child health and development. Four social determinants of early child development were selected to provide a cross-section of key time periods in a child's life from prenatal to kindergarten. They included: 1) prenatal care, 2) maternal leave, 3) child health care, and 4) child care and early childhood education. We searched international databases and reports (e.g. Organization for Economic Cooperation and Development, World Bank, and UNICEF) to obtain information about early child development policies, services and outcomes. Although a comparative analysis cannot claim causation, our analysis suggests that redistributive policies aimed at reducing social inequalities are associated with a positive influence on the social determinants of early child development. Generous redistributive policies are associated with a higher maternal leave allowance and pay and more preventive child healthcare visits. A decreasing trend in infant mortality, low birth weight rate, and under five mortality rate were observed with an increase in redistributive policies. No clear influence of redistributive policies was observed on breastfeeding and immunization rates. In the analysis of child care and early education, the lack of uniform measures of early child development outcomes was apparent. This paper provides further support for an association between redistributive policies and early child health and development outcomes, along with the organization of early child health and development services.

Analysis and advocacy in home- and community-based care: an approach in three parts.

PubMed

Hudson, Robert B

2010-01-01

A new chapter in health policy presents both challenges and opportunities for aging policy analysts and advocates concerned with long-term care. Millions of long-term care recipients and providers live today in a pubic policy netherworld, one principally associated with Medicaid. I suggest here that moving policy forward will entail three key steps: (a) to overcome structural lag in key home and community-based care (HCBC) policy arenas; (b) to reverse a contemporary pattern of risk-shifting from institutions to individuals; and (c) to inform and empower caregivers to have their own pressing needs recognized. Recent developments in Washington provide new optimism on these fronts. Voluntary long-term care and community-based care (LTC/HCBC) proposals are on the table within the broad context of health care reform. Whether they remain will be, in large, part a function of how far we have moved along the fronts described: modernizing policies, recognizing risks, and activating neglected policy constituencies.

Collaborative Approaches and Policy Opportunities for Accelerated Progress toward Effective Disease Prevention, Care, and Control: Using the Case of Poverty Diseases to Explore Universal Access to Affordable Health Care.

PubMed

Laokri, Samia

2017-01-01

There is a massive global momentum to progress toward the sustainable development and universal health coverage goals. However, effective policies to health-care coverage can only emerge through high-quality services delivered to empowered care users by means of strong local health systems and a translational standpoint. Health policies aimed at removing user fees for a defined health-care package may fail at reaching desired results if not applied with system thinking. Secondary data analysis of two country-based cost-of-illness studies was performed to gain knowledge in informed decision-making toward enhanced access to care in the context of resource-constraint settings. A scoping review was performed to map relevant experiences and evidence underpinning the defined research area, the economic burden of illness. Original studies reflected on catastrophic costs to patients because of care services use and related policy gaps. Poverty diseases such as tuberculosis (TB) may constitute prime examples to assess the extent of effective high-priority health-care coverage. Our findings suggest that a share of the economic burden of illness can be attributed to implementation failures of health programs and supply-side features, which may highly impair attainment of the global stated goals. We attempted to define and discuss a knowledge development framework for effective policy-making and foster system levers for integrated care. Bottlenecks to effective policy persist and rely on interrelated patterns of health-care coverage. Health system performance and policy responsiveness have to do with collaborative work among all health stakeholders. Public-private mix strategies may play a role in lowering the economic burden of disease and solving some policy gaps. We reviewed possible added value and pitfalls of collaborative approaches to enhance dynamic local knowledge development and realize integration with the various health-care silos. Despite a large political commitment and mobilization efforts from funding, the global development goal of financial protection for health-newly adopted in TB control as no TB-affected household experiencing catastrophic expenditure-may remain aspirational. To enhance effective access to care for all, innovative opportunities in patient-centered and collaborative practices must be taken. Further research is greatly needed to optimize the use of locally relevant knowledge, networks, and technologies.

Women, Citizenship and Canadian Child Care Policy in the 1990s. Occasional Paper No. 13.

ERIC Educational Resources Information Center

Tyyska, Vappu

This report analyzes developments in Canadian child care policy in the 1990s at the federal, provincial (Ontario), and municipal (Toronto and Peel) levels, highlighting problems that are associated with a male model of citizenship. The report discusses the child care policy process as one in which state bodies are challenged by the diverse and…

Understanding Aging and Disability Perspectives on Home Care: Uncovering Facts and Values in Public-Policy Narratives and Discourse

ERIC Educational Resources Information Center

Clark, Phillip G.

2007-01-01

Every public-policy problem can be defined in terms of its empirical ("facts") and normative ("values") dimensions and the interrelationship between them. An understanding of the connection between facts and values at the foundation of the home care policy debate in the Canadian health-care system is developed through the…

Nurses' engagement in AIDS policy development.

PubMed

Richter, M S; Mill, J; Muller, C E; Kahwa, E; Etowa, J; Dawkins, P; Hepburn, C

2013-03-01

A multidisciplinary team of 20 researchers and research users from six countries - Canada, Jamaica, Barbados, Kenya, Uganda and South Africa - are collaborating on a 5-year (2007-12) program of research and capacity building project. This program of research situates nurses as leaders in building capacity and promotes collaborative action with other health professionals and decision-makers to improve health systems for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) nursing care. One of the projects within this program of research focused on the influence of workplace policies on nursing care for individuals and families living with HIV. Nurses are at the forefront of HIV prevention and AIDS care in these countries but have limited involvement in related policy decisions and development. In this paper, we present findings related to the barriers and facilitators for nurses' engagement in policymaking. A participatory action research design guided the program of research. Purposive sampling was used to recruit 51 nurses (unit managers, clinic and healthcare managers, and senior nurse officers) for interviews. Participants expressed the urgent need to develop policies related to AIDS care. The need to raise awareness and to 'protect' not only the workers but also the patients were critical reason to develop policies. Nurses in all of the participating countries commented on their lack of involvement in policy development. Lack of communication from the top down and lack of information sharing were mentioned as barriers to participation in policy development. Resources were often not available to implement the policy requirement. Strong support from the management team is necessary to facilitate nurses involvement in policy development. The findings of this study clearly express the need for nurses and all other stakeholders to mobilize nurses' involvement in policy development. Long-term and sustained actions are needed to address gaps on the education, research and practice level. © 2012 The Authors. International Nursing Review © 2012 International Council of Nurses.

Social and economic attitudes shaping American health policy.

PubMed

Fein, R

1980-01-01

The Health Clark Lectures (University of London) explore the development of American health care policy in a social and economic context; the probability of transatlantic relevance is substantial. I. American Health Care: Selected Policy Issues. The U.S. economy is beset with difficulties, and social policy bends to these realities and to perceptions of them. In the climate of growing neoconservatism, efforts to develop a coherent and cohesive national health policy are discontinuous and even inconsistent. II. Efficiency and Equity in Medicine: The Role of the Economist. The critical issue for economic policy is the amount spent for health care in society; for social policy it is the way that amount is shared. Certainly, there is an interplay between the two, but we must be wary of finding common ground in economic-investment and benefit-cost approaches. Striving for equity offers the best strategy to attain efficiency.

Comparison of legislation, regulations and national health strategies for palliative care in seven European countries (Results from the Europall Research Group): a descriptive study

PubMed Central

2013-01-01

Background According to EU policy, anyone in need of palliative care should be able to have access to it. It is therefore important to investigate which palliative care topics are subject to legislation and regulations in Europe and how these are implemented in (national) health care plans. This paper aims to deliver a structured overview of the legislation, existing regulations and the different health care policies regarding palliative care in seven European countries. Methods In 2008 an inventory of the organisation of palliative care was developed by the researchers of the Europall project. Included were two open questions about legislation, regulations, and health policy in palliative care. This questionnaire was completed using palliative care experts selected from Belgium, England, France, Germany, the Netherlands, Poland and Spain. Additionally, (grey) literature on palliative care health policy and regulations from the participating countries was collected to complete the inventory. Comparative analysis of country specific information was performed afterwards. Results In all countries palliative care regulations and policies existed (either in laws, royal decrees, or national policies). An explicit right to palliative care was mentioned in the Belgium, French and German law. In addition, access to palliative care was mentioned by all countries, varying from explicit regulations to policy intentions in national plans. Also, all countries had a national policy on palliative care, although sometimes mainly related to national cancer plans. Differences existed in policy regarding palliative care leave, advance directives, national funding, palliative care training, research, opioids and the role of volunteers. Conclusions Although all included European countries have policies on palliative care, countries largely differ in the presence of legislation and regulations on palliative care as well as the included topics. European healthcare policy recommendations should support palliative care access across Europe. PMID:23866928

[The development of public policies for elderly care in Brazil].

PubMed

Fernandes, Maria Teresinha de Oliveira; Soares, Sônia Maria

2012-12-01

The objective of this documental analysis is to discuss the legal aspects involved in the development of elderly care policies in Brazil, considering the socio-historical-political context, and in view of the aspects that outline the wellbeing of an aged individual. Data collection was performed between June and September of 2010 via governmental websites. Documents were included if they complied with the proposed objective; were connected with elderly care policies, and lay within the legal accomplishments regarding elderly care policies in 2006 and the Elói Chaves Law of 1923. This analysis indicated that elderly wellbeing depends significantly on resource allocation in sectors other than the healthcare area, with emphasis on the elderly in the labor market and the feminization of old age. It is expected that the community and administrators will discuss the needs of the elderly population and the integration of care networks that remain necessary for the heterogeneity of this population.

Child Care in the United States: Who Shapes State Policies for Children?

ERIC Educational Resources Information Center

Ng, Guat Tin

2006-01-01

Child care research is traditionally interested in the effects of the child care experience on child development. This article examines a different question: Who shapes state child care policy in the United States? The study, based on 49 states, shows that contrary to expectations, women's political representation, governor's party affiliation,…

Promoting Access to Quality Child Care: Critical Steps in Conducting Market Rate Surveys and Establishing Rate Policies.

ERIC Educational Resources Information Center

Stoney, Louise

This report is designed to help policymakers, child care providers, and advocates establish child care rate support policies that support high quality in the context of government-subsidized, privately-provided child care. It also provides advice on the development and interpretation of market rate surveys of local child care fees. Part 1…

Surveillance of obesity-related policies in multiple environments: the Missouri Obesity, Nutrition, and Activity Policy Database, 2007-2009.

PubMed

Haire-Joshu, Debra; Elliott, Michael; Schermbeck, Rebecca; Taricone, Elsa; Green, Scoie; Brownson, Ross C

2010-07-01

The objective of this study was to develop the Missouri Obesity, Nutrition, and Activity Policy Database, a geographically representative baseline of Missouri's existing obesity-related local policies on healthy eating and physical activity. The database is organized to reflect 7 local environments (government, community, health care, worksite, school, after school, and child care) and to describe the prevalence of obesity-related policies in these environments. We employed a stratified nested cluster design using key informant interviews and review of public records to sample 2,356 sites across the 7 target environments for the presence or absence of obesity-related policies. The school environment had the most policies (88%), followed by after school (47%) and health care (32%). Community, government, and child care environments reported smaller proportions of obesity-related policies but higher rates of funding for these policies. Worksite environments had low numbers of obesity-related policies and low funding levels (17% and 6%, respectively). Sixteen of the sampled counties had high obesity-related policy occurrence; 65 had moderate and 8 had low occurrences. Except in Missouri schools, the presence of obesity-related policies is limited. More obesity-related policies are needed so that people have access to environments that support the model behaviors necessary to halt the obesity epidemic. The Missouri Obesity, Nutrition, and Activity Policy Database provides a benchmark for evaluating progress toward the development of obesity-related policies across multiple environments in Missouri.

Will embryonic stem cells change health policy?

PubMed

Sage, William M

2010-01-01

Embryonic stem cells are actively debated in political and public policy arenas. However, the connections between stem cell innovation and overall health care policy are seldom elucidated. As with many controversial aspects of medical care, the stem cell debate bridges to a variety of social conversations beyond abortion. Some issues, such as translational medicine, commercialization, patient and public safety, health care spending, physician practice, and access to insurance and health care services, are core health policy concerns. Other issues, such as economic development, technologic progress, fiscal politics, and tort reform, are only indirectly related to the health care system but are frequently seen through a health care lens. These connections will help determine whether the stem cell debate reaches a resolution, and what that resolution might be.

Developing a policy to empower informal carers to administer subcutaneous medication in community palliative care; a feasibility project.

PubMed

Lee, Louise; Howard, Kay; Wilkinson, Lyn; Kern, Cheryl; Hall, Sarah

2016-08-01

This article describes the development and implementation of a policy to support community professionals to train informal carers to give, 'as required ', subcutaneous medications to their relative. In a rural county, Lincolnshire, despite out of hours responsive services, patients could wait up to one hour for subcutaneous medications. Additionally there were increasing requests from carers to participate in this role. To provide a safe and effective framework via a robust policy to support informal carers to give, as required, subcutaneous medications in today's health-care environment. A group of professionals working in adult community palliative care formed a working party to scope the literature and existing policies, and to consider risks, legalities and local infrastructure. The policy was developed and based on available literature. A consultation process on the policy was commenced before a series of educational workshops supported its roll out. The small number of informal carers (n=5) who undertook this role reported positive experiences and felt empowered. Professionals found the policy was able to be implemented quickly and was adhered to. From the small numbers audited it could be suggested that if the process is well managed and the informal carers feel supported they can safely and effectively administer subcutaneous injections in community palliative care. More importantly, if a policy is available, staff can respond to requests from carers in a timely manner.

The development of hospital-based palliative care services in public hospitals in the Western Cape, South Africa.

PubMed

Gwyther, L; Krause, R; Cupido, C; Stanford, J; Grey, H; Credé, T; De Vos, A; Arendse, J; Raubenheimer, P

2018-02-01

With the recent approval of a South African (SA) National Policy Framework and Strategy for Palliative Care by the National Health Council, it is pertinent to reflect on initiatives to develop palliative care services in public hospitals. This article reviews the development of hospital-based palliative care services in the Western Cape, SA. Palliative care services in SA started in the non-governmental sector in the 1980s. The first SA hospital-based palliative care team was established in Charlotte Maxeke Johannesburg Academic Hospital in 2001. The awareness of the benefit of palliative care in the hospital setting led to the development of isolated pockets of excellence providing palliative care in the public health sector in SA. This article describes models for palliative care at tertiary, provincial and district hospital level, which could inform development of hospital-based palliative care as the national policy for palliative care is implemented in SA.

Policy choices in dementia care-An exploratory analysis of the Alberta continuing care system (ACCS) using system dynamics.

PubMed

Cepoiu-Martin, Monica; Bischak, Diane P

2018-02-01

The increase in the incidence of dementia in the aging population and the decrease in the availability of informal caregivers put pressure on continuing care systems to care for a growing number of people with disabilities. Policy changes in the continuing care system need to address this shift in the population structure. One of the most effective tools for assessing policies in complex systems is system dynamics. Nevertheless, this method is underused in continuing care capacity planning. A system dynamics model of the Alberta Continuing Care System was developed using stylized data. Sensitivity analyses and policy evaluations were conducted to demonstrate the use of system dynamics modelling in this area of public health planning. We focused our policy exploration on introducing staff/resident benchmarks in both supportive living and long-term care (LTC). The sensitivity analyses presented in this paper help identify leverage points in the system that need to be acknowledged when policy decisions are made. Our policy explorations showed that the deficits of staff increase dramatically when benchmarks are introduced, as expected, but at the end of the simulation period, the difference in deficits of both nurses and health care aids are similar between the 2 scenarios tested. Modifying the benchmarks in LTC only versus in both supportive living and LTC has similar effects on staff deficits in long term, under the assumptions of this particular model. The continuing care system dynamics model can be used to test various policy scenarios, allowing decision makers to visualize the effect of a certain policy choice on different system variables and to compare different policy options. Our exploration illustrates the use of system dynamics models for policy making in complex health care systems. © 2017 John Wiley & Sons, Ltd.

Heightened vulnerabilities and better care for all: disability and end-of-life care.

PubMed

Stienstra, Deborah; D'Aubin, April; Derksen, Jim

2012-03-01

The purpose of this study was to assess the extent to which vulnerability was present or heightened as a result of either disability or end-of-life policies, or both, when people with disabilities face end of life. People with disabilities and policy makers from four Canadian provinces and at the federal level were interviewed or participated in focus groups to identify interactions between disability policies and end-of-life policies. Relevant policy documents in each jurisdiction were also analyzed. Key theme analysis was used on transcripts and policy documents. Fact sheets identifying five key issues were developed and shared in the four provinces with policy makers and people with disabilities. Examples of heightened vulnerability are evident in discontinuity from formal healthcare providers with knowledge of conditions and impairments, separation from informal care providers and support systems, and lack of coordination with and gaps in disability-related supports. When policies seek to increase the dignity, autonomy, and capacity of all individuals, including those who experience heightened vulnerability, they can mitigate or lessen some of the vulnerability. Specific policies addressing access to community-based palliative care, coordination between long-standing formal care providers and new care providers, and support and respect for informal care providers, can redress these heightened vulnerabilities. The interactions between disability and end-of-life policies can be used to create inclusive end-of-life policies, resulting in better end-of-life care for all people, including people with disabilities.

78 FR 38989 - New Policies and Procedural Requirements for Electronic Submission of State Plans, and Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-28

...). Child Care and Development Fund Form ACF-696T: Child Care and Mandatory & Matching. Development Fund Annual Financial Report for Tribes. Child Care and Development Fund Form ACF-402: Improper Mandatory & Matching. Authorizations. Child Care and Development Fund Form ACF-696: Child Care and Mandatory & Matching...

WA42 Proving its worth - changing public policy for palliative care, end of life care and bereavement through advocacy and communications.

PubMed

Edghill, Angela; Donohoe, Miriam

2015-04-01

The 2015 palliative care budget is €72 million (Euros) but up to €1.3 billion spent on end of life care annually - much of this larger figure unplanned and uncoordinated. Geographic and other inequities evident in palliative care provision. Build support for the development and implementation of a National Strategy on Palliative Care, End of Life and Bereavement. Multi-layered approach to raising awareness and building consensus: Targeting the correct audience who can make change happen Presenting robust evidence including costs justifying reform and investment Demonstrating that issues affect a significant number of people Sharing experience and knowledge Knowing their policy priorities Staying resilient - advancing and introducing new angles to argument Engaging directly as advocates within the political system at all political levels - developing relationships with politicians Identifying advocates in the public service to promote policy change Using a variety of new and existing projects and programmes Encouraging patients and families to be self-advocates - using a novel project for discussing and recording future care preferences Supporting healthcare professionals to become effective advocates for patients Creating alliances to lobby for policy development Using media opportunities to sell the message The recognition of the importance of a strategic approach to palliative and end of life care acknowledged in Parliamentary Committee Report affords an opportunity to develop further policy and practice. This a long - term exercise, dependent on supporting the implementation plan, building momentum and promoting a public dialogue on sensitive issues around dying, death and bereavement. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Health Sector Reform in the Kurdistan Region - Iraq: Financing Reform, Primary Care, and Patient Safety.

PubMed

Anthony, C Ross; Moore, Melinda; Hilborne, Lee H; Mulcahy, Andrew W

2014-12-30

In 2010, the Kurdistan Regional Government asked the RAND Corporation to help guide reform of the health care system in the Kurdistan Region of Iraq. The overarching goal of reform was to help establish a health system that would provide high-quality services efficiently to everyone to prevent, treat, and manage physical and mental illnesses and injuries. This article summarizes the second phase of RAND's work, when researchers analyzed three distinct but intertwined health policy issue areas: development of financing policy, implementation of early primary care recommendations, and evaluation of quality and patient safety. For health financing, the researchers reviewed the relevant literature, explored the issue in discussions with key stakeholders, developed and assessed various policy options, and developed plans or approaches to overcome barriers and achieve stated policy objectives. In the area of primary care, they developed and helped to implement a new management information system. In the area of quality and patient safety, they reviewed relevant literature, discussed issues and options with health leaders, and recommended an approach toward incremental implementation.

Nurses' attitudes and experiences surrounding palliative sedation: components for developing policy for nursing professionals.

PubMed

Patel, Bansari; Gorawara-Bhat, Rita; Levine, Stacie; Shega, Joseph W

2012-04-01

Nurses play an integral role in providing care for patients with end of life (EOL) symptoms refractory to conventional treatments and that may necessitate palliative sedation (PS). A paucity of research on nurses' attitudes, knowledge, and experience with PS exists, despite nurses being instrumental in evaluating its appropriateness and carrying out the care plan. The objective of the study was to elicit nurses' perspectives and conceptualizations of knowledge and skills needed to administer PS in order to inform development of a hospital policy that addresses identified concerns. Four focus groups were conducted with nurses likely to have had exposure to PS (oncology, intensive care, and hospice) at an academic medical center. Focus groups were audiotaped, transcribed verbatim, and coded for salient themes. Grounded theory principles were used for the analysis. Among the four focus groups (n=31), 87% were female, 58% between the ages of 36 and 55, and more than 40% reported 10-plus years of providing patient care. Five domains emerged as important in developing a PS policy: 1) ability to define PS; 2) criterion for using PS; 3) skill set for administering PS; 4) policy and procedural guidelines; and 5) education on PS and EOL care. Nurses identified knowledge, skills, and guidelines as key considerations for implementing PS. Comprehensive policies along with adequate training are needed to expand the availability of PS in acute care hospitals and hospice programs.

The role of ethical banks in health care policy and financing in Spain.

PubMed

Salvador-Carulla, Luis; Solans, Josep; Duaigues, Mónica; Balot, Jordi; García-Gutierrez, Juan Carlos

2009-01-01

Ethical, social, or civic banks, constitute a secondary source of financing, which is particularly relevant in Southern and Central Europe. However there is no information on the scientific literature on this source of health care financing. We review the characteristics of saving banks in Spain and illustrate the contribution of one institution "Obra Social Caixa Catalunya" (OS-CC) to the health care financing in Spain. Savings bank health care funding was equivalent to 3 percent of the public health expenditure for 2008. The programs developed by OS-CC illustrate the complex role of savings banks in health financing, provision, training, and policy, particularly in the fields of integrated care and innovation. Financing is a basic tool for health policy. However, the role of social banking in the development of integrated care networks has been largely disregarded, in spite of its significant contribution to complementary health and social care in Southern and Central Europe. Decision makers both at the public health agencies and at the social welfare departments of savings banks should become aware of the policy implications and impact of savings bank activities in the long-term care system.

"Recognize Our Humanity": Immigrant Youth Voices on Health Care in Arizona's Restrictive Political Environment.

PubMed

Gómez, Sofía; Castañeda, Heide

2018-02-01

The "DACAmented Voices in Healthcare" project examined the intersection of restrictive immigration policies and health care via photovoice, a participatory action research approach, with immigrant youth living in Arizona, who were recipients of the Deferred Action for Childhood Arrivals (DACA) program. These "DACAmented" youth took part in nine photovoice sessions exploring their health care experiences and accessibility to care using documentary photography and narratives. They poignantly illustrated their experiences through images identifying their main health concerns and strengths, facilitating the development of health policy recommendations. This article illustrates the thematic findings and discusses policy recommendations and lessons learned from presentations to policy makers and health care providers. Findings suggest that immigrant youth are knowledgeable of their family's health care needs and hold a unique and important position within mixed-status households. Health care providers can benefit from the proposed recommendations by building bridges to care to address health equity in immigrant communities.

An official American Thoracic Society/International Society for Heart and Lung Transplantation/Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement: ethical and policy considerations in organ donation after circulatory determination of death.

PubMed

Gries, Cynthia J; White, Douglas B; Truog, Robert D; Dubois, James; Cosio, Carmen C; Dhanani, Sonny; Chan, Kevin M; Corris, Paul; Dark, John; Fulda, Gerald; Glazier, Alexandra K; Higgins, Robert; Love, Robert; Mason, David P; Nakagawa, Thomas A; Shapiro, Ron; Shemie, Sam; Tracy, Mary Fran; Travaline, John M; Valapour, Maryam; West, Lori; Zaas, David; Halpern, Scott D

2013-07-01

Donation after circulatory determination of death (DCDD) has the potential to increase the number of organs available for transplantation. Because consent and management of potential donors must occur before death, DCDD raises unique ethical and policy issues. To develop an ethics and health policy statement on adult and pediatric DCDD relevant to critical care and transplantation stakeholders. A multidisciplinary panel of stakeholders was convened to develop an ethics and health policy statement. The panel consisted of representatives from the American Thoracic Society, Society of Critical Care Medicine, International Society for Heart and Lung Transplantation, Association of Organ Procurement Organizations, and the United Network of Organ Sharing. The panel reviewed the literature, discussed important ethics and health policy considerations, and developed a guiding framework for decision making by stakeholders. A framework to guide ethics and health policy statement was established, which addressed the consent process, pre- and post mortem interventions, the determination of death, provisions of end-of-life care, and pediatric DCDD. The information presented in this Statement is based on the current evidence, experience, and clinical rationale. New clinical research and the development and dissemination of new technologies will eventually necessitate an update of this Statement.

Bridging knowledge to develop an action plan for integrated care for chronic diseases in Greece

PubMed Central

Lionis, Christos; Yfantopoulos, John

2015-01-01

The health, social and economic impact of chronic diseases is well documented in Europe. However, chronic diseases threaten relatively more the ‘memorandum and peripheral’ Eurozone countries (i.e., Greece, Spain, Portugal and Ireland), which were under heavy recession after the economic crisis in 2009. Especially in Greece, where the crisis was the most severe across Europe, the austerity measures affected mainly people with chronic diseases. As a result, the urgency to tackle the threat of chronic diseases in Greece by promoting public health and providing effective chronic care while flattening the rising health care expenditure is eminent. In many European countries, integrated care is seen as a means to achieve this. The aim of this paper was to support Greek health policy makers to develop an action plan from 2015 onwards, to integrate care by bridging local policy context and needs with knowledge and experience from other European countries. To achieve this aim, we adopted a conceptual framework developed by the World Health Organization on one hand to analyse the status of integrated care in Greece, and on the other to develop an action plan for reform. The action plan was based on an analysis of the Greek health care system regarding prerequisite conditions to integrate care, a clear understanding of its context and successful examples of integrated care from other European countries. This study showed that chronic diseases are poorly addressed in Greece and integrated care is in embryonic stage. Greek policy makers have to realise that this is the opportunity to make substantial reforms in chronic care. Failing to reform towards integrated care would lead to the significant risk of collapse of the Greek health care system with all associated negative consequences. The action plan provided in this paper could support policy makers to make the first serious step to face this challenge. The details and specifications of the action plan can only be decided by Greek policy makers in close cooperation with other health and social care partners. This is the appropriate time for doing so. PMID:27118957

Leadership development in the English National Health Service: A counter narrative to inform policy.

PubMed

Hewison, Alistair; Morrell, Kevin

2014-04-01

To examine the current approach to leadership development in the English National Health Service (NHS) and consider its implications for nursing. To stimulate debate about the nature of leadership development in a range of health care settings. Good leadership is central to the provision of high quality nursing care. This has focussed attention on the leadership development of nurses and other health care staff. It has been a key policy concern in the English NHS of late and fostered the growth of leadership development programmes founded on competency based approaches. This is a policy review informed by the concept of episteme. Relevant policy documents and related literature. Using Foucault's concept of episteme, leadership development policy is examined in context and a 'counter narrative' developed to demonstrate that current approaches are rooted in competency based accounts which constitute a limited, yet dominant narrative. Leadership takes many forms and varies hugely according to task and context. Acknowledging this in the form of a counter narrative offers a contribution to more constructive policy development in the English NHS and more widely. A more nuanced debate about leadership development and greater diversity in the provision of development programmes and activities is required. Leadership development has been advocated as being crucial to the advancement of nursing. Detailed analysis of its nature and function is essential if it is to meet the needs of nurse leaders. Copyright © 2013 Elsevier Ltd. All rights reserved.

Early Child-Care and Educational Policies for the Developing World: The Brazilian Case

ERIC Educational Resources Information Center

Rosemberg, Fulvia

2004-01-01

This article intends to show that contemporary proposals for early child-care and education (ECCE), typical of the modern process of neo-liberal policies, have been familiar to developing countries since the 1960s. Their heralds continue to announce the same news; they have just changed their clothes. These heralds are the international…

How to Improve Integrated Care for People with Chronic Conditions: Key Findings from EU FP-7 Project INTEGRATE and Beyond.

PubMed

Borgermans, Liesbeth; Marchal, Yannick; Busetto, Loraine; Kalseth, Jorid; Kasteng, Frida; Suija, Kadri; Oona, Marje; Tigova, Olena; Rösenmuller, Magda; Devroey, Dirk

2017-09-25

Political and public health leaders increasingly recognize the need to take urgent action to address the problem of chronic diseases and multi-morbidity. European countries are facing unprecedented demand to find new ways to deliver care to improve patient-centredness and personalization, and to avoid unnecessary time in hospitals. People-centred and integrated care has become a central part of policy initiatives to improve the access, quality, continuity, effectiveness and sustainability of healthcare systems and are thus preconditions for the economic sustainability of the EU health and social care systems. This study presents an overview of lessons learned and critical success factors to policy making on integrated care based on findings from the EU FP-7 Project Integrate, a literature review, other EU projects with relevance to this study, a number of best practices on integrated care and our own experiences with research and policy making in integrated care at the national and international level. Seven lessons learned and critical success factors to policy making on integrated care were identified. The lessons learned and critical success factors to policy making on integrated care show that a comprehensive systems perspective should guide the development of integrated care towards better health practices, education, research and policy.

How to Improve Integrated Care for People with Chronic Conditions: Key Findings from EU FP-7 Project INTEGRATE and Beyond

PubMed Central

Marchal, Yannick; Busetto, Loraine; Kalseth, Jorid; Kasteng, Frida; Suija, Kadri; Oona, Marje; Tigova, Olena; Rösenmuller, Magda; Devroey, Dirk

2017-01-01

Background: Political and public health leaders increasingly recognize the need to take urgent action to address the problem of chronic diseases and multi-morbidity. European countries are facing unprecedented demand to find new ways to deliver care to improve patient-centredness and personalization, and to avoid unnecessary time in hospitals. People-centred and integrated care has become a central part of policy initiatives to improve the access, quality, continuity, effectiveness and sustainability of healthcare systems and are thus preconditions for the economic sustainability of the EU health and social care systems. Purpose: This study presents an overview of lessons learned and critical success factors to policy making on integrated care based on findings from the EU FP-7 Project Integrate, a literature review, other EU projects with relevance to this study, a number of best practices on integrated care and our own experiences with research and policy making in integrated care at the national and international level. Results: Seven lessons learned and critical success factors to policy making on integrated care were identified. Conclusion: The lessons learned and critical success factors to policy making on integrated care show that a comprehensive systems perspective should guide the development of integrated care towards better health practices, education, research and policy. PMID:29588630

Enhancing the contribution of research to health care policy-making: a case study of the Dutch Health Care Performance Report.

PubMed

Hegger, Ingrid; Marks, Lisanne K; Janssen, Susan W J; Schuit, Albertine J; van Oers, Hans A M

2016-01-01

The Dutch Health Care Performance Report, issued by the National Institute of Public Health and the Environment, aims to monitor health care performance in The Netherlands. Both the National Institute and the Ministry of Health wish to increase the contribution of the Report to health care policy-making. Our aim was to identify ways to achieve that. We used contribution mapping as a theoretical framework that recognizes alignment of research as crucial to managing contributions to policy-making. To investigate which areas need alignment efforts by researchers and/or policy-makers, we interviewed National Institute researchers and policy-makers from the Ministry of Health and assessed the process for developing the 2010 Report. We identified six areas where alignment is specifically relevant for enhancing the contributions of future versions of the Dutch Health Care Performance Report: well-balanced information for different ministerial directorates; backstage work; double role actors; reports of other knowledge institutes; data collection/generation and presentation forms. The contribution of health care performance reporting to policy-making is complex and requires continuous alignment efforts between researchers and policy-makers. These efforts should form an inseparable part of health care performance reporting and although this demands considerable resources, it is worth considering since it may pay back in better contributions to policy-making. © The Author(s) 2015.

End-of-life care policy: An integrated care plan for the dying

PubMed Central

Myatra, Sheila Nainan; Salins, Naveen; Iyer, Shivakumar; Macaden, Stanley C.; Divatia, Jigeeshu V.; Muckaden, Maryann; Kulkarni, Priyadarshini; Simha, Srinagesh; Mani, Raj Kumar

2014-01-01

Purpose: The purpose was to develop an end-of-life care (EOLC) policy for patients who are dying with an advanced life limiting illness and to develop practical procedural guidelines for limiting inappropriate therapeutic medical interventions and improve the quality of care of the dying within an ethical framework and through a professional and family/patient consensus process. Evidence: The Indian Society of Critical Care Medicine (ISCCM) published its first guidelines on EOLC in 2005 [1] which was later revised in 2012.[2] Since these publications, there has been an exponential increase in empirical information and discussion on the subject. The literature reviewed observational studies, surveys, randomized controlled studies, as well as guidelines and recommendations, for education and quality improvement published across the world. The search terms were: EOLC; do not resuscitate directives; withdrawal and withholding; intensive care; terminal care; medical futility; ethical issues; palliative care; EOLC in India; cultural variations. Indian Association of Palliative Care (IAPC) also recently published its consensus position statement on EOLC policy for the dying.[3] Method: An expert committee of members of the ISCCM and IAPC was formed to make a joint EOLC policy for the dying patients. Proposals from the chair were discussed, debated, and recommendations were formulated through a consensus process. The members extensively reviewed national and international established ethical principles and current procedural practices. This joint EOLC policy has incorporated the sociocultural, ethical, and legal perspectives, while taking into account the needs and situation unique to India. PMID:25249748

Scanning the horizon in a decentralized healthcare system: the Canadian experience.

PubMed

Morrison, Andra

2012-07-01

Canada has a highly decentralized health care system with 13 provinces and territories delivering health care within their own respective jurisdictions. Decisions regarding which innovative health technologies to adopt are often driven by the unique health care priorities of each jurisdiction's population. To understand these needs, the Canadian Agency for Drugs and Technologies in Health's (CADTH's) Early Awareness Service has expanded its activities. In addition to proactively scanning the horizon for new and emerging health technologies, the Early Awareness Service also scans the horizon for national and jurisdictional health policy issues. This paper looks at CADTH's process for identifying and monitoring policy issues at a national and jurisdictional level. CADTH's Early Awareness Service delivers timely information on emerging health care concerns and technologies that may affect health care finances, facilities, operations, and patient care. The identification of important policy issues can help determine which new and emerging technologies will have the most significant impact on the health care system. The information that CADTH scans can also be used to help decision-makers prepare for potential developments and events that may have an impact on health care systems. By improving its capability to identify and share policy issues across and within jurisdictions, CADTH is better situated to provide information that can be used by policy-makers to help them plan and anticipate for the introduction of new technologies and future developments affecting the unique health care needs of their jurisdictions.

Policy versus practice: a community-based qualitative study of the realities of pharmacy services in Nunavut, Canada.

PubMed

Romain, Sandra J; Kohler, Jillian C; Young, Kue

2015-01-01

Nunavut is an Arctic territory in Canada subject to many social, economic and health disparities in comparison to the rest of the nation. The territory is affected by health care provision challenges caused by small, geographically isolated communities where staffing shortages and weather related access barriers are common concerns. In addition to national universal healthcare, the majority of the inhabitants of Nunavut (~85 %) are Inuit beneficiaries of no-charge pharmaceuticals provided through federal and/or territorial budgetary allocations. This research examines how existing pharmaceutical administration and distribution policies and practices in Nunavut impact patient care. This grounded theory research includes document analysis and semi-structured interviews conducted in 2013/14 with patients, health care providers, administrators and policy makers in several communities in Nunavut. Thirty five informants in total participated in the study. Interviews were audiotaped, transcribed and analyzed with qualitative data analysis software for internal consistency and emerging themes. Four distinct themes emerge from the research that have the potential to impact patient care and which may provide direction for future policy development: 1) tensions between national versus territorial financial responsibilities influence health provider decisions that may affect patient care, 2) significant human resources are utilized in Community Health Centres to perform distribution duties associated with retail pharmacy medications, 3) large quantities of unclaimed prescription medications are suggestive of significant financial losses, suboptimal patient care and low adherence rates, and 4) the absence of a clear policy and oversight for some controlled substances, such as narcotics, leaves communities at risk for potential illegal procurement or abuse. Addressing these issues in future policy development may result in system-wide economic benefits, improved patient care and adherence, and reduced risk to communities. The interview informants who participated in this research are best positioned to identify issues in need of attention and will benefit the most from policy development to address their concerns.

Policy.

ERIC Educational Resources Information Center

Evans, Judith L.; And Others

1995-01-01

This theme issue is devoted to discussions of early childhood policy issues. "Creating a Shared Vision: How Policy Affects Early Childhood Care and Development" (Judith L. Evans) defines policy, discusses the motivation for changing or creating national policy and the process for changing such policies, and provides a sample design for…

Nurses' Attitudes and Experiences Surrounding Palliative Sedation: Components for Developing Policy for Nursing Professionals

PubMed Central

Gorawara-Bhat, Rita; Levine, Stacie; Shega, Joseph W.

2012-01-01

Abstract Background Nurses play an integral role in providing care for patients with end of life (EOL) symptoms refractory to conventional treatments and that may necessitate palliative sedation (PS). A paucity of research on nurses' attitudes, knowledge, and experience with PS exists, despite nurses being instrumental in evaluating its appropriateness and carrying out the care plan. Objective The objective of the study was to elicit nurses' perspectives and conceptualizations of knowledge and skills needed to administer PS in order to inform development of a hospital policy that addresses identified concerns. Methods Four focus groups were conducted with nurses likely to have had exposure to PS (oncology, intensive care, and hospice) at an academic medical center. Focus groups were audiotaped, transcribed verbatim, and coded for salient themes. Grounded theory principles were used for the analysis. Results Among the four focus groups (n=31), 87% were female, 58% between the ages of 36 and 55, and more than 40% reported 10-plus years of providing patient care. Five domains emerged as important in developing a PS policy: 1) ability to define PS; 2) criterion for using PS; 3) skill set for administering PS; 4) policy and procedural guidelines; and 5) education on PS and EOL care. Conclusions Nurses identified knowledge, skills, and guidelines as key considerations for implementing PS. Comprehensive policies along with adequate training are needed to expand the availability of PS in acute care hospitals and hospice programs. PMID:22500480

Children and Society Policy Review: Health Policy Affecting Children and Young People

ERIC Educational Resources Information Center

Simkiss, Doug

2013-01-01

The Health and Social Care Act comes into force in April 2013. It changes the organisation of the health service and accelerates the integration of health and social care. New relationships between primary and secondary healthcare will develop and the culture of clinical and cost effectiveness will expand into social care; work on children in…

Projecting the effects of long-term care policy on the labor market participation of primary informal family caregivers of elderly with disability: insights from a dynamic simulation model.

PubMed

Ansah, John P; Matchar, David B; Malhotra, Rahul; Love, Sean R; Liu, Chang; Do, Young

2016-03-23

Using Singapore as a case study, this paper aims to understand the effects of the current long-term care policy and various alternative policy options on the labor market participation of primary informal family caregivers of elderly with disability. A model of the long-term care system in Singapore was developed using System Dynamics methodology. Under the current long-term care policy, by 2030, 6.9 percent of primary informal family caregivers (0.34 percent of the domestic labor supply) are expected to withdraw from the labor market. Alternative policy options reduce primary informal family caregiver labor market withdrawal; however, the number of workers required to scale up long-term care services is greater than the number of caregivers who can be expected to return to the labor market. Policymakers may face a dilemma between admitting more foreign workers to provide long-term care services and depending on primary informal family caregivers.

A Framework for an Institutional High Level Security Policy for the Processing of Medical Data and their Transmission through the Internet

PubMed Central

Pangalos, George

2001-01-01

Background The Internet provides many advantages when used for interaction and data sharing among health care providers, patients, and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality, integrity, and availability of information. It is therefore essential that Health Care Establishments processing and exchanging medical data use an appropriate security policy. Objective To develop a High Level Security Policy for the processing of medical data and their transmission through the Internet, which is a set of high-level statements intended to guide Health Care Establishment personnel who process and manage sensitive health care information. Methods We developed the policy based on a detailed study of the existing framework in the EU countries, USA, and Canada, and on consultations with users in the context of the Intranet Health Clinic project. More specifically, this paper has taken into account the major directives, technical reports, law, and recommendations that are related to the protection of individuals with regard to the processing of personal data, and the protection of privacy and medical data on the Internet. Results We present a High Level Security Policy for Health Care Establishments, which includes a set of 7 principles and 45 guidelines detailed in this paper. The proposed principles and guidelines have been made as generic and open to specific implementations as possible, to provide for maximum flexibility and adaptability to local environments. The High Level Security Policy establishes the basic security requirements that must be addressed to use the Internet to safely transmit patient and other sensitive health care information. Conclusions The High Level Security Policy is primarily intended for large Health Care Establishments in Europe, USA, and Canada. It is clear however that the general framework presented here can only serve as reference material for developing an appropriate High Level Security Policy in a specific implementation environment. When implemented in specific environments, these principles and guidelines must also be complemented by measures, which are more specific. Even when a High Level Security Policy already exists in an institution, it is advisable that the management of the Health Care Establishment periodically revisits it to see whether it should be modified or augmented. PMID:11720956

A framework for an institutional high level security policy for the processing of medical data and their transmission through the Internet.

PubMed

Ilioudis, C; Pangalos, G

2001-01-01

The Internet provides many advantages when used for interaction and data sharing among health care providers, patients, and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality, integrity, and availability of information. It is therefore essential that Health Care Establishments processing and exchanging medical data use an appropriate security policy. To develop a High Level Security Policy for the processing of medical data and their transmission through the Internet, which is a set of high-level statements intended to guide Health Care Establishment personnel who process and manage sensitive health care information. We developed the policy based on a detailed study of the existing framework in the EU countries, USA, and Canada, and on consultations with users in the context of the Intranet Health Clinic project. More specifically, this paper has taken into account the major directives, technical reports, law, and recommendations that are related to the protection of individuals with regard to the processing of personal data, and the protection of privacy and medical data on the Internet. We present a High Level Security Policy for Health Care Establishments, which includes a set of 7 principles and 45 guidelines detailed in this paper. The proposed principles and guidelines have been made as generic and open to specific implementations as possible, to provide for maximum flexibility and adaptability to local environments. The High Level Security Policy establishes the basic security requirements that must be addressed to use the Internet to safely transmit patient and other sensitive health care information. The High Level Security Policy is primarily intended for large Health Care Establishments in Europe, USA, and Canada. It is clear however that the general framework presented here can only serve as reference material for developing an appropriate High Level Security Policy in a specific implementation environment. When implemented in specific environments, these principles and guidelines must also be complemented by measures, which are more specific. Even when a High Level Security Policy already exists in an institution, it is advisable that the management of the Health Care Establishment periodically revisits it to see whether it should be modified or augmented.

How Much for Whom? Lessons from an Efficacy Study of Modest Professional Development for Child Care Providers

ERIC Educational Resources Information Center

Gerde, Hope K.; Duke, Nell K.; Moses, Annie M.; Spybrook, Jessaca; Shedd, Meagan K.

2014-01-01

Research Findings: Examining the effects of professional development of the early childhood workforce that fit within the constraints of government policy is crucial for identifying types and amounts of effective training and informing child care policy. The present study used a cluster-randomized trial to evaluate the effects of a professional…

Home health nursing care agenda based on health policy in Korea.

PubMed

Ryu, Hosihn; An, Jiyoung; Koabyashi, Mia

2005-06-01

Home health nursing care (HHNC) in Korea has taken on an important role under the mandate of the national health care system since 2000. This program was developed to verify the possibility of early discharge of hospitalized patients and cost containment through a research and development project that was conducted with the government from 1994 to 1999. The process of development of HHNC provided an opportunity to realize the advancement and changes in the system into a consumer-focused structure. This is an important turning point for the Korean health care system that suggests certain possibilities for building a foundation for further changes in the service delivery structure. The structure, which had been limited to a supplier-oriented model, is moving to a consumer-oriented structure. Accordingly, the major function and role of nursing policy makers in Korea is to develop an agenda and alternatives for policy-making in a systematic manner and to present implementation strategies clearly.

The Persistent Gap between Education and Care: A "History of the Present" Research on Belgian Child Care Provision and Policy

ERIC Educational Resources Information Center

Vandenbroeck, Michel

2006-01-01

The first Belgian creches for children from birth to three years of age date from the nineteenth century. From 1919, formal legislation on child care was developed. In the early twentieth century, the origins of Belgian childcare and in its initial legislation some core aspects of present-day child care policy and practice can be found. This…

Development and communication of written ethics policies on euthanasia in Catholic hospitals and nursing homes in Belgium (Flanders).

PubMed

Gastmans, Chris; Lemiengre, Joke; de Casterlé, Bernadette Dierckx

2006-10-01

To describe whether and how Catholic hospitals and nursing homes in Belgium (Flanders) have developed written ethics policies on euthanasia and communicated these policies to their employees, patients, and patient's relatives. A cross-sectional mail survey of general directors of Catholic hospitals and nursing homes in Belgium (Flanders). Of the 298 targeted institutions, 81% of hospitals and 62% of nursing homes returned complete questionnaires. A high percentage of Catholic hospitals (79%) and a moderate percentage of nursing homes (30%) had written ethics policies on euthanasia. Both caregivers and healthcare administrators were involved in the development and approval of these policies. Physicians and nurses were best informed about the policies. More than half of the nursing homes (57%) took the initiative to inform both residents and relatives about the policies, while only one hospital did so. The high prevalence of written ethics policies on euthanasia in Flemish Catholic hospitals may reflect the concern of healthcare administrators to maintain the quality of care for patients requesting euthanasia. However, the true contribution of these policies to quality end-of-life care and to supporting caregivers remains unknown and needs further research. Legislation and centrally developed guidelines might influence healthcare institutions to develop ethics policies.

Policies to improve end-of-life decisions in Flemish hospitals: communication, training of health care providers and use of quality assessments.

PubMed

D'Haene, Ina; Vander Stichele, Robert H; Pasman, H Roeline W; Noortgate, Nele Van den; Bilsen, Johan; Mortier, Freddy; Deliens, Luc

2009-12-30

The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals. A cross-sectional mail survey was sent to all acute hospitals (67 main campuses) in Flanders (Belgium). The questionnaire asked about hospital characteristics, the prevalence of policies on five types of end-of-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level. The response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-not-resuscitate decisions: 98%, palliative sedation: 79%). While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to patients and/or family (between 17% and 50%). More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals. Most Flemish acute hospitals have developed a policy on end-of-life practices. However, communication, training and the education of health care providers about these policies is not always provided, and quality assessment tools are used in less than half of the hospitals.

What about Us? Economic and Policy Changes Affecting Rural HIV/AIDS Services and Care.

PubMed

Albritton, Tashuna; Martinez, Isabel; Gibson, Crystal; Angley, Meghan; Grandelski, Valen R

2017-01-01

Health care budgets and policies are chief drivers in the delivery and access to health services. Place is also a factor that affects patient and provider experiences within the health care system. We examine the impact of policy changes and subsequent budget cuts on rural HIV/AIDS care, support services, and prevention. We interviewed 11 social workers, case managers, and outreach workers who serve rural people living with HIV/AIDS. We conducted telephone interviews inquiring about the effect of economics and policies on direct practice with rural clients. We analyzed data using a content analysis approach. We found several themes from the data. Ryan White funding and policy changes shifted direct practice to a medical case management model. Changes in federal and state poverty levels affected client eligibility for the AIDS Drugs Assistance Program. Policy banning financial support for syringe service programs hindered prevention efforts to reduce HIV/AIDS transmission. Ancillary services were reduced, such as housing assistance, transportation, and emergency financial assistance. In conclusion, we highlight the importance of place-based policies to improve access to healthcare and services. We also provide recommendations for greater inclusion in HIV/AIDS-related policy development, care, and service planning for rural workers.

South African mental health care service user views on priorities for supporting recovery: implications for policy and service development.

PubMed

Kleintjes, Sharon; Lund, Crick; Swartz, Leslie

2012-01-01

The paper documents the views of South African mental health care service users on policy directions and service developments that are required to support their recovery. Semi-structured interviews were conducted with forty service users and service user advocates. A framework analysis approach was used to analyse the qualitative data. Service user priorities included addressing stigma, discrimination and disempowerment, and the links between mental health and poverty. They suggested that these challenges be addressed through public awareness campaigns, legislative and policy reform for rights protection, development of a national lobby to advocate for changes, and user empowerment. Users suggested that empowerment can be facilitated through opportunities for improved social relatedness and equitable access to social and economic resources. This study suggests three strategies to bridge the gap between mental health care service users rights and needs on one hand, and unsupportive attitudes, policies and practices on the other. These are: giving priority to service user involvement in policy and service reform, creating empathic alliances to promote user priorities, and building enabling partnerships to effect these priorities.

Workforce Information: A Critical Component of Coordinated State Early Care and Education Data Systems. Policy Brief

ERIC Educational Resources Information Center

Kipnis, Fran; Whitebook, Marcy

2011-01-01

The Center for the Study of Child Care Employment (CSCCE) receives support from the Birth to Five Policy Alliance and the David and Lucile Packard Foundation to assist states with early care and education (ECE) workforce systems development. Their efforts include membership in the Early Childhood Data Collaborative (ECDC), and their participation…

[Evolution and new perspectives of health care financing in developing countries].

PubMed

Audibert, Martine; Mathonnat, Jacky; de Roodenbeke, Eric

2003-01-01

Over the last twenty five years, the perspective of health care financing has dramatically changed in developing countries. In this context, it is worth reviewing the literature and the experiences in order to understand the major shifts on this topic. During the sixties, health care policies focused on fighting major epidemics. Programs were dedicated to reduce the threat to population health. Financing related to the mobilization of resources for these programs and most of them were not managed within national administrations. The success of these policies was not sustainable. After Alma Ata, primary health care became a priority but it took some years before the management of the health care district was introduced as a major topic. In the eighties, with the district policy and the Bamako Initiative, the economic approach became a major part of all health care policies. At that time, most of health care financing was related to cost recovery strategies. All the attention was then drawn on how it worked: Fee policies, distribution of revenues, efficient use of resources and so on. In the second half of the nineties, cost recovery was relegated to the back scene, health care financing policy then becoming a major front scene matter. Two major reasons may explain this change in perspective: HIV which causes a major burden on the whole health system, and fighting poverty in relation with debts reduction. In most developing countries, with high HIV prevalence, access to care is no longer possible within the framework of the ongoing heath care financing scheme. Health plays a major role in poverty reduction strategies but health care officials must take into account every aspect of public financing. New facts also have to be taken into account: Decentralization/autonomy policies, the growing role of third party payment and the rising number of qualified health care professionals. All these facts, along with a broader emphasis given to the market, introduce a need for a better management of resources through financing mechanisms. Some major reports from WHO and the World Bank are the landmarks of the evolution on how to approach health care financing: The 1993 World Bank report on investing in health, the 2000 WHO report on health in the world and the WHO report on macroeconomics and health. In this early millenium, there is a general agreement on some major aspects of health care financing such as: Lack of resources for financing health care; cost recovery as a part of any sustainable health care system; health as a public good needing some extended subsidies; protecting people from the burden of disease as a part of financing schemes; equity in relation with the public private mix at the center of many debates; financing as a key mechanism for the regulation of the whole health care system and not only as a resource mobilization; HIV in bringing up new problems clearly shows how all these matters are related. Health care financing is at the heart of ongoing questions on health care reforms. Although developing countries have low insurance coverage and weak modern medical care, they share the same questions as developed countries: How to promote technical and allocative efficiency? What place for incentives? What role for the public sector? How can market and contracting bring results? What progress through stewardship and better governance?

Developing policy, standard orders, and quality-assurance monitoring for palliative sedation therapy.

PubMed

Ghafoor, Virginia L; Silus, Lauren S

2011-03-15

The development of a policy, evidence-based standard orders, and monitoring for palliative sedation therapy (PST) is described. Concerns regarding PST at the University of Minnesota Medical Center (UMMC) arose and needed to be addressed in a formal process. A multidisciplinary group consisting of palliative care physicians, nurse practitioners, clinical nurse specialists, and clinical pharmacy specialists reached consensus on the practice model and medications to be used for PST. Major elements of the plan included the development and implementation of an institutional policy for palliative sedation; standard orders for patient care, sedation, and monitoring; education for staff, patients, and patients' family members; and quality-assurance monitoring. A literature review was performed to identify research and guidelines defining the practice of PST. Policy content includes the use of a standard order set linking patient care, medication administration, the monitoring of sedation, and symptom management. Approval of the policy involved several UMMC committees. An evaluation matrix was used to determine critical areas for PST monitoring and to guide development of a form to monitor quality. A retrospective chart audit using the quality-assurance monitoring form assessed baseline sedation medication and patient outcomes. Assessment of compliance began in the fall of 2008, after the policy and standard orders were approved by the UMMC medical executive committee. In 2008, two cases of PST were monitored using the standardized form. PST cases will be continually monitored and analyzed. Development of policy, standard orders, and quality-assurance monitoring for PST required a formal multidisciplinary process. A process-improvement process is critical to defining institutional policy, educational goals, and outcome metrics for PST.

Aging and Elder Care in Japan: A Call for Empowerment-Oriented Community Development.

PubMed

Inaba, Miyuki

This article provides a brief overview of the situation of the elderly and their caregivers in Japan, including demographic changes in Japan, development and changes in long-term care policy that have targeted the poorly integrated community care system, and other challenges that the elderly and family caregivers face. Policy direction designed to address these issues is increasingly targeting care by the community versus support care by society (which was initially the main strategy). The potential of empowerment-oriented community development intervention strategies to decrease the gap between available institutional and formal community-based services and the needs of the elderly and their families in their efforts to meet late life challenges is described. The need for an increased role of social workers in community development interventions is explored and strategies are suggested.

Divergent modes of integration: the Canadian way.

PubMed

Jiwani, Izzat; Fleury, Marie-Josée

2011-01-01

The paper highlights key trajectories and outcomes of the recent policy developments toward integrated health care delivery systems in Quebec and Ontario in the primary care sector and in the development of regional networks of health and social services. It particularly explores how policy legacies, interests and cultures may be mitigated to develop and sustain different models of integrated health care that are pertinent to the local contexts. In Quebec, three decades of iterative developments in health and social services evolved in 2005 into integrated centres for health and social services at the local levels (CSSSs). Four integrated university-based health care networks provide ultra-specialised services. Family Medicine Groups and network clinics are designed to enhance access and continuity of care. Ontario's Family Health Teams (2004) constitute an innovative public funding for private delivery model that is set up to enhance the capacity of primary care and to facilitate patient-based care. Ontario's Local Health Integration Networks (LHINs) with autonomous boards of provider organisations are intended to coordinate and integrate care. Integration strategies in Quebec and Ontario yield clinical autonomy and power to physicians while simultaneously making them key partners in change. Contextual factors combined with increased and varied forms of physician remunerations and incentives mitigated some of the challenges from policy legacies, interests and cultures. Virtual partnerships and accountability agreements between providers promise positive but gradual movement toward integrated health service systems.

Integrated care through disease-oriented clinical care pathways: experience from Japan’s regional health planning initiatives

PubMed Central

Okamoto, Etsuji; Miyamoto, Masaki; Hara, Kazuhiro; Yoshida, Jun; Muto, Masaki; Hirai, Aizan; Tatsumi, Haruyuki; Mizuno, Masaaki; Nagata, Hiroshi; Yamakata, Daisuke; Tanaka, Hiroshi

2011-01-01

Introduction In April 2008, Japan launched a radical reform in regional health planning that emphasized the development of disease-oriented clinical care pathways. These ‘inter-provider critical paths’ have sought to ensure effective integration of various providers ranging among primary care practitioners, acute care hospitals, rehabilitation hospitals, long-term care facilities and home care. Description of policy practice All 47 prefectures in Japan developed their Regional Health Plans pursuant to the guideline requiring that these should include at least four diseases: diabetes, acute myocardial infarction, cerebrovascular accident and cancer. To illustrate the care pathways developed, this paper describes the guideline referring to strokes and provides examples of the new Regional Health Plans as well as examples of disease-oriented inter-provider clinical paths. In particular, the paper examines the development of information sharing through electronic health records (EHR) to enhance effective integration among providers is discussed. Discussion and conclusion Japan’s reform in 2008 is unique in that the concept of ‘disease-oriented regional inter-provider critical paths’ was adopted as a national policy and all 47 prefectures developed their Regional Health Plans simultaneously. How much the new regional health planning policy has improved the quality and outcome of care remains to be seen and will be evaluated in 2013 after the five-year planned period of implementation has concluded. Whilst electronic health records appear to be a useful tool in supporting care integration they do not guarantee success in the application of an inter-provider critical path. PMID:22128281

Think like a payer when patients are uninsured.

PubMed

2012-04-01

Hospitals need to develop a detailed policy of when and how they'll provide post-acute financial assistance for uninsured or under-insured patients. The policy should allow staff to get real time decisions about what will be covered. Staff should apply the policy consistently to all patients in all situations. A policy frees up case managers to coordinate care for all their patients rather than spending hours at a time trying to line up post-acute care for unfunded patients.

Sorry doctor, I can't afford the root canal, I have a job: Canadian dental care policy and the working poor.

PubMed

Quiñonez, Carlos; Figueiredo, Rafael

2010-01-01

In Canada, most dental care is privately financed through employment-based insurance, with only a small amount of care supported by governments for groups deemed in social need. Recently, this low level of public financing has been linked to problems in accessing dental care, and one group that has received major attention are the working poor (WP), or those who maintain regular employment but remain in relative poverty. The WP highlight a significant gap in Canadian dental care policy, as they are generally not eligible for either public or private insurance. This is a mixed methods study, comprised of an historical review of Canadian dental care policy and a telephone interview survey of WP Canadian adults. By its very definitions, Canadian dental care policy recognizes the WP as persons with employment, yet incorrectly assumes that they will have ready access to employment-based insurance. In addition, through historically developed biases, it also fails to recognize them as persons in social need. Our telephone survey suggests that this policy approach has important impacts in that oral health and dental care outcomes are significantly mitigated by the presence of dental insurance. Canadian dental care policy should be reassessed in terms of how it determines need in order to close a gap that holds negative consequences for many Canadian families.

Integrating mental health and social development in theory and practice.

PubMed

Plagerson, Sophie

2015-03-01

In many low and middle income countries, attention to mental illness remains compartmentalized and consigned as a matter for specialist policy. Despite great advances in global mental health, mental health policy and practice dovetail only to a limited degree with social development efforts. They often lag behind broader approaches to health and development. This gap ignores the small but growing evidence that social development unavoidably impacts the mental health of those affected, and that this influence can be both positive and negative. This article examines the theoretical and practical challenges that need to be overcome for a more effective integration of social development and mental health policy. From a theoretical perspective, this article demonstrates compatibility between social development and mental health paradigms. In particular, the capability approach is shown to provide a strong framework for integrating mental health and development. Yet, capability-oriented critiques on 'happiness' have recently been applied to mental health with potentially detrimental outcomes. With regard to policy and practice, horizontal and vertical integration strategies are suggested. Horizontal strategies require stronger devolution of mental health care to the primary care level, more unified messages regarding mental health care provision and the gradual expansion of mental health packages of care. Vertical integration refers to the alignment of mental health with related policy domains (particularly the social, economic and political domains). Evidence from mental health research reinforces aspects of social development theory in a way that can have tangible implications on practice. First, it encourages a focus on avoiding exclusion of those affected by or at risk of mental illness. Secondly, it underscores the importance of the process of implementation as an integral component of successful policies. Finally, by retaining a focus on the individual, it seeks to avoid uneven approaches to development. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Nurses' knowledge of universal health coverage for inclusive and sustainable elderly care services

PubMed Central

Tung, Fabian Ling Ngai; Yan, Vincent Chun Man; Tai, Winnie Ling Yin; Chen, Jing Han; Chung, Joanne Wai-yee; Wong, Thomas Kwok Shing

2016-01-01

Objectives: to explore nurses' knowledge of universal health coverage (UHC) for inclusive and sustainable development of elderly care services. Method: this was a cross-sectional survey. A convenience sample of 326 currently practicing enrolled nurses (EN) or registered nurses (RN) was recruited. Respondents completed a questionnaire which was based on the implementation strategies advocated by the WHO Global Forum for Governmental Chief Nursing Officers and Midwives (GCNOMs). Questions covered the government initiative, healthcare financing policy, human resources policy, and the respondents' perception of importance and contribution of nurses in achieving UHC in elderly care services. Results: the knowledge of nurses about UHC in elderly care services was fairly satisfactory. Nurses in both clinical practice and management perceived themselves as having more contribution and importance than those in education. They were relatively indifferent to healthcare policy and politics. Conclusion: the survey uncovered a considerable knowledge gap in nurses' knowledge of UHC in elderly care services, and shed light on the need for nurses to be more attuned to healthcare policy. The educational curriculum for nurses should be strengthened to include studies in public policy and advocacy. Nurses can make a difference through their participation in the development and implementation of UHC in healthcare services. PMID:26959330

Developing and Implementing Work-Family Policies for Faculty

ERIC Educational Resources Information Center

Sullivan, Beth; Hollenshead, Carol; Smith, Gilia

2004-01-01

Today, American families juggle many competing priorities: home, work, school, medical care, after-school activities, and other responsibilities required to raise a family and maintain a household. At the same time, more employers are developing policies that acknowledge the need for a healthy balance between work and home. These policies allow…

Improving performance management for delivering appropriate care for patients no longer needing acute hospital care.

PubMed

Penney, Christine; Henry, Effie

2008-01-01

The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also raised by the finding in Australia that the current case-mix system is inadequate to describe these patients. Further, given the inadequacy of our understanding of health system capacity and output, consideration of a more comprehensive national reporting system along the care continuum may be warranted. This project is an example of effective collaboration between the provincial government, a national organization and HAs, and suggests that provincial governments can participate in a meaningful way to accomplish research-informed health services policy.

European Union health policy and its implications for national convergence.

PubMed

Cucic, S

2000-06-01

This paper explores the relevance for health care of European Union (EU) legislation, regulation and policies. Reports, communications and other materials of the European Commission and other relevant European bodies are screened for their implications for health care, primarily on the national health system level. The paper provides a brief overview of EU history and its main institutions, followed by an analysis of health (care)-related provisions in the EU's main legal documents--its treaties. The impact of the EU actions on health protection is considered with regard to both actions in the field of public health and health protection requirements in its policies. In the public health area, information systems that are now being developed are discussed, followed by an outline of health protection requirements in EU policies that can have an impact on health systems. These policies are then analysed using the political factions model. Finally an attempt is made to predict future developments, stressing the need for a far-reaching synchronization of national systems.

Chronic disease management and the home-care alternative in Ontario, Canada.

PubMed

Tsasis, Peter

2009-08-01

The pressure on our health-care system to deliver efficient, quality and cost-effective care is increasing. The debate on its sustainability is also expanding. These challenges can be managed with revisions to our health-care policy frameworks governing how and what public health-care services are delivered. Chronic disease management and home care can together ease many of the present and future pressures facing the health-care system. However, the current level of investment and the present policy are not effectively supporting movement in this direction. Updating the Canada Health Act to reflect the realities of our health-care system, and developing policies to support the areas of interdisciplinary teamwork and system integration are needed to facilitate chronic disease management and home care in Canada. This article lays out the challenges, highlights the impending issues and suggests a framework for moving forward.

Common threads? Palliative care service developments in seven European countries.

PubMed

Clark, D; ten Have, H; Janssens, R

2000-11-01

Since the late 1960s hospice and palliative care services have been developing in many European countries. Although attention has been given to patterns of development in specific national contexts, so far we lack a comparative understanding of how these services are organized and delivered. Such a comparison poses certain practical and methodological difficulties. It does, however, allow a wider view of the current provision of palliative care in Europe, together with a consideration of implications for the future. We report on an analysis of palliative care developments in seven European countries which gave attention to early origins, patterns of provision, and structural and policy integration. We conclude that, despite different processes of development, the emergent discipline of palliative care now finds its most congenial home within the structures of the formal health care system. Accordingly, inequities between the seven countries can be more clearly identified, posing continuing challenges to policy makers and planners who operate with a European perspective.

The Influence of Health Care Policies on Children's Health and Development. Social Policy Report. Volume 29, Number 4

ERIC Educational Resources Information Center

Perrin, James M.; Boat, Thomas F.; Kelleher, Kelly J.

2016-01-01

Rates of health insurance for children have improved significantly over the past few decades, and more children have insurance than ever before in U.S. history. Health care does improve child health and well-being, but growing understanding of social and community influences has led health care practitioners to work toward more comprehensive and…

The Evolution of Health Care Advance Planning Law and Policy

PubMed Central

Sabatino, Charles P

2010-01-01

Context: The legal tools of health care advance planning have substantially changed since their emergence in the mid-1970s. Thirty years of policy development, primarily at the state legislative level addressing surrogate decision making and advance directives, have resulted in a disjointed policy landscape, yet with important points of convergence evolving over time. An understanding of the evolution of advance care planning policy has important implications for policy at both the state and federal levels. Methods: This article is a longitudinal statutory and literature review of health care advance planning from its origins to the present. Findings: While considerable variability across the states still remains, changes in law and policy over time suggest a gradual paradigm shift from what is described as a “legal transactional approach” to a “communications approach,” the most recent extension of which is the emergence of Physician Orders for Life-Sustaining Treatment, or POLST. The communications approach helps translate patients’ goals into visible and portable medical orders. Conclusions: States are likely to continue gradually moving away from a legal transactional mode of advance planning toward a communications model, albeit with challenges to authentic and reliable communication that accurately translates patients’ wishes into the care they receive. In the meantime, the states and their health care institutions will continue to serve as the primary laboratory for advance care planning policy and practice. PMID:20579283

The evolution of health care advance planning law and policy.

PubMed

Sabatino, Charles P

2010-06-01

The legal tools of health care advance planning have substantially changed since their emergence in the mid-1970s. Thirty years of policy development, primarily at the state legislative level addressing surrogate decision making and advance directives, have resulted in a disjointed policy landscape, yet with important points of convergence evolving over time. An understanding of the evolution of advance care planning policy has important implications for policy at both the state and federal levels. This article is a longitudinal statutory and literature review of health care advance planning from its origins to the present. While considerable variability across the states still remains, changes in law and policy over time suggest a gradual paradigm shift from what is described as a "legal transactional approach" to a "communications approach," the most recent extension of which is the emergence of Physician Orders for Life-Sustaining Treatment, or POLST. The communications approach helps translate patients' goals into visible and portable medical orders. States are likely to continue gradually moving away from a legal transactional mode of advance planning toward a communications model, albeit with challenges to authentic and reliable communication that accurately translates patients' wishes into the care they receive. In the meantime, the states and their health care institutions will continue to serve as the primary laboratory for advance care planning policy and practice.

A model for evaluating the activities of a coalition-based policy action group: the case of Hermosa Vida.

PubMed

Hardy, Lisa Jane; Wertheim, Peter; Bohan, Kyle; Quezada, Julio Cesar; Henley, Eric

2013-07-01

Scholars and clinicians are increasingly recognizing the complexity of social contexts of health and the need for multifunctioning approaches to health care problems including community- and policy-level strategies. Barriers to change in health care policy can sometimes be attributed to the actions of advocacy coalitions who operate from a limited view of "policy change." Advocates have a tendency to pressure stakeholders to mandate laws as a final resolution of a movement, often leading to failure or, worse, stigmatizing of issues. A more inclusive focus on health policy change as an ongoing process increases the efficacy of advocacy and outcomes measurement. This article presents a tool for policy action that coalition members developed through the implementation of a 3-year grant to improve the safety net for preventing childhood obesity. Scholars and policy makers developed the Policy Coalition Evaluation Tool with the intent to create a model to guide and measure efforts and outcomes of a local community-based policy coalition. The authors suggest using community-based participatory research approaches for developing a coalition-specific Policy Coalition Evaluation Tool to increase the effectiveness of advocacy groups and the documentation of coalition activities over time.

A Policy Guide on Integrated Care (PGIC): Lessons Learned from EU Project INTEGRATE and Beyond

PubMed Central

Devroey, Dirk

2017-01-01

Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC) as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012–2016) and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care. PMID:29588631

A Policy Guide on Integrated Care (PGIC): Lessons Learned from EU Project INTEGRATE and Beyond.

PubMed

Borgermans, Liesbeth; Devroey, Dirk

2017-09-25

Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC) as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012-2016) and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care.

The potential of health sector non-governmental organizations: policy options.

PubMed

Gilson, L; Sen, P D; Mohammed, S; Mujinja, P

1994-03-01

Non-governmental organizations (NGOs) have increasingly been promoted as alternative health care providers to the state, furthering the same goals but less hampered by government inefficiencies and resource constraints. However, the reality of NGO health care provision is more complex. Not only is the distinction between government and NGO providers sometimes difficult to determine because of their operational integration, but NGOs may also suffer from resource constraionts and management inefficiencies similar to those of government providers. Some registered NGOs operate as for-profit providers in practice. Policy development must reflect the strengths and weaknesses of NGOs in particular settings and should be built on NGO advantages over government in terms of resource mobilization, efficiency and/or quality. Policy development will always require a strong government presence in co-ordinating and regulating health care provision, and an NGO sector responsive to the policy goals of government.

The development of Korea's new long-term care service infrastructure and its results: focusing on the market-friendly policy used for expansion of the numbers of service providers and personal care workers.

PubMed

Chon, Yongho

2013-01-01

One of the main reasons for reforming long-term care systems is a deficient existing service infrastructure for the elderly. This article provides an overview of why and how the Korean government expanded long-term care infrastructure through the introduction of a new compulsory insurance system, with a particular focus on the market-friendly policies used to expand the infrastructure. Then, the positive results of the expansion of the long-term care infrastructure and the challenges that have emerged are examined. Finally, it is argued that the Korean government should actively implement a range of practical policies and interventions within the new system.

New hospital-based policy for children whose parents present at the ER due to domestic violence, substance abuse and/or a suicide attempt.

PubMed

Hoytema van Konijnenburg, Eva M M; Sieswerda-Hoogendoorn, Tessa; Brilleslijper-Kater, Sonja N; van der Lee, Johanna H; Teeuw, Arianne H

2013-02-01

Child maltreatment is a major social problem with many adverse consequences, and a substantial number of maltreated children are not identified by health care professionals. In 2010, in order to improve the identification of maltreated children in hospitals, a new hospital-based policy was developed in Amsterdam, The Netherlands. This policy was adapted from another policy that was developed in The Hague, the Netherlands, in 2007. In the new Amsterdam policy, all adults presenting at the emergency department due to domestic violence, substance abuse, and/or a suicide attempt are asked whether they have any children in their care. If this is the case, parents are urged to visit the outpatient pediatric department together with all of their children. During this visit, problems are evaluated and voluntary referrals can be arranged to different care organizations. If parents refuse to cooperate, their children are reported to the Dutch Child Abuse Counseling and Reporting Centre. The two aims of this study are to describe (1) characteristics of the identified families and (2) the referrals made to different voluntary and involuntary care organizations during the first 2 years after implementation of the policy. Data were collected from medical records. One hundred and six children from 60 households were included, of which 68 children because their mother was a victim of domestic violence. Referrals to care organizations were arranged for 99 children, of which 67 on a voluntary basis. The Amsterdam policy seems successful in arranging voluntary support for the majority of identified children.

Advancing team-based primary health care: a comparative analysis of policies in western Canada.

PubMed

Suter, Esther; Mallinson, Sara; Misfeldt, Renee; Boakye, Omenaa; Nasmith, Louise; Wong, Sabrina T

2017-07-17

We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.

Official conceptualizations of person-centered care: which person counts?

PubMed

O'Dwyer, Ciara

2013-08-01

Numerous studies have indicated that a "psycho-social" person-centered care approach, involving the delivery of a compassionate, respectful model of care, leads to a high quality of life, particularly for older people living in residential care. This has prompted policy-makers to endorse this approach. Yet, some commentators have argued that the model of person-centered care in official government policies equates to a "consumer-based" rather than a psycho-social approach, as it focuses solely on offering service-users more choice and on promoting independence. However, as such arguments are made in the absence of any empirical analysis, it is unclear both whether such a distinction exists in practice, and, if so, how this alternative model developed. This study explores the development of minimum standards for residential care settings for older people in Ireland in order to address this gap in our understanding of person-centered care. Findings confirm that a consumer-driven model of person-centered care underpins the Irish Standards; residential care is portrayed as a hotel-like service and residents as discerning consumers, which may be unsuitable for older people in residential care with limited capacity to make key choices. Analysis indicates that this model can be seen both as an extension of consumer-driven policies endorsed by many neo-liberal governments, and also of policy-makers' fears of losing their autonomy when they reach the "Fourth Age". This study is particularly illuminating, given the similarities between the Irish care system with England, Scotland, Wales, Northern Ireland and Australia. Copyright © 2013 Elsevier Inc. All rights reserved.

Lessons from Albion: Can Australia learn from England's approach to primary healthcare funding?

PubMed

Norman, Richard; Robinson, Suzanne

2015-01-01

As Australia struggles to meet increased demand for healthcare and contain expenditure there has been a focus on primary care and its role in demand management and keeping people out of expensive secondary care. However, with domestic policy struggling to find a suitable approach consideration of English policy could well be fruitful in the quest to strengthen and develop primary care in Australia. The purpose of this paper is to consider policy developments in England and explores these in relation to the Australian healthcare system. The authors highlight the key changes to policy that have occurred in the English healthcare system in recent years, and discuss whether they have proven successful. The authors discuss the barriers to implementing similar approaches in Australia, particularly the difference in system structure that would necessitate policy adaptation. Whilst there are differences in the structure and organisation of funding and service provision between countries, there are developments in England that are worthy of consideration from an Australian perspective. These include a focus on funding and commissioning that rewards quality not just activity and volume. As Australia sees the development of new primary care organisations that are tasked with commissioning then developments and lessons around the technical and relational aspects will be important to consider. The work highlights that Australia might consider learning from the English experience in this area and the types of incentives that may increase efficiency and quality of health service provision. This is important as it potentially gives greater certainty about those approaches most likely to yield beneficial outcomes for patients and the broader system.

State 'laboratories' test health care reform solutions.

PubMed

Elliott, B A

1993-02-01

Widely recognized by the states as a pressing policy issue, health care reform appears to have moved up on the national policy agenda as well. President Clinton has promised to address the issue during his first 100 days in office. Previously, however, the federal government has been deadlocked on health care reform, leaving the states to become the laboratories for developing and testing proposed solutions to our health care crisis. By passing MinnesotaCare in last year's legislative session, Minnesota joined the growing number of states attempting to provide access to affordable, quality health care to their citizens.

Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments.

PubMed

Schnitker, Linda M; Martin-Khan, Melinda; Burkett, Ellen; Brand, Caroline A; Beattie, Elizabeth R A; Jones, Richard N; Gray, Len C

2015-03-01

The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs). A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e., advisory panel) leading to development of a draft set of SQIs; 3) field testing of drafted SQIs in eight EDs, leading to refinement of the SQI set; and 4) an independent voting process among the panelists for SQI inclusion in a final set, using preestablished inclusion and exclusion criteria. At the conclusion of the process, five SQIs targeting the management of older ED patients with cognitive impairment were developed: 1) the ED has a policy outlining the management of older people with cognitive impairment during the ED episode of care; 2) the ED has a policy outlining issues relevant to carers of older people with cognitive impairment, encompassing the need to include the (family) carer in the ED episode of care; 3) the ED has a policy outlining the assessment and management of behavioral symptoms, with specific reference to older people with cognitive impairment; 4) the ED has a policy outlining delirium prevention strategies, including the assessment of patients' delirium risk factors; and 5) the ED has a policy outlining pain assessment and management for older people with cognitive impairment. This article presents a set of SQIs for the evaluation of performance in caring for older people with cognitive impairment in EDs. © 2015 by the Society for Academic Emergency Medicine.

Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project.

PubMed

Zgierska, Aleksandra E; Vidaver, Regina M; Smith, Paul; Ales, Mary W; Nisbet, Kate; Boss, Deanne; Tuan, Wen-Jan; Hahn, David L

2018-06-05

Systematic implementation of guidelines for opioid therapy management in chronic non-cancer pain can reduce opioid-related harms. However, implementation of guideline-recommended practices in routine care is subpar. The goal of this quality improvement (QI) project is to assess whether a clinic-tailored QI intervention improves the implementation of a health system-wide, guideline-driven policy on opioid prescribing in primary care. This manuscript describes the protocol for this QI project. A health system with 28 primary care clinics caring for approximately 294,000 primary care patients developed and implemented a guideline-driven policy on long-term opioid therapy in adults with opioid-treated chronic non-cancer pain (estimated N = 3980). The policy provided multiple recommendations, including the universal use of treatment agreements, urine drug testing, depression and opioid misuse risk screening, and standardized documentation of the chronic pain diagnosis and treatment plan. The project team drew upon existing guidelines, feedback from end-users, experts and health system leadership to develop a robust QI intervention, targeting clinic-level implementation of policy-directed practices. The resulting multi-pronged QI intervention included clinic-wide and individual clinician-level educational interventions. The QI intervention will augment the health system's "routine rollout" method, consisting of a single educational presentation to clinicians in group settings and a separate presentation for staff. A stepped-wedge design will enable 9 primary care clinics to receive the intervention and assessment of within-clinic and between-clinic changes in adherence to the policy items measured by clinic-level electronic health record-based measures and process measures of the experience with the intervention. Developing methods for a health system-tailored QI intervention required a multi-step process to incorporate end-user feedback and account for the needs of targeted clinic team members. Delivery of such tailored QI interventions has the potential to enhance uptake of opioid therapy management policies in primary care. Results from this study are anticipated to elucidate the relative value of such QI activities.

Implications of measures of quality of life for policy development.

PubMed

Mosteller, F

1987-01-01

Quality of life measurements can lead to legislative programs for health, new policies for the health care system, and possibly new attitudes in the courts. Clinical decisions, public health evaluations, and advice for legislatures and courts require diverse measures. We illustrate potential use of such measures with reimbursement problems, programs like Head Start, mainstreaming the handicapped, day care and prenatal care, terminal care for the elderly, monitoring programs, and chronic disabilities. The many treatment policies discussed at the Portugal Conference show the need for quality of life measures in clinical trials. The courts, although considering quality of life, do not seem to consider quality of life measures. If scientists and medical experts wish to establish or change the positions of the courts, consensus conferences appear more effective than regulation or new legislation. To contribute more than they now do to policy, workers measuring quality of life need to develop a variety of measures and methods. They, then, must apply them to medical and health problems, build up a substantial literature, and set priorities for the research needs of the field.

Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

PubMed Central

Lionis, Christos; Symvoulakis, Emmanouil K; Markaki, Adelais; Vardavas, Constantine; Papadakaki, Maria; Daniilidou, Natasa; Souliotis, Kyriakos; Kyriopoulos, Ioannis

2009-01-01

Background Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. Purpose This paper explores the extent to which integrated primary health care (PHC) is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. Methods A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Results Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Conclusion Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development. PMID:19777112

Going global: the transnationalization of care.

PubMed

Yeates, Nicola

2011-01-01

This article critically examines the contours of ‘care transnationalization’ as an ongoing social process and a field of enquiry. Care transnationalization scholarship combines structural understandings of global power relations with an emphasis on social interactions between defined actors in ways that keep sight of human agency, material welfare and wider social development. It has, however, tended to privilege particular forms, dynamics and sites of care transnationalization over others. The body of research on care labour migration, which is otherwise the most developed literature on care transnationalization to date, contains a number of biases and omissions in its coverage of border-spanning relations and their mediation across country contexts. At the same time, other significant forms of care transnationalization, such as those involving consumer-based care migration, corporate restructuring and the formation of care policy, have suffered from comparative neglect. Working towards an integrated agenda that addresses these diverse expressions of care transnationalization and how they ‘touch down’ in a range of sectoral, social and country contexts is of prime importance to policy research agendas directed at understanding the wider development impacts of processes of social and economic restructuring.

Child Care during Nonstandard Work Hours: Research to Policy Resources

ERIC Educational Resources Information Center

Ferguson, Daniel

2016-01-01

In November 2014, the Child Care and Development Block Grant (CCDBG) Act of 2014 was signed into law, reauthorizing the Child Care and Development Fund (CCDF)--the federal child care subsidy program--for the first time since 1996. In December 2015, the U.S. Office of Child Care issued a Notice of Proposed Rulemaking, which updated CCDF regulations…

The long reach of Alzheimer's disease: patients, practice, and policy.

PubMed

Bynum, Julie P W

2014-04-01

The impact of Alzheimer's disease and related dementias reaches well beyond the health care needs of the person with dementia. As dementia inexorably progresses, the patient becomes increasingly dependent on others for basic daily care and routine tasks, a physically safe environment, and protection from exploitation or abuse. Addressing the diverse medical and social care needs of the burgeoning US population with Alzheimer's disease and related dementias requires the adoption of a broad-based policy framework and agenda that explicitly acknowledge the complex and unique needs of people with dementia and the impacts of dementia on caregivers and society at large. Public policies related to social service providers, agencies that provide appropriate housing, financial and legal services, and law enforcement must complement other policies focused on prevention and risk reduction, effective treatment development, and efficient health care delivery.

Developing and implementing mental health policy in Zanzibar, a low income country off the coast of East Africa

PubMed Central

2011-01-01

Background The Zanzibar Ministry of Health and Social Welfare, concerned about mental health in the country, requested technical assistance from WHO in 1997. Aims This article describes the facilitation over many years by a WHO Collaborating Centre, of sustainable mental health developments in Zanzibar, one of the poorest countries in the world, using systematic approaches to policy design and implementation. Methods Based on intensive prior situation appraisal and consultation, a multi-faceted set of interventions combining situation appraisal to inform planning; sustained policy dialogue at Union and state levels; development of policy and legislation, development of strategic action plans, establishment of intersectoral national mental health implementation committee, establishment of national mental health coordination system, integration of mental health into primary care, strengthening of primary-secondary care liaison, rationalisation and strengthening of secondary care system, ensuring adequate supply of medicines, use of good practice guidelines and health information systems, development of services for people with intellectual disability, establishment of formal mechanism for close liaison between the mental health services and other governmental, non-governmental and traditional sectors, mental health promotion, suicide prevention, and research and development. Results The policy and legislation introduced in 1999 have resulted in enhanced mental health activities over the ensuing decade, within a setting of extreme low resource. However, advances ebb and flow and continued efforts are required to maintain progress and continue mental health developments. Lessons learnt have informed the development of mental health policies in neighbouring countries. Conclusions A multi-faceted and comprehensive programme can be effective in achieving considerable strengthening of mental health programmes and services even in extremely low resource settings, but requires sustained input and advocacy if gains are to be maintained and enhanced. PMID:21320308

Advancing palliative care in the Uganda health system: an evidence-based policy brief.

PubMed

Nabudere, Harriet; Obuku, Ekwaro; Lamorde, Mohammed

2014-12-01

This paper describes the development and findings for a policy brief on "Advancing the Integration of Palliative Care into the National Health System" and the subsequent use of this report. Key stakeholders involved with palliative care helped identify the problem and potential policy solutions to scale up these services within the health system. A working group of national stakeholder representatives and external reviewers commented on and contributed to successive drafts of the report. Research describing the problem, policy options and implementation considerations was identified by reviewing government documents, routinely collected data, electronic literature searches, contact with key informants, and reviewing the reference lists of relevant documents that were retrieved. The palliative burden is not only high but increasing due to the rise in population and life expectancy. A few options for holistic, supportive care include: Home-based care increases chances of a peaceful death for the terminally ill surrounded by their loved ones; supporting informal caregivers improves their quality of life and discharge planning reduces unscheduled admissions and has the potential to free up capacity for acute care services. A combination of strategies is needed to effectively implement the proposed options as discussed further in this article. The policy brief report was used as a background document for two stakeholder dialogues whose main outcome was that a comprehensive national palliative care policy should be instituted to include all the options, which need to be integrated within the public health system. A draft policy is now in process.

45 CFR 98.1 - Goals and purposes.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND... each State maximum flexibility in developing child care programs and policies that best suit the needs... make their own decisions on the child care that best suits their family's needs; (3) Encourage States...

45 CFR 98.1 - Goals and purposes.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND... each State maximum flexibility in developing child care programs and policies that best suit the needs... make their own decisions on the child care that best suits their family's needs; (3) Encourage States...

National quality indicators and policies from 15 countries leading in adult end-of-life care: a systematic environmental scan.

PubMed

Virdun, Claudia; Luckett, Tim; Lorenz, Karl A; Phillips, Jane

2018-06-01

The importance of measuring the quality of end-of-life care provision is undisputed, but determining how best to achieve this is yet to be confirmed. This study sought to identify and describe national end-of-life care quality indicators and supporting policies used by countries leading in their end-of-life care provision. A systematic environmental scan that included a web search to identify relevant national policies and indicators; hand searching for additional materials; information from experts listed for the top 10 (n=15) countries ranked in the 'quality of care' category of the 2015 Quality of Death Index study; and snowballing from Index experts. Ten countries (66%) have national policy support for end-of-life care measurement, five have national indicator sets, with two indicator sets suitable for all service providers. No countries mandate indicator use, and there is limited evidence of consumer engagement in development of indicators. Two thirds of the 128 identified indicators are outcomes measures (62%), and 38% are process measures. Most indicators pertain to symptom management (38%), social care (32%) or care delivery (27%). Measurement of end-of-life care quality varies globally and rarely covers all care domains or service providers. There is a need to reduce duplication of indicator development, involve consumers, consider all care providers and ensure measurable and relevant indicators to improve end-of-life care experiences for patients and families. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Written institutional ethics policies on euthanasia: an empirical-based organizational-ethical framework.

PubMed

Lemiengre, Joke; Dierckx de Casterlé, Bernadette; Schotsmans, Paul; Gastmans, Chris

2014-05-01

As euthanasia has become a widely debated issue in many Western countries, hospitals and nursing homes especially are increasingly being confronted with this ethically sensitive societal issue. The focus of this paper is how healthcare institutions can deal with euthanasia requests on an organizational level by means of a written institutional ethics policy. The general aim is to make a critical analysis whether these policies can be considered as organizational-ethical instruments that support healthcare institutions to take their institutional responsibility for dealing with euthanasia requests. By means of an interpretative analysis, we conducted a process of reinterpretation of results of former Belgian empirical studies on written institutional ethics policies on euthanasia in dialogue with the existing international literature. The study findings revealed that legal regulations, ethical and care-oriented aspects strongly affected the development, the content, and the impact of written institutional ethics policies on euthanasia. Hence, these three cornerstones-law, care and ethics-constituted the basis for the empirical-based organizational-ethical framework for written institutional ethics policies on euthanasia that is presented in this paper. However, having a euthanasia policy does not automatically lead to more legal transparency, or to a more professional and ethical care practice. The study findings suggest that the development and implementation of an ethics policy on euthanasia as an organizational-ethical instrument should be considered as a dynamic process. Administrators and ethics committees must take responsibility to actively create an ethical climate supporting care providers who have to deal with ethical dilemmas in their practice.

Enhancing the diversity of the pediatrician workforce.

PubMed

Friedman, Aaron L

2007-04-01

This policy statement describes the key issues related to diversity within the pediatrician and health care workforce to identify barriers to enhancing diversity and offer policy recommendations to overcome these barriers in the future. The statement addresses topics such as health disparities, affirmative action, recent policy developments and reports on workforce diversity, and research on patient and provider diversity. It also broadens the discussion of diversity beyond the traditional realms of race and ethnicity to include cultural attributes that may have an effect on the quality of health care. Although workforce diversity is related to the provision of culturally effective pediatric care, it is a discrete issue that merits separate discussion and policy formulation. At the heart of this policy-driven action are multiorganizational and multispecialty collaborations designed to address substantive educational, financial, organizational, and other barriers to improved workforce diversity.

Explaining Large-Scale Policy Change in the Turkish Health Care System: Ideas, Institutions, and Political Actors.

PubMed

Agartan, Tuba I

2015-10-01

Explaining policy change has been one of the major concerns of the health care politics and policy development literature. This article aims to explain the specific dynamics of large-scale reforms introduced within the framework of the Health Transformation Program in Turkey. It argues that confluence of the three streams - problem, policy, and politics - with the exceptional political will of the Justice and Development Party's (JDP) leaders opened up a window of opportunity for a large-scale policy change. The article also underscores the contribution of recent ideational perspectives that help explain "why" political actors in Turkey would focus on health care reform, given that there are a number of issues waiting to be addressed in the policy agenda. Examining how political actors framed problems and policies deepens our understanding of the content of the reform initiatives as well as the construction of the need to reform. The article builds on the insights of both the ideational and institutionalist perspectives when it argues that the interests, aspirations, and fears of the JDP, alongside the peculiar characteristics of the institutional context, have shaped its priorities and determination to carry out this reform initiative. Copyright © 2015 by Duke University Press.

Early Childhood Education and Care Policy in England under the Coalition Government

ERIC Educational Resources Information Center

Lloyd, Eva

2015-01-01

This paper reviews developments in policy on early childhood education and care--early years--under the Coalition Government in England. Three factors came to define the Coalition's performance and record in this area: ambivalence about the rationales for the two areas of early education and childcare; a disconnect between early years and other…

On Relating Health Care Policy to the Provision of Health Care to Black Families.

ERIC Educational Resources Information Center

Darity, William A.

This paper addresses health and social issues as well as other socioeconomic problems which affect the black family, and the development of appropriate policy and programs to deal with those problems. Data on infant mortality, life expectancy, maternal mortality, physician and dental visits, and some selected death rates from specific causes are…

Interventions geared towards strengthening the health system of Namibia through the integration of palliative care.

PubMed

Freeman, Rachel; Luyirika, Emmanuel Bk; Namisango, Eve; Kiyange, Fatia

2016-01-01

The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care providers, educators, the public, patients, and families. The main focus of stakeholder engagement should address some core interventions geared towards improving knowledge and awareness, strengthening skills and attitudes about palliative care. These interventions include educating health and allied healthcare professionals on the palliative care-related problems of patients and best practices for care, explaining palliative care as a clinical and holistic discipline and demonstrating its effectiveness, the need to include palliative care into national policies, strategic plans, training curriculums of healthcare professionals and the engagement of patients, families, and communities. Interventions from a five-year programme that was aimed at strengthening the health system of Namibia through the integration of palliative care for people living with HIV and AIDS and cancer in Namibia are shared. This article illustrates how a country can implement the World Health Organisation's public health strategy for developing palliative care services, which recommends four pillars: government policy, education, drug availability, and implementation.

Policies on Conflicts of Interest in Health Care Guideline Development: A Cross-Sectional Analysis

PubMed Central

Morciano, Cristina; Basevi, Vittorio; Faralli, Carla; Hilton Boon, Michele; Tonon, Sabina; Taruscio, Domenica

2016-01-01

Objective To assess whether organisations that develop health care guidelines have conflict of interest (COI) policies and to review the content of the available COI policies. Methods Survey and content analysis of COI policies available in English, French, Spanish, and Italian conducted between September 2014 and June 2015. A 24-item data abstraction instrument was created on the basis of guideline development standards. Results The survey identified 29 organisations from 19 countries that met the inclusion criteria. From these organisations, 19 policies were eligible for inclusion in the content analysis. Over one-third of the policies (7/19, 37%) did not report or did not clearly report whether disclosure was a prerequisite for membership of the guideline panel. Strategies for the prevention of COI such as divestment were mentioned by only two organisations. Only 21% of policies (4/19) used criteria to determine whether an interest constitutes a COI and to assess the severity of the risk imposed. Conclusions The finding that some organisations, in contradiction of widely available standards, still do not have COI policies publicly available is concerning. Also troubling were the findings that some policies did not clearly report critical steps in obtaining, managing and communicating disclosure of relationships of interest. This in addition to the variability encountered in content and accessibility of COI policies may cause confusion and distrust among guideline users. It is in the interest of guideline users and developers to design an agreed-upon, comprehensive, clear, and accessible COI policy. PMID:27846255

Implementation of ICU palliative care guidelines and procedures: a quality improvement initiative following an investigation of alleged euthanasia.

PubMed

Kuschner, Ware G; Gruenewald, David A; Clum, Nancy; Beal, Alice; Ezeji-Okoye, Stephen C

2009-01-01

Ethical conflicts are commonly encountered in the course of delivering end-of-life care in the ICU. Some ethical concerns have legal dimensions, including concerns about inappropriate hastening of death. Despite these concerns, many ICUs do not have explicit policies and procedures for withdrawal of life-sustaining treatments. We describe a US Office of Inspector General (OIG) investigation of end-of-life care practices in our ICU. The investigation focused on care delivered to four critically ill patients with terminal diseases and an ICU nurse's concern that the patients had been subjected to euthanasia. The OIG investigation also assessed the validity of allegations that patient flow in and out of our ICU was inappropriately influenced by scheduled surgeries and that end-of-life care policies in our ICU were not clear. Although the investigation did not substantiate the allegations of euthanasia or inappropriate ICU patient flow, it did find that the policies that discuss end-of-life care issues were not clear and allowed for wide-ranging interpretations. Acting on the OIG recommendations, we developed a quality improvement initiative addressing end-of-life care in our ICU, intended to enhance communication and understanding about palliative care practices in our ICU, to prevent ethical conflicts surrounding end-of-life care, and to improve patient care. The initiative included the introduction of newly developed ICU comfort care guidelines, a physician order set, and a physician template note. Additionally, we implemented an educational program for ICU staff. Staff feedback regarding the initiative has been highly favorable, and the nurse whose concerns led to the investigation was satisfied not only with the investigation but also the policies and procedures that were subsequently introduced in our ICU.

Practice nursing in Australia: A review of education and career pathways

PubMed Central

Parker, Rhian M; Keleher, Helen M; Francis, Karen; Abdulwadud, Omar

2009-01-01

Background Nurses in Australia are often not educated in their pre registration years to meet the needs of primary care. Careers in primary care may not be as attractive to nursing graduates as high-tech settings such as intensive or acute care. Yet, it is in primary care that increasingly complex health problems are managed. The Australian government has invested in incentives for general practices to employ practice nurses. However, no policy framework has been developed for practice nursing to support career development and post-registration education and training programs are developed in an ad hoc manner and are not underpinned by core professional competencies. This paper reports on a systematic review undertaken to establish the available evidence on education models and career pathways with a view to enhancing recruitment and retention of practice nurses in primary care in Australia. Methods Search terms describing education models, career pathways and policy associated with primary care (practice) nursing were established. These search terms were used to search electronic databases. The search strategy identified 1394 citations of which 408 addressed one or more of the key search terms on policy, education and career pathways. Grey literature from the UK and New Zealand internet sites were sourced and examined. The UK and New Zealand Internet sites were selected because they have well established and advanced developments in education and career pathways for practice nurses. Two reviewers examined titles, abstracts and studies, based on inclusion and exclusion criteria. Disagreement between the reviewers was resolved by consensus or by a third reviewer. Results Significant advances have been made in New Zealand and the UK towards strengthening frameworks for primary care nursing education and career pathways. However, in Australia there is no policy at national level prepare nurses to work in primary care sector and no framework for education or career pathways for nurses working in that sector. Conclusion There is a need for national training standards and a process of accreditation for practice nursing in Australia to support the development of a responsive and sustainable nursing workforce in primary care and to provide quality education and career pathways. PMID:19473493

Practice nursing in Australia: A review of education and career pathways.

PubMed

Parker, Rhian M; Keleher, Helen M; Francis, Karen; Abdulwadud, Omar

2009-05-27

Nurses in Australia are often not educated in their pre registration years to meet the needs of primary care. Careers in primary care may not be as attractive to nursing graduates as high-tech settings such as intensive or acute care. Yet, it is in primary care that increasingly complex health problems are managed. The Australian government has invested in incentives for general practices to employ practice nurses. However, no policy framework has been developed for practice nursing to support career development and post-registration education and training programs are developed in an ad hoc manner and are not underpinned by core professional competencies. This paper reports on a systematic review undertaken to establish the available evidence on education models and career pathways with a view to enhancing recruitment and retention of practice nurses in primary care in Australia. Search terms describing education models, career pathways and policy associated with primary care (practice) nursing were established. These search terms were used to search electronic databases. The search strategy identified 1394 citations of which 408 addressed one or more of the key search terms on policy, education and career pathways. Grey literature from the UK and New Zealand internet sites were sourced and examined. The UK and New Zealand Internet sites were selected because they have well established and advanced developments in education and career pathways for practice nurses.Two reviewers examined titles, abstracts and studies, based on inclusion and exclusion criteria. Disagreement between the reviewers was resolved by consensus or by a third reviewer. Significant advances have been made in New Zealand and the UK towards strengthening frameworks for primary care nursing education and career pathways. However, in Australia there is no policy at national level prepare nurses to work in primary care sector and no framework for education or career pathways for nurses working in that sector. There is a need for national training standards and a process of accreditation for practice nursing in Australia to support the development of a responsive and sustainable nursing workforce in primary care and to provide quality education and career pathways.

Integrated mental health services in England: a policy paradox

PubMed Central

England, Elizabeth; Lester, Helen

2005-01-01

Abstract Purpose The purpose of this paper is to examine the effects of health care policy on the development of integrated mental health services in England. Data sources Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primary/secondary interface for people with serious mental illness. Conclusion We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoric/reality gap in practice. This has particular implications for people with serious mental health problems. Discussion We conclude with suggestions for strategies that may facilitate more integrated working. PMID:16773165

A nursing association's leadership in primary health care: policy, projects, and partnerships in the 1990s.

PubMed

Whyte, N; Stone, S

2000-06-01

This paper documents the work of one provincial nursing association, the Registered Nurses Association of British Columbia (RNABC), to promote primary health care (PHC) as the foundation of the health-care system. In 1990 the RNABC embarked on a comprehensive policy program to influence change from a nursing perspective. A wide array of strategies was used over a 10-year period to help make PHC a reality in British Columbia's health-care system. Successful strategies used during this period included: writing and distributing policy papers, conducting and evaluating demonstration projects, and developing partnerships with other groups. Some of the projects and their outcomes are highlighted, followed by a critical reflection on lessons learned through the various initiatives. Although remarkable achievements were made from the RNABC's policy work during the 1990s, the advancement of PHC requires further collaborative efforts using multiple strategies.

An integrated approach to preventing cardiovascular disease: community-based approaches, health system initiatives, and public health policy.

PubMed

Karwalajtys, Tina; Kaczorowski, Janusz

2010-01-01

Cardiovascular disease (CVD) is largely the product of interactions among modifiable risk factors that are common in developed nations and increasingly of concern in developing countries. Hypertension is an important precursor to the development of CVD, and although detection and treatment rates have improved in recent years in some jurisdictions, effective strategies and policies supporting a shift in distribution of risk factors at the population level remain paramount. Challenges in managing cardiovascular health more effectively include factors at the patient, provider, and system level. Strategies to reduce hypertension and CVD should be population based, incorporate multilevel, multicomponent, and socioenvironmental approaches, and integrate community resources with public health and clinical care. There is an urgent need to improve monitoring and management of risk factors through community-wide, primary care-linked initiatives, increase the evidence base for community-based prevention strategies, further develop and evaluate promising program components, and develop new approaches to support healthy lifestyle behaviors in diverse age, socioeconomic, and ethnocultural groups. Policy and system changes are critical to reduce risk in populations, including legislation and public education to reduce dietary sodium and trans-fatty acids, food pricing policies, and changes to health care delivery systems to explicitly support prevention and management of CVD.

A strategy for translating evidence into policy and practice to close the gap - developing essential service standards for Aboriginal and Torres Strait Islander cardiovascular care.

PubMed

Brown, Alex; O'Shea, Rebekah L; Mott, Kathy; McBride, Katharine F; Lawson, Tony; Jennings, Garry L R

2015-02-01

The development and application of essential standards for cardiovascular care for Aboriginal and Torres Strait Islander people creates a strategic platform on which to systematically close the gap in the health outcomes and life expectancy between Aboriginal and Torres Strait Islander and non-Indigenous people in Australia. We outline six developmental stages that can be used to enhance the effective translation of evidence into practice that reduces life expectancy differentials. Focussing efforts where the biggest gain can be made; considering how to make a policy-relevant difference with an emphasis on translation into policy and practice; establishing a foundation for action by engaging with stakeholders throughout the process; developing a framework to guide action; drafting policy-relevant and framework-appropriate essential service standards; and defining standards that help policy decision makers achieve current priority policy targets. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Long-term care policy and financing as a public or private matter in the United States.

PubMed

Yee, D L

2001-01-01

Effective approaches to assure adequate resources, infrastructure, and broad societal support to address chronic care needs are volatile and potentially unpopular issues that can result in many losers (those getting far less than they want) and few winners (those who gain access to scarce societal resources for care). In the United States, debates on long-term care involve a complex set of issues and services that link health, social services (welfare), and economic policies that often pit public and private sector interests and values against one another. Yet long-term care policies fill a necessary function in society to clarify roles, expectations, and functions of public, non-profit, for profit, individual, and family sectors of a society. By assessing and developing policy proposals that include all long-term care system dimensions, a society can arrive at systematic, fair, and rational decisions. Limiting decisions to system financing aspects alone is likely to result in unforeseen or unintended effects in a long-term care system that stopgap "fixes" cannot resolve. Three underlying policy challenges are presented: the need for policymakers to consider whether the public sector is the first or last source of payment for long-term care; whether government is seen primarily as a risk or cost manager; and the extent to which choice is afforded to elders and family caregivers with regard to the types, settings, and amount of long-term care desired to complement family care.

Occupational health and safety management practices and musculoskeletal disorders in aged care.

PubMed

Oakman, Jodi; Bartram, Timothy

2017-05-15

Purpose The purpose of this paper is to examine whether occupational health and safety (OHS) management used to manage musculoskeletal disorders (MSDs) in the aged care sector reflects contemporary research evidence of best practice to reduce the incidence of these disorders. Design/methodology/approach In total, 58 interviews were conducted with managers and supervisors in the aged care sector across four organisations in Australia. Policies and procedures relating to MSDs were reviewed for each organisation. Findings Policies and procedures for managing MSDs do not reflect contemporary evidence, which supports a complex aetiology, related to a range of physical and psychosocial workplace factors. Despite strong evidence that psychosocial factors contribute to MSD development, these were not included in the policies and procedures reviewed. Findings from the interviews management practices including leadership and various components of HRM were functioning well but fragmentation was evident due to the challenging nature of the aged care sector. Practical implications To address the significant burden of MSDs in the aged care sector, policies and procedures need to include coverage of psychosocial and physical workplace factors. The development of systematic and integrated OHS management at the workplace level may play an important role in the effective management of MSDs. Originality/value This study offers insights into the previously unexplored area of MSD risk management and the role of management practices such as HRM in the aged care sector.

A decade of integration and collaboration: the development of integrated health care in Sweden 2000–2010

PubMed Central

Ahgren, Bengt; Axelsson, Runo

2011-01-01

Introduction The recent history of integrated health care in Sweden is explored in this article, focusing on the first decade of the 2000s. In addition, there are some reflections about successes and setbacks in this development and challenges for the next decade. Description of policy and practice The first efforts to integrate health care in Sweden appeared in the beginning of the 1990s. The focus was on integration of intra-organisational processes, aiming at a more cost-effective health care provision. Partly as a reaction to the increasing economism at that time, there was also a growing interest in quality improvement. Out of this work emerged the ‘chains of care’, integrating all health care providers involved in the care of specific patient groups. During the 2000s, many county councils have also introduced inter-organisational systems of ‘local health care’. There has also been increasing collaboration between health professionals and other professional groups in different health and welfare services. Discussion and conclusion Local health care meant that the chains of care and other forms of integration and collaboration became embedded in a more integrative context. At the same time, however, policy makers have promoted free patient choice in primary health care and also mergers of hospitals and clinical departments. These policies tend to fragment the provision of health care and have an adverse effect on the development of integrated care. As a counterbalance, more efforts should be put into evaluation of integrated health care, in order to replace political convictions with evidence concerning the benefits of such health care provision. PMID:21677844

Long-term care policy for the elderly in the Zaporozhye region of Ukraine: a case study of social development following the collapse of Communism.

PubMed

Palley, Howard A; Romanenkova, Lyudmyla A

2004-01-01

In this paper, we review the status of social policy for the elderly in Ukraine since the fall of Communism and the breakup of the Soviet Union. We specifically address the problem of "rebuilding" an income and services policy for the at-risk elderly after the unraveling of the system that existed prior to the fall of Communism. Also, we address some existing problems faced by the elderly in the health care system. Within this context, we present a case study of the current status of long-term care policy for the elderly in one province of Ukraine, the eastern province of Zaporozhye, encompassing the industrial city of Zaporozhye on the Dnieper River. This case study particularly pays attention to current attempts to promote a social development process of long-term care services for the elderly. It examines recent developments with respect to public sector organizations and voluntary sector organizations that are trying to provide necessary services to the needy elderly. With respect to the voluntary sector, the paper pays particular attention to the American Jewish Joint Distribution Committee (JDC) model of a largely externally funded NGO that provides comprehensive and integrated social supports, while emphasizing local empowerment and the use of volunteers, for the needy Jewish population in the province of Zaporozhye. Based on our findings, we make some proposals regarding the improvement of income and services policy with respect to the elderly in Zaporozhye and Ukraine.

Passing a smoke-free law in a pro-tobacco culture: a multiple streams approach.

PubMed

Greathouse, Lisa W; Hahn, Ellen J; Okoli, Chizimuzo T C; Warnick, Todd A; Riker, Carol A

2005-08-01

This article describes a case study of the policy development and political decision-making process involved in the enactment of Lexington, Kentucky's smoke-free law. The multiple streams framework is used to analyze the development of the law in a seemingly unlikely and challenging political environment. Proponents developed a dissemination research plan targeted at policy makers and the public to demonstrate the need for a comprehensive law. The existence of a strong coalition of health care providers and health care systems including the board of health, as well as long-standing tobacco control expertise and a strong legal team, were essential ingredients for success. A deliberate strategy to expose the tobacco industry was effective in preparing policy makers for the opponents' policy arguments. As expected, a hospitality industry association was formed to oppose the ordinance, resulting in a legal challenge that delayed enactment of the law.

Social Determinants and Disparities in Health: Their Crucifixion, Resurrection, and Ultimate Triumph(?) in Health Policy.

PubMed

House, James S

2016-08-01

David Mechanic has been a principal founder of modern sociological and social science approaches to health, especially in relation to health policy. These approaches have since the 1950s and 1960s resurrected ideas that had currency in the mid-nineteenth century but seemed crucified, dead, and buried by the rise of modern biomedicine from the mid-nineteenth century through the mid-twentieth century. Problems and lacunae in purely biomedical approaches to health in the later twentieth century, along with developments of new biopsychosocial approaches to health, have spawned a return toward ideas of Rudolf Virchow and mid-nineteenth-century social medicine that social determinants and disparities are major drivers of population health. Since individual health and population health constitute the major determinants of health care utilization and expenditures, social determinants and disparities in health are arguably the foundation of a new "demand-side" health policy that can resolve America's paradoxical health policy crisis of spending increasingly more than any nation on health care and insurance yet achieving increasingly worsening health outcomes relative to virtually all developed countries and some developing ones as well, something that current "supply-side" health policy, including Obamacare, cannot do, important as it is for expanding access to health insurance and care. Copyright © 2016 by Duke University Press.

Netherlands Institute of Care and Welfare/NIZW: Source of Knowledge and Inspiration.

ERIC Educational Resources Information Center

Netherlands Inst. of Care and Welfare, Utrecht.

Playing an important role in developing new social policies and introducing new methods, the Netherlands Institute of Care and Welfare (NIZW) is an independent foundation funded by a combination of private and public monies to conduct research and to develop and implement programs in five areas: (1) care and nursing; (2) organization of care; (3)…

[The actual issues of development of manpower potential in health care].

PubMed

Belostotskii, A V; Gridnev, O V; Grishina, N K; Znachkova, E A

2016-01-01

The analysis was implemented concerning main directions of development of health care manpower policy in Moscow. The activities are established related to improvement of actual situation with development of potential of medical personnel, increasing of motivation ofphysicians and paramedical personnel, improvement of conditions of development of manpower resources.

Implications of Changes in Households and Living Arrangements for Future Home-based Care Needs and Costs of Disabled Elders in China1

PubMed Central

Zeng, Yi; Chen, Huashuai; Wang, Zhenglian; Land, Kenneth C.

2016-01-01

Objectives Understand future home-based care needs/costs for disabled elders in China. Method Further develop/apply ProFamy extended cohort-component method. Results (1) Chinese disabled elders and percentage of national GDP devoted to home-based care costs for disabled elders will increase much quicker than growth of total elderly population; (2) Home-based care needs/costs for disabled oldest-old aged 80+ will increase much faster than that for disabled young-old aged 65–79 after 2030; (3) Disabled unmarried elders living alone and their home-based care costs increase substantially faster than disabled unmarried elders living with children; (4) Sensitivity analyses shown that possible changes in mortality and elderly disability status are the major factors affecting home-based care needs and costs; (5) Caregivers resources under two-child policy will be substantially better than under current fertility policy unchanged. Discussion Policy recommendations concerning reductions of prevalence of disability, gender equality, two-child policy, encouraging elder’s residential proximity to their adult children, etc. PMID:25213460

Intersectional policy analysis of self-directed mental health care in Canada.

PubMed

Cook, Judith A; Morrow, Marina; Battersby, Lupin

2017-06-01

Recovery from mental illness is influenced by one's social location along multiple dimensions of identity, such as race, class, gender, age, and ability, and by how these social locations are expressed through structural and institutional barriers. This project was developed using an intersectional policy analysis framework designed to promote equity across identity locations-called the multistrand method-to examine the potential use of self-directed care financing approaches in the Canadian mental health system. A panel of 16 diverse stakeholders came together 4 times at structured 6-hr meetings to examine the evidence for self-directed care and explore its application in the Canadian context. Telephone interviews with evidence panel members were conducted to assess their perceptions of the group process and outcomes. Our analysis revealed ways that intersecting strand locations might differentially influence the degree of choice and recovery experienced by self-directed care participants. Individualized resource allocation, draining financial resources from ethnically specific services, unevenness in acceptance of the recovery orientation, and paucity of service options in different geographical regions were identified as contexts in which self-directed care policies could promote inequity. However, greater peer involvement in the model's implementation, use of indigenous community supports, purchase of material goods by economically disenfranchised persons, and access to services from ethnically diverse clinicians in the private sector were identified as equity-promoting model features. By couching their analysis at the level of unique socially-situated perspectives, the group developed detailed policy recommendations and insights into both the potential and limitations of self-directed care. The knowledge gained from our project can be used to develop uniquely Canadian self-directed care models tailored to promote recovery through empowerment and self-determination across intersecting identity strand locations. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Developing a nursing personnel policy to address body art using an evidence-based model.

PubMed

Dorwart, Shawna D; Kuntz, Sandra W; Armstrong, Myrna L

2010-12-01

An increase in the prevalence of body art as a form of self-expression has motivated health care organizations to develop policies addressing nursing personnel's body art. A systematic review of literature on body art was completed and a telephone survey of 15 hospitals was conducted to query existing policy statements addressing nursing personnel's body art. The literature established no prevalence of body art among nurses or effect of nurses' body art. Of the 13 hospitals (86%) that shared their policy on body art, none provided a rationale or references to support their existing policies. A lack of published evidence identifying the effect of body art among nurses shifts the burden of determining care outcomes to the leadership of individual hospitals. Further research on patients' perception of nursing personnel with visible body art, using an evidence-based model, is recommended. Copyright 2010, SLACK Incorporated.

The management of new primary care organizations: an international perspective.

PubMed

Meads, Geoffrey; Wild, Andrea; Griffiths, Frances; Iwami, Michiyo; Moore, Phillipa

2006-08-01

Management practice arising from parallel policies for modernizing health systems is examined across a purposive sample of 16 countries. In each, novel organizational developments in primary care are a defining feature of the proposed future direction. Semistructured interviews with national leaders in primary care policy development and local service implementation indicate that management strategies, which effectively address the organized resistance of medical professions to modernizing policies, have these four consistent characteristics: extended community and patient participation models; national frameworks for interprofessional education and representation; mechanisms for multiple funding and accountabilities; and the diversification of non-governmental organizations and their roles. The research, based on a two-year fieldwork programme, indicates that at the meso-level of management planning and practice, there is a considerable potential for exchange and transferable learning between previously unconnected countries. The effectiveness of management strategies abroad, for example, in contexts where for the first time alternative but comparable new primary care organizations are exercising responsibilities for local resource utilization, may be understood through the application of stakeholder analyses, such as those employed to promote parity of relationships in NHS primary care trusts.

Knowledge generation about care-giving in the UK: a critical review of research paradigms.

PubMed

Milne, Alisoun; Larkin, Mary

2015-01-01

While discourse about care and caring is well developed in the UK, the nature of knowledge generation about care and the research paradigms that underpin it have been subjected to limited critical reflection and analysis. An overarching synthesis of evidence - intended to promote debate and facilitate new understandings - identifies two largely separate bodies of carer-related research. The first body of work - referred to as Gathering and Evaluating - provides evidence of the extent of care-giving, who provides care to whom and with what impact; it also focuses on evaluating policy and service efficacy. This type of research tends to dominate public perception about caring, influences the type and extent of policy and support for carers and attracts funding from policy and health-related sources. However, it also tends to be conceptually and theoretically narrow, has limited engagement with carers' perspectives and adopts an atomistic purview on the care-giving landscape. The second body of work - Conceptualising and Theorising - explores the conceptual and experiential nature of care and aims to extend thinking and theory about caring. It is concerned with promoting understanding of care as an integral part of human relationships, embedded in the life course, and a product of interdependence and reciprocity. This work conceptualises care as both an activity and a disposition and foregrounds the development of an 'ethic of care', thereby providing a perspective within which to recognise both the challenges care-giving may present and the significance of care as a normative activity. It tends to be funded from social science sources and, while strong in capturing carers' experiences, has limited policy and service-related purchase. Much could be gained for citizens, carers and families, and the generation of knowledge advanced, if the two bodies of research were integrated to a greater degree. © 2014 John Wiley & Sons Ltd.

Validation of the Policy Advocacy Engagement Scale for frontline healthcare professionals.

PubMed

Jansson, Bruce S; Nyamathi, Adeline; Heidemann, Gretchen; Duan, Lei; Kaplan, Charles

2017-05-01

Nurses, social workers, and medical residents are ethically mandated to engage in policy advocacy to promote the health and well-being of patients and increase access to care. Yet, no instrument exists to measure their level of engagement in policy advocacy. To describe the development and validation of the Policy Advocacy Engagement Scale, designed to measure frontline healthcare professionals' engagement in policy advocacy with respect to a broad range of issues, including patients' ethical rights, quality of care, culturally competent care, preventive care, affordability/accessibility of care, mental healthcare, and community-based care. Cross-sectional data were gathered to estimate the content and construct validity, internal consistency, and test-retest reliability of the Policy Advocacy Engagement Scale. Participants and context: In all, 97 nurses, 94 social workers, and 104 medical residents (N = 295) were recruited from eight acute-care hospitals in Los Angeles County. Ethical considerations: Informed consent was obtained via Qualtrics and covered purposes, risks and benefits; voluntary participation; confidentiality; and compensation. Institutional Review Board approval was obtained from the University of Southern California and all hospitals. Results supported the validity of the concept and the instrument. In confirmatory factor analysis, seven items loaded onto one component with indices indicating adequate model fit. A Pearson correlation coefficient of .36 supported the scale's test-retest stability. Cronbach's α of .93 indicated strong internal consistency. The Policy Advocacy Engagement Scale demonstrated satisfactory psychometric properties in this initial test. Findings should be considered within the context of the study's limitations, which include a low response rate and limited geographic scope. The Policy Advocacy Engagement Scale appears to be the first validated scale to measure frontline healthcare professionals' engagement in policy advocacy. With it, researchers can analyze variations in professionals' levels of policy advocacy engagement, understand what factors are associated with it, and remedy barriers that might exist to their provision of it.

Recent developments in health care law: partners in innovation.

PubMed

Berry, Roberta M; Bliss, Lisa; Caley, Sylvia; Lombardo, Paul A; Rooker, Jerri Nims; Todres, Jonathan; Wolf, Leslie E

2010-06-01

This article reviews recent developments in health care law, focusing on the engagement of law as a partner in health care innovation. The article addresses: the history and contents of recent United States federal law restricting the use of genetic information by insurers and employers; the recent federal policy recommending routine HIV testing; the recent revision of federal policy regarding the funding of human embryonic stem cell research; the history, current status, and need for future attention to advance directives; the recent emergence of medical-legal partnerships and their benefits for patients; the obesity epidemic and its implications for the child's right to health under international conventions.

An analysis of England's nursing policy on compassion and the 6Cs: the hidden presence of M. Simone Roach's model of caring.

PubMed

Bradshaw, Ann

2016-03-01

In 2012, chief nursing officers (CNO) in England published a policy on compassion in response to serious criticisms of patients' care. Because their objective is fundamentally to shape nursing, this study argues, following Popper, that the policy should be analysed. An appraisal tool, developed from Popper, Gadamer, Jauss and Thiselton, is the framework for this analysis. The CNO policy document identified six values and behaviours, termed '6Cs', required by all nurses, midwives and care staff. The document contains no data, references or acknowledgements, but is similar to the 6Cs defined by the Canadian nursing nun, Sister M. Simone Roach, in her theory of caring published 30 years earlier. Roach considered caring and the components of it, including compassion, to be moral virtues, an inner motivation to care. This study suggests that without explicit reference to Roach's ideas, and her underlying theoretical base, the CNO requirement has the effect of turning virtues into commodities and a form of external control, described by Ritzer as a McDonaldized dehumanization. This study, which has international relevance beyond England and the UK, suggests that the CNO revise their policy by acknowledging Roach's 6Cs and openly discuss the implications of her work for their policy. © 2015 John Wiley & Sons Ltd.

Staff immunisation: policy and practice in child care.

PubMed

Spokes, Paula J; Ferson, Mark J; Ressler, Kelly-Anne

2011-08-01

The aims of this study were to determine the level of knowledge among child-care centre directors regarding the National Health and Medical Research Council (NHMRC) recommendations for the immunisation of child-care workers, the extent to which this knowledge was translated into practice and any organisational barriers to the development and implementation of staff immunisation policy. A cross-sectional survey, conducted in August 2006, in which a postal questionnaire was sent to a random sample of 784 NSW child-care centres. Centre directors were asked to complete the questionnaire on immunisation knowledge, policy and practice for the centre. A multivariate logistic-regression model was used to identify factors independently associated with centres with an immunisation policy for staff and centres that offered to pay all or part of the cost of vaccination of staff. Directors from 437 centres participated in the study for a response rate of 56%. Of these, 49% were aware of the NHMRC recommendations, and 57% had a staff immunisation policy in place. In the logistic regression model, centres with a written immunisation policy for staff were more likely to be aware of the NHMRC guidelines and offer long day care services. Centres that offered to pay all or part of the cost of immunisation for staff were more likely to be aware of the NHMRC guidelines, offer other child-care services and not operate for profit. Barriers to staff immunisation were related to the implementation of policy and included cost, time and access to information. The level of awareness of specific staff immunisation recommendations was relatively low. The transition of knowledge to policy was encouraging, although implementation of policies requires further commitment. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Working to improve the management of sarcoma patients across Europe: a policy checklist.

PubMed

Kasper, Bernd; Lecointe-Artzner, Estelle; Wait, Suzanne; Boldon, Shannon; Wilson, Roger; Gronchi, Alessandro; Valverde, Claudia; Eriksson, Mikael; Dumont, Sarah; Drove, Nora; Kanli, Athanasia; Wartenberg, Markus

2018-04-16

The Sarcoma Policy Checklist was created by a multidisciplinary expert group to provide policymakers with priority areas to improve care for sarcoma patients. This paper draws on this research, by looking more closely at how France, Germany, Italy, Spain, Sweden and the United Kingdom are addressing each of these priority areas. It aims to highlight key gaps in research, policy and practice, as well as ongoing initiatives that may impact the future care of sarcoma patients in different European countries. A pragmatic review of the published and web-based literature was undertaken. Telephone interviews were conducted in each country with clinical and patient experts to substantiate findings. Research findings were discussed within the expert group and developed into five core policy recommendations. The five identified priority areas were: the development of designated and accredited centres of reference; more professional training; multidisciplinary care; greater incentives for research and innovation; and more rapid access to effective treatments. Most of the countries studied have ongoing initiatives addressing many of these priorities; however, many are in early stages of development, or require additional funding and resources. Gaps in access to quality care are particularly concerning in many of Europe's lower-resourced countries. Equitable access to information, clinical trials, innovative treatments and quality specialist care should be available to all sarcoma patients. Achieving this across Europe will require close collaboration between all stakeholders at both the national and European level.

Protecting health care workers from tuberculosis in China: a review of policy and practice in China and the United States.

PubMed

Chai, Shua J; Mattingly, Daniel C; Varma, Jay K

2013-01-01

Tuberculosis causes >1.7 million deaths worldwide each year and is frequently transmitted in hospitals. Outbreaks of multidrug-resistant tuberculosis have led to illness and death among health care workers (HCWs) in many countries. Some countries, such as the United States, implemented occupational health policies that substantially reduced tuberculosis rates among HCWs. Inadequate tuberculosis infection control in China may contribute to its high burden of tuberculosis and multidrug-resistant tuberculosis, which are both the second highest worldwide. Occupational health policies in China for tuberculosis control can be strengthened. We reviewed the development and content of tuberculosis infection control policies in the United States and China. Sources included published academic literature, Chinese Ministry of Health policies, US government agency reports, legal databases, personal observations of hospitals, review of internet discussion sites, and discussions with HCWs and health care and law experts. In the United States, slow acceptance of the tuberculosis problem in HCWs resulted in decades of inaction. Tuberculosis infection control policies, based mostly on expert opinion, were implemented only after tuberculosis resurged in the 1980s. Effective evidence-based policies were developed only after multiple cycles of policy implementation, evaluation and revision. These policies have now substantially reduced occupational tuberculosis. In China, tuberculosis has not been formally recognized as an occupational disease, and data regarding the burden in HCWs are sparse. Vagueness of current labour laws and suboptimal alignment of infection control authority and expertise result in varied and sometimes absent protection of HCWs against tuberculosis. Formal evaluations of occupational tuberculosis policies have not been reported. By collecting data on its current HCW tuberculosis burden and infection control practices, refining policies, continually evaluating its policies based on accumulated evidence and rapidly identifying unsuspected tuberculosis cases, China can develop a more comprehensive strategy to ensure the health of HCWs and reduce transmission of tuberculosis and multidrug-resistant tuberculosis.

Policies and Practices in Canadian Family Child Care Agencies. You Bet I Care!

ERIC Educational Resources Information Center

Doherty, Gillian; Lero, Donna S.; Tougas, Jocelyne; LaGrange, Annette; Goelman, Hillel

Four Canadian provinces license or contract with family child care agencies, which in turn recruit and monitor child care providers. These family child care agencies have two primary roles: monitoring and supervising providers, and supplying their affiliated family child care providers with professional development opportunities and other types of…

How do Policy and Institutional Settings Shape Opportunities for Community-Based Primary Health Care? A Comparison of Ontario, Québec and New Zealand

PubMed Central

Miller, Fiona; Breton, Mylaine; Couturier, Yves; Morton-Chang, Frances; Ashton, Toni; Sheridan, Nicolette; Peckham, Alexandra; Williams, A Paul; Kenealy, Tim; Wodchis, Walter

2017-01-01

Community-based primary health care describes a model of service provision that is oriented to the population health needs and wants of service users and communities, and has particular relevance to supporting the growing proportion of the population with multiple chronic conditions. Internationally, aspirations for community-based primary health care have stimulated local initiatives and influenced the design of policy solutions. However, the ways in which these ideas and influences find their way into policy and practice is strongly mediated by policy settings and institutional legacies of particular jurisdictions. This paper seeks to compare the key institutional and policy features of Ontario, Québec and New Zealand that shape the ‘space available’ for models of community-based primary health care to take root and develop. Our analysis suggests that two key conditions are the integration of relevant health and social sector organisations, and the range of policy levers that are available and used by governments. New Zealand has the most favourable conditions, and Ontario the least favourable. All jurisdictions, however, share a crucial barrier, namely the ‘barbed-wire fence’ that separates funding of medical and ‘non-medical’ primary care services, and the clear interests primary care doctors have in maintaining this fence. Moves in the direction of system-wide community-based primary health care require a gradual dismantling of this fence. PMID:28970754

The Development of a Pharmacy Student Work Values Inventory (PSWVI).

ERIC Educational Resources Information Center

Woodward, Jean Bouchard; Kirk, Kenneth W.

1987-01-01

An instrument developed to measure pharmacy student work values revealed 11 reliable factors: quality patient care; supervision and company policy; work creativity/variety; status; management/leadership; economic return; work schedule; family responsibilities; job security; co-worker relationships; and policies and procedures. There were…

When the private sphere goes public: exploring the issues facing family caregiver organizations in the development of long-term care policies.

PubMed

Rozario, Philip A; Palley, Elizabeth

2008-01-01

Though family caregiving forms the backbone of the long-term care system in the United States, long-term care policies have traditionally focused on paid services that frail older people and people with disabilities utilize for their day-to-day functioning. Part of the exclusion of family caregiving from the long-term care discourse stems from the traditional separation of the private sphere, where family caregiving occurs, from the public sphere of policy making. However, the passage of the Family and Medical Leave Act (FMLA), the National Family Caregiver Support Program (NFCSP) and Medicaid waiver legislation may reflect recent changes in the government's position on their role in addressing issues related to the "private spheres." In this article, we explore the nature of family caregiving in the United States, the divide between the public and private spheres and provide an overview of family caregiving-related policies and programs in the U.S. In our review, we examine the provisions in the FMLA, NFCSP, and Medicaid waiver legislation that support family caregiving efforts. We also examine the roles of family caregiver organizations in making family caregiving an important element of long-term care policy and influencing policy-making.

Legislative and Policy Developments and Imperatives for Advancing the Primary Care Behavioral Health (PCBH) Model.

PubMed

Freeman, Dennis S; Hudgins, Cathy; Hornberger, Joel

2018-06-01

The Primary Care Behavioral Health (PCBH) practice model continues to gain converts among primary care and behavioral health professionals as the evidence supporting its effectiveness continues to accumulate. Despite a growing number of practices and organizations using the model effectively, widespread implementation has been hampered by outmoded policies and regulatory barriers. As policymakers and legislators begin to recognize the contributions that PCBH model services make to the care of complex patients and the expansion of access to those in need of behavioral health interventions, some encouraging policy initiatives are emerging and the policy environment is becoming more favorable to implementation of the PCBH model. This article outlines the necessity for policy change, exposing the policy issues and barriers that serve to limit the practice of the PCBH model; highlights innovative approaches some states are taking to foster integrated practice; and discusses the compatibility of the PCBH model with the nation's health care reform agenda. Psychologists have emerged as leaders in the design and implementation of PCBH model integration and are encouraged to continue to advance the model through the demonstration of efficient and effective clinical practice, participation in the expansion of an appropriately trained workforce, and advocacy for the inclusion of this practice model in emerging healthcare systems and value-based payment methodologies.

Community psychiatric care: from libertarianism to coercion. Moral panic and mental health policy in Britain.

PubMed

Holloway, F

1996-08-01

This article discusses recent developments in mental health policy in Britain, focusing on the move towards compulsory supervision of mentally ill people in the community. It is argued that the desire for compulsion reflects moral panic rather than rational appraisal of the undoubted problems with community mental health care. Alternative strategies involving education of the patient and cares, the deployment of psychological treatments of psychosis and an emphasis on the negotiation of treatment plans, are advocated.

Psychological Science and Innovative Strategies for Informing Health Care Redesign: A Policy Brief.

PubMed

Asarnow, Joan Rosenbaum; Hoagwood, Kimberly E; Stancin, Terry; Lochman, John E; Hughes, Jennifer L; Miranda, Jeanne M; Wysocki, Tim; Portwood, Sharon G; Piacentini, John; Tynan, Douglas; Atkins, Marc; Kazak, Anne E

2015-01-01

Recent health care legislation and shifting health care financing strategies are transforming health and behavioral health (a broad term referring to mental health, substance use, and health behavior) care in the United States. Advances in knowledge regarding effective treatment and services coupled with incentives for innovation in health and behavioral health care delivery systems make this a unique time for mobilizing our science to enhance the success of health and behavioral health care redesign. To optimize the potential of our current health care environment, a team was formed composed of leaders from the Societies of Clinical Child & Adolescent Psychology, Pediatric Psychology, and Child and Family Policy and Practice (Divisions 53, 54, and 37 of the American Psychological Association). This team was charged with reviewing the scientific and policy literature with a focus on five major issues: (a) improving access to care and reducing health disparities, (b) integrating behavioral health care within primary care, (c) preventive services, (d) enhancing quality and outcomes of care, and (e) training and workforce development. The products of that work are summarized here, including recommendations for future research, clinical, training, and policy directions. We conclude that the current emphasis on accountable care and evaluation of the outcomes of care offer numerous opportunities for psychologists to integrate science and practice for the benefit of our children, families, and nation. The dramatic changes that are occurring in psychological and behavioral health care services and payment systems also require evolution in our practice and training models.

Psychological Science and Innovative Strategies for Informing Health Care Redesign: A Policy Brief

PubMed Central

Asarnow, Joan Rosenbaum; Hoagwood, Kimberly E.; Stancin, Terry; Lochman, John E.; Hughes, Jennifer L.; Miranda, Jeanne M.; Wysocki, Tim; Portwood, Sharon G.; Piacentini, John; Tynan, Douglas; Atkins, Marc; Kazak, Anne E.

2017-01-01

Recent health care legislation and shifting health care financing strategies are transforming health and behavioral health (a broad term referring to mental health, substance use, and health behavior) care in the United States. Advances in knowledge regarding effective treatment and services coupled with incentives for innovation in health and behavioral health care delivery systems make this a unique time for mobilizing our science to enhance the success of health and behavioral health care redesign. To optimize the potential of our current health care environment, a team was formed composed of leaders from the Societies of Clinical Child & Adolescent Psychology, Pediatric Psychology, and Child and Family Policy and Practice (Divisions 53, 54, and 37 of the American Psychological Association). This team was charged with reviewing the scientific and policy literature with a focus on five major issues: (a) improving access to care and reducing health disparities, (b) integrating behavioral health care within primary care, (c) preventive services, (d) enhancing quality and outcomes of care, and (e) training and workforce development. The products of that work are summarized here, including recommendations for future research, clinical, training, and policy directions. We conclude that the current emphasis on accountable care and evaluation of the outcomes of care offer numerous opportunities for psychologists to integrate science and practice for the benefit of our children, families, and nation. The dramatic changes that are occurring in psychological and behavioral health care services and payment systems also require evolution in our practice and training models. PMID:26430948

Rapid Change without Transformation: The Dominance of a National Policy Paradigm over International Influences on ECEC Development in Ireland 1995-2012

ERIC Educational Resources Information Center

Wolfe, Toby; O'Donoghue-Hynes, Bernie; Hayes, Nóirín

2013-01-01

The rapidity of change in Irish early childhood policy over the last 20 years is clear to observers (OECD Thematic Review of Early Childhood Education and Care Policy in Ireland. "Organisation for Economic Co-operation and Development," Paris, 2004). What may be debated is how significant the changes are. In this paper, we analyse…

Policy feedbacks and the impact of policy designs on public opinion.

PubMed

Campbell, Andrea Louise

2011-12-01

A recently developed analytic approach--policy feedback effects--provides health policy analysts with a crucial new tool for understanding the politics of health policy. Three cases--senior citizens' opposition to the Obama health care reform, tax breaks for employer-provided health insurance, and the Medicare Part D prescription drug program--demonstrate how policy designs affect subsequent policy outcomes. To differing degrees, the three cases show how public policies can create constituencies with particular understandings of their benefits who attempt to thwart reform; can highlight or reduce the visibility of the government role in health care, shaping attitudes about the worth of government action; and can provide half solutions that fail to maximize beneficiary welfare but that deflate momentum for policy improvements. The cases illustrate a general pattern revealed by wide-ranging research on policy feedback effects: the designs of public policies influence preferences and alter patterns of political mobilization, effects that feed back into the political system, shaping the political environment and the possibilities for future policy making.

Human resources and access to maternal health care.

PubMed

ten Hoope-Bender, P; Liljestrand, J; MacDonagh, S

2006-09-01

The lack of human resources is one of the main bottlenecks to achieving the Millennium Development Goals on maternal and child health. A coherent national policy, recognized across government, needs to be in place to overcome this especially in countries severely affected by HIV/AIDS. Such a policy should cover selection of pre-service students, the qualifications of trainers and training sites, supportive supervision, career path development, a package of carefully thought-out incentives for the retention of staff, strategies for interaction with communities, and an agreed-upon health staff HIV/AIDS policy. Without such coherent human resource planning, a large number of countries will fail to reduce maternal and newborn mortality.

Potential Effects of Health Care Policy Decisions on Physician Availability

NASA Technical Reports Server (NTRS)

Garcia, Christopher; Goodrich, Michael

2011-01-01

Many regions in America are experiencing downward trends in the number of practicing physicians and the number of available physician hours, resulting in a worrisome decrease in the availability of health care services. Recent changes in American health care legislation may induce a rapid change in the demand for health care services, which in turn will result in a new supply-demand equilibrium . In this paper we develop a system dynamics model linking physician availability to health care demand and profitability. We use this model to explore scenarios based on different initial conditions and describe possible outcomes for a range of different policy decisions.

Palliative Care for Children with Cancer in the Middle East: A Comparative Study.

PubMed

Mojen, Leila Khanali; Rassouli, Maryam; Eshghi, Peyman; Sari, Ali Akbari; Karimooi, Majideh Heravi

2017-01-01

High incidence rates of childhood cancer and the consequent deaths in the Middle East is one of the major reasons for the need for palliative care in these countries. Using the experiences and innovations of the other countries can provide a pattern for the countries of the region and lead to the development of palliative care in children. Therefore, the aim of this study is to compare the status of pediatric palliative care in Egypt, Lebanon, Jordan, Turkey, and Iran. This is a comparative study in which the information related to pediatric palliative care system in the target countries (from 2000 to 2016) has been collected, summarized, and classified by searching in databases, such as "PubMed, Scopus, Google scholar, Ovid, and science direct." Palliative care in children in the Middle East is still in its early stages and there are many obstacles to its development, namely, lack of professional knowledge, inadequate support of policy-makers, and lack of access to opioids and financial resources. Despite these challenges, providing services at the community level, support of nongovernmental organizations (NGOs), using trained specialists and multi-disciplinary approach is an opportunity in some countries. Considering the necessity of the development of pediatric palliative care in the region, solutions such as training the human resources, integrating palliative care programs into the curriculum of the related fields, establishing facilitating policies in prescription and accessibility of opioids, providing the necessary support by policy-makers, doing research on assessment of palliative care quality, as well as NGOs' participation and public education are suggested.

Public sector hospitals and organizational change: an agenda for policy analysis.

PubMed

Collins, C; Green, A

1999-01-01

An important feature of health care systems in recent years is the change in the organizational position and relations of public sector hospitals. Health sector reforms have led to increasing heterogeneity in the organizational location and status of public sector hospitals and new organizational forms of public-private relations are being developed by and for hospitals. These changes can have important implications for health and health care. They raise issues around equity, control, accountability and performance of health care. Yet the policy process in practice may be failing to develop and implement appropriate forms of policy formulation on health sector reform. This paper focuses on the organizational position and relations of hospitals within public sector health services. It firstly outlines key elements of health sector reform and relates these to two dimensions of organizational change for hospitals: increasing heterogeneity and forms of public-private relations. The paper provides a descriptive format for classifying forms of hospital organizational change and proposes a framework of six questions for analysing these organizational forms. This may be used to assess the appropriateness of specific policies to particular country situations and to develop more open debate around hospital organizational forms.

One stop crisis centres: A policy analysis of the Malaysian response to intimate partner violence.

PubMed

Colombini, Manuela; Ali, Siti Hawa; Watts, Charlotte; Mayhew, Susannah H

2011-06-21

This article aims to investigate the processes, actors and other influencing factors behind the development and the national scale-up of the One Stop Crisis Centre (OSCC) policy and the subsequent health model for violence-response. Methods used included policy analysis of legal, policy and regulatory framework documents, and in-depth interviews with key informants from governmental and non-governmental organisations in two States of Malaysia. The findings show that women's NGOs and health professionals were instrumental in the formulation and scaling-up of the OSCC policy. However, the subsequent breakdown of the NGO-health coalition negatively impacted on the long-term implementation of the policy, which lacked financial resources and clear policy guidance from the Ministry of Health. The findings confirm that a clearly-defined partnership between NGOs and health staff can be very powerful for influencing the legal and policy environment in which health care services for intimate partner violence are developed. It is critical to gain high level support from the Ministry of Health in order to institutionalise the violence-response across the entire health care system. Without clear operational details and resources policy implementation cannot be fully ensured and taken to scale.

Arguing for Rural Health in Medicare: A Progressive Rhetoric for Rural America

ERIC Educational Resources Information Center

Ricketts, Thomas C.

2004-01-01

Rural health policy is the laws, regulations, rules, and interpretations that benefit or affect health and health care for rural populations. This paper examines how rural health policy is viewed in the broader field of public policy, discusses the role of advocacy in developing rural health policy, and suggests ways to make that advocacy more…

Interventions geared towards strengthening the health system of Namibia through the integration of palliative care

PubMed Central

Freeman, Rachel; Luyirika, Emmanuel BK; Namisango, Eve; Kiyange, Fatia

2016-01-01

The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care providers, educators, the public, patients, and families. The main focus of stakeholder engagement should address some core interventions geared towards improving knowledge and awareness, strengthening skills and attitudes about palliative care. These interventions include educating health and allied healthcare professionals on the palliative care-related problems of patients and best practices for care, explaining palliative care as a clinical and holistic discipline and demonstrating its effectiveness, the need to include palliative care into national policies, strategic plans, training curriculums of healthcare professionals and the engagement of patients, families, and communities. Interventions from a five-year programme that was aimed at strengthening the health system of Namibia through the integration of palliative care for people living with HIV and AIDS and cancer in Namibia are shared. This article illustrates how a country can implement the World Health Organisation’s public health strategy for developing palliative care services, which recommends four pillars: government policy, education, drug availability, and implementation. PMID:27563348

Alignment between Chronic Disease Policy and Practice: Case Study at a Primary Care Facility

PubMed Central

Draper, Claire A.; Draper, Catherine E.; Bresick, Graham F.

2014-01-01

Background Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. Methods One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. Results The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. Conclusions Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar findings and factors are present at other primary care facilities in Cape Town. At a philosophical level, this research highlights the tension between primary health care principles and a diseased-based approach in a primary care setting. PMID:25141191

Alignment between chronic disease policy and practice: case study at a primary care facility.

PubMed

Draper, Claire A; Draper, Catherine E; Bresick, Graham F

2014-01-01

Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar findings and factors are present at other primary care facilities in Cape Town. At a philosophical level, this research highlights the tension between primary health care principles and a diseased-based approach in a primary care setting.

Who Cares about APA Policy and Does it Have an Impact? 2006 Annual Report of the APA Policy and Planning Board

ERIC Educational Resources Information Center

American Psychologist, 2007

2007-01-01

What constitutes American Psychological Association (APA) policy? How does it affect the everyday and professional lives of APA members? How personally aware are psychologists of APA policies? In this report, the APA explores these questions and provide some intriguing findings on the fate of policies developed through the APA's complicated and…

Learning organisations: the challenge of finding a safe space in a climate of accountability.

PubMed

McKee, Anne

2017-03-01

The effects of health policy reforms over a twenty-five year period have changed the NHS as a place in which to work and learn. Some of these changes have had unintentional consequences for learning in the workplace. A recent King's Fund contribution to quality improvement debates included an extensive review of NHS policies encouraging change 'from within' the NHS and renewed calls to develop learning organisations there. I draw upon an action research project designed to develop learning organisations in primary care to locate quality improvement debates amid the realities of practice. The project identified key challenges primary care practices encountered to protect time and space for this form of work based learning, even when they recognised the need for it and wanted to engage in it. Implications for policy makers, primary care practices and health professional educationalists are identified.

An official American Thoracic Society policy statement: pay-for-performance in pulmonary, critical care, and sleep medicine.

PubMed

Kahn, Jeremy M; Scales, Damon C; Au, David H; Carson, Shannon S; Curtis, J Randall; Dudley, R Adams; Iwashyna, Theodore J; Krishnan, Jerry A; Maurer, Janet R; Mularski, Richard; Popovich, John; Rubenfeld, Gordon D; Sinuff, Tasnim; Heffner, John E

2010-04-01

Pay-for-performance is a model for health care financing that seeks to link reimbursement to quality. The American Thoracic Society and its members have a significant stake in the development of pay-for-performance programs. To develop an official ATS policy statement addressing the role of pay-for-performance in pulmonary, critical care and sleep medicine. The statement was developed by the ATS Health Policy Committee using an iterative consensus process including an expert workshop and review by ATS committees and assemblies. Pay-for-performance is increasingly utilized by health care purchasers including the United States government. Published studies generally show that programs result in small but measurable gains in quality, although the data are heterogeneous. Pay-for-performance may result in several negative consequences, including the potential to increase costs, worsen health outcomes, and widen health disparities, among others. Future research should be directed at developing reliable and valid performance measures, increasing the efficacy of pay-for-performance programs, minimizing negative unintended consequences, and examining issues of costs and cost-effectiveness. The ATS and its members can play a key role in the design and evaluation of these programs by advancing the science of performance measurement, regularly developing quality metrics alongside clinical practice guidelines, and working with payors to make performance improvement a routine part of clinical practice. Pay-for-performance programs will expand in the coming years. Pulmonary, critical care and sleep practitioners can use these programs as an opportunity to partner with purchasers to improve health care quality.

Integrated Crew Health Care System for Space Flight

NASA Technical Reports Server (NTRS)

Davis, Jeffrey R.

2007-01-01

Dr. Davis' presentation includes a brief overview of space flight and the lessons learned for health care in microgravity. He will describe the development of policy for health care for international crews. He will conclude his remarks with a discussion of an integrated health care system.

Improving the care of older persons in Australian prisons using the Policy Delphi method.

PubMed

Patterson, Karen; Newman, Claire; Doona, Katherine

2016-09-01

There are currently no internationally recognised and approved processes relating to the care of older persons with dementia in prison. This research aimed to develop tools and procedures related to managing the care of, including the identification and assessment of, older persons with dementia who are imprisoned in New South Wales, Australia. A modified approach to the Policy Delphi method, using both surveys and facilitated discussion groups, enabled experts to come together to discuss improving the quality of care provision for older persons with dementia in prison and achieve research aims. © The Author(s) 2014.

Cost Containment in Europe

PubMed Central

Culyer, A. J.

1989-01-01

Health care cost containment is not in itself a sensible policy objective, because any assessment of the appropriateness of health care expenditure in aggregate, as of that on specific programs, requires a balancing of costs and benefits at the margin. International data on expenditures can, however, provide indications of the likely impact on costs and expenditures of structural features of health care systems. Data from the Organization for Economic Cooperation and Development for both European countries and a wider set are reviewed, and some current policies in Europe that are directed at controlling health care costs are outlined. PMID:10313433

"No place like home": Gender, family, and the politics of home care in post-world war II Ontario.

PubMed

Struthers, James

2003-01-01

Since the early 1990s home care increasingly has emerged as a favoured policy response to the growing costs which an aging population poses for our health care system. This paper explores the early history of home care for the elderly in Ontario during the first three decades after World War II. It demonstrates that policy debates over the merits of home versus institutional care for the elderly, and community-based over hospital-based approaches to home care are not recent phenomenon but have been on going since the 1940s within the public health and social services sector. The paper examines why home care failed for so long to develop beyond the margins of Ontario's highly institutionalized health care system. It also explores how earlier visions of community-based home care, designed to help the elderly age in place, increasingly were obscured by an exclusive preoccupation with home care's "cost effectiveness" as an alternative to hospital or residential care, a rationale which discounted home care's costs to unpaid and principally female care givers. The paper concludes that the Ontario health ministry's systematic devaluing of caregiving and home maker skills, the fear of undermining the family's willingness to provide care, as well as the failure to develop effective mechanisms for integrated regional health care planning, also impeded the progress of home care's development before the 1980s.

The impact of labor policies on the health of young children in the context of economic globalization.

PubMed

Heymann, Jody; Earle, Alison; McNeill, Kristen

2013-01-01

Globalization has transformed the workplace at the same time that increasing numbers of children live in families in which all adults work for pay outside the home. Extensive research evidence demonstrates the importance of parental involvement in the early years of a child's life. Yet, parents caring for young children may face challenges in fulfilling both work and family responsibilities under current labor force conditions. In this article, we review the evidence on the importance of parental care for meeting young children's routine care needs, preventive health care needs, and curative medical treatment requirements. We examine the evidence regarding the impact of four policies in particular on young children's health and development: parental leave, breastfeeding breaks, early childhood care and education, and leave for children's health needs. Last, we examine the availability of these policies worldwide and discuss the potential economic implications.

Minding Ps and Qs: The Political and Policy Questions Framing Health Care Spending.

PubMed

Sage, William M

2016-12-01

Tracing the evolution of political conversations about health care spending and their relationship to the formation of policy is a valuable exercise. Health care spending is about science and ethics, markets and government, freedom and community. By the late 1980s the unique upward trajectory of post-Medicare U.S. health care spending had been established, recessions and tax cuts were eroding federal and state budgets, and efforts to harness market forces to serve policy goals were accelerating. From the initial writings on "managed competition," through the failed Clinton health reform effort in the early 1990s, to the passage of the Affordable Care Act in 2010, the policy narrative of health spending acquired a superficial consistency. On closer examination, however, it becomes apparent that the cost problem has been repeatedly reframed in political discourse even during this relatively brief period. The clearest transition has been from a narrative centered on rationing necessary care to one committed to reducing wasteful care - although the role of accumulated law and regulation in perpetuating waste remains largely unrecognized and the recently articulated commitment to population health seems an imperfect proxy for explicitly developing social solidarity with respect to health and health care in the United States.

Child Care in Rhode Island: Caring for Infants and Pre-School Children. Issue Brief.

ERIC Educational Resources Information Center

Harrington, Ann-Marie, Ed.; Walsh, Catherine Boisvert, Ed.; Bryant, Elizabeth Burke, Ed.

1997-01-01

This report of the Rhode Island Kids Count organization details the state's infant and preschool child care, components of quality care, and state policies to increase the supply of quality care. The report begins with a discussion of the importance of providing good quality child care to enhance healthy child development, especially brain…

The brain and child development: time for some critical thinking.

PubMed Central

Bruer, J T

1998-01-01

There is widespread interest in the claim that new breakthroughs in neuroscience have radical implications for early child care policy. Yet despite parents', educators', and policy makers' enthusiasm, there are good reasons to be skeptical. The neuroscience cited in the policy arguments is not new, depending primarily on three well-established neurobiological findings: rapid postnatal synapse formation, critical periods in development, and the effects of enriched rearing on brain connectivity in rats. Furthermore, this neuroscience is often oversimplified and misinterpreted. While child care advocates are enthusiastic about potential applications of brain science, for the most part neuroscientists are more cautious and skeptical. After reviewing the evidence and the arguments, the author suggests that in the interest of good science and sound policy, more of us might adopt a skeptical stance. Images p388-a p389-a PMID:9769763

Long-term care for people with developmental disabilities: a critical analysis.

PubMed

Palley, H A; Van Hollen, V

2000-08-01

This article explores how the trends toward long-term community care affecting people with developmental disabilities developed. Appropriateness of care and quality of life issues are discussed. The article also reviews the development of long-term care for frail and disabled elderly people and explores the arguments for a continuum of care that have developed in this area. The authors conclude that future policies with respect to meeting long-term care needs for people with developmental disabilities must be addressed flexibly on an individual basis, related to individual needs, and must provide a continuum of care services.

Eliciting the Functional Processes of Apologizing for Errors in Health Care

PubMed Central

Prothero, Marie M.; Morse, Janice M.

2017-01-01

The purpose of this article was to analyze the concept development of apology in the context of errors in health care, the administrative response, policy and format/process of the subsequent apology. Using pragmatic utility and a systematic review of the literature, 29 articles and one book provided attributes involved in apologizing. Analytic questions were developed to guide the data synthesis and types of apologies used in different circumstances identified. The antecedents of apologizing, and the attributes and outcomes were identified. A model was constructed illustrating the components of a complete apology, other types of apologies, and ramifications/outcomes of each. Clinical implications of developing formal policies for correcting medical errors through apologies are recommended. Defining the essential elements of apology is the first step in establishing a just culture in health care. Respect for patient-centered care reduces the retaliate consequences following an error, and may even restore the physician patient relationship. PMID:28540337

What Can Be Learned from Existing Investigations of Weight-Related Practices and Policies with the Potential to Impact Disparities in US Child-Care Settings? A Narrative Review and Call for Surveillance and Evaluation Efforts.

PubMed

Larson, Nicole; Ayers Looby, Anna; Frost, Natasha; Nanney, Marilyn S; Story, Mary

2017-10-01

Child-care settings and the combination of policies and regulations under which they operate may reduce or perpetuate disparities in weight-related health, depending on the environmental supports they provide for healthy eating and activity. The objectives of this review are to summarize research on state and local policies germane to weight-related health equity among young children in the United States and on how federal policies and regulations may provide supports for child-care providers serving families with the most limited resources. In addition, a third objective is to comprehensively review studies of whether there are differences in practices and policies within US child-care facilities according to the location or demographics of providers and children. The review found there is growing evidence addressing disparities in the social and physical child-care environments provided for young children, but scientific gaps are present in the current understanding of how resources should best be allocated and policies designed to promote health equity. Additional research is needed to address limitations of prior studies relating to the measurement of supports for weight-related health; complexities of categorizing socioeconomic position, ethnicity/race, and urban and rural areas; exclusion of legally nonlicensed care settings from most research; and the cross-sectional nature of most study designs. There is a particularly great need for the development of strong surveillance systems to allow for better monitoring and evaluation of state policies that may impact weight-related aspects of child-care environments, implementation at the program level, and needed implementation supports. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Managing conflicts of interest in the UK National Institute for Health and Care Excellence (NICE) clinical guidelines programme: qualitative study.

PubMed

Graham, Tanya; Alderson, Phil; Stokes, Tim

2015-01-01

There is international concern that conflicts of interest (COI) may bias clinical guideline development and render it untrustworthy. Guideline COI policies exist with the aim of reducing this bias but it is not known how such policies are interpreted and used by guideline producing organisations. This study sought to determine how conflicts of interest (COIs) are disclosed and managed by a national clinical guideline developer (NICE: the UK National Institute for Health and Care Excellence). Qualitative study using semi-structured telephone interviews with 14 key informants: 8 senior staff of NICE's guideline development centres and 6 chairs of guideline development groups (GDGs). We conducted a thematic analysis. Participants regard the NICE COI policy as comprehensive leading to transparent and independent guidance. The application of the NICE COI policy is, however, not straightforward and clarity could be improved. Disclosure of COI relies on self reporting and guideline developers have to take "on trust" the information they receive, certain types of COI (non-financial) are difficult to categorise and manage and disclosed COI can impact on the ability to recruit clinical experts to GDGs. Participants considered it both disruptive and stressful to exclude members from GDG meetings when required by the COI policy. Nonetheless the impact of this disruption can be minimised with good group chairing skills. We consider that the successful implementation of a COI policy in clinical guideline development requires clear policies and procedures, appropriate training of GDG chairs and an evaluation of how the policy is used in practice.

Health system strategies supporting transition to adult care.

PubMed

Hepburn, Charlotte Moore; Cohen, Eyal; Bhawra, Jasmin; Weiser, Natalie; Hayeems, Robin Z; Guttmann, Astrid

2015-06-01

The transition from paediatric to adult care is associated with poor clinical outcomes, increased costs and low patient and family satisfaction. However, little is known about health system strategies to streamline and safeguard care for youth transitioning to adult services. Moreover, the needs of children and youth are often excluded from broader health system reform discussions, leaving this population especially vulnerable to system 'disintegration'. (1) To explore the international policy profile of paediatric-to-adult care transitions, and (2) to document policy objectives, initiatives and outcomes for jurisdictions publicly committed to addressing transition issues. An international policy scoping review of all publicly available government documents detailing transition-related strategies was completed using a web-based search. Our analysis included a comparable cohort of nine wealthy Organisation for Economic Co-operation and Development (OECD) jurisdictions with Beveridge-style healthcare systems (deemed those most likely to benefit from system-level transition strategies). Few jurisdictions address transition of care issues in either health or broader social policy documents. While many jurisdictions refer to standardised practice guidelines, a few report the intention to use powerful policy levers (including physician remuneration and non-physician investments) to facilitate the uptake of best practice. Most jurisdictions do not address the policy infrastructure required to support successful transitions, and rigorous evaluations of transition strategies are rare. Despite the well-documented risks and costs associated with a poor transition from paediatric to adult care, little policy attention has been paid to this issue. We recommend that healthcare providers engage health system planners in the design and evaluation of system-level, policy-sensitive transition strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Was access to health care easy for immigrants in Spain? The perspectives of health personnel in Catalonia and Andalusia.

PubMed

Vázquez, María-Luisa; Vargas, Ingrid; Jaramillo, Daniel López; Porthé, Victoria; López-Fernández, Luis Andrés; Vargas, Hernán; Bosch, Lola; Hernández, Silvia S; Azarola, Ainhoa Ruiz

2016-04-01

Until April 2012, all Spanish citizens were entitled to health care and policies had been developed at national and regional level to remove potential barriers of access, however, evidence suggested problems of access for immigrants. In order to identify factors affecting immigrants' access to health care, we conducted a qualitative study based on individual interviews with healthcare managers (n=27) and professionals (n=65) in Catalonia and Andalusia, before the policy change that restricted access for some groups. A thematic analysis was carried out. Health professionals considered access to health care "easy" for immigrants and similar to access for autochthons in both regions. Clear barriers were identified to enter the health system (in obtaining the health card) and in using services, indicating a mismatch between the characteristics of services and those of immigrants. Results did not differ among regions, except for in Catalonia, where access to care was considered harder for users without a health card, due to the fees charged, and in general, because of the distance to primary health care in rural areas. In conclusion, despite the universal coverage granted by the Spanish healthcare system and developed health policies, a number of barriers in access emerged that would require implementing the existing policies. However, the measures taken in the context of the economic crisis are pointing in the opposite direction, towards maintaining or increasing barriers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Public, patient and carers' views on palliative and end-of-life care in India.

PubMed

Ramasamy Venkatasalu, M; Sirala Jagadeesh, N; Elavally, S; Pappas, Y; Mhlanga, F; Pallipalayam Varatharajan, R

2018-06-01

To systematically review the existing evidence on the Indian public, patient and carers' perspectives on palliative and end-of-life care. With a growing population of terminally ill people across the world, there is also an increasing awareness among international health policy makers of the need to improve the quality of life for terminally ill patients. Understanding service users' (patients, family and public) perspectives is crucial in developing and sustaining successful community-centred palliative nursing policies and service models especially in countries like India with diverse population. An integrative review was performed on five databases, using hand searches of key journals and reference citation tracking for empirical studies published in English from 1990 to 2015. A thematic analysis framework was used to analyse and identify key themes. Analysis of the six eligible studies revealed five themes. Themes describe how social, economic, cultural, religious, spiritual and traditional factors influenced the palliative and end-of-life care perspectives and experiences among Indians. They also illustrated preferences relating to place of care, as well as benefits and challenges of family caregiving during the last days of life. Although we found minimal evidence on user perspectives, nurses need to aware of those unique components of context-specific palliative and end-of-life care practices in India - socioeconomic, cultural and religious factors - on their nursing encounters. Nurses need to advocate same in policy development to enable accessibility and utility of palliative and end-of-life care services, which are scant in India. Nurses can be central in gathering the contextual evidence that advocate users' perspectives to inform further studies and national palliative care policies in India. Emerging policies in nursing education need to focus on integrating family-centred palliative and end-of-life care within curricula, whereas nursing practice may promote nurse-led community models to address the patchy palliative and end-of-life service provision in India. © 2017 International Council of Nurses.

Implementing Medical Teaching Policy in University Hospitals

ERIC Educational Resources Information Center

Engbers, Rik; Fluit, Cornelia Cornelia R. M. G.; Bolhuis, Sanneke; de Visser, Marieke; Laan, Roland F. J. M.

2017-01-01

Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have…

Early Childhood Development Policy and Programming in India: Critical Issues and Directions for Paradigm Change

ERIC Educational Resources Information Center

Sharma, Adarsh; Sen, Rekha Sharma; Gulati, Renu

2008-01-01

The critical importance of the early childhood years and the rights perspective to human development has made policy and programming for early childhood development an imperative for every nation. In India, poverty, changing economic and social structures resulting in the breakdown of traditional coping mechanisms and family care systems, and the…

Palliative care is not yet a well-defined product within the Dutch healthcare insurance system.

PubMed

Jansen, Wim J J; Vissers, Kris C P; Zuurmond, Wouter W A; van Montfort, Guus P W P; Rhebergen, Andre; Loer, Stephan A

2009-07-01

In the Netherlands, the quality and availability of palliative care has improved markedly within the last decade. However, many open questions remain concerning the position of palliative care as an insurable product on the Dutch healthcare market. Therefore, we analysed the policies of all private Dutch healthcare insurance companies as well as the public insurance policy for extraordinary medical costs. We studied how and which parts of palliative care were reimbursed in 2007. We observed a huge variability in costs and reimbursement regulations reflecting a rapid turnover of products for palliative care due to various new developments on this specific field of medical care. We conclude that a better definition of the product 'palliative care' is necessary for patients, health care providers and insurance companies.

Translating evidence into policy for cardiovascular disease control in India

PubMed Central

2011-01-01

Cardiovascular diseases (CVD) are leading causes of premature mortality in India. Evidence from developed countries shows that mortality from these can be substantially prevented using population-wide and individual-based strategies. Policy initiatives for control of CVD in India have been suggested but evidence of efficacy has emerged only recently. These initiatives can have immediate impact in reducing morbidity and mortality. Of the prevention strategies, primordial involve improvement in socioeconomic status and literacy, adequate healthcare financing and public health insurance, effective national CVD control programme, smoking control policies, legislative control of saturated fats, trans fats, salt and alcohol, and development of facilities for increasing physical activity through better urban planning and school-based and worksite interventions. Primary prevention entails change in medical educational curriculum and improved healthcare delivery for control of CVD risk factors-smoking, hypertension, dyslipidemia and diabetes. Secondary prevention involves creation of facilities and human resources for optimum acute CVD care and secondary prevention. There is need to integrate various policy makers, develop effective policies and modify healthcare systems for effective delivery of CVD preventive care. PMID:21306620

Analysis of current laboratory animal science policies and administration in China.

PubMed

Kong, Qi; Qin, Chuan

2009-01-01

Laboratory animal science (LAS) advances scientific understanding of the care and use of animals that play a key role in research supporting the development of biomedicine. LAS has developed quickly in China in recent decades, and this report provides an analysis of the current status of the countrys LAS policies and administration. National and provincial laws, regulations, guidelines, and standards apply to quality control and licensing, quarantine and infectious disease control, breeding and husbandry, transgenic animals, staff qualifications, animal welfare, and imports, exports, and transportation. Regulation and oversight of lab animal use are the responsibility of the national Ministry of Science and Technology, provincial departments of science and technology, and institutional animal care and use committees. We begin with an explanation of the rationale behind this paper and then offer a brief history of policy-related activities and achievements. We then present various policies, discuss their implementation, and hypothesize about future policy developments. With the improvement of policies under an integrated, multitiered administration, the use of high-quality lab animals in Chinese scientific research is increasing and many more papers describing animal experiments performed in China are being published in international journals.

Using social media to engage nurses in health policy development.

PubMed

O'Connor, Siobhan

2017-11-01

To explore nurses' views on future priorities for the profession and to examine social media as an engagement tool to aid policy discussion and development. Nurses are often not directly involved in policy creation and some feel it is a process they cannot easily influence. A descriptive mixed methods study of a Twitter chat hosted by the Chief Nursing Officer for Scotland was undertaken. Data were gathered using an analytics platform and NCapture software. The framework approach aided thematic analysis to draw out themes. Sixty-four people took part in the Twitter chat (#CNOScot) and posted 444 tweets. Nurses called for investment in technology, nursing research, education and mental health. Primary care and advanced practice roles to support older adults with complex health and social care needs were also seen as vital to develop further. Social media can help reach and engage nurses in policy discussion and ensure there is better continuity between policy and practice but some groups risk being excluded using this digital medium. Nursing leaders should consider social media as one of many engagement strategies to ensure nurses and other stakeholders participate in policy debate that informs health strategy development. © 2017 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd.

A Review of Literature to Understand the Complexity of Equity, Ethics and Management for Achieving Public Health Goals in India

PubMed Central

Garg, Pankaj; Nagpal, Jitender

2014-01-01

In the context of inadequate public spending on health care in India (0.9% of the GDP); government liberalized its policies in the form of subsidized lands and tax incentives, resulting in the mushrooming of private hospitals and clinics in India. Paradoxically, a robust framework was not developed for the regulation of these health care providers, resulting in disorganized health sector, inadequate financing models, and lack of prioritization of services, as well as a sub-optimal achievement of the Millennium Development Goals (MDG). We systematically reviewed the evidence base regarding regulation of private hospitals, applicability of private-public mix, state of health insurance and effective policy development for India, while seeking lessons on regulation of private health systems, from South African (a developing country) and Australian (a developed country) health care systems. PMID:24701465

The struggle over employee benefits: the role of labor in influencing modern health policy.

PubMed

Rosner, David; Markowitz, Gerald

2003-01-01

After organized labor failed to institute national health insurance in the mid-twentieth century, its influence on health care policy diminished even further. This article proposes an alternative interpretation of the development of health care policy in the United States, by examining the association of health policy with the relationships between employers and employees. The social welfare and health insurance systems that resulted were a direct outcome of the pressures brought by organized and unorganized labor movements. The greater dependency created by industrial and demographic changes, conflicts between labor and capital over the political meaning of disease and accidents, and attempts by the political system to mitigate the impending social crisis all helped determine new health policy options.

Building Long-Term Care Policies in Latin America: New Programs in Chile.

PubMed

Matus-Lopez, Mauricio; Cid Pedraza, Camilo

2015-10-01

Little is known about long-term care policies in developing regions. Latin America is one of those regions. In less than 20 years, it will surpass Europe's elderly population. At that point, Chile will be the country with the largest share of elderly population in the region. For that reason, long-term care pilot programs have been implemented in recent years. This article describes the long-term care policy in Chile, analyzed according to the international experience. National directors of these programs were asked to complete questionnaires with a description of each, and the results of the past year. This information was compared with interviews to experts and official information available online. Programs follow the international trends, although they are underfinanced and lack the necessary mechanisms to control service quality. It is suggested that budgets should be increased, and there should be higher requirements for caregiver training. Also, mechanisms for quality control should be established, and policies should be evaluated for formal direct hiring through a cash-for-care system. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Opportunities in Public Policy to Support Infant and Early Childhood Mental Health: The Role of Psychologists and Policymakers

ERIC Educational Resources Information Center

Nelson, Florence; Mann, Tammy

2011-01-01

Infant and early childhood mental health practices can be supported by policies and professional standards of care that foster the healthy development of young children. Policies that support infants and toddlers include those that strengthen their families to provide a family environment that promotes mental wellness. Policy issues for infants,…

The cost-effectiveness of changes to the care pathway used to identify depression and provide treatment amongst people with diabetes in England: a model-based economic evaluation.

PubMed

Kearns, Ben; Rafia, R; Leaviss, J; Preston, L; Brazier, J E; Palmer, S; Ara, R

2017-01-24

Diabetes is associated with premature death and a number of serious complications. The presence of comorbid depression makes these outcomes more likely and results in increased healthcare costs. The aim of this work was to assess the health economic outcomes associated with having both diabetes and depression, and assess the cost-effectiveness of potential policy changes to improve the care pathway: improved opportunistic screening for depression, collaborative care for depression treatment, and the combination of both. A mathematical model of the care pathways experienced by people diagnosed with type-2 diabetes in England was developed. Both an NHS perspective and wider social benefits were considered. Evidence was taken from the published literature, identified via scoping and targeted searches. Compared with current practice, all three policies reduced both the time spent with depression and the number of diabetes-related complications experienced. The policies were associated with an improvement in quality of life, but with an increase in health care costs. In an incremental analysis, collaborative care dominated improved opportunistic screening. The incremental cost-effectiveness ratio (ICER) for collaborative care compared with current practice was £10,798 per QALY. Compared to collaborative care, the combined policy had an ICER of £68,017 per QALY. Policies targeted at identifying and treating depression early in patients with diabetes may lead to reductions in diabetes related complications and depression, which in turn increase life expectancy and improve health-related quality of life. Implementing collaborative care was cost-effective based on current national guidance in England.

Political devolution and the health services in Great Britain.

PubMed

Woods, Kevin J

2004-01-01

This article reviews the effects of political devolution on health care in the countries of Great Britain at the end of the first term of the new political institutions created in 1999. In the light of the powers transferred, an assessment is made of the nature and extent of policy autonomy exercised by the devolved administrations. The author considers the question of whether political devolution is leading to local variations in health care provision that threaten established concepts of equity in a U.K. National Health Service. Policy areas discussed include the personal care of older people, mental health, governance, competition, the role of the private sector, and the health care workforce. Also discussed are the dynamics of intergovernmental relations in the longer term, including the effects of the developing European Union. The article concludes by assessing the extent to which the individual countries within Great Britain are likely to develop health care systems with distinctive identities.

45 CFR 98.1 - Goals and purposes.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND... each State maximum flexibility in developing child care programs and policies that best suit the needs of children and parents within the State; (2) Promote parental choice to empower working parents to...

Eliciting the Functional Processes of Apologizing for Errors in Health Care: Developing an Explanatory Model of Apology.

PubMed

Prothero, Marie M; Morse, Janice M

2017-01-01

The purpose of this article was to analyze the concept development of apology in the context of errors in health care, the administrative response, policy and format/process of the subsequent apology. Using pragmatic utility and a systematic review of the literature, 29 articles and one book provided attributes involved in apologizing. Analytic questions were developed to guide the data synthesis and types of apologies used in different circumstances identified. The antecedents of apologizing, and the attributes and outcomes were identified. A model was constructed illustrating the components of a complete apology, other types of apologies, and ramifications/outcomes of each. Clinical implications of developing formal policies for correcting medical errors through apologies are recommended. Defining the essential elements of apology is the first step in establishing a just culture in health care. Respect for patient-centered care reduces the retaliate consequences following an error, and may even restore the physician patient relationship.

World Health Organization Public Health Model: A Roadmap for Palliative Care Development.

PubMed

Callaway, Mary V; Connor, Stephen R; Foley, Kathleen M

2018-02-01

The Open Society Foundation's International Palliative Care Initiative (IPCI) began to support palliative care development in Central and Eastern Europe and the Former Soviet Union in 1999. Twenty-five country representatives were invited to discuss the need for palliative care in their countries and to identify key areas that should be addressed to improve the care of adults and children with life-limiting illnesses. As a public health concern, progress in palliative care requires integration into health policy, education and training of health care professionals, availability of essential pain relieving medications, and health care services. IPCI created the Palliative Care Roadmap to serve as a model for government and/or nongovernment organizations to use to frame the necessary elements and steps for palliative care integration. The roadmap includes the creation of multiple Ministry of Health-approved working groups to address: palliative care inclusion in national health policy, legislation, and finance; availability of essential palliative care medications, especially oral opioids; education and training of health care professionals; and the implementation of palliative care services at home or in inpatient settings for adults and children. Each working group is tasked with developing a pathway with multiple signposts as indicators of progress made. The roadmap may be entered at different signposts depending upon the state of palliative care development in the country. The progress of the working groups often takes place simultaneously but at variable rates. Based on our experience, the IPCI Roadmap is one possible framework for palliative care development in resource constrained countries but requires both health care professional engagement and political will for progress to be made. Copyright © 2017. Published by Elsevier Inc.

International health policy and stagnating maternal mortality: is there a causal link?

PubMed

Unger, Jean-Pierre; Van Dessel, Patrick; Sen, Kasturi; De Paepe, Pierre

2009-05-01

This paper examines why progress towards Millennium Development Goal 5 on maternal health appears to have stagnated in much of the global south. We contend that besides the widely recognised existence of weak health systems, including weak services, low staffing levels, managerial weaknesses, and lack of infrastructure and information, this stagnation relates to the inability of most countries to meet two essential conditions: to develop access to publicly funded, comprehensive health care, and to provide the not-for-profit sector with needed political, technical and financial support. This paper offers a critical perspective on the past 15 years of international health policies as a possible cofactor of high maternal mortality, because of their emphasis on disease control in public health services at the expense of access to comprehensive health care, and failures of contracting out and public-private partnerships in health care. Health care delivery cannot be an issue both of trade and of right. Without policies to make health systems in the global south more publicly-oriented and accountable, the current standards of maternal and child health care are likely to remain poor, and maternal deaths will continue to affect women and their families at an intolerably high level.

PNAUM: integrated approach to Pharmaceutical Services, Science, Technology and Innovation

PubMed Central

Gadelha, Carlos Augusto Grabois; Costa, Karen Sarmento; do Nascimento, José Miguel; Soeiro, Orlando Mário; Mengue, Sotero Serrate; da Motta, Márcia Luz; de Carvalho, Antônio Carlos Campos

2016-01-01

ABSTRACT This paper describes the development process of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines) based on an integrated approach to pharmaceutical services, science, technology and innovation. It starts by contextualizing health and development in Brazil and features elements of the National Policy for Science, Technology and Innovation in Health in Brazil and the National Policy for Pharmaceutical Services. On presenting pharmaceutical policy guidelines, it stresses the lack of nationwide data. This survey, commissioned by the Brazilian Ministry of Health, has two components: household survey and evaluation of pharmaceutical services in primary care. The findings point to perspectives that represent, besides the enhancement of public policy for pharmaceutical services and public health, results of government action aimed at developing the economic and industrial health care complex to improve the health conditions of the Brazilian population. PMID:27982379

Insights into managed care--operational, legal and actuarial.

PubMed

Melek, S P; Johnson, B A; Schryver, D

1997-01-01

Understanding the operational, legal and actuarial dimensions of managed care is essential to developing managed care contracts between managed care organizations and individual health care providers or groups such as provider-sponsored organizations or independent practice associations. Operationally, it is important to understand managed care and its trends, emphasizing business issues, knowing your practice and defining acceptable levels of reimbursement and risk. Legally, there are a number of common themes or issues relevant to all managed care contracts, including primary care vs. specialist contracts, services offered, program policies and procedures, utilization review, physician reimbursement and compensation, payment schedule, terms and conditions, term and termination, continuation of care requirements, indemnification, amendment of contract and program policies, and stop-loss insurance. Actuarial issues include membership, geography, age-gender distribution, degree of health care management, local managed care utilization levels, historical utilization levels, health plan benefit design, among others.

42 CFR 460.62 - Governing body.

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) PACE... patient care responsibilities. (5) Fiscal operations. (6) Development of policies on participant health and safety, including a comprehensive, systemic operational plan to ensure the health and safety of...

Funding Early Years Education and Care: Can a Mixed Economy of Providers Deliver Universal High Quality Provision?

ERIC Educational Resources Information Center

West, Anne; Roberts, Jonathan; Noden, Philip

2010-01-01

There has been a focus on policies relating to early years education and care across the developed world and particularly in Europe. In the UK, there has been a raft of policy changes alongside increased investment. However, this paper argues that these changes may not be sufficient to meet EU objectives in terms of quality or the government's…

Health policy and integrated mental health care in the SADC region: strategic clarification using the Rainbow Model.

PubMed

van Rensburg, André Janse; Fourie, Pieter

2016-01-01

Mental illness is a well-known challenge to global development, particularly in low-to-middle income countries. A key health systems response to mental illness is different models of integrated health care, especially popular in the South African Development Community (SADC) region. This complex construct is often not well-defined in health policy, hampering implementation efforts. A key development in this vein has been the Rainbow Model of integrated care, a comprehensive framework and taxonomy of integrated care based on the integrative functions of primary care. The purpose of this study was to explore the nature and strategic forms of integrated mental health care in selected SADC countries, specifically how integrated care is outlined in state-driven policies. Health policies from five SADC countries were analysed using the Rainbow Model as framework. Electronic copies of policy documents were transferred into NVivo 10, which aided in the framework analysis on the different types of integrated mental health care promoted in the countries assessed. Several Rainbow Model components were emphasised. Clinical integration strategies (coordination of person-focused care) such as centrality of client needs, case management and continuity were central considerations, while others such as patient education and client satisfaction were largely lacking. Professional integration (inter-professional partnerships) was mentioned in terms of agreements on interdisciplinary collaboration and performance management, while organisational integration (inter-organisational relationships) emerged under the guise of inter-organisational governance, population needs and interest management. Among others, available resources, population management and stakeholder management fed into system integration strategies (horizontally and vertically integrated systems), while functional integration strategies (financial, management and information system functions) included human resource, information and resource management. Normative integration (a common frame of reference) included collective attitude, sense of urgency, and linking cultures, though aspects such as conflict management, quality features of the informal collaboration, and trust were largely lacking. Most countries stressed the importance of integrating mental health on primary healthcare level, though an absence of supporting strategies could prove to bar implementation. Inter-service collaboration emerged as a significant goal, though a lack of (especially) normative integration dimensions could prove to be a key omission. Despite the usefulness of the Rainbow Model, it failed to adequately frame regional governance aspects of integration, as the SADC Secretariat could play an important role in coordinating and supporting the development and strengthening of better mental health systems.

Workforce Development in Early Childhood Education and Care. Research Overview

ERIC Educational Resources Information Center

Bretherton, Tanya

2010-01-01

The early childhood education and care industry in Australia is undergoing a shift in philosophy. Changes in policy are driving the industry towards a combined early childhood education and care focus, away from one on child care only. This move has implications for the skilling of the child care workforce. This research overview describes the…

State Child Care Policies for Limited English Proficient Families

ERIC Educational Resources Information Center

Firgens, Emily; Matthews, Hannah

2012-01-01

The Child Care and Development Block Grant (CCDBG), the largest source of federal funding for child care assistance available to states, provides low-income families with help paying for child care. Studies have shown that low-income LEP (limited English proficient), as well as immigrant families, are less likely to receive child care assistance.…

Developing the Child Care Workforce: Understanding "Fight" or "Flight" Amongst Workers

ERIC Educational Resources Information Center

Bretherton, Tanya

2010-01-01

The early childhood education and care sector in Australia is undergoing a shift in philosophy. Changes in policy are driving the industry towards a combined early childhood education and care focus, away from one only on child care. This move has implications for the skilling of the child care workforce. This report examines workforce development…

[Intercultural health care policy from the perspective of health care providers and Mapuche clients].

PubMed

Alarcón, Ana María; Astudillo, Paula; Barrios, Sara; Rivas, Edith

2004-09-01

Intercultural health is becoming an emergent topic in the design of health care programs for Mapuche people of Chile. This process faces important challenges such as the scarce theoretical support about the meaning of intercultural health and their practical consequences for providers and clients. To explore the perception in providers and Mapuche clients about intercultural health. A survey performed in 11 counties with the highest concentration of Mapuche people, of the IX region of Chile. The perception about the development of a new health policy specially designed for Mapuche patients was surveyed in 399 Mapuche patients and 64 providers of primary health care centers. Mapuche clients considered, as the main regional challenges, the indifference and discrimination of health care teams towards Mapuche patients, aggravated by the indifference of authorities. Providers considered that the main problem was a lack of knowledge about Mapuche culture and skills to deal with this ethnic group. Patients and providers agreed on the need to use Mapuche dialect in health care attentions, to coordinate actions with traditional healers and to accept ethnical therapeutic practices. There is scarce agreement between providers and Mapuche clients about the need for an special intercultural health policy, its contents, and the regional conditions for its implementation and development.

Rural health network development: public policy issues and state initiatives.

PubMed

Casey, M M; Wellever, A; Moscovice, I

1997-02-01

Rural health networks are a potential way for rural health care systems to improve access to care, reduce costs, and enhance quality of care. Networks provide a means for rural providers to contract with managed care organizations, develop their own managed care entities, share resources, and structure practice opportunities to support recruitment and retention of rural physicians and other health care professionals. The results of early network development initiatives indicate a need for state officials and others interested in encouraging network development to agree on common rural health network definitions, to identify clearly the goals of network development programs, and to document and analyze program outcomes. Future network development efforts need to be much more comprehensive if they are to have a significant impact on rural health care. This article analyzes public policy issues related to integrated rural health network development, discusses current efforts to encourage network development in rural areas, and suggests actions that states may take if they desire to support rural health network development. These actions include adopting a formal rural health network definition, providing networks with alternatives to certain regulatory requirements, and providing incentives such as matching grants, loans, or technical assistance. Without public sector support for networks, managed care options may continue to be unavailable in many less densely populated rural areas of the country, and locally controlled rural health networks are unlikely to develop as an alternative to the dominant pattern of managed care expansion by large urban entities. Implementation of Medicare reform legislation could provide significant incentives for the development of rural health networks, depending on the reimbursement provisions, financial solvency standards, and antitrust exemptions for provider-sponsored networks in the final legislation and federal regulations.

Integrated health and social care in England--Progress and prospects.

PubMed

Humphries, Richard

2015-07-01

This paper reviews recent policy initiatives in England to achieve the closer integration of health and social care. This has been a policy goal of successive UK governments for over 40 years but overall progress has been patchy and limited. The coalition government has a new national framework for integrated care and variety of new policy initiatives including the 'pioneer' programme, the introduction of a new pooled budget--the 'Better Care Fund'--and a new programme of personal commissioning. Further change is likely as the NHS begins to develop new models of care delivery. There are significant tensions between these very different policy levers and styles of implementation. It is too early to assess their combined impact. Expectations that integration will achieve substantial financial savings are not supported by evidence. Local effort alone will be insufficient to overcome the fundamental differences in entitlement, funding and delivery between the NHS and the social care system. With a national election set to take place in May 2015, all political parties are committed to the integration of health and social care but clear evidence about the best means to achieve it is likely to remain as elusive as ever. Copyright © 2015 The Author. Published by Elsevier Ireland Ltd.. All rights reserved.

Working towards a national health information system in Australia.

PubMed

Bomba, B; Cooper, J; Miller, M

1995-01-01

One of the major administrative dilemmas facing the Australian national health care system is the need to reform practices associated with massive data-information overload. The current system is burdened with paper-based administrative forms, patient record files, referral notes and other manual methods of data organisation. An integrated computer-based information system may be perceived as an attractive solution to such burdens. However, computerisation must not be seen as a panacea with the possibility of exacerbating information overload and accentuating privacy concerns. Recent surveys in Australia [1] and the US [2] indicate a perceived causal link between computers and privacy invasion. Any moves toward a national health information system must counter this perception through macro-level education schemes of affected parties and micro-level mechanisms such as the establishment of hospital privacy officers. Such concerns may be viewed as a subset of the wider privacy debate, and information policy development should address such considerations to develop policies to prevent unauthorized access to personal information and to avoid the extraction and sale of sensitive health data. Conservative in nature and slow to change the health care sector may be forced to adopt more efficient work practices through the increasing proliferation of information technology (IT) in health care delivery and an escalating emphasis upon accountability and efficiency of the public health care dollar. The economic rationalist stance taken by governments in Australia and other nations generally will also force health care workers to adopt and develop more efficient information management practices, health indicators and best practice care methods than presently employed by this sector The benefits of a national health information system are far reaching, particularly in developing a more effective health care system through better identifying and understanding community health care trends and in applying IT to the efficient collection of data for the development of more appropriate performance measures and statistical indicators. A coherent and integrated approach is called for in the design of a national health information system which incorporates the necessary and requisite security features to meet privacy concerns. Protecting information privacy poses complex political, economic, technological, legal and social problems for systems developers and health care providers alike [2]. According to Brannigan [3] there are three components involved in the formulation and implementation of privacy: public policy (What level of privacy does society want?); legal structure (Does the law adequately provide for society's privacy requirements?); and technical (how much privacy can technical tools provide, at what cost, and with what effects on the system?). Examining technical tools alone, it is apparent that the necessary technologies are available in Australia to provide the security of medical records required by public policy. Such tools may include encryption, user and data authentication methods, authorisation schemes and mechanisms for the prevention of data inference. While none of these available measures are infallible, it is suitable for most applications where the encryption mechanism can provide protection for a given length of time. Australia needs to develop a coherent national health information infrastructure policy to ultimately avoid fragmented, duplicated and incompatible systems that rely on different standards and protocols. Such a policy will only work by addressing the key issue of patient privacy within a technological framework. The application of IT to health care systems is a sensitive social experiment affecting many professions including general practitioners, medical administrators, politicians, lawyers, computer specialists, privacy advocates and patients whose records will ultimately reside in the system. (abstract trun

Negotiating the new health system: purchasing publicly accountable managed care.

PubMed

Rosenbaum, S

1998-04-01

The transformation to managed care is one of the most important and complex changes ever to take place in the American health system. One key aspect of this transformation is its implications for public health policy and practice. Both public and private buyers purchase managed care; increasingly, public programs that used to act as their own insurers (i.e., Medicare, Medicaid and CHAMPUS) are purchasing large quantities of managed care insurance from private companies. The transformation to managed care is altering the manner in which public health policy makers conceive of and carry out public health activities (particularly activities that involve the provision of personal health services). The degree to which managed care changes public health and in turn is altered by public health will depend in great measure on the extent to which public and private policy makers understand the implications of their choices for various aspects of public health and take steps to address them. Because both publicly and privately managed care arrangements are relatively deregulated, much of the dialogue between public health and managed care purchasers can be expected to take place within the context of the large service agreements that are negotiated between buyers and sellers of managed care products. This is particularly true for Medicaid because of the importance of Medicaid coverage, payment and access policies to public health policy makers, and because of the public nature of the Medicaid contracting process. A nationwide study of Medicaid managed care contracts offers the first detailed analysis of the content and structure of managed care service agreements and the public health issues they raise. Four major findings emerge from a review of the contracts. First, most of the agreements fail to address key issues regarding which Medicaid-covered services and benefits are the contractor's responsibility and which remain the residual responsibility of the state agency. Second, most contracts fail to address the legal and structural issues arising from the relationship between the managed care service system and the public health system, including such key matters as access to care for communicable diseases and contractors' relationship to state public health laboratories. Third, many contracts are silent on health agencies' access to data for surveillance and community health measurement purposes. Finally, many contracts may be developed with only a limited understanding of the key public health-related issues facing the community from which the members will be drawn. The CDC and state and local public health agencies must expand their activities in the area of managed care contract specifications. For several years the CDC has been involved in an ongoing effort to develop quality of care measures to be collected from all companies through the HEDIS process. As important as this effort is, it represents only an attempt to measure what managed care does rather than an a priori effort to shape the underlying policy and organizational structure of managed care itself. Integrating managed care with public health policy will require this type of affirmative effort with both Medicaid agencies as well as other managed care purchasers.

Exploring team working and shared leadership in multi-disciplinary cancer care.

PubMed

Willcocks, Stephen George

2018-02-05

Purpose The purpose of this paper is to explore the relevance of shared leadership to multi-disciplinary cancer care. It examines the policy background and applies concepts from shared leadership to this context. It includes discussion of the implications and recommendations. Design/methodology/approach This is a conceptual paper examining policy documents and secondary literature on the topic. While it focuses on the UK National Health Services, it is also relevant to other countries given they follow a broadly similar path with regard to multi-disciplinary working. Findings The paper suggests that shared leadership is a possible way forward for multi-disciplinary cancer care, particularly as policy developments are supportive of this. It shows that a shared perspective is likely to be beneficial to the further development of multi-disciplinary working. Research limitations/implications Adopting shared leadership needs to be explored further using appropriate empirical research. Practical implications The paper offers comments on the implications of introducing shared leadership and makes recommendations including being aware of the barriers to its implementation. Originality/value The paper offers an alternative view on leadership in the health-care context.

Home care in Austria: the interplay of family orientation, cash-for-care and migrant care.

PubMed

Österle, August; Bauer, Gudrun

2012-05-01

This article discusses the development of the home care sector in Austria. It analyses what impacts the interplay of the traditional family orientation to care, a universal cash-for-care scheme (reaching about 5% of the population) and a growing migrant care sector have on formal home care in Austria. The article is based on an analysis of research papers, policy documents and statistical data covering the period from the introduction of the cash-for-care scheme in 1993 up to 2011. Some authors have argued that generous cash benefits with no direct link to service use - as in the case of Austria - limit the development of home care, particularly in countries with a traditionally strong family orientation towards long-term care. Additionally, a tradition of family care and an emphasis on cash benefits may be conducive to the employment of migrant carers in private households, as a potential substitute for both family care and formal care. Despite this context, Austria has seen a substantial increase in formal home care over the past two decades. This has been driven by clients using their increased purchasing power and by policy priorities emphasising the extension of home care. Migrant care work was regularised in 2007, and the analysis suggests that while migrant care has usually worked as a substitute for other care arrangements, migrant care can also become a more integral element of care schemes. The article concludes that family orientation, unconditional cash benefits and the use of migrant carers do not necessarily preclude the development of a strong social service sector. However, there is a risk that budgetary limitations will primarily affect social service development. © 2011 Blackwell Publishing Ltd.

The nursing profession in Sri Lanka: time for policy changes.

PubMed

Aluwihare-Samaranayake, D; Ogilvie, L; Cummings, G G; Gellatly, Ian R

2017-09-01

We address issues and challenges in nursing in Sri Lanka with the aim of identifying where and how policy changes need to be made. Increased global interconnectivity calls for professional leadership, research, education, and policy reform in nursing as these are identified as enhancing health workforce performance and professionalization, thereby improving health systems. We draw on first-hand knowledge of health care and nursing in Sri Lanka and a recent survey of nurses at a large urban government hospital in Sri Lanka, followed by discussion and proposed action on themes identified through analysis of published and unpublished literature about the nursing profession. Policy and action are needed to: (a) establish mandatory nurse licensure in the public and private healthcare sectors; (b) implement realistic policies to further develop nursing education; (c) develop a professionalization process to support nursing autonomy and voice; and (d) promote systematic processes for educational accreditation, curriculum revision, continuing professional development, evidence-based practice, research, leadership, and information systems. There is a policy vacuum that requires careful analysis and strategic planning by formal nurse leaders. Implementing change will require political and professional power and strategic, innovative, and evolutionary policy initiatives as well as organizational infrastructure modifications best achieved through committed multidisciplinary collaboration, augmented research capacity, bolstered nursing leadership, and promotion of partnerships with policy makers. © 2017 International Council of Nurses.

What predicts the quality of advanced cancer care in Latin America? A look at five countries: Argentina, Brazil, Cuba, Mexico, and Peru.

PubMed

Torres Vigil, Isabel; Aday, Lu Ann; De Lima, Liliana; Cleeland, Charles S

2007-09-01

Cancer is now a leading cause of death among adults in most Latin American nations. Yet, until recently, there has been limited research on the quality of, and access to, advanced cancer care in developing regions such as Latin America. This landmark, cross-national study assessed the quality of advanced cancer care in five Latin American countries by surveying a convenience sample of 777 physicians and nurses, and identifying the most salient influences on their quality-of-care assessments based on multiple linear regression analyses. Strategies for disseminating this survey included mass mailings, distribution at professional meetings/conferences, collaboration with Latin American institutions, professional organizations, and the Pan American Health Organization, and online posting. Results indicate that the respondents' assessments of the quality of, access to, and affordability of advanced cancer care varied significantly across nations (P<0.001). The strongest predictor of providers' national-level assessments of the quality of care was their ratings of access to advanced cancer care (Beta=0.647). Other predictors included affordability of care, country (Cuba vs. the other four countries), income-gap quintile, and institutional availability of opioid analgesics. Low prioritization of palliative care in both health care policy formulation and provider education also predicted the quality-of-care ratings. Findings from this study suggest that providers from five different nations hold similar equitable notions of quality care that are dependent on the provision of accessible and affordable care. Measures of social equity, such as the income-gap quintile of nations, and measures of policy barriers, such as the scale developed in this study, should be replicated in future studies to enable policy makers to assess and improve advanced cancer care in their countries.

Can hospitals prohibit euthanasia? An analysis from a European human rights perspective.

PubMed

Tack, Sylvie

2011-06-01

At present, in four European countries euthanasia and/ or physician assisted suicide (PAS) are tolerated under strict legal conditions. However, in practice these patient groups are often deprived of the possibility to undergo such decisions. Particularly Catholic health care institutions have developed policies which restrict the internal application of the law. Yet, the legitimacy of such policies is questionable. From a European human rights perspective it can be defended that the freedom of association allows hospitals to develop policies elaborating their ethical stances on euthanasia and PAS. However, to respect the patient's right to self-determination the concerned hospitals should at least inform current and future patients about the restrictive policy and deal carefully with euthanasia and PAS requests. If a patient's wish remains seriously incompatible with the ethical stances of the hospital, at least reasonable and attainable alternatives (such as a referral to a tolerant regional hospital) should be offered.

New Mexico community voices: policy reform to reduce oral health disparities.

PubMed

Powell, Wayne; Hollis, Christine; de la Rosa, Mario; Helitzer, Deborah L; Derksen, Daniel

2006-02-01

Using a socio-ecological framework to guide the initiative, New Mexico Community Voices developed, with state and local stakeholders, responsive oral health policies to address oral health disparities. Several policy objectives were achieved: increasing awareness of the public health importance of oral health; improving access to dental services for uninsured or underserved populations; enhancing dental services specialty care; and increasing sustainable oral health infrastructure through pipeline development of oral health providers to relieve service shortages and diversify the oral health workforce. Improving access to oral health and augmenting numbers of dental providers in rural areas were also successful. The governor has appointed the New Mexico Oral Health Advisory Council to address state oral health issues. The New Mexico partnerships have demonstrated how effective policy change can generate important incremental shifts in oral health care delivery and provide best practice models that diminish the oral health crisis faced by underserved populations.

Third sector primary care for vulnerable populations.

PubMed

Crampton, P; Dowell, A; Woodward, A

2001-12-01

This paper aims to describe and explain the development of third sector primary care organisations in New Zealand. The third sector is the non-government, non-profit sector. International literature suggests that this sector fulfils an important role in democratic societies with market-based economies, providing services otherwise neglected by the government and private for-profit sectors. Third sector organisations provided a range of social services throughout New Zealand's colonial history. However, it was not until the 1980s that third sector organisations providing comprehensive primary medical and related services started having a significant presence in New Zealand. In 1994 a range of union health centres, tribally based Mäori health providers, and community-based primary care providers established a formal network -- Health Care Aotearoa. While not representing all third sector primary care providers in New Zealand, Health Care Aotearoa was the best-developed example of a grouping of third sector primary care organisations. Member organisations served populations that were largely non-European and lived in deprived areas, and tended to adopt population approaches to funding and provision of services. The development of Health Care Aotearoa has been consistent with international experience of third sector involvement -- there were perceived "failures" in government policies for funding primary care and private sector responses to these policies, resulting in lack of universal funding and provision of primary care and continuing patient co-payments. The principal policy implication concerns the role of the third sector in providing primary care services for vulnerable populations as a partial alternative to universal funding and provision of primary care. Such an alternative may be convenient for proponents of reduced state involvement in funding and provision of health care, but may not be desirable from the point of view of equity and social cohesion insofar as the role of the welfare state is diminished.

Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015.

PubMed

Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L

2018-03-31

To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.

Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations.

PubMed

Kiima, David; Jenkins, Rachel

2010-06-28

Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care); development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines to accompany the general health policy, tobacco legislation, adaptation of the WHO primary care guidelines for Kenya, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, some strengthening of intersectoral liaison with police, prisons and schools, and public education about mental health. The project has demonstrated the importance of using a multi-faceted and comprehensive programme to promote sustainable system change, key elements of which include a focus on the use of rapid appropriate assessment and treatment at primary care level, strengthening the referral system, interministerial and intersectoral liaison, rehabilitation, social inclusion, promotion and advocacy to mobilize community engagement.

Employers' knowledge and attitudes regarding organizational policy toward workers caring for aging family members.

PubMed

Katz, Ruth; Lowenstein, Ariela; Prilutzky, Dana; Halperin, Dafna

2011-04-01

The study examined employers' knowledge of and attitudes toward working carers who care for aging family members. The study was based on the ecological model. One hundred employers were interviewed using structured questionnaires and 13 employers by additional in-depth interviews. Both research instruments included areas of disruption to the organization, existing policies, and feasibility as to developing appropriate policies to support working carers. Results show that caregiving caused a disruption in workers' functioning mainly by being absent, leaving work early, and coming to work late. Usually, there was "no policy," and half of the employers did not support introducing such a policy. Women managers in public organizations, who had less seniority and less previous experience with working-carers, tended to be more positive about supportive policies. Recommendations are included.

Obesity and government.

PubMed

Kahan, Scott; Zvenyach, Tracy

2016-10-01

Despite much effort, obesity prevalence and disease severity continues to worsen. The purpose of this review is to describe the leading government supported food and nutrition interventions and policies to prevent and address obesity in the USA. The review also summarizes obesity interventions and policies that the government plays a role in, but further development is warranted. The government's role in obesity has largely focused on interventions and policies such as national surveillance, obesity education and awareness, grant-based food subsidy programs, zoning for food access, school-based nutrition programs, dietary guidelines, nutrition labeling, and food marketing and pricing policies. The government has played a lesser role in obesity interventions and policies that provide access to evidence-based obesity care to people affected by the disease. Given the magnitude of the obesity epidemic, the government should explore multiple evidence-based interventions and policies across prevention and clinical care.

Policy recommendations for rare disease centres of expertise.

PubMed

Syed, Ahmed M; Camp, Rob; Mischorr-Boch, Christina; Houÿez, Francois; Aro, Arja R

2015-10-01

Rare diseases are a serious public health concern and are a priority in the EU. This study aims to develop policy recommendations for rare disease centres of expertise (CoEs) in order to improve standards and quality of care. A modified 3-round Delphi technique was used. Participants included rare diseases patients, carers, patient representatives and healthcare professionals (HCPs) from CoEs in two countries-Denmark and the UK. The results suggest the need to make improvements within current CoE environments, access to CoEs and the need for coordination and cooperation of services within and outside CoEs. It is recommended that CoEs are not overly 'medicalised', while at the same time they should be established as research facilities. The importance of including patient representatives in CoE performance management was also highlighted. Raising awareness and provision of appropriate training amongst non-specialist HCPs is seen as a priority for early and correct diagnosis and ensuring high quality care. Similarly, provision of targeted information about patients' illness and care was considered essential along with access to social assistance within CoEs. Policy recommendations were developed in areas previously recognised as having gaps. Their implementation is expected to strengthen and improve current care provision for rare disease patients. In member states where national plans and strategies are being developed, it is recommended to replicate the methodological approach used in this study as it has proven to be a helpful tool in rare disease centres of expertise policy development. Copyright © 2015 Elsevier Ltd. All rights reserved.

Taking Our Seat at the Advocacy Table

ERIC Educational Resources Information Center

Laverdure, Patricia

2017-01-01

The Policy-Advocacy-Leadership (PAL) column is developed to initiate and facilitate important dialogue about health care and educational policy, and develop and share the knowledge, tools, and resources that enable all of us to be effective advocates for our clients and our practice and leaders in our practice settings and profession. In this…

Early Childhood Diplomacy: Policy Planning for Early Childhood Development

ERIC Educational Resources Information Center

Vargas-Barón, Emily; Diehl, Kristel

2018-01-01

Children who are well nurtured, appropriately cared for, and provided with positive learning opportunities in their early years have a better chance of becoming healthy and productive citizens of nations and of the world. This article reviews the art and science of policy planning for early childhood development (ECD) from a diplomacy perspective.…

Research on Bereavement: Implications for Social Policy Development.

ERIC Educational Resources Information Center

Kiely, Margaret C.

This paper describes the results of an evaluation of the Palliative Care Service, one of the first hospices in North America (Montreal), and the implications of that research for social policy development. The objectives of the research were to evaluate the reliability of predictive assessments of bereavement risk and the effectiveness of…

Behind a High School Literacy Policy: The Surfacing of a Hidden Curriculum.

ERIC Educational Resources Information Center

Simon, Roger I.; Willinsky, John

1980-01-01

Argues that the articulation of school language policies deserves careful attention as they implicitly formulate a hidden curriculum with reference to the relation between education and society. Discusses issues in context of policy developed in an urban high school in Ontario. Considers cultural values, social convention, and social control.…

Families That Work: Policies for Reconciling Parenthood and Employment

ERIC Educational Resources Information Center

Gornick, Janet C.; Meyers, Marcia K.

2003-01-01

Parents around the world grapple with the common challenge of balancing work and child care. Despite common problems, the industrialized nations have developed dramatically different social and labor market policies--policies that vary widely in the level of support they provide for parents and the extent to which they encourage an equal division…

Getting an evidence-based post-partum haemorrhage policy into practice.

PubMed

Cameron, Carolyn A; Roberts, Christine L; Bell, Jane; Fischer, Wendy

2007-06-01

Post-partum haemorrhage (PPH) is a potentially life-threatening complication of childbirth occurring in up to 10% of births. The NSW Department of Health (DoH) issued a new evidence-based policy (Framework for Prevention, Early Recognition and Management of Post-partum Haemorrhage) in November 2002. Feedback from maternity units indicated that there were deficiencies in the skills and experience is needed to develop the written protocols and local plans of action required by the Framework. All 96 hospitals in NSW that provide care for childbirth were surveyed. A senior midwife completed a semistructured telephone interview. Ninety four per cent of hospitals had PPH policies. Among hospitals that provided a copy of their policy, 83% were dated after the release of the DoH's Framework, but 22% contained an incorrect definition of PPH. Only 71% of respondents in small rural and urban district hospitals recalled receiving a copy of the Framework. There was considerable variation in the frequency of postnatal observations. Key factors that impede local policy development were resources, entrenched practices and centralised policy development. Enabling factors were effective relationships, the DoH policy directive (Framework), education and organisational issues/time. Greater assistance is needed to ensure that hospitals have the capacity to develop a policy applicable to local needs. Maternity hospitals throughout the state provide different levels of care and NSW DoH policy directives should not be 'one size fits all' documents. Earlier recognition of PPH may be facilitated by routine post-partum monitoring of all women and should be consistent throughout the state, regardless of hospital level.

Fueling innovation in medical devices (and beyond): venture capital in health care.

PubMed

Ackerly, D Clay; Valverde, Ana M; Diener, Lawrence W; Dossary, Kristin L; Schulman, Kevin A

2009-01-01

Innovation in health care requires new ideas and the capital to develop and commercialize those ideas into products or services. The necessary capital is often "venture capital," but the link between public policy and the venture capital industry has not been well examined. In this paper we explore the link between venture capital and innovation in health care, and we present new descriptive data from a survey of health care venture capital fund managers. Respondents generally viewed policy levers (for example, reimbursement and regulations) as important risks to venture capital investments, potentially affecting their ability to raise capital for early-stage investment funds.

ELL School Readiness and Pre-Kindergarten Care

ERIC Educational Resources Information Center

Gottfried, Michael A.

2017-01-01

The increased utilization of non-parental pre-kindergarten care has spurred interest by both researchers and policy makers as to what types of care might be effective at boosting school readiness. Under-developed in the research has been an assessment of the influence of pre-kindergarten care on school readiness for English Language Learners…

One stop crisis centres: A policy analysis of the Malaysian response to intimate partner violence

PubMed Central

2011-01-01

Background This article aims to investigate the processes, actors and other influencing factors behind the development and the national scale-up of the One Stop Crisis Centre (OSCC) policy and the subsequent health model for violence-response. Methods Methods used included policy analysis of legal, policy and regulatory framework documents, and in-depth interviews with key informants from governmental and non-governmental organisations in two States of Malaysia. Results The findings show that women's NGOs and health professionals were instrumental in the formulation and scaling-up of the OSCC policy. However, the subsequent breakdown of the NGO-health coalition negatively impacted on the long-term implementation of the policy, which lacked financial resources and clear policy guidance from the Ministry of Health. Conclusion The findings confirm that a clearly-defined partnership between NGOs and health staff can be very powerful for influencing the legal and policy environment in which health care services for intimate partner violence are developed. It is critical to gain high level support from the Ministry of Health in order to institutionalise the violence-response across the entire health care system. Without clear operational details and resources policy implementation cannot be fully ensured and taken to scale. PMID:21693029

Working on reform. How workers' compensation medical care is affected by health care reform.

PubMed

Himmelstein, J; Rest, K

1996-01-01

The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies?

Developing a policy for delegation of nursing care in the school setting.

PubMed

Spriggle, Melinda

2009-04-01

School nurses are in a unique position to provide care for students with special health care needs in the school setting. The incidence of chronic conditions and improved technology necessitate care of complex health care needs that had formerly been managed in inpatient settings. Delegation is a tool that may be used by registered nurses to allow unlicensed assistive personnel to perform appropriate nursing tasks and activities while keeping in mind that the registered nurse ultimately retains accountability for the delegation. The legal parameters for nursing delegation are defined by State Nurse Practice Acts, State Board of Nursing guidelines, and Nursing Administrative Rules/Regulations. Delegation becomes more challenging when carried out in a non-health care setting. School administrators may not be aware of legal issues related to delegation of nursing care in the school setting. It is crucial for school nurses to have a working knowledge of the delegation process. Development of a specific delegation policy will ensure that delegation is carried out in a manner providing for safe and appropriate care in the school setting.

Report on milestones for care and support under the U.S. National Plan to Address Alzheimer's Disease.

PubMed

Borson, Soo; Boustani, Malaz A; Buckwalter, Kathleen C; Burgio, Louis D; Chodosh, Joshua; Fortinsky, Richard H; Gifford, David R; Gwyther, Lisa P; Koren, Mary Jane; Lynn, Joanne; Phillips, Cheryl; Roherty, Martha; Ronch, Judah; Stahl, Claudia; Rodgers, Lauren; Kim, Hye; Baumgart, Matthew; Geiger, Angela

2016-03-01

Under the U.S. national Alzheimer's plan, the National Institutes of Health identified milestones required to meet the plan's biomedical research goal (Goal 1). However, similar milestones have not been created for the goals on care (Goal 2) and support (Goal 3). The Alzheimer's Association convened a workgroup with expertise in clinical care, long-term services and supports, dementia care and support research, and public policy. The workgroup reviewed the literature on Alzheimer's care and support; reviewed how other countries are addressing the issue; and identified public policies needed over the next 10 years to achieve a more ideal care and support system. The workgroup developed and recommended 73 milestones for Goal 2 and 56 milestones for Goal 3. To advance the implementation of the U.S. national Alzheimer's plan, the U.S. government should adopt these recommended milestones, or develop similar milestones, to be incorporated into the national plan. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

[Health and gender relations: a reflection on the challenges for the implementation of public policies for health care for indigenous women].

PubMed

Ferreira, Luciane Ouriques

2013-04-01

This article presents some contrasts that exist between the discourses of public policies concerning women's health care, especially with respect to indigenous women, and the ethnological discourse which emphasizes the specificity of gender relations within indigenous societies. We worked on the assumption that the development of these public policies as well as the organization of health care services offered, which in fact are necessary, have a transforming effect on prevailing gender relations within Amerindian Societies. On the one hand, gender relations between indigenous people are associated with the domains of kinship and corporeality. On the other hand, the process of creating public policies, by means of biomedical intervention and the medicalization of the female body, constitutes a powerful tool for body modeling and the construction of subjectivities contributing to making women worthy of citizenship. The female gender is under discussion and its content is being negotiated.

Addressing the ethical, legal, and social issues raised by voting by persons with dementia.

PubMed

Karlawish, Jason H; Bonnie, Richard J; Appelbaum, Paul S; Lyketsos, Constantine; James, Bryan; Knopman, David; Patusky, Christopher; Kane, Rosalie A; Karlan, Pamela S

2004-09-15

This article addresses an emerging policy problem in the United States participation in the electoral process by citizens with dementia. At present, health care professionals, family caregivers, and long-term care staff lack adequate guidance to decide whether individuals with dementia should be precluded from or assisted in casting a ballot. Voting by persons with dementia raises a series of important questions about the autonomy of individuals with dementia, the integrity of the electoral process, and the prevention of fraud. Three subsidiary issues warrant special attention: development of a method to assess capacity to vote; identification of appropriate kinds of assistance to enable persons with cognitive impairment to vote; and formulation of uniform and workable policies for voting in long-term care settings. In some instances, extrapolation from existing policies and research permits reasonable recommendations to guide policy and practice. However, in other instances, additional research is necessary.

Meeting the policy agenda, part 1: the role of the modern district nurse.

PubMed

Dickson, Caroline A W; Gough, Helen; Bain, Heather

2011-10-01

The challenges posed by the current context of health and social care offer opportunities for different models of care delivery. District nursing has evolved, and continues to evolve to meet these challenges. The traditional reactive role of district nursing has developed as contemporary practice expects district nurses to meet both planned and unplanned care required by practice populations. Modern anticipatory care approaches to care are being adopted, while care and case management is being facilitated and delivered to patients and families with complex health and social care needs. Additionally, district nurses are recognizing the need to further develop management and leadership skills as the teams delivering care consist of a skill mix of nurses and other disciplines. They are also charged with evidencing the impact of what they do and influencing care delivery at every level of healthcare organizations. This first paper of two will explore the current UK policy context and ways in which district nursing services within each country are changing to meet the challenges posed. A second article will argue the need to ensure the district nursing workforce is underpinned by robust educational standards that ensure protection of the public. The influences of education and development from professional and organizational perspectives will be examined.

Development of health policy and systems research in Nigeria: lessons for developing countries' evidence-based health policy making process and practice.

PubMed

Uneke, Chigozie J; Ezeoha, Abel E; Ndukwe, Chinwendu D; Oyibo, Patrick G; Onwe, Friday

2010-08-01

Health policy and systems research (HPSR), which aims to produce reliable and rigorous evidence to inform the many critical decisions that must be made about health systems, is a new concept in Nigeria. In this study, policy makers and other stakeholders in the health sector identified the challenges and the potential intervention strategies to HPSR evidence use in policy making in Nigeria. The major challenges identified included capacity constraints at individual and organizational levels, communication gaps and poor networking between policy makers and researchers, and the non-involvement of healthcare recipients in identifying and planning care delivery needs. The main solutions suggested included promotion of strategies to encourage partnership between researchers and policy makers, improvement of staff incentives and facilities for research activities, improved budgetary provision for research, and sustainable institutional capacity development. These strategies have been shown to improve evidence-based policy making in developed countries and are likely to produce better outcomes in the developing world.

Development of Health Policy and Systems Research in Nigeria: Lessons for Developing Countries' Evidence-Based Health Policy Making Process and Practice

PubMed Central

Uneke, Chigozie J.; Ezeoha, Abel E.; Ndukwe, Chinwendu D.; Oyibo, Patrick G.; Onwe, Friday

2010-01-01

Health policy and systems research (HPSR), which aims to produce reliable and rigorous evidence to inform the many critical decisions that must be made about health systems, is a new concept in Nigeria. In this study, policy makers and other stakeholders in the health sector identified the challenges and the potential intervention strategies to HPSR evidence use in policy making in Nigeria. The major challenges identified included capacity constraints at individual and organizational levels, communication gaps and poor networking between policy makers and researchers, and the non-involvement of healthcare recipients in identifying and planning care delivery needs. The main solutions suggested included promotion of strategies to encourage partnership between researchers and policy makers, improvement of staff incentives and facilities for research activities, improved budgetary provision for research, and sustainable institutional capacity development. These strategies have been shown to improve evidence-based policy making in developed countries and are likely to produce better outcomes in the developing world. PMID:21804832

Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms.

PubMed

Thoumi, Andrea; Udayakumar, Krishna; Drobnick, Elizabeth; Taylor, Andrea; McClellan, Mark

2015-09-01

The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease prevention, diagnosis, and treatment. Although evidence on the effectiveness of innovative care models is emerging, scaling up or extending these models beyond their original setting has been difficult. We developed a framework to highlight policy barriers-institutional, regulatory, and financial-to the diffusion of transformative innovations in diabetes care. The framework builds on accountable care principles that support higher-value care, or better patient-level outcomes at lower cost. We applied this framework to three case studies from the United States, Mexico, and India to describe how innovators and policy leaders have addressed barriers, with a focus on important financing barriers to provider and consumer payment. The lessons have implications for policy reform to promote innovation through new funding approaches, institutional reforms, and performance measures with the goal of addressing the growing burdens of diabetes and other chronic diseases. Project HOPE—The People-to-People Health Foundation, Inc.

Older persons' experiences and perspectives of receiving social care: a systematic review of the qualitative literature.

PubMed

de São José, José; Barros, Rosanna; Samitca, Sanda; Teixeira, Ana

2016-01-01

The topic of social care for older people has gained increasing attention from the part of academics, professionals, policy makers and media. However, we know little about this topic from the perspectives of older persons, which hinders future developments in terms of theory, empirical research, professional practice and social policy. This article presents and discusses a systematic review of relevant qualitative research-based evidence on the older persons' experiences and perspectives of receiving social care published between 1990 and September 2014. This review aimed to obtain answers to the following questions: How is the reception of social care experienced by the older persons? What are the negative and positive aspects of these experiences? What are the factors which influence the experiences? The synthesis of the findings of reviewed papers identified six analytical themes: asking for care as a major challenge; ambivalences; (dis)engagement in decisions concerning care; multiple losses as outcomes of receiving social care; multiple strategies to deal with losses originated by the ageing process; and properties of 'good care'. These themes are discussed from the point of view of their implications for theory, care practice and social policy, and future research. © 2015 John Wiley & Sons Ltd.

Managing Law Enforcement Presence in the Emergency Department: Highlighting the Need for New Policy Recommendations.

PubMed

Tahouni, Morsal R; Liscord, Emory; Mowafi, Hani

2015-10-01

The Emergency Department (ED) is the portal of entry to the health care system for a large percentage of patients. This is especially true for victims and perpetrators of interpersonal violence. Frequently, law enforcement personnel (LEP) accompany patients to the ED or seek access to patients during their ED stay or subsequent hospitalization. The time-sensitive nature of both emergency care and criminal investigation motivates both health care personnel and LEP, and can lead to potential conflicts of interest regarding access to patients in the ED. We hope to examine the relationship among patients, providers, and LEP in the ED, and the potential impact these interactions have on patient care. This article presents a review of the relevant literature and policy consideration as well as provides guidance on the development of such policies for EDs. Hospitals, EDs, and trauma resuscitation rooms are highly regulated environments, but LEP largely fall outside the ethical and institutional guidelines of health care institutions. Many potential areas of conflict exist when LEP are present in the ED that can have detrimental effects on patient care, provider liability, and LEP efficacy. Patients' perceptions of collaboration between ED personnel and LEP can compromise emergency patient care. There is a need for hospital policies to govern interactions among patients, emergency health care providers, and LEP in the ED. Copyright © 2015 Elsevier Inc. All rights reserved.

Reflecting on the ethical administration of computerized medical records

NASA Astrophysics Data System (ADS)

Collmann, Jeff R.

1995-05-01

This presentation examines the ethical issues raised by computerized image management and communication systems (IMAC), the ethical principals that should guide development of policies, procedures and practices for IMACS systems, and who should be involved in developing a hospital's approach to these issues. The ready access of computerized records creates special hazards of which hospitals must beware. Hospitals must maintain confidentiality of patient's records while making records available to authorized users as efficiently as possible. The general conditions of contemporary health care undermine protecting the confidentiality of patient record. Patients may not provide health care institutions with information about themselves under conditions of informed consent. The field of information science must design sophisticated systems of computer security that stratify access, create audit trails on data changes and system use, safeguard patient data from corruption, and protect the databases from outside invasion. Radiology professionals must both work with information science experts in their own hospitals to create institutional safeguards and include the adequacy of security measures as a criterion for evaluating PACS systems. New policies and procedures on maintaining computerized patient records must be developed that obligate all members of the health care staff, not just care givers. Patients must be informed about the existence of computerized medical records, the rules and practices that govern their dissemination and given the opportunity to give or withhold consent for their use. Departmental and hospital policies on confidentiality should be reviewed to determine if revisions are necessary to manage computer-based records. Well developed discussions of the ethical principles and administrative policies on confidentiality and informed consent and of the risks posed by computer-based patient records systems should be included in initial and continuing staff system training. Administration should develop ways to monitor staff compliance with confidentiality policies and should assess diligence in maintaining patient record confidentiality as part of staff annual performance evaluations. Ethical management of IMAC systems is the business of all members of the health care team. Computerized patient records management (including IMAC) should be scrutinized as any other clinical medial ethical issue. If hospitals include these processes in their planning for RIS, IMACS, and HIS systems, they should have time to develop institutional expertise on these questions before and as systems are installed rather than only as ethical dilemmas develop during their use.

Addressing disparities in maternal health care in Pakistan: gender, class and exclusion

PubMed Central

2012-01-01

Background After more than two decades of the Safe Motherhood Initiative and Millennium Development Goals aimed at reducing maternal mortality, women continue to die in childbirth at unacceptably high rates in Pakistan. While an extensive literature describes various programmatic strategies, it neglects the rigorous analysis of the reasons these strategies have been unsuccessful, especially for women living at the economic and social margins of society. A critical gap in current knowledge is a detailed understanding of the root causes of disparities in maternal health care, and in particular, how gender and class influence policy formulation and the design and delivery of maternal health care services. Taking Pakistan as a case study, this research builds upon two distinct yet interlinked conceptual approaches to understanding the phenomenon of inequity in access to maternal health care: social exclusion and health systems as social institutions. Methods/Design This four year project consists of two interrelated modules that focus on two distinct groups of participants: (1) poor, disadvantaged women and men and (2) policy makers, program managers and health service providers. Module one will employ critical ethnography to understand the key axes of social exclusion as related to gender, class and zaat and how they affect women’s experiences of using maternal health care. Through health care setting observations, interviews and document review, Module two will assess policy design and delivery of maternal health services. Discussion This research will provide theoretical advances to enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems in Pakistan. It will also provide empirical evidence to support formulation of maternal health care policies and health care system practices aimed at reducing disparities in maternal health care in Pakistan. Lastly, it will enhance inter-disciplinary research capacity in the emerging field of social exclusion and maternal health and help reduce social inequities and achieve the Millennium Development Goal No. 5. PMID:22871056

Bridging the Gap between Health and Social Care for Rare Diseases: Key Issues and Innovative Solutions.

PubMed

Castro, Raquel; Senecat, Juliette; de Chalendar, Myriam; Vajda, Ildikó; Dan, Dorica; Boncz, Béata

2017-01-01

Bridging the gaps between health and social care for rare diseases is not only necessary but crucial to increase the life expectancy, quality of life and autonomy of people living with a rare disease, supporting them in the full realisation of their fundamental human rights.The complexity of rare diseases, their strong relation to disability and the current unmet social and daily life needs of people living with a rare disease must not be underestimated and require urgent attention from all stakeholders involved in care provision, from healthcare to social and community services.The Commission Expert Group Recommendations to Support the Incorporation of Rare Diseases into Social Services and Policies, adopted unanimously in April 2016, by the representatives of European Member States and the other rare disease stakeholders, clearly set the tone for the need to promote measures that facilitate multidisciplinary, holistic, continuous, person-centred and participative care provision to people living with rare diseases.These recommendations, sided by other recent policy developments at European and national levels, represent an important policy step into approaching rare diseases' complex challenges in regards to holistic care provision.Innovative approaches aiming at bridging the gap between health, social and community service and support providers are currently being developed and tested in different European countries: standards of care, networks of expertise, case management services, one-stop-shop services, amongst others.These ongoing pilot approaches, presented in this chapter, have the power to inspire future policies and the effective and efficient implementation of holistic care pathways for people living with a rare disease, bringing about significant changes for patients, carers, care providers, competent authorities and the society at large.Nonetheless, the challenges to fully address this issue remain numerous and other key issues will also need to be taken into account when moving forward with the implementation of measures that aim at bridging the gaps between care providers and providing holistic care to people living with a rare disease.

Who Lives Where and Does It Matter? Changes in the Health Profiles of Older People Living in Long Term Care and the Community over Two Decades in a High Income Country.

PubMed

Matthews, Fiona E; Bennett, Holly; Wittenberg, Raphael; Jagger, Carol; Dening, Tom; Brayne, Carol

2016-01-01

There have been fundamental shifts in the attitude towards, access to and nature of long term care in high income countries. The proportion and profile of the older population living in such settings varies according to social, cultural, and economic characteristics as well as governmental policies. Changes in the profiles of people in different settings are important for policy makers and care providers. Although details will differ, how change occurs across time is important to all, including lower and middle income countries developing policies themselves. Here change is examined across two decades in England. Using the two Cognitive Function and Ageing Studies (CFAS I: 77% response, CFAS II: 56% response), two population based studies of older people carried out in the same areas conducted two decades apart, the study diagnosis of dementia using the Automated Geriatric Examination for Computer Assisted Taxonomy, health and wellbeing were examined, focusing on long term care. The proportion of individuals with three or more health conditions increased for everyone living in long term care between CFAS I (47.6%, 95% CI: 42.3-53.1) and CFAS II (62.7%, 95% CI: 54.8-70.0) and was consistently higher in those without dementia compared to those with dementia in both studies. Functional impairment measured by activities of daily living increased in assisted living facilities from 48% (95% CI: 44%-52%) to 67% (95% CI: 62%-71%). Health profiles of residents in long term care have changed dramatically over time. Dementia prevalence and reporting multiple health conditions have increased. Receiving care in the community puts pressure on unpaid carers and formal services; these results have implications for policies about supporting people at home as well as for service provision within long term care including quality of care, health management, cost, and the development of a skilled, caring, and informed workforce.

Implementing oral care practices and policy into long-term care: the Brushing up on Mouth Care project.

PubMed

McNally, Mary; Martin-Misener, Ruth; McNeil, Karen; Brillant, Martha; Moorhouse, Paige; Crowell, Sandra; Matthews, Debora; Clovis, Joanne

2015-03-01

Optimal mouth care is integral to the health and quality of life of dependent older adults.Yet, a persistent lack of adequate oral care in long-term care (LTC) facilities exacerbates the burden of disease experienced by residents. The reasons for this are complex and create enormous challenges for care providers, clinicians, and administrators dedicated to comprehensive high quality care. The aim of this study was to develop, implement, and evaluate a comprehensive program for daily mouth care for LTC. A case study design using a participatory and qualitative approach examined how individual, organizational (workplace practices and culture), and system factors (standards and policy) influenced the development and implementation of a comprehensive program to improve the delivery of daily oral care in LTC. The research was undertaken in 3 LTC residences administered under the same health authority and included personal care providers, nurse managers, and directors of care. A comprehensive program for care providers including, education, resources, and organizational guidelines, to improve the delivery of daily mouth care to LTC residents was created, rolled out, and refined over a 12-month period. Data was collected through diary studies, targeted interviews, field notes, oral care activities records, site team meetings, and direct feedback from members of the care team. The oral care intervention resulted in a heightened awareness, support and greater efficiency amongst care team. The presence of a "champion" was a key feature for sustaining processes. Management had a clear role to play to ensure support and accountability for the intervention. Optimizing oral care in long-term care can be achieved through an integrated approach that includes education, provision of resources, an oral care champion, support from managers and administrators, and appropriate organizational policy. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Comparative federal health care policy: evidence of collaborative federalism in Pakistan and Venezuela.

PubMed

Baracskay, Daniel

2013-01-01

Collaborative federalism has provided an effective analytical foundation for understanding how complex public policies are implemented in federal systems through intergovernmental and intersectoral alignments. This has particularly been the case in issue areas like public health policy where diseases are detected and treated at the local level. While past studies on collaborative federalism and health care policy have focused on federal systems that are largely democratic, little research has been conducted to examine the extent of collaboration in authoritarian structures. This article applies the collaborative federalism approach to the Islamic Republic of Pakistan and the Bolivarian Republic of Venezuela. Evidence suggests that while both nations have exhibited authoritarian governing structures, there have been discernible policy areas where collaborative federalism is embraced to facilitate the implementation process. Further, while not an innate aspect of their federal structures, Pakistan and Venezuela can potentially expand their use of the collaborative approach to successfully implement health care policy and the epidemiological surveillance and intervention functions. Yet, as argued, this would necessitate further development of their structures on a sustained basis to create an environment conducive for collaborative federalism to flourish, and possibly expand to other policy areas as well.

[Public policy-making on breast cancer in Latin America].

PubMed

González-Robledo, M C; González-Robledo, L M; Nigenda, G

2013-03-01

To understand the public policy-making process as it relates to breast cancer care in five Latin American countries. An exploratory-evaluative study was conducted in Argentina, Brazil, Colombia, Mexico, and Venezuela in 2010, with the selection of countries based on convenience sampling. Sixty-five semi-structured interviews were conducted with government officials, academics, and representatives of trade associations and civil society organizations. A content analysis of secondary sources was performed. Information sources, data, and informants were mixed using the triangulation method for purposes of analysis. The countries that have made the most progress in public policy-making related to breast cancer are Brazil and Mexico. Although Argentina, Colombia, and Venezuela do not have policies, they do have breast cancer care programs and activities. Two perspectives on the development of public policies became evident: the first includes the broad participation of both governmental and nongovernmental sectors, whereas the second, more narrow approach involves government authorities alone. The results point to significant differences in public policy-making related to breast cancer in the Region. They also show that greater progress has been made in countries where policies have been developed through inclusive participation processes.

From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care.

PubMed

Harnagea, Hermina; Lamothe, Lise; Couturier, Yves; Esfandiari, Shahrokh; Voyer, René; Charbonneau, Anne; Emami, Elham

2018-02-15

Despite its importance, the integration of oral health into primary care is still an emerging practice in the field of health care services. This scoping review aims to map the literature and provide a summary on the conceptual frameworks, policies and programs related to this concept. Using the Levac et al. six-stage framework, we performed a systematic search of electronic databases, organizational websites and grey literature from 1978 to April 2016. All relevant original publications with a focus on the integration of oral health into primary care were retrieved. Content analyses were performed to synthesize the results. From a total of 1619 citations, 67 publications were included in the review. Two conceptual frameworks were identified. Policies regarding oral heath integration into primary care were mostly oriented toward common risk factors approach and care coordination processes. In general, oral health integrated care programs were designed in the public health sector and based on partnerships with various private and public health organizations, governmental bodies and academic institutions. These programmes used various strategies to empower oral health integrated care, including building interdisciplinary networks, training non-dental care providers, oral health champion modelling, enabling care linkages and care coordinated process, as well as the use of e-health technologies. The majority of studies on the programs outcomes were descriptive in nature without reporting long-term outcomes. This scoping review provided a comprehensive overview on the concept of integration of oral health in primary care. The findings identified major gaps in reported programs outcomes mainly because of the lack of related research. However, the results could be considered as a first step in the development of health care policies that support collaborative practices and patient-centred care in the field of primary care sector.

Decentralization and primary health care: some negative implications in developing countries.

PubMed

Collins, C; Green, A

1994-01-01

Decentralization is a highly popular concept, being a key element of Primary Health Care policies. There are, however, certain negative implications of decentralization that must be taken into account. These are analyzed in this article with particular reference to developing countries. The authors criticize the tendency for decentralization to be associated with state limitations, and discuss the dilemma of relating decentralization, which is the enhancement of the different, to equity, which is the promotion of equivalence. Those situations in which decentralization can strengthen political domination are described. The authors conclude by setting out a checklist of warning questions and issues to be taken into account to ensure that decentralization genuinely facilitates the Primary Health Care orientation of health policy.

Social Rights and Economics: Claims to Health Care and Education in Developing Countries. Policy Research Working Paper.

ERIC Educational Resources Information Center

Gauri, Varun

This paper analyzes contemporary rights-based and economic approaches to health care and education in developing countries. The paper assesses the foundations and uses of social rights in development; outlines an economic approach to improving health and education service provision; and highlights differences, similarities, and the hard questions…

An Integrated Approach to Early Childhood Education and Care: A Preliminary Study. Occasional Paper.

ERIC Educational Resources Information Center

Haddad, Lenira

This paper reflects upon the policy development and implementation of integrated or coordinated services of early childhood education and care (ECEC) within a systemic perspective, focusing on issues of relevance to both developed and developing countries. The paper is divided into four parts: (1) issues related to ECEC's cultural and historical…

Developing a Policy for Delegation of Nursing Care in the School Setting

ERIC Educational Resources Information Center

Spriggle, Melinda

2009-01-01

School nurses are in a unique position to provide care for students with special health care needs in the school setting. The incidence of chronic conditions and improved technology necessitate care of complex health care needs that had formerly been managed in inpatient settings. Delegation is a tool that may be used by registered nurses to allow…

Older people’s perspectives on an elderly-friendly hospital environment: an exploratory study

PubMed Central

Karki, Sushmita; Bhatta, Dharma Nand; Aryal, Umesh Raj

2015-01-01

Background Many older people are vulnerable with multiple health problems and need of extensive care and support for quality of life. The main objective of this study was to explore the older people’s perspectives on an “elderly-friendly” hospital. Methods Hospital was stratified by four domains including government, semi-government, community, and private. We interviewed 33 hospitalized older patients and four hospital managers between June and December 2014 in Kathmandu, Nepal, using purposive sampling technique. We executed a qualitative content analysis step with extensive review of the interviews. Final name of the theme was given after the agreement between the research team and experts to improve trustworthiness. Elderly-friendly services, expectation from government and hospital, and health policy related to senior citizen were developed as main themes. Results Most of the participants were satisfied with the behavior of health personnel. However, none of the health personnel were trained with geriatric health care. Elderly-friendly hospital guidelines and policy were not developed by any hospitals. Older people health card, advocacy for older people’s health and benefit, and hospital environment were the common expectations of older patients. Government policy and budget constraint were the main obstacles to promote elderly-friendly health care services. Conclusion Elderly-related health policies, physical environments of hospital, elderly-friendly health manpower, advocacy, and other facilities and benefits should be improved and developed. There are urgent needs to develop elderly-friendly hospital policies and guidelines that focus on older people’s health benefits and friendly services. PMID:26028980

Where We Stand—CMA Position Papers: • Abortion • Acupuncture • Chiropractic • Confidentiality • Cost of Care • Drug Abuse • Environmental Health • Health Education for the Public • Health in the United States • Health Quackery • Health Maintenance Organizations and Prepaid Health Plans • Health Manpower • National Health Insurance • Physician's Assistants • Physician Unions • Professional Standards Review Organizations • Quality Medical Care

PubMed Central

1973-01-01

To serve the interests of members and to function in the public interest, the California Medical Association must set policies and take positions on current issues affecting the health care of Californians. These policies then guide the activities of the Association in fulfilling its leadership role and its responsibility to the public. Delegates, elected by the membership of CMA's component medical societies, meet annually to deliberate and determine the policies and courses of action for the Association. Between meetings of these Delegates, the CMA Councilors, elected by their district membership, implement the directives of the Delegates and set interim policies. By this democratic process, the membership governs the CMA. Association members must be informed if they are to participate effectively in the affairs of their medical organizations. To disseminate better understanding of CMA's activities, position papers on current issues have been developed. They are based on House of Delegates resolutions and Council actions. Entitled “Where We Stand on Medical and Health Issues,” these papers represent the current policy positions of CMA. Each paper is annotated to give the reference source of the policy actions. As with any organization, CMA policies are subject to timely revision. When policies are amended or new policies are adopted, new papers will be developed. PMID:4148533

State responses to biotechnology.

PubMed

Harris, Rebecca C

2015-01-01

This article reviews biotechnology legislation in the 50 states for 11 policy areas spanning 1990-2010, an era of immense growth in biotechnology, genetic knowledge, and significant policy development. Policies regarding health insurance, life insurance, long-term care insurance, DNA data bank collection, biotech research protection, biotech promotion and support, employment discrimination, genetic counselor licensing, human cloning, and genetic privacy each represent major policy responses arising from biotechnology and coinciding with key areas of state regulation (insurance, criminal justice, economic development, labor law, health and safety, privacy, and property rights). This analysis seeks to answer three questions regarding biotechnology legislation at the state level: who is acting (policy adoption), when is policy adopted (policy timing), and what is policy doing (policy content). Theoretical concerns examine state ideology (conservative or liberal), policy type (economic or moral), and the role of external events (federal law, news events, etc.) on state policy adoption. Findings suggest ideological patterns in adoption, timing, and content of biotech policy. Findings also suggest economic policies tend to be more uniform in content than moral policies, and findings also document a clear link between federal policy development, external events, and state policy response.

Introducing an Equal Rights Framework for Older Persons in Residential Care

PubMed Central

Jönson, Håkan; Harnett, Tove

2016-01-01

This article reconceptualizes residential care for older persons by introducing a framework developed from a rights-based principle of disability policies: the normalization principle. This principle is part of the social model and states that society should make available for people who have impairments living conditions that are as close as possible to those of “others.” Using the framework on the case of eldercare in Sweden shows that although disability policies have used people without impairments as a comparative (external) reference group for claiming rights, eldercare policies use internal reference groups, basing comparisons on other care users. The article highlights the need for external comparisons in eldercare and suggests that the third age, which so far has been a normative reference group for older people, could be a comparative reference group when older persons in need of care claim rights to equal conditions. PMID:26035884

Prospects for rebuilding primary care using the patient-centered medical home.

PubMed

Landon, Bruce E; Gill, James M; Antonelli, Richard C; Rich, Eugene C

2010-05-01

Existing research suggests that models of enhanced primary care lead to health care systems with better performance. What the research does not show is whether such an approach is feasible or likely to be effective within the U.S. health care system. Many commentators have adopted the model of the patient-centered medical home as policy shorthand to address the reinvention of primary care in the United States. We analyze potential barriers to implementing the medical home model for policy makers and practitioners. Among others, these include developing new payment models, as well as the need for up-front funding to assemble the personnel and infrastructure required by an enhanced non-visit-based primary care practice and methods to facilitate transformation of existing practices to functioning medical homes.

Development of an Internet Security Policy for health care establishments.

PubMed

Ilioudis, C; Pangalos, G

2000-01-01

The Internet provides unprecedented opportunities for interaction and data sharing among health care providers, patients and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality and integrity of information. This paper defines the basic security requirements that must be addressed in order to use the Internet to safely transmit patient and/or other sensitive Health Care information. It describes a suitable Internet Security Policy for Health Care Establishments and provides the set of technical measures that are needed for its implementation. The proposed security policy and technical approaches have been based on an extensive study of the related recommendations from the security and standard groups both in EU amid USA and our related work and experience. The results have been utilized in the framework of the Intranet Health Clinic project, where the use of the Internet for the transmission of sensitive Health Care information is of vital importance.

The use of a policy dialogue to facilitate evidence-informed policy development for improved access to care: the case of the Winnipeg Central Intake Service (WCIS).

PubMed

Damani, Zaheed; MacKean, Gail; Bohm, Eric; DeMone, Brie; Wright, Brock; Noseworthy, Tom; Holroyd-Leduc, Jayna; Marshall, Deborah A

2016-10-18

Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba. Using guiding principles of public participation processes, we hosted a policy roundtable meeting to engage stakeholders and use their input to refine the policy directions. Here, we report on the use and input of a policy roundtable meeting and its role in contributing to the development of evidence-informed policy. Our evidence-informed policy directions focused on formal measurement/monitoring of quality, central intake as a preferred model for service delivery, provincial scope, transparent processes/performance indicators, and patient choice of provider. We held a policy roundtable meeting and used outcomes of facilitated discussions to refine these directions. Individuals from our team and six stakeholder groups across Manitoba participated (n = 44), including patients, family physicians, orthopaedic surgeons, surgical office assistants, Winnipeg Central Intake team, and administrators/managers. We developed evaluation forms to assess the meeting process, and collected decision-maker partners' perspectives on the value of the policy roundtable meeting and use of policy directions to improve access to scheduled clinical services after the meeting, and again 15 months later. We analyzed roundtable and evaluation data using thematic analysis to identify key themes. Four key findings emerged. First, participants supported all policy directions, with revisions and key implementation considerations identified. Second, participants felt the policy roundtable meeting achieved its purpose (to engage stakeholders, elicit feedback, refine policy directions). Third, our decision-maker partners' expectations of the policy roundtable meeting were exceeded; they re-affirmed its value and described the refined policy directions as foundational to establishing the vocabulary, vision and framework for improving access to scheduled clinical services in Manitoba. Finally, our adaptation of key design elements was conducive to discussion of issues surrounding access to care. Our policy roundtable process was an effective tool for acquiring broad input from stakeholders, refining policy directions and forming the necessary consensus starting points to move towards evidence-informed policy.

The food and beverage vending environment in health care facilities participating in the healthy eating, active communities program.

PubMed

Lawrence, Sally; Boyle, Maria; Craypo, Lisa; Samuels, Sarah

2009-06-01

Little has been done to ensure that the foods sold within health care facilities promote healthy lifestyles. Policies to improve school nutrition environments can serve as models for health care organizations. This study was designed to assess the healthfulness of foods sold in health care facility vending machines as well as how health care organizations are using policies to create healthy food environments. Food and beverage assessments were conducted in 19 California health care facilities that serve children in the Healthy Eating, Active Communities sites. Items sold in vending machines were inventoried at each facility and interviews conducted for information on vending policies. Analyses examined the types of products sold and the healthfulness of these products. Ninety-six vending machines were observed in 15 (79%) of the facilities. Hospitals averaged 9.3 vending machines per facility compared with 3 vending machines per health department and 1.4 per clinic. Sodas comprised the greatest percentage of all beverages offered for sale: 30% in hospital vending machines and 38% in clinic vending machines. Water (20%) was the most prevalent in health departments. Candy comprised the greatest percentage of all foods offered in vending machines: 31% in clinics, 24% in hospitals, and 20% in health department facilities. Across all facilities, 75% of beverages and 81% of foods sold in vending machines did not adhere to the California school nutrition standards (Senate Bill 12). Nine (47%) of the health care facilities had adopted, or were in the process of adopting, policies that set nutrition standards for vending machines. According to the California school nutrition standards, the majority of items found in the vending machines in participating health care facilities were unhealthy. Consumption of sweetened beverages and high-energy-density foods has been linked to increased prevalence of obesity. Some health care facilities are developing policies that set nutrition standards for vending machines. These policies could be effective in increasing access to healthy foods and beverages in institutional settings.

Series: Clinical Epidemiology in South Africa. Paper 1: Evidence-based health care and policy in Africa: past, present, and future.

PubMed

Young, Taryn; Garner, Paul; Clarke, Mike; Volmink, Jimmy

2017-03-01

Africa has high disease burden and health system challenges but is making progress in recognizing, accepting, and adopting evidence-based health care (EBHC). In this article, we reflect on the developments of the past 2 decades and consider further steps that will help with the translation of reliable research results into the decision making process. There has been a rapid growth in various initiatives to promote EBHC in the African region. These include the conduct and reporting of primary and secondary research, research capacity development and supportive initiatives, access to information, and work with decision makers in getting research into clinical guidelines and health policies. Much, however, still needs to be done to improve the impact on health in the region. A multipronged approach consisting of regionally relevant well-conducted research addressing priority health problems, increased uptake of research in health care policy and practice, dedicated capacity development initiatives to support the conduct as well as use of research, facilitated by wider collaboration, and equitable partnerships will be important. Working together in mutually supporting partnerships is key to advancing both evidence-informed health care practices and better health. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa - a qualitative study.

PubMed

Muhwava, Lorrein Shamiso; Murphy, Katherine; Zarowsky, Christina; Levitt, Naomi

2018-05-10

Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders' perspectives on the barriers to -- and opportunities for -- delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant's first year of life. Following a document review of policy and clinical practice guidelines, in-depth interviews were conducted with 11 key informants who were key policy makers, health service managers and clinicians working in the public health services in South Africa's two major cities (Johannesburg and Cape Town). Data were analysed using qualitative content analysis procedures. The document review and interviews established that it is policy that health services adhere to international guidelines for GDM diagnosis and management, in addition to locally developed guidelines and protocols for clinical practice. All key informants confirmed that lack of postpartum follow-up for GDM women is a significant problem. Health systems barriers include fragmentation of care and the absence of standardised postnatal care for post-GDM women. Key informants also raised patient - related challenges including lack of perceived future risk of developing type 2 diabetes and non-attendance for postpartum follow up, as barriers to postnatal care for GDM women. All participants supported integrated primary health services but cautioned against overloading health workers. Although there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided.

The "leap forward" in nursing home development in urban China: future policy directions.

PubMed

Shum, Michelle H Y; Lou, Vivian W Q; He, Kelly Z J; Chen, Coco C H; Wang, Junfang

2015-09-01

In the past decade, the number of nursing beds in China has increased annually by an average of 10%, reaching 4.3 million in 2013. Although the State Council pushed for further increases to a ratio of 30 nursing home beds per 1000 persons by 2015, service utilization, quality assurance, and regulatory oversight are the inherent challenges in developing an equitable long-term care (LTC) system that can safeguard older persons' rights. We review and analyze both laws and policies in light of demographic and socioeconomic changes and advocate 3 policy directions for LTC development in China: allocating LTC resources with comprehensive eligibility criteria, with particular consideration of family needs; establishing viable quality standards for outcome-driven evaluation; and highlighting standardized monitoring mechanisms in both institutional and home LTC settings. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Sustainable development and public health: a national perspective.

PubMed

Adshead, Fiona; Thorpe, Allison; Rutter, Jill

2006-12-01

The increasing policy focus on sustainable development offers new opportunities to align the public health narrative with that of sustainable development to promote both sustainable health for the population, and a sustainable health care system for England. This paper provides some insights into ways in which potential linkages between the two areas can be made meaningful across a wide range of policies at a national level.

Shared decision making in the United States: policy and implementation activity on multiple fronts.

PubMed

Frosch, Dominick L; Moulton, Benjamin W; Wexler, Richard M; Holmes-Rovner, Margaret; Volk, Robert J; Levin, Carrie A

2011-01-01

Shared decision making in the United States has become an important element in health policy debates. The recently passed federal health care reform legislation includes several key provisions related to shared decision making (SDM) and patient decision support. Several states have passed or are considering legislation that incorporates SDM as a key component of improved health care provision. Research on SDM is funded by a range of public and private organizations. Non-profit, for-profit, academic and government organizations are developing decision support interventions for numerous conditions. Some interventions are publicly available; others are distributed to patients through health insurance and healthcare providers. A significant number of clinical implementation projects are underway to test and evaluate different ways of incorporating SDM and patient decision support into routine clinical care. Numerous professional organizations are advocating for SDM and social networking efforts are increasing their advocacy as well. Policy makers are intrigued by the potential of SDM to improve health care provision and potentially lower costs. The role of shared decision making in policy and practice will be part of the larger health care reform debate. 2011. Published by Elsevier GmbH.

Health services and policy research in hepatology.

PubMed

Talwalkar, Jayant A

2014-05-01

This article examines recent health services and policy research studies in hepatology and liver transplantation. Critical issues include access to medical care, timeliness of referral and consultation, resource utilization in clinical practice, comparative effectiveness research, and the evaluation of care delivery models. Despite policymaking efforts, there continues to be unwarranted variation in access to subspecialty care and liver transplantation services based on race and geographic location. Variations in primary care and specialist awareness of practice guidelines for liver disease contribute to disparities in appropriateness and timeliness of treatments. Defining the cost-effectiveness of increased resource utilization for novel antiviral therapies and liver transplantation continues to stimulate controversy. Few comparative effectiveness studies in hepatology exist to date, yet a growing number of analyses using national datasets will help inform policy in this arena. Identifying care delivery models that demonstrate high value for populations with chronic liver disease is critical in the context of recent healthcare reform efforts. Health services and policy research is a growing field of investigation in hepatology and liver transplantation. Further emphasis on research training and workforce development in this area will be critical for understanding and improving patient-centered outcomes for this population.

Developing Policy for Integrating Biomedicine and Traditional Chinese Medical Practice Using Focus Groups and the Delphi Technique

PubMed Central

Chung, Vincent C. H.; Ma, Polly H. X.; Lau, Chun Hong; Griffiths, Sian M.

2012-01-01

In Hong Kong, statutory regulation for traditional Chinese medicine (TCM) practitioners has been implemented in the past decade. Increasing use of TCM on top of biomedicine (BM) services by the population has been followed; but corresponding policy development to integrate their practices has not yet been discussed. Using focus group methodology, we explore policy ideas for integration by collating views from frontline BM (n = 50) and TCM clinicians (n = 50). Qualitative data were analyzed under the guidance of structuration model of collaboration, a theoretical model for understanding interprofessional collaboration. From focus group findings we generated 28 possible approaches, and subsequently their acceptability was assessed by a two round Delphi survey amongst BM and TCM policy stakeholders (n = 12). Consensus was reached only on 13 statements. Stakeholders agreed that clinicians from both paradigms should share common goals of providing patient-centered care, promoting the development of protocols for shared care and information exchange, as well as strengthening interprofessional connectivity and leadership for integration. On the other hand, attitudes amongst policy stakeholders were split on the possibility of fostering trust and mutual learning, as well as on enhancing innovation and governmental support. Future policy initiatives should focus on these controversial areas. PMID:22649469

China on the Mekong: Legitimacy Imperatives and Policy Case Studies

DTIC Science & Technology

2013-12-01

1  B.  IMPORTANCE ................................................................................................1  C.  PROBLEMS...gross domestic product GMS Greater Mekong Subregion HDI human development indicators MRC Mekong River Commission MOU memoranda of understanding MPS...home affect China’s policies along the Mekong River? B. IMPORTANCE A careful investigation of PRC policies on the Mekong River will contribute to a

Early Childhood Policy in England 1997-2013: Anatomy of a Missed Opportunity

ERIC Educational Resources Information Center

Moss, Peter

2014-01-01

The new Labour government that entered office in 1997 made early childhood education and care (ECEC) a policy priority, after decades of neglect. The article provides an overview of the subsequent policy developments, looking at three areas in more detail: governance and finance; the organisation and management of services; and the workforce. It…

Reflections from organization science on the development of primary health care research networks.

PubMed

Fenton, E; Harvey, J; Griffiths, F; Wild, A; Sturt, J

2001-10-01

In the UK, policy changes in primary health care research and development have led to the establishment of primary care research networks. These organizations aim to increase research culture, capacity and evidence base in primary care. As publicly funded bodies, these networks need to be accountable. Organizational science has studied network organizations including why and how they develop and how they function most effectively. This paper draws on organizational science to reflect on why primary care research networks appear to be appropriate for primary care research and how their structures and processes can best enable the achievement of their aims.

The Professional Development Needs of Special Needs Assistants in Irish Post-Primary Schools

ERIC Educational Resources Information Center

Kerins, Pauline; Casserly, Ann Marie; Deacy, Evelyn; Harvey, Deirdre; McDonagh, Dolores; Tiernan, Bairbre

2018-01-01

According to government policy in Ireland, special needs assistants (SNAs) may be employed in post-primary schools to support students deemed to have chronic and serious care needs. There is currently no national policy regarding the continuing professional development (CPD) of SNAs, to meet the requirements of their role. This study investigated…

Health policy evolution in Lao People’s Democratic Republic: context, processes and agency

PubMed Central

Jönsson, Kristina; Phoummalaysith, Bounfeng; Wahlström, Rolf; Tomson, Göran

2015-01-01

During the last 20 years Lao People’s Democratic Republic has successfully developed and adopted some 30 health policies, strategies, decrees and laws in the field of health. Still, the implementation process remains arduous. This article aims at discussing challenges of health policy development and effective implementation by contextualizing the policy evolution over time and by focusing particularly on the National Drug Policy and the Health Care Law. Special attention is given to the role of research in policymaking. The analysis was guided by the conceptual framework of policy context, process, content and actors, combined with an institutional perspective, and showed that effective implementation of a health policy is highly dependent on both structures and agency of those involved in the policy process. The National Drug Policy was formulated and adopted in a short period of time in a resource-scarce setting, but with dedicated policy entrepreneurs and support of concerned international collaborators. Timely introduction of operational health systems research played a crucial role to support the implementation, as well as the subsequent revision of the policy. The development of the Health Care Law took several years and once adopted, the implementation was delayed by institutional legacies and issues concerning the choice of institutional design and financing, despite strong support of the law among the policymakers. Among many factors, timing of the implementation appeared to be of crucial importance, in combination with strong leadership. These two examples show that more research, that problematizes the complex policy environment in combination with improved communication between researchers and policymakers, is necessary to inform about measures for effective implementation. A way forward can be to strengthen the domestic research capacity and the international research collaboration regionally as well as globally. PMID:24740710

7 CFR 1703.101 - Policy.

Code of Federal Regulations, 2014 CFR

2014-01-01

... RURAL DEVELOPMENT Distance Learning and Telemedicine Loan and Grant Program-General § 1703.101 Policy... rural Americans. To further this objective, RUS will provide financial assistance to distance learning... educational, learning, training, and health care services. (b) In providing financial assistance, RUS will...

Economics and Health Reform: Academic Research and Public Policy.

PubMed

Glied, Sherry A; Miller, Erin A

2015-08-01

Two prior studies, conducted in 1966 and in 1979, examined the role of economic research in health policy development. Both concluded that health economics had not been an important contributor to policy. Passage of the Affordable Care Act offers an opportunity to reassess this question. We find that the evolution of health economics research has given it an increasingly important role in policy. Research in the field has followed three related paths over the past century-institutionalist research that described problems; theoretical research, which proposed relationships that might extend beyond existing institutions; and empirical assessments of structural parameters identified in the theoretical research. These three strands operating in concert allowed economic research to be used to predict the fiscal and coverage consequences of alternative policy paths. This ability made economic research a powerful policy force. Key conclusions of health economics research are clearly evident in the Affordable Care Act. © The Author(s) 2015.

State CCDBG Plans to Promote Opportunities for Babies & Toddlers in Child Care

ERIC Educational Resources Information Center

Lim, Teresa; Schumacher, Rachel

2009-01-01

State child care policies can promote the quality and continuity of early childhood experiences and foster the healthy growth and development of babies and toddlers in all child care settings, especially if they are informed by research. The quality of the relationship between children and those who care for them influences every aspect of young…

Immigrant Families and Child Care Subsidies: What Federal Law and Guidance Says

ERIC Educational Resources Information Center

Matthews, Hannah

2010-01-01

One in four young children in the United States lives in an immigrant family. Federal law establishes policies on immigrant eligibility for child care assistance, yet questions regarding eligibility remain at the state and local level. Most child care assistance is funded through the Child Care and Development Block Grant (CCDBG) and the Temporary…

Home Care Quality Indicators (HCQIS) Based on the MDS-HC

ERIC Educational Resources Information Center

Hirdes, John P.; Fries, Brant E.; Morris, John N.; Ikegami, Naoki; Zimmerman, David; Dalby, Dawn M.; Aliaga, Pablo; Hammer, Suzanne; Jones, Richard

2004-01-01

Purpose: This study aimed to develop home care quality indicators (HCQIs) to be used by a variety of audiences including consumers, agencies, regulators, and policy makers to support evidence-based decision making related to the quality of home care services. Design and Methods: Data from 3,041 Canadian and 11,252 U.S. home care clients assessed…

Developing a public health policy-research nexus: an evaluation of Nurse Practitioner models in aged care.

PubMed

Prosser, Brenton; Clark, Shannon; Davey, Rachel; Parker, Rhian

2013-10-01

A frustration often expressed by researchers and policy-makers in public health is an apparent mismatch between respective priorities and expectations for research. Academics bemoan an oversimplification of their work, a reticence for independent critique and the constant pressure to pursue evaluation funding. Meanwhile, policy-makers look for research reports written in plain language with clear application, which are attuned to current policy settings and produced quickly. In a context where there are calls in western nations for evidence based policy with stronger links to academic research, such a mismatch can present significant challenges to policy program evaluation. The purpose of this paper is to present one attempt to overcome these challenges. Specifically, the paper describes the development of a conceptual framework for a large-scale, multifaceted evaluation of an Australian Government health initiative to expand Nurse Practitioner models of practice in aged care service delivery. In doing so, the paper provides a brief review of key points for the facilitation of a strong research-policy nexus in public health evaluations, as well as describes how this particular evaluation embodies these key points. As such, the paper presents an evaluation approach which may be adopted and adapted by others undertaking public health policy program evaluations. Copyright © 2013 Elsevier Ltd. All rights reserved.

Transforming long-term care pain management in north america: the policy-clinical interface.

PubMed

Hadjistavropoulos, Thomas; Marchildon, Gregory P; Fine, Perry G; Herr, Keela; Palley, Howard A; Kaasalainen, Sharon; Béland, François

2009-04-01

The undertreatment of pain in older adults who reside in long-term care (LTC) facilities has been well documented, leading to clinical guideline development and professional educational programs designed to foster better pain assessment and management in this population. Despite these efforts, little improvement has occurred, and we postulate that focused attention to public policy and cost implications of systemic change is required to create positive pain-related outcomes. Our goal was to outline feasible and cost-effective clinical and public policy recommendations designed to address the undermanagement of pain in LTC facilities. We arranged a 2-day consensus meeting of prominent United States and Canadian pain and public policy experts. An initial document describing the problem of pain undermanagement in LTC was developed and circulated prior to the meeting. Participants were also asked to respond to a list of relevant questions before arriving. Following formal presentations of a variety of proposals and extensive discussion among clinicians and policy experts, a set of recommendations was developed. We outline key elements of a transformational model of pain management in LTC for the United States and Canada. Consistent with previously formulated clinical guidelines but with attention to readily implementable public policy change in both countries, this transformational model of LTC has important implications for LTC managers and policy makers as well as major quality of life implications for LTC residents.

New approaches to ambulatory care facilities in the United Kingdom--an investor developer's perspective.

PubMed

Eminson, C; Dawson, D

1999-01-01

The purpose of this article is to describe the strategic context within which ambulatory care facilities are being developed, to consider a range of models of care facilities available, and, by drawing on the experience of the authors, to comment on some of the investment and development issues arising from two projects in progress--the community hospitals in Richmond, Yorkshire, in rural north England, and Thames Ditton on the borders of outer south London. In the final section, we consider the possible future of ambulatory care development in the light of government policy.

Funding models in palliative care: Lessons from international experience.

PubMed

Groeneveld, E Iris; Cassel, J Brian; Bausewein, Claudia; Csikós, Ágnes; Krajnik, Malgorzata; Ryan, Karen; Haugen, Dagny Faksvåg; Eychmueller, Steffen; Gudat Keller, Heike; Allan, Simon; Hasselaar, Jeroen; García-Baquero Merino, Teresa; Swetenham, Kate; Piper, Kym; Fürst, Carl Johan; Murtagh, Fliss Em

2017-04-01

Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. To assess national models and methods for financing and reimbursing palliative care. Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest.

Ten years of integrated care: backwards and forwards. The case of the province of Québec, Canada

PubMed Central

Vedel, Isabelle; Monette, Michele; Beland, François; Monette, Johanne; Bergman, Howard

2011-01-01

Introduction Québec’s rapidly growing elderly and chronically ill population represents a major challenge to its healthcare delivery system, attributable in part to the system’s focus on acute care and fragmented delivery. Description of policy practice Over the past few years, reforms have been implemented at the provincial policy level to integrate hospital-based, nursing home, homecare and social services in 95 catchment areas. Recent organizational changes in primary care have also resulted in the implementation of family medicine groups and network clinics. Several localized initiatives were also developed to improve integration of care for older persons or persons with chronic diseases. Conclusion and discussion Québec has a history of integration of health and social services at the structural level. Recent evaluations of the current reform show that the care provided by various institutions in the healthcare system is becoming better integrated. The Québec health care system nevertheless continues to face three important challenges in its management of chronic diseases: implementing the reorganization of primary care, successfully integrating primary and secondary care at the clinical level, and developing effective governance and change management. Efforts should focus on strengthening primary care by implementing nurse practitioners, developing a shared information system, and achieving better collaboration between primary and secondary care. PMID:21677842

Accounting for charity care on a systemwide basis.

PubMed

Peck, T

1988-06-01

The Daughters of Charity National Health System (DCNHS), St. Louis, has developed a systemwide model which formally sets a policy statement, goals, and procedures that enable the 42 DCNHS health-care ministries to effectively serve the poor in their communities on a daily basis, while addressing the long-term challenges of providing charity care for the sick poor. One of the first steps was forming a task force known as the Working Group on Care of the Poor. Its goal was to set the stage for the expansion and accountability of charity care at every level within the new national system. The group outlined these objectives: To identify and recommend several advocacy models. To recommend test models of healthcare delivery for the poor. To recommend strategies for involving the private sector. To develop a method of documenting charity care. To recommend linkage models to jointly provide charity care with related organizations. To gain a firm knowledge of charity care actually provided by the Daughters of Charity After hours of discussions and research, the task force developed a cohesive, workable set of goals and policies that today is helping individual health-care ministries nationwide meet local needs for care of the sick poor. By identifying specific programs and determining how to report charity care in terms of money and services, individual health-care institutions gain insights into their annual operational planning and reporting for the present and the future. This approach ensures that charity care remains in the forefront at every level of planning.

A research agenda for bridging the 'quality chasm.'.

PubMed

Fernandopulle, Rushika; Ferris, Timothy; Epstein, Arnold; McNeil, Barbara; Newhouse, Joseph; Pisano, Gary; Blumenthal, David

2003-01-01

Realizing the vision of the IOM's landmark report, Crossing the Quality Chasm, will require new knowledge to support new policy and management. This paper lays out a research agenda that must be pursued if the health care system is to bridge the quality chasm. Based on a consensus process involving leading health care researchers and authorities, the paper highlights knowledge gaps and research directions in five areas identified by the Quality Chasm report as critical to its goals of building organizational supports for change; applying evidence to health care delivery; developing information technology; aligning payment policies with quality improvement; and preparing the workforce.

Community/hospital indicators in South African public sector mental health services.

PubMed

Lund, Crick; Flisher, Alan J

2003-12-01

The need to balance resources between community and hospital-based mental health services in the post-deinstitutionalisation era has been well-documented. However, few indicators have been developed to monitor the relationship between community and hospital services, in either developed or developing countries. There is a particular need for such indicators in the South African context, with its history of inequitable services based in custodial institutions under apartheid, and a new policy that proposes the development of more equitable community-based care. Indicators are needed to measure the distribution of resources and the relative utilisation of community and hospital-based services during the reform process. These indicators are potentially useful for assessing the implementation of policy objectives over time. To develop and document community/hospital indicators in public sector mental health services in South Africa. A questionnaire was distributed to provincial mental health coordinators requesting numbers of full-time equivalent (FTE) staff who provide mental health care at all service levels, annual patient admissions to hospitals and annual patient attendances at ambulatory care facilities. The information was supplemented by consultations with mental health coordinators in each of the 9 provinces. Population data were obtained from preliminary findings of the 1996 census. The community/hospital indicator measuring staff distribution was defined as the ratio of staff employed in community settings to all staff, expressed as a percentage. The community/hospital indicator measuring patient service utilisation was defined as the ratio of the annual ambulatory care attendance rate per 100,000 population to the sum of this rate and the annual hospital admission rate per 100,000 population, expressed as a percentage. Of psychiatric public sector staff, 25% are located in community settings in South Africa (provincial range: 11-70%). If hospital outpatient services are included in the definition of ' 'hospital' ', this figure is reduced to 17% (provincial range: 3-56%). In terms of service utilisation, 66% of patient contacts with mental health services occur through ambulatory care services in South Africa (provincial range: 44-93%). Community/hospital staff distribution indicates an overemphasis on centralised hospital-based care in most provinces and inadequate hospital care in certain provinces. Patterns of patient service utilisation indicate an over-reliance on central hospital-based services and substantial unmet need. The findings draw attention to problems in information systems for mental health care in South Africa. The community/hospital indicators developed for this study form a useful measure for assessing the implementation of mental health policy over time. For the South African context, the community/hospital indicators are a measure of the extent of resource redistribution from hospital to community services and changing patterns of service utilisation over time. Currently, patterns of resource distribution and service utilisation are inconsistent with government policy. Further research is needed into the development of mental health information systems, refining service indicators and improving methodologies for assessing the implementation of mental health policies in service delivery.

Developing organizational charity-care policies and procedures.

PubMed

Lefton, Ray B

2002-04-01

A lack of standards in healthcare organizations often makes it difficult to consistently define and report charity care. Accurately documenting services provided to patients who are unwilling or unable to pay can be difficult for many organizations. Temple East, Inc., Philadelphia, Pennsylvania, established several policies in an attempt to clarify its charity-care provisions. Among the organization's guiding principles were that all unreimbursed costs of caring for patients who are either uninsured or enrolled in a Medicaid program and all bad debt directly attributable to services to low-income or uninsured patients should be included as charity care. The organization also determined that contractual allowances and disallowances for payers other than government payers should not be included as charity care. Determining clear, unambiguous definitions for several terms related to charity care also helped the organization better track and document its charity-care services--a task that will become increasingly important for hospitals in the future.

End of Life Care Policy for the Dying: Consensus Position Statement of Indian Association of Palliative Care

PubMed Central

Macaden, Stanley C; Salins, Naveen; Muckaden, Maryann; Kulkarni, Priyadarshini; Joad, Anjum; Nirabhawane, Vivek; Simha, Srinagesh

2014-01-01

EXECUTIVE SUMMARY Purpose: To develop an End of Life Care (EOLC) Policy for patients who are dying with an advanced life limiting illness. To improve the quality of care of the dying by limiting unnecessary therapeutic medical interventions, providing access to trained palliative care providers, ensuring availability of essential medications for pain and symptom control and improving awareness of EOLC issues through education initiatives. Evidence: A review of Country reports, observational studies and key surveys demonstrates that EOLC in India is delivered ineffectively, with a majority of the Indian population dying with no access to palliative care at end of life and essential medications for pain and symptom control. Limited awareness of EOLC among public and health care providers, lack of EOLC education, absent EOLC policy and ambiguous legal standpoint are some of the major barriers in effective EOLC delivery. Recommendations: Access to receive good palliative and EOLC is a human right. All patients are entitled to a dignified death. Government of India (GOI) to take urgent steps towards a legislation supporting good EOLC, and all hospitals and health care institutions to have a working EOLC policyProviding a comprehensive care process that minimizes physical and non physical symptoms in the end of life phase and ensuring access to essential medications for pain and symptom controlPalliative care and EOLC to be part of all hospital and community/home based programsStandards of palliative and EOLC as established by appropriate authorities and Indian Association of Palliative Care (IAPC) met and standards accredited and monitored by national and international accreditation bodiesAll health care providers with direct patient contact are urged to undergo EOLC certification, and EOLC training should be incorporated into the curriculum of health care education. PMID:25191002

Using a Policy of "Gross National Happiness" to Guide the Development of Sustainable Early Learning Programs in the Kingdom of Bhutan: Aspirations and Challenges

ERIC Educational Resources Information Center

Ball, Jessica; Wangchuk, Karma Chimi

2015-01-01

A national study on demand for early childhood care and development programs in Bhutan found strong support for development of a new early childhood care and development (ECCD) sector. A wide range of stakeholders participating in the study, including ministries of education and health, post-secondary institutions, private preschool providers,…

Development and testing of an instrument to measure holistic nursing values in nurse practitioner care.

PubMed

Kinchen, Elizabeth

2015-01-01

As primary care delivery evolves in the United States with nurse practitioners (NPs) as key providers, exploring the patient's perception of the nature and quality of NPs' care is of critical importance to healthcare consumers, providers, educators, policy makers, and underwriters. The aim of this study was to describe the development and testing of the Nurse Practitioner Holistic Caring Instrument, a new, investigator-developed measure of the preservation of holistic nursing values in NP care. Results suggest that NPs provide patient-centered, comprehensive, and clinically competent care, rendering them ideally suited to leading primary health care delivery. However, further testing in more diverse populations and settings is needed to strengthen preliminary findings.

The International Association for Hospice and Palliative Care: Advancing Hospice and Palliative Care Worldwide.

PubMed

De Lima, Liliana; Radbruch, Lukas

2018-02-01

The International Association for Hospice and Palliative Care (IAHPC) is a membership-based organization dedicated to the development and improvement of hospice and palliative care worldwide. The mission of IAHPC is to improve the quality of life of adults and children with life-threatening conditions and their families. The vision of IAHPC is universal access to high-quality palliative care, integrated into all levels of health care systems in a continuum of care with disease prevention, early diagnosis, and treatment, to assure that any patient's or family caregiver's suffering is relieved to the greatest extent possible. IAHPC focuses on the advancement of four areas of palliative care: education, access to medicines, health policies, and service implementation. IAHPC works on three levels: at the grass roots, developing resources, and educational strategies that enable health workers to provide cost-effective palliative care; at the national level, working with government representatives to improve national policies to ensure adequate care and access to medicines; and at the international level, advocating with the UN organizations to ensure that access to palliative care and to essential medicines for palliative care and pain treatment is stipulated and incorporated as an obligation of member states. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Women's maternity care needs and related service models in rural areas: A comprehensive systematic review of qualitative evidence.

PubMed

Hoang, Ha; Le, Quynh; Ogden, Kathryn

2014-12-01

Understanding the needs of rural women in maternity care and service models available to them is significant for the development of effective policies and the sustainability of rural communities. Nevertheless, no systematic review of studies addressing these needs has been conducted. To synthesise the best available evidence on the experiences of women's needs in maternity care and existing service models in rural areas. Literature search of ten electronic databases, digital theses, and reference lists of relevant studies applying inclusion/exclusion criteria was conducted. Selected papers were assessed using standardised critical appraisal instruments from JBI-QARI. Data extracted from these studies were synthesised using thematic synthesis. 12 studies met the inclusion criteria. There were three main themes and several sub-themes identified. A comprehensive set of the maternity care expectations of rural women was reported in this review including safety (7), continuity of care (6) and quality of care (6), and informed choices needs (4). In addition, challenges in accessing maternity services also emerged from the literature such as access (6), risk of travelling (9) and associated cost of travel (9). Four models of maternity care examined in the literature were medically led care (5), GP-led care (4), midwifery-led care (7) and home birth (6). The systematic review demonstrates the importance of including well-conducted qualitative studies in informing the development of evidence-based policies to address women's maternity care needs and inform service models. Synthesising the findings from qualitative studies offers important insight for informing effective public health policy. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Pennsylvania: Penn State University Integrated Pest Management Project (A Former EPA CARE Project)

EPA Pesticide Factsheets

Penn State University (PSU) is the recipient of a Level II CARE cooperative agreement targeting environmental risks in Philadelphia communities. PSU is involved in developing IPM management practices recommendations and policies.

[Nursing care priorities and problems: the nurses point of view].

PubMed

Piccoli, Michele; Di Giulio, Paola; Ruffino, Emanuele; Zollesi, Germana; Dello Russo, Carolina

2006-01-01

An experience of a tentative contribution of the nurses to the health policy planning is described. Fifty one focus groups were organized, with nurses from different contexts (hospital, district, free lance nurses; caring for paediatric, geriatric surgical and medical patients) and nurses were asked to identify problems encountered in patients care, select one, discuss contributing causes assign a weight (from 1 to 100) and define the nurses' contribution to the resolution/improvement of each cause. The problems were discussed in groups and possible solutions identified, with specific attention to the potential implications of regional health policies. The main difficulties identified were the lack of continuity in patients care (for geriatric and paediatrics patients), 12 groups, and the management of chronic patients (7 groups); the lack of information to patients, 6 groups; the appropriateness of care, from hospital admissions to waiting lists, 5 groups; the management of surgical patients, 5 groups; the lack of nursing personnel, 5 groups; the safety of patients and health personnel, 4 groups; and other problems reported by less than 3 groups. This experience allowed nurses to reflect on health care problems throughout the trajectory from the specific problem to its general implications, also for the health care policies. The solutions identified in fact, encompass a dimension relevant for health policy planning. It is also an experience of opportunity (and feasibility) of involvement of the "general nurses" and not only nurse managers, to reflect on practice and propose a specific and original contribution to the development of regional and local policies.

Report of the Northern California Conference for Guidelines on Aid-in-Dying: definitions, differences, convergences, conclusions.

PubMed Central

Young, E W; Marcus, F S; Drought, T; Mendiola, M; Ciesielski-Carlucci, C; Alpers, A; Eaton, M; Koenig, B A; Loewy, E; Raffin, T A; Ross, C

1997-01-01

In September 1996, the Stanford University Center for Biomedical Ethics convened a conference entitled "Comprehensive Care of the Terminally Ill: The Northern California Consensus Development Conference for Guidelines on Aid-in-Dying." The regionally based, multidisciplinary conference gathered people from a variety of disciplines and diverse perspectives on physician aid-in-dying. This report documents important points of convergence, disagreement, and uncertainty that emerged from the conference and provides commentary on crucial issues: the definition of terminal illness, ensuring adequate palliative care, psychiatric challenges, coping with family pressures, the doctor-patient relationship, the managed care context, the role of ethics committees, and institutional challenges. Should physician aid-in-dying become a legal practice in California, the report will provide guidance to health care organizations, health professionals, and public policy officials engaged in local or state guideline or policy development. PMID:9217449

Leadership in Surgery for Public Sector Hospitals in Jamaica: Strategies for the Operating Room

PubMed Central

Cawich, Shamir O; Harding, Hyacinth E; Crandon, Ivor W; McGaw, Clarence D; Barnett, Alan T; Tennant, Ingrid; Evans, Necia R; Martin, Allie C; Simpson, Lindberg K; Johnson, Peter

2013-01-01

The barriers to health care delivery in developing nations are many: underfunding, limited support services, scarce resources, suboptimal health care worker attitudes, and deficient health care policies are some of the challenges. The literature contains little information about health care leadership in developing nations. This discursive paper examines the impact of leadership on the delivery of operating room (OR) services in public sector hospitals in Jamaica. Delivery of OR services in Jamaica is hindered by many unique cultural, financial, political, and environmental barriers. We identify six leadership goals adapted to this environment to achieve change. Effective leadership must adapt to the environment. Delivery of OR services in Jamaica may be improved by addressing leadership training, workplace safety, interpersonal communication, and work environment and by revising existing policies. Additionally, there should be regular practice audits and quality control surveys. PMID:24355903

Older parents enjoy better filial piety and care from daughters than sons in China

PubMed Central

Yi, Zeng; George, Linda; Sereny, Melanie; Gu, Danan; Vaupel, James W.

2016-01-01

This study analyzes the unique datasets of the Chinese Longitudinal Healthy Longevity Survey using logistic regression and controlling for various covariates. Our analyses clearly demonstrate that disabled older parents are more satisfied with care provided by daughters than sons and that older parents enjoy greater filial piety from and better relationships with daughters than sons. The daughter-advantages of enjoying greater filial piety from and better relationships with children are stronger among the oldest-old aged 80+ than the young-old aged 65–79, and surprisingly more profound in rural areas than urban areas, while son-preference is much more prevalent among rural residents. We also discuss why China’s rigorous fertility policy until October-2015 and much less-developed pension system in rural areas substantially contribute to sustaining traditional son-preference and a high sex ratio at birth (SRB) when fertility is low. We recommend China take integrative public health policy actions of informing the public that having daughter(s) is beneficial for old age care, developing the rural pension system and implementing the universal two-child policy as soon as possible. We believe that these policy actions would help to reduce son-preference, bring down the high SRB, and enable more future elderly parents to enjoy better care from their children and healthier lives. PMID:28529965

Losing an only child: the one-child policy and elderly care in China.

PubMed

Song, Yu

2014-05-01

China has had the one-child policy for more than 30 years. It reduced China's population growth within a short period of time and promoted economic development. However, it has also led to difficulties, and this paper focuses on those which pertain to ageing and losing one's only child. Approximately one million families have lost their only child in China. They suffer mentally and physically, and sometimes face social stigma and economic loss. What worries them most, however, is elderly care, which has become a severe crisis for the families who have lost their only children. This article draws upon several qualitative studies and 12 cases reported by the Chinese media in 2012 and 2013, and existing laws and policies for supporting those who have lost only children. It also analyses the current elderly care situation facing these families. The Chinese government has recognized the predicament and provides some help, which is increasing but is still not always adequate. To both sustain China's economic development and limit population growth, it is essential for the government to reform the one-child policy and provide a comprehensive support system for the families who have lost their only children, including financial relief and elderly care, and work to reduce stigma against these families. Copyright © 2014 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Learning from the implementation of inter-organisational web-based care planning and coordination.

PubMed

Walker, Rae; Blacker, Vivian; Pandita, Linda; Close, Jacky; Mason, Wendy; Watson, Julie

2013-01-01

In Victoria, despite strong policy support, e-care planning and coordination is poorly developed. The action research project discussed here was developed to overcome organisational and worker-level barriers to change. The project outcomes highlighted the need for work on the building blocks of e-care coordination that enhance workers' knowledge and skills, and provide permission and support for appropriate collaborative system and services coordination practices.

Ensuring quality: a key consideration in scaling-up HIV-related point-of-care testing programs

PubMed Central

Fonjungo, Peter N.; Osmanov, Saladin; Kuritsky, Joel; Ndihokubwayo, Jean Bosco; Bachanas, Pam; Peeling, Rosanna W.; Timperi, Ralph; Fine, Glenn; Stevens, Wendy; Habiyambere, Vincent; Nkengasong, John N.

2016-01-01

Objective: The objective of the WHO/US President's Emergency Plan for AIDS Relief consultation was to discuss innovative strategies, offer guidance, and develop a comprehensive policy framework for implementing quality-assured HIV-related point-of-care testing (POCT). Methods: The consultation was attended by representatives from international agencies (WHO, UNICEF, UNITAID, Clinton Health Access Initiative), United States Agency for International Development, Centers for Disease Control and Prevention/President's Emergency Plan for AIDS Relief Cooperative Agreement Partners, and experts from more than 25 countries, including policy makers, clinicians, laboratory experts, and program implementers. Main outcomes: There was strong consensus among all participants that ensuring access to quality of POCT represents one of the key challenges for the success of HIV prevention, treatment, and care programs. The following four strategies were recommended: implement a newly proposed concept of a sustainable quality assurance cycle that includes careful planning; definition of goals and targets; timely implementation; continuous monitoring; improvements and adjustments, where necessary; and a detailed evaluation; the importance of supporting a cadre of workers [e.g. volunteer quality corps (Q-Corps)] with the role to ensure that the quality assurance cycle is followed and sustained; implementation of the new strategy should be seen as a step-wise process, supported by development of appropriate policies and tools; and joint partnership under the leadership of the ministries of health to ensure sustainability of implementing novel approaches. Conclusion: The outcomes of this consultation have been well received by program implementers in the field. The recommendations also laid the groundwork for developing key policy and quality documents for the implementation of HIV-related POCT. PMID:26807969

Ethical environment: reports of practicing nurses.

PubMed

McDaniel, C

1998-06-01

Reports from the development of the Ethics Environment Questionnaire identify three critical features for ethical environments in health care settings of registered nurses. They are the ability of nurses to engage in discussions about patient care, support from administrators, and the development of policies-procedures that support their practice. Implications for clinical practicing nurses are explored.

Perspectives of policy-makers and stakeholders about health care waste management in community-based care in South Africa: a qualitative study.

PubMed

Hangulu, Lydia; Akintola, Olagoke

2017-04-19

In South Africa, a new primary health care (PHC) re-engineering initiative aims to scale up the provision of community-based care (CBC). A central element in this initiative is the use of outreach teams comprising nurses and community health workers to provide care to the largely poor and marginalised communities across the country. The provision of care will inevitably lead to an increase in the amount of health care waste (HCW) generated in homes and suggests the need to pay more attention to the HCW that emanates from homes where there is care of a patient. CBC in South Africa is guided by the home-based care policy. However, this policy does not deal with issues about how HCW should be managed in CBC. This study sought to explore health care waste management (HCWM) in CBC in South Africa from the policy-makers' and stakeholders' perspective. Semi-structured interviews were conducted with 9 policy-makers and 21 stakeholders working in 29 communities in Durban, South Africa. Interviews were conducted in English; were guided by an interview guide with open-ended questions. Data was analysed thematically. The Durban Solid waste (DSW) unit of the eThekwini municipality is responsible for overseeing all waste management programmes in communities. Lack of segregation of waste and illegal dumping of waste were the main barriers to proper management practices of HCW at household level while at the municipal level, corrupt tender processes and inadequate funding for waste management programmes were identified as the main barriers. In order to address these issues, all the policy-makers and stakeholders have taken steps to collaborate and develop education awareness programmes. They also liaise with various government offices to provide resources aimed at waste management programmes. HCW is generated in CBC and it is poorly managed and treated as domestic waste. With the rollout of the new primary health care model, there is a greater need to consider HCWM in CBC. There is need for the Department of Health to work together with the municipality to ensure that they devise measures that will help to deal with improper HCWM in the communities.

Participation in the Child and Adult Care Food Program Is Associated with Healthier Nutrition Environments at Family Child Care Homes in Mississippi.

PubMed

Erinosho, Temitope; Vaughn, Amber; Hales, Derek; Mazzucca, Stephanie; Gizlice, Ziya; Ward, Dianne

2018-05-01

Describe foods and beverages offered, nutrition practices, and nutrition policies of family child care homes in Mississippi and differences by participation in the Child and Adult Care Food Program (CACFP). Cross-sectional study conducted between fall, 2015 and spring, 2016. Mississippi. Random, stratified sample of 134 family child care homes that enroll 3- to 5-year-olds. Providers completed a modified version of the Environment and Policy Assessment and Observation-self-report tool. Foods and beverages offered at lunch, provider practices regarding nutrition, and presence or absence of written nutrition policies. Descriptive statistics, likelihood ratio chi-square, and t tests. Most homes (>75%) provided components from the fruit, vegetable, grain/bread, meat/meat alternative, and milk food groups at lunch. At some homes, the food and beverage selections offered were high in fat, sugar, and refined grains. Providers at CACFP-participating homes (P < .05) reported healthier beverage selections, more healthful nutrition practices, and more written nutrition policies compared with providers at non-CACFP homes. Interventions and regulatory standards are needed, particularly in non-CACFP homes, to ensure that food and beverage offerings, provider practices, and policies regarding nutrition support the development of healthful dietary behaviors in early childhood. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Barriers encountered during the implementation of a policy guideline on the vaccination of health care workers during the 2013-2014 measles outbreak in the Netherlands: a qualitative study.

PubMed

Borggreve, Stephanie Jessica; Timen, Aura

2015-12-14

In 2013 the Netherlands faced a measles epidemic, during which more than 2600 individuals were infected, including 19 health care workers (HCW). Vaccinating health care workers can lead to benefits on both the individual and public health level, underscoring the need for HCW vaccination. In June of 2013 the Dutch National Institute for Public Health and the Environment (RIVM) developed a measles guideline (MG) that advised Dutch hospitals to strengthen their policies concerning measles vaccination of HCWs. A key problem with guidelines, however, is adherence, which can be due to several barriers. The objective of this research was to identify the barriers that Dutch hospital professionals encountered during the implementation of this policy guideline, in order to improve the implementation of similar policies in the future. In-depth interviews (n = 9) were conducted with 12 hospital health care professionals involved with prevention and control of communicable diseases. These participants represented ten different Dutch hospitals located in eight of the twelve different provinces. Participants were asked about their experiences during the 2013-2014 measles epidemic regarding infection prevention measures, including vaccination of HCWs, with a specific focus on barriers to the implementation of the RIVM guideline. The implementation of the MG was impeded by several (types of) barriers. First, barriers were found related to knowledge and attitude, and included lack of agreement, barriers associated with leadership and issues related to evidence-based decision making. Second, barriers related to characteristics of the guideline, mostly related to unclear or missing guideline content. Finally, contextual and social factors such as human and financial resources, belief systems, physical facilities and technical support, and national views on vaccination policies also play an important role in policy implementation. This study has provided valuable insights into the barriers infection prevention specialists encounter during the implementation of new policies concerning vaccination of HCWs in times of a major outbreak. Moreover, this study exposed the complexity and breadth of barriers that are of importance when implementing vaccination policies in the hospital setting. In order to improve the implementation of similar policies in the future, guideline developers and health care providers and administrators alike should aim to eliminate or minimise these identified barriers by taking into account the suggestions made by the authors.

[Shared decision-making in mental health care: a role model from youth mental health care].

PubMed

Westermann, G M A; Maurer, J M G

2015-01-01

In the communication and interaction between doctor and patient in Western health care there has been a paradigm shift from the paternalistic approach to shared decision-making. To summarise the background situation, recent developments and the current level of shared decision-making in (youth) mental health care. We conducted a critical review of the literature relating to the methodology development, research and the use of counselling and decision-making in mental health care. The majority of patients, professionals and other stakeholders consider shared decision-making to be desirable and important for improving the quality and efficiency of care. Up till recently most research and studies have concentrated on helping patients to develop decision-making skills and on showing patients how and where to access information. At the moment more attention is being given to the development of skills and circumstances that will increase patients' interaction with care professionals and patients' emotional involvement in shared decision-making. In mental health for children and adolescents, more often than in adult mental health care, it has been customary to give more attention to these aspects of shared decision-making, particularly during counselling sessions that mark the transition from diagnosis to treatment. This emphasis has been apparent for a long time in textbooks, daily practice, methodology development and research in youth mental health care. Currently, a number of similar developments are taking place in adult mental health care. Although most health professionals support the policy of shared decision-making, the implementation of the policy in mental health care is still at an early stage. In practice, a number of obstacles still have to be surmounted. However, the experience gained with counselling and decision-making in (youth) mental health care may serve as an example to other sections of mental health care and play an important role in the further development of shared decision-making.

The medical home and integrated behavioral health: advancing the policy agenda.

PubMed

Ader, Jeremy; Stille, Christopher J; Keller, David; Miller, Benjamin F; Barr, Michael S; Perrin, James M

2015-05-01

There has been a considerable expansion of the patient-centered medical home model of primary care delivery, in an effort to reduce health care costs and to improve patient experience and population health. To attain these goals, it is essential to integrate behavioral health services into the patient-centered medical home, because behavioral health problems often first present in the primary care setting, and they significantly affect physical health. At the 2013 Patient-Centered Medical Home Research Conference, an expert workgroup convened to determine policy recommendations to promote the integration of primary care and behavioral health. In this article we present these recommendations: Build demonstration projects to test existing approaches of integration, develop interdisciplinary training programs to support members of the integrated care team, implement population-based strategies to improve behavioral health, eliminate behavioral health carve-outs and test innovative payment models, and develop population-based measures to evaluate integration. Copyright © 2015 by the American Academy of Pediatrics.

Health Care Reform and Concurrent Curative Care for Terminally Ill Children: A Policy Analysis

PubMed Central

Lindley, Lisa C.

2012-01-01

Within the Patient Protection and Affordable Care Act of 2010 or health care reform, is a relatively small provision about concurrent curative care that significantly affects terminally ill children. Effective on March 23, 2010, terminally ill children, who are enrolled in a Medicaid or state Children’s Health Insurance Plans (CHIP) hospice benefit, may concurrently receive curative care related to their terminal health condition. The purpose of this article was to conduct a policy analysis of the concurrent curative care legislation by examining the intended goals of the policy to improve access to care and enhance quality of end of life care for terminally ill children. In addition, the policy analysis explored the political feasibility of implementing concurrent curative care at the state-level. Based on this policy analysis, the federal policy of concurrent curative care for children would generally achieve its intended goals. However, important policy omissions focus attention on the need for further federal end of life care legislation for children. These findings have implications nurses. PMID:22822304

Expanding Early Childhood Care and Education: How Much Does It Cost? A Proposal for a Methodology to Estimate the Costs of Early Childhood Care and Education at Macro-Level, Applied to Arab States. Working Papers in Early Childhood Development, No. 46

ERIC Educational Resources Information Center

van Ravens, Jan; Aggio, Carlos

2008-01-01

While the critical importance of early childhood care and education (ECCE) is undisputed, few developing countries are presently pursuing strong national policies to expand it. Thus, Goal One of the Education for All (EFA) agenda--"Expanding and improving comprehensive early childhood care and education, especially for the most vulnerable and…

Primary care in an unstable security, humanitarian, economic and political context: the Kurdistan Region of Iraq.

PubMed

Shukor, Ali R; Klazinga, Niek S; Kringos, Dionne S

2017-08-23

This study presents a descriptive synthesis of Kurdistan Region of Iraq's (KRI) primary care system, which is undergoing comprehensive primary care reforms within the context of a cross-cutting structural economic adjustment program and protracted security, humanitarian, economic and political crises. The descriptive analysis used a framework operationalizing Starfield's classic primary care model for health services research. A scoping review was performed using relevant sources, and expert consultations were conducted for completing and validating data. The descriptive analysis presents a complex narrative of a primary care system undergoing classical developmental processes of transitioning middle-income countries. The system is simultaneously under tremendous pressure to adapt to the continuously changing, complex and resource-intensive needs of sub-populations exhibiting varying morbidity patterns, within the context of protracted security, humanitarian, economic, and political crises. Despite exhibiting significant resilience in the face of the ongoing crises, the continued influx of IDPs and Syrian refugees, coupled with extremely limited resources and weak governance at policy, organizational and clinical levels threaten the sustainability of KRI's public primary care system. Diverse trajectories to the strengthening and development of primary care are underway by local and international actors, notably the World Bank, RAND Corporation, UN organizations and USAID, focusing on varying imperatives related to the protracted humanitarian and economic crises. The convergence, interaction and outcomes of the diverse initiatives and policy approaches in relation to the development of KRI's primary care system are complex and highly uncertain. A common vision of primary care is required to align resources, initiatives and policies, and to enable synergy between all local and international actors involved in the developmental and humanitarian response. Further research that integrates the knowledge synthesized in this article, and enables actors in KRI to learn from their own experiences and efforts, along with those of other jurisdictions, would be invaluable towards the ongoing development of primary care.

Defining Advance Care Planning for Adults: A Consensus Definition from a Multidisciplinary Delphi Panel

PubMed Central

Sudore, Rebecca L.; Lum, Hillary D.; You, John J.; Hanson, Laura C.; Meier, Diane E.; Pantilat, Steven Z.; Matlock, Daniel D.; Rietjens, Judith A. C.; Korfage, Ida J.; Ritchie, Christine S.; Kutner, Jean S.; Teno, Joan M.; Thomas, Judy; McMahan, Ryan D.; Heyland, Daren K.

2017-01-01

Background Despite increasing interest in advance care planning (ACP) and prior ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives. Objective To develop a consensus definition of ACP for adults. Design Delphi Panel Setting/Participants Participants included a multidisciplinary panel of international ACP experts consisting of 52 clinicians, researchers, and policy leaders from 4 countries, and a patient/surrogate advisory committee. Measurements We conducted 10 rounds of a modified Delphi method and qualitatively analyzed panelists’ input. Panelists identified several themes lacking consensus, and iteratively discussed and developed a final consensus definition. Results Panelists identified several tensions concerning ACP concepts such as whether the definition should focus on conversations vs. written advance directives; patients’ values vs. treatment preferences; current shared decision making vs. future medical decisions; and who should be included in the process. The panel achieved a final consensus one-sentence definition and accompanying goals statement: “Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.” The panel also described strategies to best support adults in ACP. Conclusions A multidisciplinary Delphi panel developed a consensus definition for ACP for adults that can be used to inform implementation and measurement of ACP clinical, research, and policy initiatives. PMID:28062339

Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel.

PubMed

Sudore, Rebecca L; Lum, Hillary D; You, John J; Hanson, Laura C; Meier, Diane E; Pantilat, Steven Z; Matlock, Daniel D; Rietjens, Judith A C; Korfage, Ida J; Ritchie, Christine S; Kutner, Jean S; Teno, Joan M; Thomas, Judy; McMahan, Ryan D; Heyland, Daren K

2017-05-01

Despite increasing interest in advance care planning (ACP) and previous ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives. The aim of this study was to develop a consensus definition of ACP for adults. We convened a Delphi panel of multidisciplinary, international ACP experts consisting of 52 clinicians, researchers, and policy leaders from four countries and a patient/surrogate advisory committee. We conducted 10 rounds using a modified Delphi method and qualitatively analyzed panelists' input. Panelists identified several themes lacking consensus and iteratively discussed and developed a final consensus definition. Panelists identified several tensions concerning ACP concepts such as whether the definition should focus on conversations vs. written advance directives; patients' values vs. treatment preferences; current shared decision making vs. future medical decisions; and who should be included in the process. The panel achieved a final consensus one-sentence definition and accompanying goals statement: "Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness." The panel also described strategies to best support adults in ACP. A multidisciplinary Delphi panel developed a consensus definition for ACP for adults that can be used to inform implementation and measurement of ACP clinical, research, and policy initiatives. Published by Elsevier Inc.

Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis.

PubMed

Mc Hugh, Sheena M; Perry, Ivan J; Bradley, Colin; Brugha, Ruairí

2014-09-18

In 2006, the Health Service Executive (HSE) in Ireland established an Expert Advisory Group (EAG) for Diabetes, to act as its main source of operational policy and strategic advice for this chronic condition. The process was heralded as the starting point for the development of formal chronic disease management programmes. Although recommendations were published in 2008, implementation did not proceed as expected. Our aim was to examine the development of recommendations by the EAG as an instrumental case study of the policy formulation process, in the context of a health system undergoing organisational and financial upheaval. This study uses Kingdon's Multiple Streams Theory to examine the evolution of the EAG recommendations. Semi-structured interviews were conducted with a purposive sample of 15 stakeholders from the advisory group. Interview data were supplemented with documentary analysis of published and unpublished documents. Thematic analysis was guided by the propositions of the Kingdon model. In the problem stream, the prioritisation of diabetes within the policy arena was a gradual process resulting from an accumulation of evidence, international comparison, and experience. The policy stream was bolstered by group consensus rather than complete agreement on the best way to manage the condition. The EAG assumed the politics stream was also on course to converge with the other streams, as the group was established by the HSE, which had the remit for policy implementation. However, the politics stream did not converge due to waning support from health service management and changes to the organisational structure and financial capacity of the health system. These changes trumped the EAG process and the policy window remained closed, stalling implementation. Our results reflect the dynamic nature of the policy process and the importance of timing. The results highlight the limits of rational policy making in the face of organisational and fiscal upheaval. Diabetes care is coming on to the agenda again in Ireland under the National Clinical Care Programme. This may represent the opening of a new policy window for diabetes services, the challenge will be maintaining momentum and interest in the absence of dedicated resources.

Progress in palliative care in Israel: comparative mapping and next steps

PubMed Central

2012-01-01

Palliative care was established rapidly in some countries, while in other countries its establishment has taken a different trajectory. This paper identifies core steps in developing a medical specialty and examines those taken by Israel as compared with the US and England for palliative care. It considers the next steps Israel may take. Palliative care aims to provide quality of life for those with serious illnesses by attending to the illness-prompted physical, mental, social, and spiritual needs of patients and their families. It has ancient roots in medicine; its modern iteration began against the backdrop of new cures and life-sustaining technology which challenged conceptions of how to respect the sanctity of life. The first modern hospice was created by Saunders; it provided proof that palliative care works, and this has occurred in Israel as well (the first step). Another key step is usually skills development among clinicians; in Israel, few education and training opportunities exist so far. Specialty recognition also has not yet occurred in Israel. Service development remains limited and a major shortage of services exists, compared to the US. Research capacity in Israel is also limited. Policy to develop and sustain palliative care in Israel is underway; in 2009, the Ministry of Health established policy for implementing palliative care. However, it still lacks a financially viable infrastructure. We conclude that palliative care in Israel is emerging but has far to go. Adequate resource allocation, educational guidelines, credentialed manpower and specialty leadership are the key factors that palliative care development in Israel needs. PMID:22913773

Assessing state efforts to meet baby boomers' long-term care needs: a case study in compensatory federalism.

PubMed

Pandey, Sanjay K

2002-01-01

The role of the state government and the character of federal-state relations in social policy have evolved considerably. Frank Thompson uses the phrase compensatory federalism to describe increased activity by state governments to make up for a diminished federal role. For compensatory federalism to work, it is essential for states to take leadership roles in key policy areas. Few studies examine whether states have risen to the challenge of compensatory federalism in social policy. This paper examines an emerging issue of great significance in social policy-challenges involved in meeting future long-term care needs for the baby boomer generation. The paper provides an in-depth case study of attempts by Maryland to meet the challenges of financing long-term care needs for the baby boomer generation. The detailed description of the agenda-setting and problem-structuring process in Maryland is followed by an analysis that uses three different frameworks to assess the policy development processes. These models are rooted in a bureaucratic politics perspective, an agenda-setting perspective and an interest group politics perspective. The paper concludes with a discussion of the limitations and possibilities of state leadership in the social policy sphere.

[Regionalization of perinatal health care in the province of Santa Fe, Argentina].

PubMed

Simioni, Alberto Tomás; Llanos, Oraldo; Romero, Mariana; Ramos, Silvina; Brizuela, Vanessa; Abalos, Edgardo

2017-05-25

Improve the performance of the regionalization policy in the province of Santa Fe, Argentina, as a strategy to improve perinatal health care by analyzing implementation processes and building consensus among decision makers and stakeholders around an action plan. Implementation research was conducted using mixed methodology. A needs assessment established tracer indicators to measure adherence to the components of the policy. Actors were studied to identify the barriers and facilitators of implementation. Training was provided on the development of consensus- and evidence-based policies, through workshops in which policy briefs were prepared and through a deliberative dialogue. There were improvements in the number of births in appropriate hospitals and in the number of births in maternity hospitals with Essential Obstetric and Neonatal Care (CONE). Barriers were identified in the referral systems and in communication on policy, which resulted in an initial agreement on the need for guidelines and specific technical training on the transfer of babies and mothers. The participation of health workers in identifying barriers and strategies to overcome them, and the use of tools to report this to management, permit the adoption of consensus- and evidence-based strategies to improve policy implementation.

Understanding public elderly care policy in Norway: A narrative analysis of governmental White papers.

PubMed

Jacobsen, Frode F

2015-08-01

How the general public in Norway conceives being an older adult and the meaning of chronological age has changed over the last few decades. As narratives of aging may be identified in the Norwegian mass media and in the population at large, dominant narratives may also be identified in policy documents, such as government health policy papers. This article explores a narrative analytical framework based on stories, subtexts, and counterstories; it argues that such narratives are characterized as much by what is unsaid as by what is said, and as much by choice of words and word combinations as by explicit messages. Culture strongly influences the conception of a likely future (what will be) and an envisioned future (what ought to be) regarding aging and geriatric care in Norway, as expressed in the public policy papers. The public policy story is discussed as both a story continuously developing, where later health policy papers relate to and comment on earlier documents, and as a story characterized by a measure of cultural incoherence. Some recent government documents dealing with professional geriatric care will serve as material for a narrative analysis. Copyright © 2015 Elsevier Inc. All rights reserved.

Developing inclusive partnerships: user-defined outcomes, networking and knowledge--a case study.

PubMed

Beresford, Peter; Branfield, Fran

2006-09-01

Two major developments have been associated with the reorientation of United Kingdom health and social care policy and provision in recent years, placing a new emphasis on: quality and 'outcome' measures; and service user (and public and patient) involvement. These issues have become central to health and social care, representing expressions of the shift in political and ideological interest in public policy. However, these two strands of development have tended to be treated as discrete discourses and have developed separately in policy. Nevertheless, it can hardly be assumed that what policy makers, service planners, providers and purchasers would value and prioritise as good quality would necessarily coincide with what service users would want. Developing effective partnership working needs to go beyond considerations of organisations and professional groupings, and fully involve service users as one of the key stakeholders. This paper describes the findings of three projects undertaken by Shaping Our Lives. These studies confirmed that service-user concepts of outcomes and quality may differ significantly from those currently employed; moreover, service users are able to offer a complex and sophisticated model of what outcome measures might look like if they were centrally involved in their definition and application. Nevertheless, service users currently have little impact in defining and influencing quality outcomes. The projects also highlight the importance of networking and knowledge sharing for service users and user organisations in their ability to influence policy definitions of quality, and a number of the barriers and obstacles which undermine this process. The paper concludes with two proposals which, considered together, offer the basis for taking forward effective and inclusive partnerships and developing measures for quality consistent with the rights and preferences of service users themselves. They are an essential complement to broader efforts and strategies to develop effective partnerships in health and social care.

Public humanization policies: integrative literature review.

PubMed

Moreira, Márcia Adriana Dias Meirelles; Lustosa, Abdon Moreira; Dutra, Fernando; Barros, Eveline de Oliveira; Batista, Jaqueline Brito Vidal; Duarte, Marcella Costa Souto

2015-10-01

The study aimed to investigate the scientific literature on Public Humanization Policies, available in online periodicals, from 2009 to 2012, in the health field. This is an integrative literature review conducted in the Virtual Health Library databases: Latin-America and Caribbean Health Sciences (Lilacs) and the Scientific Electronic Library Online (SciELO) and Portal Capes. Data were collected in July 2013. To this end, the following Health Sciences Descriptors (DeCS) were used: "Humanization of Care," "Public Policies," "National Humanization Policy". The sample consisted of 27 articles about the investigated theme. From the publications selected for the research, three categories emerged according to their respective approaches: National Human-ization Policy: history and processes involved in its implementation; National Humanization Policy: health professionals contribution; Humanization and in the care process. The study showed that the National Humanization Policy is an important benchmark in the development of health practices. For this reason, there is a pressing multiplication of related reflections on ways to promote human-ization in health services.

The Medicare Policy of Payment Adjustment for Health Care-Associated Infections: Perspectives on Potential Unintended Consequences

PubMed Central

Hartmann, Christine W.; Hoff, Timothy; Palmer, Jennifer A.; Wroe, Peter; Dutta-Linn, M. Maya; Lee, Grace

2014-01-01

In 2008, the Centers for Medicare & Medicaid Services introduced a new policy to adjust payment to hospitals for health care-associated infections (HAIs) not present on admission. Interviews with 36 hospital infection preventionists across the United States explored the perspectives of these key stakeholders on the potential unintended consequences of the current policy. Responses were analyzed using an iterative coding process where themes were developed from the data. Participants’ descriptions of unintended impacts of the policy centered around three themes. Results suggest the policy has focused more attention on targeted HAIs and has affected hospital staff; relatively fewer systems changes have ensued. Some consequences of the policy, such as infection preventionists having less time to devote to HAIs other than those in the policy or having less time to implement prevention activities, may have undesirable effects on HAI rates if hospitals do not recognize and react to potential time and resource gaps. PMID:21810797

The State of Transgender Health Care: Policy, Law, and Medical Frameworks

PubMed Central

2014-01-01

I review the current status of transgender people’s access to health care in the United States and analyze federal policies regarding health care services for transgender people and the limitations thereof. I suggest a preliminary outline to enhance health care services and recommend the formulation of explicit federal policies regarding the provision of health care services to transgender people in accordance with recently issued medical care guidelines, allocation of research funding, education of health care workers, and implementation of existing nondiscrimination policies. Current policies denying medical coverage for sex reassignment surgery contradict standards of medical care and must be amended. PMID:24432926

Next steps for federal child care policy.

PubMed

Greenberg, Mark

2007-01-01

In Mark Greenberg's view, a national child care strategy should pursue four goals. Every parent who needs child care to get or keep work should be able to afford care without having to leave children in unhealthy or dangerous environments; all families should be able to place their children in settings that foster education and healthy development; parental choice should be respected; and a set of good choices should be available. Attaining these goals, says Greenberg, requires revamping both federal child care subsidy programs and federal tax policy related to child care. Today subsidies are principally provided through a block grant structure in which states must restrict eligibility, access, or the extent of assistance because both federal and state funds are limited. Tax policy principally involves a modest nonrefundable credit that provides little or no assistance to poor and low-income families. Greenberg would replace the block grant with a federal guarantee of assistance for all families with incomes under 200 percent of poverty that need child care to enter or sustain employment. States would administer the federal assistance program under a federal-state matching formula with the federal government paying most of the cost. States would develop and implement plans to improve the quality of child care, coordinate child care with other early education programs, and ensure that child care payment rates are sufficient to allow families to obtain care that fosters healthy child development. Greenberg would also make the federal dependent care tax credit refundable, with the credit set at 50 percent of covered child care costs for the lowest-income families and gradually phasing down to 20 percent as family income increases. The combined subsidy and tax changes would lead to a better-coordinated system of child care subsidies that would assure substantial financial help to families below 200 percent of poverty, while tax-based help would ensure continued, albeit significantly reduced, assistance for families with higher incomes. Greenberg indicates that the tax credit expansions are estimated to cost about $5 billion a year, and the subsidy and quality expansions would cost about $18 billion a year.

The redefinition of the familialist home care model in France: the complex formalization of care through cash payment.

PubMed

Le Bihan, Blanche

2012-05-01

This article investigates the impact of policy measures on the organisation of home-based care for older people in France, by examining the balance between formal and informal care and the redefinition of the initial familialist model. It focuses on the specific cash for care scheme (the Allocation personnalisée d'autonomie - Personalised allowance for autonomy) which is at the core of the French home-based care policy. The author argues that in a redefined context of 'welfare mix', the French public strategy for supporting home-based care in France is articulated around two major objectives, which can appear contradictory. It aims to formalise a professional care sector, with respect to the employment policy while allowing the development of new forms of informal care, which cannot be considered to be formal employment. The data collection is two-fold. Firstly, a detailed analysis was made of different policy documents and public reports, together with a systematic review of existing studies. Secondly, statistical analysis on home-based care resources were collected, which was not easy, as home-care services for older people in France are part of a larger sector of activity, 'personal services' (services à la personne). The article exposes three main findings. First, it highlights the complexity of the formalisation process related to the introduction of the French care allowance and demonstrates that formalisation, which facilitates the recognition of care as work, does not necessarily mean professionalisation. Second, it outlines the diversity of the resources available: heterogeneous professional care, semi-formal forms of care work with the possibility to employ a relative and informal family care. Finally, the analysis outlines the importance of the regulation of cash payments on the reshaping of formal and informal care and comments on its impact on the redefinition of informal caring activities. © 2012 Blackwell Publishing Ltd.

Health care reform and changes: the Malaysian experience.

PubMed

Merican, Mohd Ismail; bin Yon, Rohaizat

2002-01-01

Health care reform is an intentional, sustained and systematic process of structural change to one or more health subsystems to improve efficiency, effectiveness, patient choices and equity. Health care all over the world is continuously reforming with time. Health care reform has become an increasingly important agenda for policy change in both developed and developing countries including Malaysia. This paper provides an overview of the Malaysian health care system, its achievements, and issues and challenges leading to ongoing reform towards a more efficient and equitable health care system that possess a better quality of life for the population.

Walking the tightrope-perspectives on local politicians' role in implementing a national social care policy on evidence-based practice.

PubMed

Bäck, A; Ståhl, C; von Thiele Schwarz, U; Richter, A; Hasson, H

2016-01-01

Despite national policy recommending evidence-based practice (EBP), its application in social care has been limited. While local politicians can affect the process, little is known about their knowledge, attitudes and roles regarding EBP. The aim here is twofold: to explore the role of local politicians in the implementation of EBP in social care from both their own and a management perspective; and to examine factors politicians perceive as affecting their decisions and actions concerning the implementation of EBP policy. Local politicians (N = 13) and managers (N = 22) in social care were interviewed. Qualitative thematic analysis with both inductive and deductive codes was used. Politicians were rather uninformed regarding EBP and national policy. The factors limiting their actions were, beside the lack of awareness, lack of ability to question existing working methods, and a need for support in the steering of EBP. Thus, personal interest played a significant part in what role the politicians assumed. This resulted in some politicians taking a more active role in steering EBP while others were not involved. From the managers' perspective, a more active steering by politicians was desired. Setting budget and objectives, as well as active follow-up of work processes and outcomes, were identified as means to affect the implementation of EBP. However, the politicians seemed unaware of the facilitating effects of these actions. Local politicians had a possibility to facilitate the implementation of EBP, but their role was unclear. Personal interest played a big part in determining what role was taken. The results imply that social care politicians might need support in the development of their steering of EBP. Moving the responsibility for EBP facilitation upwards in the political structure could be an important step in developing EBP in social care.

Nursing shaping and influencing health and social care policy.

PubMed

Fyffe, Theresa

2009-09-01

This paper seeks to consider how nursing as a profession in the United Kingdom is developing its role in shaping and influencing policy using lessons learnt from a policy study tour undertaken in the United States of America and extensive experience as a senior nurse within the government, the health service and more recently within a Professional Organization. The nursing profession faces major changes in health and health care and nurses need to be visible in the public debate about future models of health and health care. This paper critically reviews recent UK and USA literature and policy with relevance to nursing. Strategies that support nurses and nursing to influence policy are in place but more needs to be done to address all levels of nursing in order to find creative solutions that promote and increase the participation of nurses in the political process and health policy. There are lessons to be learnt in the UK from the US nursing experience. These need to be considered in the context of the UK and devolution. Although much has been achieved in positioning nurses and nursing as an influencer in the arena of policy and political decision-making, there is a need for greater co-ordination of action to ensure that nursing is actively supported in influencing and shaping health and health care policy. All leaders and other stakeholders require to play their part in considering how the actions set out in this article can be taken forward and how gaps such as education, fellowship experience and media engagement can be addressed in the future.

Improving care for people with osteoarthritis of the hip and knee: how has national policy for osteoarthritis been translated into service models in Australia?

PubMed

Brand, Caroline; Hunter, David; Hinman, Rana; March, Lyn; Osborne, Richard; Bennell, Kim

2011-05-01

There is strong rationale for improving care for people with chronic conditions, including osteoarthritis (OA). Successful implementation of healthcare reform requires new concepts and directions that are strongly supported by policy, new models of care (service redesign) and changes in day-to-day practice (healthcare provider and patient practice). In this paper we discuss the extent to which policy about management of OA of the hip and knee has been translated into new service models in Australia. A structured search of government and other key health websites in Australia was performed to identify policy, funding initiatives and new services models for managing OA of the hip and knee. This search was supported by a literature review. Musculoskeletal conditions were designated a National Health Priority in Australia in 2002. Under the Better Arthritis and Osteoporosis Care initiative, Australia has developed a national policy for OA care and national evidence-based clinical practice guidelines for management of OA of the hip and knee. Only two well-described examples of new chronic disease management service models, the Osteoarthritis Clinical Pathway (OACP) model and the Osteoarthritis Hip and Knee Service (OAHKS) were identified. Primarily focused within acute care public hospital settings, these have been shown to be feasible and acceptable but have limited data on clinical impact and cost-effectiveness. While policy is extant, implementation has not been systematic and comprehensive. Clinicians have evidence-based recommendations for OA management but are poorly supported by service models to deliver these effectively and efficiently. © 2011 The Authors. International Journal of Rheumatic Diseases © 2011 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd.

How Safe? The Status of State Efforts To Protect Children in Child Care.

ERIC Educational Resources Information Center

Adams, Gina

Based on the view that strong state child care licensing policies can influence the quality of child care and thereby enhance children's health and development, this report examines the status of state efforts to improve the quality of child care programs. Almost all data were collected for a 1993 Parenting Magazine survey, and were verified by…

Mapping support policies for informal carers across the European Union.

PubMed

Courtin, Emilie; Jemiai, Nadia; Mossialos, Elias

2014-10-01

At a time when health and social care services in European countries are under pressure to contain or cut costs, informal carers are relied upon as the main providers of long-term care. However, still little is known about the availability of direct and indirect support for informal carers across the European Union. Primary data collection in all EU member states was supplemented with an extensive review of the available literature. Various forms and levels of support have been implemented across Europe to facilitate the role of informal caregivers. Financial support is the most common type of support provided, followed by respite care and training. Most countries do not have a process in place to systematically identify informal carers and to assess their needs. Policies are often at an early stage of development and the breadth of support varies significantly across the EU. Policy developments are uneven across the member states, with some countries having mechanisms in place to assess the needs and support informal carers while others are only starting to take an interest in developing support services. Given the unprecedented challenges posed by population ageing, further research and better data are needed to capture and monitor information on informal carers, to help design adequate support policies and eventually to evaluate their impact across the EU. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Work process, performance and professional profile of a Hearing Health Network: reference for satisfaction.

PubMed

Escarce, Andrezza Gonzalez; Lemos, Stela Maris Aguiar; Carvalho, Sirley Alves da Silva

2016-01-01

To analyze the correlation between the satisfaction of professionals from the Hearing Health Care network in two micro-regions of Minas Gerais state and the sociodemographic profile, work process, and work performance in the health service. This is a cross-sectional, observational, analytic study with a non-probabilistic sample including 34 professionals from the Hearing Health Care services. Data collection occurred through individual interviews in the municipality of professional practice. Associations between the Professional Satisfaction variable and the explanatory variables Sociodemographic Data, Work Routine, and Developed Actions were conducted. Professionals with graduate studies were more satisfied with the human resources policy and the activities developed, whereas health civil servants showed more satisfaction with the wage policy and the work schedule. The correlation analysis between work process and satisfaction revealed a moderate positive correlation between items such as Health Promotion Actions, Satisfaction with Diagnostic Equipment, and Satisfaction with Maintenance Equipment. The present study revealed a higher level of satisfaction among professionals with graduate studies (human resources policy and activities developed) and civil servants (wage policy and work schedule). The relevance of this study lies on the important role that health professionals play on the Health Care Network. Additionally, the study of satisfaction level can provide a search for improvements, considering that satisfied professionals not only improve service quality, but also show greater creativity, commitment, and performance.

Factors that act as facilitators and barriers to nurse leaders’ participation in health policy development

PubMed Central

2014-01-01

Background Health policies impact on nursing profession and health care. Nurses' involvement in health policy development ensures that health care is safe, of a high quality, accessible and affordable. Numerous factors influence nurse leaders' ability to be politically active in influencing health policy development. These factors can be facilitators or barriers to their participation. There is scant research evidence from Eastern African region that draws attention to this topic. This paper reports part of the larger study. The objectives reported in this paper were those aimed to: build consensus on factors that act as facilitators and barriers to nurse leaders' participation in health policy development in Kenya, Uganda and Tanzania. Methods A Delphi survey was applied which included: expert panelists, iterative rounds, statistical analysis, and consensus building. The expert panelists were purposively selected and included national nurse leaders in leadership positions in East Africa. Data collection was done, in three iterative rounds, and utilized a questionnaire with open and closed ended questions. 78 expert panelists were invited to participate in the study; the response rate was 47% of these 64.8% participated in the second round and of those 100% participated in the third round. Data analysis was done by examining the data for the most commonly occurring categories for the open ended questions and descriptive statistics for structured questions. Results The findings of the study indicate that both facilitators and barriers exist. The former include: being involved in health policy development, having knowledge and skills, enhancing the image of nursing and enabling structures and processes. The latter include: lack of involvement, negative image of nursing and structures and processes which exclude them. Conclusion There is a window of opportunity to enhance national nurse leaders' participation in health policy development. Nurse leaders have a key role in mentoring, supporting and developing future nurse policy makers. PMID:25053921

[Comments on policy--elderly count for much, or counting the elderly? A new statement on policy for the elderly].

PubMed

Knapen, M; van der Zanden, G H

1990-12-01

The Dutch government has published a new white paper 'Elderly count for much' on policy for the aged. In this document the central principle for social policy is the integration of the elderly in society. Old age policy is characterized as 'integral policy' that is it tries to integrate the traditional fields of social and economic policy, and as 'complementary' policy, that is it tries to complement general policy. The main characteristics of the action program 1990-1994 include: prevention, the integration of housing and services, care for elderly with chronic diseases, education, strengthening of labor-market participation of 50+, the position of elderly women and societal attitudes towards aging and the elderly. In this comment it is argued that this white paper initiates positive developments, but there remain several minor and major problems. We are critical about the role of education, the instruments for an active labor-market policy, the lack of attention for the European dimension, and about the lack of attention for future developments in generational equity and age-rationing of service allocation. We appreciate the attention for age discrimination, and possibilities for longitudinal research. We conclude that 'integrated policy' is only in its initial phase. In this white paper the government is only successful in an integrated policy in the fields of housing and care, not in other fields like technology, labor and education. 'Complementary' policy is not enough to create a firm infrastructure in the aging field. If initiatives in the field of aging are considered as 'extra's' this policy will soon be confronted with the boundaries it creates itself. Although attention for the challenges of graying is growing, old age policy is still marginal compared to the main general policy.

Mandates for Collaboration: Health Care and Child Welfare Policy and Practice Reforms Create the Platform for Improved Health for Children in Foster Care.

PubMed

Zlotnik, Sarah; Wilson, Leigh; Scribano, Philip; Wood, Joanne N; Noonan, Kathleen

2015-10-01

Improving the health of children in foster care requires close collaboration between pediatrics and the child welfare system. Propelled by recent health care and child welfare policy reforms, there is a strong foundation for more accountable, collaborative models of care. Over the last 2 decades health care reforms have driven greater accountability in outcomes, access to care, and integrated services for children in foster care. Concurrently, changes in child welfare legislation have expanded the responsibility of child welfare agencies in ensuring child health. Bolstered by federal legislation, numerous jurisdictions are developing innovative cross-system workforce and payment strategies to improve health care delivery and health care outcomes for children in foster care, including: (1) hiring child welfare medical directors, (2) embedding nurses in child welfare agencies, (3) establishing specialized health care clinics, and (4) developing tailored child welfare managed care organizations. As pediatricians engage in cross-system efforts, they should keep in mind the following common elements to enhance their impact: embed staff with health expertise within child welfare settings, identify long-term sustainable funding mechanisms, and implement models for effective information sharing. Now is an opportune time for pediatricians to help strengthen health care provision for children involved with child welfare. Copyright © 2015. Published by Elsevier Inc.

Health care economics, financing, organization, and delivery.

PubMed

Cox, Malcolm; Pacala, James T; Vercellotti, Gregory M; Shea, Judy A

2004-01-01

The US health care system is in a state of rapid evolution, with changing payment, organizational, and management structures. To learn how to function optimally in a system in which care is increasingly managed and competitive, today's medical students must understand the structural and economic underpinnings of the system within which they will practice. At the outset of the Undergraduate Medical Education for the 21st Century (UME-21) project, the great majority of medical school curricula were lacking in areas of health care financing and organizational structure. The institutions involved in the UME-21 project sought to address curricular deficiencies in two broad areas: (1) the structure and financing of the US health care system ("health policy") and (2) the manner in which this system is reflected in the organization and activities of health care providers ("care delivery"). This article discusses the development, implementation, and evaluation of the first of the two areas. Data were abstracted from written reports provided by each of the UME-21 schools to the project's Executive Committee and sponsor. In selected cases, additional data were obtained by personal communications with project directors and evaluators. Local UME-21 project leaders verified all data presented. Curricular philosophy and teaching methods varied widely, but health policy curricula were predominantly preclinical and didactic in nature. At the school level, much was achieved in terms of student knowledge, curricula were generally well received by students, attitudes toward managed care generally moved in a positive direction, and behavior may have been positively influenced as well. At the project level, many potentially interesting changes exist within the 18 schools and between the UME-21 and other schools, but it is not clear whether or what parts of the health policy curricula were responsible for these changes. Nonetheless, as measured by changes in health policy-related items on the Association of American Medical Colleges Graduation Questionnaire, it appears that UME-21 schools outperformed their non-UME-21 counterparts. All of the UME-21 schools were enthusiastic about their health policy innovations, and this extended across all key stakeholders. Most schools avoided focusing on managed care and instead adopted more neutral themes that introduced the same material. Integrating the new material in conjunction with the more traditional aspects of the curriculum was also an effective implementation strategy. Health policy should be incorporated into both the preclinical and clinical years. The former emphasizes health care economics as one of the foundations of medical practice, whereas the latter provides the opportunity for its use on a daily basis in clinical settings. However, like any new curriculum, to achieve equal status with the traditional biomedical curriculum, it must be presented in a scholarly, rigorous, and reasonably comprehensive fashion. Mounting a scholarly health policy curriculum requires a wide-ranging, interdisciplinary faculty. If it is to become a central component of the medical school curriculum, creative approaches to faculty recruitment and development will be needed. This will require both careful educational policy formulation and new investment.

Child Health Guidelines: Health, Nutrition, Infants and Toddlers. Revised Edition.

ERIC Educational Resources Information Center

Allison, Ursula; And Others

Forms and guidelines presented in this manual were compiled and/or developed by staff of agencies serving nursery schools, group day care centers, and family day care homes. The health and safety guidelines focus on excluding ill children and staff, caring for ill children, safety policies, emergency procedures, fire emergencies, pets, bites, and…

Teaching Behavioral Sciences in Schools of Medicine. Volume One: Summary Report.

ERIC Educational Resources Information Center

Kennedy, Donald A.; And Others

This document, the first of three volumes, summarizes and describes how behavioral science in health care has developed in response to recent trends in medical education and health care in the U.S. and presents the policy recommendations of an interdisciplinary study committee. Summary reports concern: health care and medical education,…

Using research to determine support for a policy on family presence during resuscitation.

PubMed

Basol, Roberta; Ohman, Kathleen; Simones, Joyce; Skillings, Kirsten

2009-01-01

National guidelines and professional organizations have recommended allowing family presence during resuscitation and bedside invasive procedures. Studies found that only 5% of critical care units have written policies. Periodic requests by family members prompted the creation of a task force, including nurses, physicians, and respiratory therapists, to develop this controversial policy. Before development, a research study of healthcare personnel attitudes, concerns, and beliefs toward family presence during cardiopulmonary resuscitation and bedside invasive procedures was done. This descriptive and correlational study showed support for family presence by critical care and emergency department nurses. Findings revealed both support and non-support for families to be present during resuscitative efforts. Providing family presence as an option offers an opportunity for reluctant healthcare team members to refuse their presence and an opportunity for those who support family presence to welcome the family.

Integration of fall prevention into state policy in Connecticut.

PubMed

Murphy, Terrence E; Baker, Dorothy I; Leo-Summers, Linda S; Bianco, Luann; Gottschalk, Margaret; Acampora, Denise; King, Mary B

2013-06-01

To describe the ongoing efforts of the Connecticut Collaboration for Fall Prevention (CCFP) to move evidence regarding fall prevention into clinical practice and state policy. A university-based team developed methods of networking with existing statewide organizations to influence clinical practice and state policy. We describe steps taken that led to funding and legislation of fall prevention efforts in the state of Connecticut. We summarize CCFP's direct outreach by tabulating the educational sessions delivered and the numbers and types of clinical care providers that were trained. Community organizations that had sustained clinical practices incorporating evidence-based fall prevention were subsequently funded through mini-grants to develop innovative interventional activities. These mini-grants targeted specific subpopulations of older persons at high risk for falls. Building collaborative relationships with existing stakeholders and care providers throughout the state, CCFP continues to facilitate the integration of evidence-based fall prevention into clinical practice and state-funded policy using strategies that may be useful to others.

Social implications of the Human Genome Project: Policy roundtable series and journals. Final progress report, March 15, 2001 - March 15, 2002

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

Seiguer, Erica

2002-12-30

This report reflects the activities of the Harvard Health Caucus at Harvard Medical School that were supported, in part, by the Department of Energy. The following policy roundtables and panels were held: Spring 2001 Policy Roundtable Series: The social implications of the Human Genome Project; Spring 2002 Policy Roundtable Series: Managing globalization to improve health; 13 February 2002 Keynote Address: The globalization of health; 25 February 2002 Healthier or Wealthier: Which comes first in the new global era?; 28 February 2002 The crisis of neglected diseases: Creating R&D incentives for diseases of developing countries; 7 March 2002 Health care educationmore » in the developing world: Bridging global and local health care practices; 20 March 2002 Building a legal framework for global health: How can the US and UN work to reduce global disparities?; 25 April 2002 The role of mass media and tobacco control efforts. Caucus organizational information is also included.« less

After-hours coverage

PubMed Central

Bordman, Risa; Wheler, David; Drummond, Neil; White, David; Crighton, Eric

2005-01-01

OBJECTIVE To determine the prevalence and content of existing or developing policies and guidelines of medical associations and colleges regarding after-hours care by family physicians and general practitioners, especially legal requirements. DESIGN Telephone survey in fall 2002, updated in fall 2004. SETTING Canada. PARTICIPANTS All national and provincial medical associations, Colleges of Family Physicians, Colleges of Physicians and Surgeons, local government offices for the north, and the Canadian Medical Protective Association (CMPA). MAIN OUTCOME MEASURE Response to the question: “Does your agency have a policy in place regarding after-hours health care coverage by FPs/GPs, or are there active discussions regarding such a policy?” RESULTS The College of Physicians and Surgeons of British Columbia was the first to institute a policy, in 1995, requiring physicians to make “specific arrangements” for after-hours care of their patients. The College of Physicians and Surgeons of Alberta adopted a similar policy in 1996 along with a guideline to aid implementation. In 2002, the College of Physicians and Surgeons of Nova Scotia approved a guideline on the Availability of Physicians After Hours. The Saskatchewan Medical Association and the College of Physicians and Surgeons of Saskatchewan formulated a joint policy on medical practice coverage that was released in 2003. Many agencies actively discussed the topic. Provincial and national Colleges of Family Physicians did not have any policies in place. The CMPA does not generate guidelines but released in an information letter in May 2000 a section entitled “Reducing your risk when you’re not available.” CONCLUSION There is increasing interest Canada-wide in setting policy for after-hours care. While provincial Colleges of Physicians and Surgeons have traditionally led the way, a trend toward more collaboration between associations was identified. The effect of policy implementation on physicians’ coverage of patients is unclear. PMID:16926930

Chronic Care Management evolves towards Integrated Care in Counties Manukau, New Zealand.

PubMed

Rea, Harry; Kenealy, Tim; Wellingham, John; Moffitt, Allan; Sinclair, Gary; McAuley, Sue; Goodman, Meg; Arcus, Kim

2007-04-13

Despite anecdotes of many chronic care management and integrated care projects around New Zealand, there is no formal process to collect and share relevant learning within (but especially between) District Health Boards (DHBs). We wish to share our experiences and hope to stimulate a productive exchange of ongoing learning. We define chronic care management and integrated care, then summarise current theory and evidence. We describe national policy development (relevant to integrated care, since 2000) including the New Zealand Health Strategy, the NZ Primary Care Strategy, the development of Primary Health Organisations (PHOs), capitation payments, Care Plus, and Services to Improve Access funding. We then describe chronic care management in Counties Manukau, which evolved both prior to and during the international refinement of theory and evidence and the national policy development and implementation. We reflect on local progress to date and opportunities for (and barriers to) future improvements, aided by comparative reflections on the United Kingdom (UK). Our most important messages are addressed as follows: To policymakers and funders--a fragile culture change towards teamwork in the health system is taking place in New Zealand; this change needs to be specifically and actively supported. To PHOs--general practices need help to align their internal (within-practice) financial signals with the new world of capitation and integrated care. To primary and secondary care doctors, nurses, and other carers - systematic chronic care management and integrated care can improve patient quality of life; and if healthcare structures and systems are properly managed to support integration, then healthcare provider professional and personal satisfaction will improve.

Principles to promote physician satisfaction and work-life balance.

PubMed

Shanafelt, Tait D; West, Colin P; Poland, Gregory A; LaRusso, Nicolas F; Menaker, Ronald; Bahn, Rebecca S

2008-12-01

Substantial evidence suggests that difficulty balancing their personal and professional life is a major contributor to physician distress. Limited evidence suggests that the mission and policies of health care organizations may relate to physician satisfaction. In this article, we describe principles to promote professional satisfaction and work-life integration developed by the Mayo Clinic department of medicine. These principles can be used to measure and align policies. It is hoped they will serve as a model that can be used by other health care organizations.

Addressing the determinants of child mental health: intersectionality as a guide to primary health care renewal.

PubMed

McPherson, Charmaine M; McGibbon, Elizabeth A

2010-09-01

Primary health care (PHC) renewal was designed explicitly to attend to the multidimensional factors impacting on health, including the social determinants of health. These determinants are central considerations in the development of integrated, cross-sectoral, and multi-jurisdictional policies such as those that inform models of shared mental health care for children. However, there are complex theoretical challenges in translating these multidimensional issues into policy. One of these is the rarely discussed interrelationships among the social determinants of health and identities such as race, gender, age, sexuality, and social class within the added confluence of geographic contexts. An intersectionality lens is used to examine the complex interrelationships among the factors affecting child mental health and the associated policy challenges surrounding PHC renewal. The authors argue that an understanding of the intersections of social determinants of health, identity, and geography is pivotal in guiding policy-makers as they address child mental health inequities using a PHC renewal agenda.

The Office of Warrior Care Policy

Science.gov Websites

Health Affairs Website Heath Affairs Blog Special Features The Office of Warrior Care Policy Mission Activity The Office of Warrior Care Policy James Rodriguez Mr. James Rodriguez Deputy Assistant Secretary of Defense (WCP) The Office of Warrior Care Policy ensures recovering wounded, ill, injured, and

Integrated primary health care in Australia.

PubMed

Davies, Gawaine Powell; Perkins, David; McDonald, Julie; Williams, Anna

2009-10-14

To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.

Development of a South African integrated syndromic respiratory disease guideline for primary care.

PubMed

English, René G; Bateman, Eric D; Zwarenstein, Merrick F; Fairall, Lara R; Bheekie, Angeni; Bachmann, Max O; Majara, Bosielo; Ottmani, Salah-Eddine; Scherpbier, Robert W

2008-09-01

The Practical Approach to Lung Health in South Africa (PALSA) initiative aimed to develop an integrated symptom- and sign-based (syndromic) respiratory disease guideline for nurse care practitioners working in primary care in a developing country. A multidisciplinary team developed the guideline after reviewing local barriers to respiratory health care provision, relevant health care policies, existing respiratory guidelines, and literature. Guideline drafts were evaluated by means of focus group discussions. Existing evidence-based guideline development methodologies were tailored for development of the guideline. A locally-applicable guideline based on syndromic diagnostic algorithms was developed for the management of patients 15 years and older who presented to primary care facilities with cough or difficulty breathing. PALSA has developed a guideline that integrates and presents diagnostic and management recommendations for priority respiratory diseases in adults using a symptom- and sign-based algorithmic guideline for nurses in developing countries.

Reforming long-term care financing through insurance

PubMed Central

Meiners, Mark R.

1988-01-01

Until recently, insurance for long-term care was not viewed as feasible. This perception has changed dramatically in the past few years. Several models of long-term care insurance have begun to be tested. Although the application of insurance principles to long-term care is still new, the emergence of private market interest in developing long-term care insurance has been a catalyst to renewed public-policy support for reforming the way we pay for long-term care. States, in particular, have become interested in developing public-private partnerships to support the emergence of long-term care insurance that could help relieve the mounting pressure on Medicaid budgets. PMID:10312962

Introduction: evaluation in analytic theory and political practice.

PubMed

Brown, Lawrence D; Gusmano, Michael K

2013-12-01

The development of professional policy analysis was driven by a desire to apply "science" to policy decisions, but the vision of apolitical policy analysis is as unattainable today as it was at the inception of the field. While there is powerful evidence that schemes to "get around" politics are futile, they never seem to lose their popularity. The contemporary enthusiasm for health technology assessment and comparative-effectiveness research extends these efforts to find technical, bureaucratic fixes to the problem of health care costs. As the benefits and costs of health care continue to grow, so too will the search for analytic evidence and insights. It is important to recognize that the goal of these efforts should not be to eliminate but rather to enrich political deliberations that govern what societies pay for and get from their health care systems.

The Life Course Health Development Model: A Guide to Children's Health Care Policy and Practice

ERIC Educational Resources Information Center

Halfon, Neal; Russ, Shirley; Regalado, Michael

2005-01-01

As medical knowledge and treatments improve, pediatricians' role in promoting children's health continues to change. Genetics and early experiences may have long-term effects on health and development. Theoretical models that influence providers' decisions about the use of health-care resources are: the disease model, the neuromaturational model,…

Getting Started in the Child Care Business.

ERIC Educational Resources Information Center

Kimery, Sharon

This pamphlet discusses questions to consider when planning a child care facility. Topics discussed include licensing, financial management, written policies on facility operation, recordkeeping, insurance, the physical nature of the facility, program planning, scheduling of daily activities, personnel selection, staff development, parent…

[Financing healthcare in low-income countries: recurring questions, new challenges].

PubMed

Audibert, M; Mathonnat, J; de Roodenbeke, E

2004-01-01

Healthcare financing policies in low-income countries have gone through three successive phases. In the first phase the dominant approach was based on free access to healthcare and focused first on development of vertical programs and then on the necessity of providing primary care to all. While maintaining the emphasis on accessibility to primary care, the second policy phase introduced user fees and attempted to integrate healthcare programs into district-based healthcare structures. The third phase has been strongly influenced by the relationship between healthcare and development and the Millenium Objectives and places strong emphasis on necessity of developing insurance schemes. Recent studies on the relationship between healthcare spending and health status indicate that the efficiency and effectiveness of healthcare spending plays a more determinant role than the amount. At the same time an effort is being made to develop synergy between the different players in the health care systems and to clarify the role of each player by hinging financing decisions on operating criteria such as "public welfare", externalities, catastrophic costs, and equity. Although many countries have made significant progress, there are still several lagging areas, i.e., coverage for the poorest segment of the population (despite the rhetoric), follow-up of financing, and governance. Increasing external aid already initiated by several states may have a non-negligible impact on the macroeconomic balance. Since these changes could lead to adverse effects on health, there is a need to implement careful non-dogmatic policies.

The Lorenzini Foundation in a changing scenario of patient management.

PubMed

Peracino, A; Paoletti, R

2009-06-10

The loss of life, disability, and economic burden attributed to cardiovascular disease (CVD) in Europe has created an urgent need for all stakeholders in CVD prevention to partner together to address the barriers in local health policy and produce effective programs in individual and population risk reduction and rational use of health services. Countries have a legal and moral obligation to achieve the highest standard of CV health care for citizens and to improve national health care systems accordingly. As part of a vision for future potential opportunities in CVD prevention, the Lorenzini Foundation would like to raise awareness of several key areas among the European authorities: Integration of interventions aimed at several risk factors within an individual country's health care system; implementation of a comprehensive approach combining policy development, capacity building, partnership and information support at all levels; promotion of transversal health policies, including coordinated action outside of the health sector to address major determinants of ill health; a combination of health policy and high-risk strategies to link health promotion, public health services, primary care, and hospital care; and, finally, reduction in ethnic, cultural, socioeconomic, and gender inequalities to multiple risk factor management among and within countries through use of cost-effective medications and medical technologies.

Recommendations for sexual expression management in long-term care: a qualitative needs assessment

PubMed Central

Syme, Maggie L.; Lichtenberg, Peter; Moye, Jennifer

2017-01-01

Aims To conduct a qualitative needs assessment of Directors of Nursing regarding challenges and recommendations for addressing sexual expression and consent. Background Sexual expression management among long-term care residents is a complex issue for nursing home staff. Little guidance is available for those wanting to follow a person-centred approach. Policies and procedures are needed, and must be usable across long-term care settings. Design Qualitative design for in-depth exploration. Methods Semi-structured interviews were conducted with 20 Directors of Nursing in the spring and summer of 2013, representing a range of regions, facility sizes and resident populations. Interview questions prompted them to identify recommendations that address challenges to improving sexual expression management in long-term care settings. Results Comparative thematic analysis resulted in several codes, which were grouped into eight overall categories. Recommendation categories that addressed key challenges included: address the issue, make environmental changes, identify staff expertise, provide education and training, assess sexuality initially and recurrently, establish policies/procedures for sexual expression management, develop assessment tools for sexual expression and consent, and clarify legal issues. The recommendation to develop national guidelines was observed across categories. Discussion Directors of Nursing report several challenges to sexual expression management in their facilities, and perceive their current methods to be ad hoc. A proactive approach to policy and procedure development is needed. PMID:27188413

Prioritizing interventions to manage polypharmacy in Australian aged care facilities.

PubMed

Jokanovic, Natali; Wang, Kate N; Dooley, Michael J; Lalic, Samanta; Tan, Edwin Ck; Kirkpatrick, Carl M; Bell, J Simon

Polypharmacy is highly prevalent in residential aged care facilities (RACFs). Although polypharmacy is sometimes unavoidable, polypharmacy has been associated with increased morbidity and mortality. To identify and prioritize a range of potential interventions to manage polypharmacy in RACFs from the perspectives of health care professionals, health policy and consumer representatives. Two nominal group technique (NGT) sessions were convened in August 2015. A purposive sample (n = 19) of clinicians, researchers, managers and representatives of consumer, professional and health policy organizations were asked to nominate interventions to address the prevalence and appropriateness of medication use. Participants were then asked to prioritize five interventions suitable for possible implementation at the system level. Six of 16 potential interventions were prioritized highest for possible implementation in clinical practice, with two interventions prioritized as second highest. The top interventions in rank order were 'implementation of a pharmacist-led medication reconciliation service for new residents,' 'conduct facility-level audits and feedback to staff and health care professionals,' 'develop deprescribing scripts to assist clinician-resident discussion,' 'develop or revise prescribing guidelines specific to older people with multimorbidity in RACFs,' 'implement electronic medication charts and records' and 'better support Medication Advisory Committees (MACs) to address medication appropriateness.' This study prioritized a range of potential interventions that may be used to assist clinicians and policy makers develop a comprehensive strategy to manage polypharmacy in RACFs. Copyright © 2016 Elsevier Inc. All rights reserved.

Two decades of maternity care fee exemption policies in Ghana: have they benefited the poor?

PubMed

Johnson, Fiifi Amoako; Frempong-Ainguah, Faustina; Padmadas, Sabu S

2016-02-01

To investigate, the impact of maternity-related fee payment policies on the uptake of skilled birth care amongst the poor in Ghana. Population data representing 12 288 births between November 1990 and October 2008 from four consecutive rounds of the Ghana demographic and health surveys were used to examine the impact of four major maternity-related payment policies: the full-cost recovery 'cash and carry' scheme; 'antenatal care fee exemption'; 'delivery care fee exemption' and the 'National Health Insurance Scheme (NHIS)'. Concentration curves were used to analyse the rich-poor gap in the use of skilled birth care by the four policy interventions. Multilevel logistic regression was used to examine the effect of the policies on the uptake of skilled birth care, adjusting for relevant predictors and clustering within communities and districts. The uptake of skilled birth care over the policy periods for the poorest women was trivial when compared with their non-poor counterparts. The rich-poor gap in skilled birth care use was highly pronounced during the 'cash and carry' and 'free antenatal care' policies period. The benefits during the 'free delivery care' and ' NHIS' policy periods accrued more for the rich than the poor. There exist significant differences in skilled birth care use between and within communities and districts, even after adjusting for policy effects and other relevant predictors. The maternal care fee exemption policies specifically targeted towards the poorest women had limited impact on the uptake of skilled birth care. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Post‐war development of emergency medicine in Kosovo

PubMed Central

O'Hanlon, K P

2007-01-01

Objectives To (1) investigate emergency medical care priorities in Kosovo, (2) assess Kosovo's post‐war development of emergency medical services and (3) identify expectations. Methods An instrument with seven open‐ended questions, approved by the institutional review board, was designed for in‐person interviews (preferred) or written survey. The survey was administered in October 2003 at the Kosovo University Clinical Center, Pristina, Kosovo, and one regional hospital. Targeted participants were emergency care providers, clinical consultants and health policy consultants. Surveys were conducted by interview with simultaneous interpretation by a native Albanian speaker, an orthopaedic surgeon or in written Albanian form. The responses were evaluated quantitatively and qualitatively. Results 13 respondents participated in the study: 10 gave interviews and 3 provided written response; 7 were emergency care providers, 4 were emergency care consultants and 2 were health policy consultants. Emergency care priorities were defined as trauma, cardiac disease and suicide. Most respondents believed that emergency medicine as a specialised field was a post‐war development. The international community was credited with the provision of infrastructure, supplies and training. Most respondents denied any harm from international assistance. However, some respondents described instances of inappropriate international investment. Ongoing needs are training of providers and equipping of facilities and vehicles. Improved hospital management, political administration and international involvement are thought to be necessary for continued development. Conclusions Survey respondents agreed on priorities in emergency care, credited the international community with development to date, and identified administrative structures and international training support as the keys to ongoing development. PMID:17183036

An Important Question for Student Journalists: Must Freedom, Rules/Law Inevitably Conflict?

ERIC Educational Resources Information Center

Martinson, David L.

2001-01-01

Considers the importance of developing a well constructed publications policy and notes that a carefully designed policy will provide some mechanism for addressing questions regarding the inevitable conflicts that will arise when students express a desire to publish certain controversial material. (SC)

Mental health care in Nepal: current situation and challenges for development of a district mental health care plan.

PubMed

Luitel, Nagendra P; Jordans, Mark Jd; Adhikari, Anup; Upadhaya, Nawaraj; Hanlon, Charlotte; Lund, Crick; Komproe, Ivan H

2015-01-01

Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal. A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records. Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry of Health and Population (MoHP). Strategies to overcome these challenges included involvement of MoHP in the process, especially by providing psychotropic medicines and appointing a senior level officer to facilitate project activities, and collaboration with National Health Training Centers (NHTC) in training programs. This study describes many challenges facing mental health care in Nepal. Most of these challenges are not new, yet this study contributes to our understanding of these difficulties by outlining the national and district level factors that have a direct influence on the development of a district level mental health care plan.

Management of ethical issues related to care of seriously ill dialysis patients in free-standing facilities.

PubMed

Song, Mi-Kyung; Hanson, Laura C; Gilet, Constance A; Jo, Minjeong; Reed, Teresa J; Hladik, Gerald A

2014-09-01

There are few data on the frequency and current management of clinical ethical issues related to care of seriously ill dialysis patients in free-standing dialysis facilities. To examine the extent of clinical ethical challenges experienced by care providers in free-standing facilities and their perceptions about how those issues are managed. A total of 183 care providers recruited from 15 facilities in North Carolina completed a survey regarding the occurrence and management of ethical issues in the past year. Care plan meetings were observed at four of the facilities for three consecutive months. Also, current policies and procedures at each of the facilities were reviewed. The two most frequently experienced challenges involved dialyzing frail patients with multiple comorbidities and caring for disruptive/difficult patients. The most common ways of managing ethical issues were discussions in care plan meetings (n = 47) or discussions with the clinic manager (n = 47). Although policies were in place to guide management of some of the challenges, respondents were often not aware of those policies. Also, although participants reported that ethical issues related to dialyzing undocumented immigrants were fairly common, no facility had a policy for managing this challenge. Participants suggested that all staff obtain training in clinical ethics and communication skills, facilities develop ethics teams, and there be clear policies to guide management of ethical challenges. The scope of ethical challenges was extensive, how these challenges were managed varied widely, and there were limited resources for assistance. Multifaceted efforts, encompassing endeavors at the individual, facility, organization, and national levels, are needed to support staff in improving the management of ethical challenges in dialysis facilities. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Funding models in palliative care: Lessons from international experience

PubMed Central

Groeneveld, E Iris; Cassel, J Brian; Bausewein, Claudia; Csikós, Ágnes; Krajnik, Malgorzata; Ryan, Karen; Haugen, Dagny Faksvåg; Eychmueller, Steffen; Gudat Keller, Heike; Allan, Simon; Hasselaar, Jeroen; García-Baquero Merino, Teresa; Swetenham, Kate; Piper, Kym; Fürst, Carl Johan; Murtagh, Fliss EM

2017-01-01

Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest. PMID:28156188

Who Lives Where and Does It Matter? Changes in the Health Profiles of Older People Living in Long Term Care and the Community over Two Decades in a High Income Country

PubMed Central

Matthews, Fiona E.; Bennett, Holly; Wittenberg, Raphael; Jagger, Carol; Dening, Tom; Brayne, Carol

2016-01-01

Background There have been fundamental shifts in the attitude towards, access to and nature of long term care in high income countries. The proportion and profile of the older population living in such settings varies according to social, cultural, and economic characteristics as well as governmental policies. Changes in the profiles of people in different settings are important for policy makers and care providers. Although details will differ, how change occurs across time is important to all, including lower and middle income countries developing policies themselves. Here change is examined across two decades in England. Methods and Findings Using the two Cognitive Function and Ageing Studies (CFAS I: 77% response, CFAS II: 56% response), two population based studies of older people carried out in the same areas conducted two decades apart, the study diagnosis of dementia using the Automated Geriatric Examination for Computer Assisted Taxonomy, health and wellbeing were examined, focusing on long term care. The proportion of individuals with three or more health conditions increased for everyone living in long term care between CFAS I (47.6%, 95% CI: 42.3–53.1) and CFAS II (62.7%, 95% CI: 54.8–70.0) and was consistently higher in those without dementia compared to those with dementia in both studies. Functional impairment measured by activities of daily living increased in assisted living facilities from 48% (95% CI: 44%-52%) to 67% (95% CI: 62%-71%). Conclusions Health profiles of residents in long term care have changed dramatically over time. Dementia prevalence and reporting multiple health conditions have increased. Receiving care in the community puts pressure on unpaid carers and formal services; these results have implications for policies about supporting people at home as well as for service provision within long term care including quality of care, health management, cost, and the development of a skilled, caring, and informed workforce. PMID:27589586

Japan's healthcare policy for the elderly through the concepts of self-help (Ji-jo), mutual aid (Go-jo), social solidarity care (Kyo-jo), and governmental care (Ko-jo).

PubMed

Sudo, Kyoko; Kobayashi, Jun; Noda, Shinichiro; Fukuda, Yoshiharu; Takahashi, Kenzo

2018-03-18

Elderly care is an emerging global issue threatening both developed and developing countries. The elderly in Japan increased to 26.7% of the population in 2015, and Japan is classified as a super-aged society. In this article, we introduce the financial aspects of the medical care and welfare services policy for the elderly in Japan. Japan's universal health insurance coverage system has been in place since 1961. Long-term care includes welfare services, which were separated from the medical care insurance scheme in 2000 when Japan was already recognized as an aging society. Since then, the percentage of the population over 65 has increased dramatically, with the productive-age population on the decrease. The Japanese government, therefore, is seeking to implement "The Community-based Integrated Care System" with the aim of building comprehensive up-to-the-end-of-life support services in each community. The system has four proposed elements: self-help (Ji-jo), mutual aid (Go-jo), social solidarity care (Kyo-jo), and government care (Ko-jo). From the financial perspective, as the government struggles against the financial burdens of an aging population, they are considering self-help and mutual aid. Based on Japan's present situation, both elements could lead to positive results. The Japanese government must also entrust the responsibility for implementing preventive support to municipalities through strongly required regional autonomy. As Japan has resolved this new challenge through several discussions over a long period of time, other aging countries could learn from the Japanese experience of solving barriers to healthcare policy for the elderly.

Health Care Organizations and Policy Leadership: Perspectives on Nonsmoker-Only Hiring Policies.

PubMed

McDaniel, Patricia A; Malone, Ruth E

2018-02-01

To explore employers' decisions to base hiring policies on tobacco or nicotine use and community perspectives on such policies, and analyze the implications for organizational identity, community engagement, and health promotion. From 2013 to 2016, 11 executives from six health care organizations and one non-health-care organization with nonsmoker-only hiring policies were interviewed about why and how their policies were created and implemented, concerns about the policies, and perceptions of employee and public reactions. Focus groups were conducted with community members (n = 51) who lived in or near cities where participating employers were based, exploring participants' opinions about why an employer would stop hiring smokers and their support (or not) for such a policy. Most employers excluded from employment those using all forms of nicotine. Several explained their adoption of the policy as a natural extension of a smoke-free campus and as consistent with their identity as health care organizations. They regarded the policy as promoting health. No employer mentioned engaging in a community dialogue before adopting the policy or reported efforts to track the policy's impact on rejected applicants. Community members understood the cost-saving appeal of such policies, but most opposed them. They made few exceptions for health care organizations. Policy decisions undertaken by health care organizations have influence beyond their immediate setting and may establish precedents that others follow. Nonsmoker-only hiring policies may fit with a health care organization's institutional identity but may not be congruent with community values or promote public health.

The growth and development of gerontological nurse leaders in policy.

PubMed

Perez, G Adriana; Mason, Diana J; Harden, J Taylor; Cortes, Tara A

The National Hartford Center of Gerontological Nursing Excellence (NHCGNE) Scholars/Fellows Award Program was designed to promote the growth and development of nurse scientists, educators, and leaders in aging. McBride's conceptual framework of the growth and development of nurse leaders was used to examine the NHCGNE impact on health and aging policy work among scholars/fellows, including barriers, facilitators, and resources. A multimethod two-phased approach included an online survey (phase I) focused on research and policy impact at local, state, or national level. Telephone interviews (phase II) were conducted to further understand the nature, depth, and focus of respondents' policy work. Based on our findings, we propose multilevel recommendations for advancing nurse scientists' capacity to be leaders in shaping policy. Keen research skills are influential in policy advancement but not sufficient to advance policy. Preparing nurse scientists with competencies in translating research into policy can ultimately transform health and health care for older adults. Copyright © 2017 Elsevier Inc. All rights reserved.

Child Care: The Employer's Role. Report of the Task Force on Child Care: Series 4.

ERIC Educational Resources Information Center

Townson, Monica; And Others

The two research studies in this volume focus on the employer's role in child care. The studies were commissioned as part of an effort to provide detailed analyses of issues of special relevance to child care and parental leave policies and the effects of these issues on the Canadian family. Paper l provides a basis for the development of paid…

Providing Child Care to Military Families: The Role of the Demand Formula in Defining Need and Informing Policy

ERIC Educational Resources Information Center

Moini, Joy S.; Zellman, Gail L.; Gates, Susan M.

2006-01-01

The Department of Defense (DoD) is committed to meeting the need for child care among military families. DoD supports the largest employer-sponsored system of high-quality child care in the country. Through accredited child development centers (CDCs), family child care (FCC) homes, youth centers, and other after-school programs, DoD currently…

Group Care for Young Children: Considerations for Child Care and Health Professionals, Public Policy Makers, and Parents. Pediatric Round Table: 12. Summary of a Conference (Key Biscayne, Florida, October 1986).

ERIC Educational Resources Information Center

Gunzenhauser, Nina, Ed.; Caldwell, Bettye M., Ed.

Participants in this pediatric round table met to (l) detrivialize child care; (2) advance the concept of child care as a continuum of services; (3) establish the role of health care professionals in the design and implementation of high quality child care; and (4) develop action guidelines for use by professionals attempting to provide high…

An Australian casemix classification for palliative care: lessons and policy implications of a national study.

PubMed

Eagar, Kathy; Gordon, Robert; Green, Janette; Smith, Michael

2004-04-01

To provide a nontechnical discussion of the development of a palliative care casemix classification and some policy implications of its implementation. 3866 palliative care patients who, in a three month period, had 4596 episodes of care provided by 58 palliative care services in Australia and New Zealand. A detailed clinical and service utilization profile was collected on each patient with staff time and other resources measured on a daily basis. A statistical summary of the clinical variables was compiled as the first stage of the analysis. Palliative care phase was found to be a good predictor of resource use, with patients fairly evenly distributed across the five categories. Clients treated in an inpatient setting had poorer function and higher symptom severity scores than those treated in an ambulatory setting, a result that is not surprising in this Australian setting. Implementation of the resultant AN-SNAP classification has been proceeding since 1998 in some Australian jurisdictions. The development and implementation of a classification such as AN-SNAP provides the possibility of having a consistent approach to collecting palliative care data in Australia as well as a growing body of experience on how to progressively improve the classification over time.

Media and politics: Empirical data on their cross-influence in health policy.

PubMed

2011-01-01

OBJECTIVES: Despite the central influence of public policies on health and welfare, relatively little is known about actual health care policy-making processes. This presentation will offer preliminary results from a federally funded project aimed at gaining insights into the interrelations among interest-group strategies, media discourses and political debates in health care. The policy debate on health care privatization in Quebec is used as a case study. APPROACH: Two sources of data were used: media sources and political debates. Media sources were the six main provincial newspapers in Quebec, two national newspapers and The Canadian Press, as well as transcripts from specific news-related programs of three national television stations and two national radio stations. Political debates were obtained through transcripts of all question periods in the Parliament and debates in the standing committee on health. Sources were systematically searched to identify all relevant data. Multiple search syntaxes were developed and tested to maximize sensitivity and specificity. All data was entered and coded into qualitative analysis software. RESULTS: Data was analyzed longitudinally from June 2005 to January 1, 2010. Four levels of results will be presented: 1) Descriptive analysis of the interest groups involved, their policy preferences and the rhetoric they employed to support their views. 2) Descriptive analysis of the main policy proposals that structured the debate as well as of the coalition of groups behind those proposals. 3) Graphic longitudinal analysis of the intensity of the debate and of the relative importance and evolution of various policy proposals. 4) Preliminary results on the nature, direction and level of inter-influence between the policy and media agendas. CONCLUSION: This presentation provides empirical evidence on current policy-making processes in health care. It shows, unsurprisingly, that policy-making is a circumvoluted process of inter-influence among interest groups, politicians and the media. It also highlights the fact that scientific evidence actually plays a minor (if any) role in policy processes.

Health Services Research for Drug and Alcohol Treatment and Prevention.

PubMed

McCarty, Dennis; Roman, Paul M; Sorensen, James; Weisner, Constance

2009-01-01

Health services research is a multidisciplinary field that examines ways to organize, manage, finance, and deliver high-quality care. This specialty within substance abuse research developed from policy analyses and needs assessments that shaped federal policy and promoted system development in the 1970s. After the authorization of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA), patient information systems supported studies of treatment processes and outcomes. Health services research grew substantially in the 1990s when NIAAA and NIDA moved into the National Institutes of Health and legislation allocated 15% of their research portfolio to services research. The next decade will emphasize research on quality of care, adoption and use of evidence-based practices (including medication), financing reforms and integration of substance abuse treatment with primary care and mental health services.

Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

PubMed

Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

2017-01-01

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

Innovation in Health Policy Education: Project-Based Service Learning at a Distance for Graduate Midwifery Students.

PubMed

Van Hoover, Cheri

2015-01-01

Core competencies for midwifery practice include an understanding of systems of health care delivery and advocacy for legislation and policy initiatives that promote quality in health care. Today's rapidly changing health care environment, due in part to the implementation of the Patient Protection and Affordable Care Act, mandates that midwives possess greater literacy in health policy and comfort with political action than ever before. Frequently disinterested in politics and intimidated by the policymaking process, student midwives lack the foundational knowledge and practical skills needed to meet this professional obligation. The Midwifery Institute of Philadelphia University graduate program educates both student nurse-midwives and student midwives in health policy using an innovative, project-based service-learning approach featuring real-world collaborative experiences. This novel teaching style is ideally suited for instruction at a distance because of the diversity of experience brought to the virtual classroom by students in widely disparate geopolitical locations. As students accomplish measurable objectives within their individually developed projects and reflect with classmates about their experiences, they feel empowered to effect change and report lower perceived barriers to future political engagement. © 2015 by the American College of Nurse-Midwives.

Schizophrenia—Time to Commit to Policy Change

PubMed Central

Fleischhacker, W. Wolfgang

2014-01-01

Care and outcomes for people with schizophrenia have improved in recent years, but further progress is needed to help more individuals achieve an independent and fulfilled life. This report sets out the current need, informs policy makers and all relevant stakeholders who influence care quality, and supports their commitment to creating a better future. The authors recommend the following policy actions, based on research evidence, stakeholder consultation, and examples of best practice worldwide. (1) Provide an evidence-based, integrated care package for people with schizophrenia that addresses their mental and physical health needs. (2) Provide support for people with schizophrenia to enter and to remain in their community, and develop mechanisms to help guide them through the complex benefit and employment systems. (3) Provide concrete support, information, and educational programs to families and carers on how to enhance care for an individual living with schizophrenia in a manner that entails minimal disruption to their lives. (4) All stakeholders, including organizations that support people living with schizophrenia, should be consulted to regularly revise, update, and improve policy on the management of schizophrenia. (5) Provide support, which is proportionate to the impact of the disease, for research and development of new treatments. (6) Establish adequately funded, ongoing, and regular awareness-raising campaigns that form an integral part of routine plans of action. Implementation of the above recommendations will require engagement by every stakeholder, but with commitment from all, change can be achieved. PMID:24778411

The Dutch Health Care Performance Report: seven years of health care performance assessment in the Netherlands.

PubMed

van den Berg, Michael J; Kringos, Dionne S; Marks, Lisanne K; Klazinga, Niek S

2014-01-09

In 2006, the first edition of a monitoring tool for the performance of the Dutch health care system was released: the Dutch Health Care Performance Report (DHCPR). The Netherlands was among the first countries in the world developing such a comprehensive tool for reporting performance on quality, access, and affordability of health care. The tool contains 125 performance indicators; the choice for specific indicators resulted from a dialogue between researchers and policy makers. In the 'policy cycle', the DHCPR can rationally be placed between evaluation (accountability) and agenda-setting (for strategic decision making). In this paper, we reflect on important lessons learned after seven years of health care system performance assessment. These lessons entail the importance of a good conceptual framework for health system performance assessment, the importance of repeated measurement, the strength of combining multiple perspectives (e.g., patient, professional, objective, subjective) on the same issue, the importance of a central role for the patients' perspective in performance assessment, how to deal with the absence of data in relevant domains, the value of international benchmarking and the continuous exchange between researchers and policy makers.

Role of Health Services Research in Producing High-Value Rehabilitation Care.

PubMed

Rundell, Sean D; Goode, Adam P; Friedly, Janna L; Jarvik, Jeffrey G; Sullivan, Sean D; Bresnahan, Brian W

2015-12-01

The concept of value is receiving greater attention in rehabilitation and the broader health care environment. The overall purpose of this article is to present a framework to help clinicians, researchers, educators, and policy makers better understand the role of health services research in developing and evaluating evidence on value in rehabilitation. Value in health care is a multidimensional concept and may be defined differently by various stakeholders, but assessing value typically involves considering a combination of several health and economic outcomes. However, health care stakeholders often lack sufficient information on these outcomes to make well-informed decisions. Health services approaches such as comparative effectiveness research, patient-centered outcomes research, and health economics assessments are some ways to evaluate value. The evidence generated from such studies directly informs decision making and health policy. Rehabilitation professionals have a great opportunity to increase their engagement in describing, evaluating, delivering, and disseminating high-value care, but there are several barriers they need to consider to be most successful. Embracing health services research best practices is essential for advancing appropriate rehabilitation practice, research, and policy and for addressing challenges to implementing high-value care. © 2015 American Physical Therapy Association.

The Impact of Policy Incentives on Long-Term Care Insurance and Medicaid Costs: Does Underwriting Matter?

PubMed

Cornell, Portia Y; Grabowski, David C

2018-05-16

To test whether underwriting modifies the effect of state-based incentives on individuals' purchase of long-term care insurance. Health and Retirement Study (HRS), 1996-2012. We estimated difference-in-difference regression models with an interaction of state policy indicators with individuals' probabilities of being approved for long-term care insurance. We imputed probabilities of underwriting approval for respondents in the HRS using a model developed with underwriting decisions from two U.S. insurance firms. We measured the elasticity response to long-term care insurance price using changes in simulated after-tax price as an instrumental variable for premium price. Tax incentives and Partnership programs increased insurance purchase by 3.62 percentage points and 1.8 percentage points, respectively, among those with the lowest risk (highest approval probability). Neither had any statistically significant effects among the highest risk individuals. We show that ignoring the effects of underwriting may lead to biased estimates of the potential state budget savings of long-term care insurance tax incentives. If the private market is to play a role in financing long-term care, policies need to address the underlying adverse selection problems. © Health Research and Educational Trust.

Role of Health Services Research in Producing High-Value Rehabilitation Care

PubMed Central

Goode, Adam P.; Friedly, Janna L.; Jarvik, Jeffrey G.; Sullivan, Sean D.; Bresnahan, Brian W.

2015-01-01

The concept of value is receiving greater attention in rehabilitation and the broader health care environment. The overall purpose of this article is to present a framework to help clinicians, researchers, educators, and policy makers better understand the role of health services research in developing and evaluating evidence on value in rehabilitation. Value in health care is a multidimensional concept and may be defined differently by various stakeholders, but assessing value typically involves considering a combination of several health and economic outcomes. However, health care stakeholders often lack sufficient information on these outcomes to make well-informed decisions. Health services approaches such as comparative effectiveness research, patient-centered outcomes research, and health economics assessments are some ways to evaluate value. The evidence generated from such studies directly informs decision making and health policy. Rehabilitation professionals have a great opportunity to increase their engagement in describing, evaluating, delivering, and disseminating high-value care, but there are several barriers they need to consider to be most successful. Embracing health services research best practices is essential for advancing appropriate rehabilitation practice, research, and policy and for addressing challenges to implementing high-value care. PMID:26316531

Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples.

PubMed

Bailie, Ross; Si, Damin; Shannon, Cindy; Semmens, James; Rowley, Kevin; Scrimgeour, David J; Nagel, Tricia; Anderson, Ian; Connors, Christine; Weeramanthri, Tarun; Thompson, Sandra; McDermott, Robyn; Burke, Hugh; Moore, Elizabeth; Leon, Dallas; Weston, Richard; Grogan, Haylene; Stanley, Andrew; Gardner, Karen

2010-05-19

Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1) explore the factors associated with variation in clinical performance; 2) examine specific strategies that have been effective in improving primary care clinical performance; and 3) work with health service staff, management and policy makers to enhance the effective implementation of successful strategies. The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria) over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management. By linking researchers directly to users of research (service providers, managers and policy makers), the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary health care and fostering effective and efficient exchange and use of data and information among service providers and policy makers to achieve evidence-based resource allocation, service planning, system development, and improvements of service delivery and Indigenous health outcomes.

DNA methylation in complex disease: applications in nursing research, practice, and policy.

PubMed

Wright, Michelle L; Ralph, Jody L; Ohm, Joyce E; Anderson, Cindy M

2013-01-01

DNA methylation is an epigenomic modification that is essential to normal human development and biological processes. DNA methylation patterns are heritable and dynamic throughout the life span. Environmental exposures can alter DNA methylation patterns, contributing to the development of complex disease. Identification and modulation of environmental factors influencing disease susceptibility through alterations in DNA methylation are amenable to nursing intervention and form the basis for individualized patient care. Here we describe the evidence supporting the translation of DNA methylation analyses as a tool for screening, diagnosis, and treatment of complex disease in nursing research and practice. The ethical, legal, social, and economic considerations of advances in genomics are considered as a model for epigenomic policy. We conclude that contemporary and informed nurse scientists and clinicians are uniquely poised to apply innovations in epigenomic research to clinical populations and develop appropriate policies that guide equitable and ethical use of new strategies to improve patient care. Copyright © 2013 Elsevier Inc. All rights reserved.

Early Childhood Education and Care in Urban China: The Importance of Parental Choice

ERIC Educational Resources Information Center

Nyland, Berenice; Nyland, Chris; Maharaj, Elizabeth Ann

2009-01-01

The education and care of children during their first years has long been a topic of debate for policy-makers and researchers. In recent years, neurological and longitudinal research has highlighted the impact the education and care environment can have on the long-term cognitive, social and emotional development of young children. China's…

Improving the Postsecondary Educational Attainment of Youth in Foster Care

ERIC Educational Resources Information Center

Dworsky, Amy

2018-01-01

This chapter examines what we know about the disparity in postsecondary educational attainment between youth in foster care and their non-foster care peers, the reasons for it, and the policies and programs that have been developed to address that disparity. It also discusses the unique role that community colleges can play in reducing this…

The Supply of Dentists and Access to Care in Rural Kansas

ERIC Educational Resources Information Center

Allison, R. Andrew; Manski, Richard J.

2007-01-01

Context: Rural deficits in dental care and oral health are well documented and are typically attributed to the low number of dentists practicing in rural areas, but the relationships between rural residence, dental supply, and access to care have not been firmly established, impeding the development of effective public policy. Purpose: The purpose…

Five policies to promote palliative care for patients with ESRD.

PubMed

Tamura, Manjula Kurella; Meier, Diane E

2013-10-01

Patients with ESRD experience complex and costly care that does not always meet their needs. Palliative care, which focuses on improving quality of life and relieving suffering for patients with serious illnesses, could address a large unmet need among patients with ESRD. Strengthening palliative care is a top policy priority for health reform efforts based on strong evidence that palliative care improves value. This commentary outlines palliative care policies for patients with ESRD and is directed at policymakers, dialysis providers, nephrology professional societies, accreditation organizations, and funding agencies who play a key role in the delivery and determination of quality of ESRD care. Herein we suggest policies to promote palliative care for patients with ESRD by addressing key barriers, including the lack of access to palliative care, lack of capacity to deliver palliative care, and a limited evidence base. We also provide examples of how these policies could be implemented within the existing ESRD care infrastructure.

Estimating the Size and Components of the U.S. Child Care Workforce and Caregiving Population. Key Findings from the Child Care Workforce Estimate. Preliminary Report.

ERIC Educational Resources Information Center

Burton, Alice; Whitebook, Marcy; Young, Marci; Bellm, Dan; Wayne, Claudia; Brandon, Richard N.; Maher, Erin

In response to rising demand for information on the child care workforce, the Center for the Child Care Workforce (CCW) and the Human Services Policy Center (HSPC) have initiated a 2-year project to develop a framework and methodology for quantifying the size and characteristics of the U.S. child care workforce, focusing on the workforce serving…

Ten Years of a National Oral Health Policy in Brazil: Innovation, Boldness, and Numerous Challenges.

PubMed

Pucca, G A; Gabriel, M; de Araujo, M E; de Almeida, F C S

2015-10-01

Brazil is the only country in the world to propose a universal health care system with the aim of guaranteeing delivery of all levels of health care, free of charge, to a population of over 200 million inhabitants by means of a unified health system ("Sistema Único de Saúde" [SUS]). The national policy of oral health, also known as Smiling Brazil ("Brasil Sorridente"), was implemented in 2004. Oral health was designated as 1 of the 4 priority areas of the SUS, transforming oral health care in Brazil, with the objective that the SUS achieve the integrality of care envisaged at its creation. The aim of this article is to share part of this experience in order to prompt reflection about the inclusion of oral health care in other health care systems around the world. The most significant results of Smiling Brazil can be seen in 3 areas: (1) oral health epidemiological indicators, (2) financial investment and professional development, and (3) the building of an oral health care network throughout the 10 y of the policy. The "Discovery!" article presented here portrays 10 y of evolution; however, it is important to point out that this is a process undergoing construction and that the oral health care network needs to be further expanded, refined, and solidified so that over time and through changes in the political parties in power, Smiling Brazil prevails as a perennial policy and not merely an action by a single government. © International & American Associations for Dental Research 2015.

Maintaining the Social Flow of Evidence-Informed Palliative Care: Use and Misuse of YouTube

PubMed Central

Jamwal, Nisha Rani; Kumar, Senthil Paramasivam

2016-01-01

This review article is aimed to explore the use of the social media website YouTube (www.youtube.com) as an evidence resource in palliative care, for patients and caregivers, students and professionals, and providers and policy-makers in developing countries’ settings. The reviewed evidence reiterated the role of this social media website in palliative care practice, education and research in the area of cancer. Efficacy studies on impact of such media on palliative care delivery in developing countries are still lacking. PMID:26962290

From Policy to Practice: Implementation of Water Policies in Child Care Centers in Connecticut

ERIC Educational Resources Information Center

Middleton, Ann E.; Henderson, Kathryn E.; Schwartz, Marlene B.

2013-01-01

Objective: Child care policies may contribute to healthy beverage consumption patterns. This study documented availability and accessibility of water and correspondence with state and federal policy and accreditation standards in child care centers. Design: One-day observations were conducted in a random sample of 40 Child and Adult Care Food…

Health policy in Denmark: leaving the decentralized welfare path?

PubMed

Vrangbaek, Karsten; Christiansen, Terkel

2005-01-01

In this article, we investigate developments in Danish health care policy. After a short presentation of its historical roots, we focus on the decades after the administrative reform of 1970, which shaped the current decentralized public health care system. Theories of path dependency and institutional inertia are used to explain the relative stability in the overall structure, and theories of policy process and reform are used to discuss gradual changes within the overall framework. Although comprehensive reforms have not taken place in Denmark, many gradual changes may pave the way for more radical changes in the future. The political climate currently seems to be more favorable toward structural reform than in the past.

Collaborative Practitioner Research: Opening a Third Space for Local Knowledge Production

ERIC Educational Resources Information Center

Skattebol, Jen; Arthur, Leonie Maree

2014-01-01

Early childhood education and care is currently experiencing unprecedented policy interest and expansion. This policy and practice landscape requires new forms of adaptive leadership, new spaces for production of the knowledge necessary for this changing context, and tools that can support the development of leadership qualities. This paper…

Moving Forward or Standing Still? A Reflection of "Special" Educational Provision in Malaysia

ERIC Educational Resources Information Center

Chong, Pei Wen

2016-01-01

This paper investigates influential discourses embedded within policy documents and policy-makers' accounts to trace special education development in Malaysia. With a heavy reliance on the medical model, the distinction of the "educable" and "ineducable" based on self-care abilities is incongruent with inclusive ideals that…

Teacher Responsibility: Shifting Care from Student to (Professional) Self?

ERIC Educational Resources Information Center

Chatelier, Stephen; Rudolph, Sophie

2018-01-01

The professionalisation of teaching in Australia is a policy shift that transpires within broader policy dynamics which are increasingly influenced by neoliberal logics. In this article we examine teacher responsibility through analysis of a new measure introduced in Victoria. This requires teachers to prove professional development hours in the…

Campuses Confront AIDS: Tapping the Vitality of Caring and Community.

ERIC Educational Resources Information Center

Keeling, Richard P.

1993-01-01

In response to needs created by the acquired immune deficiency syndrome (AIDS) epidemic, colleges and universities have struggled to develop or redesign policies and services to promote behavioral change. Effective institutional response requires comprehensive policy, services and referral, and education and prevention focusing on identity and…

Technology assessment in medicine. The role of the American Medical Association.

PubMed

McGivney, W T; Hendee, W R

1988-12-01

Public policy decisions about health care and decisions about an individual patient's care are only as sound as the data and information on which they are founded. The formal systematic evaluation of the safety, effectiveness, and cost-effectiveness of a medical technology provides such information and is essential to the appropriate application of technology in patient care. The American Medical Association (AMA) historically has recognized the need for the practicing medical community to develop and communicate accurate and balanced evaluative information to physicians and other health care professionals. In recent years, the association has established formal programs to accomplish this objective. This article describes the AMA's three major assessment programs, the Diagnostic and Therapeutic Technology Assessment program, the Council on Scientific Affairs, and AMA Drug Evaluations. The implications of these activities for patient care and public policy are discussed.

The 2016 Academic Emergency Medicine Consensus Conference, Shared Decision Making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda May 10, 2016, New Orleans, LA.

PubMed

Grudzen, Corita R; Anderson, Jana R; Carpenter, Christopher R; Hess, Erik P

2016-12-01

Shared decision making in emergency medicine has the potential to improve the quality, safety, and outcomes of emergency department (ED) patients. Given that the ED is the gateway to care for patients with a variety of illnesses and injuries and the safety net for patients otherwise unable to access care, shared decision making in the ED is relevant to numerous disciplines and the interests of the United States (U.S.) public. On May 10, 2016 the 16th annual Academic Emergency Medicine (AEM) consensus conference, "Shared Decision Making: Development of a Policy-Relevant Patient-Centered Research Agenda" was held in New Orleans, Louisiana. During this one-day conference clinicians, researchers, policy-makers, patient and caregiver representatives, funding agency representatives, trainees, and content experts across many areas of medicine interacted to define high priority areas for research in 1 of 6 domains: 1) diagnostic testing; 2) policy, 3) dissemination/implementation and education, 4) development and testing of shared decision making approaches and tools in practice, 5) palliative care and geriatrics, and 6) vulnerable populations and limited health literacy. This manuscript describes the current state of shared decision making in the ED context, provides an overview of the conference planning process, the aims of the conference, the focus of each respective breakout session, the roles of patient and caregiver representatives and an overview of the conference agenda. The results of this conference published in this issue of AEM provide an essential summary of the future research priorities for shared decision making to increase quality of care and patient-centered outcomes. © 2016 by the Society for Academic Emergency Medicine.

International nurse migration: lessons from the Philippines.

PubMed

Brush, Barbara L; Sochalski, Julie

2007-02-01

Developed countries facing nursing shortages have increasingly turned to aggressive foreign nurse recruitment, primarily from developing nations, to offset their lagging domestic nurse supplies and meet growing health care demands. Few donor nations are prepared to manage the loss of their nurse workforce to migration. The sole country with an explicit nurse export policy and the world's leading donor of nurse labor - the Philippines - is itself facing serious provider maldistribution and countrywide health disparities. Examining the historical roots of Philippines nurse migration provides lessons from which other nurse exporting countries may learn. The authors discuss factors that have predicated nurse migration and policies that have eased the way. Furthermore, the authors analyze how various stakeholders influence migratory patterns, the implications of migration for nurses and the public in their care, and the challenges that future social policy and political systems face in addressing global health issues engendered by unfettered recruitment of nurses and other health workers.

[Human resources for health in Chile: the reform's pending challenge].

PubMed

Méndez, Claudio A

2009-09-01

Omission of human resources from health policy development has been identified as a barrier in the health sector reform's adoption phase. Since 2002, Chile's health care system has been undergoing a transformation based on the principles of health as a human right, equity, solidarity, efficiency, and social participation. While the reform has set forth the redefinition of the medical professions, continuing education, scheduled accreditation, and the introduction of career development incentives, it has not considered management options tailored to the new setting, a human resources strategy that has the consensus of key players and sector policy, or a process for understanding the needs of health care staff and professionals. However, there is still time to undo the shortcomings, in large part because the reform's implementation phase only recently has begun. Overcoming this challenge is in the hands of the experts charged with designing public health strategies and policies.

Health Care Policies for Children in Out-of-Home Care.

ERIC Educational Resources Information Center

Risley-Curtiss, Christina; Kronenfeld, Jennie Jacobs

2001-01-01

Examined health care policies and services for children under 46 state welfare agencies. Found that most states had written policies regarding health care for foster children, but half had no management system to record health care data. Most states did not meet standards set by the Child Welfare League of America for health care of these…

Towards integrated care for chronic conditions: Dutch policy developments to overcome the (financial) barriers.

PubMed

Tsiachristas, Apostolos; Hipple-Walters, Bethany; Lemmens, Karin M M; Nieboer, Anna P; Rutten-van Mölken, Maureen P M H

2011-07-01

Chronic non-communicable diseases are a major threat to population health and have a major economic impact on health care systems. Worldwide, integrated chronic care delivery systems have been developed to tackle this challenge. In the Netherlands, the recently introduced integrated payment system--the chain-DTC--is seen as the cornerstone of a policy stimulating the development of a well-functioning integrated chronic care system. The purpose of this paper is to describe the recent attempts in the Netherlands to stimulate the delivery of integrated chronic care, focusing specifically on the new integrated payment scheme and the barriers to introducing this scheme. We also highlight possible threats and identify necessary conditions to the success of the system. This paper is based on a combination of methods and sources including literature, government documents, personal communications and site visits to disease management programs (DMPs). The most important conditions for the success of the new payment system are: complete care protocols describing both general (e.g. smoking cessation, physical activity) and disease-specific chronic care modules, coverage of all components of a DMP by basic health care insurance, adequate information systems that facilitate communication between caregivers, explicit links between the quality and the price of a DMP, expansion of the amount of specialized care included in the chain-DTC, inclusion of a multi-morbidity factor in the risk equalization formula of insurers, and thorough economic evaluation of DMPs. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Opening the black box of ethics policy work: evaluating a covert practice.

PubMed

Frolic, Andrea; Drolet, Katherine; Bryanton, Kim; Caron, Carole; Cupido, Cynthia; Flaherty, Barb; Fung, Sylvia; McCall, Lori

2012-01-01

Hospital ethics committees (HECs) and ethicists generally describe themselves as engaged in four domains of practice: case consultation, research, education, and policy work. Despite the increasing attention to quality indicators, practice standards, and evaluation methods for the other domains, comparatively little is known or published about the policy work of HECs or ethicists. This article attempts to open the "black box" of this health care ethics practice by providing two detailed case examples of ethics policy reviews. We also describe the development and application of an evaluation strategy to assess the quality of ethics policy review work, and to enable continuous improvement of ethics policy review processes. Given the potential for policy work to impact entire patient populations and organizational systems, it is imperative that HECs and ethicists develop clearer roles, responsibilities, procedural standards, and evaluation methods to ensure the delivery of consistent, relevant, and high-quality ethics policy reviews.

Primary health care in Canada: systems in motion.

PubMed

Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie

2011-06-01

During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

Toward an Effective Parenting Partnership for Children in Child Welfare Agencies and Foster Parent Programs.

ERIC Educational Resources Information Center

MacLean, Ian N.

This practicum was designed to improve the level and quality of involvement of foster parents and social workers in the development of timely and compliant foster care plans at a child care agency in Ontario. The writer developed: (1) an agency policy that defined the unique relationship between foster parents and the child welfare agency and…

British Society of Paediatric Dentistry: a policy document on consent and the use of physical intervention in the dental care of children.

PubMed

Nunn, June; Foster, Martin; Master, Selina; Greening, Sue

2008-11-01

This policy document was prepared by J Nunn, M Foster, S Master and S Greening on behalf of the British Society of Paediatric Dentistry (BSPD). Policy documents produced by the BSPD represent a majority view, based on a consideration of currently available evidence. They are produced to provide guidance with the intention that the policy be regularly reviewed and updated to take account of changing views and developments.

Categorizing the telehealth policy response of countries and their implications for complementarity of telehealth policy.

PubMed

Varghese, Sunil; Scott, Richard E

2004-01-01

Developing countries are exploring the role of telehealth to overcome the challenges of providing adequate health care services. However, this process faces disparities, and no complementarity in telehealth policy development. Telehealth has the potential to transcend geopolitical boundaries, yet telehealth policy developed in one jurisdiction may hamper applications in another. Understanding such policy complexities is essential for telehealth to realize its full global potential. This study investigated 12 East Asian countries that may represent a microcosm of the world, to determine if the telehealth policy response of countries could be categorized, and whether any implications could be identified for the development of complementary telehealth policy. The countries were Cambodia, China, Hong Kong, Indonesia, Japan, Malaysia, Myanmar, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Three categories of country response were identified in regard to national policy support and development. The first category was "None" (Cambodia, Myanmar, and Vietnam) where international partners, driven by humanitarian concerns, lead telehealth activity. The second category was "Proactive" (China, Indonesia, Malaysia, Singapore, South Korea, Taiwan, and Thailand) where national policies were designed with the view that telehealth initiatives are a component of larger development objectives. The third was "Reactive" (Hong Kong and Japan), where policies were only proffered after telehealth activities were sustainable. It is concluded that although complementarity of telehealth policy development is not occurring, increased interjurisdictional telehealth activity, regional clusters, and concerted and coordinated effort amongst researchers, practitioners, and policy makers may alter this trend.

Palliative care in India: successes and limitations.

PubMed

Rajagopal, M R; Venkateswaran, Chitra

2003-01-01

Palliative care in India is in a relatively early stage of development and consequently faces numerous problems. The extent of problems relating to the lack of such care is not well described for cancer or nonmalignant diseases. Opioid availability is seriously limited. Many inexpensive drugs are not readily available and some very expensive drugs are often prescribed, adding to the patients' burden. Enormous psychosocial needs often are neglected in busy clinics. The government's palliative care policy has not been implemented. There are clear needs for improvement in multiple areas that must be addressed as new services develop. A system based on outpatient care has proven cost-effective, empowering families to care for patients at home. Whenever possible, inpatient facility and home visits should be available for those who need them. Some measures of quality assurance should develop concurrent with growth of the palliative care movement. Successes and problems in the development of palliative care in India are discussed.

Health policy evolution in Lao People's Democratic Republic: context, processes and agency.

PubMed

Jönsson, Kristina; Phoummalaysith, Bounfeng; Wahlström, Rolf; Tomson, Göran

2015-05-01

During the last 20 years Lao People's Democratic Republic has successfully developed and adopted some 30 health policies, strategies, decrees and laws in the field of health. Still, the implementation process remains arduous. This article aims at discussing challenges of health policy development and effective implementation by contextualizing the policy evolution over time and by focusing particularly on the National Drug Policy and the Health Care Law. Special attention is given to the role of research in policymaking. The analysis was guided by the conceptual framework of policy context, process, content and actors, combined with an institutional perspective, and showed that effective implementation of a health policy is highly dependent on both structures and agency of those involved in the policy process. The National Drug Policy was formulated and adopted in a short period of time in a resource-scarce setting, but with dedicated policy entrepreneurs and support of concerned international collaborators. Timely introduction of operational health systems research played a crucial role to support the implementation, as well as the subsequent revision of the policy. The development of the Health Care Law took several years and once adopted, the implementation was delayed by institutional legacies and issues concerning the choice of institutional design and financing, despite strong support of the law among the policymakers. Among many factors, timing of the implementation appeared to be of crucial importance, in combination with strong leadership. These two examples show that more research, that problematizes the complex policy environment in combination with improved communication between researchers and policymakers, is necessary to inform about measures for effective implementation. A way forward can be to strengthen the domestic research capacity and the international research collaboration regionally as well as globally. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. © The Author 2014.

Can innovative health financing policies increase access to MDG-related services? Evidence from Rwanda.

PubMed

Sekabaraga, Claude; Diop, Francois; Soucat, Agnes

2011-11-01

Ensuring financial access to health services is a critical challenge for poor countries if they are to reach the health Millennium Development Goals (MDGs). This article examines the case of Rwanda, a country which has championed innovative health care financing policies. Between 2000 and 2007, Rwanda has improved financial access for the poor, increased utilization of health services and reduced out-of-pocket payments for health care. Poor groups' utilization has increased for all health services, sometimes dramatically. Use of assisted deliveries, for example, increased from 12.1% to 42.7% among the poorest quintile; payments at the point of delivery have also been reduced; and catastrophic expenditures have declined. Part of these achievements is likely linked to innovative health financing policies, particularly the expansion of micro-insurance ('mutuelles') and performance-based financing. The paper concludes that the Rwanda experience provides a useful example of effective implementation of policies that reduce the financial barrier to health services, hereby contributing to the health MDGs. Today's main challenge is to build the sustainability of this system. Finally, the paper proposes a simple set of rigorous metrics to assess the impact of health financing policies and calls for implementing rigorous impact evaluation of health care financing policies in low-income countries.

Does public reporting measure up? Federalism, accountability and child-care policy in Canada.

PubMed

Anderson, Lynell; Findlay, Tammy

2010-01-01

Governments in Canada have recently been exploring new accountability measures within intergovernmental relations. Public reporting has become the preferred mechanism in a range of policy areas, including early learning and child-care, and the authors assess its effectiveness as an accountability measure. The article is based on their experience with a community capacity-building project that considers the relationship between the public policy, funding and accountability mechanisms under the federal/provincial/territorial agreements related to child-care. The authors argue that in its current form, public reporting has not lived up to its promise of accountability to citizens. This evaluation is based on the standards that governments have set for themselves under the federal/provincial/territorial agreements, as well as guidelines set by the Public Sector Accounting Board, an independent body that develops accounting standards over time through consultation with governments.

Will housing tenure drive unequal outcomes for Consumer-Directed Care recipients?

PubMed

Cornell, Victoria

2018-06-01

Initiatives to promote consumer choice are increasingly a feature of Australian welfare policies and programs. Consumer Directed Care (CDC) for older people and the National Disability Insurance Scheme for people younger than 65 years with a disability are two examples of this move towards consumer choice in policy and program development. The ability for service users to benefit from these programs is premised on the fact that their housing is stable and suitable. Yet, there is evidence that this is not the case, and many older people and people with disabilities experience significant housing challenges and stress. This article focuses on CDC and its implications for one particular group under housing stress - low-income older renters. Might they be at risk of limited access to home care services, and what are the broader local neighbourhood implications of this policy? © 2018 AJA Inc.

What constitutes an effective community pharmacy?--development of a preliminary model of organizational effectiveness through concept mapping with multiple stakeholders.

PubMed

Scahill, S L; Harrison, J; Carswell, P

2010-08-01

To develop a multi-constituent model of organizational effectiveness for community pharmacy. Using Concept Systems software, a project with 14 stakeholders included a three stage process: (i) face to face brainstorming to generate statements describing what constitutes an effective community pharmacy, followed by (ii) statement reduction and approval by participants, followed by (iii) sorting of the statements into themes with rating of each statement for importance. Primary care in a government-funded, national health care system. A multi-constituent group representing policy-makers and health care providers including; community pharmacy, professional pharmacy organizations, primary health care funders and policy-makers, general practitioners and general practice support organizations. Statement clusters included: 'has safe and effective workflows', 'contributes to the safe use of medicines', 'manages human resources and has leadership', 'has a community focus', 'is integrated within primary care', 'is a respected innovator', 'provides health promotion and preventative care', 'communicates and advocates'. These clusters fit into a quadrant model setting stakeholder focus against role development. The poles of stakeholder focus are 'internal capacity' and 'social utility'. The poles of role development are labelled 'traditional safety roles' and 'integration and innovation'. Organizational effectiveness in community pharmacy includes the internal and external focus of the organization and role development. Our preliminary model describes an effective community pharmacy and provides a platform for investigation of the factors that may influence the organizational effectiveness of individual community pharmacies now and into the future.

The match between institutional elderly care management research and management challenges - a systematic literature review.

PubMed

Kokkonen, Kaija; Rissanen, Sari; Hujala, Anneli

2012-11-08

Elderly care practice and its management together with policy and research play a crucial role in responding to increasing challenges in institutional care for elderly people. Successful dialogue between these is necessary. The purpose of this systematic literature review is to compare how institutional elderly care management research meets the care challenges currently emphasized in international long-term care policy documents. This paper was based on a systematic literature review. After screening 1971 abstracts using inclusion/exclusion criteria, 58 refereed articles published between 2000 and 2010 remained for analysis. The articles were analyzed using theory-based content analysis by comparing the results to the framework based on analysis of international long-term care management policy documents. The current challenges of long-term care management identified from policy documents were Integrated Care Management, Productivity Management, Quality Management, Workforce Management and ICT Management. The research on institutional elderly care management responded somewhat to the challenges mentioned in policy documents. However, some of the challenges were studied broadly and some were paid only minor attention. Further, only few studies focused on the core items of challenges addressed in policy documents. Institutional care management research needs to focus more on challenges in integrated care, productivity, ICT and division of labor. Managers, researchers and policy-makers should assume more active collaborative roles in processes of research, policymaking and policy implementation. In addition managers' and policymakers' scientific literacy needs to be enhanced.

The match between institutional elderly care management research and management challenges - a systematic literature review

PubMed Central

2012-01-01

Background Elderly care practice and its management together with policy and research play a crucial role in responding to increasing challenges in institutional care for elderly people. Successful dialogue between these is necessary. The purpose of this systematic literature review is to compare how institutional elderly care management research meets the care challenges currently emphasized in international long-term care policy documents. Methods This paper was based on a systematic literature review. After screening 1971 abstracts using inclusion/exclusion criteria, 58 refereed articles published between 2000 and 2010 remained for analysis. The articles were analyzed using theory-based content analysis by comparing the results to the framework based on analysis of international long-term care management policy documents. Results The current challenges of long-term care management identified from policy documents were Integrated Care Management, Productivity Management, Quality Management, Workforce Management and ICT Management. The research on institutional elderly care management responded somewhat to the challenges mentioned in policy documents. However, some of the challenges were studied broadly and some were paid only minor attention. Further, only few studies focused on the core items of challenges addressed in policy documents. Conclusions Institutional care management research needs to focus more on challenges in integrated care, productivity, ICT and division of labor. Managers, researchers and policy-makers should assume more active collaborative roles in processes of research, policymaking and policy implementation. In addition managers’ and policymakers’ scientific literacy needs to be enhanced. PMID:23137416

The French health care system: liberal universalism.

PubMed

Steffen, Monika

2010-06-01

This article analyzes the reforms introduced over the last quarter century into the French health care system. A particular public-private combination, rooted in French history and institutionalized through a specific division of the policy field between private doctors and public hospitals, explains the system's core characteristics: universal access, free choice, high quality, and a weak capacity for regulation. The dual architecture of this unique system leads to different reform strategies and outcomes in its two main parts. While the state has leverage in the hospital sector, it has failed repeatedly in attempts to regulate the ambulatory care sector. The first section of this article sets out the main characteristics and historical landmarks that continue to affect policy framing and implementation. Section 2 focuses on the evolution in financing and access, section 3 on management and governance in the (private) ambulatory care sector, and section 4 on the (mainly public) hospital sector. The conclusion compares the French model with those developed in the comparative literature and sets out the terms of the dilemma: a state-run social health insurance that lacks both the legitimacy of Bismarckian systems and the leverages of state-run systems. The French system therefore pursues contradictory policy goals, simultaneously developing universalism and liberalism, which explains both the direct state intervention and its limits.

Negotiating and managing partnership in primary care.

PubMed

Charlesworth, J

2001-09-01

In the UK public service organisations are increasingly working together in new partnerships, networks and alliances, largely stimulated by government legislation, which aims to encourage 'joined-up' policy-making. This is particularly prevalent in health-care where local government, health authorities and trusts, voluntary and community groups are extending existing, and developing new, forms of partnership, particularly around Health Improvement Programmes and new primary care organisations. This paper explores two main aspects of how these new interorganizational relationships are being developed and managed and is based on research conducted in one case study locality. First, the new structures of partnership in primary care are mapped out, together with discussion on why these particular patterns of relationship between statutory and voluntary sector organisations have emerged, exploring both centrally and locally determined influences. Secondly, the paper explores the tensions associated with working within new policy-making and management structures, and how the additional demands of audit, performance measurement and the sheer pace of change, pose a potential threat to the partnership process.

Working on reform. How workers' compensation medical care is affected by health care reform.

PubMed Central

Himmelstein, J; Rest, K

1996-01-01

The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies? Images p13-a p14-a p15-a p16-a p18-a p19-a p20-a p22-a p24-a PMID:8610187

How Do Health Care Providers Diagnose Hypoparathyroidism?

MedlinePlus

... Funding Opportunities & Notices Contract Opportunities Grants Process, Policies & Strategies Peer Review Small Business Programs Training & Career Development For Applicants Sample Applications ...

Policy issues related to educating the future Israeli medical workforce: an international perspective.

PubMed

Schoenbaum, Stephen C; Crome, Peter; Curry, Raymond H; Gershon, Elliot S; Glick, Shimon M; Katz, David R; Paltiel, Ora; Shapiro, Jo

2015-01-01

A 2014 external review of medical schools in Israel identified several issues of importance to the nation's health. This paper focuses on three inter-related policy-relevant topics: planning the physician and healthcare workforce to meet the needs of Israel's population in the 21(st) century; enhancing the coordination and efficiency of medical education across the continuum of education and training; and the financing of medical education. All three involve both education and health care delivery. The physician workforce is aging and will need to be replenished. Several physician specialties have been in short supply, and some are being addressed through incentive programs. Israel's needs for primary care clinicians are increasing due to growth and aging of the population and to the increasing prevalence of chronic conditions at all ages. Attention to the structure and content of both undergraduate and graduate medical education and to aligning incentives will be required to address current and projected workforce shortage areas. Effective workforce planning depends upon data that can inform the development of appropriate policies and on recognition of the time lag between developing such policies and seeing the results of their implementation. The preclinical and clinical phases of Israeli undergraduate medical education (medical school), the mandatory rotating internship (stáge), and graduate medical education (residency) are conducted as separate "silos" and not well coordinated. The content of basic science education should be relevant to clinical medicine and research. It should stimulate inquiry, scholarship, and lifelong learning. Clinical exposures should begin early and be as hands-on as possible. Medical students and residents should acquire specific competencies. With an increasing shift of medical care from hospitals to ambulatory settings, development of ambulatory teachers and learning environments is increasingly important. Objectives such as these will require development of new policies. Undergraduate medical education (UME) in Israel is financed primarily through universities, and they receive funds through VATAT, an education-related entity. The integration of basic science and clinical education, development of earlier, more hands-on clinical experiences, and increased ambulatory and community-based medical education will demand new funding and operating partnerships between the universities and the health care delivery system. Additional financing policies will be needed to ensure the appropriate infrastructure and support for both educators and learners. If Israel develops collaborations between various government agencies such as the Ministries of Education, Health, and Finance, the universities, hospitals, and the sick funds (HMOs), it should be able to address successfully the challenges of the 21st century for the health professions and meet its population's needs.

JERM model of care: an in-principle model for dental health policy.

PubMed

Lam, Raymond; Kruger, Estie; Tennant, Marc

2014-01-01

Oral diseases are the most prevalent conditions in the community. Their economic burden is high and their impact on quality of life is profound. There is an increasing body of evidence indicating that oral diseases have wider implications beyond the confines of the mouth. The importance of oral health has not been unnoticed by the government. The Commonwealth (Federal) government under the Howard-led Coalition in 2004 had broken tradition by placing dentistry in its universal health insurance scheme, Medicare. Known as the Chronic Disease Dental Scheme (CDDS), the program aimed to manage patients with chronic conditions as part of the Enhanced Primary Care initiative. This scheme was a landmark policy for several reasons. Besides being the first major dental policy under Medicare, the program proved to be the most expensive and controversial. Unfortunately, cost containment and problems with service provision led to its cessation in 2012 by the Gillard Labor Government. Despite being seen as a failure, the CDDS provided a unique opportunity to assess national policy in practice. By analysing the policy-relevant effects of the CDDS, important lessons can be learnt for policy development. This paper discusses these lessons and has formulated a set of principles recommended for effective oral health policy. The JERM model represents the principles of a justified, economical and research-based model of care.

Translational Genomics in Low and Middle Income Countries: Opportunities and Challenges

PubMed Central

Tekola-Ayele, Fasil; Rotimi, Charles N.

2015-01-01

Translation of genomic discoveries into patient care is slowly becoming a reality in developed economies around the world. In contrast, low and middle income countries (LMIC) have participated minimally in genomic research for several reasons including lack of coherent national policies, limited number of well-trained genomic scientists, poor research infrastructure, and local economic and cultural challenges. Recent initiatives such as the Human Heredity and Health in Africa (H3Africa), the Qatar Genome Project and the Mexico National Institute of Genomic Medicine (INMEGEN) that aim to address these problems through capacity building and empowerment of local researchers have sparked a paradigm shift. In this short communication, we describe experiences of small-scale medical genetics and translational genomics research programs in LMIC. The lessons drawn from these programs drive home the importance of addressing resource, policy, and socio-cultural dynamics to realize the promise of precision medicine driven by genomic science globally. By echoing lessons from a bench-to-community translational genomics research, we advocate that large-scale genomics research projects can be successfully linked with health care programs. To harness the benefits of genomics-led health care, LMIC governments should begin to develop national genomics policies that will address human and technology capacity development within the context of their national economic and socio-cultural uniqueness. These policies should encourage international collaboration and promote link between the public health program and genomics researchers. Finally, we highlight the potential catalytic roles of the global community to foster translational genomics in LMIC. PMID:26138992

Gender, ageing, and injustice: social and political contexts of bioethics.

PubMed

Dodds, S

2005-05-01

There has been considerable work in bioethics addressing injustice and gender oppression in the provision of healthcare services, in the interaction between client and healthcare professional, and in allocation of healthcare services within a particular hospital or health service. There remain several sites of continued injustice that can only be addressed adequately from a broader analytical perspective, one that attends to the social and political contexts framing healthcare policy and practice. Feminist bioethicists have a strong track record in providing this kind of analysis. Using current Australian aged care and welfare policy this paper demonstrates some of the ways in which issues of gender, age, and social inequity shape bioethical debate, policy, and practice in the areas of aged care and welfare provision. The author develops an argument that demonstrates the gender injustice underlying health care and welfare policy. This argument recognises the inevitability of human dependency relations, and questions the adequacy of current political theories to address the requirements for full and equal citizenship. The author shows that an adequate analysis of the ethics of aged healthcare depends on sufficient consideration of the social and political context within which healthcare policy is framed and an adequate understanding of human dependency.

The health care bureaucracy: small changes, big consequences.

PubMed

Morone, J A

1993-01-01

Administrative changes have been reshaping health policy for the past decade. One consequence is a more constrained medical profession. Another is a more powerful health care bureaucracy. Most industrialized nations have called on democratic principles to balance professional norms; in contrast, Americans are developing a distinctly bureaucratic health care regime. This article suggests why and explores the ramifications for both the politics of health care and the practice of medicine.

Disintegrated care: the Achilles heel of international health policies in low and middle-income countries

PubMed Central

Unger, Jean-Pierre; De Paepe, Pierre; Ghilbert, Patricia; Soors, Werner; Green, Andrew

2006-01-01

Abstract Purpose To review the evidence basis of international aid and health policy. Context of case Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. Data sources National policies, international programmes and pilot experiments are examined in both scientific and grey literature. Conclusions and discussion We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care. PMID:17006553

Good intentions, increased inequities: developing social care services in Emergency Departments in the UK.

PubMed

Bywaters, Paul; McLeod, Eileen; Fisher, Joanne; Cooke, Matthew; Swann, Garry

2011-09-01

Addressing the quality of services provided in Emergency Departments (EDs) has been a central area of development for UK government policy since 1997. Amongst other aspects of this concern has been the recognition that EDs constitute a critical boundary between the community and the hospital and a key point for the identification of social care needs. Consequently, EDs have become the focus for a variety of service developments which combine the provision of acute medical and nursing assessment and care with a range of activities in which social care is a prominent feature. One approach to this has been the establishment of multidisciplinary teams aiming to prevent re-attendance or admission, re-direct patients to other services, or speed patients through EDs with the aim of providing improved quality of care. This study, carried out between September 2007 and April 2008, was the first UK national survey of social care initiatives based in EDs and aimed to determine the objectives, organisation, extent, functions, funding and evidence on outcomes of such interventions. Eighty-three per cent of UK Type I and II EDs responded to the survey. Approximately, one-third of EDs had embedded social care teams, with two-thirds relying on referrals to external social care services. These teams varied in their focus, size and composition, leadership, availability, funding and permanence. As a result, the unintended effect has been to increase inequities in access to social care services through EDs. Three further conclusions are drawn about policy led, locally-based service development. This survey adds to international evidence pointing to the potential benefits of a variety of social care interventions being based in EDs and justifies the establishment of a research programme which can provide answers to key outstanding questions. © 2011 Blackwell Publishing Ltd.

A situational analysis of ocular health promotion in the South African primary health-care system.

PubMed

Sithole, Hlupheka Lawrence

2017-03-01

South Africa has a serious burden of avoidable blindness and visual impairment, which may be due to poor ocular health promotional policies and programs or implementation. Therefore, this paper sought to critically analyse the South African primary health-care policies and programs, to identify the components of ocular health promotional policies and programs as well as how they are currently being implemented and to suggest areas that can be improved in order to minimise the burden of blindness and visual impairment. Triangulated quantitative and qualitative research methods were used in the study. Questionnaire and interviews were used to solicit data from national and provincial managers of different health directorates. Eye-care managers from each province also completed the questionnaire. Furthermore, relevant health policy and program documents from national and provincial departments of health were studied to identify areas relating to ocular health promotion. The study found varying degrees of implementation of various ocular health promotional activities in the provinces with the majority of respondents (62 per cent) indicating that ocular health promotion was not part of their responsibility and another 81 per cent revealing that vision screening does not form part of their health promotional programs. It further revealed a lack of a dedicated directorate for ocular health-care issues and the absence of an integrated ocular health promotional policy. Ocular health promotional activities were absent in other provinces. This may be a major contributing factor to poor ocular health promotion in South Africa and hence, the high prevalence of blindness and visual impairment. Therefore, it is recommended that an integrated ocular health promotional model (directorate and policies) be developed and be part of the South African primary health-care system. © 2016 Optometry Australia.

eHealth in Latin America and the Caribbean: Development and Policy Issues

PubMed Central

Risk, Ahmad

2003-01-01

This paper reviews trends and issues in health and in the information and communication technologies (ICT) market as they relate to the deployment of eHealth solutions in Latin America and the Caribbean. Heretofore designed for industrialized countries and large organizations, eHealth solutions are being proposed as an answer to a variety of health-system management problems and health care demands faced by all health organizations including those in developing societies. Particularly, eHealth is seen as especially useful in the operational support of the new health care models being implemented in many countries. The authors examine those developments vis-à-vis the characteristics of the Latin American and the Caribbean health-sector organizational preparedness and technological infrastructure, and propose policy and organizational actions to foster the development of eHealth solutions in the region. PMID:12746209

Selecting effective incentive structures in health care: A decision framework to support health care purchasers in finding the right incentives to drive performance

PubMed Central

Custers, Thomas; Hurley, Jeremiah; Klazinga, Niek S; Brown, Adalsteinn D

2008-01-01

Background The Ontario health care system is devolving planning and funding authority to community based organizations and moving from steering through rules and regulations to steering on performance. As part of this transformation, the Ontario Ministry of Health and Long-Term Care (MOHLTC) are interested in using incentives as a strategy to ensure alignment – that is, health service providers' goals are in accord with the goals of the health system. The objective of the study was to develop a decision framework to assist policymakers in choosing and designing effective incentive systems. Methods The first part of the study was an extensive review of the literature to identify incentives models that are used in the various health care systems and their effectiveness. The second part was the development of policy principles to ensure that the used incentive models are congruent with the values of the Ontario health care system. The principles were developed by reviewing the Ontario policy documents and through discussions with policymakers. The validation of the principles and the suggested incentive models for use in Ontario took place at two meetings. The first meeting was with experts from the research and policy community, the second with senior policymakers from the MOHLTC. Based on the outcome of those two meetings, the researchers built a decision framework for incentives. The framework was send to the participants of both meetings and four additional experts for validation. Results We identified several models that have proven, with a varying degree of evidence, to be effective in changing or enabling a health provider's performance. Overall, the literature suggests that there is no single best approach to create incentives yet and the ability of financial and non-financial incentives to achieve results depends on a number of contextual elements. After assessing the initial set of incentive models on their congruence with the four policy principles we defined nine incentive models to be appropriate for use in Ontario and potentially other health care systems that want to introduce incentives to improve performance. Subsequently, the models were incorporated in the resulting decision framework. Conclusion The design of an incentive must reflect the values and goals of the health care system, be well matched to the performance objectives and reflect a range of contextual factors that can influence the effectiveness of even well-designed incentives. As a consequence, a single policy recommendation around incentives is inappropriate. The decision framework provides health care policymakers and purchasers with a tool to support the selection of an incentive model that is the most appropriate to improve the targeted performance. PMID:18371198

Contracting for intensive care services.

PubMed

Dorman, S

1996-01-01

Purchasers will increasingly expect clinical services in the NHS internal market to provide objective measures of their benefits and cost effectiveness in order to maintain or develop current funding levels. There is limited scientific evidence to demonstrate the clinical effectiveness of intensive care services in terms of mortality/morbidity. Intensive care is a high-cost service and studies of cost-effectiveness need to take account of case-mix variations, differences in admission and discharge policies, and other differences between units. Decisions over development or rationalisation of intensive care services should be based on proper outcome studies of well defined patient groups. The purchasing function itself requires development in order to support effective contracting.

Advance care planning for nursing home residents with dementia: policy vs. practice.

PubMed

Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

2016-03-01

The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.

Teasing Apart the Child Care Conundrum: A Factorial Survey Analysis of Perceptions of Child Care Quality, Fair Market Price and Willingness to Pay by Low-Income, African American Parents

ERIC Educational Resources Information Center

Shlay, Anne B.; Tran, Henry; Weinraub, Marsha; Harmon, Michelle

2005-01-01

Child care quality plays a crucial role in children's social and cognitive development. While child care quality is a critical issue for all children, it matters more for low-income children. Policy makers have increased the emphasis on allowing parents, not government, to make decisions about the type of care they want for their children. Yet…

Reimbursement issues facing patients, providers, and payers.

PubMed

Antman, K

1993-11-01

Escalating costs of health care delivery and the current constraints imposed by the federal budget deficit seriously threaten to compromise patient care and innovative biomedical research. Recent third-party refusal to cover some patients treated in protocols has had considerable impact on trial research. In addition, reimbursement for conventional care sometimes has been refused if delivered as part of a study (e.g., MOPP therapy versus ABVD therapy) or for an indication that is not specifically cited on the Food and Drug Administration label. Who should cover the patient care costs of patients participating in clinical trials? One approach would have patients cover these costs themselves. A second approach is the reinstitution of patient care costs into research grants. A third possibility is that the pharmaceutical industry support patient care costs of clinical research. Historically, hospital expenses of patients participating in studies have been paid by health insurance policies. In the absence of a clinical trial, many patients would be treated with Food and Drug Administration-approved therapies despite a lack of substantial benefit. Such marginal treatments are compensated by third-party payers routinely. The current system is arbitrary and expensive, compromises research and development, and equates new treatment with no treatment. By refusing to reimburse the patient care costs of investigational therapy, third-party carriers are, in fact, making medical decisions. There is a growing and legitimate concern that the pace of clinical research will be impeded significantly at a time when many exciting developments will be ready for clinical trials. The molecular steps in carcinogenesis are being documented rapidly for common malignancies, such as colon cancer. Immunologic, biologic, and hormonal approaches, and emerging technologies, such as marrow transplant or antibody toxin conjugates, already are being studied in the clinic. Health policy legislation and decisions by the insurance industry have a direct impact on physicians, facilitating, or often impeding, the care physicians are able to provide. Who makes health policy decisions? Increasingly, these decisions are being made not by physicians, but by public health experts, economists, and, more recently, large industries grappling with the cost of providing insurance coverage (and its effects on competitive pricing in a world market). Therefore, physicians need to position themselves to influence the development of medical policy, particularly as it relates to the prevention, diagnosis, and treatment of patients with cancer.

Investigating patients' experiences: methodological usefulness of interpretive interactionism.

PubMed

Tower, Marion; Rowe, Jennifer; Wallis, Marianne

2012-01-01

To demonstrate the methodological usefulness of interpretive interactionism by applying it to the example of a study investigating healthcare experiences of women affected by domestic violence. Understanding patients' experiences of health, illness and health care is important to nurses. For many years, biomedical discourse has prevailed in healthcare language and research, and has influenced healthcare responses. Contemporary nursing scholarship can be developed by engaging with new ways of understanding therapeutic interactions with patients. Research that uses qualitative methods of inquiry is an important paradigm for nurses who seek to explain and understand or describe experiences rather than predict outcomes. Interpretive interactionism is an interpretive form of inquiry for conducting studies of social or personal problems that have healthcare policy implications. It puts the patient at the centre of the research process and makes visible the experiences of patients as they interact with the healthcare and social systems that surround them. Interpretive interactionism draws on concepts of symbolic interactionism, phenomenology and hermeneutics. Interpretive interactionism is a patient-centred methodology that provides an alternative way of understanding patients' experiences. It can contribute to policy and practice development by drawing on the perspectives and experiences of patients, who are central to the research process. It also allows research findings to be situated in and linked to healthcare policy, professional ethics and organisational approaches to care. Interpretive interactionism has methodological utility because it can contribute to policy and practice development by drawing on the perspectives and experiences of patients who are central to the research process. Interpretive interactionism allows research findings to be situated in and linked to health policy, professional ethics and organisational approaches to caring.

Person-centred medicines optimisation policy in England: an agenda for research on polypharmacy.

PubMed

Heaton, Janet; Britten, Nicky; Krska, Janet; Reeve, Joanne

2017-01-01

Aim To examine how patient perspectives and person-centred care values have been represented in documents on medicines optimisation policy in England. There has been growing support in England for a policy of medicines optimisation as a response to the rise of problematic polypharmacy. Conceptually, medicines optimisation differs from the medicines management model of prescribing in being based around the patient rather than processes and systems. This critical examination of current official and independent policy documents questions how central the patient is in them and whether relevant evidence has been utilised in their development. A documentary analysis of reports on medicines optimisation published by the Royal Pharmaceutical Society (RPS), The King's Fund and National Institute for Health and Social Care Excellence since 2013. The analysis draws on a non-systematic review of research on patient experiences of using medicines. Findings The reports varied in their inclusion of patient perspectives and person-centred care values, and in the extent to which they drew on evidence from research on patients' experiences of polypharmacy and medicines use. In the RPS report, medicines optimisation is represented as being a 'step change' from medicines management, in contrast to the other documents which suggest that it is facilitated by the systems and processes that comprise the latter model. Only The King's Fund report considered evidence from qualitative studies of people's use of medicines. However, these studies are not without their limitations. We suggest five ways in which researchers could improve this evidence base and so inform the development of future policy: by facilitating reviews of existing research; conducting studies of patient experiences of polypharmacy and multimorbidity; evaluating medicines optimisation interventions; making better use of relevant theories, concepts and tools; and improving patient and public involvement in research and in guideline development.

Development of the Policy Indicator Checklist: A Tool to Identify and Measure Policies for Calorie-Dense Foods and Sugar-Sweetened Beverages Across Multiple Settings

PubMed Central

Hallett, Allen M.; Parker, Nathan; Kudia, Ousswa; Kao, Dennis; Modelska, Maria; Rifai, Hanadi; O’Connor, Daniel P.

2015-01-01

Objectives. We developed the policy indicator checklist (PIC) to identify and measure policies for calorie-dense foods and sugar-sweetened beverages to determine how policies are clustered across multiple settings. Methods. In 2012 and 2013 we used existing literature, policy documents, government recommendations, and instruments to identify key policies. We then developed the PIC to examine the policy environments across 3 settings (communities, schools, and early care and education centers) in 8 communities participating in the Childhood Obesity Research Demonstration Project. Results. Principal components analysis revealed 5 components related to calorie-dense food policies and 4 components related to sugar-sweetened beverage policies. Communities with higher youth and racial/ethnic minority populations tended to have fewer and weaker policy environments concerning calorie-dense foods and healthy foods and beverages. Conclusions. The PIC was a helpful tool to identify policies that promote healthy food environments across multiple settings and to measure and compare the overall policy environments across communities. There is need for improved coordination across settings, particularly in areas with greater concentration of youths and racial/ethnic minority populations. Policies to support healthy eating are not equally distributed across communities, and disparities continue to exist in nutrition policies. PMID:25790397

Development of the policy indicator checklist: a tool to identify and measure policies for calorie-dense foods and sugar-sweetened beverages across multiple settings.

PubMed

Lee, Rebecca E; Hallett, Allen M; Parker, Nathan; Kudia, Ousswa; Kao, Dennis; Modelska, Maria; Rifai, Hanadi; O'Connor, Daniel P

2015-05-01

We developed the policy indicator checklist (PIC) to identify and measure policies for calorie-dense foods and sugar-sweetened beverages to determine how policies are clustered across multiple settings. In 2012 and 2013 we used existing literature, policy documents, government recommendations, and instruments to identify key policies. We then developed the PIC to examine the policy environments across 3 settings (communities, schools, and early care and education centers) in 8 communities participating in the Childhood Obesity Research Demonstration Project. Principal components analysis revealed 5 components related to calorie-dense food policies and 4 components related to sugar-sweetened beverage policies. Communities with higher youth and racial/ethnic minority populations tended to have fewer and weaker policy environments concerning calorie-dense foods and healthy foods and beverages. The PIC was a helpful tool to identify policies that promote healthy food environments across multiple settings and to measure and compare the overall policy environments across communities. There is need for improved coordination across settings, particularly in areas with greater concentration of youths and racial/ethnic minority populations. Policies to support healthy eating are not equally distributed across communities, and disparities continue to exist in nutrition policies.

"Must do CPR??": strategies to cope with the new College of Physicians and Surgeons of Ontario policy on end-of-life care.

PubMed

Hawryluck, Laura; Oczkowski, Simon J W; Handelman, Mark

2016-08-01

The College of Physicians and Surgeons of Ontario recently released a new policy, Planning for and Providing Quality End-of-Life Care. The revised policy is more accurate in its consideration of the legal framework in which physicians practice and more reflective of ethical issues that arise in end-of-life (EOL) care. It also recognizes valid instances for not offering cardiopulmonary resuscitation (CPR). Nevertheless, the policy poses a significant ethical and legal dilemma-i.e., if disputes over EOL care arise, then physicians must provide CPR even when resuscitation would fall outside this medical standard of care. While the policy applies in Ontario, it is likely to influence other physician colleges across Canada as they review their standards of practice. This paper explores the rationale for the mandated CPR, clarifies the policy's impact on the medical standard of care, and discusses strategies to improve EOL care within the policy. These strategies include understanding the help-hurt line, changing the language used when discussing cardiac arrest, clarifying care plans during the perioperative period, engaging the intensive care unit team early in goals-of-care discussions, mentoring hospital staff to improve skills in goals-of-care discussions, avoiding use of the "slow code", and continuing to advocate for quality EOL care and a more responsive legal adjudication process.

The impact of a bundled policy intervention on improving the performance of rural healthcare in China.

PubMed

Wu, Jian; Li, Xiaofang; Song, Yao; Shao, Hui; Shi, Qian; Qin, Doudou; Xie, Shuangbao; Shi, Lizheng

2016-03-10

The strategy of health policy has been changed for improving the performances to meeting the increasing healthcare demands. However, limited evidences were found to prove that the bundled payment was valid for service delivering in public sector. This study was designed to evaluate the effectiveness of a bundled policy on strengthening the county-village communication and improving the quality of chronic disease management. This is a retrospective cohort study using the data collected in 2011, 2012 and 2014 from the Rural Health Development Project in China. The policy intervention included performance-related contract with health facilities, developing technical guideline for doctors and nurses, routine monitoring of performance, and efforts to increase public awareness about the services. There were two intervention counties in Henan Province, China, while one county with similar characteristics in Henan was selected as control. Funding allocation, work load and salary for health care workers, volume of township-to-village technical assistance were reported before and after the policy was implemented. Our study also examined the policy impacts on improving treatment outcomes of diabetes and hypertension care. There were substantial increases in the provision of the basic package of services including 96.6 % of patients with hypertension, 91.2 % of patients with diabetes under the health management system. After the intervention, there were 34.3 % (hypertension) and 42.0 % (diabetes) increase in regular follow-up visit rates, 24.6 and 17.2 % increase in blood pressure and blood glucose control rates, respectively. The family health records system covered 96 % of the rural families. Technical assistance between township health centres and village clinics were enhanced. Compared with baseline, the monthly training meeting and field supervision & guidance between township health centres and village clinics increased 1.0 meeting, 1.5 field visits, respectively, while the increases in the control county were only 0.3 meeting and 0.3 field visits. At the end of this study, 93.8 % of health workers achieved their performance goals. More patients were referred to appropriate levels of care. This bundled policy intervention effectively improved rural health care delivery. The result of our study can be used for local governments to implement performance-based health system management in developing country.

New Long-Term Care Policies in Latin America: The National System of Care in Uruguay.

PubMed

Matus-Lopez, Mauricio; Pedraza, Camilo Cid

2016-07-01

Uruguay is the Latin American country with the largest share of elderly population and it has the greatest pressure for formal long-term care services in the region. For this reason, last year the government approved a law creating a National System of Care. This article describes and analyzes the long-term care policy in the recently created National System of Care of Uruguay. The Director of the National System of Care was asked to complete a questionnaire with a description and management of long-term care programs. This information was completed with official information and peer-reviewed articles of long-term care in Uruguay. The National System of Care includes long-term care services. The main services are carried out through a cash-for-care system for home-based services, but in the future the benefits will expand to day centers and residential and nursing homes. The system follows international trends in terms of universality, services, and regulations dealing with care. However, the current and future financing is low, and this condition could undermine its development capacity. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Quality from a Toddler's Perspective: A Bottom-Up Examination of Classroom Experiences

ERIC Educational Resources Information Center

Hallam, Rena; Fouts, Hillary; Bargreen, Kaitlin; Caudle, Lori

2009-01-01

Defining and measuring quality in group care settings has become a central issue in the field of early care and education in the United States, particularly as states develop systems to improve child care quality. Most research and policy definitions of quality rely on a top-down perspective focusing on structural and environmental features of the…

Where Should People with Dementia Live? Using the Views of Service Users to Inform Models of Care

ERIC Educational Resources Information Center

Forbat, Liz; Wilkinson, Heather

2008-01-01

This paper reports on research that illuminates how people with a learning disability understand dementia and indicates the implications of these understandings for developing appropriate models of care. As this new policy and practice area struggles to provide appropriate and effective models of care for people with a learning disability and…

Selecting Students for Training in Health Care. A Practical Guide to Improving Selection Procedures. WHO Offset Publication No. 74.

ERIC Educational Resources Information Center

Bennett, Mick; Wakeford, Richard

This guide is intended to help those responsible for choosing health care trainees to develop and improve their selection procedures. Special reference is given to health workers in maternal and child health. Chapter 1 deals with health care policy implications for selection of trainees, the different functions of selection and conflicts that…

Getting into the Black Box: How Do Low-Income Parents Make Choices about Early Care and Education in Maryland? Publication #2012-42

ERIC Educational Resources Information Center

Forry, Nicole; Wessel, Julia; Simkin, Shana; Rodrigues, Katherine

2012-01-01

Existing literature highlights the positive influence of high-quality early care and education on the development of young children, and particularly young children in impoverished or low-income families. Reflecting the promising influence of high-quality early care and education on children's developmental outcomes, policy makers and state…

Compendium of Quality Rating Systems and Evaluations: The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Tout, Kathryn; Starr, Rebecca; Soli, Margaret; Moodie, Shannon; Kirby, Gretchen; Boller, Kimberly

2010-01-01

Quality Rating Systems (QRS) are currently operating, under development, or being piloted in over 25 states or local areas. As the QRS model becomes integrated into the landscape of child care and education service delivery, policy, and the decisions parents make about child care across the United States, there is an increasing need for…

Health care technology assessment

NASA Astrophysics Data System (ADS)

Goodman, Clifford

1994-12-01

The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.

How Peru introduced a plan for comprehensive HIV prevention and care for transwomen.

PubMed

Salazar, Ximena; Núnez-Curto, Arón; Villayzán, Jana; Castillo, Regina; Benites, Carlos; Caballero, Patricia; Cáceres, Carlos F

2016-01-01

As a group, transwomen in Peru have the highest prevalence of HIV (>20%) in the country, but they have little access to HIV prevention, testing and care services. Until recently, Peru's national HIV programme did not recognize transwomen and had remained essentially static for decades. This changed in December 2014, when the Ministry of Health expressed its commitment to improve programming for transwomen and to involve transwomen organizations by prioritizing the development of a "Targeted Strategy Plan of STIs/HIV/AIDS Prevention and Comprehensive Care for Transwomen." A policy dialogue between key stakeholders - Peru's Ministry of Health, academic scientists, civil society, transgender leaders and international agencies - created the conditions for a change in Peru's national HIV policy for transwomen. Supported by the effective engagement of all sectors, the Ministry of Health launched a plan to provide comprehensive HIV prevention and care for transwomen. The five-year plan includes new national guidelines for HIV prevention, care and support, and country-level investments in infrastructure and equipment. In addition to new biomedical strategies, the plan also incorporates several strategies to address structural factors that contribute to the vulnerability of transwomen. We identified three key factors that created the right conditions for this change in Peru's HIV policy. These factors include (1) the availability of solid evidence, based on scientific research; (2) ongoing efforts within the transwomen community to become better advocates of their own rights; and (3) a dialogue involving honest discussions between stakeholders about possibilities of changing the nation's HIV policy. The creation of Peru's national plan for HIV prevention and care for transwomen shows that long-term processes, focused on human rights for transwomen in Peru, can lead to organizational and public-policy change.

How Peru introduced a plan for comprehensive HIV prevention and care for transwomen

PubMed Central

Salazar, Ximena; Núnez-Curto, Arón; Villayzán, Jana; Castillo, Regina; Benites, Carlos; Caballero, Patricia; Cáceres, Carlos F

2016-01-01

Introduction As a group, transwomen in Peru have the highest prevalence of HIV (>20%) in the country, but they have little access to HIV prevention, testing and care services. Until recently, Peru's national HIV programme did not recognize transwomen and had remained essentially static for decades. This changed in December 2014, when the Ministry of Health expressed its commitment to improve programming for transwomen and to involve transwomen organizations by prioritizing the development of a “Targeted Strategy Plan of STIs/HIV/AIDS Prevention and Comprehensive Care for Transwomen.” Discussion A policy dialogue between key stakeholders – Peru's Ministry of Health, academic scientists, civil society, transgender leaders and international agencies – created the conditions for a change in Peru's national HIV policy for transwomen. Supported by the effective engagement of all sectors, the Ministry of Health launched a plan to provide comprehensive HIV prevention and care for transwomen. The five-year plan includes new national guidelines for HIV prevention, care and support, and country-level investments in infrastructure and equipment. In addition to new biomedical strategies, the plan also incorporates several strategies to address structural factors that contribute to the vulnerability of transwomen. We identified three key factors that created the right conditions for this change in Peru's HIV policy. These factors include (1) the availability of solid evidence, based on scientific research; (2) ongoing efforts within the transwomen community to become better advocates of their own rights; and (3) a dialogue involving honest discussions between stakeholders about possibilities of changing the nation's HIV policy. Conclusions The creation of Peru's national plan for HIV prevention and care for transwomen shows that long-term processes, focused on human rights for transwomen in Peru, can lead to organizational and public-policy change. PMID:27431469

Development of a family nursing model for prevention of cancer and other noncommunicable diseases through an appreciative inquiry.

PubMed

Jongudomkarn, Darunee; Macduff, Colin

2014-01-01

Cancer and non-communicable diseases are a major issue not only for the developed but also developing countries. Public health and primary care nursing offer great potential for primary and secondary prevention of these diseases through community and family-based approaches. Within Thailand there are related established educational curricula but less is known about how graduate practitioners enact ideas in practice and how these can influence policy at local levels. The aim of this inquiry was to develop family nursing practice in primary care settings in the Isaan region or Northeastern Thailand and to distill what worked well into a nursing model to guide practice. An appreciative inquiry approach involving analysis of written reports, focus group discussions and individual interviews was used to synthesize what worked well for fourteen family nurses involved in primary care delivery and to build the related model. Three main strategies were seen to offer a basis for optimal care delivery, namely: enacting a participatory action approach mobilizing families' social capital; using family nursing process; and implementing action strategies within communities. These were distilled into a new conceptual model. The model has some features in common with related community partnership models and the World Health Organization Europe Family Health Nurse model, but highlights practical strategies for family nursing enactment. The model offers a basis not only for planning and implementing family care to help prevent cancer and other diseases but also for education of nurses and health care providers working in communities. This articulation of what works in this culture also offers possible transference to different contexts internationally, with related potential to inform health and social care policies, and international development of care models.

Advance care planning for cancer patients in primary care: a feasibility study

PubMed Central

Boyd, Kirsty; Mason, Bruce; Kendall, Marilyn; Barclay, Stephen; Chinn, David; Thomas, Keri; Sheikh, Aziz; Murray, Scott A

2010-01-01

Background Advance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging. Aim To assess the feasibility of implementing advance care planning in UK primary care. Design of study Mixed methods evaluation of a pilot educational intervention. Setting Four general practices in south-east Scotland. Method Interviews with 20 GPs and eight community nurses before and after a practice-based workshop; this was followed by telephone interviews with nine other GPs with a special interest in palliative care from across the UK. Results End-of-life care planning for patients typically starts as an urgent response to clear evidence of a short prognosis, and aims to achieve a ‘good death’. Findings suggest that there were multiple barriers to earlier planning: prognostic uncertainty; limited collaboration with secondary care; a desire to maintain hope; and resistance to any kind of ‘tick-box’ approach. Following the workshop, participants' knowledge and skills were enhanced but there was little evidence of more proactive planning. GPs from other parts of the UK described confusion over terminology and were concerned about the difficulties of implementing inflexible, policy-driven care. Conclusion A clear divide was found between UK policy directives and delivery of end-of-life care in the community that educational interventions targeting primary care professionals are unlikely to address. Advance care planning has the potential to promote autonomy and shared decision making about end-of-life care, but this will require a significant shift in attitudes. PMID:21144189

Dateline Child Care.

ERIC Educational Resources Information Center

Child Care Information Exchange, 1993

1993-01-01

Reports on the Clinton administration's budget decisions concerning Head Start and the Child Care and Development Block Grant; the Children's Defense Fund's support of Clinton administration policies; cuts in United Way aid to local charities; and the ineligibility of a center at which Bible stories are read to receive a Small Business…

Health system strengthening in Cambodia-a case study of health policy response to social transition.

PubMed

Grundy, John; Khut, Qiu Yi; Oum, Sophal; Annear, Peter; Ky, Veng

2009-10-01

Cambodia, following decades of civil conflict and social and economic transition, has in the last 10 years developed health policy innovations in the areas of health contracting, health financing and health planning. This paper aims to outline recent social, epidemiological and demographic health trends in Cambodia, and on the basis of this outline, to analyse and discuss these policy responses to social transition. Sources of information included a literature review, participant observation in health planning development in Cambodia between 1993 and 2008, and comparative analysis of demographic health surveys between 2000 and 2005. In Cambodia there have been sharp but unequal improvements in child mortality, and persisting high maternal mortality rates. Data analysis demonstrates associations between location, education level and access to facility based care, suggesting the dominant role of socio-economic factors in determining access to facility based health care. These events are taking place against a background of rapid social transition in Cambodian history, including processes of decentralization, privatization and the development of open market economic systems. Primary policy responses of the Ministry of Health to social transition and associated health inequities include the establishment of health contracting, hospital health equity funds and public-private collaborations. Despite the internationally recognized health policy flexibility and innovation demonstrated in Cambodia, policy response still lags well behind the reality of social transition. In order to minimize the delay between transition and response, new policy making tactics are required in order to provide more flexible and timely responses to the ongoing social transition and its impacts on population health needs in the lowest socio-economic quintiles.

Perioperative management of obstructive sleep apnea: a survey of Veterans Affairs health care providers.

PubMed

Dhanda Patil, Reena; Patil, Yash J

2012-01-01

(1) To determine the presence of Veterans Affairs (VA) institutional guidelines for the perioperative management of obstructive sleep apnea (OSA); (2) to examine current use of preoperative screening tools for OSA in the VA; and (3) to understand current VA practice patterns regarding postoperative disposition of patients with OSA. Survey study. Veterans Affairs hospitals with surgical services; sample size 102 facilities. Veterans Affairs health care providers. The authors surveyed health care providers at VA hospitals using a survey tool developed by the authors. The response rate was 80%. A variety of preoperative screening tools for OSA were used by respondents, most commonly American Society of Anesthesiologists guidelines (53%). A policy for postoperative disposition of known and presumed OSA was present in 26% and 19% of responses, respectively. Of those respondents reporting a formal postoperative care policy, 48% and 30% admitted patients to a monitored ward bed and surgical intensive care unit, respectively. Of the 74% of respondents unaware of an institutional policy, Anesthesia and Surgery worked together to dictate postoperative disposition of patients with known OSA 73% of the time. The degree of OSA was ranked as the most important factor (58%) influencing postoperative disposition. Ten percent of respondents reported a major perioperative complication attributable to OSA in the past year. This survey study elucidates the heterogeneity of preoperative screening for and postoperative care of veterans with OSA. Future investigators may use these data to formalize institutional policies with regard to patients with OSA, with potentially significant impacts on patient care and usage of financial resources.

Implications of changes in households and living arrangements for future home-based care needs and costs for disabled elders in China.

PubMed

Zeng, Yi; Chen, Huashuai; Wang, Zhenglian; Land, Kenneth C

2015-04-01

To better understand future home-based care needs and costs for disabled elders in China. To further develop and apply the ProFamy extended cohort-component method and the most recent census and survey data. (a) Chinese disabled elders and the annual growth rate of the percentage of national gross domestic product (GDP) devoted to home-based care costs for disabled elders will increase much more rapidly than the growth of total elderly population; (b) home-based care needs and costs for disabled oldest-old aged 80+ will increase much faster than that for disabled young-old aged 65-79 after 2030; (c) disabled unmarried elders living alone and their home-based care costs increase substantially faster than those disabled unmarried elders living with children; (d) percent of rural disabled oldest-old will be substantially higher than that of rural population after 2030; (e) sensitivity analyses show that possible changes in mortality and elderly disability status are the major direct factors affecting home-based care needs and costs; (f) caregivers resources under the universal two-child policy will be substantially better than that under the rigorous fertility policy unchanged. We discuss policy recommendations concerning pathways to healthy aging with relatively reduced care costs, including reductions of the prevalence of disability, gender equality, the universal two-child policy and resources of caregivers, encouragements of rural-to-urban family migration and elder's residential proximity to their adult children, and remarriages of not-married elders. © The Author(s) 2014.

Comprehensive taxonomy and worldwide trends in pharmaceutical policies in relation to country income status.

PubMed

Maniadakis, N; Kourlaba, G; Shen, J; Holtorf, A

2017-05-25

Rapidly evolving socioeconomic and technological trends make it challenging to improve access, effectiveness and efficiency in the use of pharmaceuticals. This paper identifies and systematically classifies the prevailing pharmaceutical policies worldwide in relation to a country's income status. A literature search was undertaken to identify and taxonomize prevailing policies worldwide. Countries that apply those policies and those that do not were then grouped by income status. Pharmaceutical policies are linked to a country's socioeconomics. Developed countries have universal coverage and control pharmaceuticals with external and internal price referencing systems, and indirect price-cost controls; they carry out health technology assessments and demand utilization controls. Price-volume and risk-sharing agreements are also evolving. Developing countries are underperforming in terms of coverage and they rely mostly on restrictive state controls to regulate prices and expenditure. There are significant disparities worldwide in the access to pharmaceuticals, their use, and the reimbursement of costs. The challenge in high-income countries is to maintain access to care whilst dealing with trends in technology and aging. Essential drugs should be available to all; however, many low- and middle-income countries still provide most of their population with only poor access to medicines. As economies grow, there should be greater investment in pharmaceutical care, looking to the policies of high-income countries to increase efficiency. Pharmaceutical companies could also develop special access schemes with low prices to facilitate coverage in low-income countries.

Behavioral health in the Department of Defense Patient-Centered Medical Home: history, finance, policy, work force development, and evaluation.

PubMed

Hunter, Christopher L; Goodie, Jeffrey L

2012-09-01

Integrating behavioral health services into the patient-centered medical home (PCMH) is an important component for meeting the goals of easy access, whole person, coordinated, and integrated care. Unlike most PCMH initiatives, the Department of Defense's (DoD) Military Health System (MHS) launched its PCMH initiative with integrated behavioral health services. This integration facilitates the MHS's goal to meet its strategic imperatives under the "Quadruple Aim" of (1) maximizing readiness, (2) improving the health of the population, (3) enhancing the patient experience of care (including quality, access, and reliability), and (4) responsibly managing per capita cost of care. The MHS experience serves as a guide to other organizations. We discuss the historical underpinnings, funding, policy, and work force development strategies that contributed to integrated behavioral healthcare being a mandated component of the MHS's PCMH.

Patient Core Data Set. Standard for a longitudinal health/medical record.

PubMed

Renner, A L; Swart, J C

1997-01-01

Blue Chip Computers Company, in collaboration with Wright State University-Miami Valley College of Nursing and Health, with support from the Agency for Health Care Policy and Research, Public Health Service, completed Small Business innovative Research research to design a comprehensive integrated Patient information System. The Wright State University consultants undertook the development of a Patient Core Data Set (PCDS) in response to the lack of uniform standards of minimum data sets, and lack of standards in data transfer for continuity of care. The purpose of the Patient Core Data Set is to develop a longitudinal patient health record and medical history using a common set of standard data elements with uniform definitions and coding consistent with Health Level 7 (HL7) protocol and the American Society for Testing and Materials (ASTM) standards. The PCDS, intended for transfer across all patient-care settings, is essential information for clinicians, administrators, researchers, and health policy makers.

Listening to Families: The Role of Values in Shaping Effective Social Policy.

ERIC Educational Resources Information Center

Sylvester, Kathleen

Noting that the American public's concern for children is shaped by complicated and sometimes conflicting beliefs about family life, this paper examines the policy debates surrounding child care, early childhood development, family leave, and children's health insurance, and analyzes how well advocates have adapted to the new realities. Part 1 of…

Ecological support for rural land-use planning.

Treesearch

David M. Theobald; Thomas Spies; Jeff Kline; Bruce Maxwell; N. T. Hobbs; Virginia H. Dale

2005-01-01

How can ecologists be more effective in supporting ecologically informed rural land-use planning and policy? Improved decision making about rural lands requires careful consideration of how ecological information and analyses can inform specific planning and policy needs. We provide a brief overview of rural land-use planning, including recently developed approaches to...

Three Approaches for Developing Training Materials and Curriculum Policies.

ERIC Educational Resources Information Center

Doxey, Isabel

Agencies funding early childhood education projects, policy analysts, and research consumers have created a demand for research tools generating data with applied reliability. This paper examines the focus group as a social science research tool which meets this demand. Part 1 defines a focus group as a carefully planned discussion designed to…

A scoping review of training and deployment policies for human resources for health for maternal, newborn, and child health in rural Africa.

PubMed

Murphy, Gail Tomblin; Goma, Fastone; MacKenzie, Adrian; Bradish, Stephanie; Price, Sheri; Nzala, Selestine; Rose, Annette Elliott; Rigby, Janet; Muzongwe, Chilweza; Chizuni, Nellisiwe; Carey, Amanda; Hamavhwa, Derrick

2014-12-16

Most African countries are facing a human resources for health (HRH) crisis, lacking the required workforce to deliver basic health care, including care for mothers and children. This is especially acute in rural areas and has limited countries' abilities to meet maternal, newborn, and child health (MNCH) targets outlined by Millennium Development Goals 4 and 5. To address the HRH challenges, evidence-based deployment and training policies are required. However, the resources available to country-level policy makers to create such policies are limited. To inform future HRH planning, a scoping review was conducted to identify the type, extent, and quality of evidence that exists on HRH policies for rural MNCH in Africa. Fourteen electronic health and health education databases were searched for peer-reviewed papers specific to training and deployment policies for doctors, nurses, and midwives for rural MNCH in African countries with English, Portuguese, or French as official languages. Non-peer reviewed literature and policy documents were also identified through systematic searches of selected international organizations and government websites. Documents were included based on pre-determined criteria. There was an overall paucity of information on training and deployment policies for HRH for MNCH in rural Africa; 37 articles met the inclusion criteria. Of these, the majority of primary research studies employed a variety of qualitative and quantitative methods. Doctors, nurses, and midwives were equally represented in the selected policy literature. Policies focusing exclusively on training or deployment were limited; most documents focused on both training and deployment or were broader with embedded implications for the management of HRH or MNCH. Relevant government websites varied in functionality and in the availability of policy documents. The lack of available documentation and an apparent bias towards HRH research in developed areas suggest a need for strengthened capacity for HRH policy research in Africa. This will result in enhanced potential for evidence uptake into policy. Enhanced alignment between policy-makers' information needs and the independent research agenda could further assist knowledge development and uptake. The results of this scoping review informed an in-depth analysis of relevant policies in a sub-set of African countries.

Model Child Care Health Policies.

ERIC Educational Resources Information Center

Aronson, Susan; Smith, Herberta

Drawn from a review of policies at over 100 child care programs nationwide, the model health policies presented in this report are intended for adaptation and selective use by out-of-home child care facilities. Following an introduction, the report presents model policy forms with blanks for adding individualized information for the following…

Policies and protocols for preventing transmission of HIV infection in oral health care in South Africa.

PubMed

Ogunbodede, E O; Rudolph, M J

2002-12-01

Human immunodeficiency virus (HIV) infection constitutes an unparalleled public health challenge. The unique nature of most oral health procedures, instrumentation and patient-care settings requires specific strategies and protocols aimed at preventing the transmission of HIV/AIDS between oral health care providers and patients, as well as between patients themselves. The present study investigated the level of information and training about protocols and policies for preventing the transmission of HIV/AIDS in oral health care settings in South Africa. The data collection techniques utilised available information, in-depth interviews and an open-ended questionnaire. The respondents were 20 purposively selected key informants who were senior officers for HIV/AIDS programmes and/or oral health organisations. Sixteen (80%) of the respondents reported that there were no existing oral health policies on HIV/AIDS in their health care institutions or organisations. None of the interviewees knew of any specific protocols on HIV/AIDS in the oral health care setting that emanated from South Africa. In addition, none of the dental professional associations had established an infection control committee or a support system for members who might become infected with HIV and develop AIDS. Territorial boundaries existed between sectors within the medical disciplines, as well as between the medical and oral health disciplines. Numerous general impediments were identified, such as prejudice, denial and fear, inadequate training and/or information about the infection, lack of representation and resources for policy planning, a lack of interest from the business sector, and approaching HIV/AIDS in the workplace as a 'one-time issue' Other obstacles identified included unemployment, poverty, illiteracy, disempowerment of women and inadequate communication of policies to service providers. Additional issues raised included the migrant labour systeM, complexities of language and culture, the large unstructured sex industry, high prevalence of sexually transmitted infections and lack of funding. All of these have an impact on oral health. Future policy directions identified included 'increasing access to HIV information and postexposure prophylaxis' 'shift towards care and support for those living with HIV/AIDS with emphasis on community and home-based care' and 'improving intersectoral co-ordination and collaboration'. The study demonstrated gaps in availability and access to policies and protocols on HIV/AIDS by managers and health workers. Specific strategic recommendations are made for oral health.

The New Politics of US Health Care Prices: Institutional Reconfiguration and the Emergence of All-Payer Claims Databases.

PubMed

Rocco, Philip; Kelly, Andrew S; Béland, Daniel; Kinane, Michael

2017-02-01

Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs' efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices. Drawing on pragmatist institutional theory, this article shows how APCDs emerged as the dominant model for reforming health care prices. While APCD advocates faced significant institutional barriers to policy change, we show how they reconfigured existing ideas, tactical repertoires, and legal-technical infrastructures to develop a politically and technologically robust reform. Our analysis has important implications for theories of how change agents overcome structural barriers to health reform. Copyright © 2017 by Duke University Press.

Evolving reimbursement and pricing policies for devices in Europe and the United States should encourage greater value.

PubMed

Sorenson, Corinna; Drummond, Michael; Burns, Lawton R

2013-04-01

Rising health care costs are an international concern, particularly in the United States, where spending on health care outpaces that of other industrialized countries. Consequently, there is growing desire in the United States and Europe to take a more value-based approach to health care, particularly with respect to the adoption and use of new health technology. This article examines medical device reimbursement and pricing policies in the United States and Europe, with a particular focus on value. Compared to the United States, Europe more formally and consistently considers value to determine which technologies to cover and at what price, especially for complex, costly devices. Both the United States and Europe have introduced policies to provide temporary coverage and reimbursement for promising technologies while additional evidence of value is generated. But additional actions are needed in both the United States and Europe to ensure wise value-based reimbursement and pricing policies for all devices, including the generation of better pre- and postmarket evidence and the development of new methods to evaluate value and link evidence of value to reimbursement.

Gender Dysphoria in the Military.

PubMed

Ford, Shannon; Schnitzlein, Carla

2017-11-07

With the announcement that members of the military who identify as transgender are allowed to serve openly, the need for Department of Defense behavioral health providers to be comfortable in the assessment, diagnosis, and treatment of this population becomes quickly evident. This population has been seeking care in the community and standards have been developed to help guide decision-making, but a comparable document does not exist for the military population. Previously published papers were written in anticipation of the policy allowing for open service. The civilian sector has treatment guidelines and evidence supporting the same for reference. There is no similar document for the military population, likely due to the recent change and ongoing development. This paper attempts to provide an overview of the recent Department of Defense policy and walks the reader through key considerations when providing care to a transgender member of the military as it relates to those who are currently serving in the military through the use of a case example. The military transgender population faces some unique challenges due to the need to balance readiness and deployability with medically necessary health care. Also complicating patient care is that policy development is ongoing-as of this publication, the decision has not yet been made regarding how people who identify as transgender will access into the military nor is there final approval regarding coverage for surgical procedures. Unique circumstances of this population are brought up to generate more discussion and encourage further evaluation and refinement of the process.

The development of a classification system for maternity models of care.

PubMed

Donnolley, Natasha; Butler-Henderson, Kerryn; Chapman, Michael; Sullivan, Elizabeth

2016-08-01

A lack of standard terminology or means to identify and define models of maternity care in Australia has prevented accurate evaluations of outcomes for mothers and babies in different models of maternity care. As part of the Commonwealth-funded National Maternity Data Development Project, a classification system was developed utilising a data set specification that defines characteristics of models of maternity care. The Maternity Care Classification System or MaCCS was developed using a participatory action research design that built upon the published and grey literature. The study identified the characteristics that differentiate models of care and classifies models into eleven different Major Model Categories. The MaCCS will enable individual health services, local health districts (networks), jurisdictional and national health authorities to make better informed decisions for planning, policy development and delivery of maternity services in Australia. © The Author(s) 2016.

The health-promoting nurse as a health policy career expert and entrepreneur.

PubMed

Whitehead, Dean

2003-11-01

A plethora of literature suggests that many nurses struggle in their attempts to develop a political role that allows them to directly influence and implement health policy activity. Nursing curricula are an integral part of ensuring that nurses are capable of taking on a more active role in initiating and developing health policy processes, through a broadening of the health promotion curriculum that focuses on socio-political approaches to health care provision. Despite this, the available literature suggests that the majority of nursing curricula are yet to fulfil this role. Such a role could be supported by attempts to define and promote a specific career route that develops nurses as health policy experts and entrepreneurs early on in their careers. This article aims to put forward a rationale for developing such a position in nursing education.

Integrated networks and health care provider cooperatives: new models for rural health care delivery and financing.

PubMed

Casey, M M

1997-01-01

Minnesota's 1994 health care reform legislation authorized the establishment of community integrated service networks (CISNs) and health care provider cooperatives, which were envisioned as new health care delivery models that could be successfully implemented in rural areas of the state. Four CISNs are licensed, and three organizations are incorporated as health care provider cooperatives. Many of the policy issues Minnesota has faced regarding the development of CISNs and health care provider cooperatives in rural areas are similar to those raised by current Medicare reform proposals.

The assessment on impact of essential drugs policy on primary health care system in rural areas of Shandong Province policy and regulation division of the Health Department of Shandong Province.

PubMed

Li, Zhuge; Shu, Defeng; Xia, Mei; Gao, Dehai; Lu, Dan; Huang, Ning; Tian, Xiaoqing; An, Limei; Li, Shixue; Li, Sheng

2015-01-01

At present, China has achieved an initial establishment and gradual implementation of a framework for national essential drugs policy. With the further implementation of the national essential drugs policy, it is not clear how the policy works, whether it achieves the original intention of essential drugs policy, and what impact essential drugs policy exerts on the primary health care system. In view of it, we conducted a field research on sample areas of Shandong Province to understand the conditions of the implementation of the essential drugs policy in Shandong Province. From three perspectives of medical institutions, patients and medical staff, this thesis analyzes the impact of essential drugs policy on village-level and township-level health service system, summarizes the effectiveness of implementing essential drugs policy, discovers the problems of various aspects and conducts an in-depth analysis of the causes, and puts forward feasible suggestions to provide reference for improving the essential drugs policy. The assessment results show that the implementation of essential drugs policy in Shandong Province has played a positive role in promoting the sound development of the primary health care system, changed the situation of covering hospital expenses with medicine revenue in the past, contributed to the return of medical institutions to public welfare, and reduced the patient's economic burden of disease. But there emerge many problems as follows: impact on the doctor's diagnosis and treatment due to incompleteness of drug types, and distribution not in place, patient loss and operational difficulty of village clinic. Thus, this thesis makes recommendations of drugs catalog formulation, drug procurement, sales and use, and meanwhile points out that the supporting financial compensation policy and performance appraisal policy and other measures in place are a prerequisite for a positive role of essential drugs policy.

Losing Sight of the Child? Human Capital Theory and Its Role for Early Childhood Education and Care Policies in Finland and England since the Mid-1990s

ERIC Educational Resources Information Center

Campbell-Barr, Verity; Nygård, Mikael

2014-01-01

The international interest in early childhood education and care (ECEC) by supranational organisations, including the European Union, has grown considerably due to its dual function of sustaining parental employment and fostering child development. Focussing primarily on child development debates around ECEC, this article argues that human capital…

Childcare Market Management: How the United Kingdom Government Has Reshaped Its Role in Developing Early Childhood Education and Care

ERIC Educational Resources Information Center

Penn, Helen

2007-01-01

This article reviews early education and care policies in the United Kingdom since 1997, when a Labour Government came to power, and sets them in the wider context of international changes. It argues that the Labour Government has, by intention and by default, supported the development of private sector, and especially corporate sector childcare.…

Quality and equity in early childhood care in Peru

NASA Astrophysics Data System (ADS)

Izu, Regina Moromizato

2007-01-01

The present study examines educational policy documents and programs on early childhood development and education in Peru. The author provides an evaluation of early childhood learning programs and their outcomes in different education centers in Peru. Health, nutrition, development, and participation are identified as key areas of concern. The study concludes with a reference to the importance of monitoring quality and equity in early childhood care.

A National Palliative Care Strategy for Canada

PubMed Central

2017-01-01

Abstract Objective: To identify barrier to achieving universal access to high quality palliative care in Canada, review published national strategies and frameworks to promote palliative care, examine key aspects that have been linked to successful outcomes, and make recommendations for Canada. Background: In 2014, the World Health Organization called on members to develop and implement policies to ensure palliative care is integrated into national health services. Methods: Rapid review supplemented by the author's personal files, outreach to colleagues within the international palliative care community, review of European Association for Palliative Care publications, and a subsequent search of the table of contents of the major palliative care journals. Results: Frameworks were found for 10 countries ranging from detailed and comprehensive multi-year strategies to more general approaches including laws guaranteeing access to palliative care services for “dying” patients or recommendations for the development of clinical infrastructure. Few formal evaluations were found minimal comparative data exist regarding the quality of care, access to palliative care services, timing of access in the disease trajectory, and patient and family satisfaction with care. Factors that appear to be associated with success include: 1) input and early involvement of senior policy makers; 2) comprehensive strategies that address major barriers to universal access and that involve the key constituents; 3) a focus on enhancing the evidence base and developing a national system of quality reporting; and 4) substantial and sustained government investment. Discussion: Comprehensive national strategies appear to improve access to high quality palliative care for persons with serious illness and their families. Such strategies require sustained government funding and address barriers related to infrastructure, professional and public education, workforce shortages, and an inadequate evidence base. PMID:29283876

Care plans and care planning in long-term conditions: a conceptual model.

PubMed

Burt, Jenni; Rick, Jo; Blakeman, Thomas; Protheroe, Joanne; Roland, Martin; Bower, Pete

2014-10-01

The prevalence and impact of long-term conditions continues to rise. Care planning for people with long-term conditions has been a policy priority for chronic disease management in a number of health-care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between 'care planning' (the process by which health-care professionals and patients discuss, agree and review an action plan to achieve the goals or behaviour change of most relevance and concern to the patient) and a 'care plan' (a written document recording the outcome of a care planning process). We propose a typology of care planning and care plans with three core dimensions: perspective (patient or professional), scope (a focus on goals or on behaviours) and networks (confined to the professional-patient dyad or extending to the entire care network). In addition, we draw on psychological models of mediation and moderation to outline potential mechanisms through which care planning and care plans may lead to improved outcomes for both patients and the wider health-care system. The proposed typology of care planning and care plans offered here, along with the model of the process by which care planning may influence outcomes, provide a useful framework for future policy developments and evaluations. Empirical work is required to explore the degree to which current care planning approaches and care plans can be described according to these dimensions, and the factors that determine which types of patients and professionals use which type of care plans.

Care plans and care planning in long term conditions: a conceptual model

PubMed Central

Burt, J; Rick, J; Blakeman, T; Protheroe, J; Roland, M; Bower, P

2013-01-01

The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority for chronic disease management in a number of health care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between ‘care planning’ (the process by which health care professionals and patients discuss, agree and review an action plan to achieve the goals or behaviour change of most relevance and concern to the patient) and a ‘care plan’ (a written document recording the outcome of a care planning process). We propose a typology of care planning and care plans with three core dimensions: perspective (patient or professional), scope (a focus on goals or on behaviours) and networks (confined to the professional-patient dyad or extending to the entire care network). In addition, we draw on psychological models of mediation and moderation to outline potential mechanisms through which care planning and care plans may lead to improved outcomes for both patients and the wider health care system. The proposed typology of care planning and care plans offered here, along with the model of the process by which care planning may influence outcomes, provide a useful framework for future policy developments and evaluations. Empirical work is required to explore the degree to which current care planning approaches and care plans can be described according to these dimensions, and the factors that determine which types of patients and professionals use which type of care plans. PMID:23883621

Do family policy regimes matter for children's well-being?

PubMed

Engster, Daniel; Stensöta, Helena Olofsdotter

2011-01-01

Researchers have studied the impact of different welfare state regimes, and particularly family policy regimes, on gender equality. Very little research has been conducted, however, on the association between different family policy regimes and children's well-being. This article explores how the different family policy regimes of twenty OECD countries relate to children's well-being in the areas of child poverty, child mortality, and educational attainment and achievement. We focus specifically on three family policies: family cash and tax benefits, paid parenting leaves, and public child care support. Using panel data for the years 1995, 2000, and 2005, we test the association between these policies and child well-being while holding constant for a number of structural and policy variables. Our analysis shows that the dual-earner regimes, combining high levels of support for paid parenting leaves and public child care, are strongly associated with low levels of child poverty and child mortality. We find little long-term effect of family policies on educational achievement, but a significant positive correlation between high family policy support and higher educational attainment. We conclude that family policies have a significant impact on improving children's well-being, and that dual-earner regimes represent the best practice for promoting children's health and development.

Participation and coordination in Dutch health care policy-making. A network analysis of the system of intermediate organizations in Dutch health care.

PubMed

Lamping, Antonie J; Raab, Jörg; Kenis, Patrick

2013-06-01

This study explores the system of intermediate organizations in Dutch health care as the crucial system to understand health care policy-making in the Netherlands. We argue that the Dutch health care system can be understood as a system consisting of distinct but inter-related policy domains. In this study, we analyze four such policy domains: Finances, quality of care, manpower planning and pharmaceuticals. With the help of network analytic techniques, we describe how this highly differentiated system of >200 intermediate organizations is structured and coordinated and what (policy) consequences can be observed with regard to its particular structure and coordination mechanisms. We further analyze the extent to which this system of intermediate organizations enables participation of stakeholders in policy-making using network visualization tools. The results indicate that coordination between the different policy domains within the health care sector takes place not as one would expect through governmental agencies, but through representative organizations such as the representative organizations of the (general) hospitals, the health care consumers and the employers' association. We further conclude that the system allows as well as denies a large number of potential participants access to the policy-making process. As a consequence, the representation of interests is not necessarily balanced, which in turn affects health care policy. We find that the interests of the Dutch health care consumers are well accommodated with the national umbrella organization NPCF in the lead. However, this is no safeguard for the overall community values of good health care since, for example, the interests of the public health sector are likely to be marginalized.

Episodes of care: is emergency medicine ready?

PubMed

Wiler, Jennifer L; Beck, Dennis; Asplin, Brent R; Granovsky, Michael; Moorhead, John; Pilgrim, Randy; Schuur, Jeremiah D

2012-05-01

Optimizing resource use, eliminating waste, aligning provider incentives, reducing overall costs, and coordinating the delivery of quality care while improving outcomes have been major themes of health care reform initiatives. Recent legislation contains several provisions designed to move away from the current fee-for-service payment mechanism toward a model that reimburses providers for caring for a population of patients over time while shifting more financial risk to providers. In this article, we review current approaches to episode of care development and reimbursement. We describe the challenges of incorporating emergency medicine into the episode of care approach and the uncertain influence this delivery model will have on emergency medicine care, including quality outcomes. We discuss the limitations of the episode of care payment model for emergency services and advocate retention of the current fee-for-service payment model, as well as identify research gaps that, if addressed, could be used to inform future policy decisions of emergency medicine health policy leaders. We then describe a meaningful role for emergency medicine in an episode of care setting. Copyright © 2011. Published by Mosby, Inc.

Public policy: extending psychology's contributions to national priorities.

PubMed

DeLeon, Patrick H; Kazdin, Alan E

2010-08-01

Much of today's psychological research and practice is relevant to our national health agenda and can serve the public interest. President Obama's landmark health care reform success provides an unprecedented opportunity to revolutionize society's definition of "quality care" and highlight rehabilitation's potential. Advocacy, vision, and a public policy presence with persistence are critical. Those involved often focus exclusively upon specific issues (e.g., reimbursement, research funding, or graduate student support). By developing a "bigger picture" approach addressing society's real needs and embracing the changes technology will ultimately bring, psychology can have a more lasting impact. There are unlimited opportunities to advance the profession through personal involvement in the public policy arena. It is essential that psychology's next generation receives relevant mentoring.

Horizontal inequity in public health care service utilization for non-communicable diseases in urban Vietnam

PubMed Central

Kien, Vu Duy; Van Minh, Hoang; Giang, Kim Bao; Weinehall, Lars; Ng, Nawi

2014-01-01

Background A health system that provides equitable health care is a principal goal in many countries. Measuring horizontal inequity (HI) in health care utilization is important to develop appropriate and equitable public policies, especially policies related to non-communicable diseases (NCDs). Design A cross-sectional survey of 1,211 randomly selected households in slum and non-slum areas was carried out in four urban districts of Hanoi city in 2013. This study utilized data from 3,736 individuals aged 15 years and older. Respondents were asked about health care use during the previous 12 months; information included sex, age, and self-reported NCDs. We assessed the extent of inequity in utilization of public health care services. Concentration indexes for health care utilization and health care needs were constructed via probit regression of individual utilization of public health care services, controlling for age, sex, and NCDs. In addition, concentration indexes were decomposed to identify factors contributing to inequalities in health care utilization. Results The proportion of healthcare utilization in the slum and non-slum areas was 21.4 and 26.9%, respectively. HI in health care utilization in favor of the rich was observed in the slum areas, whereas horizontal equity was achieved among the non-slum areas. In the slum areas, we identified some key factors that affect the utilization of public health care services. Conclusion Our results suggest that to achieve horizontal equity in utilization of public health care services, policy should target preventive interventions for NCDs, focusing more on the poor in slum areas. PMID:25095780

Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries.

PubMed

Broda, Anja; Bieber, Anja; Meyer, Gabriele; Hopper, Louise; Joyce, Rachael; Irving, Kate; Zanetti, Orazio; Portolani, Elisa; Kerpershoek, Liselot; Verhey, Frans; Vugt, Marjolein de; Wolfs, Claire; Eriksen, Siren; Røsvik, Janne; Marques, Maria J; Gonçalves-Pereira, Manuel; Sjölund, Britt-Marie; Woods, Bob; Jelley, Hannah; Orrell, Martin; Stephan, Astrid

2017-08-03

As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.

Hospice and Palliative Care in China: Development and Challenges

PubMed Central

Lu, Yuhan; Gu, Youhui; Yu, Wenhua

2018-01-01

Hospice and palliative care have been demonstrated to improve quality of life, shorten hospital stays, and save costs. As a developing country, faced with a rapidly aging population and an increasing number of patients with life-threatening illnesses such as cancer, China has made great progress in promoting hospice and palliative care during the past few decades. A trained nurse can play a significant role in promoting quality hospice and palliative care by providing care, coordinating a multidisciplinary team, calling for policy support, and raising public awareness. It is critical for nurses to clearly understand the development and challenges that currently exist in the country. With this awareness, nurses will improve their ability to recognize and address patients’ and families’ needs, resulting in quality, dignified, and individualized end-of-life care. PMID:29379830

The Economics of Child Care.

ERIC Educational Resources Information Center

Blau, David M., Ed.

Economic issues are an important part of the debate over child care policy. This volume presents findings from economic analyses of research on child care issues surrounding recent policy decisions and scholarly debates. The book's introduction discusses four main issues; government involvement in child care policies, its effect on quality of…

Stakeholder engagement and public policy evaluation: factors contributing to the development and implementation of a regional network for geriatric care.

PubMed

Glover, Catherine; Hillier, Loretta M; Gutmanis, Iris

2007-01-01

The development and implementation of a regional network that provides universally accessible and consistent services to the frail elderly living in Southwestern Ontario is described. Through continuous stakeholder engagement, clear network goals were identified and operationalized. Stakeholder commitment to the integration of expertise and specialized services, to evidence-based public policy and to iterative evaluation cycles were key to network success.

The Essential Process for a Successful Rural Strategy. A Policy Statement Following a National Evaluation of Title V of the Rural Development Act of 1972.

ERIC Educational Resources Information Center

Cornman, John M.; Madden, J. Patrick

During its three-year pilot period, Title V of the Rural Development Act of 1972 demonstrated its potential as part of a broad national rural strategy and should be carefully expanded with special attention to funding, organization, and evaluation policies. Initial funding at $20 million yearly would provide each state with $100,000 (an amount…

Informal care and the self-management partnership: implications for Australian health policy and practice.

PubMed

Essue, Beverley M; Jowsey, Tanisha; Jeon, Yun-Hee; Mirzaei, Masoud; Pearce-Brown, Carmen L; Aspin, Clive; Usherwood, Tim P

2010-11-01

The Serious and Continuing Illness Policy and Practice Study (SCIPPS) aims to improve the care and support for patients with chronic illness and their family carers. Here we describe the carers' contribution to the self-management partnership and discuss the policy and practice implications that are relevant to improving the support available for informal care in Australia. A secondary analysis of SCIPPS data. Fourteen carers of patients between 45 and 85 years with chronic heart failure, chronic obstructive pulmonary disease and diabetes were conveniently sampled from western Sydney and the Australian Capital Territory. Semi-structured interviews were conducted. Data were analysed using qualitative content analysis. Key roles that carers perform in the self-management partnership included: home helper; lifestyle coach; advocate; technical care manager; and health information interpreter. Two negative consequences of juggling these roles included: self-neglect and conflict. Rigid eligibility criteria limit carers' access to essential support programs which underestimates and undervalues their contributions to the self-management partnership. Support services should focus on the development of practical skills to perform the caregiving roles. In addition, health professionals require support to work more effectively with carers to minimise the conflict that can overshadow the care and self-management partnership.

Continuing Medical Education, Needs Assessment, and Program Development: Theoretical Constructs.

ERIC Educational Resources Information Center

Aherne, Michael; Lamble, Wayne; Davis, Paul

2001-01-01

Continuing medical education needs assessment should be reconceived for a changing health-care environment. The physician-patient relationship is being changed by empowerment of health consumers and public policy concerns regarding the health care system. Needs assessment should focus on environmental scanning, identification of key forces, use of…

Ensuring due process in the IACUC and animal welfare setting: considerations in developing noncompliance policies and procedures for institutional animal care and use committees and institutional officials.

PubMed

Hansen, Barbara C; Gografe, Sylvia; Pritt, Stacy; Jen, Kai-Lin Catherine; McWhirter, Camille A; Barman, Susan M; Comuzzie, Anthony; Greene, Molly; McNulty, Justin A; Michele, Daniel Eugene; Moaddab, Naz; Nelson, Randall J; Norris, Karen; Uray, Karen D; Banks, Ron; Westlund, Karin N; Yates, Bill J; Silverman, Jerald; Hansen, Kenneth D; Redman, Barbara

2017-10-01

Every institution that is involved in research with animals is expected to have in place policies and procedures for the management of allegations of noncompliance with the Animal Welfare Act and the U.S. Public Health Service Policy on the Humane Care and Use of Laboratory Animals. We present here a model set of recommendations for institutional animal care and use committees and institutional officials to ensure appropriate consideration of allegations of noncompliance with federal Animal Welfare Act regulations that carry a significant risk or specific threat to animal welfare. This guidance has 3 overarching aims: 1 ) protecting the welfare of research animals; 2 ) according fair treatment and due process to an individual accused of noncompliance; and 3 ) ensuring compliance with federal regulations. Through this guidance, the present work seeks to advance the cause of scientific integrity, animal welfare, and the public trust while recognizing and supporting the critical importance of animal research for the betterment of the health of both humans and animals.-Hansen, B. C., Gografe, S., Pritt, S., Jen, K.-L. C., McWhirter, C. A., Barman, S. M., Comuzzie, A., Greene, M., McNulty, J. A., Michele, D. E., Moaddab, N., Nelson, R. J., Norris, K., Uray, K. D., Banks, R., Westlund, K. N., Yates, B. J., Silverman, J., Hansen, K. D., Redman, B. Ensuring due process in the IACUC and animal welfare setting: considerations in developing noncompliance policies and procedures for institutional animal care and use committees and institutional officials. © FASEB.

Self-care among older people living with chronic conditions.

PubMed

LeBlanc, Raeann G; Jacelon, Cynthia S

2018-03-24

The aim of this study was to clarify the concept of self-care among older people living with chronic health conditions. This concept clarification will assist nurses in addressing self-care among older people through research, policy and practice in offering an expanded conceptual model. Several policy influences over the past decade directly relate to the increased importance and economic necessity to require self-directed care for older people living with chronic health conditions to maintain their care at home in the community. A selective review of literature on the concept of self-care included 31 sources. The Norris Concept Clarification method (1982) was used for clarification. The phenomenon is described historically according to its antecedents, attributes and consequences. A proposed definition is provided based on the clarification of this concept. A conceptual model is presented through an ecological framework. Self-care among older people living with chronic conditions is multidimensional and has multilevel influences (individual, community, system levels) and is mediated by the contexts and processes of ageing. Self-care originates along one's life course and is learned. Self-care responses are based on care needs when living with chronic health conditions. Self-care is an individual capacity, disposition and activity older people manifest in living with multiple chronic conditions. These features (capacity, disposition, action) influence one another and are hierarchical and continuous. Research, practice and policies that promote self-care among older people can focus on these features to improve health outcomes and promote new models of care consistent with personal development and chronic care needs in older age. This concept clarification can offer a model to support self-care among older people living with chronic conditions. © 2018 John Wiley & Sons Ltd.

Advance care planning for nursing home residents with dementia: Influence of 'we DECide' on policy and practice.

PubMed

Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

2017-01-01

(1) To pilot 'we DECide' in terms of influence on advance care planning policy and practice in nursing home dementia care units. (2) To investigate barriers and facilitators for implementing 'we DECide'. This was a pre-test-post-test study in 18 nursing homes. Measurements included: compliance with best practice of advance care planning policy (ACP-audit); advance care planning practice (ACP criteria: degree to which advance care planning was discussed, and OPTION scale: degree of involvement of residents and families in conversations). Advance care planning policy was significantly more compliant with best practice after 'we DECide'; policy in the control group was not. Advance care planning was not discussed more frequently, nor were residents and families involved to a higher degree in conversations after 'we DECide'. Barriers to realizing advance care planning included staff's limited responsibilities; facilitators included support by management staff, and involvement of the whole organization. 'We DECide' had a positive influence on advance care planning policy. Daily practice, however, did not change. Future studies should pay more attention to long-term implementation strategies. Long-term implementation of advance care planning requires involvement of the whole organization and a continuing support system for health care professionals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Palliative Care in Moldova.

PubMed

Gherman, Liliana; Pogonet, Vadim; Soltan, Viorel; Isac, Valerian

2018-02-01

The article describes the important steps of palliative care development in Moldova, the current status, main achievements and challenges to be addressed in the future. It covers background information, policy development, medicines access and availability, education, and training, as well as services' provision. Palliative care development in Moldova registered real progress in spite of frequent political changes at governmental levels and difficulties to ensure the continuity of the development process during the last 10 years. However, the unmet need for palliative care for patients with life-limiting illnesses from different disease and age groups remains high. Further effort is needed to increase the availability and access to opioid analgesics and other essential palliative care medications. Government commitment and support, together with adequate funding, trained and educated health care professionals, and easy access to and availability of medicines, are essential to ensure the successful implementation of palliative care services nationwide, and to deliver the most appropriate qualitative palliative care for patients. To speed up palliative care development, a national strategy on palliative care development should be considered. The authors took part and continue to be involved in different ways in palliative care development in the country. Copyright © 2017. Published by Elsevier Inc.

Large-scale organizational and managerial change in health care: a review of the literature.

PubMed

Ferlie, E

1997-07-01

This paper takes an overview of the organizational and managerial literature on recent large-scale change efforts within health care organizations. Such literature refers to issues of enhanced policy significance, as a succession of such changes has swept through health care, at an international level. Interpretive and case study method have been widely employed in this field. While the literature is emergent, key empirical concerns can be identified: (1) Changing roles and relationships, with the rise of management and the challenge to clinical domination; some argue that radical deprofessionalization now is evident, while others take a more nuanced view. (2) The impact of marketization, with health care becoming more of a commodity; various models of a health care 'quasi market' have been formulated. (3) Understanding the process of change in health care organizations, such as the development of a management of change literature. New theoretical frameworks have been developed, notably 'the reform cycle' as a way of understanding progressive cycles of organizational reform, the impact on health care of the rise of the new public management, and examining the demedicalization thesis through the more generic literature on professions. The paper concludes with a discussion of what this research base could contribute to policy-making.

Bullying in a caring profession: reasons, results, and recommendations.

PubMed

Broome, Barbara S; Williams-Evans, Shiphrah

2011-10-01

The theories of Florence Nightingale and Jean Watson provide a framework for the caring work of nurses. Ironically, this caring profession struggles with bullying. Bullying has both physiological and psychological ramifications for the person being bullied and a negative impact on the organization and patient care. Strategies to address bullying include education, developing codes of acceptable conduct for the workplace, and a zero-tolerance policy. Mental health nurses have a vital role in helping nurses return to roles of caring. Copyright 2011, SLACK Incorporated.

Health-care data collecting, sharing, and using in Thailand, China mainland, South Korea, Taiwan, Japan, and Malaysia.

PubMed

Aljunid, Syed Mohamed; Srithamrongsawat, Samrit; Chen, Wen; Bae, Seung Jin; Pwu, Raoh-Fang; Ikeda, Shunya; Xu, Ling

2012-01-01

This article sought to describe the health-care data situation in six selected economies in the Asia-Pacific region. Authors from Thailand, China mainland, South Korea, Taiwan, Japan, and Malaysia present their analyses in three parts. The first part of the article describes the data-collection process and the sources of data. The second part of the article presents issues around policies of data sharing with the stakeholders. The third and final part of the article focuses on the extent of health-care data use for policy reform in these different economies. Even though these economies differ in their economic structure and population size, they share some similarities on issues related to health-care data. There are two main institutions that collect and manage the health-care data in these economies. In Thailand, China mainland, Taiwan, and Malaysia, the Ministry of Health is responsible through its various agencies for collecting and managing the health-care data. On the other hand, health insurance is the main institution that collects and stores health-care data in South Korea and Japan. In all economies, sharing of and access to data is an issue. The reasons for limited access to some data are privacy protection, fragmented health-care system, poor quality of routinely collected data, unclear policies and procedures to access the data, and control on the freedom on publication. The primary objective of collecting health-care data in these economies is to aid the policymakers and researchers in policy decision making as well as create an awareness on health-care issues for the general public. The usage of data in monitoring the performance of the heath system is still in the process of development. In conclusion, for the region under discussion, health-care data collection is under the responsibility of the Ministry of Health and health insurance agencies. Data are collected from health-care providers mainly from the public sector. Routinely collected data are supplemented by national surveys. Accessibility to the data is a major issue in most of the economies under discussion. Accurate health-care data are required mainly to support policy making and evidence-based decisions. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Policy mapping for establishing a national emergency health policy for Nigeria

PubMed Central

Aliyu, Zakari Y

2002-01-01

Background The number of potential life years lost due to accidents and injuries though poorly studied has resulted in tremendous economic and social loss to Nigeria. Numerous socio-cultural, economic and political factors including the current epidemic of ethnic and religious conflicts act in concert in predisposing to and enabling the ongoing catastrophe of accident and injuries in Nigeria. Methods Using the "policymaker", Microsoft-Windows® based software, the information generated on accidents and injuries and emergency health care in Nigeria from literature review, content analysis of relevant documents, expert interviewing and consensus opinion, a model National Emergency Health Policy was designed and analyzed. A major point of analysis for the policy is the current political feasibility of the policy including its opportunities and obstacles in the country. Results A model National Emergency Health Policy with policy goals, objectives, programs and evaluation benchmarks was generated. Critical analyses of potential policy problems, associated multiple players, diverging interests and implementation guidelines were developed. Conclusions "Political health modeling" a term proposed here would be invaluable to policy makers and scholars in developing countries in assessing the political feasibility of policy managing. Political modeling applied to the development of a NEHP in Nigeria would empower policy makers and the policy making process and would ensure a sustainable emergency health policy in Nigeria. PMID:12181080

Janani Suraksha Yojana: the conditional cash transfer scheme to reduce maternal mortality in India - a need for reassessment.

PubMed

Rai, Rajesh Kumar; Singh, Prashant Kumar

2012-01-01

Alongside endorsing Millennium Development Goal 5 in 2000, India launched its National Population Policy in 2000 and the National Health Policy in 2002. However, these have failed thus far to reduce the maternal mortality ratio (MMR) by the targeted 5.5% per annum. Under the banner of the National Rural Health Mission, the Government of India launched a national conditional cash transfer (CCT) scheme in 2005 called Janani Suraksha Yojana (JSY), aimed to encourage women to give birth in health facilities which, in turn, should reduce maternal deaths. Poor prenatal care in general, and postnatal care in particular, could be considered the causes of the high number of maternal deaths in India (the highest in the world). Undoubtedly, institutional delivery in India has increased and MMR has reduced over time as a result of socioeconomic development coupled with advancement in health care including improved women's education, awareness and availability of health services. However, in the light of its performance, we argue that the JSY scheme was not well enough designed to be considered as an effective pathway to reduce MMR. We propose that the service-based CCT is not the solution to avoid/reduce maternal deaths and that policy-makers and programme managers should reconsider the 'package' of continuum of care and maternal health services to ensure that they start from adolescence and the pre-pregnancy period, and extend to delivery, postnatal and continued maternal health care.

Model Child Care Health Policies. Fourth Edition.

ERIC Educational Resources Information Center

Aronson, Susan S.

Drawn from a review of policies at over 100 child care programs nationwide, this document compiles model health policies intended for adaptation and selective use by out-of-home child care facilities. Following an introduction, the document presents model policy forms with blanks for adding individualized information for the following areas: (1)…

Sense of place, organizational context and the strategic management of publicly funded hospitals.

PubMed

Hanlon, N T

2001-11-01

An era of managerialism in health care delivery systems is now well ensconced throughout the nations of the OECD. This development has occurred, in large part, as a response to funding pressures in institutionally based health care delivery imposed by principal third party insurers. In the case of publicly funded hospitals, the more traditional concerns for stewardship and appeasement of professional groups is being replaced by a greater emphasis on cost consciousness and corporate-style leadership as these organizations seek to reposition themselves in new funding and regulatory environments. While institutional theory and strategic management perspectives help illuminate these issues, this paper argues that a place-based perspective is also needed to understand the changes currently underway in health care delivery and publicly funded human services more generally. This is illustrated with reference to developments in the strategic management of public hospitals in the province of Ontario. Evidence from a survey of senior administrators of public hospitals, distributed at the height of these policy reform initiatives, is examined to shed light on local level management responses to changing policy and fiscal pressures. The data suggest that the latest policy directions in the province of Ontario will 'encourage' hospital executives in particular community settings to steer their organizations in very unfamiliar directions. The findings suggest a need for greater attention to context and setting in health services research and policy.

Developing a policy guidance for financing dental care in Iran using the RAND Appropriateness Method.

PubMed

Jadidfard, M P; Yazdani, S; Khoshnevisan, M H

2013-12-01

This study aimed to provide recommendations on health care financing with special emphasis on dental care. The RAND Appropriateness Method was employed to obtain the collective opinion of a multidisciplinary panel of experts on a set of recommendation statements regarding Iranian dental care financing. An initial set of recommendations were identified from a literature review. Panel members, selected purposively and by peer nomination, each rated the appropriateness and necessity of the recommendations in a structured process of two rounds. Each recommendation was classified as inappropriate, uncertain, appropriate but not necessary, or appropriate and necessary according to the median rating score and the level of disagreement among the panellists. Of 28 initial recommendations, 25 were agreed on as appropriate, of which 22 were considered as necessary. Altogether, these recommendations provide a holistic picture of an oral health system's financing in three domains: revenue collection, pooling of revenues and purchasing of dental services. The policy guidance recommendations are intended to provide the Iranian oral health authorities with an evidence-base for financing dental care. The recommendations may be transferrable, at least in part, particularly to developing countries with similar hybrid health system structures. Finally, the method used to develop the recommendations can serve as a model for use elsewhere.

Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom.

PubMed

Shawe, Jill; Delbaere, Ilse; Ekstrand, Maria; Hegaard, Hanne Kristine; Larsson, Margareta; Mastroiacovo, Pierpaolo; Stern, Jenny; Steegers, Eric; Stephenson, Judith; Tydén, Tanja

2015-04-01

Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries. In 2013, an electronic search and investigation was undertaken of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. Findings were compared within five categories: Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites. All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations for healthy women and men were fragmented and inconsistent. Preconception guidance was often included in antenatal and pregnancy guidelines. Differences between countries were seen with regard to nutritional and lifestyle advice particularly in relation to fish, caffeine and alcohol consumption, and vitamin supplementation. Current guidelines are heterogeneous. Collaborative research across Europe is required in order to develop evidence-based guidelines for preconception health and care. There is a need to establish a clear strategy for promoting advice and guidance within the European childbearing population.

National health policy: a draft prepared by the Indian Medical Association.

PubMed

1979-03-16

The draft of the Indian national health policy deals with health as a fundamental right, the expenses of health, health as an integral part of national development, the health movement, the role of indigenous systems, priority in health care, and the infrastructure of health care delivery. The principles outlined in the policy focus on improvement of living conditions, health education and the health movement, preventive and promotive health, coverage of the felt needs of the people, primary health care, continuing medical education, pharmaceuticals, medical education curriculum, biomedical engineering, legislation, coordination, health insurance, and nationalization. In order for this policy to be implemented, proper strategy and planning needs to be carried out after identifying short-term and long-tern goals. The short-term goals include the following: declaration by the government that enjoyment of health is a fundamental right; 2) eradication/control of communicable diseases; 3) provision of adequate nutrition and rational health care in the rural areas and urban slums; 4) organization of a health movement and health education of the people and spread the message of health and family welfare; and 5) identification of the different areas of indigenous system of medicine to initiate scientific scrutiny of these areas for incorporation in the modern scientific system.

Open Source, Open Standards, and Health Care Information Systems

PubMed Central

2011-01-01

Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy. PMID:21447469

Open source, open standards, and health care information systems.

PubMed

Reynolds, Carl J; Wyatt, Jeremy C

2011-02-17

Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy.

Citizens' Jury and Elder Care: Public Participation and Deliberation in Long-Term Care Policy in Thailand.

PubMed

Chuengsatiansup, Komatra; Tengrang, Kanisorn; Posayanonda, Tipicha; Sihapark, Siranee

2018-02-16

Health care policies for the elderly are complex, multidimensional, and contextually circumscribed. While engagement of health experts, economists, health care administrators, and political leaders is generally viewed as instrumental to the success and sustainability of eldercare programs, the elders themselves are often viewed as passive recipients of care and not included in the policy processes. Experiences and expectations from users' perspectives can be invaluable information for policy formulation and systems design. This paper examines a participatory policy process using a "citizens' jury" to promote public engagement in eldercare policy. The process was initiated by the National Health Commission Office in Thailand to explore how a citizens' jury as a model for civic deliberation can be utilized to provide sophisticated policy recommendations on long-term care policies for the elderly. The objectives of this paper are to (1) examine how public participation in health policy can be actualized through the citizens' jury as an operational model, (2) understand the strengths and weaknesses of the ways the idea was implemented, and (3) provide recommendations for further use of the model. Details of how a citizens' jury was deployed are discussed, with recommendations for further use provided at the end.

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

PubMed Central

Berman, P.

2000-01-01

Success in the provision of ambulatory personal health services, i.e. providing individuals with treatment for acute illness and preventive health care on an ambulatory basis, is the most significant contributor to the health care system's performance in most developing countries. Ambulatory personal health care has the potential to contribute the largest immediate gains in health status in populations, especially for the poor. At present, such health care accounts for the largest share of the total health expenditure in most lower income countries. It frequently comprises the largest share of the financial burden on households associated with health care consumption, which is typically regressively distributed. The "organization" of ambulatory personal health services is a critical determinant of the health system's performance which, at present, is poorly understood and insufficiently considered in policies and programmes for reforming health care systems. This article begins with a brief analysis of the importance of ambulatory care in the overall health system performance and this is followed by a summary of the inadequate global data on ambulatory care organization. It then defines the concept of "macro organization of health care" at a system level. Outlined also is a framework for analysing the organization of health care services and the major pathways through which the organization of ambulatory personal health care services can affect system performance. Examples of recent policy interventions to influence primary care organization--both government and nongovernmental providers and market structure--are reviewed. It is argued that the characteristics of health care markets in developing countries and of most primary care goods result in relatively diverse and competitive environments for ambulatory care services, compared with other types of health care. Therefore, governments will be required to use a variety of approaches beyond direct public provision of services to improve performance. To do this wisely, much better information on ambulatory care organization is needed, as well as more experience with diverse approaches to improve performance. PMID:10916916