This article examines issues on health care costs and describes measures taken by public districts to reduce spending. As in most companies in America, health plan designs in public districts are being changed to reflect higher out-of-pocket costs, such as higher deductibles on visits to providers, hospital stays, and prescription drugs. District…
Clarke, Susan S.
Health care costs at Rensselaer Polytechnic Institute (New York) were projected to double between 1986 and 1990. The university has met cost-reduction goals through varied approaches, planned future cuts in overall costs by studying its employee population and is working toward a flexible plan for diverse health care needs. (MSE)
De Jesus, Maria; Xiao, Chenyang
There are two competing research explanations to account for Latinos' underutilization of health services relative to non-Latino Whites in the United States. One hypothesis examines the impact of health locus of control (HLOC) beliefs, while the other focuses on the role of access factors on health care use. To date, the relative strength of…
Durable power of attorney for health care; Health care proxy; End-of-life - health care agent; Life support treatment - ... Respirator - health care agent; Ventilator - health care agent; Power of attorney - health care agent; POA - health care ...
Rowe, Jennifer L.; Bruce, Martha L.; Conwell, Yeates
Home health care patients often have several late-life risk factors for suicide and constitute a high risk group for suicidal behaviors. In this study, we examined the characteristics of 14 older adult home health care utilizers who died by suicide and four community controls who used similar services. Both groups of home health care utilizers had…
Marmor, Theodore; Oberlander, Jonathan; White, Joseph
Controlling the costs of medical care has long been an elusive goal in U.S. health policy. This article examines the options for health care cost control under the Obama administration. The authors argue that the administration's approach to health reform offers some potential for cost control but also embraces many strategies that are not likely to be successful. Lessons the United States can learn from other countries' experiences in constraining medical care spending are then explored.
Rubin, Fred H.; Black, Judith S.
Two hospitals have conducted semiannual Town Meeting for Seniors to provide community-based health education, helping seniors make informed decisions about medical care, Medigap insurance, advance directives, and proper nutrition. Town Meeting has been enthusiastically received by consumers and has led to creation of several new community…
Claassens, L; Widdershoven, G A; Van Rhijn, S C; Van Nes, F; Broese van Groenou, M I; Deeg, D J H; Huisman, M
Frail older adults are increasingly encouraged to be in control of their health care, in Western societies. However, little is known about how they themselves perceive control in health care. Therefore, this study aims to investigate the concept of health care-related perceived control from the viewpoint of frail older adults. A qualitative interview study was conducted following a Grounded Theory approach. Thirty-two Dutch frail older adults, aged 65 and over, participated in 20 in-depth interviews (n=20) and three focus group discussions (n=12). Data were analysed according to techniques of coding and constant comparison. From this analysis constituting factors of perceived control emerged, providing elements of a conceptual model. Perceived control reflects the feeling or belief that health care is under control, which is constituted by five, either internal or external, factors: (I) self-confidence in organising professional and/or informal care, (II) self-confidence in health management in the home setting, (III) perceived support from people in the social network, (IV) perceived support from health care professionals and organisations, and (V) perceived support from (health care) infrastructure and services. Therefore, the concept does not only consist of people's own perceived efforts, but also includes the influence of external sources. Our conceptual model points out what external factors should be taken into consideration by health care professionals and policy makers when enhancing older people's perceived control. Moreover, it can serve as the basis for the development of a measurement instrument, to enable future quantitative research on health care-related perceived control among older adults.
Patel, Priti R; Srinivasan, Arjun; Perz, Joseph F
Our experiences with health departments and health care facilities suggest that questions surrounding instrument reprocessing errors and other infection control breaches are becoming increasingly common. We describe an approach to management of these incidents that focuses on risk of bloodborne pathogen transmission and the role of public health and other stakeholders to inform patient notification and testing decisions.
Hageman, Jeffrey C; Hazim, Carmen; Wilson, Katie; Malpiedi, Paul; Gupta, Neil; Bennett, Sarah; Kolwaite, Amy; Tumpey, Abbigail; Brinsley-Rainisch, Kristin; Christensen, Bryan; Gould, Carolyn; Fisher, Angela; Jhung, Michael; Hamilton, Douglas; Moran, Kerri; Delaney, Lisa; Dowell, Chad; Bell, Michael; Srinivasan, Arjun; Schaefer, Melissa; Fagan, Ryan; Adrien, Nedghie; Chea, Nora; Park, Benjamin J
The 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa underscores the need for health care infection prevention and control (IPC) practices to be implemented properly and consistently to interrupt transmission of pathogens in health care settings to patients and health care workers. Training and assessing IPC practices in general health care facilities not designated as Ebola treatment units or centers became a priority for CDC as the number of Ebola virus transmissions among health care workers in West Africa began to affect the West African health care system and increasingly more persons became infected. CDC and partners developed policies, procedures, and training materials tailored to the affected countries. Safety training courses were also provided to U.S. health care workers intending to work with Ebola patients in West Africa. As the Ebola epidemic continued in West Africa, the possibility that patients with Ebola could be identified and treated in the United States became more realistic. In response, CDC, other federal components (e.g., Office of the Assistant Secretary for Preparedness and Response) and public health partners focused on health care worker training and preparedness for U.S. health care facilities. CDC used the input from these partners to develop guidelines on IPC for hospitalized patients with known or suspected Ebola, which was updated based on feedback from partners who provided care for Ebola patients in the United States. Strengthening and sustaining IPC helps health care systems be better prepared to prevent and respond to current and future infectious disease threats.The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).
Bosco, Joseph; Iorio, Richard; Barber, Thomas; Barron, Chloe; Caplan, Arthur
The United States health-care expenditure is rising precipitously. The Congressional Budget Office has estimated that, in 2025, at our current rate of increased spending, 25% of the gross domestic product will be allocated to health care. Our per-capita spending on health care also far exceeds that of any other industrialized country. Health-care costs must be addressed if our country is to remain competitive in the global marketplace and to maintain its financial solvency. If unchecked, the uncontrolled rise in health-care expenditures will not only affect our capacity to provide our patients with high-quality care but also threaten the ability of our nation to compete economically on the global stage. This is not hyperbole but fiscal reality.As physicians, we are becoming increasingly familiar with the economics impacting health-care policy. Thus, we are in a unique position to control the cost of health care. This includes an increased reliance on creating and adhering to evidence-based guidelines. We can do this and still continue to respect the primacy of patient welfare and the right of patients to act in their own self-interest. However, as evidenced by the use of high-volume centers of excellence, each strategy adapted to control costs must be vetted and must be monitored for its unintended ethical consequences.The solution to this complex problem must involve the input of all of the health-care stakeholders, including the patients, payers, and providers. Physicians ought to play a role in designing and executing a remedy. After all, we are the ones who best understand medicine and whose moral obligation is to the welfare of our patients.
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The complexity of our health care environment and organizations requires a management style that moves beyond control to empowerment. Even though this complexity minimizes our ability to control events, many organizations are still preoccupied with the illusion of control. This restrains the performance of our health care organizations. Some of the contributing factors supporting this illusion are bureaucracy, scientific methodology, individualism, and our confusion of management with leadership. The concept of "community" is discussed from an organizational perspective. It is suggested that we can improve the performance of our organizations by rediscovering the values of community.
Panaretto, Kathryn S; Wenitong, Mark; Button, Selwyn; Ring, Ian T
The national Closing the Gap framework commits to reducing persisting disadvantage in the health of Aboriginal and Torres Strait Islander people in Australia, with cross-government-sector initiatives and investment. Central to efforts to build healthier communities is the Aboriginal community controlled health service (ACCHS) sector; its focus on prevention, early intervention and comprehensive care has reduced barriers to access and unintentional racism, progressively improving individual health outcomes for Aboriginal people. There is now a broad range of primary health care data that provides a sound evidence base for comparing the health outcomes for Indigenous people in ACCHSs with the outcomes achieved through mainstream services, and these data show: models of comprehensive primary health care consistent with the patient-centred medical home model; coverage of the Aboriginal population higher than 60% outside major metropolitan centres; consistently improving performance in key performance on best-practice care indicators; and superior performance to mainstream general practice. ACCHSs play a significant role in training the medical workforce and employing Aboriginal people. ACCHSs have risen to the challenge of delivering best-practice care and there is a case for expanding ACCHSs into new areas. To achieve the best returns, the current mainstream Closing the Gap investment should be shifted to the community controlled health sector.
Oosthuysen, Jeanné; Potgieter, Elsa; Fossey, Annabel
Many publications are available on the topic of compliance with infection prevention and control in oral health-care facilities all over the world. The approaches of developing and developed countries show wide variation, but the principles of infection prevention and control are the same globally. This study is a systematic review and global perspective of the available literature on infection prevention and control in oral health-care facilities. Nine focus areas on compliance with infection-control measures were investigated: knowledge of infectious occupational hazards; personal hygiene and care of hands; correct application of personal protective equipment; use of environmental barriers and disposable items; sterilisation (recirculation) of instruments and handpieces; disinfection (surfaces) and housekeeping; management of waste disposal; quality control of dental unit waterlines, biofilms and water; and some special considerations. Various international studies from developed countries have reported highly scientific evidence-based information. In developed countries, the resources for infection prevention and control are freely available, which is not the case in developing countries. The studies in developing countries also indicate serious shortcomings with regard to infection prevention and control knowledge and education in oral health-care facilities. This review highlights the fact that availability of resources will always be a challenge, but more so in developing countries. This presents unique challenges and the opportunity for innovative thinking to promote infection prevention and control.
It is well established that health care workers (HCWs) have a considerably higher risk of occupationally acquired tuberculosis (TB). To reduce the transmission of TB to HCWs and patients, TB infection control programs should be implemented in health care settings. The first and most important level of all protection and control programs is administrative control. Its goals are to prevent HCWs, other staff, and patients from being exposed to TB, and to reduce the transmission of infection by ensuring rapid diagnosis and treatment of affected individuals. Administrative control measures recommended by the United States Centers for Disease Control and Prevention and the World Health Organization include prompt identification of people with TB symptoms, isolation of infectious patients, control of the spread of the pathogen, and minimization of time spent in health care facilities. Another key component of measures undertaken is the baseline and serial screening for latent TB infection in HCWs who are at risk of exposure to TB. Although the interferon-gamma release assay has some advantages over the tuberculin skin test, the former has serious limitations, mostly due to its high conversion rate. PMID:28119743
Rozzi, M V
The confluence of two trends--health care "consumerism" and employee self-service benefits programs--offers employers a promising opportunity for health care cost control. To take advantage of this opportunity, employers must take a fresh look at the health care cost dilemma and find ways to simultaneously offer employees a new kind of benefit and implement more effective cost-control measures.
... Healthy Living > Living With Lung Disease > Respiratory Home Health Care Font: Aerosol Delivery Oxygen Resources Immunizations Pollution Nutrition ... Disease Articles written by Respiratory Experts Respiratory Home Health Care Respiratory care at home can contribute to improved ...
Udasin, I G
More people are employed in the health care sector than in any other industry in the United States. Health care workers are exposed to a wide variety of hazards, including biological, chemical, physical and psychological stressors. Concerns about exposure to contagious diseases such as HIV, Hepatitis B and C, and tuberculosis have influenced the career choices of many health professionals. Physical hazards, especially ergonomic ones, account for the majority of the disability faced by health care workers. Chemical exposure and psychosocial stresses are also present in health care institutions. The exposure encountered in health care facilities is potentially dangerous to health care workers as well as to their family members and unborn children.
O'Hara, Lyndsay; Bryce, Elizabeth Ann; Scharf, Sydney; Yassi, Annalee
A user-friendly, high quality workplace assessment field guide and an accompanying worksheet are invaluable tools for recognizing hazards in the hospital environment. These tools ensure that both front line workers as well as health and safety and infection control professionals can systematically evaluate hazards and formulate recommendations.…
Mecaskey, Jeffrey W; Ngirwamungu, Edith; Kilima, Peter M
Tanzania was among the first countries to launch a trachoma control program with support from the International Trachoma Initiative (ITI) using surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) strategy with azithromycin. More than one million children less than 10 years of age in Tanzania have active disease and an estimated 54,000 people have trichiasis. Since 2000, Tanzania has implemented major health sector reform that have been carried out in three phases in 114 districts. A key aspect of the reform process is the policy of developing locally distributed essential health packages that then serve as the basis of the comprehensive council health plan. In 2002, the Tanzania Ministry of Health in collaboration with the ITI, the World Bank, and the office of the President embarked on a program of information for districts where trachoma is endemic but where no control program has been launched. Clear goals for the trachoma control program have been reviewed and discussed by the districts and as a result trachoma control was integrated into the comprehensive council health plans for 2003. This is expected to expand in 2004 and 2005. This work is presented as a model for the support and integration of disease-specific control efforts into the primary health care system.
Rudasingwa, Martin; Soeters, Robert; Bossuyt, Michel
To strengthen the health care delivery, the Burundian Government in collaboration with international NGOs piloted performance-based financing (PBF) in 2006. The health facilities were assigned - by using a simple matching method - to begin PBF scheme or to continue with the traditional input-based funding. Our objective was to analyse the effect of that PBF scheme on the quality of health services between 2006 and 2008. We conducted the analysis in 16 health facilities with PBF scheme and 13 health facilities without PBF scheme. We analysed the PBF effect by using 58 composite quality indicators of eight health services: Care management, outpatient care, maternity care, prenatal care, family planning, laboratory services, medicines management and materials management. The differences in quality improvement in the two groups of health facilities were performed applying descriptive statistics, a paired non-parametric Wilcoxon Signed Ranks test and a simple difference-in-difference approach at a significance level of 5%. We found an improvement of the quality of care in the PBF group and a significant deterioration in the non-PBF group in the same four health services: care management, outpatient care, maternity care, and prenatal care. The findings suggest a PBF effect of between 38 and 66 percentage points (p<0.001) in the quality scores of care management, outpatient care, prenatal care, and maternal care. We found no PBF effect on clinical support services: laboratory services, medicines management, and material management. The PBF scheme in Burundi contributed to the improvement of the health services that were strongly under the control of medical personnel (physicians and nurses) in a short time of two years. The clinical support services that did not significantly improved were strongly under the control of laboratory technicians, pharmacists and non-medical personnel.
Powell, Suzanne K
Health care tourism is often a preplanned event carefully laying out all the details. Sometimes, when one least expects it, medical care is needed outside of the mainland. This Editorial speaks to an unplanned experience.
Tutty, O. R.
Many physical systems make repeated executions of the same finite time duration task. One example is a robot in a factory or warehouse whose task is to collect an object in sequence from a location, transfer it over a finite duration, place it at a specified location or on a moving conveyor and then return for the next one and so on. Iterative learning control was especially developed for systems with this mode of operation and this paper gives an overview of this control design method using relatively recent relevant applications in wind turbines, free-electron lasers and health care, as exemplars to demonstrate its applicability. PMID:27713654
Rogers, E.; Tutty, O. R.
Many physical systems make repeated executions of the same finite time duration task. One example is a robot in a factory or warehouse whose task is to collect an object in sequence from a location, transfer it over a finite duration, place it at a specified location or on a moving conveyor and then return for the next one and so on. Iterative learning control was especially developed for systems with this mode of operation and this paper gives an overview of this control design method using relatively recent relevant applications in wind turbines, free-electron lasers and health care, as exemplars to demonstrate its applicability.
This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.
... page: //medlineplus.gov/ency/article/001937.htm Vacation health care To use the sharing features on this page, ... and help you avoid problems. Talk to your health care provider or visit a travel clinic 4 to ...
Bulger, R J
As prefigured in the Greek tragedy Antigone, one of the primary conflicts in contemporary health care is that between humane concern for the individual and concern for society at large and administrative rules. The computerization of the health care system and development of large data bases will create new forms of this conflict that will challenge the self-definition of health care and health care professionals.
staggering cost of hospitalization and health care in general. Vast insurance pools that pay the bills encourage both the provider and consumer to utilize...incentives built into the system for either the consumer or the provider to encourage medical services cost control. 6 Massive, expensive and seemingly...1991.11 Ethical Considerations in Health Care Bioethical questions will prevail during any discussion of how to resolve America’s health care crisis. The
Landman, Natalie; Aannestad, Liv K; Smoldt, Robert K; Cortese, Denis A
It is becoming increasingly clear that maintaining and improving the health of the population, and doing so in a financially sustainable manner, requires the coordination of acute medical care with long-term care, and social support services, that is, team-based care. Despite a growing body of evidence on the benefits of team-based care, the health care ecosystem remains "resistant" to a broader implementation of such care models. This resistance is a function of both system-wide and organizational barriers, which result primarily from fragmentation in reimbursement for health care services, regulatory restrictions, and the siloed nature of health professional education. To promote the broader adoption of team-based care models, the health care system must transition to pay for value reimbursement, as well as break down the educational silos and move toward team-based and value-based education of health professionals.
Khorsan, Raheleh; Coulter, Ian D.; Crawford, Cindy; Hsiao, An-Fu
A systematic review was conducted to assess the level of evidence for integrative health care research. We searched PubMed, Allied and Complementary Medicine (AMED), BIOSIS Previews, EMBASE, the entire Cochrane Library, MANTIS, Social SciSearch, SciSearch Cited Ref Sci, PsychInfo, CINAHL, and NCCAM grantee publications listings, from database inception to May 2009, as well as searches of the “gray literature.” Available studies published in English language were included. Three independent reviewers rated each article and assessed the methodological quality of studies using the Scottish Intercollegiate Guidelines Network (SIGN 50). Our search yielded 11,891 total citations but 6 clinical studies, including 4 randomized, met our inclusion criteria. There are no available systematic reviews/meta-analyses published that met our inclusion criteria. The methodological quality of the included studies was assessed independently using quality checklists of the SIGN 50. Only a small number of RCTs and CCTs with a limited number of patients and lack of adequate control groups assessing integrative health care research are available. These studies provide limited evidence of effective integrative health care on some modalities. However, integrative health care regimen appears to be generally safe. PMID:20953383
Woith, Wendy Mann; Volchenkov, Grigory; Larson, Janet L.
SUMMARY Setting Five inpatient and outpatient tuberculosis care facilities in two regions of Russia. Objective: To identify barriers and motivators to use of infection control measures among Russian TB health care workers. Design In this qualitative study, a convenience sample of 96 HCWs was used to generate 15 homogeneous focus groups consisting of physicians, nurses, lab staff, or support staff. Results Barriers and motivators related to knowledge, attitudes and beliefs, and practices were identified. Three main barriers were a) knowledge deficits, including the belief that TB was transmitted by dust, linens, and eating utensils; b) negative attitudes related to the discomfort of respirators; and c) practices with respect to quality and care of respirators. Education and training, fear of infecting loved ones, and fear of punishment were the main motivators. Conclusions Our results point to the need for evaluation of current educational programs. Positive health promotion messages that appeal to fear might also be successful in promoting use of TB infection control. Individualized rewards based on personal motivators or group rewards that build on collectivist theory could be explored. PMID:22687261
Background Current asthma management guidelines are based on the level of asthma control. The impact of asthma control on health care resources and quality of life (QoL) is insufficiently studied. EUCOAST study was designed to describe costs and QoL in adult patients according to level of asthma control in France and Spain. Methods An observational cost of illness study was conducted simultaneously in both countries among patients age greater or equal to 18 with a diagnosis of asthma for at least 12 months. Patients were recruited prospectively by GPs in 2010 in four waves to avoid a seasonal bias. Health care resources utilization of the three months before the inclusion was collected through physician questionnaires. Asthma control was evaluated using 2009 GINA criteria over a 3-month period. QoL was assessed using EQ-5D-3L®. Results 2,671 patients (France: 1,154; Spain: 1,517) were enrolled. Asthma was controlled in 40.6% [95% CI: 37.7% - 43.4%] and 29.9% [95% CI: 27.6% - 32.3%] of French and Spanish patients respectively. For all types of costs, the percentage of patients using health care resources varied significantly according to the level of asthma control. The average cost (euros/3-months/patient) of controlled asthma was €85.4 (SD: 153.5) in France compared with €314.0 (SD: 2,160.4) for partially controlled asthma and €537.9 (SD: 2,355.7) for uncontrolled asthma (p<0.0001). In Spain, the corresponding figures were €152.6 (SD: 162.1), €241.2 (SD: 266.8), and €556.8 (SD: 762.4). EQ-5D-3L® score was higher (p<0.0001) in patients with controlled asthma compared to partially controlled and uncontrolled asthma in both countries (respectively 0.88; 0.78; 0.63 in France and 0.89; 0.82; 0.69 in Spain). Conclusions In both countries, patients presenting with uncontrolled asthma had a significantly higher asthma costs and lower scores of Qol compared to the others. PMID:23517484
Vraciu, R A
The planning, budgeting, and controlling processes (PBCP) largely subsume all of the planning and controlling activities of an organization. This paper discusses these activities within the context of a single management control system, focusing on three topics. First, a brief historical perspective of management concerns which relate to PBCP is presented and several important external pressures currently imposed on the health care industry are discussed. Second, normative models of the processes--programming, budgeting, and controlling--are presented. The discussion focuses on the elements and relationships of these processes, and numerous references to the literature are provided. Third, several issues related to the gap between the state of the art in PBCP for hospitals and the current state of practice are discussed. PMID:116990
Erberich, Stephan G.; Documet, Jorge; Zhou, Michael Z.; Cao, Fei; Liu, Brent J.; Mogel, Greg T.; Huang, H. K.
Image workflow in today's Picture Archiving and Communication Systems (PACS) is controlled from fixed Display Workstations (DW) using proprietary control interfaces. A remote access to the Hospital Information System (HIS) and Radiology Information System (RIS) for urgent patient information retrieval does not exist or gradually become available. The lack for remote access and workflow control for HIS and RIS is especially true when it comes to medical images of a PACS on Department or Hospital level. As images become more complex and data sizes expand rapidly with new image techniques like functional MRI, Mammography or routine spiral CT to name a few, the access and manageability becomes an important issue. Long image downloads or incomplete work lists cannot be tolerated in a busy health care environment. In addition, the domain of the PACS is no longer limited to the imaging department and PACS is also being used in the ER and emergency care units. Thus a prompt and secure access and manageability not only by the radiologist, but also from the physician becomes crucial to optimally utilize the PACS in the health care enterprise of the new millennium. The purpose of this paper is to introduce a concept and its implementation of a remote access and workflow control of the PACS combining wireless, Internet and Internet2 technologies. A wireless device, the Personal Digital Assistant (PDA), is used to communicate to a PACS web server that acts as a gateway controlling the commands for which the user has access to the PACS server. The commands implemented for this test-bed are query/retrieve of the patient list and study list including modality, examination, series and image selection and pushing any list items to a selected DW on the PACS network.
Exner, M; Kramer, A; Kistemann, T; Gebel, J; Engelhart, S
New epidemiological and microbiological investigations using molecular typing methods to link patient and environmental strains demonstrate a strong association between water-borne pathogens and nosocomial infections. Avoiding patient exposure to these pathogens results in a decreased incidence of water-borne nosocomial infections. There remains a tremendous potential to reduce hospital acquired infections previously viewed as inevitable and unavoidable through intervention and preventive measures. The characteristics of water application in health care facilities, the vulnerability of patients, the spectrum of relevant pathogens and their ecologic aspects, legal issues and important measures for prevention and control are discussed.
Raveis, Victoria H.; Conway, Laurie J.; Uchida, Mayuko; Pogorzelska-Maziarz, Monika; Larson, Elaine L.; Stone, Patricia W.
Health-care-associated infections (HAIs) remain a major patient safety problem even as policy and programmatic efforts designed to reduce HAIs have increased. Although information on implementing effective infection control (IC) efforts has steadily grown, knowledge gaps remain regarding the organizational elements that improve bedside practice and accommodate variations in clinical care settings. We conducted in-depth, semistructured interviews in 11 hospitals across the United States with a range of hospital personnel involved in IC (n = 116). We examined the collective nature of IC and the organizational elements that can enable disparate groups to work together to prevent HAIs. Our content analysis of participants’ narratives yielded a rich description of the organizational process of implementing adherence to IC. Findings document the dynamic, fluid, interactional, and reactive nature of this process. Three themes emerged: implementing adherence efforts institution-wide, promoting an institutional culture to sustain adherence, and contending with opposition to the IC mandate. PMID:24598775
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Miller, Franklin G; Kim, Scott Y H
The idea of a "learning health care system"--one that systematically integrates clinical research with medical care--has received considerable attention recently. Some commentators argue that under certain conditions pragmatic comparative effectiveness randomized trials can be conducted ethically within the context of a learning health care system without the informed consent of patients for research participation. In this article, we challenge this perspective and contend that conducting randomized trials of individual treatment options without consent is neither necessary nor desirable to promote and sustain learning health care systems. Our argument draws on the normative conception of personal care developed by Charles Fried in a landmark 1974 book on the ethics of randomized controlled trials.
Brazil has great geopolitical importance because of its size, environmental resources, and potential economic power. The organisation of its health care system reflects the schisms within Brazilian society. High technology private care is available to the rich and inadequate public care to the poor. Limited financial resources have been overconcentrated on health care in the hospital sector and health professionals are generally inappropriately trained to meet the needs of the community. However, recent changes in the organisation of health care are taking power away from federal government to state and local authorities. This should help the process of reform, but many vested interests remain to be overcome. A link programme between Britain and Brazil focusing on primary care has resulted in exchange of ideas and staff between the two countries. If primary care in Brazil can be improved it could help to narrow the health divide between rich and poor. Images p503-a p504-a p505-a PMID:8448465
Elfering, Achim; Schade, Volker; Stoecklin, Lukas; Baur, Simone; Burger, Christian; Radlinger, Lorenz
Slip, trip, and fall injuries are frequent among health care workers. Stochastic resonance whole-body vibration training was tested to improve postural control. Participants included 124 employees of a Swiss university hospital. The randomized controlled trial included an experimental group given 8 weeks of training and a control group with no intervention. In both groups, postural control was assessed as mediolateral sway on a force plate before and after the 8-week trial. Mediolateral sway was significantly decreased by stochastic resonance whole-body vibration training in the experimental group but not in the control group that received no training (p < .05). Stochastic resonance whole-body vibration training is an option in the primary prevention of balance-related injury at work.
Background Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making. Methods/Design Dyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the
Walsh, J A; Warren, K S
Priorities among the infectious diseases affecting the three billion people in the less developed world have been based on prevalence, morbidity, mortality and feasibility of control. With these priorities in mind a program of selective primary health care is compared with other approaches and suggested as the most cost-effective form of medical intervention in the least developed countries. A flexible program delivered by either fixed or mobile units might include measles and diphtheria-pertussis-tetanus vaccination, treatment for febrile malaria and oral rehydration for diarrhea in children, and tetanus toxoid and encouragement of breast feeding in mothers. Other interventions might be added on the basis of regional needs and new developments. For major diseases for which control measures are inadequate, research is an inexpensive approach on the basis of cost per infected person per year.
Nazareth, Meaghan; Richards, Jordan; Javalkar, Karina; Haberman, Cara; Zhong, Yi; Rak, Eniko; Jain, Nina; Ferris, Maria
Introduction Health locus of control refers to the belief that health is in one’s control (internal control) or is not in one’s control (external control). Among adults, external locus of control is associated with negative health outcomes, whereas internal locus of control is associated with favorable outcomes. Few studies examined these associations among youths. The objective of our study was to determine how locus of control relates to health care use, medication adherence, missed school, and readiness for transition to adult medical care for youths with chronic conditions. Methods Participants at a camp for youths aged 6 to 17 years with chronic health conditions completed a survey measuring locus of control, readiness for transition to adult care, and medication adherence. Their parents completed a separate part of the survey about health care use and missed school days in the past year. Results A total of 163 youths completed the survey (78.5% white; 52.1% female; mean age, 12.3 y). Internal locus of control (β = 0.196; P = .013) and external Doctor locus of control with doctors controlling disease (β = 0.181; P = .025) were positively associated with transition readiness. External control by chance or with others controlling disease was negatively associated with transition readiness (β = −0.248; P = .002) and positively associated with emergency department visits (β = 0.225; P = .004) and with number of hospital inpatient nights at hospital (β = 0.166; P = .04). Conclusion Adolescents with external control of their health by chance or by other people are at increased risk for negative health outcomes and may fail to develop the self-management skills needed for successful transitioning to adult care. Future studies should examine effects of changes in locus of control on health outcomes among youths. PMID:27442993
Big employers like Boeing and Intel are directly contracting with hospitals in an effort to control health care prices. Some hospital CEOs see direct contracting as the future, while others wonder how they can participate.
Esteban, Cynthia A.; Klein, Robert B.; McQuaid, Elizabeth L.; Fritz, Gregory K.; Seifer, Ronald; Kopel, Sheryl J.; Santana, Jose Rodriguez; Colon, Angel; Alvarez, Maria; Koinis-Mitchell, Daphne; Ortega, Alexander N.; Martinez-Nieves, Brenda; Canino, Glorisa
Background The lifetime prevalence of self-reported asthma among Puerto Ricans is very high, with increased asthma hospitalizations, emergency department visits, and mortality rates. Differences in asthma severity between the mainland and island, however, remain largely unknown. Objective We sought to characterize differences in asthma severity and control among 4 groups: (1) Island Puerto Ricans, (2) Rhode Island (RI) Puerto Ricans, (3) RI Dominicans, and (4) RI whites. Methods Eight hundred five children aged 7 to 15 years completed a diagnostic clinic session, including a formal interview, physical examination, spirometry, and allergy testing. Using a visual grid adapted from the Global Initiative for Asthma, asthma specialists practicing in each site determined an asthma severity rating. A corresponding level of asthma control was determined by using a computer algorithm. Results Island Puerto Ricans had significantly milder asthma severity compared with RI Puerto Ricans, Dominicans, and whites (P < .001). Island Puerto Ricans were not significantly different from RI whites in asthma control. RI Puerto Ricans showed a trend toward less control compared with island Puerto Ricans (P = .061). RI Dominicans had the lowest rate of controlled asthma. Paradoxically, island Puerto Ricans had more emergency department visits in the past 12 months (P < .001) compared with the 3 RI groups. Conclusions Potential explanations for the paradoxic finding of milder asthma in island Puerto Ricans in the face of high health care use are discussed. Difficulties in determining guideline-based composite ratings for severity versus control are explored in the context of disparate groups. PMID:19615729
Babamoto, Kenneth S.; Sey, Kwa A.; Camilleri, Angela J.; Karlan, Vicki J.; Catalasan, Joana; Morisky, Donald E.
The increasing prevalence of diabetes and obesity, growing health disparities, and shortage of bilingual and culturally trained health care professionals underscore the role of trained community health workers (CHWs) to provide economically sustainable and culturally relevant services. This prospective randomized design evaluated the relative…
La Rosa-Salas, Virginia; Tricas-Sauras, Sandra
It has long been known that a segment of the population enjoys distinctly better health status and higher quality of health care than others. To solve this problem, prioritization is unavoidable, and the question is how priorities should be set. Rational priority setting would seek equity amongst the whole population, the extent to which people receive equal care for equal needs. Equity in health care is an ethical imperative not only because of the intrinsic worth of good health, or the value that society places on good health, but because, without good health, people would be unable to enjoy life's other sources of happiness. This paper also argues the importance of the health care's efficiency, but at the same time, it highlights how any innovation and rationalization undertaken in the provision of the health system should be achieved from the consideration of human dignity, making the person prevail over economic criteria. Therefore, the underlying principles on which this health care equity paper is based are fundamental human rights. The main aim is to ensure the implementation of these essential rights by those carrying out public duties. Viewed from this angle, equity in health care means equality: equality in access to services and treatment, and equality in the quality of care provided. As a result, this paper attempts to address both human dignity and efficiency through the context of equity to reconcile them in the middle ground.
variety of specialists including chiropractors , optometrists, speech therapists, and mental health specialists (IBISWorld, 2006). Registered nurses... treatment services. These establishments have an organized staff of health care practitioners to provide patient care services and provide other services...Carroll, 2003). Complementary and Alternative Medicine includes a wide variety of treatments and therapies that are generally not supported by scientific
Schultz, D S; Rafferty, M P
Health and health care in the Soviet Union are drawing special attention during these first years of perestroika, Mikhail Gorbachev's reform of Soviet political and economic life. This report briefly describes the current state of Soviet health and medical care, Gorbachev's plans for reform, and the prospects for success. In recent years the Soviet Union has experienced a rising infant mortality rate and declining life expectancy. The health care system has been increasingly criticized for its uncaring providers, low quality of care, and unequal access. The proposed measures will increase by 50 percent the state's contribution to health care financing, encourage private medicine on a small scale, and begin experimentation with capitation financing. It seems unlikely that the government will be able to finance its share of planned health improvements, or that private medicine, constrained by the government's tight control, will contribute much in the near term. Recovery of the Soviet economy in general as well as the ability of health care institutions to gain access to Western materials will largely determine the success of reform of the Soviet health care system. PMID:2297064
Kilbourne, Amy M.; Barbaresso, Michelle M.; Lai, Zongshan; Nord, Kristina M.; Bramlet, Margretta; Goodrich, David E.; Post, Edward P.; Almirall, Daniel; Bauer, Mark S.
Objective Persons with chronic mental disorders are disproportionately burdened with physical health conditions. We determined whether Life Goals Collaborative Care compared to usual care improves physical health in patients with mental disorders within 12 months. Method This single-blind randomized controlled effectiveness study of a collaborative care model was conducted at a mid-western Veterans Affairs urban outpatient mental health clinic. Patients (N=293 out of 474 eligible approached) with an ICD-9-CM diagnosis of schizophrenia, bipolar disorder, or major depressive disorder and at least one cardiovascular disease risk factor were consented and randomized (02/24/10 to 04/29/15) to Life Goals (N=146) or usual care (N=147). A total of 287 completed baseline assessments and 245 completed 12-month follow-up assessments. Life Goals included five weekly sessions that provided semi-structured guidance on managing physical and mental health symptoms through healthy behavior changes, augmented by ongoing care coordination. The primary outcome was change in physical health-related quality of life score (VR-12 physical health component score). Secondary outcomes included control of cardiovascular risk factors from baseline to 12 months (blood pressure, lipids, weight), mental health-related quality of life, and mental health symptoms. Results Among patients completing baseline and 12-month outcomes assessments (N=245), the mean age was 55.3 (SD=10.8; range 28-75 years) and 15.4% were female. Intent-to-treat analysis revealed that compared to those in usual care, patients randomized to Life Goals had slightly increased VR-12 physical health scores (coefficient=3.21;p=0.01). Conclusion Patients with chronic mental disorders and cardiovascular disease risk who received Life Goals had improved physical health-related quality of life. PMID:27780336
Brenes-Camacho, Gilbert; Rosero-Bixby, Luis
Background Costa Rica, like other developing countries, is experiencing an increasing burden of chronic conditions such as diabetes mellitus (DM), especially among its elderly population. This article has two goals: (1) to assess the level of metabolic control among the diabetic population age ≥ 60 years old in Costa Rica, and (2) to test whether diabetic elderly patients of community health centers differ from patients in other health care settings in terms of the level of metabolic control. Methods Data come from the project CRELES, a nationally representative study of people aged 60 and over in Costa Rica. This article analyzes a subsample of 542 participants in CRELES with self-reported diagnosis of diabetes mellitus. Odds ratios of poor levels of metabolic control at different health care settings are computed using logistic regressions. Results Lack of metabolic control among elderly diabetic population in Costa Rica is described as follows: 37% have glycated hemoglobin ≥ 7%; 78% have systolic blood pressure ≥ 130 mmHg; 66% have diastolic blood pressure ≥ 80 mmHg; 48% have triglycerides ≥ 150 mg/dl; 78% have LDL ≥ 100 mg/dl; 70% have HDL ≤ 40 mg/dl. Elevated levels of triglycerides and LDL were higher in patients of community health centers than in patients of other clinical settings. There were no statistical differences in the other metabolic control indicators across health care settings. Conclusion Levels of metabolic control among elderly population with DM in Costa Rica are not that different from those observed in industrialized countries. Elevated levels of triglycerides and LDL at community health centers may indicate problems of dyslipidemia treatment among diabetic patients; these problems are not observed in other health care settings. The Costa Rican health care system should address this problem, given that community health centers constitute a means of democratizing access to primary health care to underserved and poor areas. PMID
Köhn, Monica; Persson Lundholm, Ulla; Bryngelsson, Ing-Liss; Anderzén-Carlsson, Agneta; Westerdahl, Elisabeth
An increasing number of patients are suffering from stress-related symptoms and diagnoses. The purpose of this study was to evaluate the medical yoga treatment in patients with stress-related symptoms and diagnoses in primary health care. A randomized controlled study was performed at a primary health care centre in Sweden from March to June, 2011. Patients were randomly allocated to a control group receiving standard care or a yoga group treated with medical yoga for 1 hour, once a week, over a 12-week period in addition to the standard care. A total of 37 men and women, mean age of 53 ± 12 years were included. General stress level (measured using Perceived Stress Scale (PSS)), burnout (Shirom-Melamed Burnout Questionnaire (SMBQ)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), insomnia severity (Insomnia Severity Index (ISI)), pain (visual analogue scale (VAS)), and overall health status (Euro Quality of Life VAS (EQ-VAS)) were measured before and after 12 weeks. Patients assigned to the Yoga group showed significantly greater improvements on measures of general stress level (P < 0.000), anxiety (P < 0.019), and overall health status (P < 0.018) compared to controls. Treatment with medical yoga is effective in reducing levels of stress and anxiety in patients with stress-related symptoms in primary health care.
Köhn, Monica; Persson Lundholm, Ulla; Bryngelsson, Ing-Liss; Anderzén-Carlsson, Agneta; Westerdahl, Elisabeth
An increasing number of patients are suffering from stress-related symptoms and diagnoses. The purpose of this study was to evaluate the medical yoga treatment in patients with stress-related symptoms and diagnoses in primary health care. A randomized controlled study was performed at a primary health care centre in Sweden from March to June, 2011. Patients were randomly allocated to a control group receiving standard care or a yoga group treated with medical yoga for 1 hour, once a week, over a 12-week period in addition to the standard care. A total of 37 men and women, mean age of 53 ± 12 years were included. General stress level (measured using Perceived Stress Scale (PSS)), burnout (Shirom-Melamed Burnout Questionnaire (SMBQ)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), insomnia severity (Insomnia Severity Index (ISI)), pain (visual analogue scale (VAS)), and overall health status (Euro Quality of Life VAS (EQ-VAS)) were measured before and after 12 weeks. Patients assigned to the Yoga group showed significantly greater improvements on measures of general stress level (P < 0.000), anxiety (P < 0.019), and overall health status (P < 0.018) compared to controls. Treatment with medical yoga is effective in reducing levels of stress and anxiety in patients with stress-related symptoms in primary health care. PMID:23533465
Bowman, Darcia Harris
The Broad Acres clinic is one of 1,500 school-based health centers nationwide that bring a wide range of medical, nutritional, and mental-health care to millions of students and their families. The centers provide an important safety net for children and adolescents--particularly the more than 10 million today who lack health insurance, according…
Brown, M S
This is the third and last article reporting professional exchange tours between American nurses and nurses of other countries. In this article, the health care system of Kenya is discussed and comparisons made between this system and our own. Out of this comparison come several insights into our own way of doing things and possibilities for improving them. "Health Care in the Soviet Union" appeared in the April 1984 issue of The Nurse Practitioner. "Health Care in China" appeared in the May 1984 issue of the journal.
Data Insight: Health care spending in the U.S. grew 7.7% in 2003, down from 9.3% in 2002, marking the first decline in costs in seven years, according to a report by the Centers for Medicare & Medicaid Services Office of the Actuary. CMS economists say spending declined because state Medicaid programs cut budgets and became more efficient through the use of managed care.
Tapia-Conyer, Roberto; Gallardo-Rincón, Héctor; Saucedo-Martinez, Rodrigo
Mexico and other Latin American countries are currently facing a dramatic increase in the number of adults suffering from non-communicable diseases (NCDs) such as diabetes, cardiovascular disease (CVD) and chronic kidney disease (CKD), which require prolonged, continuous care. This epidemiological shift has created new challenges for health-care systems. Both the World Health Organization (WHO) and the United Nations (UN) have recognised the growing human and economic costs of NCDs and outlined an action plan, recognising that NCDs are preventable, often with common preventable risk factors linked to risky health behaviours. In line with international best practices, Mexico has applied a number of approaches to tackle these diseases. However, challenges remain for the Mexican health-care system, and in planning a strategy for combating and preventing NCDs, it must consider how best to integrate these strategies with existing health-care infrastructure. Shifting the paradigm of care in Mexico from a curative, passive approach to a preventive, proactive model will require an innovative and replicable system that guarantees availability of medicines and services, strengthens human capital through ongoing professional education, expands early and continuous access to care through proactive prevention strategies and incorporates technological innovations in order to do so. Here, we describe CASALUD: an innovative model in health-care that leverages international best practices and uses innovative technology to deliver NCD care, control and prevention. In addition, we describe the lessons learned from the initial implementation of the model for its effective use in Mexico, as well as the plans for wider implementation throughout the country, in partnership with the Mexican Ministry of Health.
Casas, Irma; Dominguez, Jose; Rodríguez, Soledad; Matllo, Joan; Altet, Neus
Tuberculosis remains one of the communicable diseases that cause increased morbidity and mortality worldwide. With an incidence rate of 13,04 per 100,000 population, Spain ranks third among the most affected European countries. These data show a tendency to decrease meaning that it may go unnoticed with the potential to miss the appropriate preventive measures in a suspected case. In centers where patients are treated with tuberculosis, health care worker presents risk of transmission. This risk is higher in some areas or work units. The Occupational health physicians' services, which monitorize the health of health care workers, use different strategies in order to prevent and detect tuberculosis infection. The national guidelines include the tuberculin skin test as a screening test for tuberculosis infection with mention of new diagnostic tests based on the in vitro detection of gamma interferon (IGRA) for certain cases. The purpose of this guide is to establish common criteria for IGRA tests, as a supplementary aid to the tuberculin skin test in health care workers, from the evidence available today. Recommendations for its use have been adapted to the different situations faced by the professionals involved in monitoring the health of health workers.
Seattle-King County Dept. of Public Health, Seattle, WA.
This day care infection control manual was assembled to provide technical guidance for the prevention and control of communicable diseases to child day care facilities in Seattle and King County, Washington. For each disease, the manual provides background information, public health control recommendations, and letters that can be used to…
... This infection causes diarrhea, stomach cramps, and gas. Ear infections, colds, coughs, sore throats, and runny noses ... Head lice and scabies are other common health problems that occur in day care centers. You can ...
... Disease (Nephropathy) Gastroparesis Mental Health Step On Up Treatment & Care Blood Glucose Testing Medication Doctors, Nurses & More ... us get closer to curing diabetes and better treatments for those living with diabetes. Other Ways to ...
Lanpher, Michele G.; Askew, Sandy; Bennett, Gary G.
In the U.S., 90 million adults have low health literacy. An important public health challenge is developing obesity treatment interventions suitable for those with low health literacy. The objective of this study was to examine differences in sociodemographic and clinical characteristics, as well as weight and intervention engagement outcomes by health literacy. We randomized 194 participants to usual care or to the Shape Program intervention, a 12 month digital health treatment aimed to prevent weight gain among overweight and class I obese black women in primary care practice. We administered the Newest Vital Sign instrument to assess health literacy. Over half (55%)of participants had low health literacy, which was more common for those with fewer years of educational attainment and lower income. There was no effect of health literacy on 12-month weight change or on intervention engagement outcomes (completion of coaching calls and interactive voice response self-monitoring calls). Low health literacy did not preclude successful weight gain prevention in the Shape Program intervention. Goal focused behavior change approaches like that used in Shape may be particularly helpful for treating and engaging populations with low health literacy. PMID:27043756
Lee, Ji Yeon
Transmission of tuberculosis (TB) is a recognized risk to patients and healthcare workers in healthcare settings. The literature review suggests that implementation of combination control measures reduces the risk of TB transmission. Guidelines suggest a three-level hierarchy of controls including administrative, environmental, and respiratory protection. Among environmental controls, installation of ventilation systems is a priority because ventilation reduces the number of infectious particles in the air. Natural ventilation is cost-effective but depends on climatic conditions. Supplemented intervention such as air-cleaning methods including high efficiency particulate air filtration and ultraviolet germicidal irradiation should be considered in areas where adequate ventilation is difficult to achieve. Personal protective equipment including particulate respirators provides additional benefit when administrative and environmental controls cannot assure protection.
Transmission of tuberculosis (TB) is a recognized risk to patients and healthcare workers in healthcare settings. The literature review suggests that implementation of combination control measures reduces the risk of TB transmission. Guidelines suggest a three-level hierarchy of controls including administrative, environmental, and respiratory protection. Among environmental controls, installation of ventilation systems is a priority because ventilation reduces the number of infectious particles in the air. Natural ventilation is cost-effective but depends on climatic conditions. Supplemented intervention such as air-cleaning methods including high efficiency particulate air filtration and ultraviolet germicidal irradiation should be considered in areas where adequate ventilation is difficult to achieve. Personal protective equipment including particulate respirators provides additional benefit when administrative and environmental controls cannot assure protection. PMID:27790274
Bartley, J M
The Association for Professionals in Infection Control and Epidemiology, Inc (APIC), is a multidisciplinary organization of more than 12,000 health care professionals who practice infection control and epidemiology within a variety of health care settings. This report reviews issues the infection control professional should consider related to construction and renovation projects in health care facilities. Preventing transmission of infectious agents to vulnerable patient populations, health care workers, and visitors remains an important component of infection control programs. Environmental dispersal of microorganisms during construction, resulting in nosocomial infections, has been described previously, and select examples are provided in Table I as a reminder that there is a solid, scientific basis for these concerns. Environmental airborne contaminants and infectious agents are closely related to water and moisture-related conditions and figure prominently in construction activity. Weems et al have established construction activity as an independent variable for infectious risks in such circumstances. Construction-related outbreak literature will not be revisited in detail; however, pertinent citations will identify resources as appropriate.
Williams, David E.
This paper will provide an overview of the International Space Station (ISS) Environmental Control and Life Support (ECLS) design of the Crew Health Care System (CHeCS) Rack 1 and it will document some of the lessons that have been learned to date for the ECLS equipment in this rack.
Deressa, Wakgari; Ali, Ahmed; Hailemariam, Damen
A range of activities are currently underway to improve access to malaria prevention and control interventions. As disease control strategies change over time, it is crucial to understand the health-seeking behaviour and the local socio-cultural context in which the changes in interventions operate. This paper reflects on how people in an area of seasonal malaria perceive the causes and transmission of the disease, and what prevention and treatment measures they practise to cope with the disease. It also highlights some of the challenges of malaria treatment for health care providers. The study was undertaken in 2003 in Adami Tulu District in south-central Ethiopia, where malaria is a major health problem. Pre-tested structured questionnaires and focus group discussions were conducted among men and women. Malaria, locally known as busa, was perceived as the most important cause of ill health in the area. Respondent's perception and knowledge about the cause and transmission of the disease were relatively high. The newly introduced insecticide-treated nets were not popular in the area, and only 6.4% of households possessed at least one. The results showed that patients use multiple sources of health care for malaria treatment. Public health facilities, private clinics and community health workers were the main providers of malaria treatment. Despite higher treatment costs, people preferred to use private health care providers for malaria treatment due to the higher perceived quality of care they offer. In conclusion, effort in the prevention and control of malaria should be intensified through addressing not only public facilities, but also the private sector and community-based control interventions. Appropriate and relevant information on malaria should be disseminated to the local community. The authors propose the provision of effective antimalarial drugs and malaria prevention tools such as subsidized or free insecticide-treated nets.
This paper performs an empirical comparison of health systems. Health systems are seen as networks of delegation relationships among principals and agents, subject to agency problems. Following the institutional economics approach, a health system's efficiency is considered to be determined by the existence and treatment of agency problems. Agency problems can be controlled by mechanisms built into the health system, or can also be controlled by an external actor, for example, the government, either by using the instruments available or by conducting institutional reforms. To explain differences in the amenability of a country's health system to external governmental control, I combine the veto player approach and the incentives for societal actors to exert influence, into the concept of indirect veto players: the more indirect veto players exist, the less external control will be exercised.I derive indicators capturing both forms of control and perform a comparison of health systems based on institutional and performance data. Using data reducing methods, I identify two dimensions of control underlying the institutional setting of the health system and three dimensions of health system performance. The relationships found between control and performance confirm the hypotheses derived from the adopted theoretical approach.
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.
This paper is about the management of change; and, most especially, about the changing tides of thinking that health planning and, more latterly, competition could bring about desired change in the health industry towards cost containment, efficiency and control. Looking back over the decade of the 1980s, it was characterised, for many countries, as a real questioning of the role of the public sector in people's life, and--in terms of public/private provision--a re-examination of what is public and should be. Coupled with this inquiry was a growing belief that comprehensive health planning was too lofty a goal, and that however elegant in theory, its delivery in practice fell far short of its ideals. Attention has therefore focused on the workings of competitive markets, and the extent to which objectives of cost containment and economic efficiency can be better addressed through competition and internal markets. In reality, the mixed economy is the only policy option available to developed countries today. Public and private monopolies are frowned upon, and the search is on for intermediate possibilities that capture some of the advantages of markets without their disadvantages, and arrangements that motivate consumer choice and simultaneously yield efficiency in the production and distribution of health care. By way of illustration, this paper looks at a number of innovations taking place to address these issues; and, in the context of the UK, at the most recent government proposals in respect of self-governing trusts and GP budget holders, as illustrations of the move towards the internal market, or to managed competition. Not surprisingly, the two areas that feature large on the agenda are hospital (and community) information systems; and, the motivations, rewards and penalties of the provider institutions that deliver services, and the consumers and purchasers who will "buy" them. Whether the mould can and should be broken is left tantalisingly open in the
Derzon, Robert A.
As the federal government shifted from its traditional roles in health to the payment for personal health care, the relationship between public and private sectors has deteriorated. Today federal and state revenue funds and trusts are the largest purchasers of services from a predominantly private health system. This financing or “gap-filling” role is essential; so too is the purchaser's concern for the costs and prices it must meet. The cost per person for personal health care in 1980 is expected to average $950, triple for the aged. Hospital costs vary considerably and inexplicably among states; California residents, for example, spend 50 percent more per year for hospital care than do state of Washington residents. The failure of each sector to understand the other is potentially damaging to the parties and to patients. First, and most important, differences can and must be moderated through definite changes in the attitudes of the protagonists. PMID:6770551
Background To evaluate the effectiveness of a new multifactorial intervention to improve health care for chronic ischemic heart disease patients in primary care. The strategy has two components: a) organizational for the patient/professional relationship and b) training for professionals. Methods/design Experimental study. Randomized clinical trial. Follow-up period: one year. Study setting: primary care, multicenter (15 health centers). For the intervention group 15 health centers are selected from those participating in ESCARVAL study. Once the center agreed to participate patients are randomly selected from the total amount of patients with ischemic heart disease registered in the electronic health records. For the control group a random sample of patients with ischemic heart disease is selected from all 72 health centers electronic records. Intervention components: a) Organizational intervention on the patient/professional relationship. Centered on the Chronic Care Model, the Stanford Expert Patient Program and the Kaiser Permanente model: Teamwork, informed and active patient, decision making shared with the patient, recommendations based on clinical guidelines, single electronic medical history per patient that allows the use of indicators for risk monitoring and stratification. b) Formative strategy for professionals: 4 face-to-face training workshops (one every 3 months), monthly update clinical sessions, online tutorial by a cardiologist, availability through the intranet of the action protocol and related documents. Measurements: Blood pressure, blood glucose, HbA1c, lipid profile and smoking. Frequent health care visits. Number of hospitalizations related to vascular disease. Therapeutic compliance. Drug use. Discussion This study aims to evaluate the efficacy of a multifactorial intervention strategy involving patients with ischemic heart disease for the improvement of the degree of control of the cardiovascular risk factors and of the quality of life
Marušič, Dorjan; Prevolnik Rupel, Valentina
In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.
Prevolnik Rupel, Valentina
Abstract In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country. PMID:27703543
Khan, Muhammad Amir; Ahmed, Maqsood; Anil, Shirin; Walley, John
Background Respiratory diseases, namely asthma and chronic obstructive pulmonary disease (COPD), account for one-fourth of the patients at the primary health-care (PHC) facilities in Pakistan. Standard care practices to manage these diseases are necessary to reduce the morbidity and mortality rate associated with non-communicable diseases in developing countries. Objective To develop and measure the effectiveness of operational guidelines and implementation materials, with sound scientific evidence, for expanding lung health care, especially asthma and COPD through PHC facilities already strengthened for tuberculosis (TB) care in Pakistan. Design A cluster randomized controlled trial with two arms (intervention and control), with qualitative and costing study components, is being conducted in 34 clusters; 17 clusters per arm (428 asthma and 306 COPD patients), in three districts in Pakistan from October 2014 to December 2016. The intervention consists of enhanced case management of asthma and COPD patients through strengthening of PHC facilities. The main outcomes to be measured are asthma and COPD control among the registered cases at 6 months. Cluster- and individual-level analyses will be done according to intention to treat. Residual confounding will be addressed by multivariable logistic and linear regression models for asthma and COPD control, respectively. The trial is registered with ISRCTN registry (ISRCTN 17409338). Conclusions Currently, only about 20% of the estimated prevalent asthma and COPD cases are being identified and reported through the respective PHC network. Lung health care and prevention has not been effectively integrated into the core PHC package, although a very well-functioning TB program exists at the PHC level. Inclusion of these diseases in the already existent TB program is expected to increase detection rates and care for asthma and COPD. PMID:26578109
Jackson, C N; Manning, M R
This study explores the relationship between burnout and health care utilization of 238 employed adults. Burnout was measured by the Maslach Burnout Inventory and health care utilization by insurance company records regarding these employees' health care costs and number of times they accessed health care services over a one year period. ANOVAs were conducted using Golembiewski and Munzenrider's approach to define the burnout phase. Significant differences in health care costs were found.
The first part of the paper is concerned with the health care values of various groups; namely, those which are resource oriented, disease oriented, political decision-makers, organized sellers and purchasers of health care and patients. These groups are further divided according to selected political/ideological and socio-economic characteristics, essentially along capitalist and socialist lines. Some of the ways in which the values held by these groups are determined, formulated and, by implication at least, changed and the political, economic and other bases for some of their practical applications are identified. The second part of the paper focuses upon values in public health education and related practice. It is argued that to become more useful to the 'health of the public' the new public health worker will have to become more activist, assuming an adversarial stance toward the market economy in capitalist countries and oppressive governmental structures everywhere. A wider integration of knowledge concerning the effects of health of all types of economic, social and political practices is required; this, in turn, would contribute to the emergence of alternative forms of public health analysis and practice. The recognition of wider forms of public health leadership should follow, coupled with organizational changes directed at the greater participation of popular groupings in all types of public health activities.
Hembree, William E
Health care cost increases are showing a resurgence. Despite recent years' comparatively modest increases, the projections for 2015 cost increases range from 6.6% to 7%--three to four times larger than 2015's expected underlying inflation. This resurgence is just one of many rapidly changing external and internal challenges health plan sponsors must overcome (and this resurgence advances the date when the majority of employers will trigger the "Cadillac tax"). What's needed is a planning approach that is effective in overcoming all known and yet-to-be-discovered challenges, not just affordability. This article provides detailed guidance in adopting six proven strategic planning steps. Following these steps will proactively and effectively create a flexible strategic plan for the present and future of employers' health plans that will withstand all internal and external challenges.
Cremers, A. L.; Janssen, S.; Huson, M. A. M.; Bikene, G.; Bélard, S.; Gerrets, R. P. M.
Setting: Lambaréné, Gabon. Objectives: To describe patient perceptions of tuberculosis (TB) and to determine factors that influence health care seeking behaviour to gain insight into the management of multidrug-resistant TB. Design: Participant observation, in-depth semi-structured interviews and focus group discussions were conducted with 30 TB patients, 36 relatives, 11 health care providers and 18 traditional/spiritual healers. Recruitment of patients was linked to the PanEpi study and took place at the Albert Schweitzer Hospital, the General Hospital and the TB-HIV (human immunodeficiency virus) clinic. Results: Patients generally described TB as a natural and/or magical disease. The majority of the patients combined treatment at the hospital with (herbal) self-treatment and traditional/spiritual healing. Despite the free availability of anti-tuberculosis treatment in principle, patient adherence was problematic, hindering effective TB control. Most patients delayed or defaulted from treatment due to financial constraints, stigmatisation, ignorance about treatment, change of health care service or use of non-prescribed antibiotics. The situation was occasionally complicated by drug stockouts. Conclusion: There is an urgent need to bridge the gap between patients and the hospital by avoiding drug shortages, intensifying culturally sensitive TB health education, embedding TB care into the cultural context and enhancing cooperation between hospitals, patients, traditional healers and communities. PMID:26393056
Freda, M C
Of the many social trends that will have an impact on the ethical debates surrounding women's health in the 21st century, three are discussed: the shifting demographics of age and race in the United States; the fundamental change in the health care system to a community-based, preventive model; and the equal voice of women in the government. Using these trends as a framework, this article hypothesizes the ethical debates that will occur in the 21st century concerning such issues as fetal viability, abortion, contraception, infertility, genetic engineering, aggressive versus nonaggressive treatment of aging women, scarce resources, menopause, organ transplants, sexism in biomedical research, fertility in postmenopausal women, birthing centers, fetal surgery, and fetal therapy.
Chin, Jean Lau; Yee, Barbara W K; Banks, Martha E
As health care reform promises to change the landscape of health care delivery, its potential impact on women's health looms large. Whereas health and mental health systems have historically been fragmented, the Affordable Care Act (ACA) mandates integrated health care as the strategy for reform. Current systems fragment women's health not only in their primary care, mental health, obstetrical, and gynecological needs, but also in their roles as the primary caregivers for parents, spouses, and children. Changes in reimbursement, and in restructuring financing and care coordination systems through accountable care organizations and medical homes, will potentially improve women's health care.
The cost of hospital care depends on the quality of the service, on the personal characteristics of the patient, on the effort of the medical staff and on information asymmetry. In this article the cost minimizing properties of alternative payment systems will be discussed in a context where hospitals can observe patient severity and compete according to the rules of Hotelling's spatial competition. The scheme is designed from the standpoint of a purchaser that sets up a contract with several providers for services of a given quality at the least possible cost. Patients' severity cannot be observed and quality cannot be verified, but the latter can be inferred through the choice of patients. The model shows that in the health care market, prospective payments and yardstick competition are weak instruments for cost containment; incentive compatible schemes are, at least from a theoretical point of view, better instruments especially in a context where the purchaser can use signals relating to the variables it cannot observe. Cost inflation has two components: the information rent paid to the provider and inefficiency. In our model the information rent is used by the provider to get more patients to his hospital; spatial competition can then be used to curb the cost of providing hospital care.
Background Sepsis sequelae include critical illness polyneuropathy, myopathy, wasting, neurocognitive deficits, post-traumatic stress disorder, depression and chronic pain. Little is known howlong-term sequelae following hospital discharge are treated. The aim of our study is to determine the effect of a primary care-based, long-term program on health-related quality of life in sepsis survivors. Methods/Design In a two-armed randomized multicenter interventional study, patients after sepsis (n = 290) will be assessed at 6, 12 and 24 months. Patients are eligible if severe sepsis or septic shock (ICD-10), at least two criteria of systemic inflammatory response syndrome (SIRS), at least one organ dysfunction and sufficient cognitive capacity are present. The intervention comprises 1) discharge management, 2) training of general practitioners and patients in evidence-based care for sepsis sequelae and 3) telephone monitoring of patients. At six months, we expect an improved primary outcome (health-related quality of life/SF-36) and improved secondary outcomes such as costs, mortality, clinical-, psycho-social- and process-of-care measures in the intervention group compared to the control group. Discussion This study evaluates a primary care-based, long-term program for patients after severe sepsis. Study results may add evidence for improved sepsis care management. General practitioners may contribute efficiently to sepsis aftercare. Trial registration U1111-1119-6345. DRKS00000741, CCT-NAPN-20875 (25 February 2011). PMID:25015838
Earnshaw, Valerie; Lewis, Jessica B.; Kershaw, Trace S.; Magriples, Urania; Stasko, Emily; Rising, Sharon Schindler; Cassells, Andrea; Cunningham, Shayna; Bernstein, Peter; Tobin, Jonathan N.
Objectives. We compared an evidence-based model of group prenatal care to traditional individual prenatal care on birth, neonatal, and reproductive health outcomes. Methods. We performed a multisite cluster randomized controlled trial in 14 health centers in New York City (2008–2012). We analyzed 1148 pregnant women aged 14 to 21 years, at less than 24 weeks of gestation, and not at high obstetrical risk. We assessed outcomes via medical records and surveys. Results. In intention-to-treat analyses, women at intervention sites were significantly less likely to have infants small for gestational age (< 10th percentile; 11.0% vs 15.8%; odds ratio = 0.66; 95% confidence interval = 0.44, 0.99). In as-treated analyses, women with more group visits had better outcomes, including small for gestational age, gestational age, birth weight, days in neonatal intensive care unit, rapid repeat pregnancy, condom use, and unprotected sex (P = .030 to < .001). There were no associated risks. Conclusions. CenteringPregnancy Plus group prenatal care resulted in more favorable birth, neonatal, and reproductive outcomes. Successful translation of clinical innovations to enhance care, improve outcomes, and reduce cost requires strategies that facilitate patient adherence and support organizational change. PMID:26691105
Shiferaw, Solomon; Spigt, Mark; Tekie, Michael; Abdullah, Muna; Fantahun, Mesganaw; Dinant, Geert-Jan
Background Although there are studies showing that mobile phone solutions can improve health service delivery outcomes in the developed world, there is little empirical evidence that demonstrates the impact of mHealth interventions on key maternal health outcomes in low income settings. Methods A non-randomized controlled study was conducted in the Amhara region, Ethiopia in 10 health facilities (5 intervention, 5 control) together serving around 250,000 people. Health workers in the intervention group received an android phone (3 phones per facility) loaded with an application that sends reminders for scheduled visits during antenatal care (ANC), delivery and postnatal care (PNC), and educational messages on dangers signs and common complaints during pregnancy. The intervention was developed at Addis Ababa University in Ethiopia. Primary outcomes were the percentage of women who had at least 4 ANC visits, institutional delivery and PNC visits at the health center after 12 months of implementation of the intervention. Findings Overall 933 and 1037 women were included in the cross-sectional surveys at baseline and at follow-up respectively. In addition, the medical records of 1224 women who had at least one antenatal care visit were followed in the longitudinal study. Women who had their ANC visit in the intervention health centers were significantly more likely to deliver their baby in the same health center compared to the control group (43.1% versus 28.4%; Adjusted Odds Ratio (AOR): 1.98 (95%CI 1.53–2.55)). A significantly higher percentage of women who had ANC in the intervention group had PNC in the same health center compared to the control health centers (41.2% versus 21.1%: AOR: 2.77 (95%CI 2.12–3.61)). Conclusions Our findings demonstrated that a locally customized mHealth application during ANC can significantly improve delivery and postnatal care service utilization possibly through positively influencing the behavior of health workers and their
This ethnographic investigation was concerned with the way mental health nurses' construct their practice in an acute inpatient psychiatric unit in light of the current challenges, demands and influences brought about by service reforms of the 1990s. The setting for this study was a 22-bed acute inpatient mental health facility. Over a 5-month period, data were collected through fieldwork observations, focused interviews and discussion groups. In this article, common cultural practices in relation to the imperatives of relationships, power, restrictions and safety are discussed. The findings demonstrate how the client stabilization role of the unit locates these imperatives as central to the delivery of nursing care. The discussion reveals nurses negotiating relationships that are contradictory and challenging in ordinary and everyday ways within the exigencies of daily practice.
Kunin, Sharon Brown; Kanze, David Mitchell
Pretravel care for the health care provider begins with an inventory, including the destination, length of stay, logistical arrangements, type of lodging, food and water supply, team members, personal medical needs, and the needs of the community to be treated. This inventory should be created and processed well in advance of the planned medical excursion. The key thing to remember in one's planning is to be a health care provider during one's global health care travel and not to become a patient oneself. This article will help demonstrate the medical requirements and recommendations for such planning.
... medlineplus.gov/ency/patientinstructions/000878.htm Understanding your health care costs To use the sharing features on this ... This is the payment you make for certain health care provider visits and prescriptions. It is a set ...
Fadope, Cece Modupe; And Others
A series of articles that examine environmental health and discuss health care reform; connections between chlorine, chlorinated pesticides, and dioxins and reproductive disorders and cancers; the rise in asthma; connections between poverty and environmental health problems; and organizations for health care professionals who want to address…
Onyeonoro, Ugochukwu U.; Ogah, Okechukwu S.; Ukegbu, Andrew U.; Chukwuonye, Innocent I.; Madukwe, Okechukwu O.; Moses, Akhimiem O.
BACKGROUND Understanding the differences in care-seeking pattern is key in designing interventions aimed at improving health-care service delivery, including prevention and control of noncommunicable diseases. The aim of this study was to identify the differences and determinants of care-seeking patterns of urban and rural residents in Abia State in southeast Nigeria. METHODS This was a cross-sectional, community-based, study involving 2999 respondents aged 18 years and above. Data were collected using the modified World Health Organization’s STEPS questionnaire, including data on care seeking following the onset of illness. Descriptive statistics and logistic regressions were used to analyze care-seeking behavior and to identify differences among those seeking care in urban and rural areas. RESULTS In both urban and rural areas, patent medicine vendors (73.0%) were the most common sources of primary care following the onset of illness, while only 20.0% of the participants used formal care. Significant predictors of difference in care-seeking practices between residents in urban and rural communities were educational status, income, occupation, and body mass index. CONCLUSIONS Efforts should be made to reduce barriers to formal health-care service utilization in the state by increasing health insurance coverage, strengthening the health-care system, and increasing the role of patent medicine vendors in the formal health-care delivery system. PMID:27721654
Guralnick, Eva, Ed.; Zamani, Rahman, Ed.; Evinger, Sara, Ed.; Dailey, Lyn, Ed.; Sherman, Marsha, Ed.; Oku, Cheryl, Ed.; Kunitz, Judith, Ed.
This document is comprised of the six 2002 issues of a bimonthly newsletter on children's health for California's child care professionals. The newsletter provides information on current and emerging health and safety issues relevant to child care providers and links the health, safety, and child care communities. Regular features include columns…
Igari, Hidetoshi; Watanabe, Akira; Ichimura, Yasunori; Sakurai, Takayuki; Taniguchi, Toshibumi; Ishiwada, Naruhiko
QuantiFERON-TB gold in-tube has been used for screening latent tuberculosis infection in newly employed health care workers in Japan. There have been a few studies concerning quality control. We retrospectively analysed QuantiFERON-TB gold in-tube results in a hospital in Japan. Interferon-γ values in three blood collection tubes for QuantiFERON-TB gold in-tube were analysed in association with the positivity rate. The data set consisted of health care workers aged 20-29 years during the 7 years between 2010 and 2016. The yearly QuantiFERON-TB gold in-tube positivity rate was 0.9%, 16.4%, 3.0%, 39.3%, 2.8%, 0.9% and 1.5%, and was extremely high in 2011 and 2013. The interferon-γ values in the tuberculosis antigen tube were elevated in these two years, as indicated by higher median and wider interquartile range. The interferon-γ value in the negative control tube was also higher in 2011. The higher interferon-γ values in collection tubes (tuberculosis antigen tube and/or negative control tube) resulted in higher QuantiFERON-TB gold in-tube positivity rate. The distribution of interferon-γ in tuberculosis antigen tube and negative control tube, as evaluated by median and interquartile range, proved to be an effective index for the quality control of QuantiFERON-TB gold in-tube.
Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A
Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.
Changes in the scale of values associated with society entering plural democracy caused as regards conceptual problems of health care some ethical doubts and objections. In the author's opinion the most important ones are: problems on the essence of health and mission of health policy, responsibility for health care, nature of health services under conditions of market economy, problems of the interpretation of right to health, health requirements and the importance of equity in advanced cultural societies.
Schieber, G J; Puollier, J P
Trends in health are reviewed for the member countries of the Organization for Economic Cooperation and Development (OECD) covering the following: the basic difficulties inherent in international comparative studies; the absolute levels of health expenditures in 1984; the levels and rates of growth of the health share in the gross domestic product (GDP) and the public share of total health expenditures; the elasticities of real health expenditures to real GDP for the 1960-75, 1975-84, and 1960-84 time periods; growth in health expenditures for the largest 7 OECD countries in terms of growth in population, health prices, health care prices in excess of overall prices, and utilization/intensity of services per person. International comparisons are a problem due to differences in defining the boundaries of the health sector, the heterogeneity of data, and methodological problems arising from comparing different economic, demographic, cultural, and institutional structures. The most difficult problem in international comparisons of health expenditures is lack of appropriate measures of health outcome. Exhibit 1 contains per capita health expenditures denominated in US dollars based on GDP purchasing power parities for 21 OECD countries for 1984. Per capita health expenditures ranged from less than $500 in Greece, Portugal, and Spain to over $1400 in Sweden and the US, with an OECD average of $871. After adjusting for price level differences, there still appears to be a greater than 3-fold difference in the "volume" of services consumed across the OECD countries. To determine if per capita health expenditures are related to a country's wealth as measured by its per capita GDP, the relationship between per capita health expenditures and per capita GDP for the 21 countries were examined for 1984. The data points and the "best fitting" trend line indicate a statistically significant relationship in which each $100 difference in per capita GDP is associated with a $10
Consumer health-care information technology is intended to improve patients' opportunities to gather information about their own health. Ideally, this will be achieved through an improved involvement of existing data bases and an improved communication of information to patients and to care providers, if desired by patients. Additionally, further interconnection of existing and new systems and pervasive system design may be used. All consumer health-care information technology services are optional and leave patients in control of their medical data at all times. This article reflects the current status of consumer health-care information technology research and suggests further research areas that should be addressed.
Sanz-Paris, Alejandro; Boj-Carceller, Diana; Lardies-Sanchez, Beatriz; Perez-Fernandez, Leticia; Cruz-Jentoft, Alfonso J
Diabetes-specific formulas are an effective alternative for providing nutrients and maintaining glycemic control. This study assesses the effect of treatment with an oral enteral nutrition with a hypercaloric diabetes-specific formula (HDSF) for one year, on health-care resources use, health-care costs, glucose control and nutritional status, in 93 type-2 diabetes mellitus (T2DM) malnourished patients. Changes in health-care resources use and health-care costs were collected the year before and during the year of intervention. Glucose status and nutritional laboratory parameters were analyzed at baseline and one-year after the administration of HDSF. The administration of HDSF was significantly associated with a reduced use of health-care resources, fewer hospital admissions (54.7%; p < 0.001), days spent at hospital (64.1%; p < 0.001) and emergency visits (57.7%; p < 0.001). Health-care costs were reduced by 65.6% (p < 0.001) during the intervention. Glycemic control (short- and long-term) and the need of pharmacological treatment did not change, while some nutritional parameters were improved at one year (albumin: +10.6%, p < 0.001; hemoglobin: +6.4%, p = 0.026). In conclusion, using HDSF in malnourished older type-2 diabetic patients may allow increasing energy intake while maintaining glucose control and improving nutritional parameters. The use of health-care resources and costs were significantly reduced during the nutritional intervention.
Barbieri, Raquel Rodrigues; Sales, Anna Maria; Hacker, Mariana Andrea; Nery, José Augusto da Costa; Duppre, Nádia Cristina; Machado, Alice de Miranda; Moraes, Milton Ozório; Sarno, Euzenir Nunes
Reorientation of the public health policies in Brazil over the last 20 years in association with a stable rate of new-case detection prompted the establishment of a decentralized leprosy control strategy. The aim was to move from a vertical model associated with general dermatological services to one in which the diagnosis and treatment of the disease would be integrated into the primary care level of the national health care facilities. Once patients demand for leprosy reference centers began to be affected by the process of integrating leprosy diagnosis into the basic health care services, it was necessary to determine the profile of all our referrals in light of the new decentralization policy. Objective We evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals. Methods This is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy. Result Our data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis. Conclusion The results of
Howard, Steven W; Bernell, Stephanie L; Yoon, Jangho; Luck, Jeff; Ranit, Claire M
To control Medicaid costs, improve quality, and drive community engagement, the Oregon Health Authority introduced a new system of coordinated care organizations (CCOs). While CCOs resemble traditional Medicaid managed care, they have differences that have been deliberately designed to improve care coordination, increase accountability, and incorporate greater community governance. Reforms include global budgets integrating medical, behavioral, and oral health care and public health functions; risk-adjusted payments rewarding outcomes and evidence-based practice; increased transparency; and greater community engagement. The CCO model faces several implementation challenges. If successful, it will provide improved health care delivery, better health outcomes, and overall savings.
... Care » Program Overview » Outreach Materials » FAQs Women Veterans Health Care Menu Menu Womens Health Women Veterans Health Care ... Who can I call for more help? What health care services are available to women Veterans? A full ...
Saito, K; Korzenik, J R; Jekel, J F; Bhattacharji, S
The contribution of maternal nutritional knowledge and attitudes to children's nutritional status was investigated in a case-control study conducted in a rural area in Tamil Nadu, India. 34 cases (mothers of a severely malnourished child under 4 years of age) and 34 controls (mothers of a well-nourished age- and location-matched child) were selected from the Christian Medical Center and Hospital registry. The 68 mothers interviewed were predominantly young (mean age, 25 years), poor, and illiterate (67.6%). Severe malnutrition, defined as less than 60% of expected weight-for-age, was significantly associated with female gender (odds ratio (OR), 3.44) and father's occupation as a laborer (OR, 2.98), as opposed to a civil servant or private sector professional. Knowledge of the role of lack of food or nutrition in mild marasmus-kwashiorkor mixed malnutrition was significantly higher among controls (59%) than cases (35%), but there were no significant differences in health-seeking behaviors. In general, mothers from this area did not regard medical care as an appropriate intervention for malnutrition or measles. Only 28% of mothers indicated they would seek medical care for malnutrition. Conversely, medical care was considered indicated for diarrhea, colds, and worms. These findings indicate a need for intensive nutritional programs targeted toward the families of low-income female children.
Coma del Corral, Maria Jesús; Abaigar Luquín, Pedro; Cordero Guevara, José; Olea Movilla, Angel; Torres Torres, Gerardo; Lozano Garcia, Javier
Background UniNet is an Internet-based thematic network for a virtual community of users (VCU). It supports a virtual multidisciplinary community for physicians, focused on the improvement of clinical practice. This is a study of the effects of a thematic network such as UniNet on primary care medicine in a rural area, specifically as a platform of communication between specialists at the hospital and doctors in the rural area. Methods In order to study the effects of a thematic network such as UniNet on primary care medicine in a rural area, we designed an interventional study that included a control group. The measurements included the number of patient displacements due to disease, number of patient hospital stays and the number of prescriptions of drugs of low therapeutic utility and generic drug prescriptions by doctors. These data were analysed and compared with those of the control center. Results Our study showed positive changes in medical practice, reflected in the improvement of the evaluated parameters in the rural health area where the interventional study was carried out, compared with the control area. We discuss the strengths and weaknesses of UniNet as a potential medium to improve the quality of medical care in rural areas. Conclusion The rural doctors had an effective, useful, user-friendly and cheap source of medical information that may have contributed to the improvement observed in the medical quality indices. PMID:16042778
Petrochuk, M A; Javalgi, R G
Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.
National Consortium on Health Science and Technology Education, Okemos, MI.
This document presents the National Health Care Skill Standards, which were developed by the National Consortium on Health Science and Technology and West Ed Regional Research Laboratory, in partnership with educators and health care employers. The document begins with an overview of the purpose and benefits of skill standards. Presented next are…
This article presents a structured survey of the German health care and health insurance system, and analyzes major developments of current German health policy. The German statutory health insurance system has been known as a system that provides all citizens with ready access to comprehensive high quality medical care at a cost the country considered socially acceptable. However, an increasing concern for rapidly rising health care expenditure led to a number of cost-containment measures since 1977. The aim was to bring the growth of health care expenditure in line with the growth of wages and salaries of the sickness fund members. The recent health care reforms of 1989 and 1993 yielded only short-term reductions of health care expenditure, with increases in the subsequent years. 'Stability of the contribution rate' is the uppermost political objective of current health care reform initiatives. Options under discussion include reductions in the benefit package and increases of patients' co-payments. The article concludes with the possible consequences of the 1997 health care reform of which the major part became effective 1 July 1997.
Udonsi, J K; Ogan, V N
In a 30 months' longitudinal study, primary health care intervention was effective in reducing the prevalence of three common intestinal nematode infections (Ascaris lumbricoides, Trichuris trichiura and Necator americanus) in three communities. This was achieved by training school leavers and auxiliary aides as microscopists, health inspectors and field assistants and deploying them to provide screening, surveillance, environmental sanitation, and mass-expulsion chemotherapy (MEC). Post-control surveillance confirmed that the prevalence of these infections had been greatly reduced. The prevalence of Ascaris lumbricoides had declined from 49.3% (pre-intervention) to 10.5% (post-intervention). Hookworm had fallen from 31.4% (pre-intervention) to 4.1% (post-intervention) and whipworm from 40.7% (pre-intervention) to 6.5% (post-intervention). Overall percentage decreases of 78.7%, 86.9% and 84.0% were recorded for Ascaris lumbricoides, Necator americanus and Trichuris trichiura respectively. The initial decline in prevalence was due to the MEC campaign, but the improved sanitation and health education presumably reduced the reinfection rate. If the entire population participated, periodic repetition of the mass expulsion therapy campaign at appropriate intervals combined with continued attention to environmental hygiene and prolonged health education could bring these infections under control within a few years.
Schlesinger, Mark; Quon, Nicole; Wynia, Matthew; Cummins, Deborah; Gray, Bradford
Objective To compare the relative trustworthiness of nonprofit and for-profit health plans, using physician assessments to measure dimensions of plan performance that are difficult for consumers to evaluate. Data Source A nationally representative sample of 1,621 physicians who responded to a special topics module of the 1998 Socioeconomic Monitoring System Survey (SMS), fielded by the American Medical Association. Physicians assessed various aspects of their primary managed care plan, defined as the plan in which they had the largest number of patients. Study Design Plan ownership was measured as the interaction of tax-exempt status (nonprofit versus for-profit) and corporate control (single state versus multistate health plans). Two sets of regression models are estimated. The dependent variables in the regressions are five measures of performance related to plan trustworthiness: two related to deceptive practices and three to dimensions of quality that are largely hidden from enrollees. The first set (baseline) models relate plan ownership to trustworthy practices, controlling for other characteristics of the plan, the marketplace for health insurance, and the physician respondents. The second (interactive) set of models examines how the magnitude of ownership-related differences in trustworthiness varies with the market share of nonprofit plans in each community. Data Collection The 1998 SMS was fielded between April and September of 1998 by Westat Inc. The average time required for a completed interview was approximately 30 minutes. The overall response rate was 52.2 percent. Principal Findings Compared with more local nonprofit plans, for-profit plans affiliated with multistate corporations are consistently reported by their affiliated physicians to engage in practices associated with reduced trustworthiness. Nonprofit plans affiliated with multistate corporations have more physician-reported practices associated with trustworthiness than do for
Tuttle, Mark S.
Non-health-care uses of information technology (IT) provide important lessons for health care informatics that are often overlooked because of the focus on the ways in which health care is different from other domains. Eight examples of IT use outside health care provide a context in which to examine the content and potential relevance of these lessons. Drawn from personal experience, five books, and two interviews, the examples deal with the role of leadership, academia, the private sector, the government, and individuals working in large organizations. The interviews focus on the need to manage technologic change. The lessons shed light on how to manage complexity, create and deploy standards, empower individuals, and overcome the occasional “wrongness” of conventional wisdom. One conclusion is that any health care informatics self-examination should be outward-looking and focus on the role of health care IT in the larger context of the evolving uses of IT in all domains. PMID:10495095
Tablan, Ofelia C; Anderson, Larry J; Besser, Richard; Bridges, Carolyn; Hajjeh, Rana
This report updates, expands, and replaces the previously published CDC "Guideline for Prevention of Nosocomial Pneumonia". The new guidelines are designed to reduce the incidence of pneumonia and other severe, acute lower respiratory tract infections in acute-care hospitals and in other health-care settings (e.g., ambulatory and long-term care institutions) and other facilities where health care is provided. Among the changes in the recommendations to prevent bacterial pneumonia, especially ventilator-associated pneumonia, are the preferential use of oro-tracheal rather than naso-tracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions; no recommendations were made about the use of sucralfate, histamine-2 receptor antagonists, or antacids for stress-bleeding prophylaxis. For prevention of health-care--associated Legionnaires disease, the changes include maintaining potable hot water at temperatures not suitable for amplification of Legionella spp., considering routine culturing of water samples from the potable water system of a facility's organ-transplant unit when it is done as part of the facility's comprehensive program to prevent and control health-care--associated Legionnaires disease, and initiating an investigation for the source of Legionella spp. when one definite or one possible case of laboratory-confirmed health-care--associated Legionnaires disease is identified in an inpatient hemopoietic stem-cell transplant (HSCT) recipient or in two or more HSCT recipients who had visited an outpatient HSCT unit during all or part of the 2-10 day period before illness onset. In the section on aspergillosis, the revised recommendations
Gypsies in the United States are not a healthy group. They have a high incidence of heart disease, diabetes mellitus, and hypertension. When they seek medical care, Gypsies often come into conflict with medical personnel who find their behavior confusing, demanding, and chaotic. For their part, Gypsies are often suspicious of non-Gypsy people and institutions, viewing them as a source of disease and uncleanliness. Gypsy ideas about health and illness are closely related to notions of good and bad fortune, purity and impurity, and inclusion and exclusion from the group. These basic concepts affect everyday life, including the way Gypsies deal with eating and washing, physicians and hospitals, the diagnosis of illness, shopping around for cures, and coping with birth and death. PMID:1413769
Sherertz, R. J.; Bassetti, S.; Bassetti-Wyss, B.
Certain bacteria dispersed by health-care workers can cause hospital infections. Asymptomatic health-care workers colonized rectally, vaginally, or on the skin with group A streptococci have caused outbreaks of surgical site infection by airborne dispersal. Outbreaks have been associated with skin colonization or viral upper respiratory tract infection in a phenomenon of airborne dispersal of Staphylococcus aureus called the "cloud" phenomenon. This review summarizes the data supporting the existence of cloud health-care workers. PMID:11294715
Brown, Judith Belle; French, Reta; McCulloch, Amy; Clendinning, Eric
Abstract Objective To explore the knowledge and perceptions of fourth-year medical students regarding the new models of primary health care (PHC) and to ascertain whether that knowledge influenced their decisions to pursue careers in family medicine. Design Qualitative study using semistructured interviews. Setting The Schulich School of Medicine and Dentistry at The University of Western Ontario in London. Participants Fourth-year medical students graduating in 2009 who indicated family medicine as a possible career choice on their Canadian Residency Matching Service applications. Methods Eleven semistructured interviews were conducted between January and April of 2009. Data were analyzed using an iterative and interpretive approach. The analysis strategy of immersion and crystallization assisted in synthesizing the data to provide a comprehensive view of key themes and overarching concepts. Main findings Four key themes were identified: the level of students’ knowledge regarding PHC models varied; the knowledge was generally obtained from practical experiences rather than classroom learning; students could identify both advantages and disadvantages of working within the new PHC models; and although students regarded the new PHC models positively, these models did not influence their decisions to pursue careers in family medicine. Conclusion Knowledge of the new PHC models varies among fourth-year students, indicating a need for improved education strategies in the years before clinical training. Being able to identify advantages and disadvantages of the PHC models was not enough to influence participants’ choice of specialty. Educators and health care policy makers need to determine the best methods to promote and facilitate knowledge transfer about these PHC models. PMID:22518904
Rushmer, R; Davies, H
Learning in health care is essential if healthcare organisations are to tackle a challenging quality of care agenda. Yet while we know a reasonable amount about the nature of learning, how learning occurs, the forms it can take, and the routines that encourage it to happen within organisations, we know very little about the nature and processes of unlearning. We review the literature addressing issues pivotal to unlearning (what it is, why it is important, and why it is often neglected), and go further to explore the conditions under which unlearning is likely to be encouraged. There is a difference between routine unlearning (and subsequent re-learning) and deep unlearning—unlearning that requires a substantive break with previous modes of understanding, doing, and being. We argue that routine unlearning merely requires the establishment of new habits, whereas deep unlearning is a sudden, potentially painful, confrontation of the inadequacy in our substantive view of the world and our capacity to cope with that world competently. PMID:15576685
Edgar, Andrew; Pattison, Stephen
The purpose of this paper is to offer an account of 'flourishing' that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as 'happiness', 'well-being' or 'quality of life', 'flourishing' uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is argued that humans are at once beings who are autonomous and thereby capable of making sense of their lives, but also subject to the contingencies of their bodies and environments. To flourish requires that one engages, imaginatively and creatively, with those contingencies. The experience of illness, highlighting the vulnerability of the human being, thereby becomes an important experience, stimulating reflection in order to make sense of one's life as a narrative. To flourish, it is argued, is to tell a story of one's life, realistically engaging with vulnerability and suffering, and thus creating a framework through which one can meaningful and constructively go on with one's life.
Ottenbacher, Kenneth J; Fisher, Steve R; Jennings, Kristofer; Brown, Arleen F; Swartz, Maria C; Lyons, Elizabeth J
Background Cardiovascular disease is the leading cause of mortality in the United States. Maintaining healthy levels of physical activity is critical to cardiovascular health, but many older adults are inactive. There is a growing body of evidence linking low motivation and inactivity. Standard behavioral counseling techniques used within the primary care setting strive to increase motivation, but often do not emphasize the key component of self-control. The addition of electronic activity monitors (EAMs) to counseling protocols may provide more effective behavior change and increase overall motivation for exercise through interactive self-monitoring, feedback, and social support from other users. Objective The objective of the study is to conduct a three month intervention trial that will test the feasibility of adding an EAM system to brief counseling within a primary care setting. Participants (n=40) will be randomized to receive evidence-based brief counseling plus either an EAM or a pedometer. Methods Throughout the intervention, we will test its feasibility and acceptability, the change in primary outcomes (cardiovascular risk and physical activity), and the change in secondary outcomes (adherence, weight and body composition, health status, motivation, physical function, psychological feelings, and self-regulation). Upon completion of the intervention, we will also conduct focus groups with the participants and with primary care stakeholders. Results The study started recruitment in October 2015 and is scheduled to be completed by October 2016. Conclusions This project will lay the groundwork and establish the infrastructure for intervention refinement and ultimately translation within the primary care setting in order to prevent cardiovascular disease on a population level. Trial Registration ClinicalTrails.gov NCT02554435; https://clinicaltrials.gov/ct2/show/NCT02554435 (Archived by WebCite at http://www.webcitation/6fUlW5tdT) PMID:27129602
Tracy, Jane; McDonald, Rachael
Background: Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving high-quality health care.…
Background Weight management constitutes a substantial problem particularly among groups of low socio-economic status. Interventions at work places may be a solution, but high quality worksite interventions documenting prolonged weight loss are lacking. This paper presents results of an intervention aimed to achieve a 12 months weight loss among overweight health care workers. Methods Ninety-eight overweight female health care workers were randomized into an intervention or a reference group. The intervention consisted of diet, physical exercise and cognitive behavioral training during working hours 1 hour/week. The reference group was offered monthly oral presentations. Several anthropometric measures, blood pressure, cardiorespiratory fitness, maximal muscle strength, and musculoskeletal pain were measured before and after the 12-months intervention period. Data were analyzed by intention-to-treat analysis. Results The intervention group significantly reduced body weight by 6 kg (p < 0.001), BMI by 2.2 (p < 0.001) and body fat percentage by 2.8 (p < 0.001). There were no statistical reductions in the control group, resulting in significant differences between the two groups over time. Conclusions The intervention generated substantial reductions in body weight, BMI and body fat percentage among overweight female health care workers over 12 months. The positive results support the workplace as an efficient arena for weight loss among overweight females. Trial registration NCT01015716. PMID:22871173
Toussaint, John S; Berry, Leonard L
An urgent need in American health care is improving quality and efficiency while controlling costs. One promising management approach implemented by some leading health care institutions is Lean, a quality improvement philosophy and set of principles originated by the Toyota Motor Company. Health care cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing. When well executed, Lean transforms how an organization works and creates an insatiable quest for improvement. In this article, we define Lean and present 6 principles that constitute the essential dynamic of Lean management: attitude of continuous improvement, value creation, unity of purpose, respect for front-line workers, visual tracking, and flexible regimentation. Health care case studies illustrate each principle. The goal of this article is to provide a template for health care leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations.
Jones, W. L.
Space age health care delivery is being delivered to both NASA astronauts and employees with primary emphasis on preventive medicine. The program relies heavily on comprehensive health physical exams, health education, screening programs and physical fitness programs. Medical data from the program is stored in a computer bank so epidemiological significance can be established and better procedures can be obtained. Besides health care delivery to the NASA population, NASA is working with HEW on a telemedicine project STARPAHC, applying space technology to provide health care delivery to remotely located populations.
Ganju, Sunite A; Kanga, Anil K; Bhagra, Suruchi; Guleria, Ramesh C; Singh, Dig Vijay; Agnihotri, Vinay; Verma, Santwana
Introduction: The National AIDS Control Organization has designed multiple synergistic interventions to identify and control curable sexually transmitted infections (STIs). Objective: To assess the impact of services offered at designated STI clinics in the state of Himachal Pradesh, India and the profile of the attending clients. Materials and Methods: This was a two-year prospective study, conducted from April 2011 to March 2013. Training on delivering STI/RTI services was imparted to the staff of 16 designated STI clinics including recording of data. The staff in each STI clinic comprises of one doctor, one counselor, one nurse, and one laboratory technician. The clients attending these designated clinics were offered counseling, syndromic case management (SCM), and diagnostic services wherever possible. Monthly data of STI clinic attendees was collected, compiled, and analyzed. Results: A total of 65,760 clinic visits were reported, of which 32,385 (49%) visits were for index STI/RTI complaint(s). The ratio of male to female attendees was 1:2. The commonest age group accessing the STI clinics was 25-44 years (n = 38,966; 59.3%). According to SCM, 52.9% clients were managed. The commonest presenting syndrome was urethral discharge (n = 4,500; 41%) in males, and vaginal discharge (n = 13,305; 56%) in females. Genital ulcer disease was treated in 2099 cases. Laboratory tests were performed only in 6466 patients, and 39,597 antenatal mothers were screened for syphilis. Counseling services were provided to 51,298 (f = 34,804; 68%: m = 16,494; 32%) clients and of these, 48% (n = 25,056) of the clients were referred to integrated counseling and testing centers. Forty-three clients (m = 24: f = 19) were detected positive for HIV infection. Conclusion: Uniform and standardized services delivered to clients attending public health clinics can gather reliable data to monitor trends of STI infection. PMID:25165642
Hölzel, L P; Vollmer, M; Kriston, L; Siegel, A; Härter, M
An integrated health care project called "Gesundes Kinzigtal" was conducted in a rural area in Germany. As part of the project, physicians were trained and other measures were taken to enhance patient involvement in medical decision making. As part of the external evaluation, various effects regarding patient involvement in medical decision making, patient involvement and information preference, decision confidence, patient satisfaction with ambulatory care and patient quality of life were examined. The data were gathered by means of a questionnaire on an annual basis between 2007 and 2009. Effects were compared between patients who were participating in the integrated care project and two control groups. Analyses are based on the data of 1,205 patients. Over time all outcomes decreased slightly, except for information preference and physical quality of life. No statistically significant intervention effects on patient involvement in medical decision making or any other outcome variable could be found. The intensity of the training was presumably too low to establish an enduring change in the physician-patient interaction.
This editorial reviews areas of health care reform including managed health care, diagnosis-related groups, and the Resource-Based Relative Value Scale for physician services. Relevance of such reforms to people with developmental disabilities is considered. Much needed insurance reform is not thought to be likely, however. (DB)
Maronde, Robert F.
Pharmacists' contribution to the health care of the future in the future in the U.S. may have to be in the context of increasing the efficiency and effectiveness of health-care delivery. It is from the area of drug therapy, now poorly administered, that the pharmacist will have to justify his role in a cost-effective manner. (Author/LBH)
Financial problems plague both higher education and health care, two sectors that struggle to meet public expectations for quality services at affordable rates. Both higher education and health care also have a complex bottom line, heavy reliance on relatively autonomous professionals, and clients who share personal responsibility for achieving…
... Loan Guaranty Medical Care Vocational Rehabilitation and Employment Health Care Benefits: 1-877-222-8387 Additional Numbers and Websites Resource Phone Number Website Bereavement Counseling 1-202-461-6530 Children of Women ... Civilian Health and Medical Program (CHAMPVA) 1-800-733-8387 ...
Wick, Jeannette Y; Zanni, Guido R
When groups of people relocate from their homelands to other nations, especially if the movement is involuntary, minority populations are created in the countries that receive them. The issues related to these diaspora and diasporic communities--any groups that have been dispersed outside their traditional homelands--are financial, social, historical, political, or religious. In health care, issues include heritable diseases, cultural barriers, patients' health care beliefs, and unique disease presentations. In long-term care, many residents and health care providers have relocated to the United States from other countries.
McDavid, Lolita M
Children in foster care need more from health providers than routine well-child care. The changes in legislation that were designed to prevent children from languishing in foster care also necessitate a plan that works with the child, the biological family, and the foster family in ensuring the best outcome for the child. This approach acknowledges that most foster children will return to the biological family. Recent research on the effect of adverse childhood experiences across all socioeconomic categories points to the need for specifically designed, focused, and coordinated health and mental health services for children in foster care.
... Program Overview » Outreach Materials » FAQs Women Veterans Health Care Menu Menu Womens Health Women Veterans Health Care ... can I call for more help? What health care services are available to women Veterans? A full ...
Kenagy, J W; Berwick, D M; Shore, M F
Although US health care is described as "the world's largest service industry," the quality of service--that is, the characteristics that shape the experience of care beyond technical competence--is rarely discussed in the medical literature. This article illustrates service quality principles by analyzing a routine encounter in health care from a service quality point of view. This illustration and a review of related literature from both inside and outside health care has led to the following 2 premises: First, if high-quality service had a greater presence in our practices and institutions, it would improve clinical outcomes and patient and physician satisfaction while reducing cost, and it would create competitive advantage for those who are expert in its application. Second, many other industries in the service sector have taken service quality to a high level, their techniques are readily transferable to health care, and physicians caring for patients can learn from them.
... prevention practices. They can reduce your risk of health problems. Use protective equipment, follow infection control guidelines, ... manage stress. National Institute for Occupational Safety and Health
Halamandaris, V J
In summary, the nation's health care system is in serious need of reform. It is expensive and woefully inefficient. Millions of people are excluded from coverage, while others receive limited or second-class care. For those millions who suffer serious chronic problems that require long-term care, there is virtually no help. There is no help for the family whose loved one suffers from Alzheimer's disease. There is no help for the family whose child is born with cerebral palsy or epilepsy. There is no help for the middle-aged father, disabled in an automobile accident. Providing good care to all Americans is not a matter of money. America currently spends some 13% of its gross national product on health care, and yet the health statistics of Americans are the worst in the industrialized world. What America needs is a comprehensive system of health care that includes both acute and long-term care. Congress must take action to restore health care as a basic constitutional right of all Americans. Coverage for long-term care must be included within the context of any new national health care program. Funding for such a program should come from the most progressive tax that the Congress can fashion, which to this point is the federal income tax. Although there is an appropriate role for private insurance, it should function as a supplement to rather than as a substitute for a new national program. There are several other elements that are key to a national health care program: Home care must be the first line of any national long-term care program.(ABSTRACT TRUNCATED AT 250 WORDS)
Chang, Jason; McLemore, Elisabeth; Tejirian, Talar
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy. The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate. Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area. Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases. In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists. PMID:27723447
Chang, Jason; Mclemore, Elisabeth; Tejirian, Talar
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.
Merlino, James I; Raman, Ananth
The Cleveland Clinic has long had a reputation for medical excellence. But in 2009 the CEO acknowledged that patients did not think much of their experience there and decided to act. Since then the Clinic has leaped to the top tier of patient-satisfaction surveys, and it now draws hospital executives from around the world who want to study its practices. The Clinic's journey also holds Lessons for organizations outside health care that must suddenly compete by creating a superior customer experience. The authors, one of whom was critical to steering the hospital's transformation, detail the processes that allowed the Clinic to excel at patient satisfaction without jeopardizing its traditional strengths. Hospital leaders: Publicized the problem internally. Seeing the hospital's dismal service scores shocked employees into recognizing that serious flaws existed. Worked to understand patients' needs. Management commissioned studies to get at the root causes of dissatisfaction. Made everyone a caregiver. An enterprisewide program trained everyone, from physicians to janitors, to put the patient first. Increased employee engagement. The Clinic instituted a "caregiver celebration" program and redoubled other motivational efforts. Established new processes. For example, any patient, for any reason, can now make a same-day appointment with a single call. Set patients' expectations. Printed and online materials educate patients about their stays--before they're admitted. Operating a truly patient-centered organization, the authors conclude, isn't a program; it's a way of life.
Miles, Stephen H.; And Others
A discussion of the role of academic health centers in health care reform efforts looks at the following issues: balancing academic objectivity and social advocacy; managing sometimes divergent interests of centers, faculty, and society; and the challenge to develop infrastructure support for reform. Academic health centers' participation in…
Beatty, Rebecca M.
Survey responses from 71 health professionals, benchmarking data from 8 hospitals, continuing education program evaluations, and focus groups with nursing, allied health, and primary care providers indicated a need for professional continuing education on women's health issues. Primary topic needs were identified. The data formed the basis for…
Leanza, Francesco; Hauser, Diane
Teens are avid users of new technologies and social media. Nearly 95% of US adolescents are online at least occasionally. Health care professionals and organizations that work with teens should identify online health information that is both accurate and teen friendly. Early studies indicate that some of the new health technology tools are acceptable to teens, particularly texting, computer-based psychosocial screening, and online interventions. Technology is being used to provide sexual health education, medication reminders for contraception, and information on locally available health care services. This article reviews early and emerging studies of technology use to promote teen health.
Peng, Hui; Tao, Xiu-Bin; Li, Yan; Hu, Qiang; Qian, Li-Hua; Wu, Qun; Ruan, Jing-Jing; Cai, Dong-Zhen
Using a standardized methodology by the National Nosocomial Infection Surveillance System, a continuous health care-associated infections (HAIs) surveillance was conducted in our mixed intensive care unit at a Chinese teaching hospital. During the study period (2010-2014), 4,013 patients were hospitalized for 32,924 bed days and acquired 427 HAIs (482 HAI events), with an overall rate of 10.64% and 14.640 HAIs per 1,000 bed days. Ventilator-associated pneumonia was the most common device-associated health care-acquired infection, with an incidence rate of 19.561 per 1,000 mechanical ventilator days.
Podein, Rian J; Hernke, Michael T
Unsustainable development around the world has contributed to ecological degradation and human suffering while compromising the ability of ecosystems and social institutions to support human life. The United States health care system and its institutions are significant contributors to unsustainable development, but leaders of change are emerging from the health care arena. Health professionals, including primary care providers, are poised to serve as models for sustainability and to facilitate the necessary transformation toward more sustainable practices. Health professionals must, within a practical framework, embrace an objective definition of sustainability and then act to achieve it.
Pemán, Javier; Zaragoza, Rafael; Salavert, Miguel
Knowledge of the epidemiology of invasive fungal diseases caused by yeasts (Candida spp., especially) in health care settings allows the establishment of the levels necessary for its prevention. A first step is to identify groups of patients at high risk of nosocomial invasive fungal infections, establish accurate risk factors, observing the periods of greatest risk, and analyze the epidemiological profile in genera and species as well as the patterns of antifungal resistance. Secondly, mechanisms to avoid persistent exposure to potential fungal pathogens must be programed, protecting areas and recommending measures such as the control of the quality of the air and water, inside and outside the hospital, and other products or substances able to cause outbreaks. Finally, apart from the correct implementation of these measures, in selected patients at very high risk, the use of antifungal prophylaxis should be considered following the guidelines published.
Jang, Chun Sun; Shin, Yong Soon
Intubated patients are at risk of oral health problems. Although a variety of oral care regimens for intubated patients have been studied, there is a lack of research on the effects of combination oral care that includes tooth brushing, chlorhexidine and cold water. This open-labelled, randomized, controlled trial aimed to evaluate the effects of combination oral care on oral health status. Participants aged 20 years and older were recruited on the first day after intubation through convenience sampling in a medical intensive care unit. Random assignment was performed using an internet randomization service. The primary outcome was oral health status. Data were collected during May and June 2013. Participants were randomized to one of two groups (23 intervention and 21 control). The final analysis included 18 patients with combination oral care and 17 in the control group. The intervention group had better oral health (effect size = 1.56), less dry mouth and higher salivary pH than the control group. Any additional burden of providing combination oral care to patients who are mechanically ventilated is worthwhile in terms of clinical outcomes.
McDonald, S C
Total quality management (TQM), continuous quality improvement (CQI) and quality control are terms that are becoming very familiar to workers in the health care environment. The purpose of this article is to discuss these terms and the concepts they describe. The origins of TQM and the keen interest in its application to the health care environment today are addressed. In other environments, TQM has shown significant increases in productivity while increasing effectiveness. Its application to the health care environment is the provision of the best possible care through continuously improving service to meet or exceed the needs and expectations of the customer. The customer in the health care environment could be the patient, staff, physician and community serviced by the hospital. Characteristics of the new organizational structure are reviewed. Established techniques and processes are commonly used to identify process-improvement opportunities to assist the manager in continuously evaluating quality trends.
Stempsey, William E
Virtually all activities of health care are motivated at some level by hope. Patients hope for a cure; for relief from pain; for a return home. Physicians hope to prevent illness in their patients; to make the correct diagnosis when illness presents itself; that their prescribed treatments will be effective. Researchers hope to learn more about the causes of illness; to discover new and more effective treatments; to understand how treatments work. Ultimately, all who work in health care hope to offer their patients hope. In this paper, I offer a brief analysis of hope, considering the definitions of Hobbes, Locke, Hume and Thomas Aquinas. I then differentiate shallow and deep hope and show how hope in health care can remain shallow. Next, I explore what a philosophy of deep hope in health care might look like, drawing important points from Ernst Bloch and Gabriel Marcel. Finally, I suggest some implications of this philosophy of hope for patients, physicians, and researchers.
... m-health (mobile health), includes a variety of health care services, including but not limited to: Online support ... self-management tools Email and online communication with health care providers Electronic health records Remote monitoring of vital ...
If you have been diagnosed with cancer, finding a doctor and treatment facility for your cancer care is an important step to getting the best treatment possible. Learn tips for choosing a doctor and treatment facility to manage your cancer care.
Blanchard, Anita K; Goodall, Perpetua
Specialists in general obstetrics and gynecology are key providers of primary care in women. They diagnose and provide the initial management of many medical conditions unrelated to reproductive health. Most importantly they can impact the overall health of patients through incorporating preventive approaches in the annual well-woman visit. This article defines preventive care and identifies leading causes of mortality in women. A framework for identifying key elements of the well-woman examination is summarized. Examples of prevention are provided, which focus on major health care issues that affect adult women.
Since the late 1980s, virtually every developed, and many developing, countries have re-examined the structure of their health care systems. Health care reform has become a truly global phenomenon with considerable potential for cross-nation lesson-learning. In countries where the state has been the central actor in the health sector, its role is being reassessed and, in some cases, reconfigured. The introduction of market principles to health care is a feature of many countries: market romantics believe markets in health care will improve efficiency, empower consumers, control costs, and overthrow monolithic bureaucracies. But will they? The evidence, such as it is, suggests otherwise. The greatest pressure for change and for introducing markets into health care has been in the relative role of the private sector in the operation, and in some countries also the financing of health care services. But it is not a simple case of the state versus the market. The issues are much more complex and various hybrid models are emerging involving some sort of public-private mix. The move is towards greater diversity and pluralism, an inevitable consequence of which is growing fragmentation in the funding and provision of care with all the associated on-costs in terms of increased coordination and management that this entails. The policy aim is to harness the benefits of market behaviour without also adopting the inherent weaknesses of markets with regard to questions of distributive justice and equity.
... This information in Spanish ( en español ) Paying for health care More information on paying for health care Better ... Coping without insurance More information on paying for health care Explore other publications and websites Age Page: Choosing ...
Caron, A; Neuhauser, D V
Some medical centers have developed quarterly quality performance reports consisting of key quality characteristics reported in the form of annotated control charts. The content of these reports needs to be linked with the mission, vision, values, and the structure of the organization. A partial example using one hospital's Joint Commission on Accreditation of Healthcare Organizations' ORYX measures is presented along with comments. The examples have been chosen to show the use of different types of control charts (XmR, P, and rare events) and different clinical conditions (congestive heart failure, low birth weight, and chronic obstructive pulmonary disease).
Marasović Šušnjara, Ivana
Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.
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…
Hamdan, Motasem; Defever, Mia; Abdeen, Ziad
Palestinians were given control over their own health services in late 1994. Since then they have been facing the challenge of reorganizing disordered health services into a cohesive, regulated and sustainable health care system. This paper focuses on the experience of organizing health care during political instability. It considers the ways that health care is currently provided and funded in the Palestinian Territories. The patterns of accessibility to health care services in terms of insurance coverage and provision (physical allocation) of services are discussed. Finally, the major health care policy changes in this transitional period are examined.
Simms, Mark D.; Freundlich, Madelyn; Battistelli, Ellen S.; Kaufman, Neal D.
Describes the essential features of a health care system that can meet the special needs of children in out-of-home care. Discusses some of the major recent changes brought about by welfare and health care reform. Notes that it remains to be seen whether the quality of services will improve as a result of these reforms. (Author)
In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference
Helping You Choose Quality Behavioral Health Care Selecting quality behavioral health care services for yourself, a relative or friend requires special thought and attention. The Joint Commission on ...
Greene, B M
Onchocerca volvulus, a major filarial parasite of humans, infects tens of millions of people and is a leading cause of blindness. It also causes disabling or disfiguring dermatitis and lymph node involvement. The infection is transmitted by the bite of female blackflies of Simulium species, which breed around freely flowing waterways. Vector control by aerial spraying of rivers and streams with larvicide has achieved some success in the Volta River Basin, but other areas are less well-suited for such an approach. Efforts to control onchocerciasis are plagued by emerging resistance of blackflies, excessive costs of spraying, and the lack of suitable chemotherapy for existing cases. Mass chemotherapy for infected persons as a means to limit the disease and its impact is not feasible because existing drug regiments are too complex, too toxic, or not effective enough. Selective chemotherapy directed at persons at high risk of complications may be a more effective means of minimizing the impact of the disease.
... preferred... Read More Executive Director | Dogwood Village of Orange County US - VA - Orange, Executive Director Dogwood Village of Orange County Health and Rehabilitation and Senior Living, a ...
Grazier, Kyle L; Metzler, Bridget
Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects.
Buchanan, Larry M.
It is widely recognized throughout the health care industry that the United States leads the world in health care spending per capita. However, the chilling dose of reality for American health care consumers is that for all of their spending, the World Health Organization ranks the country's health care system 37th in overall performance--right…
... Your 1- to 2-Year-Old Managing Home Health Care KidsHealth > For Parents > Managing Home Health Care A ... español La atención médica en el hogar Intensive Health Care at Home Kids can need intensive health care ...
Rastegar, Darius A.
The delivery of health care is in the process of “industrialization” in that it is undergoing changes in the organization of work which mirror those that began in other industries a century ago. This process is characterized by an increasing division of labor, standardization of roles and tasks, the rise of a managerial superstructure, and the degradation (or de-skilling) of work. The consolidation of the health care industry, the fragmentation of physician roles, and the increasing numbers of nonphysician clinicians will likely accelerate this process. Although these changes hold the promise of more efficient and effective health care, physicians should be concerned about the resultant loss of autonomy, disruption of continuity of care, and the potential erosion of professional values. PMID:15053287
Solovy, A; Serb, C
They're wired all right, and America's 100 most techno-savvy hospitals and health systems share one more thing: a commitment to using technology to link with employees, patients, suppliers, and insurers. "We want to be a health care travel agency for our community," says one chief information officer. "And we see Internet technology as a key."
A booklet on health care for limited English speakers provides information on choosing the right doctor, buying medicine, paying the bill, and the individual's role in maintaining his or her health. Cartoons, questions and puzzles concerning the message in cartoons and narrative passages, checklists about an individual's personal habits related to…
Merakou, K.; Knithaki, A.; Karageorgos, G.; Theodoridis, D.; Barbouni, A.
This study aims to assess the impact of a brief patient group education intervention in people with type 2 diabetes mellitus. The sample, 193 people with type 2 diabetes mellitus who were patients at the diabetic clinic of a primary health care setting in Attica, was assigned to two groups, intervention (138 individuals) and control group (55…
h t, a rt icle p rot videe a brief h i ctory’ ol the field of ers,’onomfnicc and explorete the interrelationship beta ee health (tare andi ergjonomic...prq/fric ionsi. Health tare Practitioners contri bute a unique Perspective to an ergonomic reiearch and intervention team. ’lhiý %ingular perspective...is based on lnozvlcdge of health issues, disease and injury etwiol(gy and prognosi s, and the psychosocial inpuct of illneAs. Topic.$ for c
Chijioke, Chioli; Okolo, Teddy; Ekwe, Esther; Eze, Chukwuemeka; Agunyenwa, Charles; Amah, Christopher; Nwadike, Kenneth; Chijioke, Udunma
Essential hypertension is the most common noncommunicable disease (NCD), affecting more than half the adult population in many countries and being the major NCD contributor to the double burden of disease in developing countries. We undertook a survey of the hypertension awareness, treatment, and control in primary and secondary referral health care clinics in Enugu, Nigeria, and compared these data with those obtained in local community surveys. The prevalence of hypertension in the primary care clinic (9.2%) was lower than in a previously reported community survey (42.2%), while, in the referral clinic, 70.3% of patients attending were hypertensive. Hypertension awareness rates were 91.9%, 29.4%, and 93.2% in these respective health care settings. Treatment and control rates (89.9% and 72.9%) were better in the secondary care clinic than in the primary care centre (87.7% and 46.0%). (Chi-square analysis confirmed statistically significant differences between these rates (p < 0.05).) These data may form a useful index of health care system effectiveness in Nigeria. Possible reasons for the differences observed and effective strategies to address the waxing pandemic of hypertension are discussed. PMID:28050277
Kalb, P E
In recent years, health care fraud and abuse have become major issues, in part because of the rising cost of health care, industry consolidation, the emergence of private "whistle-blowers," and a change in the concept of fraud to include an emerging concern about quality of care. The 3 types of conduct that are generally prohibited by health care fraud laws are false claims, kickbacks, and self-referrals. False claims are subject to several criminal, civil, and administrative prohibitions, notably the federal civil False Claims Act. Kickbacks, or inducements with the intent to influence the purchase or sale of health care-related goods or services, are prohibited under the federal Anti-Kickback statute as well as by state laws. Finally, self-referrals-the referral of patients to an entity with which the referring physician has a financial relationship-are outlawed by the Ethics in Patient Referral Act as well as numerous state statutes. Consequences of violations of these laws can include, in addition to imprisonment and fines, civil monetary penalties, loss of licensure, loss of staff privileges, and exclusion from participation in federal health care programs. Federal criminal and civil statutes are enforced by the US Department of Justice; administrative actions are pursued by the Department of Health and Human Services' Office of Inspector General; and all state actions are pursued by the individual states. In addition, private whistle-blowers may, acting in the name of the United States, file suit against an entity under the False Claims Act. Enforcement of health care fraud and abuse laws has become increasingly commonplace and now affects many mainstream providers. This trend is likely to continue.
National Environmental Education & Training Foundation, 2012
This document lays out the strategy for achieving the goals and objectives of NEETF's "Health Care Provider Initiative." The goal of NEETF's "Health Care Provider Initiative" is to incorporate environmental health into health professionals' education and practice in order to improve health care and public health, with a special emphasis on…
Edwards, Rachel; Charani, Esmita; Sevdalis, Nick; Alexandrou, Banos; Sibley, Eleanor; Mullett, David; Loveday, Heather P; Drumright, Lydia N; Holmes, Alison
Changes in the behaviour of health-care workers (HCWs) are required to improve adherence to infection prevention and control (IPC) guidelines. Despite heavy investment in strategies to change behaviour, effectiveness has not been adequately assessed. We did a systematic review to assess the effectiveness and sustainability of interventions to change IPC behaviour and assessed exploratory literature for barriers to and facilitators of behaviour change. 21 studies published from 1999 to 2011 met our inclusion criteria: seven intervention studies and 14 exploratory studies. Of the intervention studies none explicitly incorporated psychological theory and only two contained elements of social marketing in the design, although five addressed sustainability. All elicited behaviour change, reduction in infection risk, or both. The exploratory studies identified social and cultural factors that affect the IPC behaviour of HCWs. To improve the standard of research and broaden the evidence base, we recommend that quality criteria are added to existing systematic review guidelines to enable the inclusion of qualitative research and to ensure robust design, implementation, and reporting of interventions.
Halfon, Neal; And Others
Outlines access to health care for children in out-of-home care under current law, reviews how health care access for these children would be affected by President Clinton's health care reform initiative, and proposes additional measures that could be considered to improve access and service coordination for children in the child welfare system.…
Courtois, X; Dumoulin, J
Health centres of Idjwi district (Zaire) have been self-financed through the selling of drugs since 1985. Medical care is expensive and its use is low (24 visits per year per 100 inhabitants). In 1989 the medical team tried to reduce the cost of visits by changing the prices of drugs and prescriptions. A limited control was set up to assess this intervention. The study showed that although prescribed drug costs were stabilized compared to inflation, there was no increase in the use of medical care. Moreover, the reduction of drug profit margins for health centres seriously affected the health care institution by causing a drop in income. Six months after the intervention the monthly accounts showed a deficit in 6 centres out of 8. The need for health care centres to be self-financing is a major limiting factor in the use of health care in Idjwi district. There are no easy solutions for health centre managers that satisfy both low-cost access to care and health care self-financing. Some minimal financial participation from the state is required. Only then can the concept of financing health care through the selling of drugs be operational.
Binagwaho, Agnes; Ngabo, Fidele; Mugeni, Cathy; Gatera, Maurice; Nutt, Cameron T; Nsanzimana, Sabin
Abstract Problem Although it is highly preventable and treatable, cervical cancer is the most common and most deadly cancer among women in Rwanda. Approach By mobilizing a diverse coalition of partnerships, Rwanda became the first country in Africa to develop and implement a national strategic plan for cervical cancer prevention, screening and treatment. Local setting Rwanda – a small, landlocked nation in East Africa with a population of 10.4 million – is well positioned to tackle a number of “high-burden” noncommunicable diseases. The country’s integrated response to infectious diseases has resulted in steep declines in premature mortality over the past decade. Relevant changes In 2011–2012, Rwanda vaccinated 227 246 girls with all three doses of the human papillomavirus (HPV) vaccine. Among eligible girls, three-dose coverage rates of 93.2% and 96.6% were achieved in 2011 and 2012, respectively. The country has also initiated nationwide screening and treatment programmes that are based on visual inspection of the cervix with acetic acid, testing for HPV DNA, cryotherapy, the loop electrosurgical excision procedure and various advanced treatment options. Lessons learnt Low-income countries should begin to address cervical cancer by integrating prevention, screening and treatment into routine women’s health services. This requires political will, cross-sectoral collaboration and planning, innovative partnerships and robust monitoring and evaluation. With external support and adequate planning, high nationwide coverage rates for HPV vaccination and screening for cervical cancer can be achieved within a few years. PMID:24101786
The health promotion discourse is comprised of assumptions about health and health care that are compatible with primary health care. An examination of the health promotion discourse illustrates how assumptions of health can help to inform primary health care. Despite health promotion being a good fit for primary health care, this analysis demonstrates that the scope in which it is being implemented in primary health care settings is limited. The health promotion discourse appears largely compatible with primary health care-in theory and in the health care practices that follow. The aim of this article is to contribute to the advancement of theoretical understanding of the health promotion discourse, and the relevance of health promotion to primary health care.
Bolíbar, Bonaventura; Pareja, Clara; Astier-Peña, M Pilar; Morán, Julio; Rodríguez-Blanco, Teresa; Rosell-Murphy, Magdalena; Iglesias, Manuel; Juncosa, Sebastián; Mascort, Juanjo; Violan, Concepció; Magallón, Rosa; Apezteguia, Javier
Background Preventive activities carried out in primary care have important variability that makes necessary to know which factors have an impact in order to establish future strategies for improvement. The present study has three objectives: 1) To describe the variability in the implementation of 7 preventive services (screening for smoking status, alcohol abuse, hypertension, hypercholesterolemia, obesity, influenza and tetanus immunization) and to determine their related factors; 2) To describe the degree of control of 5 identified health problems (smoking, alcohol abuse, hypertension, hypercholesterolemia and obesity); 3) To calculate intraclass correlation coefficients. Design Multi-centered cross-sectional study of a randomised sample of primary health care teams from 3 regions of Spain designed to analyse variability and related factors of 7 selected preventive services in years 2006 and 2007. At the end of 2008, we will perform a cross-sectional study of a cohort of patients attended in 2006 or 2007 to asses the degree of control of 5 identified health problems. All subjects older than16 years assigned to a randomised sample of 22 computerized primary health care teams and attended during the study period are included in each region providing a sample with more than 850.000 subjects. The main outcome measures will be implementation of 7 preventive services and control of 5 identified health problems. Furthermore, there will be 3 levels of data collection: 1) Patient level (age, gender, morbidity, preventive services, attendance); 2) Health-care professional level (professional characteristics, years working at the team, workload); 3) Team level (characteristics, electronic clinical record system). Data will be transferred from electronic clinical records to a central database with prior encryption and dissociation of subject, professional and team identity. Global and regional analysis will be performed including standard analysis for primary health care
What does it mean to say that there is a right to health care? Health care is part of a cooperative project that organizes finite resources. How are these resources to be distributed? This essay discusses three rival theories. The first two, a utilitarian theory and an interst theory, are both instrumental, in that they collapse rights to good states of affairs. A third theory, offered by Thomas Pogge, locates the question within an institutional legal context and distinguishes between a right to health care that results in claimable duties and other dimensions of health policy that do not. Pogge's argument relies on a list of "basic needs," which itself, however, relies on some kind of instrumental reasoning. The essay offers a reconstruction of Pogge's argument to bring it in line with a political conception of a right to health care. Health is a matter of equal liberty and equal citizenship, given our common human vulnerability. If we are to live as equal members in a political community, then our institutions need to create processes by which we are protected from the kinds of suffering that would make it impossible for us to live as equal members.
Goldsmith, J C
Does it sound familiar? Resources are scarce, competition is tough, and government regulations and a balanced budget are increasingly hard to meet at the same time. This is not the automobile or oil industry but the health care industry, and hospital managers are facing the same problems. And, maintains the author of this article, they must borrow some proven marketing techniques from business to survive in the new health care market. He first describes the features of the new market (the increasing economic power of physicians, new forms of health care delivery, prepaid health plans, and the changing regulatory environment) and then the possible marketing strategies for dealing with them (competing hard for physicians who control the patient flow and diversifying and promoting the mix of services). He also describes various planning solutions that make the most of a community's hospital facilities and affiliations.
Connors, H R
Telehealth has many applications, including the education and training of health professionals. This article describes the use of advanced telecommunications technology to educate family nurse practitioners in rural areas of Kansas. Four Kansas universities use compressed video technology (an interactive audio and video system) to offer five common core courses in primary care to students enrolled in FNP programs at the respective institutions. Using technology to educate FNPs in rural communities has resulted in a greater percentage of graduates (approximately 67% of 258 graduates) going to work in rural underserved communities. In addition to learning the course content, students learn to use technology as a tool to access telehealth information and services Knowing how to use these technologies provides greater opportunities to rural health care providers, as well as the recipients of health care.
... Cooperative Agreement; Correctional Health Care Executive Curriculum Development AGENCY: U.S. Department of... of a competency- based correctional health care executive curriculum to train two-person teams..., pharmaceutical, radiographic, infection control, long-term care, restorative therapy, health...
Faced with eroding profitability from rising health care costs, corporations are beginning to aggressively implement cost containment strategies. Although few companies have coordinated long range plans in place, corporations' attempts to exert control over the health care system will affect insurers, providers, and consumers. Occupational health nurses need to be aware of how cost-containment pressures will affect the various aspects of the U.S. health care system if they want to influence the changes. Occupational health nurses have an opportunity to work with benefits personnel and others in their company to maximize employee health while helping to implement programs to contain health care costs.
Lee, Bruce Y; Bartsch, Sarah M; Wong, Kim F; McKinnell, James A; Slayton, Rachel B; Miller, Loren G; Cao, Chenghua; Kim, Diane S; Kallen, Alexander J; Jernigan, John A; Huang, Susan S
Carbapenem-resistant Enterobacteriaceae (CRE), a group of pathogens resistant to most antibiotics and associated with high mortality, are a rising emerging public health threat. Current approaches to infection control and prevention have not been adequate to prevent spread. An important but unproven approach is to have hospitals in a region coordinate surveillance and infection control measures. Using our Regional Healthcare Ecosystem Analyst (RHEA) simulation model and detailed Orange County, California, patient-level data on adult inpatient hospital and nursing home admissions (2011-2012), we simulated the spread of CRE throughout Orange County health-care facilities under 3 scenarios: no specific control measures, facility-level infection control efforts (uncoordinated control measures), and a coordinated regional effort. Aggressive uncoordinated and coordinated approaches were highly similar, averting 2,976 and 2,789 CRE transmission events, respectively (72.2% and 77.0% of transmission events), by year 5. With moderate control measures, coordinated regional control resulted in 21.3% more averted cases (n = 408) than did uncoordinated control at year 5. Our model suggests that without increased infection control approaches, CRE would become endemic in nearly all Orange County health-care facilities within 10 years. While implementing the interventions in the Centers for Disease Control and Prevention's CRE toolkit would not completely stop the spread of CRE, it would cut its spread substantially, by half.
Goodman, Melody S.; Gonzalez, Maria; Gil, Sandra; Si, Xuemei; Pashoukos, Judith L.; Stafford, Jewel D.; Ford, Elsa; Pashoukos, Dennis A.
Background The Community Alliance for Research Empowering Social Change (CARES) is an academic–community research partnership designed to train community members on research methods and develop the infrastructure for community-based participatory research (CBPR) to examine and address racial/ethnic health disparities. The Brentwood Community Health Assessment (BCHA) was developed through a CBPR pilot project grant from CARES. Objectives The purpose of the BCHA is to assess health care utilization and identify existing barriers to health care access among a multi-ethnic community in the Hamlet of Brentwood, New York. Methods Using CBPR approaches, the community–academic research partnership develop the study design and survey instrument. Trained Bilingual (English/Spanish) data collectors verbally administered surveys door-to-door to residents of Brentwood from October 2010 to May 2011. Inclusion criteria required participants to be at least 18 years of age and speak either English or Spanish. Results Overall, 232 residents completed the BCHA; 49% were male, 66% Hispanic, 13% non-Hispanic White, 13% non-Hispanic Black, 29% had less than a high school education, and 33% were born in United States. The assessment results revealed that most residents are able to access health care when needed and the most significant barriers to health care access are insurance and cost. Conclusions We describe the community–academic partnered process used to develop and implement the BCHA and report assessment findings; the community-partnered approach improved data collection and allowed access into one of Suffolk County’s most vulnerable communities. PMID:24859100
Under the Pol Pot Khmer Rouge regime, most physicians with clinical experience were either killed or fled the country. The few practitioners who managed to survive were forced to hide their knowledge; much of that knowledge and experience is now lost. As part of a general process of national rehabilitation, Cambodia has trained since the 1980s hundreds of physicians and physician assistants. There were 700 physicians, 1300 physician assistants, and 4000 nurses in the country by 1992. Problems do, however, remain with medical education in Cambodia. In particular, the medical texts and lectures are in French, a language which very few of the younger generation speak; instructional texts are designed to meet the needs of developing nations, not a rehabilitating one like Cambodia; emphasis is upon curative health care, hospitals, and vertical programs instead of primary and preventive health care; Cambodian physicians are used to a system based upon the division of patients by ability to pay instead of by age, disease, or need; corruption has grown as the cost of living has outstripped the level of official salaries; and there is neither professional contact, feedback, nor program evaluation within health care programs. The authors is a resident in obstetrics and gynecology at the University of Chicago who worked at two clinics during a stay in Phnom Penh. She recommends that instead of simply training more doctors, these training-related problems should be addressed, including a revision of the curriculum to include both primary health care medicine and psychiatry. Moreover, people in Cambodia need to be taught the importance of preventive health care, which should then reduce the number of visits to physicians. This process will be accomplished more effectively with the cooperation of physicians, the government, nongovernmental organizations, and international organizations associated with health care.
Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio
OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949
Heller, Kathryn Wolff; Avant, Mary Jane Thompson
Teachers need to maintain a safe, healthy environment for all their students in order to promote learning. However, there are additional considerations when students require health care procedures, such as tube feeding or clean intermittent catheterization. Teachers must effectively monitor their students and understand their roles and…
Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R
As reimbursement transitions from a volume-based to a value-based system, innovation in health care delivery will be needed. The process of innovation begins with framing the problem that needs to be solved along with the strategic vision that has to be achieved. Similar to scientific testing, a hypothesis is generated for a new solution to a problem. Innovation requires conducting a disciplined form of experimentation and then learning from the process. This manuscript will discuss the different types of innovation, and the key steps necessary for successful innovation in the health care field.
Several ways in which elderly people may assume an active role when using welfare services are discussed here. Selected findings are presented from a study that explored the experience and behaviour of elderly people on discharge from inpatient care with regard to criteria indicating user influence or control (namely participation, representation, access, choice, information and redress). Data were collected via semistructured interviews with service users (n = 30) soon after their return home from hospital. A number of differences were revealed between health care and social care in relation to users being provided with opportunities to assume an active role and in being willing and able to assume an active role. These differences were manifest in elderly service users accessing services, seeking information, exercising choice and acting independently of service providers. It appeared paradoxical that contact points were more easily defined with regard to health care yet users were more likely to exercise choice and act independently in securing social care. It is suggested that social care needs and appropriate service delivery are more easily recognised than making the link between perceived health care needs and appropriate services. In addition, it appeared that informal and private providers are more widely available and accessible for social care. If comprehensive continuing care is to be provided, incorporating both health and social care elements, greater uniformity appears to be required across the welfare sector. Lessons for social care provision from the delivery of health care suggest the clear definition of contact points to facilitate service use. Making health care more accessible, however, does not appear to be easily attainable due to the monopoly provision of health care and the lack of direct purchasing power by potential users.
Addresses the crisis in health care, considering costs, lack of access, and system ineffectiveness. Reviews "Setting Relationships Right," the Catholic Health Association's proposal for health care reform. Advocates educators' awareness of children's health needs and health care reform issues and support for the Every Fifth Child Act of…
Mawn, Barbara; Siqueira, Eduardo; Koren, Ainat; Slatin, Craig; Devereaux Melillo, Karen; Pearce, Carole; Hoff, Lee Ann
In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.
Legido-Quigley, Helena; Camacho Lopez, Paul Anthony; Balabanova, Dina; Perel, Pablo; Lopez-Jaramillo, Patricio; Nieuwlaat, Robby; Schwalm, J-D; McCready, Tara; Yusuf, Salim; McKee, Martin
Hypertension is a leading cause of premature death worldwide and the most important modifiable risk factor for cardiovascular disease. Effective screening programs, communication with patients, regular monitoring, and adherence to treatment are essential to successful management but may be challenging in health systems facing resource constraints. This qualitative study explored patients’ knowledge, attitudes, behaviour and health care seeking experiences in relation to detection, treatment and control of hypertension in Colombia. We conducted in-depth interviews and focus group discussions with 26 individuals with hypertension and 4 family members in two regions. Few participants were aware of ways to prevent high blood pressure. Once diagnosed, most reported taking medication but had little information about their condition and had a poor understanding of their treatment regime. The desire for good communication and a trusting relationship with the doctor emerged as key themes in promoting adherence to medication and regular attendance at medical appointments. Barriers to accessing treatment included co-payments for medication; costs of transport to health care facilities; unavailability of drugs; and poor access to specialist care. Some patients overcame these barriers with support from social networks, family members and neighbours. However, those who lacked such support, experienced loneliness and struggled to access health care services. The health insurance scheme was frequently described as administratively confusing and those accessing the state subsidized system believed that the treatment was inferior to that provided under the compulsory contributory system. Measures that should be addressed to improve hypertension management in Colombia include better communication between health care professionals and patients, measures to improve understanding of the importance of adherence to treatment, reduction of co-payments and transport costs, and easier
Legido-Quigley, Helena; Camacho Lopez, Paul Anthony; Balabanova, Dina; Perel, Pablo; Lopez-Jaramillo, Patricio; Nieuwlaat, Robby; Schwalm, J-D; McCready, Tara; Yusuf, Salim; McKee, Martin
Hypertension is a leading cause of premature death worldwide and the most important modifiable risk factor for cardiovascular disease. Effective screening programs, communication with patients, regular monitoring, and adherence to treatment are essential to successful management but may be challenging in health systems facing resource constraints. This qualitative study explored patients' knowledge, attitudes, behaviour and health care seeking experiences in relation to detection, treatment and control of hypertension in Colombia. We conducted in-depth interviews and focus group discussions with 26 individuals with hypertension and 4 family members in two regions. Few participants were aware of ways to prevent high blood pressure. Once diagnosed, most reported taking medication but had little information about their condition and had a poor understanding of their treatment regime. The desire for good communication and a trusting relationship with the doctor emerged as key themes in promoting adherence to medication and regular attendance at medical appointments. Barriers to accessing treatment included co-payments for medication; costs of transport to health care facilities; unavailability of drugs; and poor access to specialist care. Some patients overcame these barriers with support from social networks, family members and neighbours. However, those who lacked such support, experienced loneliness and struggled to access health care services. The health insurance scheme was frequently described as administratively confusing and those accessing the state subsidized system believed that the treatment was inferior to that provided under the compulsory contributory system. Measures that should be addressed to improve hypertension management in Colombia include better communication between health care professionals and patients, measures to improve understanding of the importance of adherence to treatment, reduction of co-payments and transport costs, and easier access
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Berwick, Donald M.; Knapp, Marian Gilbert
As competition, cost control, and new modes of delivery emerge in health care, there is a need to reexamine both the traditional definitions of health care quality and the methods by which it is measured. Industries other than health care have much to teach regarding the methods for obtaining, analyzing, and displaying data; techniques for problem identification, problem solving, and reassessment; and ideas about organizational factors that produce a high quality product or service. The Quality-of-Care Measurement Department at the Harvard Community Health Plan has built a program that draws from a distinguished health care quality assurance tradition and incorporates techniques that have been successful in other industries. PMID:10312319
Lewis, John; Dempsey, Joanne R.
An article on American health care which focuses on health care costs and benefits is combined with a lesson plan on health care issues to enable students to consider both issues of cost effectiveness and morality in decisions about the allocation of health care. The article covers the history of interest in health care, the reasons for the…
'Selective primary health care' and other recent vertical health strategies have been justified on the grounds that the broad primary health care (PHC) approach cannot be afforded by developing countries in the present constrained economic circumstances. This judgement is too sweeping. A simulated case example is presented, starting with baseline health expenditure data that are representative of the situation in many developing countries. It is assumed that real economic growth occurs and that government funding of health care is allowed to grow in parallel. Two annual growth rates are considered: 2 and 5 per cent. Two restrictive conditions are applied: none of the main health services is subjected to absolute cuts; and, additional funds from existing or new sources of finance are not considered. It is shown that, even with slow growth rates, substantial increases in the funding of priority (rural and PHC) services can be achieved if the growth in expenditures of lower-priority services is curtailed. Also, savings from improved health service efficiency can be channelled to priority services. The message is that the PHC approach is viable even with slow economic growth. What is required is the technical capacity to identify and plan resource flows in the health sector, and the political will to effect resource allocations according to PHC priorities. A strategic policy like PHC should not be 'adjusted' out of effective existence because of reversible economic problems. Rather, actions should be taken to reverse the adverse economic environment. International health-related agencies should continue to support countries to develop national health systems based on PHC, and should campaign for reforms in the world economy to create at least the minimum economic conditions necessary for PHC implementation.
Health care-associated infections cause approximately 75,000 deaths annually, in addition to increasing morbidity and costs. Over the past decade, a downward trend in health care-associated infections has occurred nationwide. Basic prevention measures include administrative support, educating health care personnel, and hand hygiene and isolation precautions. Prevention of central line- or catheter-associated infections begins with avoidance of unnecessary insertion, adherence to aseptic technique when inserting, and device removal when no longer necessary. Specific recommendations for preventing central line-associated bloodstream infections include use of chlorhexidine for skin preparation, as a component of dressings, and for daily bathing of patients in intensive care units. Catheter-associated urinary tract infections are the most common device-related health care-associated infection. Maintaining a closed drainage system below the patient reduces the risk of infection. To prevent ventilator-associated pneumonia, which is associated with high mortality, mechanically ventilated patients should be placed in the semirecumbent position and receive antiseptic oral care. Prevention of surgical site infections includes hair removal using clippers, glucose control, and preoperative antibiotic prophylaxis. Reducing transmission of Clostridium difficile and multidrug-resistant organisms in the hospital setting begins with hand hygiene and contact precautions. Institutional efforts to reduce unnecessary antibiotic prescribing are also strongly recommended. Reducing rates of methicillin-resistant Staphylococcus aureus infection can be achieved through active surveillance cultures and decolonization therapy with mupirocin.
Ling, Lowell; Gomersall, Charles David; Samy, Winnie; Joynt, Gavin Matthew; Leung, Czarina CH; Wong, Wai-Tat
Background Patient safety culture is an integral aspect of good standard of care. A good patient safety culture is believed to be a prerequisite for safe medical care. However, there is little evidence on whether general education can enhance patient safety culture. Objective Our aim was to assess the impact of a standardized patient safety course on health care worker patient safety culture. Methods Health care workers from Intensive Care Units (ICU) at two hospitals (A and B) in Hong Kong were recruited to compare the changes in safety culture before and after a patient safety course. The BASIC Patient Safety course was administered only to staff from Hospital A ICU. Safety culture was assessed in both units at two time points, one before and one after the course, by using the Hospital Survey on Patient Safety Culture questionnaire. Responses were coded according to the Survey User’s Guide, and positive response percentages for each patient safety domain were compared to the 2012 Agency for Healthcare Research and Quality ICU sample of 36,120 respondents. Results We distributed 127 questionnaires across the two hospitals with an overall response rate of 74.8% (95 respondents). After the safety course, ICU A significantly improved on teamwork within hospital units (P=.008) and hospital management support for patient safety (P<.001), but decreased in the frequency of reporting mistakes compared to the initial survey (P=.006). Overall, ICU A staff showed significantly greater enhancement in positive responses in five domains than staff from ICU B. Pooled data indicated that patient safety culture was poorer in the two ICUs than the average ICU in the Agency for Healthcare Research and Quality database, both overall and in every individual domain except hospital management support for patient safety and hospital handoffs and transitions. Conclusions Our study demonstrates that a structured, reproducible short course on patient safety may be associated with an
Hayes, J A
Medical care futures contracts offer new hedging opportunities to increase protection against unexpected price changes. Commodity futures contracts can be designed explicitly to hedge volatile group health insurance premiums and capitated hospital and physician prices. This article describes one way to design and use these hedging instruments.
This paper reports in detail on a project of Integrated Health Care in cardiology at Nuremberg, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.
Arnould, R J; Finifter, D H; Schifrin, L G
This serves as an introduction to this special issue devoted to a selection of papers chosen and revised from a conference on public policy entitled "Health Care Policy: Where Is the Revolution Headed?" sponsored by the Thomas Jefferson Program in Public Policy at the College of William and Mary, Williamsburg, VA, November 12-14, 1987.
Wagner, H C; Fleming, D; Mangold, W G; LaForge, R W
Building relationships with patients is critical to the success of many health care organizations. The authors profile the relationship marketing program for a hospital's cardiac center and discuss the key strategic aspects that account for its success: a focus on a specific hospital service, an integrated marketing communication strategy, a specially designed database, and the continuous tracking of results.
Somasundaram, D. J.; van de Put, W. A.
An effort is being made in Cambodia to involve grass-roots personnel in the integration of the care of the mentally ill into a broad framework of health services. This undertaking is examined with particular reference to the work of the Transcultural Psychosocial Organization. PMID:10212521
Waldman, J Deane; Yourstone, Steven A; Smith, Howard L
This article explores the uses of learning curve theory in medicine. Though effective application of learning curve theory in health care can result in higher quality and lower cost, it is seldom methodically applied in clinical practice. Fundamental changes are necessary in the corporate culture of medicine in order to capitalize maximally on the benefits of learning.
Dev, Dipti A; McBride, Brent A; Speirs, Katherine E; Donovan, Sharon M; Cho, Hyun Keun
Few child-care providers meet the national recommendations for healthful feeding practices. Effective strategies are needed to address this disparity, but research examining influences on child-care providers' feeding practices is limited. The purpose of this study was to identify determinants of child-care providers' healthful and controlling feeding practices for children aged 2 to 5 years. In this cross-sectional study, child-care providers (n=118) from 24 center-based programs (six Head Start [HS], 11 Child and Adult Care Food Program [CACFP] funded, and seven non-CACFP) completed self-administered surveys during 2011-2012. Multilevel multivariate linear regression models were used to predict seven feeding practices. Working in an HS center predicted teaching children about nutrition and modeling healthy eating; that may be attributed to the HS performance standards that require HS providers to practice healthful feeding. Providers who reported being concerned about children's weight, being responsible for feeding children, and had an authoritarian feeding style were more likely to pressure children to eat, restrict intake, and control food intake to decrease or maintain children's weight. Providers with nonwhite race, who were trying to lose weight, who perceived nutrition as important in their own diet, and who had a greater number of nutrition training opportunities were more likely to use restrictive feeding practices. These findings suggest that individual- and child-care-level factors, particularly provider race, education, training, feeding attitudes and styles, and the child-care context may influence providers' feeding practices with young children. Considering these factors when developing interventions for providers to meet feeding practice recommendations may add to the efficacy of childhood obesity prevention programs.
Robinson, James C
The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed competition. The optimal locus of incentives will vary among health services according to the nature of the illness, the clinical technology, and the extent of discretion in utilization. A competitive market will manifest a variety of comprehensive and limited benefit designs, broad and narrow contractual networks, and single-and multispecialty provider organizations.
Halverson, P K; Mays, G P; Miller, C A; Kaluzny, A D; Richards, T B
Managed care is fast becoming the dominant form of medical care delivery and financing in the United States, yet its effects on public health practice remain largely unknown. Tuberculosis (TB) is a classic example of a disease with both public health and medical care implications, and as such it provides an opportunity for examining the impact on public health of the shift towards managed care in the medical marketplace. The authors approach the role of managed care in TB control by first considering the need for interorganizational coordination at the community level. The authors identify four basic models of how managed care organizations may fit into TB control efforts in local communities, using observations from 12 local public health jurisdictions to illustrate these models. These TB control models provide insight into the general mechanisms through which managed care organizations may affect other areas of public health practice. Images p22-a p23-a p25-a p28-a PMID:9018283
Lee, P R; Soffel, D; Luft, H S
Signs of discontent with the health care system are growing. Calls for health care reform are largely motivated by the continued increase in health care costs and the large number of people without adequate health insurance. For the past 20 years, health care spending has risen at rates higher than the gross national product. As many as 35 million people are without health insurance. As proposals for health care reform are developed, it is useful to understand the roots of the cost problem. Causes of spiraling health care costs include "market failure" in the health care market, expansion in technology, excessive administrative costs, unnecessary care and defensive medicine, increased patient complexity, excess capacity within the health care system, and low productivity. Attempts to control costs, by the federal government for the Medicare program and then by the private sector, have to date been mostly unsuccessful. New proposals for health care reform are proliferating, and important changes in the health care system are likely. PMID:1441510
Bodenmann, P; Bossart, R; Di Bernardo, N; Dominice Dao, M; Durieux, S; Faucherre, F; Hudelson, P; Keller, M; Schuster, S; Zellweger, E; Houmard, S
The development of Migrant Friendly Hospitals is an important first step towards eliminating health care disparities in Switzerland and an important reminder to health policy makers and practitioners across the health care system of their responsibility to provide non-discriminatory quality health care to all patients.
Currently 59 bills are awaiting Congressional action. Meanwhile, a national coalition of economists and medical specialists (the National Leadership Coalition for Health Care Reform) are circulating a sensible consensus health reform plan proposing national practice guidelines; universal health care access; and efficient cost control, delivery,…
Realization of health care as primary objective is necessary to strengthen primary health care (PHC). There is a need to build financial viable and sustainable PHC based on rational principles to fulfill the goals of providing quality health services on an affordable and equitable basis and also ensuring fiscal prudence. Health-care leadership, innovations in primary care, family medicine specialists, and effective and accountable health governance are the key steps toward our goal. PMID:28217580
Khalifa, Aly; Del Fiol, Guilherme; Cummins, Mollie R
We are developing a new process of health information exchange supported collaboration that leverages the HL7 consolidated CDA standard through four document types (consultation note, history and physical, progress note and discharge summary). The focus of the present study is the C-CDA consultation note template that will be submitted from poison control centers (PCC)s to emergency departments (EDs) with treatment recommendations. Specifically, we aimed to (i) create computable mappings between a poison control center database and the C-CDA consultation note template; and (ii) assess the extent and nature of information types that successfully map to discrete data elements in a poison control center database. The resulting template and mappings can be used to implement standards-based health information exchange between PCCs and EDs in the U.S. This is a part of the first formal effort to leverage health information exchange standards to support PCC-ED collaboration.
Khalifa, Aly; Del Fiol, Guilherme; Cummins, Mollie R.
We are developing a new process of health information exchange supported collaboration that leverages the HL7 consolidated CDA standard through four document types (consultation note, history and physical, progress note and discharge summary). The focus of the present study is the C-CDA consultation note template that will be submitted from poison control centers (PCC)s to emergency departments (EDs) with treatment recommendations. Specifically, we aimed to (i) create computable mappings between a poison control center database and the C-CDA consultation note template; and (ii) assess the extent and nature of information types that successfully map to discrete data elements in a poison control center database. The resulting template and mappings can be used to implement standards-based health information exchange between PCCs and EDs in the U.S. This is a part of the first formal effort to leverage health information exchange standards to support PCC-ED collaboration. PMID:28269944
According to the Institute of Medicine, health care access is defined as "the degree to which people are able to obtain appropriate care from the health care system in a timely manner." Two key components of health care access are medical insurance and having access to a usual source of health care. Recent national data show that 34% of Latino…
Deshpande, Satish P; Deshpande, Samir S
The purpose of this study was to examine factors that impact consumer satisfaction with health care. This is a secondary analysis of the Center for Studying Health System Change's 2010 Health Tracking Household Survey. Regression analysis was used to examine the impact of treatment issues, financial issues, family-related issues, sources of health care information, location, and demographics-related factors on satisfaction with health care. The study involved 12280 subjects, 56% of whom were very satisfied with their health care, whereas 66% were very satisfied with their primary care physician. Fourteen percent of the subjects had no health insurance; 34% of the subjects got their health care information from the Web. Satisfaction with primary care physician, general health status, promptness of visit to doctor, insurance type, medical cost per family, annual income, persons in family, health care information from friends, and age significantly impacted satisfaction with health care. The regression models accounted for 23% of the variance in health care satisfaction. Satisfaction with primary care physicians, health insurance, and general health status are the 3 most significant indicators of an individual's satisfaction with health care.
Patel, Shireen; Malins, Sam; Guo, Boliang; James, Marilyn; Kai, Joe; Kaylor-Hughes, Catherine; Rowley, Emma; Simpson, Jayne; Smart, David; Stubley, Michelle; Tyrer, Helen
Background Health anxiety and medically unexplained symptoms cost the National Health Service (NHS) an estimated £3 billion per year in unnecessary costs with little evidence of patient benefit. Effective treatment is rarely taken up due to issues such as stigma or previous negative experiences with mental health services. An approach to overcome this might be to offer remotely delivered psychological therapy, which can be just as effective as face-to-face therapy and may be more accessible and suitable. Aims To investigate the clinical outcomes and cost-effectiveness of remotely delivered cognitive–behavioural therapy (CBT) to people with high health anxiety repeatedly accessing unscheduled care (trial registration: NCT02298036). Method A multicentre randomised controlled trial (RCT) will be undertaken in primary and secondary care providers of unscheduled care across the East Midlands. One hundred and forty-four eligible participants will be equally randomised to receive either remote CBT (6–12 sessions) or treatment as usual (TAU). Two doctoral research studies will investigate the barriers and facilitators to delivering the intervention and the factors contributing to the optimisation of therapeutic outcome. Results This trial will be the first to test the clinical outcomes and cost-effectiveness of remotely delivered CBT for the treatment of high health anxiety. Conclusions The findings will enable an understanding as to how this intervention might fit into a wider care pathway to enhance patient experience of care. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703758
Brooks, J P; Dempsey, J
Health care managers are being required to respond to the growing concerns of the public about alcohol and drug use in the health care workplace. To this end, the following recommendations are offered. A drug testing policy should be developed with input from and support of employees and unions. "For cause" testing should be used because it results in more definitive results and better employee acceptance. Unless there are compelling reasons for random testing, "for cause" testing is the preferable method. All levels of employees and the medical staff should be subject to the drug-testing policy. Rehabilitation rather than punishment should be emphasized in dealing with employees with alcohol and drug problems.
Gould, Stephen J.
Questionnaires returned by 343 out of 350 subjects measured health attitudes and health status. Results suggest that some consumers take a more scientific approach to health care and prevention. Demographic factors, health status, and health consciousness are partial predictors of consumer attitudes and approach to health care. (SK)
place to the base unit (consultation site). The transmission is performed through GSM, Satellite links or POTS . Using this device a specialist...standardized medical protocol. Keywords – Emergency Health Care Telemedicine, GSM, Satellite, POTS I. INTRODUCTION The availability of prompt and expert...of communication means (Satellite, GSM and Plain Old Telephony System - POTS ). The base unit is comprised of a set of user-friendly software
Loewy, E H
An argument based on Kant for access to health-care for all is a most helpful addition to prior discussions. My paper argues that while such a point of view is helpful it fails to be persuasive. What is needed, in addition to a notion of the legislative will, is a viewpoint of community which sees justice as originating not merely from considerations of reason alone but from a notion of community and from a framework of common human experiences and capabilities.
... Archives learn more » For Patients Your health care choices matter. Whether you're anticipating a surgical procedure, ... 853.9028 E: firstname.lastname@example.org About Us Careers News & Resources Surveyors Find a Health Care Organization ...
... safety efforts happening across the state. Health care facility CEOs/administrators can: Implement systems to alert receiving ... Germs spread between patients and across health care facilities. Antibiotic resistance is a threat. Nightmare germs called ...
... gov/ency/patientinstructions/000864.htm Savings account for health care costs To use the sharing features on this ... can set aside tax-exempt money for your health care expenses. This means you will pay no or ...
... Information Clinical Trials Resources and Publications How do health care providers diagnose hypoparathyroidism? Skip sharing on social media links Share this: Page Content A health care provider will order a blood test to determine ...
... Urodynamic Testing Virtual Colonoscopy Celiac Disease Testing (for Health Care Professionals) Serologic tests for celiac disease provide an ... 6332) or visit www.fda.gov . Consult your health care provider for more information. September 2013 Share Alternate ...
... Press Release Archives learn more » For Patients Your health care choices matter. Whether you're anticipating a surgical ... certificate of accreditation is a sign that a health care organization meets or exceeds nationally-recognized Standards. Learn ...
... Information Clinical Trials Resources and Publications How do health care providers diagnose pheochromocytoma? Skip sharing on social media links Share this: Page Content A health care provider uses blood and urine tests that measure ...
... Information Clinical Trials Resources and Publications How do health care providers diagnose endometriosis? Skip sharing on social media ... under a microscope, to confirm the diagnosis. 1 Health care providers may also use imaging methods to produce ...
... Information Clinical Trials Resources and Publications How do health care providers diagnose vaginitis? Skip sharing on social media ... out the cause of a woman's symptoms, her health care provider will Examine the vagina, the vulva, and ...
Moore, F D
The dollar flow in United States medical care has been analyzed in terms of a six-level model; this model and the gross 1981 flow data are set forth. Of the estimated $310 billion expended in 1981, it is estimated that $85-$95 billion was the "surgical stream", i.e., that amount expended to take care of surgical patients at a variety of institutional types and including ambulatory care and surgeons' fees. Some of the determinants of surgical flow are reviewed as well as controllable costs and case mix pressures. Surgical complications, when severe, increase routine operative costs by a factor of 8 to 20. Maintenance of high quality in American surgery, despite new manpower pressures, is the single most important factor in cost containment. By voluntary or imposed controls on fees, malpractice premiums, case mix selection, and hospital utilization, a saving of $2.0-$4.0 billion can be seen as reachable and practical. This is five per cent of the surgical stream and is a part of the realistic "achievable" savings of total flow estimated to be about +15 billion or 5 per cent. PMID:3918514
Edler, A A
Over the last decade, development aid has increasingly used a more collaborative model, with donors and recipients both contributing ideas, methods and goals. Though many examples of collateral aid projects exist in agriculture, business administration and banking, few have found their way into health care and health education, a typically donor-dominated model. The following case report describes a collateral project in health care education. This case report analyzes data-inducing project proposals, personal interviews and project reports obtained through standard archival research methods. The setting for this joint project was the collaboration between international nongovernmental (NGO) aid foundations and the faculty of a major sub-Saharan African Medical School's Department of Anesthesia. The initial goal of this project was to improve record keeping for all anesthetic records, both in the operating theatres and outside. Analysis of the data was performed using ethnographic methods of constant comparative analysis. The purpose of the analysis was to critically evaluate both the goals and their results in the Department of Anesthesiology. The findings of this analysis suggested that results included not only quality assurance and improvement programs in the department but also advances in the use of critical incidents as teaching tools, hospital-wide drug and equipment utilization information and the initiation of an outreach program to district hospitals throughout the country for similar projects.
Liu, Y; Hsiao, W C; Li, Q; Liu, X; Ren, M
In the late 1970s China launched its agricultural reforms which initiated a decade of continued economic growth and significant transformation of the Chinese society. The agricultural reforms altered the peasants' incentives, weakened community organization and lessened the central government's control over local communities. These changes largely caused the collapse of the widely acclaimed rural cooperative medical system in China. Consequently China experienced a decreased supply of rural health workers, increased burden of illnesses, disintegration of the three tier medical system, reduced primary health care, and an increased demand for hospital medical services. More than ten years have elapsed since China changed its agricultural economic system and China is still struggling to find an equitable, efficient and sustainable way of financing and organizing its rural health services. The Chinese experiences provided several important lessons for other nations: there is a need to understand the limits of the market forces and to redefine the role of the government in rural health care under a market economy; community participation in and control of local health financing schemes is essential in developing a sustainable rural health system; the rural health system needs to be dynamic, rather than static, to keep pace with changing demand and needs of the population.
Background There are 4 main types of chronic or noncommunicable diseases. Of these, diabetes is one of the major therapeutic concerns globally. Moreover, Iran is among the countries with the highest incidence of diabetic patients. Furthermore, library-based studies by researchers have shown that thus far no study has been carried out to evaluate the relationship between Web-based diabetic personal health records (DPHR) and self-care indicators in Iran. Objective The objective of this study is to examine the effect of Web-based DPHR on self-care status of diabetic patients in an intervention group as compared with a control group. Methods The effect of DPHR on self-care was assessed by using a randomized controlled trial (RCT) protocol for a 2-arm parallel group with a 1:1 allocation ratio. During a 4-month trial period, the control group benefited from the routine care; the intervention group additionally had access to the Web-based DPHR app besides routine care. During the trial, 2 time points at baseline and postintervention were used to evaluate the impact of the DPHR app. A sample size of 72 people was randomly and equally assigned to both the control and intervention groups. The primary outcome measure was the self-care status of the participants. Results Test results showed that the self-care status in the intervention group in comparison with the control group had a significant difference. In addition, the dimensions of self-care, including normal values, changes trend, the last measured value, and the last time measured values had a significant difference while other dimensions had no significant difference. Furthermore, we found no correlation between Web-based DPHR system and covariates, including scores of weight, glycated hemoglobin (HbA1c), serum creatinine, high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and planned visit adherence, as well as the change trend of mean for blood glucose and blood pressure. Conclusions
McManus, Marilyn C., Ed.
This theme issue of a bulletin on family support and children's mental health focuses on managed care and the impact on children who are in need of mental health services. Articles include: "Private Sector Managed Care and Children's Mental Health" (Ira S. Lourie and others); "Just What Is Managed Care?" (Chris Koyanagi); "Managed Behavioral…
Recommends choosing appropriate health care providers for camp, and referring to them by the title their credentials warrant. Explains distinctions among nursing titles and that they vary by state. Discusses developing a health care plan suited to camp's population, program, and location. Presents guidelines required of a health care plan by…
Douglas, Bruce L.
In a context of forecasts of major changes for America's entire health care system, colleges and universities are exploring the implications of new trends in campus health care delivery. On January 30-31, 1975, the Society for College and University Planning sponsored a workshop on "Campus Health Care Services" in Chicago to discuss such issues as…
Kreps, Gary L.; Kunimoto, Elizabeth
This paper investigates the multicultural demands of health care delivery by examining the role of organizational communication in promoting effective multicultural relations in modern health care systems. The paper describes the multicultural make-up of modern health care systems--noting, for example that providers from different professional…
Barron, Gary R S
In this paper, I describe dividing practices in making up a specific medical-legal category-the revolving door patient-to identify, label, and direct the actions of particular people living with mental illness. The revolving door patient was a category that had been spoken of for some time, but became a formal legal subject with the introduction of the Alberta Mental Health Act 2010 and Community Treatment Orders (CTOs). I demonstrate how a rationale of control over unpredictable and dangerous individuals was primary in creating this new category, and that the characterization of the revolving door patient required a disciplinary technology to reduce danger. I argue that the CTO is a medical-legal technology that solves the problem of governing a subject in order to produce a patient that manages mental illness. I conclude by reflecting on how the narrative of the revolving door patient, and of mental illness more broadly, has implications for personal identity and tensions between care and control. Dans cet article, je décris comment des 'pratiques divisées' ont créé une catégorie spécifique médico-légale - le « revolving door patient » - afin d'identifier, d'étiqueter et de contrôler les comportements de certains individus vivants avec une maladie mentale. Le «revolving door patient», une catégorie dont on avait parlé depuis un certain temps, est devenu un sujet juridique formel par l'introduction de la loi de la santé mentale de l'Alberta 2010 et de l'Ordre de Traitement Communautaire (OCT). Je démontre comment une logique de contrôle sur les individus imprévisibles et dangereux eu un rôle prépondérant lors de la création de cette catégorie et que la caractérisation du «revolving door patient», entant que telle, a nécessité une technologie disciplinaire pour réduire le danger social. Je soutiens que le OTC est une technologie médico-légale qui résout le problème de contrôle d'un sujet en produisant un patient qui gère une
India's health care system, despite several significant achievements, suffers from some weaknesses and deficiencies. There has been a preoccupation with the promotion of curative and clinical services through city based hospitals which have essentially catered to certain sections of the urban population. The concept of health in its totality, with preventive and promotive health care services in addition to the curative, has yet to be made operational. There has been an overdependence on the states for health care measures and voluntary and local effort has not been able to accept responsibility in any significant way. The involvement of the people in solving their health problems has been almost nonexistent. Health needs to be viewed as part of the strategy of human resources development. Horizontal and vertical linkages must be obtained among all the interrelated programs--protected water supply environmental sanitation and hygiene, nutrition, education, family planning, and maternal and child welfare. Only with such linkages can the benefits of the various programs be optimized. An attack on the problems of diseases cannot be completely successful unless it is accompanied by an attack on poverty. For this reason the 6th plan assigns a high priority to programs of promotion, or gainful employment, eradication of poverty, population control, and meeting the basic human needs of the population. The Alma Alta Declaration of 1977 has become the accepted health policy of India, simplified into the slogan "health for all by 2000." To realize this goaL, the Planning Commission recommends in the 6th 5-Year Plan a restructing and reorientation of the country's health services. The proposed alternative scheme is more decentralized and provides for many more people to be trained at the grassroots level. People would be involved in tackling their health problems and community participation would be encouraged. Finally, the alternative strongly urges the screening of patients
Dunn, Abe; Shapiro, Adam Hale
This study examines the impact of major health insurance reform on payments made in the health care sector. We study the prices of services paid to physicians in the privately insured market during the Massachusetts health care reform. The reform increased the number of insured individuals as well as introduced an online marketplace where insurers compete. We estimate that, over the reform period, physician payments increased at least 11 percentage points relative to control areas. Payment increases began around the time legislation passed the House and Senate-the period in which their was a high probability of the bill eventually becoming law. This result is consistent with fixed-duration payment contracts being negotiated in anticipation of future demand and competition.
The Oral Health Programme (ORH) is a health promotion and disease prevention initiative. ORH should be integrated into primary health care programmes by building policies suited to each country and based on the common risk factor approach. Dental caries and periodontal diseases are highly prevalent in recommended. Although cost-effective, water and salt fluoridation are often unavailable and topical fluorides are recommended. Governments and industry must ensure availability of affordable fluoride toothpaste. Fluoride toothpaste should also be used to control periodontal diseases. The atraumatic restorative treatment approach should be used to treat dental caries. The Basic Package of Oral Care (BPOC) for deprived communities outlines this approach in detail. Continuous training and research are recommended for personnel to keep pace with changes in methods of prevention and treatment procedures.
e-Health has the potential to improve pediatric palliative care. e-Health initiatives use the Internet or health information technology to improve quality of care and have the potential to decrease costs by reducing medical errors, reducing duplication of services, improving access to diagnostic and laboratory results, and improving communication between providers and patients, and so on. The majority of e-health initiatives are for adults and only a limited amount of evidence exists in the literature on e-health interventions in palliative care that are focused on pediatrics. To explore what role e-health could play in pediatric palliative care programs, this article aims to describe the Internet use in general in the United States and in palliative care, describe the use of health information technology in general in the United States and in palliative care, and suggest areas in pediatric palliative care that might benefit from e-health interventions.
Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial
Huirne, Judith AF; Bouwsma, Esther VA; van Dongen, Johanna M; Terwee, Caroline B; van de Ven, Peter M; den Bakker, Chantal M; van der Meij, Suzan; van Baal, W Marchien; Leclercq, Wouter KG; Geomini, Peggy MAJ; Consten, Esther CJ; Schraffordt Koops, Steven E; van Kesteren, Paul JM; Stockmann, Hein BAC; ten Cate, A Dorien; Davids, Paul HP; Scholten, Petrus C; van den Heuvel, Baukje; Schaafsma, Frederieke G; Meijerink, Wilhelmus JHJ; Bonjer, H Jaap; Anema, Johannes R
Background Due to the strong reduction in the length of hospital stays in the last decade, the period of in-hospital postoperative care is limited. After discharge from the hospital, guidance and monitoring on recovery and resumption of (work) activities are usually not provided. As a consequence, return to normal activities and work after surgery is hampered, leading to a lower quality of life and higher costs due to productivity loss and increased health care consumption. Objective With this study we aim to evaluate whether an eHealth care program can improve perioperative health care in patients undergoing commonly applied abdominal surgical procedures, leading to accelerated recovery and to a reduction in costs in comparison to usual care. Methods This is a multicenter randomized, single-blinded, controlled trial. At least 308 patients between 18 and 75 years old who are on the waiting list for a laparoscopic cholecystectomy, inguinal hernia surgery, or laparoscopic adnexal surgery for a benign indication will be included. Patients will be randomized to an intervention or control group. The intervention group will have access to an innovative, perioperative eHealth care program. This intervention program consists of a website, mobile phone app, and activity tracker. It aims to improve patient self-management and empowerment by providing guidance to patients in the weeks before and after surgery. The control group will receive usual care and will have access to a nonintervention (standard) website consisting of the digital information brochure about the surgical procedure being performed. Patients are asked to complete questionnaires at 5 moments during the first 6 months after surgery. The primary outcome measure is time to return to normal activities based on a patient-specific set of 8 activities selected from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning item bank version 1.2. Secondary outcomes include social
Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L
Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspectives is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among U.S. Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, they identified several areas for improvement. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery.
Ziebarth, Deborah Jean
While performing a data search to define "wholistic health care", it was evident that a definite gap existed in published literature. In addition, there are different definitions and several similar terms (whole person care, wholistic health, whole person health, wholism, etc.), which may cause confusion. The purpose of this paper was to present the analysis of "wholistic health care" using Rodgers' Evolutionary Method. The method allows for the historical and social nature of "wholistic health care" and how it changes over time. Attributes, antecedents, and consequences of wholistic health care were reduced using a descriptive matrix. In addition, attributes that consistently occurred in wholistic health care were presented as essential attributes. Definitions of Wholistic Health Care Provider(s), Wholistic Health, Wholistic Illness, Wholistic Healing, and Patient were created from the analysis of the literature review of attributes, antecedents, and consequences of wholistic health care. Wholistic Health Care is defined as the assessment, diagnosis, treatment and prevention of wholistic illness in human beings to maintain wholistic health or enhance wholistic healing. Identified wholistic health needs are addressed simultaneously by one or a team of allied health professionals in the provision of primary care, secondary care, and tertiary care. Wholistic health care is patient centered and considers the totality of the person (e.g., human development at a given age, genetic endowments, disease processes, environment, culture, experiences, relationships, communication, assets, attitudes, beliefs, and lifestyle behaviors). Patient centered refers to the patient as active participant in deciding the course of care. Essential attributes of wholistic health care are faith (spiritual) integrating, health promoting, disease managing, coordinating, empowering, and accessing health care. Wholistic health care may occur in collaboration with a faith-based organization to
Kizer, K W
As the US health care system begins to reengineer itself to address the need for quality improvement, it also is being actively reshaped by the expectations of consumers. The confluence of these forces requires a new approach to setting health care performance standards. The National Quality Forum (NQF) has been established as a private, not-for-profit, open membership, public benefit corporation for the purposes of developing consensus about standardized health care performance measures, reporting mechanisms, and a national strategy for health care quality improvement. The NQF has broad representation from all segments of the health care industry and provides an equitable way of addressing the disparate priorities of health care's many stakeholders. Agreement and implementation of standardized health care performance measures and achievement of quality improvement in the emerging era of consumerism will be facilitated by (1) establishing national goals for health care quality; (2) embracing public policy that recognizes the complementary roles of quality improvement, cost control, and improved access; (3) giving greater priority to measuring and reporting the performance of those aspects of the health care system that directly affect consumers; (4) focusing on creating a health care culture of excellence; and (5) promoting the active collaboration of all stakeholders.
Wheeler, Sarahn M; Bryant, Allison S
A health disparity is defined as an increased burden of an adverse health outcome or health determinant within a specific subset of the population. There are well-documented racial and ethnic disparities throughout health care at the patient, provider, and health care system levels. As the minority populations within the United States grow to record numbers, it is increasingly important to invest in efforts to characterize, understand, and end racial and ethnic disparities in health care. Inequities in health outcomes and care pose real threats to the entire nation's well-being. Eliminating health disparities is fundamental to the well-being, productivity, and viability of the entire nation.
Kimmey, James R.
A discussion of the implications of health care reform for academic health centers (a complex of institutions which educate health professionals) looks at problems in the current system, the role of academic health centers in the current system, financial pressures, revenue sources other than patient care, impact on health research, and human…
Syre, Thomas R.; Wilson, Richard W.
This article discusses role delineation in the health education profession, defines and presents principles of health care marketing, describes marketing plan development, and examines major ethical issues associated with health care marketing when utilized by community health educators. A marketing plan format for community health education is…
Walley, John; Lawn, Joy E; Tinker, Anne; de Francisco, Andres; Chopra, Mickey; Rudan, Igor; Bhutta, Zulfiqar A; Black, Robert E
The principles agreed at Alma-Ata 30 years ago apply just as much now as they did then. "Health for all" by the year 2000 was not achieved, and the Millennium Development Goals (MDGs) for 2015 will not be met in most low-income countries without substantial acceleration of primary health care. Factors have included insufficient political prioritisation of health, structural adjustment policies, poor governance, population growth, inadequate health systems, and scarce research and assessment on primary health care. We propose the following priorities for revitalising primary health care. Health-service infrastructure, including human resources and essential drugs, needs strengthening, and user fees should be removed for primary health-care services to improve use. A continuum of care for maternal, newborn, and child health services, including family planning, is needed. Evidence-based, integrated packages of community and primary curative and preventive care should be adapted to country contexts, assessed, and scaled up. Community participation and community health workers linked to strengthened primary-care facilities and first-referral services are needed. Furthermore, intersectoral action linking health and development is necessary, including that for better water, sanitation, nutrition, food security, and HIV control. Chronic diseases, mental health, and child development should be addressed. Progress should be measured and accountability assured. We prioritise research questions and suggest actions and measures for stakeholders both locally and globally, which are required to revitalise primary health care.
Mani, Ameet; Shubangi, A M; Saini, Rajiv
Healthcare-associated infections are an important cause of morbidity and mortality among hospitalized patients worldwide. Transmission of health care associated pathogens generally occurs via the contaminated hands of health care workers. Hand hygiene has long been considered one of the most important infection control measures to prevent health care-associated infections. For generations, hand washing with soap and water has been considered a measure of personal hygiene. As early as 1822, a French pharmacist demonstrated that solutions containing chlorides of lime or soda could eradicate the foul odor associated with human corpses and that such solutions could be used as disinfectants and antiseptics. This paper provides a comprehensive review of data regarding hand washing and hand antisepsis in healthcare settings. In addition, it provides specific recommendations to uphold improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in healthcare settings. This article also makes recommendations and suggests the significance of hand health hygiene in infection control.
Morales-Asencio, JM; Gonzalo-Jiménez, E; Martin-Santos, FJ; Morilla-Herrera, JC; Celdráan-Mañas, M; Carrasco, A Millán; García-Arrabal, JJ; Toral-López, I
Background Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). Methods Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. Results Base-line differences in functional capacity – significantly lower in the intervention group (RR: 1.52 95%CI: 1.05–2.21; p = 0.0016) – disappeared at six months (RR: 1.31 95%CI: 0.87–1.98; p = 0.178). At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77–59.34 vs. 60.50 95%CI: 53.63–67.37; p = 0.264), (Zarit Test at six months: 53.79 95%CI: 49.67–57.92 vs. 66.26 95%CI: 60.66–71.86 p = 0.002). Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22–10.62 vs. 3.24 95%CI: 1.37–5.310; p = 0.0001) and, on average, required fewer home care visits (9
Murray, Sally B; Skull, Sue A
Refugees and asylum seekers face a number of barriers to accessing health care and improved health status. These include language difficulties, financial need and unemployment, cultural differences, legal barriers and a health workforce with generally low awareness of issues specific to refugees. Importantly, current Australian government migration and settlement policy also impacts on access to health and health status. An adequate understanding of these 'hurdles to health' is a prerequisite for health providers and health service managers if they are to tailor health care and services appropriately. We include tables of available resources and entitlements to health care according to visa category to assist providers and managers.
Hoekstra, Miriam; Vogelzang, Mathijs; Verbitskiy, Evgeny; Nijsten, Maarten W N
Current care guidelines recommend glucose control (GC) in critically ill patients. To achieve GC, many ICUs have implemented a (nurse-based) protocol on paper. However, such protocols are often complex, time-consuming, and can cause iatrogenic hypoglycemia. Computerized glucose regulation protocols may improve patient safety, efficiency, and nurse compliance. Such computerized clinical decision support systems (Cuss) use more complex logic to provide an insulin infusion rate based on previous blood glucose levels and other parameters. A computerized CDSS for glucose control has the potential to reduce overall workload, reduce the chance of human cognitive failure, and improve glucose control. Several computer-assisted glucose regulation programs have been published recently. In order of increasing complexity, the three main types of algorithms used are computerized flowcharts, Proportional-Integral-Derivative (PID), and Model Predictive Control (MPC). PID is essentially a closed-loop feedback system, whereas MPC models the behavior of glucose and insulin in ICU patients. Although the best approach has not yet been determined, it should be noted that PID controllers are generally thought to be more robust than MPC systems. The computerized Cuss that are most likely to emerge are those that are fully a part of the routine workflow, use patient-specific characteristics and apply variable sampling intervals.
Deutsch, Stephanie Anne; Fortin, Kristine
Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed.
Kansas State Dept. of Health and Environment, Topeka.
Profiles are provided for innovative public health activities that focus on the health of children in day care. All are considered to be models worthy of replication. Profiles depict (1) child care in Arizona; (2) child day care licensing in Connecticut; (3) safeguarding children in day care in Kansas; (4) paired state and local inspection in…
Birt, C A
Basic demographic and epidemiological data relevant to health problems in Vietnam are described in this paper. Existing health service arrangements are referred to, with particular emphasis on the strategy for development of primary health care. The establishment of the paediatric centre in Ho Chi Minh City is reported, and examples of its valuable work in primary health care development are described.
Watzke, Birgit; Rüddel, Heinz; Jürgensen, Ralph; Koch, Uwe; Kriston, Levente; Grothgar, Barbara; Schulz, Holger
We investigated the comparative effectiveness of cognitive-behavioural (CBT) and psychodynamic therapy (PDT) under clinically representative conditions as a subtrial of a prior study (Watzke et al., 2010, BJP). A consecutive sample of 147 patients with common mental disorders was randomised to either CBT or PDT in routine mental health care. In a primary per-protocol analysis patients randomised to CBT had a significantly better longer term outcome in the primary outcome symptom severity (General Severity Index of the SCL-14; p=.001; partial η(2)=0.073) as well as in health related quality of life (Mental Component Summary of the SF-8; p=.013; partial η(2)=.041) and concerning interpersonal issues (Inventory of Interpersonal Problems, IIP-C; p=.001; partial η(2)=.070) 6 months after treatment than patients randomised to PDT. These results could be confirmed in intention-to-treat analyses (n=180) suggesting that there was no substantial attrition bias due to drop outs at the follow-up assessment. Thus, the so called equivalence outcome paradox was not replicated in this study.
Brandejs, J. F., And Others
To effectively handle changes in health policy and health information, new designs and applications of automation are explored. Increased use of computer-based information systems in health care could serve as a means of control over the costs of developing more comprehensive health service, with applications increasing not only the automation of…
Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R
Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.
Introduction Ninety percent of the aboriginal communities of Argentina are located in areas of endemic vectorial transmission of Chagas disease. Control activities in these communities have not been effective. The goal of this research was to explore the role played by beliefs, habits, and practices of Pilaga and Wichi indigenous communities in their interaction with the local health system in the province of Formosa. This article contributes to the understanding of the cultural barriers that affect the communication process between indigenous peoples and their health care providers. Methods Twenty-nine open ended interviews were carried out with members of four indigenous communities (Pilaga and Wichi) located in central Formosa. These interviews were used to describe and compare these communities’ approach to health and disease as they pertain to Chagas as well as their perceptions of Western medicine and its incarnation in local health practice. Results Five key findings are presented: 1) members of these communities tend to see disease as caused by other people or by the person’s violation of taboos instead of as a biological process; 2) while the Pilaga are more inclined to accept Western medicine, the Wichi often favour the indigenous approach to health care over the Western approach; 3) members of these communities do not associate the vector with the transmission of the disease and they have little awareness of the need for vector control activities; 4) indigenous individuals who undergo diagnostic tests and accept treatment often do so without full information and knowledge; 5) the clinical encounter is rife with conflict between the expectations of health care providers and those of members of these communities. Conclusion Our analysis suggests that there is a need to consider the role of the cultural patterning of health and disease when developing interventions to prevent and control Chagas disease among indigenous communities in Northern Argentina
Ostry, A S
The World Trade Organization (WTO) creates new challenges for the Canadian health care system, arguably one of the most "socialized" systems in the world today. In particular, the WTO's enhanced trade dispute resolution powers, enforceable with sanctions, may make Canadian health care vulnerable to corporate penetration, particularly in the pharmaceutical and private health services delivery sectors. The Free Trade Agreement and its extension, the North American Free Trade Agreement, gave multinational pharmaceutical companies greater freedom in Canada at the expense of the Canadian generic drug industry. Recent challenges by the WTO have continued this process, which will limit the health care system's ability to control drug costs. And pressure is growing, through WTO's General Agreement on Trade in Services and moves by the Alberta provincial government to privatize health care delivery, to open up the Canadian system to corporate penetration. New WTO agreements will bring increasing pressure to privatize Canada's public health care system and limit government's ability to control pharmaceutical costs.
Wesolowski, C E
Organizations that clearly demonstrate they care about their people reap the benefits of a positive self-image, higher productivity and financial gains. Consider the effects that a demoralized, unappreciated staff have on productivity, recruitment and retention, public relations, marketing, customer satisfaction and the resulting financial repercussions. Can we afford not to care?
Domaszewicz, Sander; Havlin, Linda; Connolly, Susan
Employers affected by the recession's 2009 peak must press for cost containment in 2010, especially in health care benefits. Encouraging employee consumerism--through consumer-directed health plans and other strategies--can be enhanced by incentives, but federal efforts at health care reform add some element of uncertainty to the consumer-directed solution. This article provides some lessons to guide the course of action for employers considering implementing a consumerist approach to improve employee health and control the cost trend.
Irwin, Charles E., Jr., Ed.; And Others
Health care reform represents a major step toward achieving the goal of improved preventive and primary care services for all Americans, including children and adolescents. Adolescence is a unique developmental age district from both childhood and adulthood with special vulnerabilities, health concerns, and barriers to accessing health care. It is…
Caring for a diverse pool of patients is an ongoing challenge for health care practitioners and marketers. Communication difficulties and cultural misunderstandings still stand in the way and keep members of some minority populations from getting the health care they need. To better serve these groups, it's crucial to learn more about patients' values, needs, and expectations. Fortunately, opportunities abound for health care marketers to learn about and effectively target these still largely underserved populations.
Sorrell, Jeanne M
Health care was an important issue for both the Obama and McCain election campaigns. Now that Barack Obama is poised to serve as the 44th President of the United States, many health care providers are focused on what Obama's administration will mean for new health care initiatives. This article focuses specifically on aspects of the Obama and Biden health care plan that affects mental health care for older adults.
Tomkins, Andrew; Duff, Jean; Fitzgibbon, Atallah; Karam, Azza; Mills, Edward J; Munnings, Keith; Smith, Sally; Seshadri, Shreelata Rao; Steinberg, Avraham; Vitillo, Robert; Yugi, Philemon
Differences in religious faith-based viewpoints (controversies) on the sanctity of human life, acceptable behaviour, health-care technologies and health-care services contribute to the widespread variations in health care worldwide. Faith-linked controversies include family planning, child protection (especially child marriage, female genital mutilation, and immunisation), stigma and harm reduction, violence against women, sexual and reproductive health and HIV, gender, end-of-life issues, and faith activities including prayer. Buddhism, Christianity, Hinduism, Islam, Judaism, and traditional beliefs have similarities and differences in their viewpoints. Improved understanding by health-care providers of the heterogeneity of viewpoints, both within and between faiths, and their effect on health care is important for clinical medicine, public-health programmes, and health-care policy. Increased appreciation in faith leaders of the effect of their teachings on health care is also crucial. This Series paper outlines some faith-related controversies, describes how they influence health-care provision and uptake, and identifies opportunities for research and increased interaction between faith leaders and health-care providers to improve health care.
Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost). It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that health represents the absence of health problems. While that perspective has led to incredible advances in medical science, it now may be adversely affecting value. Problem-oriented care is clearly one of the drivers of rising costs and it could be adversely affecting the quality of care, depending upon how quality is defined. If we redefined health in terms of patient-centered goals, health care could be focused more directly on meaningful outcomes, reducing the number of irrelevant tests and treatments. Greater emphasis would be placed on prevention, meaningful activities, advance directives and personal growth and development. The role of patients within clinician-patient relationships would be elevated, strengthening therapeutic relationships. Reframing health in terms of health-related goals and directing the health care system to help people achieve them, could both improve quality and reduce costs. In the process, it could also make health care less mechanical and more humane. PMID:28367382
SHEKARCHIZADEH, Hajar; KHAMI, Mohammad R.; MOHEBBI, Simin Z.; EKHTIARI, Hamed; VIRTANEN, Jorma I.
Abstract Oral health problems, among the most prevalent comorbidities related to addiction, require more attention by both clinicians and policy-makers. Our aims were to review oral complications associated with drugs, oral health care in addiction rehabilitation, health services available, and barriers against oral health promotion among addicts. Drug abuse is associated with serious oral health problems including generalized dental caries, periodontal diseases, mucosal dysplasia, xerostomia, bruxism, tooth wear, and tooth loss. Oral health care has positive effects in recovery from drug abuse: patients’ need for pain control, destigmatization, and HIV transmission. Health care systems worldwide deliver services for addicts, but most lack oral health care programs. Barriers against oral health promotion among addicts include difficulty in accessing addicts as a target population, lack of appropriate settings and of valid assessment protocols for conducting oral health studies, and poor collaboration between dental and general health care sectors serving addicts. These interfere with an accurate picture of the situation. Moreover, lack of appropriate policies to improve access to dental services, lack of comprehensive knowledge of and interest among dental professionals in treating addicts, and low demand for non-emergency dental care affect provision of effective interventions. Management of drug addiction as a multi-organ disease requires a multidisciplinary approach. Health care programs usually lack oral health care elements. Published evidence on oral complications related to addiction emphasizes that regardless of these barriers, oral health care at various levels including education, prevention, and treatment should be integrated into general care services for addicts. PMID:26060654
One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992–2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index. Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894
Núñez, Alicia; Chi, Chunhuei
One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile.The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992-2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index.Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly.
Benjamins, S. Janine; Damen, Maurice L. W.; van Stel, Henk F.
Background In the Netherlands a need is felt for more flexible Child Health Care services, both efficient and tailored to needs. We set up a study on impact and feasibility of task delegation to child health care nurses performing all regular checkups on children aged 2 months to 4 years. Abnormal findings were discussed with the attending child health care doctor. This article describes impact and feasibility of this task delegation from four viewpoints: competences of nurses; percentage of children assigned to the nurse; change in abnormal findings and referrals; experiences of professionals and parents. Methods Two experiment teams and two control teams were compared before and after starting task delegation. Nurses in the experiment teams were trained to carry out regular checkups on healthy children. Assignment to the experiment schedule was a joint decision by doctor and nurse. Nursing competences were measured by means of questionnaires. Percentage of children assigned to the nurse and screening results of eyes, heart, hips, growth and development were extracted from the electronic health record. Difference in change was compared between experiment and control teams. Mann-Whitney tests and logistic generalized estimating equations were used to test for significance. Experiences of professionals and parents were evaluated through focus group interviews, which were subjected to a qualitative analysis. Results Nurses in the experiment regions showed improvement in medical screening skills. No difference in change was perceived in general nursing competences. In the experiment group, 69% of all children were assigned to the nurse. There were no significant differences in change in the percentages of abnormal findings or referrals in the experiment teams compared to the control teams, except for hips. Interviews showed that both doctors and nurses thought positively of the new working method, yet made some recommendations for improvements. Parents felt well
The current human resource (HR) management practices in health care are consistent with the industrial model of management. However, health care organizations are not factories. They are highly knowledge-intensive and service-oriented entities and thus require a different set of HR practices and systems to support them. Drawing from the resource-based theory, I argue that HRs are a potent weapon of competitive advantage for health care organizations and propose a five-dimensional conception of HR capability for harnessing HRs in health care organizations. The significant complementarities that exist between HRs and information technologies for delivering safer and better quality of patient care are also discussed.
Simpser, Edwin; Hudak, Mark L
Pediatric home health care is an effective and holistic venue of treatment of children with medical complexity or developmental disabilities who otherwise may experience frequent and/or prolonged hospitalizations or who may enter chronic institutional care. Demand for pediatric home health care is increasing while the provider base is eroding, primarily because of inadequate payment or restrictions on benefits. As a result, home care responsibilities assumed by family caregivers have increased and imposed financial, physical, and psychological burdens on the family. The Patient Protection and Affordable Care Act set forth 10 mandated essential health benefits. Home care should be considered as an integral component of the habilitative and rehabilitative services and devices benefit, even though it is not explicitly recognized as a specific category of service. Pediatric-specific home health care services should be defined clearly as components of pediatric services, the 10th essential benefit, and recognized by all payers. Payments for home health care services should be sufficient to maintain an adequate provider work force with the pediatric-specific expertise and skills to care for children with medical complexity or developmental disability. Furthermore, coordination of care among various providers and the necessary direct patient care from which these care coordination plans are developed should be required and enabled by adequate payment. The American Academy of Pediatrics advocates for high-quality care by calling for development of pediatric-specific home health regulations and the licensure and certification of pediatric home health providers.
Lima, Bruno R.
This paper outlines selected differences between the United States and Latin America health care systems as they relate to primary mental health care. It notes that historically both the United States and Latin America have relied on custodial psychiatric hospitals. The alternative of community care for psychiatric patients is described as it is…
Schraiber, Lilia Blima; Figueiredo, Wagner dos Santos; Gomes, Romeu; Couto, Márcia Thereza; Pinheiro, Thiago Félix; Machin, Rosana; Silva, Geórgia Sibele Nogueira da; Valença, Otávio
This study deals with the relations between masculinities and health care, approaching the recognition of health needs among male users of primary health care and the responses by the services. The study is part of a larger research project in four Brazilian States, with a convenience sample of eight health services. Ethnographic observation was compared with semi-structured interviews with 182 health care users from 15 to 65 years of age and 72 health professionals. Thematic analysis of the ethnographic records and interviews was based on gender references and studies on health work. The findings show how medicalization of health needs affects users, professionals, and services, disguising issues related to masculinity. Primary care focuses mainly on women, thereby reproducing gender inequalities in health services operations and professional performance, with women receiving disciplined care and men receiving insufficient attention and care.
Menon, Sanjay T.
The context for health empowerment includes individuals, health providers, and the regulatory environment. Psychological health empowerment consists of perceived control, perceived competence, and goal internalization. In multicultural communities, barriers to empowerment include locus of control, access to health care, and language and cultural…
Fisher, Elisa; Hasselberg, Michael; Conwell, Yeates; Weiss, Linda; Padrón, Norma A; Tiernan, Erin; Karuza, Jurgis; Donath, Jeremy; Pagán, José A
Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO(®) (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.
Murphy, John W
Primary health care has received a lot of attention since the Alma Ata Conference, convened by the World Health Organization in 1978. Key to the strategy to improve health care outlined at the Alma Ata conference is citizen participation in every phase of service delivery. Although the goals of primary health care have not been achieved, the addition of narrative medicine may facilitate these ends. But a new epistemology is necessary, one that is compatible with narrative medicine, so that local knowledge is elevated in importance and incorporated into the planning, implementation, and evaluation of health programs. In this way, relevant, sustainable, and affordable care can be provided. The aim of this article is to discuss how primary health care might be improved through the introduction of narrative medicine into planning primary health care delivery. PMID:26222094
Musich, Shirley; Wang, Shaohung; Hawkins, Kevin
Abstract The objective of this study was to evaluate the impact on health care utilization and expenditure trends over time of a personalized preventive medicine program delivering individualized care focused on lifestyle behavior modification, disease prevention, and compliance with quality-related metrics. MD-Value in Prevention (MDVIP) is a network of affiliated primary care physicians who utilize a model of health care delivery based on an augmented physician-patient relationship and focused on personalized preventive health care. Multivariate modeling was used to control for demographics, socioeconomics, supply of health care services, and health status among 10,186 MDVIP members and randomly selected, matched nonmembers. Health care utilization and expenditure trends were tracked from the pre period prior to member enrollment for a period of up to 3 years post enrollment. MDVIP members experienced reduced utilization of emergency room and urgent care services compared to nonmembers. Program savings ranges indicated that, over time, increasing percentages of members achieved cost savings compared to nonmembers. Older age groups were more likely to realize savings in the early years with preventive activities indicating condition management, and younger age groups were most likely to achieve savings by the third year after enrollment. These results indicate that a primary care model based on an enhanced physician-patient relationship and focused on quality and personalized preventive care within a time frame of 3 years can achieve positive health care expenditure outcomes and improved health management. PMID:26871762
Stöver, Heino; Wolff, Hans
Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities. Health care professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services. Health care workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners. PMID:22390510
Pont, Jörg; Stöver, Heino; Wolff, Hans
Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities. Health care professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services. Health care workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners.
Brower, Mary R.; Sull, Theresa M.
Contends that child care facility owners, boards of directors, staff, and parents need to focus on financial management, as poor financial health compromises the quality of care for children. Specifically addresses the issues of: (1) concern for providing high quality child care; (2) the connection between quality and money; and (3) strengthening…
Ahmad, Waqar I. U., Ed.; Atkin, Karl, Ed.
This collection offers a wide-ranging introduction to contemporary issues surrounding the health care needs of members of minority ethnic communities within the framework of community care in Britain. The following chapters consider state welfare, minority communities, family structures, and social change: (1) "'Race' and Community Care: An…
In his new book, futurist Russell C. Coile Jr. presents predictions about seven aspects of health care for the next five years. Aided by a panel of health care experts, he analyzes likely developments in health care consumerism, technology, managed care, and other areas that raise a number of issues for health care marketers. Even if only a few of these predictions come true, marketers will be forced to rethink some of their techniques to adapt to this rapidly changing environment.
Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26 years, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met.
Schaeffer, Leonard D
Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable. Research on costs and quality is questioning value. International comparisons rank the United States low on important health system performance measures. Yet it is not these factors but the unsustainable costs of Medicare and Medicaid that will narrow the window for health care stakeholders to shape policy. Unless the health care system is effectively reformed, sometime after the 2008 election, budget hawks and national security experts will eventually combine forces to cut health spending, ultimately determining health policy for the nation.
Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes
Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in…
Doherty, William J., Ed.; McCubbin, Hamilton I., Ed.
Discusses research and interventions related to family health care. Topics include health promotion; risk behaviors; vulnerability and illness onset; choosing health care systems; stress; caregiving and coping; family counseling; and family responses to Alzheimer's Disease, pediatric cancer, cystic fibrosis, diabetes, and obesity. (JAC)
Fujita, Daisuke; Kanaoka, Midori
The purpose of the study is to elucidate the relationship between social support, health care consciousness and mental health in developing the industrial health education aimed at improving the health habits of male employees. A questionnaire survey concerning health practices, mental health based on the General Health Questionnaire, social support from social support networks, and health care consciousness based on the Health Locus of Control was conducted on male employees in three companies in Osaka Prefecture. A total of 1,634 questionnaires were collected. Analyses by age group showed that in all age groups, the higher the social support score, the more favorable the mental health became and the stronger the family care in health care consciousness became. The better the mental health, the greater the number of good health practices was and the lower the fortune dependence in health care consciousness tended to be. The results of the study reconfirm the previous findings that it is necessary to put the mental health of male employees in good condition before everything else in effectively developing health education aimed at improving their health habits. This study also indicates that the level of perception of social support and their internal control of self and family in health care consciousness are definitely related to the stability of subjects' mental health. It is therefore presumed that measures to raise the revel of perception of social support are important since they may improve the mental health of subjects.
There are many ways in which long-term care facilities attempt to cope with the mental health problems of the elderly. The author reviews five factors crucial to effective care for the aged in these facilities. (Author/RK)
Hall, Mark A
National Federation of Independent Business v. Sebelius, the Supreme Court's ruling on the Patient Protection and Affordable Care Act, is a landmark decision - both for constitutional law and for health care law and policy. Others will study its implications for constitutional limits on a range of federal powers beyond health care. This article considers to what extent the decision is also about health care law, properly conceived. Under one view, health care law is the subdiscipline that inquires how courts and government actors take account of the special features of medicine that make legal or policy issues especially problematic - rather than regarding health care delivery and finance more generically, like most any other economic or social enterprise. Viewed this way, the opinions from the Court's conservative justices are mainly about general constitutional law principles. In contrast, Justice Ruth Bader Ginsburg's dissenting opinion for the four more liberal justices is just as much about health care law as it is about constitutional law. Her opinion gives detailed attention to the unique features of health care finance and delivery in order to inform her analysis of constitutional precedents and principles. Thus, the Court's multiple opinions give a vivid depiction of the compelling contrasts between communal versus individualistic conceptions of caring for those in need, and between health care and health insurance as ordinary commodities versus ones that merit special economic, social, and legal status.
Bindman, A B
The use of primary and managed care is likely to increase under proposed federal health care reform. I review the definition of primary care and primary care physicians and show that this delivery model can affect access to medical care, the cost of treatment, and the quality of services. Because the use of primary care is often greater in managed care than in fee-for-service, I compare the two insurance systems to further understand the delivery of primary care. Research suggests that primary care can help meet the goal of providing accessible, cost-effective, and high-quality care, but that changes in medical education and marketplace incentives will be needed to encourage students and trained physicians to enter this field. PMID:7941522
de Almeida, Patty Fidelis; dos Santos, Adriano Maia
RESUMO OBJECTIVE To analyze the breadth of care coordination by Primary Health Care in three health regions. METHODS This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. RESULTS Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. CONCLUSIONS Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries. PMID:28099663
Humphreys, B L; Hole, W T; McCray, A T; Fitzmaurice, J M
The National Library of Medicine (NLM) and the Agency for Health Care Policy and Research (AHCPR) are sponsoring a test to determine the extent to which a combination of existing health-related terminologies covers vocabulary needed in health information systems. The test vocabularies are the 30 that are fully or partially represented in the 1996 edition of the Unified Medical Language System (UMLS) Metathesaurus, plus three planned additions: the portions of SNOMED International not in the 1996 Metathesaurus Read Clinical Classification, and the Logical Observations Identifiers, Names, and Codes (LOINC) system. These vocabularies are available to testers through a special interface to the Internet-based UMLS Knowledge Source Server. The test will determine the ability of the test vocabularies to serve as a source of controlled vocabulary for health data systems and applications. It should provide the basis for realistic resource estimates for developing and maintaining a comprehensive "standard" health vocabulary that is based on existing terminologies. PMID:8816351
Polly, David W; Ackerman, Stacey J; Schneider, Karen; Pawelek, Jeff B; Akbarnia, Behrooz A
Purpose Traditional growing rod (TGR) for early-onset scoliosis (EOS) is effective but requires repeated invasive surgical lengthenings under general anesthesia. Magnetically controlled growing rod (MCGR) is lengthened noninvasively using a hand-held magnetic external remote controller in a physician office; however, the MCGR implant is expensive, and the cumulative cost savings have not been well studied. We compared direct medical costs of MCGR and TGR for EOS from the US integrated health care delivery system perspective. We hypothesized that over time, the MCGR implant cost will be offset by eliminating repeated TGR surgical lengthenings. Methods For both TGR and MCGR, the economic model estimated the cumulative costs for initial implantation, lengthenings, revisions due to device failure, surgical-site infections, device exchanges (at 3.8 years), and final fusion, over a 6-year episode of care. Model parameters were estimated from published literature, a multicenter EOS database of US institutions, and interviews. Costs were discounted at 3.0% annually and represent 2015 US dollars. Results Of 1,000 simulated patients over 6 years, MCGR was associated with an estimated 270 fewer deep surgical-site infections and 197 fewer revisions due to device failure compared with TGR. MCGR was projected to cost an additional $61 per patient over the 6-year episode of care compared with TGR. Sensitivity analyses indicated that the results were sensitive to changes in the percentage of MCGR dual rod use, months between TGR lengthenings, percentage of hospital inpatient (vs outpatient) TGR lengthenings, and MCGR implant cost. Conclusion Cost neutrality of MCGR to TGR was achieved over the 6-year episode of care by eliminating repeated TGR surgical lengthenings. To our knowledge, this is the first cost analysis comparing MCGR to TGR – from the US provider perspective – which demonstrates the efficient provision of care with MCGR. PMID:27695352
Maynard, A; Bloor, K
During the last decade, policy makers in a large number of countries have attempted various reforms of their health care systems. Health care reform has been described as a 'global epidemic' (Klein, 1993). All health care reforms consist of very complex policy choices, some of which are examined in this article. After an introductory exploration of ideological issues, the objectives of health care reformers are considered. Three major policy objectives of health care reform are examined: cost containment; efficiency; and, equity. Three types of reform which have been advocated are also considered: public planning; market regulation; and provider-advocated reforms such as a 'basic package' with copayments and alternative means of finance. Finally, appropriate features of efficient health care reform are suggested, addressing explicit policy goals.
Allina Health System embarked on a rigorous process to better understand the customer's perception of care and service. The milestone for quality is the participation of the patient, member, and family in the health care system to determine care and service quality. The challenge for those in health care is to understand and manage the complex cultural changes this inclusion implies.
Taylor, Yhenneko J; Laditka, Sarah B; Laditka, James N; Brunner Huber, Larissa R; Racine, Elizabeth F
Social and health care context may influence prenatal care use. We studied associations of government health expenditures, supply of health care professionals, and country literacy rates with prenatal care use in ten West African countries, controlling for individual factors. We used data from Demographic and Health Surveys (n = 58,512) and random effect logistic regression models to estimate the likelihood of having any prenatal care and adequate prenatal care. Each percentage increase in the literacy rate was associated with 4% higher odds of having adequate prenatal care (p = .029). Higher literacy rates among women may help to promote adequate prenatal care.
Kulshreshtha, Archana; Zacharia, Anish J; Jarouliya, Urmila; Bhadauriya, Pratiksha; Prasad, G B K S; Bisen, P S
Spirulina is a photosynthetic, filamentous, spiral-shaped and multicellular edible microbe. It is the nature's richest and most complete source of nutrition. Spirulina has a unique blend of nutrients that no single source can offer. The alga contains a wide spectrum of prophylactic and therapeutic nutrients that include B-complex vitamins, minerals, proteins, gamma-linolenic acid and the super anti-oxidants such as beta-carotene, vitamin E, trace elements and a number of unexplored bioactive compounds. Because of its apparent ability to stimulate whole human physiology, Spirulina exhibits therapeutic functions such as antioxidant, anti-bacterial, antiviral, anticancer, anti-inflammatory, anti-allergic and anti-diabetic and plethora of beneficial functions. Spirulina consumption appears to promote the growth of intestinal micro flora as well. The review discusses the potential of Spirulina in health care management.
Kolbe, J; Fergusson, W; Vamos, M; Garrett, J
BACKGROUND—Severe life threatening asthma (SLTA) is important in its own right and as a proxy for asthma death. In order to target hospital based intervention strategies to those most likely to benefit, risk factors for SLTA among those admitted to hospital need to be identified. A case-control study was undertaken to determine whether, in comparison with patients admitted to hospital with acute asthma, those with SLTA have different sociodemographic and clinical characteristics, evidence of inadequate ongoing medical care, barriers to health care, or deficiencies in management of the acute attack. METHODS—Seventy seven patients with SLTA were admitted to an intensive care unit (pH 7.17 (0.15), PaCO2 10.7 (5.0) kPa) and 239 matched controls (by date of index attack) with acute asthma were admitted to general medical wards. A questionnaire was administered 24-48 hours after admission. RESULTS—The risk of SLTA in comparison with other patients admitted with acute asthma increased with age (odds ratio (OR) 1.04/year, 95% CI 1.01 to 1.07) and was less for women (OR 0.36, 95% CI 0.20to 0.68). These variables were controlled for in all subsequent analyses. There were no differences in other sociodemographic features. Cases were more likely to have experienced a previous SLTA (OR 2.04, 95% CI 1.20 to 3.45) and to have had a hospital admission in the last year (OR 1.86, 95% CI 1.09 to 3.18). There were no differences between cases and controls in terms of indicators of quality of ongoing asthma specific medical care, nor was there evidence of disproportionate barriers to health care. During the index attack cases had more severe asthma at the time of presentation, were less likely to have presented to general practitioners, and were more likely to have called an ambulance or presented to an emergency department. In terms of pharmacological management, those with SLTA were more likely to have been using oral theophylline (OR 2.14, 95% CI 1.35 to 3.68) and less
Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes
Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in global health knowledge for deaf people including those with even higher risk of marginalization. Examples of approaches to improve access to health care, such as providing powerful and visually accessible communication through the use of sign language, the implementation of important communication technologies, and cultural awareness trainings for health professionals are discussed. Programs that raise health knowledge in Deaf communities and models of primary health care centers for deaf people are also presented. Published documents can empower deaf people to realize their right to enjoy the highest attainable standard of health.
Young, D W; Pinakiewicz, D C; McCarthy, S M; Barrett, D; Kenagy, J
Many companies are beginning to focus on value in their health care purchasing decisions, and some are going beyond value-based purchasing to value-based partnering. Value-based partnering recognizes the interdependencies among stakeholder groups in the health care system and creates a strategic reason for them to exchange information and create long-term strategic alliances. This article discusses the principles of value-based partnering, impediments to practicing it and its future role in the health care system.
In 13 more years, the first of the baby boom generation will turn 65, becoming the heaviest users of the health care system. Do you know what the boomer patients will want? And are you ready to satisfy them? In this first part of a series on boomers and health care, we'll find out why boomers aren't happy about the current health care system.
Agarwal, Shanu; Abell, Virginia; File, Thomas M
Nosocomial Legionnaire's disease is most frequently associated with presence of the organism in hospital water systems. Patients are often susceptible as a result of age, underlying comorbidities, or immunosuppression. Prevention focuses on reducing the reservoir within water systems and includes super heating, ultraviolent light, chlorination, silver-copper ionization, and distal filtration. This article reviews the epidemiology of health care-associated Legionnaire's disease, reviews characteristics of several health care-associated outbreaks, and discusses strategies to prevent health care-associated infection.
RD-RI54 682 EXCELLENCE WiTHIN THE NAVY HEALTH CARE SYSTEM (U) NAVAL I. POSTGRADUATE SCHOOL MONTEREY CA J A NORTON DEC 84 UNCLRSSIFIED F/G 6/12...STANDAROS-1963-A -J% * .NAVAL POSTGRADUATE SCHOOL Monterey, California DTIC THESIS EXCELLENCE WITHIN THE NAVY HEALTH CARE SYSTEM by JAMES ALFRED NORTON...Within the Navy Health Care December 1984 System S. PERFORMING ORG. REPORT NUMBER 7. AUTHOR(s) I. CONTRACT OR GRANT NUMBER(@) James Alfred Norton S
Thilakavathi, S; Manickam, P; Mehendale, S M
Stigma, isoIation and discrimination are typically associated with diagnosis of leprosy and its disclosure. Health care providers (HCPs) find it challenging to disclose the diagnosis of leprosy to patients and their family members. A qualitative study was done in a rural community near Chennai in Tamil Nadu, from August 2011 to March 2012, covering 155 out of 648 (23.9%) purposively selected leprosy patients from 53 out of 148 panchayats, representing 264 villages in the study area; Out of these 155 patients, 59% were males; 30% were illiterates; 70% were married; 56% were living in nuclear families; half the leprosy patients were either agricultural labourers or skilled workers (50%).Thirty two percent were multibacillary (MB) cases and 68% were pauci bacillary (PB) cases; 77% were old patients and 23% were new patients; 22% had leprosy deformity 12% had disfiguration; 23% had anaesthesia and 3% were with lagophthalmous. Of the 155 patients, 31 (20%) reported that they were not informed about diagnosis of their disease by the concerned HCPs. They were informed to be having a skin disease or a skin patch. Of these 31 patients, 22 (71%) were women; all except one with PB leprosy. Seven patients (23%) had not yet started on treatment 3 patients (10%) were given treatment when they were young and neither, them nor their parents were informed about this disease. Seven (33%) of the married patients who had the disease during their child had or when they were young, were not informed of the diagnosis by the HCPs. Ten respondents (32%) were neither bothered nor concerned about non disclosure of the disease by HCPs. Now, after knowing the diagnosis of the disease 4 females (13%) mentioned that they were having some fear, worry or stigma. As non-disclosure of leprosy by HCPs may adversely affect acceptance and adherence, to treatment by the patients, appropriate communication strategies should be developed and implemented.
Sun, Gordon H; MacEachern, Mark P; Perla, Rocco J; Gaines, Jean M; Davis, Matthew M; Shrank, William H
To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991.
Bohlmeijer, Ernst T.; Smit, Filip; Westerhof, Gerben J.
Objectives. We assessed whether an intervention based on acceptance and commitment therapy (ACT) and mindfulness was successful in promoting positive mental health by enhancing psychological flexibility. Methods. Participants were 93 adults with mild to moderate psychological distress. They were randomly assigned to the group intervention (n = 49) or to a waiting-list control group (n = 44). Participants completed measures before and after the intervention as well as 3 months later at follow-up to assess mental health in terms of emotional, psychological, and social well-being (Mental Health Continuum–Short Form) as well as psychological flexibility (i.e., acceptance of present experiences and value-based behavior, Acceptance and Action Questionnaire-II). Results. Regression analyses showed that compared with the participants on the waiting list, participants in the ACT and mindfulness intervention had greater emotional and psychological well-being after the intervention and also greater psychological flexibility at follow-up. Mediational analyses showed that the enhancement of psychological flexibility during the intervention mediated the effects of the intervention on positive mental health. Conclusions. The intervention is effective in improving positive mental health by stimulating skills of acceptance and value-based action. PMID:20966360
Priesmeyer, H R; Sharp, L F
This article applies the new science of nonlinearity to administrative issues and accounts receivable management in health care, and it provides a new perspective on common operating and quality control measures.
Malvey, Donna; Alderman, Barbara; Todd, Andrew D
The use of blogs in the workplace has emerged as a communication tool that can rapidly and simultaneously connect managers with their employees, customers, their peers, and other key stakeholders. Nowhere is this connection more critical than in health care, especially because of the uncertainty surrounding health care reform and the need for managers to have access to timely and authentic information. However, most health care managers have been slow to join the blogging bandwagon. This article examines the phenomenon of blogging and offers a list of blogs that every health care manager should read and why. This article also presents a simplified step-by-step process to set up a blog.
Wentzer, Helle; Bygholm, Ann
Introduction Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods Against a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices. Results This paper develops a conceptual framework for addressing transformations of communication and workflow in health care as a result of implementing IT. Conclusion and discussion The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences of IT implementation into health care practices and outcomes. PMID:18043725
Study protocol for a randomized, controlled, superiority trial comparing the clinical and cost- effectiveness of integrated online mental health assessment-referral-care in pregnancy to usual prenatal care on prenatal and postnatal mental health and infant health and development: the Integrated Maternal Psychosocial Assessment to Care Trial (IMPACT)
Background Stress, depression, and anxiety affect 15 to 25% of pregnant women. However, fewer than 20% of prenatal care providers assess and treat mental health problems and fewer than 20% of pregnant women seek mental healthcare. For those who seek treatment, the lack of health system integration and existing barriers frequently prevent treatment access. Without treatment, poor prenatal mental health can persist for years and impact future maternal, child, and family well-being. Methods/Design The purpose of this randomized controlled trial is to evaluate the effectiveness of an integrated process of online psychosocial assessment, referral, and cognitive behavior therapy (CBT) for pregnant women compared to usual prenatal care (no formal screening or specialized care). The primary outcome is self-reported prenatal depression, anxiety, and stress symptoms at 6 to 8 weeks postrandomization. Secondary outcomes are postpartum depression, anxiety, and stress symptoms; self-efficacy; mastery; self-esteem; sleep; relationship quality; coping; resilience; Apgar score; gestational age; birth weight; maternal-infant attachment; infant behavior and development; parenting stress/competence; and intervention cost-effectiveness, efficiency, feasibility, and acceptability. Pregnant women are eligible if they: 1) are <28 weeks gestation; 2) speak/read English; 3) are willing to complete email questionnaires; 4) have no, low, or moderate psychosocial risk on screening at recruitment; and 5) are eligible for CBT. A sample of 816 women will be recruited from large, urban primary care clinics and allocation is by computer-generated randomization. Women in the intervention group will complete an online psychosocial assessment, and those with mild or moderate depression, anxiety, or stress symptoms then complete six interactive cognitive behavior therapy modules. All women will complete email questionnaires at 6 to 8 weeks postrandomization and at 3, 6, and 12 months postpartum
Carmichael, B D
Health care organizations are facing significant economic constraints that threaten to dismantle core services. The perceived need for reform is great. Business process reengineering may be the strong medicine required to achieve dramatic productivity improvement without jeopardizing the quality and scope of core health care services. Reengineering challenges health care organizations to eliminate functions that do not contribute to a flattened organization structure in which fewer care providers deliver a wider range of health care services. Information technology is used to displace manual checks and controls. Reengineering may facilitate the implementation of contemporary management models, such as patient-focused care, case management and product or program management. The product of reengineering can be enhanced over time by Continuous Quality Improvement.
Drati, Nathan; Kleiner, Brian
Managed care has become one of the leading developments in health care financial management, but ignorance and confusion surround its meaning and origins. Managed care seeks to reduced costs and increase profits while maintaining quality, yet the evidence that it is able to achieve these aims is mixed. The following analysis is a review of the events leading to the establishment of managed care and what it has become. Various terms and health care organizations involved in managed care are identified, with emphasis placed on the strengths and weaknesses of managed care programs. This analysis is performed to gain insight and better understanding of the direction health care financial management is headed in the 21st century.
Jennings, Bonnie M; Loan, Lori A; Heiner, Stacy L; Hemman, Eileen A; Swanson, Kristen M
Patient satisfaction can be enhanced by narrowing gaps between what health care consumers experience and what they expect. A study was therefore conducted to better understand health care experiences and expectations among Army beneficiaries. Data collected using focus groups were analyzed by using qualitative research methods. A concept was identified and labeled "Soldier Care." It involves first-line care delivered at the unit level as well as the interface between first-line care and military treatment facilities. There are four features of Soldier Care, i.e., provider competence, the sick call cycle, getting appointments, and unit leadership. Together, these features affect soldiers' time from injury to recovery. Insights about Soldier Care can provide decision-makers with direction for initiating changes that may contribute to improved soldier satisfaction with health care.
Ryan, E J; Phelps, R A
The authors surveyed physicians serving the Jackson, Mississippi home health care market. They identified problems and studied physician perceptions regarding services provided by home health care agencies, private duty nursing agencies, and durable medical equipment suppliers. Respondents perceived home health care as providing: (1) increased patient satisfaction, (2) greater patient convenience, (3) earlier discharge, and (4) lowered patient costs. They least liked: (1) lack of control and involvement in the patient caring process, (2) paperwork, (3) quality control potential, and the possibility that patient costs could increase. Two sets of implications for health care marketers are presented that involve both national and regional levels. Overall results indicate that a growing and profitable market segment exists and is being served in an effective and socially responsible manner.
One of the major challenges facing the nursing profession is the globalization of nursing education, research, and practice. The word diversity is derived from the Latin word divertere meaning being different or having differences. Diversity in nursing practice means providing competent care to clients from different cultures, conducting research in multi-cultural settings, and implementing educational programs to diverse populations. Key principles and practices that provide a framework for diverse relationships in nursing practice, research, and education must be driven by a professional commitment in building a global community that is inclusive, respectful, and dedicated to global health care for all. Through international collaborations and individual and collective partnerships, nurses can build bridges between and among national health care systems, strengthen the international health care infrastructure, broaden health care delivery systems, and improve the quality of health care for all.
Cornett, Becky Sutherland
Our health-care system is burdened with high costs, health-care disparities, overtreatment, undertreatment, high error rates, and fraud and abuse. At the same time, the United States has achieved spectacular medical advances using the latest technology. As a result, health-care quality measurement, publicly reported patient safety and quality indicators, and evaluation of patients' experience of care are watchwords of a new era of accountability for health-care professionals and organizations. The health-care industry is subject to increasing regulation, private sector challenges, and public demand to make significant improvements in all three components of the quality triad: structure, process, and outcome. This article examines regulatory initiatives and industry trends pertaining to patient safety and quality measurement and concludes with specific suggestions for the professions of speech-language pathology and audiology.
Heron, W. David; Donatelli, Ben
Describes how, through a shared plan, the Health Insurance Initiative of the Independent Colleges and Universities in Florida (ICUF) is saving participating institutions millions in costs associated with providing employee health care. (EV)
Hart, Julian Tudor
Volume, costs and content of medical care depend on professional and public expectations. The UK National Health Service (NHS) removed price barriers to access, so depressed expectations became an important factor in cost control. In USA, professional control of care business inflated expectations and costs. Managed care in the NHS failed to rationalize care because managers seem even less trustworthy than clinicians as arbiters of rational expectations in contexts of underfunding. Rational expectations depend on restored trust, mutual and managerial respect for expertise of both clinicians and patients, and transcendence of the provider‐consumer model for value production in medical care. PMID:11281857
Coile, R C
The arrival of the Internet offers the opportunity to fundamentally reinvent medicine and health care delivery. The "e-health" era is nothing less than the digital transformation of the practice of medicine, as well as the business side of the health industry. Health care is only now arriving in the "Information Economy." The Internet is the next frontier of health care. Health care consumers are flooding into cyberspace, and an Internet-based industry of health information providers is springing up to serve them. Internet technology may rank with antibiotics, genetics, and computers as among the most important changes for medical care delivery. Utilizing e-health strategies will expand exponentially in the next five years, as America's health care executives shift to applying IS/IT (information systems/information technology) to the fundamental business and clinical processes of the health care enterprise. Internet-savvy physician executives will provide a bridge between medicine and management in the adoption of e-health technology.
Axtell-Thompson, Linda M
As health care costs continue to escalate, cost control measures will likely become unavoidable and painful. One approach is to engage external forces to allocate resources--for example, through managed care or outright rationing. Another approach is to engage consumers to make their own allocation decisions, through "self-rationing," wherein they are given greater awareness, control, and hence responsibility for their health care spending. Steadily gaining popularity in this context is the concept of "consumer directed health care" (CDHC), which is envisioned to both control cost and enhance choice, by combining financial incentives with information to help consumers make more informed health care decisions and to appreciate the economic trade-offs of those decisions. While CDHC is gaining attention in the popular press, business publications, and academic journals, it is not without controversy about its relative merits and demerits. CDHC raises questions regarding the ethical limits of consumer responsibility for their choices. While the emphasis on consumer choice implies that autonomy is the ruling ethical principle in CDHC, it must be tempered by justice and beneficence. Justice must temper autonomy to protect disadvantaged populations from further widening disparities in health care access and outcomes that could arise from health care reform efforts. Beneficence must temper autonomy to protect consumers from unintended consequences of uninformed decisions. Thoughtful paternalism suggests that CDHC plans offer choices that are comprehensible to lay consumers, limited in their range of options, and carefully structured with default rules that minimize potential error costs.
Barnard-Brak, Lucy; Stevens, Tara; Carpenter, Julianna
Objectives Family-centered care has been associated with positive outcomes for children with special health care needs. The purpose of the current study was to examine the relationship of family-centered care as associated with care coordination with schools and school absences (e.g., missed days) as reported by parents of children with special health care needs. Methods The current study utilized data from the National Survey of Children with Special Health Care Needs 2009-201 (N = 40,242) to achieve this purpose. The National Survey of Children with Special Health Care Needs may be considered a nationally-representative and community-based sample of parent responses for children with special health care needs across the United States. Results Results from the current study indicate that family-centered care is associated with fewer absences and improved care coordination with schools when applicable. The variables of functional difficulties, poverty level, and the number of conditions were statistically controlled. Conclusions We suggest that the positive influence of family-centered care when practiced extends beyond the family and interacts with educational outcomes. We also suggest that the role of schools appears to be under-studied given the role that schools can play in family-centered care.
delivery, benign gynecological disorders, postpartum care, and surgical, medical, and radiation treatment of breast, ovarian, cervical, and uterine...installations reported offering female- specific programs or activities, such as a post-deployment group for female servicemembers or a postpartum ...specialized services, such as obstetric care (which includes prenatal, labor and delivery, and postpartum care) and the treatment of reproductive
Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J.; McCann, Barbara A.; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica
The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. PMID:27746670
van Uden-Kraan, Cornelia F; Peek, Niels; Cuijpers, Pim; Leemans, C René; Verdonck-de Leeuw, Irma M
Background Although many cancer survivors could benefit from supportive care, they often do not utilize such services. Previous studies have shown that patient-reported outcomes (PROs) could be a solution to meet cancer survivors’ needs, for example through an eHealth application that monitors quality of life and provides personalized advice and supportive care options. In order to develop an effective application that can successfully be implemented in current health care, it is important to include health care professionals in the development process. Objective The aim of this study was to investigate health care professionals’ perspectives toward follow-up care and an eHealth application, OncoKompas, in follow-up cancer care that monitors quality of life via PROs, followed by automatically generated tailored feedback and personalized advice on supportive care. Methods Health care professionals involved in head and neck cancer care (N=11) were interviewed on current follow-up care and the anticipated value of the proposed eHealth application (Step 1). A prototype of the eHealth application, OncoKompas, was developed (Step 2). Cognitive walkthroughs were conducted among health care professionals (N=21) to investigate perceived usability (Step 3). Interviews were recorded, transcribed verbatim, and analyzed by 2 coders. Results Health care professionals indicated several barriers in current follow-up care including difficulties in detecting symptoms, patients’ perceived need for supportive care, and a lack of time to encourage survivors to obtain supportive care. Health care professionals expected the eHealth application to be of added value. The cognitive walkthroughs demonstrated that health care professionals emphasized the importance of tailoring care. They considered the navigation structure of OncoKompas to be complex. Health care professionals differed in their opinion toward the best strategy to implement the application in clinical practice but
Gustavsson, Catharina; von Koch, Lena
Background and objective In previous short-term and 2-year follow-ups, a pain and stress self-management group intervention (PASS) had better effect on pain-related disability, self-efficacy, catastrophizing, and perceived pain control than individually administered physiotherapy (IAPT) for patients with persistent tension-type neck pain. Studies that have evaluated long-term effects of self-management approaches toward persistent neck pain are sparse. The objective of this study was to compare pain-related disability, self-efficacy for activities of daily living (ADL), catastrophizing, pain, pain control, use of analgesics, and health care utilization in people with persistent tension-type neck pain 9 years after they received the PASS or IAPT. Materials and methods Of 156 people (PASS, n = 77; IAPT, n = 79) originally included in a randomized controlled trial, 129 people (PASS, n = 63; IAPT, n = 66) were eligible and were approached for the 9-year follow-up. They were sent a self-assessment questionnaire, comprising the Neck Disability Index, the Self-Efficacy Scale, the Coping Strategies Questionnaire, and questions regarding pain, analgesics, and health care utilization. Mixed linear models for repeated measures analysis or generalized estimating equations were used to evaluate the differences between groups and within groups over time (baseline, previous follow-ups, and 9-year follow-up) and the interaction effect of “time by group”. Results Ninety-four participants (73%) responded (PASS, n = 48; IAPT, n = 46). At 9 years, PASS participants reported less pain-related disability, pain at worst, and analgesics usage, and a trend toward better self-efficacy compared to IAPT participants. There was a difference between groups in terms of change over time for disability, self-efficacy for ADL, catastrophizing, perceived pain control, and health care visits in favor of PASS. Analyses of simple main effects at 9 years showed that the PASS group had less
Grumbach, Kevin; Bodenheimer, Thomas
In health care settings, individuals from different disciplines come together to care for patients. Although these groups of health care personnel are generally called teams, they need to earn true team status by demonstrating teamwork. Developing health care teams requires attention to 2 central questions: who is on the team and how do team members work together? This article chiefly focuses on the second question. Cohesive health care teams have 5 key characteristics: clear goals with measurable outcomes, clinical and administrative systems, division of labor, training of all team members, and effective communication. Two organizations are described that demonstrate these components: a private primary care practice in Bangor, Me, and Kaiser Permanente's Georgia region primary care sites. Research on patient care teams suggests that teams with greater cohesiveness are associated with better clinical outcome measures and higher patient satisfaction. In addition, medical settings in which physicians and nonphysician professionals work together as teams can demonstrate improved patient outcomes. A number of barriers to team formation exist, chiefly related to the challenges of human relationships and personalities. Taking small steps toward team development may improve the work environment in primary care practices.
Lovo Grona, Stacey; Milosavljevic, Stephan; Sari, Nazmi; Imeah, Biaka; O’Connell, Megan E
Background Chronic low back disorders (CLBDs) are a substantial burden on individuals and societies, and impact up to 20% of Canadians. Rural and remote residents are approximately 30% more likely to have CLBDs. Reduced access to appropriate team-based health services, including physical therapy, is a key factor that may magnify the impact of CLBD on pain, physical function, overall quality of life, health-related system costs, and individual costs. Objective The purpose of this project is to evaluate the validity, comparative effectiveness, costs, barriers, and facilitators of an interprofessional management approach for people with CLBDs, delivered via telehealth. Methods This project will examine 3 different health care delivery options: (1) in-person nurse practitioner (NP); (2) in-person physical therapist (PT); and (3) a team approach utilizing an NP (in-person) and a PT joining via telehealth. Validity of the telehealth team care model will be explored by comparing the diagnostic categorization and management recommendations arising from participants with CLBD who undergo a team telehealth, in-person NP, and in-person PT assessment. Comparative effectiveness and costs will be examined using a community-based randomized controlled trial in a rural Saskatchewan community with limited PT services. The 3 arms of the trial are: (1) usual care delivered by a local rural NP; (2) a local NP and an urban-based PT joining via telehealth; and (3) face-to-face services by a PT traveling to the community. Patient-reported outcomes of pain, physical function, quality of life, satisfaction, and CLBD care-related costs will be evaluated up to 6 months after the intervention. Patient and provider experiences with the team telehealth approach will be explored through qualitative interviews. Results The study was funded in July 2013 and the University of Saskatchewan Biomedical Research Ethics Board approved the study in November 2013. Participant recruitment began in
Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public’s health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite
Myers, Wayne; Russell, Jack; Baldwin, Fred D.
Wayne Myers, director of the Office of Rural Health Policy, discusses Appalachian rural health and access to health care. The health manpower shortage in Central Appalachia still exists but is less severe than 10 years ago. The needs of underserved areas could be address by training local people in the community and through telemedicine and…
Rite Gracia, S; Fernández Lorenzo, J R; Echániz Urcelay, I; Botet Mussons, F; Herranz Carrillo, G; Moreno Hernando, J; Salguero García, E; Sánchez Luna, M
A policy statement on the levels of care and minimum recommendations for neonatal healthcare was first proposed by the Standards Committee and the Board of the Spanish Society of Neonatology in 2004. This allowed us to define the level of care of each center in our country, as well as the health and technical requirements by levels of care to be defined. This review takes into account changes in neonatal care in the last few years and to optimize the location of resources. Facilities that provide care for newborn infants should be organized within a regionalized system of perinatal care. The functional capabilities of each level of care should be defined clearly and uniformly, including requirements for equipment, facilities, personnel, ancillary services, training, and the organization of services (including transport) needed to cover each level of care.
Burnes Bolton, Linda; Giger, Joyce Newman; Georges, C Alicia
Limited access to health care and a system fraught with discriminatory practices inhibit some racial and ethnic minorities from gaining access to health care and assurance of equal treatment once they enter the health care system. The purpose of this chapter is to critically and systematically analyze the research literature to determine what impact individual and institutional racism has had on the prevailing health disparities across racial and ethnic minority groups. The chapter includes the following: (1) a review of the term racism and a brief overview of the history of racism in health care; (2) a review of the research literature analyzing the impact of racism on health disparities; and (3) recommendations to end the systematic institutional racism in scientific research, which is necessary to end health disparities.
Payne, Julianne; Razi, Sima; Emery, Kyle; Quattrone, Westleigh; Tardif-Douglin, Miriam
Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs.
Josyula, Lakshmi; Lyle, Roseann
Purpose: To examine the feasibility and impact of a health care provider’s (HCP) physical activity (PA) prescription on the PA of patients on preventive care visits. Methods: Consenting adult patients completed health and PA questionnaires and were sequentially assigned to intervention groups. HCPs prescribed PA using a written prescription only…
Stone, T R; Warren, W E; Stevens, R E
The authors report the results of a segmentation study of the mental health care market. A random sample of 387 residents of a western city were interviewed by telephone. Cluster analysis of the data identified six market segments. Each is described according to the mental health care services to which it is most sensitive. Implications for targeting the segments are discussed.
The 1998 federal budget received less than glowing reviews for its provisions regarding health care, but Charlotte Gray says this lack of health care initiatives should surprise no one. After all, there won't be a federal election for another 3 years. PMID:9559020
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Liberman, A; Rotarius, T M
The application of health care marketing is seen as a relatively recent phenomenon. Marketing is discussed as a sophisticated managerial tool that includes five critical components: product, price, place, promotion, and partners. The triumvirate of health care decision makers (i.e., patients, insurance organizations, and employers) are examined vis-à-vis these five components.
Leininger, Lindsey; Levy, Helen
It might seem strange to ask whether increasing access to medical care can improve children's health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children's health.…
Health Care Financing Administration (DHEW), Washington, DC.
This document provides guidelines for individuals giving health care to adolescents through the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. Chapter One briefly indicates needs of adolescents and outlines legal aspects of health care for adolescents such as age of majority, informed consent, confidentiality, disclosure of…
Bezzina, Paul; Keogh, Johann J.; Keogh, Mariana
Nursing and radiology students (n=15) at the University of Malta who completed an interdisciplinary module on primary health care reported they found the theoretical material applicable to practice; the module enabled them to learn about their potential role in primary health care. (SK)
Klecun, Ela; Lichtner, Valentina; Cornford, Tony
This paper explores notions of e-Literacy (otherwise IT literacy or digital literacy) in health care. It proposes a multi-dimensional definition of e-Literacy in health care and provides suggestions for policy makers and managers as to how e-Literacy might be accounted for in their decisions.
BCEL Brief, 1991
This brief gives an overview of the topic of workplace literacy in the health care industry and lists program contacts. The following 35 organizations operate basic skills upgrading programs for health care workers: American Hospital Association; Chinese American Civic Association; Massachusetts Department of Employment and Training; BostonWorks;…
Smith, D G; Wheeler, J R; Rivenson, H L; Reiter, K L
To understand better the financial management practices and strategies of modern health care organizations, we conducted interviews with chief financial officers (CFOs) of several leading health care systems. In this introduction, we present an overview of the project and summary responses on corporate financial structures and strategic challenges facing CFOs.
Watzman, N; Woodall, P
The top dozen national managed health care companies and two industry trade groups spent at least $2,023,041 on lobbying expenses and campaign contributions to key lawmakers during last year's health care debate, according to an analysis of Federal Election Commission data and federal lobbying disclosure forms. Five of the top six spenders are large insurance companies that are rapidly transferring their business from traditional indemnity insurance to HMOs. Over half--52 percent--of campaign donations from the top managed care companies' and trade associations' PACs and employees went to members sitting on the five Congressional committees with jurisdiction over health care reform.
Kastner, Theodore A.; Walsh, Kevin K.
Lack of sufficient accessible community-based health care services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary health care model, with an…
Bauer, Amy M.; Collins, Laura; Dugdale, David C.
Abstract Depression is one of the more common diagnoses encountered in primary care, and primary care in turn provides the majority of care for patients with depression. Many approaches have been tried in efforts to improve the outcomes of depression management. This article outlines the partnership between the University of Washington (UW) Neighborhood Clinics and the UW Department of Psychiatry in implementing a collaborative care approach to integrating the management of anxiety and depression in the ambulatory primary care setting. This program was built on the chronic care model, which utilizes a team approach to caring for the patient. In addition to the patient and the primary care provider (PCP), the team included a medical social worker (MSW) as care manager and a psychiatrist as team consultant. The MSW would manage a registry of patients with depression at a clinic with several PCPs, contacting the patients on a regular basis to assess their status, and consulting with the psychiatrist on a weekly basis to discuss patients who were not achieving the goals of care. Any recommendation (eg, a change in medication dose or class) made by the psychiatrist was communicated to the PCP, who in turn would work with the patient on the new recommendation. This collaborative care approach resulted in a significant improvement in the number of patients who achieved care plan goals. The authors believe this is an effective method for health systems to integrate mental health services into primary care. (Population Health Management 2016;19:81–87) PMID:26348355
Oral health is often not a priority during cancer treatment; however, patients with cancer are at increased risk for oral complications during and after treatment. This article focuses on the importance of oral health care before, during, and after cancer treatment using the head, eyes, ears, nose, oral cavity, and throat, or HEENOT, approach. AT A GLANCE: Oral health is linked to overall health, and healthcare providers must be cognizant of the oral-systemic connection with patients undergoing cancer treatment, which may cause acute and chronic oral health problems. Oral assessment, prevention, early recognition, and treatment of oral problems must be incorporated into cancer care, particularly with the aid of an interprofessional team to meet patients' oral care needs. The head, eyes, ears, nose, oral cavity, and throat, or HEENOT, approach integrates oral care into patients' history taking, physical examination, and plan of cancer care. .
Ung, Brian L; Mullins, C Daniel
The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability.
Milani, Richard V; Lavie, Carl J
Chronic disease has become the great epidemic of our times, responsible for 75% of total health care costs and the majority of deaths in the US. Our current delivery model is poorly constructed to manage chronic disease, as evidenced by low adherence to quality indicators and poor control of treatable conditions. New technologies have emerged that can engage patients and offer additional modalities in the treatment of chronic disease. Modifying our delivery model to include team-based care in concert with patient-centered technologies offers great promise in managing the chronic disease epidemic.
Teitelbaum, Joel B
This article offers a brief history of healthcare civil rights, describes a range of healthcare issues that have a civil rights component, and discusses the need for an expanded civil rights framework to guide the provision of health care. Unequal health care based on race and ethnicity has received renewed attention over the past several years, but healthcare discrimination based on socioeconomic status, disability, age, and gender also deserve careful attention.
During the last two decades, the economic aspects of health care acquired an outstanding attentiveness in all developed countries. Simultaneously, the methods have been searched for a more intensive and perfect application of internal health sources, i.e. manpower, materials and money. New approaches in evaluating health care efficacy (conception of health provision as a branch of national economy) have been made. In accord with them, the efficiency of either individual or partial health actions such as health care programs, preventive measures, diagnostical and curative procedures etc.) is measured. All these questions are the up to date topic for Health care of Czechoslovakia which now is far to dispose of sources comparable with the majority of economically developed countries in Europe. At present, they are approximately similar in supplying 1 person health care needs with 500-1000 dol. a year and even more in several countries, whereas Czechoslovakia spends about 200 dol. on health needs of 1 inhabitant a year. This fact is closely connected with relatively low efficacy of our economy incapable to produce the sufficient sources for providing health care on one hand, and on the other it is due both to the budgetary politics as practiced now and the conception of national product division. The shortage in Health care sources is manifested mainly in retardation of material and technical base of health service altogether with low levelled renumeration of health workers consequential in psychologic, social and political problems. The consequences of this condition are reflected negatively in a level of health service provision. This is as far important as the czechoslovac population health status viewed from the so-called strategic health indices (averaged life expectancy, specific mortality, occurrence of cardiovascular diseases and malignancies etc.) is not favourable due to a number of factors, and its improvement will require considerable efforts from both the
Andrade, Raquel Dully; Mello, Débora Falleiros; Silva, Marta Angélica Iossi; Ventura, Carla Aparecida Arena
This narrative literature review aimed to identify the publications about health law, in the ambit of child health care. The databases LILACS and MEDLINE were searched, between 2004 and 2009. Thirteen articles were analyzed, and three themes were identified: Emphasis on knowledge, abilities and attitudes for the development of competencies; Partnerships as an imperative; Health and Law: intersectorial relationship. The studies about the practice of health law are relevant to our reality, especially in primary health care, pointing out for the possibilities of its applicability in the role of the nurses acting in the family health strategy, with families and children.
The slow but progressive adoption of health information technology (IT) nationwide promises to usher in a new era in health care. Electronic health record systems provide a complete patient record at the point of care and can help to alleviate some of the challenges of a fragmented delivery system, such as drug-drug interactions. Moreover, health IT promotes evidence-based practice by identifying gaps in recommended treatment and providing clinical decision-support tools. In addition, the data collected through digital records can be used to monitor patient outcomes and identify potential improvements in care protocols. Kaiser Permanente continues to advance its capability in each of these areas.
Durán-Arenas, Luis; Salinas-Escudero, Guillermo; Granados-García, Víctor; Martínez-Valverde, Silvia
Access to health services is a social basic determinant of health in Mexico unlike what happens in developed countries. The demand for health services is focused on primary care, but the design meets only the supply of hospital care services. So it generates a dissonance between the needs and the effective design of health services. In addition, the term affiliation refers to population contributing or in the recruitment process, that has been counted as members of these social security institutions (SS) and Popular Insurance (SP). In the case of Instituto Mexicano del Seguro Social (IMSS) three of four contributors are in contact with health services; while in the SP, this indicator does not exist. Moreover, the access gap between health services is found in the health care packages so that members of the SS and SP do not have same type of coverage. The question is: which model of health care system want the Mexicans? Primary care represents the first choice for increasing the health systems performance, as well as to fulfill their function of social protection: universal access and coverage based on needs, regardless whether it is a public or private health insurance. A central aspect for development of this component is the definition of the first contact with the health system through the creation of a primary health care team, led by a general practitioner as the responsible of a multidisciplinary health team. The process addresses the concepts of primary care nursing, consumption of inputs (mainly medical drugs), maintenance and general services. Adopting a comprehensive strategy that will benefit all Mexicans equally and without discrimination, this primary care system could be financed with a total operating cost of approximately $ 22,809 million by year.
Sun, Yuelian; Gregersen, Hans; Yuan, Wei
China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources. PMID:28356772
Sun, Yuelian; Gregersen, Hans; Yuan, Wei
China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources.
... Press Kit Read the MMWR Science Clips Making Health Care Safer Think sepsis. Time matters. Language: English Español ( ... the antibiotic type, dose, and duration are correct. Health care facility CEOs/administrators can Make infection control a ...
Quillian, J P
Community participation and utilization of community health workers (CHWs) are essential components of the primary health care model. The success of CHWs is dependent on their training and subsequent community support. Community-prepared nurses are ideal CHW educators. A training program for CHWs was implemented in Honduras emphasizing the principles of adult learning and problem-based learning. Following a 4-month program of training a primary health care clinic was opened and managed by CHWs for a population over 10,000. Approximately 80% of local health problems were managed by the CHWs proving that well-trained CHWs can have a significant impact on the delivery of health care.
Gregorio, Leah E; Gregorio, David I
This paper hypothesized that democratic nations, as characterized by Polity IV Project regime scores, spend more on health care than autocratic nations and that the association reported here is independent of other demographic, health system or economic characteristics of nations. WHO Global Observatory data on 159 nations with roughly 98% of the world's population were examined. Regime scores had significant, direct and independent associations with each of four measures of health care expenditure. For every unit increment in a nation's regime score toward a more democratic authority structure of governance, we estimated significant (p<0.05) increments in the percent of GDP expended on health care (+0.14%), percent of general government expenditures targeted to health care (+0.25%), total per capita expenditures on health (+34.4Int$) and per capita general government expenditures (+22.4Int$), while controlling for a population's age distribution, life expectancy, health care workforce and system effectiveness and gross national income. Moreover, these relationships were found to persist across socio-economic development levels. The finding that practices of health care expenditure and authority structures of government co-vary is instructive about the politics of health and the challenges of advancing global health objectives.
Davis, Alaina M.; Brown, Rebekah F.; Taylor, Julie Lounds; Epstein, Richard A.
BACKGROUND: Approximately 750 000 children in the United States with special health care needs will transition from pediatric to adult care annually. Fewer than half receive adequate transition care. METHODS: We had conversations with key informants representing clinicians who provide transition care, pediatric and adult providers of services for individuals with special health care needs, policy experts, and researchers; searched online sources for information about currently available programs and resources; and conducted a literature search to identify research on the effectiveness of transition programs. RESULTS: We identified 25 studies evaluating transition care programs. Most (n = 8) were conducted in populations with diabetes, with a smaller literature (n = 5) on transplant patients. We identified an additional 12 studies on a range of conditions, with no more than 2 studies on the same condition. Common components of care included use of a transition coordinator, a special clinic for young adults in transition, and provision of educational materials. CONCLUSIONS: The issue of how to provide transition care for children with special health care needs warrants further attention. Research needs are wide ranging, including both substantive and methodologic concerns. Although there is widespread agreement on the need for adequate transition programs, there is no accepted way to measure transition success. It will be essential to establish consistent goals to build an adequate body of literature to affect practice. PMID:25287460
CareScience, Inc. is a public company (NASDAQ: CARE) that originated ten years ago to commercialize risk adjustment and complication predictions developed by the Wharton School of Business and the University of Pennsylvania School of Medicine. Over the past decade, the company has grown to approximately 200 clients and 150 employees. Among the "firsts" recorded by the company, CareScience was the first to offer a clinical decision support system as an Application Service Provider (ASP), the first to offer peer-to-peer clinical data sharing among health care provider organizations and practitioners (Santa Barbara Care Data Exchange), and the first to provide a care management outsourcing arrangement.
Lymbery, M; Millward, A
This paper examines the establishment of social work within primary health care settings in Great Britain, following the passage of the National Health Service and Community Care Act in 1990. Although the improvement of relationships between social workers and primary health care teams has been promoted for a number of years, the advent of formal policies for community care has made this a priority for both social services and health. This paper presents interim findings from the evaluation of three pilot projects in Nottinghamshire, Great Britain. These findings are analysed from three linked perspectives. The first is the extent to which structures and organisations have worked effectively together to promote the location of social workers within health care settings. The second is the impact of professional and cultural factors on the work of the social worker in these settings. The third is the effect of interpersonal relationships on the success of the project. The paper will conclude that there is significant learning from each of these perspectives which can be applied to the future location of social workers to primary health care.
Emanuel, E J
Choice is often thought to be critical in health care, especially to foster quality improvements and lower costs. However, it is also recognized that in the current system there is significant representation of consumers, members, and patients by physicians, employers, and health plans. Consent, accountability, and protections against conflicts of interest are necessary to ensure legitimate and effective representation. This article discusses the roles and responsibilities of physicians, employers, and other parties with respect to serving as representatives of health care consumers. The author concludes that to make representation more legitimate and effective in health care will require significant changes, which include (1) changing business to a stakeholder theory, (2) involving employees in health care coverage decisions, and (3) involving members of health plans in policy decisions.
Casey, M M
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.
Hall, William J.; Lee, Kent M.; Merino, Yesenia M.; Thomas, Tainayah W.; Payne, B. Keith; Eng, Eugenia; Day, Steven H.; Coyne-Beasley, Tamera
Background. In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition. Objectives. We investigated the extent to which implicit racial/ethnic bias exists among health care professionals and examined the relationships between health care professionals’ implicit attitudes about racial/ethnic groups and health care outcomes. Search Methods. To identify relevant studies, we searched 10 computerized bibliographic databases and used a reference harvesting technique. Selection Criteria. We assessed eligibility using double independent screening based on a priori inclusion criteria. We included studies if they sampled existing health care providers or those in training to become health care providers, measured and reported results on implicit racial/ethnic bias, and were written in English. Data Collection and Analysis. We included a total of 15 studies for review and then subjected them to double independent data extraction. Information extracted included the citation, purpose of the study, use of theory, study design, study site and location, sampling strategy, response rate, sample size and characteristics, measurement of relevant variables, analyses performed, and results and findings. We summarized study design characteristics, and categorized and then synthesized substantive findings. Main Results. Almost all studies used cross-sectional designs, convenience sampling, US participants, and the Implicit Association Test to assess implicit bias. Low to moderate levels of implicit racial/ethnic bias
Fendrick, A. Mark
Although medical innovation can reduce morbidity and mortality associated with diseases or their treatments, in most instances new interventions tend to increase the amount of resources expended on health care services. In this era of increasing cost consciousness, there is a perceived tension between the desire to improve health outcomes and the necessity to control the growth of health care costs. The dramatic changes in the organization, financing, and delivery of health care services, make it no longer acceptable to provide any and all services to every individual with only a remote probability of clinical benefit. An incentive structure which rewards the practice of cost-effective medical care is rapidly replacing the 'technological imperative' of decades past. As the expansion towards managed care continues, increasing scrutiny will be paid to the clinical and cost implications of our medical interventions.
... care + Share widget - Select to show What’s home health care? What's home health care? Home health care is a wide range of ... listed. What should I expect from my home health care? Doctor’s orders are needed to start care. Once ...
Soffel, D; Luft, H S
The current proliferation of proposals for health care reform makes it difficult to sort out the differences among plans and the likely outcome of different approaches to reform. The current health care system has two basic features. The first, enrollment and eligibility functions, includes how people get into the system and gain coverage for health care services. We describe 4 models, ranging from an individual, voluntary approach to a universal, tax-based model. The second, the provision of health care, includes how physician services are organized, how they are paid for, what mechanisms are in place for quality assurance, and the degree of organization and oversight of the health care system. We describe 7 models of the organization component, including the current fee-for-service system with no national health budget, managed care, salaried providers under a budget, and managed competition with and without a national health budget. These 2 components provide the building blocks for health care plans, presented as a matrix. We also evaluate several reform proposals by how they combine these 2 elements. PMID:8273344
Macinko, James; Montenegro, Hernán; Nebot Adell, Carme; Etienne, Carissa
At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44. R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels.
Link, Denise G; Perry, Diane; Cesarotti, Evelyn L
Beginning in January 2014, millions of Americans will enroll in health insurance plans under the Affordable Care Act. Some of these individuals were obtaining health care in safety net health clinics, emergency departments, or urgent care centers; many were going without needed care and will be new to the health care system. In addition to these newly insured, the ranks of older Americans and persons in need of chronic disease management will be on the rise. The way in which health care is delivered will have to change in order for the health care workforce to meet the demand for their services without sacrificing quality or access. Nurse practitioners and registered nurses have the education and skills to provide health promotion, disease prevention, and chronic disease management services that will make up a sizable portion of the demand. Amending state practice acts so that the authority to practice matches the ability to practice and opening provider panels to advanced practice nurses will provide opportunities to establish or expand sustainable nurse-led primary care practices in health care shortage areas. Along with these changes, models of health care delivery that incorporate differentiated practice roles and shared interprofessional responsibility for providing care will maximize the capacity of the system to provide the health care that people need.
Sannicandro, Thomas; Parish, Susan L; Son, Esther; Powell, Robyn M
Objective This study compared health care utilization of children with special health care needs in 2005/06 and 2009/10. Methods Using data from the National Survey of Children with Special Health Care Needs, this study compared the health care utilization of children with special health care needs in 2005/06 (n = 40,723) and 2009/10 (n = 40,242). Descriptive statistics characterize the sample during the 2005/06 and 2009/10 surveys. Logistic regression models examined the unmet needs for specific health care and support services, delayed care, coordinated care, and medical home. Results Compared to 2005/06, in 2009/10 children with special health care needs had greater unmet dental and therapy needs and less care coordination of health services as well as access to medical home services. Conclusions These findings indicate that additional measures are needed to improve the health care access of children with special health care needs.
Waggoner, Miranda R.
Since the 1980s, maternal and child health experts have sought to redefine maternity care to include the period prior to pregnancy, essentially by expanding the concept of prenatal care to encompass the time before conception. In 2004, the Centers for Disease Control and Prevention endorsed and promoted this new definition when it launched the Preconception Health and Health Care Initiative. In arguing that prenatal care was often too little too late, a group of maternal and child health experts in the United States attempted to spur improvements in population health and address systemic problems in health care access and health disparities. By changing the terms of pregnancy risk and by using maternalism as a social policy strategy, the preconception health and health care paradigm promoted an ethic of anticipatory motherhood and conflated women’s health with maternal health, sparking public debate about the potential social and clinical consequences of preconception care. This article tracks the construction of this policy idea and its ultimate potential utility in health and health policy discussions. PMID:23262764
Hildick, Sue; Kohler, Peter O.
Traces trends in health care, including growth of managed care, increased consumer choice, and changes in administration and funding of academic health centers, and examines the challenges they create for teaching, research, and practice. The Oregon Health Plan and its effect on Oregon Health Sciences University are used for illustration. (MSE)
This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children.
Daaleman, Timothy P.
Aims To introduce a health services framework of spiritual care that addresses the empirical and applied issues surrounding spirituality and nursing practice. Background Despite over 20 years of study, the concept of spirituality is still under development, which limits application to nursing practice. Methods Three studies using a health services framework are reviewed: (1) a survey study of dying patients and family that describes the providers, types, and outcomes of spiritual care; (2) an exploratory study of the process of spiritual care; and (3) a multi-level study of the structure and outcomes of spiritual care in long-term care facilities. Results Spiritual care recipients identify family or friends (41%), clergy (17%), and health care providers (29%) as spiritual care providers. The most frequently reported type of spiritual care was help in coping with illness (87%). Just over half (55%) of spiritual care recipients were very satisfied or somewhat satisfied with the care that they received. The processes of spiritual care involved: (1) presence, or the deliberate ideation and purposeful action of providing care that went beyond medical treatment; (2) opening eyes, or the process by which providers became aware of their patient’s storied humanity and the individualized experience of their current illness, and; (3) co-creating, which was a mutual and fluid activity between patients, family members, and care providers that began with an affirmation of the patient’s life experience and led to the generation of a holistic care plan that focused on maintaining the patient’s humanity and dignity. In long term care facilities, decedents who received spiritual care were perceived as receiving better overall care in the last month of life, when compared with those decedents who did not receive spiritual care. In addition, among those receiving support for their spiritual needs, care was rated more highly among those who received support from facility staff
Perkowski, Patryk; Rodberg, Leonard
Health systems implement cost sharing to help reduce health care expenditure and utilization by discouraging the use of unnecessary health care services. We examine cost sharing in 28 countries in the Organisation for Economic Co-operation and Development from 1999 through 2009 in the areas of medical care, hospital care, and pharmaceuticals. We investigate associations between cost sharing, health care expenditures, and health care utilization and find no significant association between cost sharing and health care expenditures or utilization in these countries.
Hudson, Christopher G.; DeVito, Jo Anne
Reviews research pertinent to mental health services under health care reform proposals. Examines redistributional impact of inclusion of outpatient mental health benefits, optimal benefit packages, and findings that mental health services lower medical utilization costs. Argues that extending minimalist model of time-limited benefits to national…
... 45 Public Welfare 1 2010-10-01 2010-10-01 false Implementation specifications: Health care... for Health Care Providers § 162.414 Implementation specifications: Health care clearinghouses. A health care clearinghouse must use the NPI of any health care provider (or subpart(s), if...
... 29 Labor 3 2012-07-01 2012-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines “health care provider” as: (1) A doctor of medicine... providing health care services. (b) Others “capable of providing health care services” include only:...
... 29 Labor 3 2010-07-01 2010-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines “health care provider” as: (1) A doctor of medicine... providing health care services. (b) Others “capable of providing health care services” include only:...
This paper derives a conception of ideal socialist and communist medical care and health policy. This model is based on a review of Marxist and allied critiques of capitalist medical care policy and on theoretical work on socialist social policy. The ideal conception, operationalized in terms of 16 criteria, is then applied to a review of medical care and health policy in the Soviet Union. Hungary, and Poland. It is concluded that medical care policy in all three countries exhibits very few characteristics of socialist medical care. The possibility (for the moment repressed) provided by the Solidarity movement in Poland of a new development toward a more genuine socialist medical care and health policy is also described.
Background Home and community-based combined treatment of malaria and pneumonia has been promoted in Uganda since mid 2011. The combined treatment is justified given the considerable overlap between the symptoms of malaria and pneumonia among infants. There is limited evidence about the extent to which community-based care reduces healthcare-seeking costs at the household level in rural and urban settings. This paper assesses the rural–urban differences in direct and indirect costs of seeking care from formal health facilities compared to community medicine distributors (CMDs). Methods Exit interviews were conducted for 282 (159 rural and 123 urban) caregivers of children below five years who had received treatment for fever-related illnesses at selected health centres in Iganga and Mayuge districts. Data on the direct and indirect costs incurred while seeking care at the health centre visited were obtained. Using another tool, household level direct and indirect costs of seeking care from CMDs were collected from a total of 470 caregivers (304 rural and 166 urban). Costs incurred at health facilities were then compared with costs of seeking care from CMDs. Results Household direct costs of seeking care from health facilities were significantly higher for urban-based caregivers than the rural (median cost = US$0.42 for urban and zero for rural; p < 0.0001). The same is true for seeking care from CMDs (p = 0.0038). Overall, caregivers travelled for an average of 75 min to reach health centres and spent an average of 80 min at the health centre while receiving treatment. However, households in rural areas travelled for a significantly longer time (p < 0.001 to reach health care facilities than the urban-based caregivers. Besides travelling longer distances, rural caregivers spent 150 min seeking care from health facilities compared to 30 min from CMDs. Conclusion Time and monetary savings for seeking care from CMDs are significantly larger for
Background Low socio-economic status combined with other risk factors affects a person's physical and psychosocial health from childhood to adulthood. The societal impact of these problems is huge, and the consequences carry on into the next generation(s). Although several studies show these consequences, only a few actually intervene on these issues. In the United States, the Nurse Family Partnership focuses on high risk pregnant women and their children. The main goal of this program is primary prevention of child abuse. The Netherlands is the first country outside the United States allowed to translate and culturally adapt the Nurse Family Partnership into VoorZorg. The aim of the present study is to assess whether VoorZorg is as effective in the Netherland as in the United States. Methods The study consists of three partly overlapping phases. Phase 1 was the translation and cultural adaptation of Nurse Family Partnership and the design of a two-stage selection procedure. Phase 2 was a pilot study to examine the conditions for implementation. Phase 3 is the randomized controlled trial of VoorZorg compared to the care as usual. Primary outcome measures were smoking cessation during pregnancy and after birth, birth outcomes, child development, child abuse and domestic violence. The secondary outcome measure was the number of risk factors present. Discussion This study shows that the Nurse Family Partnership was successfully translated and culturally adapted into the Dutch health care system and that this program fulfills the needs of high-risk pregnant women. We hypothesize that this program will be effective in addressing risk factors that operate during pregnancy and childhood and compromise fetal and child development. Trial registration Current Controlled Trials ISRCTN16131117 PMID:22017924
Dow, Alan W; Bohannon, Arline; Garland, Sheryl; Mazmanian, Paul E; Retchin, Sheldon M
The Patient Protection and Affordable Care Act seeks to improve health equity in the United States by expanding Medicaid coverage for adults who are uninsured and/or socioeconomically disadvantaged; however, when millions more become eligible for Medicaid in 2014, the health care workforce and care delivery systems will be inadequate to meet the care needs of the U.S. population. To provide high-quality care efficiently to the expanded population of insured individuals, the health care workforce and care delivery structures will need to be tailored to meet the needs of specific groups within the population.To help create a foundation for understanding the use patterns of the newly insured and to recommend possible approaches to care delivery and workforce development, the authors describe the 13-year-old experience of the Virginia Coordinated Care program (VCC). The VCC, developed by Virginia Commonwealth University Health System in Richmond, Virginia, is a health-system-sponsored care coordination program that provides primary and specialty care services to patients who are indigent. The authors have categorized VCC patients from fiscal year 2011 by medical complexity. Then, on the basis of the resulting utilization data for each category over the next fiscal year, the authors describe the medical needs and health behaviors of the four different patient groups. Finally, the authors discuss possible approaches for providing primary, preventive, and specialty care to improve the health of the population while controlling costs and how adoption of the approaches might be shaped by care delivery systems and educational institutions.
Gardner, Deborah B
The connection between health care and immigration share overlaping key areas in policy reform. General concern, anger, and fear about immigration has been spreading nationwide. While illegal immigrants' use of expensive emergency department services does add to the cost for uncompensated care, this expenditure is not a primary cost driver but more a symptom of little or no access to preventative or primary health care. As a result of federal inaction, more state politicians are redefining how America copes with illegal residents including how or whether they have access to health care. The overlap of immigration and health care reform offers an opportunity for us to enter the next round of debate from a more informed vantage point.
Stroebe, Margaret; Schut, Henk; Boerner, Kathrin
Science and practice seem deeply stuck in the so-called stage theory of grief. Health-care professionals continue to "prescribe" stages. Basically, this perspective endorses the idea that bereaved people go through a set pattern of specific reactions over time following the death of a loved one. It has frequently been interpreted prescriptively, as a progression that bereaved persons must follow in order to adapt to loss. It is of paramount importance to assess stage theory, not least in view of the current status of the maladaptive "persistent complex bereavement-related disorder" as a category for further research in DSM-5. We therefore review the status and value of this approach. It has remained hugely influential among researchers as well as practitioners across recent decades, but there has also been forceful opposition. Major concerns include the absence of sound empirical evidence, conceptual clarity, or explanatory potential. It lacks practical utility for the design or allocation of treatment services, and it does not help identification of those at risk or with complications in the grieving process. Most disturbingly, the expectation that bereaved persons will, even should, go through stages of grieving can be harmful to those who do not. Following such lines of reasoning, we argue that stage theory should be discarded by all concerned (including bereaved persons themselves); at best, it should be relegated to the realms of history. There are alternative models that better represent grieving processes. We develop guidelines to enhance such a move beyond the stage approach in both theory and practice.
Schut, Henk; Boerner, Kathrin
Science and practice seem deeply stuck in the so-called stage theory of grief. Health-care professionals continue to “prescribe” stages. Basically, this perspective endorses the idea that bereaved people go through a set pattern of specific reactions over time following the death of a loved one. It has frequently been interpreted prescriptively, as a progression that bereaved persons must follow in order to adapt to loss. It is of paramount importance to assess stage theory, not least in view of the current status of the maladaptive “persistent complex bereavement-related disorder” as a category for further research in DSM-5. We therefore review the status and value of this approach. It has remained hugely influential among researchers as well as practitioners across recent decades, but there has also been forceful opposition. Major concerns include the absence of sound empirical evidence, conceptual clarity, or explanatory potential. It lacks practical utility for the design or allocation of treatment services, and it does not help identification of those at risk or with complications in the grieving process. Most disturbingly, the expectation that bereaved persons will, even should, go through stages of grieving can be harmful to those who do not. Following such lines of reasoning, we argue that stage theory should be discarded by all concerned (including bereaved persons themselves); at best, it should be relegated to the realms of history. There are alternative models that better represent grieving processes. We develop guidelines to enhance such a move beyond the stage approach in both theory and practice. PMID:28355991
Trotter, Robert T., II
This guide furnishes health care providers serving migrant and seasonal farmworkers with information to cope with the complexities of health care delivery in a multiethnic, multicultural environment. Section I provides an introduction to basic cultural concepts that influence the outcome of interactions between providers and their migrant…
The Professional Health Card Public interest group (Groupement d'Intérêt Public-Carte de professionnel de Santé (GIP-CPS)) was founded in 1993 as a joint initiative by the different parties involved in health care in France: the state, the representatives of the health care professions and the compulsory and complementary health insurance organizations. The CPS system enables safe exchange and electronic sharing of medical data. Via Intranet connections and Extranet hosting of medical files, databases, the CPS system enables health care professionals who access servers to be identified with certainty. For email exhanges, the CPS systems guarantees the sender's identity and capacity. The electronic signature gives legal value to the email. The system also enables confidential email. The health card system (CPS) contributes to making the health service efficient. Shared medical files, health care networks, health warning systems or electronic requests for reimbursement of health insurance expenses all use the CPS system. More than 300,000 health care professionals use it regularly. The freedom of movement of patients throughout Europe has led to the growth of exchanges and information sharing between health professionals in the States of the Union. More and more health professionals will be leaving their own countries to work in foreign countries in the future. It is essential that their freedom of movement is accompanied by the ability to prove their rights to practice.
Leininger, Lindsey; Levy, Helen
It might seem strange to ask whether increasing access to medical care can improve children’s health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children’s health. Nonetheless, they find that, on the whole, policies to improve access indeed improve children’s health, with the caveat that context plays a big role—medical care “matters more at some times, or for some children, than others.” Focusing on studies that can plausibly show a causal effect between policies to increase access and better health for children, and starting from an economic framework, they consider both the demand for and the supply of health care. On the demand side, they examine what happens when the government expands public insurance programs (such as Medicaid), or when parents are offered financial incentives to take their children to preventive appointments. On the supply side, they look at what happens when public insurance programs increase the payments that they offer to health-care providers, or when health-care providers are placed directly in schools where children spend their days. They also examine how the Affordable Care Act is likely to affect children’s access to medical care. Leininger and Levy reach three main conclusions. First, despite tremendous progress in recent decades, not all children have insurance coverage, and immigrant children are especially vulnerable. Second, insurance coverage alone doesn’t guarantee access to care, and insured children may still face barriers to getting the care they need. Finally, as this issue of Future of Children demonstrates, access to care is only one of the factors that policy makers should consider as they seek to make the nation’s children healthier. PMID:27516723
Leininger, Lindsey; Levy, Helen
It might seem strange to ask whether increasing access to medical care can improve children's health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children's health. Nonetheless, they find that, on the whole, policies to improve access indeed improve children's health, with the caveat that context plays a big role-medical care "matters more at some times, or for some children, than others." Focusing on studies that can plausibly show a causal effect between policies to increase access and better health for children, and starting from an economic framework, they consider both the demand for and the supply of health care. On the demand side, they examine what happens when the government expands public insurance programs (such as Medicaid), or when parents are offered financial incentives to take their children to preventive appointments. On the supply side, they look at what happens when public insurance programs increase the payments that they offer to health-care providers, or when health-care providers are placed directly in schools where children spend their days. They also examine how the Affordable Care Act is likely to affect children's access to medical care. Leininger and Levy reach three main conclusions. First, despite tremendous progress in recent decades, not all children have insurance coverage, and immigrant children are especially vulnerable. Second, insurance coverage alone doesn't guarantee access to care, and insured children may still face barriers to getting the care they need. Finally, as this issue of Future of Children demonstrates, access to care is only one of the factors that policy makers should consider as they seek to make the nation's children healthier.
Menon, Sanjay T
This article presents a model of health empowerment from an individual psychological perspective. Building on Menon's (2001) model of psychological empowerment in organizations, psychological health empowerment is developed as a construct to capture the individual community member's feelings of empowerment with regard to health and health care. The context for health empowerment is first conceptualized as an interactive system of three elements, namely, the individual community member, health service providers, and the regulatory environment consisting of health policy and systems. The individual manages his or her own health on a daily basis, interacts with health service providers when in need of specialized medical assistance, and is affected by the 'health policy and systems' element. Perceived control, perceived competence, and goal internalization, the three facets of Menon's empowerment model, are then adapted to the health context. A scale for measuring psychological health empowerment is also proposed. The implications of this approach for health care in multicultural communities are then explored.
Romøren, Tor Inge; Torjesen, Dag Olaf; Landmark, Brynjar
Introduction The Norwegian health care system is well organized within its two main sectors—primary health and long-term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures. Policy practice Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy in the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term “Coordination Reform”. These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented. Discussion The article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden. PMID:22128282
LaMay, C L
Telemedicine--the delivery of health care services to the underserved through communications technologies--has the potential to bring medical care to remote areas where health care is either inadequate or nonexistent. Telemedicine can be something as simple as a phone call, a network transmission of a radiograph or other diagnostic image, or, much more advanced, realtime video surgical consultations from anywhere on the globe. Telemedicine programs operate throughout Europe, Japan, and Australia. International programs, for profit and nonprofit, serve Asia, Africa, and the Middle East. The United States is also a major telemedicine developer, principally through government agencies such as the Department of Defense and the Office of Rural Health Policy, and, to a lesser extent, the private sector. But telemedicine in the United States has yet to prove itself economically viable, and it faces a number of political and regulatory barriers. Even more significantly, telemedicine's potential to increase overall health care spending by increasing access to health care has deterred private industry from investing heavily in it. In the short term, telemedicine's most important contribution to health care may be raising fundamental questions about United States health care policy.
Slater, R G
Improved health care in Nicaragua is a major priority of the Sandinista revolution; it has been pursued by major reforms of the national health care system, something few developing countries have attempted. In addition to its internationally recognized advances in public health, considerable progress has been made in health care delivery by expanding curative medical services through training more personnel and building more facilities to fulfill a commitment to free universal health coverage. The very uneven quality of medical care is the leading problem facing curative medicine now. Underlying factors include the difficulty of adequately training the greatly increased number of new physicians. Misdiagnosis and mismanagement continue to be major problems. The curative medical system is not well coordinated with the preventive sector. Recent innovations include initiation of a "medicina integral" residency, similar to family practice. Despite its inadequacies and the handicaps of war and poverty, the Nicaraguan curative medical system has made important progress. PMID:2705603
This module, consisting of materials for use in conducting a consumer education mini-course, deals with health care and services for consumers. Covered in the individual lessons are the following topics: understanding what is and is not covered by Medicare, assessing the need for private health insurance, purchasing private health insurance,…
Lewit, Eugene M.; And Others
Health care reform needs to assure coverage to all children regardless of income level or illnesses; address benefits, financing, administration, and delivery systems; provide substantial subsidies to low-income families; be equitable for all people; provide better monitoring of child health; protect and strengthen health providers who assist…
Cohen, Anjalee; Medlow, Sharon; Kelk, Norm; Hickie, Ian; Whitwell, Bradley
Fifteen in-depth interviews were conducted to explore young people's experiences of mental health care in Australia with the aim of informing the headspace National Youth Mental Health Foundation. The interviews revealed that significant numbers of respondents had been aware of their mental health problems for several years before seeking help and…
McGaha, Glenda S.
Presents health profile of the female offender. Discusses needs in areas of gynecology, breast assessment, and health education and services related to childbearing and parenting. Describes incarcerated health care delivery system and looks to communication and education, nursing personnel, and community resources for potential solutions to…
Hazard, Sprague W.
New trends in campus health care delivery were discussed at a workshop in Chicago sponsored by the Society for College and University Planning on January 30-31, 1975. Consideration was given to the repercussions of strong consumer demands for broader and more accessible health services, the emergence of health maintenance organizations, and…
Background Preventive health care programs can save lives and contribute to a better quality of life by diagnosing serious medical conditions early. The Preventive Health Care Facility Location (PHCFL) problem is to identify optimal locations for preventive health care facilities so as to maximize participation. When identifying locations for preventive health care facilities, we need to consider the characteristics of the preventive health care services. First, people should have more flexibility to select service locations. Second, each preventive health care facility needs to have a minimum number of clients in order to retain accreditation. Results This paper presents a new methodology for solving the PHCFL problem. In order to capture the characteristics of preventive health care services, we define a new accessibility measurement that combines the two-step floating catchment area method, distance factor, and the Huff-based competitive model. We assume that the accessibility of preventive health care services is a major determinant for participation in the service. Based on the new accessibility measurement, the PHCFL problem is formalized as a bi-objective model based on efficiency and coverage. The bi-objective model is solved using the Interchange algorithm. In order to accelerate the solving process, we implement the Interchange algorithm by building two new data structures, which captures the spatial structure of the PHCFL problem. In addition, in order to measure the spatial barrier between clients and preventive health care facilities accurately and dynamically, this paper estimates travelling distance and travelling time by calling the Google Maps Application Programming Interface (API). Conclusions Experiments based on a real application for the Alberta breast cancer screening program show that our work can increase the accessibility of breast cancer screening services in the province. PMID:20298608
Steinberg, Barbara J; Hilton, Irene V; Iida, Hiroko; Iada, Hiroko; Samelson, Renee
Current research shows that women tend to receive less dental care than usual when they are pregnant. In 2012, the first national consensus statement on oral health care during pregnancy was issued, emphasizing both the importance and safety of routine dental care for pregnant women. This article reviews the current recommendations for perinatal oral health care and common oral manifestations during pregnancy. Periodontal disease and its association with preterm birth and low birth weight are also discussed, as is the role played by dental intervention in these adverse outcomes.
Regulation of health care telecommunications is fragmented in Canada. Further neither the legislative nor the administrative nor the judicial processes have managed to respond successfully to the impact of telecommunications technology. The result is a legal environment that is necessarily speculative for both telecommunications service providers and health care personnel and facilities. Critical issues include ensuring confidentiality for sensitive patient records and health information liability of telecommunications service providers for inaccurate transmission liability of health care providers for use or non-use of telecommunications services. Limitation of legal liability for both telecommunications and health care service providers is likely to be most effective when based on contract but the creation of the necessary contracts is potentially unduly cumbersome both legally and practically. 1. CONSTITUTIONAL ASPECTS Telecommunications systems that are empowered to operate or connect cross provincial or international boundaries are subject to federal regulation bu the scheme is incomplete in respect of a system set up as a provincial agency. Health care on the other hand is very much a matter of provincial rather than federal authority as a matter of strict law but the fiscal strength of the federal government enables it to provide money to the provinces for financing health care and to4 use this as a device for securing compliance with certain federal standards. Nevertheless the political willingness of the federal health authorities to impose standards on the provinces
McDonald, Patricia A; Mecklenburg, Robert S; Martin, Lindsay A
To tame its soaring health care costs, intel tried many popular approaches: "consumer-driven health care" offerings such as high-deductible/low-premium plans, on-site clinics and employee wellness programs. But by 2009 intel realized that those programs alone would not enable the company to solve the problem, because they didn't affect its root cause: the steadily rising cost of the care employees and their families were receiving. Intel projected that its health care expenditures would hit a whopping $1 billion by 2012. So the company decided to try a novel approach. As a large purchaser of health services and with expertise in quality improvement and supplier management, intel was uniquely positioned to drive transformation in its local health care market. The company decided that it would manage the quality and cost of its health care suppliers with the same rigor it applied to its equipment suppliers by monitoring quality and cost. It spearheaded a collaborative effort in Portland, Oregon, that included two health systems, a plan administrator, and a major government employer. So far the Portland collaborative has reduced treatment costs for certain medical conditions by 24% to 49%, improved patient satisfaction, and eliminated over 10,000 hours worth of waste in the two health systems' business processes.
Fiorini, Paolo; Ali, Khaled; Seraji, Homayoun
This paper describes the approach followed in the design of a service robot for health care applications. Under the auspices of the NASA Technology Transfer program, a partnership was established between JPL and RWI, a manufacturer of mobile robots, to design and evaluate a mobile robot for health care assistance to the elderly and the handicapped. The main emphasis of the first phase of the project is on the development on a multi-modal operator interface and its evaluation by health care professionals and users. This paper describes the architecture of the system, the evaluation method used, and some preliminary results of the user evaluation.
Crema, Maria; Verbano, Chiara
This paper highlights the challenges of performance management in health care, wherein multiple different objectives have to be pursued. The literature suggests starting with quality performance, following the sand cone theory, but considering a multidimensional concept of health care quality. Moreover, new managerial approaches coming from an industrial context and adapted to health care, such as lean management and risk management, can contribute to improving quality performance. Therefore, the opportunity to analyze them arises from studying their overlaps and links in order to identify possible synergies and to investigate the opportunity to develop an integrated methodology enabling improved performance. PMID:24255600
Safer, Joshua D.; Coleman, Eli; Feldman, Jamie; Garofalo, Robert; Hembree, Wylie; Radix, Asa; Sevelius, Jae
Purpose of Review Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to health care for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them. Recent Findings Current research emphasizes sexual minorities’ self report of barriers, rather than using direct methods. The biggest barrier to health care reported by transgender individuals is lack of access due to lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers and socioeconomic barriers. Summary National research priorities should include rigorous determination of the capacity of the United States health care system to provide adequate care for transgender individuals. Studies should determine knowledge and biases of the medical work force across the spectrum of medical training with regard to transgender medical care; adequacy of sufficient providers for the care required, larger social structural barriers and status of a framework to pay for appropriate care. As well, studies should propose and validate potential solutions to address identified gaps. PMID:26910276
Cheung, Amy; Cleverley, Kristin; Chaim, Gloria; Moretti, Myla E; de Oliveira, Claire; Hawke, Lisa D; Willan, Andrew R; O'Brien, David; Heffernan, Olivia; Herzog, Tyson; Courey, Lynn; McDonald, Heather; Grant, Enid; Szatmari, Peter
Introduction Among youth, the prevalence of mental health and addiction (MHA) disorders is roughly 20%, yet youth are challenged to access evidence-based services in a timely fashion. To address MHA system gaps, this study tests the benefits of an Integrated Collaborative Care Team (ICCT) model for youth with MHA challenges. A rapid, stepped-care approach geared to need in a youth-friendly environment is expected to result in better youth MHA outcomes. Moreover, the ICCT approach is expected to decrease service wait-times, be more youth-friendly and family-friendly, and be more cost-effective, providing substantial public health benefits. Methods and analysis In partnership with four community agencies, four adolescent psychiatry hospital departments, youth and family members with lived experience of MHA service use, and other stakeholders, we have developed an innovative model of collaborative, community-based service provision involving rapid access to needs-based MHA services. A total of 500 youth presenting for hospital-based, outpatient psychiatric service will be randomised to ICCT services or hospital-based treatment as usual, following a pragmatic randomised controlled trial design. The primary outcome variable will be the youth's functioning, assessed at intake, 6 months and 12 months. Secondary outcomes will include clinical change, youth/family satisfaction and perception of care, empowerment, engagement and the incremental cost-effectiveness ratio (ICER). Intent-to-treat analyses will be used on repeated-measures data, along with cost-effectiveness and cost-utility analyses, to determine intervention effectiveness. Ethics and dissemination Research Ethics Board approval has been received from the Centre for Addiction and Mental Health, as well as institutional ethical approval from participating community sites. This study will be conducted according to Good Clinical Practice guidelines. Participants will provide informed consent prior to study
McAdoo, Joshua; Irving, Julian; Deslich, Stacie; Coustasse, Alberto
Before 2006, Massachusetts had more than 500 000 residents who lacked health insurance. Governor Mitt Romney enacted landmark legislation requiring all residents to obtain health insurance. Also, the legislation established a health insurance exchange for the purpose of broadening the choices of insurance plans made available to individuals in the state. The purpose of this research was to assess the Massachusetts health care reform in terms of access, cost, and sustainability. The methodology used was a literature review from 2006 to 2013; a total of 43 references were used. Health reform resulted in additional overall state spending of $2.42 billion on Medicaid for Massachusetts. Since the 2006 reform, 401 000 additional residents have obtained insurance. The number of Massachusetts residents who had access to health care increased substantially after the health care reform was enacted, to 98.1% of residents. The Massachusetts health care reform has not saved money for the state; its funding has been covered by Federal spending. However, reform has been sustained over time because of the high percentage of state residents who have supported the state mandate to obtain health care coverage.
Shiffman, Richard N.; Spooner, S. Andrew; Kwiatkowski, Kelly; Brennan, Patricia Flatley
In September 2000, the Agency for Healthcare Quality and Research and the American Academy of Pediatrics Center for Child Health Research sponsored a meeting of experts and knowledgeable stakeholders to identify 1) the special information needs of pediatric care and 2) health service research questions related to the use of information technology in children's health care. Technologies that support the care of children must address issues related to growth and development, children's changing physiology, and the unique diseases of children and interventions of pediatric care. Connectivity and data integration are particular concerns for child health care workers. Consumer health information needs for this population extend beyond the needs of one individual to the needs of the family. Recommendations of the attendees include rapid implementation of features in electronic health information systems that support pediatric care and involvement of child health experts in policy making, standards setting, education, and advocacy. A proposed research agenda should address both effectiveness and costs of information technology, with special consideration for the needs of children, the development and evaluation of clinical decision support in pediatric settings, understanding of the epidemiology of iatrogenic injury in childhood, supplementation of vocabulary standards with pediatrics-specific terminology, and improvement in health care access for children, using telemedicine. PMID:11687562
French, Kempa S
Limited patient literacy contributes to poorer health status, increased emergency room and hospital use, higher morbidity and mortality rates, and less use of preventive health services. All patients, however, need health information that is accurate, accessible, and actionable to make informed decisions about their health. A universal health literacy precautions approach is recommended to empower patients through shared decision-making interactions. Consistent use of evidence-based health literacy practices by front-line nurses offers the potential for transformations in nursing care through stronger patient-nurse interactions and health system partnerships.
Johnson, Mallory O
In a rapidly changing world of health care information access and patients' rights, there is limited conceptual infrastructure available to understand how people approach and engage in treatment of medical conditions. The construct of health care empowerment is defined as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. I present a model in which health care empowerment is influenced by an interplay of cultural, social, and environmental factors; personal resources; and intrapersonal factors. The model offers a framework to understand patient and provider roles in facilitating health care empowerment and presents opportunities for investigation into the role of health care empowerment in multiple outcomes across populations and settings, including inquiries into the sources and consequences of health disparities.
Bednarz, Daniel; Bae, Jaeyong; Pierce, Jessica
Petroleum is used widely in health care—primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies—and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services. PMID:21778473
Brook, R H; Williams, K N
Literature review points out that: (a) differentials in health status between the disadvantaged and the nondisadvantaged persist, often to a large degree; (b) differentials in the overall amount of care received are less striking now than heretofore, but standardization by level of need demonstrates measurable discrepancies in health services provided to the disadvantaged compared with the nondisadvantaged; (c) the quality of health care for the disadvantaged is not strikingly poorer than care for the nondisadvantaged, but, in view of demonstrable shortcomings in the quality of health care in general, this is not viewed as a positive statement; and (d) attempts to improve quality of care for the disadvantaged have not had the hoped-for impact. Four new avenues are suggested for possible further research; increased patient responsibility, increased consumer knowledge, financial accountability, and quality assurance activities. Because of the likelihood of only marginal changes in health status, rigorous evaluation of any experimental program is emphasized. During the last decade, many attempts have been made by private and governmental bodies to improve the health of the American people. In general, these efforts have focused on improving the health of members of disadvantaged groups and have included such diverse activities as building OEO health centers, developing maternal and infant care programs, and financing care for the elderly. During the last few years, a different movement, concerned with assuring high quality care for all people, has produced efforts such as quality assurance activities in health maintenance organizations, the Professional Standards Review Organization program, and the medical care evaluation program of the Joint Commission on the Accreditation of Hospitals. Consideration of these two issues, i.e., improving the health of disadvantaged groups and improving the quality of care for all people, has led to two policy-relevant questions: "Can
Chow, Clara K; Ariyarathna, Nilshan; Islam, Sheikh Mohammed Shariful; Thiagalingam, Aravinda; Redfern, Julie
Mobile health (mHealth) has been defined as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices and personal digital assistants. Cardiovascular mHealth is, arguably, leading the mHealth space, through innovation, research and implementation, and especially in the areas of prevention, cardiac rehabilitation and education. mHealth includes simple strategies, such as the use of short message service (SMS) or text messages in successful short-term smoking-cessation, weight loss and diabetes management programs. The recent Australian Tobacco, Exercise and Diet Messages (TEXT ME) randomised clinical trial addressed multiple cardiovascular risk factors. mHealth can also involve more complex strategies, such as smart phone applications (apps), global positioning systems (GPS) and Bluetooth technologies. Although many apps could be considered suitable for primary prevention, they are largely unregulated and most are not evidence-based. Some have been well-developed, such as the Food Switch app and an iPhone electrocardiogram (ECG) system. The "explosion" of apps has driven initiatives such as the Mobile Applications Rating Scale (MARS). More recently, the use of sensors to monitor and provide feedback to patients and healthcare providers is being explored. With almost two billion people currently owning a Smartphone, and 50% of adults (globally) predicted to own one by 2018, mHealth provides the prospect of delivering efficient, affordable healthcare services to widespread populations both locally and globally. In particular, it has the potential to reduce socioeconomic disparity and alleviate the burden of cardiovascular disease. There is now a need to rethink traditional health service structures and bioengineering capacity, to ensure mHealth systems are also safe, secure and robust.
I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations’ political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America. PMID:15514221
Almunawar, Mohammad Nabil; Anshari, Muhammad; Younis, Mustafa Z; Kisa, Adnan
Electronic health records (EHRs) store health-related patient information in an electronic format, improving the quality of health care management and increasing efficiency of health care processes. However, in existing information systems, health-related records are generated, managed, and controlled by health care organizations. Patients are perceived as recipients of care and normally cannot directly interact with the system that stores their health-related records; their participation in enriching this information is not possible. Many businesses now allow customers to participate in generating information for their systems, strengthening customer relationships. This trend is supported by Web 2.0, which enables interactivity through various means, including social networks. Health care systems should be able to take advantage of this development. This article proposes a novel framework in addressing the emerging need for interactivity while preserving and extending existing electronic medical data. The framework has 3 dimensions of patient health record: personal, social, and medical dimensions. The framework is designed to empower patients, changing their roles from static recipient of health care services to dynamic and active partners in health care processes.
Health care at population level is a complex problem. Having this in mind, the purpose of this paper is to focus on the goods that are ethically relevant in the process of caring for health at this level. We briefly analyze some of the Chilean health statistics that, although they show important improvements along the years, demonstrate that certain conditions are to be deemed as inadequate by both healthcare providers and patients. Ethics is a central component to determine how to structure and organize health care systems and how they should operate. We emphasize human dignity as an ethical corner stone of the health care system, along with other important values such as justice and humanization, under the scope of the ends of medicine, and other components such as technical competence of providers and the financing of the whole process. We conclude that as far as a health care system is organized in a way that medical practice is well ordered, primarily and fundamentally according the ends of medicine and the good of persons, such a health care system is ethically adequate.
Children and adolescents who enter foster care often do so with complicated and serious medical, mental health, developmental, oral health, and psychosocial problems rooted in their history of childhood trauma. Ideally, health care for this population is provided in a pediatric medical home by physicians who are familiar with the sequelae of childhood trauma and adversity. As youth with special health care needs, children and adolescents in foster care require more frequent monitoring of their health status, and pediatricians have a critical role in ensuring the well-being of children in out-of-home care through the provision of high-quality pediatric health services, health care coordination, and advocacy on their behalves.
Als, Lorraine C; Nadel, Simon; Cooper, Mehrengise; Vickers, Bea; Garralda, M Elena
Objective To assess feasibility and pilot a supported psychoeducational tool to improve parent and child mental health following discharge from a paediatric intensive care unit (PICU), in preparation for a large randomised controlled trial (RCT). Design Feasibility assessment and single-centre, parallel group, pilot RCT. A concealed computer generated list was used to randomise participants, with an allocation of 2:1 in favour of the intervention. Setting A PICU in an acute care hospital in London, UK. Participants 31 parents of children aged 4–16 years-old admitted to PICU. Intervention Parents received a psychoeducational tool supported by a telephone call. The psychoeducational tool outlined the possible psychological reactions in children and parents alongside management advice. The telephone call addressed each family's postdischarge experience, reinforced the psychoeducational material and encouraged parents to put into practice the advice given. Main outcome measures The primary outcome was the number of feasibility criteria successfully met (linked to the intervention and the study design). Secondary outcomes were questionnaire data collected at 3–6-month follow-up assessing mental health in parents and children. Results 31 parents were randomised (intervention n=22; treatment as usual, TAU n=9). 23 parents were included in the analysis of secondary outcomes (intervention n=17; TAU n=6). 3 (of 6) intervention and 1 (of 6) study design feasibility criteria were fully met. All unmet criteria could be addressed with minor or significant modifications to the protocol. At follow-up there was a tendency for parents who received the intervention to report lower post-traumatic stress symptoms in themselves and fewer emotional and behavioural difficulties in their children than TAU parents. This needs to be explored in a fully powered trial. Conclusions This feasibility and pilot RCT provided valuable information on the intervention and trial design for a full
Lohr, W David; Jones, V Faye
Children in foster care have exceptional needs due to their histories of abuse, neglect, and increased exposure to violence. The rates of psychiatric symptoms and disorders, such as attention-deficit/hyperactivity disorder, posttraumatic stress disorder, and reactive attachment disorder, are much higher in children in foster care; furthermore, the rate of these children receiving psychotropic medications is 3 times that of children who are not in foster care. Pediatricians, in their role of providing a medical home, play a central role in safeguarding the physical and mental health of these children. By taking a trauma-informed approach to understanding the unique needs and gaps in their health care, pediatricians can improve the mental health and maximize outcome for children in foster care. [Pediatr Ann. 2016;45(10):e342-e348.].
in the English language b. Exclusion Criteria - (a) Currently undergoing psychotherapy for depression (b) គ or >65 years of age (c) Active...client attitudes,’’ ‘‘cli- ent satisfaction,’’ and ‘‘treatment.’’ Restrictions for all searches included the following: English language, publication...complaints and/or malpractice lawsuits. Due to the ethical and legal responsibilities mental health practitioners have toward patients, liability can
Heinemann, G D; Schmitt, M H; Farrell, M P; Brallier, S A
The authors describe the development and psychometric testing across three study phases of an Attitudes Toward Health Care Teams Scale. The measure contains two subscales: Quality of Care/Process (14 items) and Physician Centrality (6 items). The Quality of Care/Process subscale measures team members' perceptions of the quality of care delivered by health care teams and the quality of teamwork to accomplish this. The Physician Centrality subscale measures team members' attitudes toward physicians' authority in teams and their control over information about patients. Tests of reliability and validity demonstrate that each subscale is a strong measure of its respective underlying concept. The measure has potential for use as a research tool and as a pre- and posttest tool for educational interventions with teams and for evaluating clinically based team training programs for medical and health professions students and residents.
... have been trained to care for the sick. Registered nurses (RNs) have graduated from a nursing program, have ... of a woman who has given birth. Certified registered nurse anesthetists (CRNAs) have training in the field of ...
Arizona Univ., Tucson. Cooperative Extension Service.
This manual supplies information helpful to individuals wishing to become certified in public health pest control. It is designed as a technical reference for vector control workers and as preparatory material for structural applicators of restricted use pesticides to meet the General Standards of Competency required of commercial applicators. The…
Emeritus Professor Alan Glasper, from the University of Southampton, discusses a Royal College of Nursing policy that highlights the complexities of providing high-quality and non-discriminatory health care.
The successful implementation and operation of health care networks and the efficient and effective provision of health care services is dependent upon a number of different factors: Telecommunications infrastructure and technology, medical applications and services, user acceptance, education and training, product and applications/services development and service provision aspects. The business model and market development regarding policy and legal issues also must be considered in the development and deployment of telemedicine services to become an everyday practice. This chapter presents the initiatives, role and contribution of the Greek Telecommunications Company in the health care services area and also refers to specific case-studies focusing upon the key factors and issues of applications related to the telecommunications, informatics, and health care sectors, which can also be the drivers to create opportunities for Citizens, Society and the Industry.
... Tract Imaging Urodynamic Testing Virtual Colonoscopy Celiac Disease Testing (for Health Care Professionals) Serologic tests for celiac ... MA, Loots CM, Salvatore S, Vandenplas Y, ESPGHAN EURO-PIG Working Group. Indications, methodology, and interpretation of combined ...
Burkhart, Kimberly; Knox, Michele; Hunter, Kimberly
Twenty-two pediatric residents and 31 medical students viewed the Play Nicely program. The Play Nicely program is a multimedia program that teaches health care professionals how to counsel parents to use positive parenting and disciplining strategies in response to early childhood aggression. Health care professionals completed pre- and posttraining questionnaires to assess changes in comfort with counseling, parenting knowledge, and attitudes toward spanking. Results indicated at posttraining that health care professionals were significantly more comfortable with counseling parents, had increased parenting knowledge, and decreased positive attitudes toward spanking. Findings suggest that this program holds promise for educating health care professionals on how to counsel parents on positive parenting strategies and positively change attitudes toward spanking.
This report surveys the state of the art in applications of virtual environments and related technologies for health care. Applications of these technologies are being developed for health care in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); medical therapy; preventive medicine and patient education; medical education and training; visualization of massive medical databases; skill enhancement and rehabilitation; and architectural design for health-care facilities. To date, such applications have improved the quality of health care, and in the future they will result in substantial cost savings. Tools that respond to the needs of present virtual environment systems are being refined or developed. However, additional large-scale research is necessary in the following areas: user studies, use of robots for telepresence procedures, enhanced system reality, and improved system functionality.
Immigrants represent a very heterogeneous population, with various stress factors for mental disorders. These individuals are confronted with numerous access barriers within the health care system, which are reflected in limited utilization of the mental health system and psychotherapy services. A particularly large gap in health service provision exists among refugees and asylum-seekers. There is an urgent need for action in terms of opening up of the mental health system, improving and simplifying routes of access, and facilitating treatment options.
Ports, Katie A; Reddy, Diane M; Barnack-Tavlaris, Jessica L
Research in primary care medicine demonstrates that health care providers' communication varies depending on their sex, and that these sex differences in communication can influence patients' health outcomes. The present study aimed to examine the extent to which sex differences in primary care providers' communication extend to the sensitive context of gynecological care for genital herpes and whether these potential sex differences in communication influence patients' herpes transmission prevention behaviors and herpes-related quality of life. Women (N = 123) from the United States recently diagnosed with genital herpes anonymously completed established measures in which they rated (a) their health care providers' communication, (b) their herpes transmission prevention behaviors, and (c) their herpes-related quality of life. The authors found significant sex differences in health care providers' communication; this finding supports that sex differences in primary care providers' communication extend to gynecological care for herpes. Specifically, patients with female health care providers indicated that their providers engaged in more patient-centered communication and were more satisfied with their providers' communication. However, health care providers' sex did not predict women's quality of life, a finding that suggests that health care providers' sex alone is of little importance in patients' health outcomes. Patient-centered communication was significantly associated with greater quality-of-life scores and may provide a promising avenue for intervention.
Washington State Workforce Training and Education Coordinating Board, Olympia.
A work group consisting of representatives of public agencies, education, the health care industry, and unions and professional associations was formed to examine education and training issues related to the shortage of health care workers in Washington state. The group concluded that the shortage of available workers in many health care…
Abel, Cynthia H., Ed.
This report discusses the health care needs of and benefits for women, children, and adolescents in light of national health care reform proposals put forth in 1994, and is based on presentations and discussions at an invitational workshop on maternal and child health. The report asserts that since women and children are disproportionately…
Buckey, Julia W.; Abell, Neil
Recent advances in health care technology have increased the number of health care decisions made by acute care patients and those who act on their behalf, known as health care surrogates. This study reports on the validation of a new measure, the Health Care Surrogate Preferences Scale. Designed to assess the willingness of adults to perform and…
Reilly, R F; Rabe, J R
Health care entities (and especially medical practices) are valued for a number of reasons: sale transaction pricing and structuring, merger formation and dissolution, taxation and regulatory compliance, and litigation support and dispute resolution. The identification and quantification of the entity's intangible assets are often the most important aspects of the valuation. This article illustrates the generally accepted methods for valuing health care-related intangible assets.
Sterns, J B
Access to capital will become more difficult. Capital access is dependent on ability to repay debt, which, in turn, is dependent on internally generated cash flows. Under any health care reform proposal, revenue inflows will be slowed. The use of corporate finance techniques to limit financial risk and lower cost will be a permanent response to fundamental changes to the health care system. These changes will result in greater balance sheet management, centralized capital allocation, and alternative sources of capital.
McTaggart, Aubrey C.; McTaggart, Lorna, M.
The purpose of this book is to provide useful information about the components of quality health care and to suggest ways for the consumer to find and avail himself of the best care possible. The following subjects are covered, including brief histories of sociological background and suggestions on how to judge competency: (1) physicians,…
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)…
Andrade, Rubia Laine de Paula; Scatolin, Beatriz Estuque; Wysocki, Anneliese Domingues; Beraldo, Aline Ale; Monroe, Aline Aparecida; Scatena, Lúcia Marina; Villa, Tereza Cristina Scatena
OBJECTIVE To assess primary health care and emergency medical services performance for tuberculosis diagnosis. METHODS Cross-sectional study were conducted with 90 health professionals from primary health care and 68 from emergency medical services, in Ribeirao Preto, SP, Southeastern Brazil, in 2009. A structured questionnaire based on an instrument of tuberculosis care assessment was used. The association between health service and the variables of structure and process for tuberculosis diagnosis was assessed by Chi-square test, Fisher's exact test (both with 5% of statistical significance) and multiple correspondence analysis. RESULTS Primary health care was associated with the adequate provision of inputs and human resources, as well as with the sputum test request. Emergencial medical services were associated with the availability of X-ray equipment, work overload, human resources turnover, insufficient availability of health professionals, unavailability of sputum collection pots and do not request sputum test. In both services, tuberculosis diagnosis remained as a physician's responsibility. CONCLUSIONS Emergencial medical services presented weaknesses in its structure to identify tuberculosis suspects. Gaps on the process were identified in both primary health care and emergencial medical services. This situation highlights the need for qualification of health services that are the main gateway to health system to meet sector reforms that prioritize the timely diagnosis of tuberculosis and its control. PMID:24626553
Weslin, Anna T; Silva-Smith, Amy
Performing arts medicine is a growing health care profession specializing in the needs of performing artists. As part of the performing arts venue, the dancer, a combination of athlete and artist, presents with unique health care needs requiring a more collaborative and holistic health care program. Currently there are relatively few advanced practice nurses (APNs) who specialize in performing arts health care. APNs, with focus on collaborative and holistic health care, are ideally suited to join other health care professionals in developing and implementing comprehensive health care programs for the performing artist. This article focuses on the dancer as the client in an APN practice that specializes in performing arts health care.
Brennan, Patricia Flatley; Strombom, Indiana
If nurses, physicians, and health care planners knew more about patients' health-related preferences, care would most likely be cheaper, more effective, and closer to the individuals' desires. In order for patient preferences to be effectively used in the delivery of health care, it is important that patients be able to formulate and express preferences, that these judgments be made known to the clinician at the time of care, and that these statements meaningfully inform care activities. Decision theory and health informatics offer promising strategies for eliciting subjective values and making them accessible in a clinical encounter in a manner that drives health choices. Computer-based elicitation and reporting tools are proving acceptable to patients and clinicians alike. It is time for the informatics community to turn their attention toward building computer-based applications that support clinicians in the complex cognitive process of integrating patient preferences with scientific knowledge, clinical practice guidelines, and the realities of contemporary health care. PMID:9609495
Sheahan, M D
Despite the political and economic reforms that have swept Eastern Europe in the past 5 years, there has been little change in Poland's health care system. The Ministry of Health and Social Welfare has targeted preventive care as a priority, yet the enactment of legislation to meet this goal has been slow. The process of reform has been hindered by political stagnation, economic crisis, and a lack of delineation of responsibility for implementing the reforms. Despite the delays in reform, recent developments indicate that a realistic, sustainable restructuring of the health care system is possible, with a focus on preventive services. Recent proposals for change have centered on applying national goals to limited geographic areas, with both local and international support. Regional pilot projects to restructure health care delivery at a community level, local health education and disease prevention initiatives, and a national training program for primary care and family physicians and nurses are being planned. Through regionalization, an increase in responsibility for both the physician and the patient, and redefinition of primary health care and the role of family physicians, isolated local movements and pilot projects have shown promise in achieving these goals, even under the current budgetary constraints. PMID:7610217
... AFFAIRS Proposed Information Collection (Living Will and Durable Power of Attorney for Health Care... information needed to record patient's specific instructions about health care decisions in the event he or... Power of Attorney for Health Care, VA Form 10-0137. OMB Control Number: 2900-0556. Type of...
... AFFAIRS Agency Information Collection (Locality Pay System for Nurses and Other Health Care Personnel... INFORMATION: Title: Locality Pay System for Nurses and Other Health Care Personnel. OMB Control Number: 2900... determine locality pay system for certain health care personnel. VA medical facility Directors will use...
Meredith, Lisa S; Eisenman, David P; Green, Bonnie L; Kaltman, Stacey; Wong, Eunice C; Han, Bing; Cassells, Andrea; Tobin, Jonathan N
Posttraumatic stress disorder (PTSD) is a common problem in primary care. Although effective treatments are available, little is known about whether such treatments are effective within the context of Federally Qualified Health Centers (FQHCs) that serve as national "safety nets" for providing primary care for low income and underinsured patients. The Violence and Stress Assessment (ViStA) study is the first randomized controlled trial (RCT) to test the impact of a care management intervention for treating PTSD in FQHCs. To develop a PTSD management intervention appropriate for lower resource FQHCs and the predominantly Latino patients they serve, formative work was conducted through a collaborative effort between researchers and an FQHC practice-based research network. This article describes how FQHC stakeholders were convened to review, assess, and prioritize evidence-based strategies for addressing patient, clinician, and system-level barriers to care. This multi-component care management intervention incorporates diagnosis with feedback, patient education and activation; navigation and linkage to community resources; clinician education and medication guidance; and structured cross-disciplinary communication and continuity of care, all facilitated by care managers with FQHC experience. We also describe the evaluation design of this five-year RCT and the characteristics of the 404 English or Spanish speaking patients enrolled in the study and randomized to either the intervention or to usual care. Patients are assessed at baseline, six months, and 12 months to examine intervention effectiveness on PTSD, other mental health symptoms, health-related quality-of-life, health care service use; and perceived barriers to care and satisfaction with care.
Meredith, Lisa S.; Eisenman, David P.; Green, Bonnie L.; Kaltman, Stacey; Wong, Eunice C.; Han, Bing; Cassells, Andrea; Tobin, Jonathan N.
Posttraumatic stress disorder (PTSD) is a common problem in primary care. Although effective treatments are available, little is known about whether such treatments are effective within the context of Federally Qualified Health Centers (FQHCs) that serve as national “safety nets” for providing primary care for low income and underinsured patients. The Violence and Stress Assessment (ViStA) study is the first randomized controlled trial (RCT) to test the impact of a care management intervention for treating PTSD in FQHCs. To develop a PTSD management intervention appropriate for lower resource FQHCs and the predominantly Latino patients they serve, formative work was conducted through a collaborative effort between researchers and an FQHC practice-based research network. This article describes how FQHC stakeholders were convened to review, assess, and prioritize evidence-based strategies for addressing patient, clinician, and system-level barriers to care. This multi-component care management intervention incorporates diagnosis with feedback, patient education and activation; navigation and linkage to community resources; clinician education and medication guidance; and structured cross-disciplinary communication and continuity of care, all facilitated by care managers with FQHC experience. We also describe the evaluation design of this five-year RCT and the characteristics of the 404 English or Spanish speaking patients enrolled in the study and randomized to either the intervention or to usual care. Patients are assessed at baseline, six months, and 12 months to examine intervention effectiveness on PTSD, other mental health symptoms, health-related quality-of-life, health care service use; and perceived barriers to care and satisfaction with care. PMID:24747932
Puntarić, Dinko; Stašević, Ina; Ropac, Darko; Poljičanin, Tamara; Mayer, Dijana
The article presents the basic principles of health care, health care measures and strategic objectives of these measures in Croatia. The health of the population does not depend solely on the activities of the health care system but also on various demographic indicators. Our success in implementing health care depends largely on the structure of health facilities and health workers. The Croatian health system in late 2013 had permanently employed 74,489 workers. Out of these, 77% were health care workers. Most health care workers had only secondary school education (37.7%); physicians represented 17.4% of the workforce. On assessing the health of the population, certain health indicators are of utmost importance. The leading cause of deaths were circulatory diseases (in 2012, 24,988 persons died, 585.5/100,000). Neoplasms were the cause of death in 13,940 persons (326.6/100,000), then injuries and poisoning (69.1/100,000), diseases of the gastrointestinal system (53.1/100,000), and respiratory diseases (50.4/100,000). Data are presented on the basis of diseases reported from several national registries (cancer, psychoactive drug abuse, the disabled, diabetes, and suicides). The importance of vaccination for the control of infectious diseases in Croatia is especially emphasized, as well as the experience and excellent results achieved in this area. The epidemiological situation in Croatia in terms of infectious diseases can be assessed as favorable. This is due to the general living conditions, which contributed to the entire health system, making Croatia equal to other developed countries of Europe and throughout the world.
Restum, Zulficar Gregory
US citizens face a growing threat of contracting communicable diseases owing to the high recidivism rate in state and federal prisons, poor screening and treatment of prisoners, and inferior follow-up health care upon their release. Insufficient education about communicable diseases--for prisoners and citizens alike--and other problems, such as prejudice against prisoners, escalating costs, and an unreliable correctional health care delivery system for inmates, all contribute to a public health problem that requires careful examination and correction for the protection of everyone involved.
This interpretive study sought to understand how intercultural health care to immigrants can be practically conceptualized in multicultural populations. Interviews were conducted with 20 Canadian health service informants, and 12 interviews were staged during 31 months with a multicultural coordinator in an Australian teaching hospital. Transcripts of 11 previously conducted group discussions with 34 staff members from this same Australian hospital were also included. Interpretation was based on these data as well as on the literature and the author's own experience. It was concluded that intercultural health care can be practically conceptualized as reflective health worker practice. Through this practice, responsive care can be situationally negotiated between the health worker and the client in a framework of jointly considered needs. For implementation, the barriers to negotiation must be addressed.
Walker, Deborah Klein
Although “population health” is one of the Institute for Healthcare Improvement’s Triple Aim goals, its relationship to accountable care organizations (ACOs) remains ill-defined and lacks clarity as to how the clinical delivery system intersects with the public health system. Although defining population health as “panel” management seems to be the default definition, we called for a broader “community health” definition that could improve relationships between clinical delivery and public health systems and health outcomes for communities. We discussed this broader definition and offered recommendations for linking ACOs with the public health system toward improving health for patients and their communities. PMID:23678910
Baptiste-Roberts, Kesha; Oranuba, Ebele; Werts, Niya; Edwards, Lorece V
There is evidence of health disparities between sexual minority and heterosexual populations. Although the focus of lesbian, gay, bisexual, and transgender health research has been human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infection among men who have sex with men, there are health disparities among sexual minority women. Using the minority stress framework, these disparities may in part be caused by individual prejudice, social stigma, and discrimination. To ensure equitable health for all, there is urgent need for targeted culturally sensitive health promotion, cultural sensitivity training for health care providers, and intervention-focused research.
Salkind, F. Jane; And Others
Registered nurses, interns, and residents from five hospitals in Ohio, Pennsylvania, and New Jersey were administered the Maslach Human Services Survey, Rosenberg's Self-Esteem Scale, Rotter's Locus of Control Scale, Newman's Alpha Omega Scale, and a demographic questionnaire. Results strongly suggested that an individual with high self-esteem and…
Steaban, Robin Lea
This article is meant to spur debate on the role of the professional nurse in care coordination as well as the role of nursing leaders for defining and leading to a future state. This work highlights the opportunity and benefits associated with transformation of professional nursing practice in response to the mandates of the Affordable Care Act of 2010. An understanding of core concepts and the work of care coordination are used to propose a model of care coordination based on the population health pyramid. This maximizes the roles of nurses across the continuum as transformational leaders in the patient/family and nursing relationship. The author explores the role of the nurse in a transactional versus transformational relationship with patients, leading to actualization of the nurse in care coordination. Focusing on the role of the nurse leader, the challenges and necessary actions for optimization of the professional nurse role are explored, using principles of transformational leadership.
Porta, C; Handelman, E; McGovern, P
Needlestick injuries among health care workers are a recognized health hazard, with 400,000 needlesticks occurring annually among the 4 million health care workers in the United States. Existing needlestick injury literature primarily focuses on hospital sites and may not be generalizable to other health care settings such as nursing homes, home health care sites, clinics, and emergency response units. Nurses were at high risk of needlestick injury from syringes and i.v. equipment relative to the other health care workers. Recapping, prohibited by the OSHA Bloodborne Pathogens Standard, continues to be an identified cause of injury. The literature supports comprehensive injury prevention and control strategies in conjunction with the use of safer needle devices. Health care organizations should assess their worksites to identify hazards and select products and strategies to correct the problem. Future research should clarify accurate needlestick injury rates (e.g., establish consistent denominators), address non-hospital setting risks, validate self reported data, and evaluate comprehensive interventions that employ engineering strategies to minimize the risk.
Although the National Health Service (NHS) is regarded as a national treasure, it is no longer immune from the colossal financial pressures brought about by global recession. Economic sustainability has largely driven the reform process leading to the Health and Social Care Act (HSCA) 2012, however; other considerations have also played a role in the journey to turn the health and social care service into an institution which is fit for the 21st-century needs. This article examines the impact of the HSCA 2012 on those made vulnerable through mental ill health. It then considers three issues: First, whether parity between mental and physical health can have life beyond political rhetoric; second, what impact driving up efficiency within the NHS will have upon mental health patients; and finally, the extent to which the personalisation agenda can be meaningfully applied within the mental health context. PMID:26273147
... 47 Telecommunication 3 2014-10-01 2014-10-01 false Health care provider contribution. 54.633... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.633 Health care provider contribution. (a) Health care provider contribution. All health...
... 47 Telecommunication 3 2013-10-01 2013-10-01 false Health care provider contribution. 54.633... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.633 Health care provider contribution. (a) Health care provider contribution. All health...
Grosjean, O V
Rather than our routinely blamed ageing demography, pharmaceutical promotion and the medical business, not research, are responsible for our ever growing health bill. To keep essential health care affordable, only what has been proved necessary and cost effective should be financed by some kind of risk mutualisation system. Hedonistic care should be left to the free market. From conception to death, a devastating culture of medicalization and therapeutic agressivity has turned naturally inexpensive processes, such as conception, birth, ageing and death, into over-priced medical achievements. The increasing lack of personal and social responsibility triggered by the market, such as junk food, tobacco, drugs, sedentarity or trash media, multiply life-threatening illnesses such as diabetes 2, obesity, cardiovascular diseases and all kinds of cancers. Screenings require millions of participants and intense statistical analysis to prove any efficacy. Screenings, testings and proactive practices make people sick and produce more patients than they save lives , while generating exceptional returns on investments thanks to state and insurance financing; they should be put under public control. New drugs are unaffordable in spite of their dubious efficacy which often relies on biased and underpowered studies. Because they target desperate, debilitating, up to now incurable diseases like metastatic cancers, multiple sclerosis, Alzheimer, polyarthritis, Crohn disease, patients and their families want them by any means and at any price. The answer to the North-South health gap is in a global deal: a declining demographic trend, already well under way and free circulation not only of goods but also of people which would in the long run shape up the age pyramid of a progressively mixed population. That could also save lives at both ends of the human chain: those who die from starvation and those who die from overfeeding.
Ködmön, József; Csajbók, Zoltán Ernő
Doctors, nurses and other medical professionals are spending more and more time in front of the computer, using applications developed for general practitioners, specialized care, or perhaps an integrated hospital system. The data they handle during healing and patient care are mostly sensitive data and, therefore, their management is strictly regulated. Finding our way in the jungle of laws, regulations and policies is not simple. Notwithstanding, our lack of information does not waive our responsibility. This study summarizes the most important points of international recommendations, standards and legal regulations of the field, as well as giving practical advices for managing medical and patient data securely and in compliance with the current legal regulations.
Valdmanis, Vivian; DeNicola, Arianna; Bernet, Patrick
In this paper, we assess the capacity of Florida's public health departments. We achieve this by using bootstrapped data envelopment analysis (DEA) applied to Johansen's definition of capacity utilization. Our purpose in this paper is to measure if there is, theoretically, enough excess capacity available to handle a possible surge in the demand for primary care services especially after the implementation of the Affordable Care Act that includes provisions for expanded public health services. We measure subunit service availability using a comprehensive data source available for all 67 county health departments in the provision of diagnostic care and primary health care. In this research we aim to address two related research questions. First, we structure our analysis so as to fix budgets. This is based on the assumption that State spending on social and health services could be limited, but patient needs are not. Our second research question is that, given the dearth of primary care providers in Florida if budgets are allowed to vary is there enough medical labor to provide care to clients. Using a non-parametric approach, we also apply bootstrapping to the concept of plant capacity which adds to the productivity research. To preview our findings, we report that there exists excess plant capacity for patient treatment and care, but question whether resources may be better suited for more traditional types of public health services.
Mohan, Viswanathan; Seedat, Yackoob K; Pradeepa, Rajendra
Aim. To review the available literature on burden of diabetes mellitus (DM) and hypertension (HTN) and its coexistence in Southeast Asian (SEA) and the African (AFR) regions and to suggest strategies to improve DM and HTN prevention and control in primary health care (PHC) in the two regions. Methods. A systematic review of the papers published on DM, HTN, and prevention/control of chronic diseases in SEA and AFR regions between 1980 and December 2012 was included. Results. In the year 2011, SEA region had the second largest number of people with DM (71.4 million), while the AFR region had the smallest number (14.7 million). Screening studies identified high proportions (>50%) of individuals with previously undiagnosed HTN and DM in both of the SEA and AFR regions. Studies from both regions have shown that DM and HTN coexist in type 2 DM ranging from 20.6% in India to 78.4% in Thailand in the SEA region and ranging from 9.7% in Nigeria to 70.4% in Morocco in the AFR region. There is evidence that by lifestyle modification both DM and HTN can be prevented. Conclusion. To meet the twin challenge of DM and HTN in developing countries, PHCs will have to be strengthened with a concerted and multipronged effort to provide promotive, preventive, curative, and rehabilitative services.
Mohan, Viswanathan; Seedat, Yackoob K.; Pradeepa, Rajendra
Aim. To review the available literature on burden of diabetes mellitus (DM) and hypertension (HTN) and its coexistence in Southeast Asian (SEA) and the African (AFR) regions and to suggest strategies to improve DM and HTN prevention and control in primary health care (PHC) in the two regions. Methods. A systematic review of the papers published on DM, HTN, and prevention/control of chronic diseases in SEA and AFR regions between 1980 and December 2012 was included. Results. In the year 2011, SEA region had the second largest number of people with DM (71.4 million), while the AFR region had the smallest number (14.7 million). Screening studies identified high proportions (>50%) of individuals with previously undiagnosed HTN and DM in both of the SEA and AFR regions. Studies from both regions have shown that DM and HTN coexist in type 2 DM ranging from 20.6% in India to 78.4% in Thailand in the SEA region and ranging from 9.7% in Nigeria to 70.4% in Morocco in the AFR region. There is evidence that by lifestyle modification both DM and HTN can be prevented. Conclusion. To meet the twin challenge of DM and HTN in developing countries, PHCs will have to be strengthened with a concerted and multipronged effort to provide promotive, preventive, curative, and rehabilitative services. PMID:23573413
Tanner, D J
Methods for conducting a comprehensive analysis of the potential for strategic entry or expansion in the home health-care (HHC) market are discussed. By conducting a comprehensive analysis of the HHC market, hospital pharmacists can evaluate the feasibility of developing and implementing a hospital-based HHC service. A comprehensive market analysis should include an initial assessment of potential product-line offerings, development of strengths-and-weaknesses and opportunities-and-threats profiles, evaluations of competing providers of HHC and regulatory issues, and formulation of a business plan. The potential impact of program structure, operations management, product pricing, advertising and promotion, and marketing controls should also be considered. The hospital pharmacist has a unique opportunity to further the organizational objectives of the hospital by participating in the provision of HHC; a comprehensive market analysis represents a useful method of assessing the benefits and costs associated with providing integrated HHC services.
Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R
The increasing focus on the costs of care is forcing health care organizations to critically look at their basic set of processes and activities, to determine what type of value they can deliver. A business model describes the resources, processes, and cost assumptions that an organization makes that will lead to the delivery of a unique value proposition to a customer. As health care organizations are beginning to transform their structure in preparation for a value-based delivery system, understanding business model theory can help in the redesign process.
Thorpe, Lorna E.; McVeigh, Katharine H.; Perlman, Sharon; Chan, Pui Ying; Bartley, Katherine; Schreibstein, Lauren; Rodriguez-Lopez, Jesica; Newton-Dame, Remle
Introduction: Electronic health records (EHRs) can potentially extend chronic disease surveillance, but few EHR-based initiatives tracking population-based metrics have been validated for accuracy. We designed a new EHR-based population health surveillance system for New York City (NYC) known as NYC Macroscope. This report is the third in a 3-part series describing the development and validation of that system. The first report describes governance and technical infrastructure underlying the NYC Macroscope. The second report describes validation methods and presents validation results for estimates of obesity, smoking, depression and influenza vaccination. In this third paper we present validation findings for metabolic indicators (hypertension, hyperlipidemia, diabetes). Methods: We compared EHR-based estimates to those from a gold standard surveillance source - the 2013–2014 NYC Health and Nutrition Examination Survey (NYC HANES) - overall and stratified by sex and age group, using the two one-sided test of equivalence and other validation criteria. Results: EHR-based hypertension prevalence estimates were highly concordant with NYC HANES estimates. Diabetes prevalence estimates were highly concordant when measuring diagnosed diabetes but less so when incorporating laboratory results. Hypercholesterolemia prevalence estimates were less concordant overall. Measures to assess treatment and control of the 3 metabolic conditions performed poorly. Discussion: While indicator performance was variable, findings here confirm that a carefully constructed EHR-based surveillance system can generate prevalence estimates comparable to those from gold-standard examination surveys for certain metabolic conditions such as hypertension and diabetes. Conclusions: Standardized EHR metrics have potential utility for surveillance at lower annual costs than surveys, especially as representativeness of contributing clinical practices to EHR-based surveillance systems increases. PMID
Bao, Yuhua; Eggman, Ashley; Richardson, Joshua; Bruce, Martha
Objective Depression affects one in four older adults receiving home health care. Medicare policies are influential in shaping home health practice. This study aims to identify Medicare policy areas that are aligned or misaligned with depression care quality improvement in home health care. Methods Qualitative study based on semi-structured interviews with nurses and administrators from five home health agencies in five states (n=20). Digitally recorded interviews were transcribed and analyzed using the grounded theory method. A multi-disciplinary team iteratively developed a codebook from interview data to identify themes. Results Several important Medicare policies are largely misaligned with depression care quality improvement in home health care: Medicare eligibility requirements for patients to remain homebound and to demonstrate a need for skilled care restrict nurses’ abilities to follow up with depressed patients for sufficient length of time; the lack of explicit recognition of nursing time and quality of care in the home health Prospective Payment System (PPS) provides misaligned incentives for depression care; incorporation of a two-item depression screening tool in Medicare-mandated comprehensive patient assessment raised clinician awareness of depression; however, inclusion of the tool at Start-of-Care only but not any other follow-up points limits its potential in assisting nurses with depression care management; under-development of clinical decision support for depression care in vendor-developed electronic health records constitutes an important barrier to depression quality improvement in home health care. Conclusions Several influential Medicare policies and regulations for home health practice may be misaligned with evidence-based depression care for home health patients. PMID:24632686
... Occupational Health Occupational Exposure to HIV: Advice for Health Care Workers Occupational Exposure to HIV: Advice for Health Care Workers Occupational HealthPrevention and WellnessStaying Healthy Share Occupational ...
Schiozer, Rafael Felipe; Saito, Cristiana Checchia; Saito, Richard
This paper analyzes the relationship between the financial health and organizational form of private health care providers in Brazil. It also examines the major determinants of customer satisfaction associated with the provider's organizational form. An adjusted Altman's z-score is used as an indicator of financial health. A proxy variable based on customer complaints filed at the Brazilian National Agency for Supplementary Health is used as an indicator for customer satisfaction. The study uses a sample of 270 private health care providers and their operations over the period 2003-2005. Panel data analysis includes control variables related to market, operations, and management. Principal results indicate that: (1) private health care providers benefit from economies of scale; (2) self-funded health plans have better financial health; (3) spending on marketing does not have a significant impact on customer satisfaction in Brazil; (4) weak empirical evidence exists showing that good financial performance enhances customer's satisfaction.
Levi, J; Kates, J
HIV offers a lens through which the underlying problems of the US health care system can be examined. New treatments offer the potential of prolonged quality of life for people living with HIV if they have adequate access to health care. However, increasing numbers of new cases of HIV occur among individuals with poor access to health care. Restrictions on eligibility for Medicaid (and state-by-state variability) contribute to uneven access to the most important safety net source of HIV care financing, while relatively modest discretionary programs attempt to fill in the gap with an ever-increasing caseload. Many poor people with HIV are going without care, even though aggregate public spending on HIV-related care will total $7.7 billion in fiscal year 2000, an amount sufficient to cover the care costs of one half of those living with HIV. But inefficiencies and inequities in the system (both structural and geographic) require assessment of the steps that can be taken to create a more rational model of care financing for people living with HIV that could become a model for all chronic diseases. PMID:10897178
King, Christopher J; Redwood, Yanique
The ongoing existence of institutionalized racism and discriminatory practices in various systems (education, criminal justice, housing, employment) serve as root causes of poor health in Blacks Lives. Furthermore, these unjust social structures and their complex interplay result in inefficient utilization of health services and reactive or futile interactions with medical providers. Collectively, these factors contribute to racial disparities in health and treatment represents a significant portion of the nation's health care expenditures. In order for health care systems to optimize population health goals, racism must be recognized as a determinant of health. As anchor institutions in their respective communities, we offer hospitals and health systems a conceptual framework to address the issue within internal and external constructs.
Kwakye, Gifty; Brat, Gabriel A; Makary, Martin A
The objective of this study was to identify leading practices to promote environmentally friendly and efficient efforts in the provision of surgical health care. Health care is the second leading contributor to waste in the United States. Despite widespread enthusiasm for "going green" in the US economy, little substantive information is available to the medical community, to our knowledge. We explore safe and efficient strategies for hospitals and providers to protect the environment while delivering high-quality care. We performed a systematic review of the literature using relevant PubMed search terms and surveyed a panel of hospital managers and chief executive officers of health care organizations pursuing green initiatives. Recommendations were itemized and reviewed by a 7-member panel to generate a consensus agreement. We identified 43 published articles and used interview data from the panel. The following 5 green recommendations for surgical practices were identified: operating room waste reduction and segregation, reprocessing of single-use medical devices, environmentally preferable purchasing, energy consumption management, and pharmaceutical waste management. The medical community has a large opportunity to implement green practices in surgical units. These practices can provide significant benefits to the health care community and to the environment. Additional research and advocacy are needed to further explore green practices in health care.
Coddington, D C; Moore, K D; Fischer, E A
Cooperation among the traditionally adversarial factions of physicians and hospitals has arisen in the early 1990s to develop the integrated health care system. Authors Dean C. Coddington, Keith D. Moore and Elizabeth A. Fischer explain how these two groups have been joined in the integration by an unlikely participant: health plans.
A dynamic, proactive health-care environment is beckoning. Fueled by consumer-led awareness, digital television, the Internet and a preoccupation with preventative health maintenance, it will define a new genre of products. In a series of provocative statements, this visionary article explores what the future may hold for diagnostics and medical devices.
Sells, Clifford J.; Paeth, Susan
Basic health and day care policies and procedures should be implemented and closely monitored with the help of a health consultant, particularly in terms of respiratory tract, enteric, skin, invasive bacterial, and multiple system infections; Acquired Immune Deficiency Syndrome; vaccine preventable diseases; and general safety procedures.…
Lincoln, Thomas L.; Korpman, Ralph A.
Discusses the new discipline of medical information science (MIS) and examines some problem-solving approaches used in its application in the clinical laboratory, emphasizing automation by computer technology. The health care field is viewed as one having overlapping domains of clinical medicine, health management and statistics, and fundamental…
address the best method of funding for veterans’ health care, while continuing to focus on ensuring a “seamless transition” process for servicemembers...Health Enrollment Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Table 2. VA Spending and Number of OIF and OEF...Home for Disabled Volunteer Soldiers, administered various benefits for the nation’s veterans. 9 For details on the appeals process , see CRS Report
Kvasnica, Barbara; And Others
The results of a study on the health care needs and utilization patterns of Hispanic (primarily Mexican American) families in southeastern Wisconsin are presented in this report. The methodology of the study, which included two surveys in a 9 county area, is described. Findings of the two studies, one focusing on health services utilization by…
Odeh, Bassel; Kayyali, Reem; Nabhani-Gebara, Shereen; Philip, Nada
The survival rates for patients living with cancer are increasing, due to recent advances in detection, prevention and treatment. It has been estimated that there were 28 million cancer survivors around the world in 2012. In the UK, for patients diagnosed in 2007, it is predicted that more than half of them will survive their cancer for 5 years or more. A large majority of cancer survivors report unmet supportive care needs and distressing symptoms and adverse long-term consequences related to their cancer. Cancer management could be optimized to better meet patients demand through technology, including mobile health (m-Health). m-Health is defined as the use of mobile communications and network technologies for health care. m-Health can help both patients and health-care professionals and play an important part in managing and delivering cancer care including managing side effects, supporting drug adherence, providing cancer information, planning and follow up and detecting and diagnosing cancer. Health authorities have already published guidelines regulating m-Health to insure patient safety and improve the accountability of its applications.
Cinquini, Lino; Vainieri, Milena
In recent years in Italy, as in other European countries, profound changes have been introduced in health care both at central and regional levels. Most of them were oriented towards a shift from 'hospital-centred' health care to health care based more on primary care services. This transition pursues two objectives: giving more effective responses to citizens' needs and reducing public health expenditure. Changes that involve organizational structure must also be carried out with the introduction of measurement tools that can help in planning and can control the changes. The paper provides the results obtained through the experience of modelling a measurement system for primary care carried out in 2004 and 2005 by some territorial managers and controllers in the Tuscan Health system, and the main issues in measuring primary care services emerging from this pilot experience focused on integrated home care services.
Racine, Andrew D
The persistence of child poverty in the United States and the pervasive health consequences it engenders present unique challenges to the health care system. Human capital theory and empirical observation suggest that the increased disease burden experienced by poor children originates from social conditions that provide suboptimal educational, nutritional, environmental, and parental inputs to good health. Faced with the resultant excess rates of pediatric morbidity, the US health care system has developed a variety of compensatory strategies. In the first instance, Medicaid, the federal-state governmental finance system designed to assure health insurance coverage for poor children, has increased its eligibility thresholds and expanded its benefits to allow greater access to health services for this vulnerable population. A second arm of response involves a gradual reengineering of health care delivery at the practice level, including the dissemination of patient-centered medical homes, the use of team-based approaches to care, and the expansion of care management beyond the practice to reach deep into the community. Third is a series of recent experiments involving the federal government and state Medicaid programs that includes payment reforms of various kinds, enhanced reporting, concentration on high-risk populations, and intensive case management. Fourth, pediatric practices have begun to make use of specific tools that permit the identification and referral of children facing social stresses arising from poverty. Finally, constituencies within the health care system participate in enhanced advocacy efforts to raise awareness of poverty as a distinct threat to child health and to press for public policy responses such as minimum wage increases, expansion of tax credits, paid family leave, universal preschool education, and other priorities focused on child poverty.
Seid, Omer; G/Mariam, Yemane; Fekadu, Abel; Wasihun, Yitbarek; Endris, Kedir; Bitew, Abebayehu
Introduction Anemia affects around 38.2% and 22% of pregnant women at a global and national level respectively. In developing countries, women start pregnancy with already depleted body stores of iron and other vitamins with significant variation of anemia within and between regions. Objective To identify the determinants of anemia among pregnant mothers attending antenatal care in Dessie town health facilities, northern central Ethiopia. Methods A health facility based unmatched case control study was conducted among 112 cases and 336 controls from January to March 2016 G.C. The sample size was determined by using Epi Info version 220.127.116.11. Study subjects were selected using consecutive sampling technique. Data were collected using a structured questionnaire, entered using Epi Data version 3.1 and analyzed using SPSS version 20. Bivariable and multivariable logistic regression model was used to see the determinants of anemia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value<0.05 were used to see the significant association. Results Failure to take dark green leafy vegetables per two weeks (AOR = 5.02, 95% CI: 2.16, 11.71), didn’t take chicken per two weeks (AOR = 2.68, 95% CI: 1.22, 5.86), 1st trimester (AOR = 2.07, 95% CI: 1.12, 3.84), 3rd trimester (AOR = 2.96, 95% CI: 1.53, 5.72), HIV infection (AOR = 6.78, 95% CI: 2.28, 20.18) and medication (AOR = 3.57 95% CI: 1.60, 7.98) were positively associated with anemia. Conclusions Inadequate intake of dark green leafy vegetables, inadequate consumption of chicken, trimester of the current pregnancy, HIV infection and medication were the determinants of anemia among pregnant women. Therefore, anemia prevention strategy should include promotion of adequate intake of dark green leafy vegetables and chicken, increase meal pattern during the entire pregnancy and strengthen the prevention of mother to child HIV transmission/antenatal care programs. PMID:28288159
The quality of health care in the United States is not commensurate with its cost. Americans pay more per capita for health care than citizens...Americans lack health care coverage. Although some argue that the United States can claim a quality of health care among the highest in the world, costs...in fact are soaring out of proportion to the quality of care provided to the population as a whole. Market failures prevent the health care industry
Kemper, Kathi J; Gardiner, Paula; Gobble, Jessica; Mitra, Ananda; Woods, Charles
Background Internet education is increasingly provided to health professionals, but little is known about the most effective strategies for delivering the content. The purpose of this study is to compare four strategies for delivering an Internet-based (e-) curriculum on clinicians' knowledge (K), confidence (CONF), and communication (COMM) about herbs and other dietary supplements (HDS). Methods This national randomized 2 × 2 factorial trial included physicians, pharmacists, nurses, nutritionists and trainees in these fields. Participants were randomly assigned to one of four curriculum delivery strategies for 40 brief modules about HDS: a) delivering four (4) modules weekly over ten (10) weeks by email (drip-push); b) modules accessible on web site with 4 reminders weekly for 10 weeks (drip-pull); c) 40 modules delivered within 4 days by email (bolus-push); and d) 40 modules available on the Internet with one email informing participants of availability (bolus-pull). Results Of the 1,267 enrollees, 25% were male; the average age was 40 years. The completion rate was 62%, without significant differences between delivery groups. There were statistically significant improvements in K, CONF and COMM scores after the course (P<0.001 for all), although the difference in COMM was small. There were no significant differences in any of the three outcomes by delivery strategy, but outcomes were better for those who paid for continuing education credit. Conclusion All delivery strategies tested similarly improved K, CONF, COMM scores about HDS. Educators can use the strategy that is most convenient without diminishing effectiveness. Additional curricula may be necessary to make substantial changes in clinicians' communication practices. PMID:16405734
Thompson, Michael; Cutler, Charles M
One of the contributing factors to both the increase in health care costs and the backlash to managed care was the lack of consumer awareness of the cost of health care service, the effect of health care costs on profits and wages, and the need to engage consumers more actively as consumers in health care decisions. This article reviews the birth of the health care consumerism movement and identifies gaps in health care consumerism today. The authors reveal some of the keys to building a sustainable health care consumerism framework, which involves enlisting consumers as well as other stakeholders.
Kim, Tae Jun; Vonneilich, Nico; Lüdecke, Daniel; von dem Knesebeck, Olaf
International studies have repeatedly shown that people with lower income are more likely to experience difficulties to access medical services. Less is known on why these relations vary across countries. This study investigates whether the association between income and financial barriers to health care is influenced by national public health expenditures (PHE, in % of total health expenditure). Data from the International Social Survey Programme (2011) was used (28 countries, 23,669 respondents). Financial barriers were assessed by the individual experience of forgone care due to financial reasons. Monthly equivalent household income was included as the main predictor. Other individual-level control variables were age, gender, education, subjective health, insurance coverage and place of living. PHE was considered as a macro-level predictor, adjusted for total health expenditure. Statistically significant associations between income and forgone care were found in 21 of 28 examined countries. Multilevel analyses across countries revealed that people with lower income have a higher likelihood to forgo needed medical care (OR: 3.94, 95%-CI: 2.96-5.24). After adjustments for individual-level covariates, this association slightly decreased (OR: 2.94, 95%-CI: 2.16-3.99). PHE did not moderate the relation between income and forgone care. The linkage between health system financing and inequalities in access to health care seems to be more complex than initially assumed, pointing towards further research to explore how PHE affects the redistribution of health resources in different health care systems.
Taflinger, Kimberly; West, Elizabeth; Sunderhaus, Janis; Hilton, Irene V
Health centers are unique health care delivery organizations in which multiple disciplines, such as primary care, dental, behavioral health, pharmacy, podiatry, optometry and alternative medicine, are often located at the same site. Because of this characteristic, many health centers have developed systems of integrated care. This paper describes the characteristics of health centers and highlights the integrated health care delivery system of one early adopter health center, Health Partners of Western Ohio.
Dunlop, D W
The economic realities of health sector development in Africa has been analyzed in this paper. Both the global and national macroeconomic context has been defined. Given the available data, it is clear that most African countries face increasingly serious economic realities, such as slow or even declining economic growth (per capita), a depressed food production situation, severe balance of payments crises, and increasing dependence on external financial assistance. Given the limited but increasingly available 1981 and 1982 data, the economic situation in many countries is more constrained than those indicated by the data contained in this paper. In this context, the potential competitive situation facing governmental health care systems was reviewed. In addition, the diversity in the sources of health expenditures between countries in Africa was highlighted. These data provide clear evidence that governments clearly do not finance the entire health care system and that individual payment for service in many countries represent an important source of revenue for many care providers in various health care systems operating in any given country. The potential for governments to finance either an expansion of or improvements to the government component of their health care systems is then reviewed. The highlights of this analysis include the following points. First, the tax structure in many African countries is highly dependent on export and import duties, which in turn creates dependency on sustained foreign demand for exports.(ABSTRACT TRUNCATED AT 250 WORDS)
Baranov, Alexander; Namazova-Baranova, Leyla; Albitskiy, Valeriy; Ustinova, Natalia; Terletskaya, Rimma; Komarova, Olga
We present a historical and analytical overview of the Russian child health care system describing strengths and challenges of the system. Main indicators of social environment and children's health, general demographics, and socioeconomic factors of Russia are described. The Russian health care system has preserved positive elements of the former Soviet model of pediatric care. However, beginning in 1991, it has been altered greatly in its funding and management. The child health care system is composed of a special network of outpatient and inpatient facilities. The key element of pediatric community care is the pediatric polyclinic, staffed by district pediatricians and nurses. Undergraduate pediatric training is separate from adult medical training. From day one onward, future pediatricians are trained at separate pediatric faculties of universities. Thus, they qualify as general pediatricians after only 2 years of postgraduate training. It should be emphasized that the gap between the health status of children in developed countries and the Russian Federation is largely due to the influence of socioeconomic determinants, such as traffic accidents, poverty, pollution, and hazardous life styles, including binge drinking. Further improvements of children's health require protective measures by the state to address the underlying socioeconomic determinants.
The international disparities in health and health-care provision comprise the gravest problem of medical ethics. The implications are explored of three theories of justice: an expanded version of Rawlsian contractarianism, Nozick's historical account, and a consequentialism which prioritizes the satisfaction of basic needs. The second too little satisfies medical needs to be cogent. The third is found to incorporate the strengths of the others, and to uphold fair rules and practices. Like the first, it also involves obligations transcending those to an agent's relations and fellow-citizens. These conclusions are applied to international health-care provision, which they would transform. PMID:2231643
Engebretson, M J; Cembrowski, G S
With the enactment of the Clinical Laboratory Improvement Amendments of 1988 (CLIA 88), the federal government is now using proficiency testing as the primary indicator of laboratory quality. Laboratories with proficiency test failures are now at risk of a variety of harsh penalties including large monetary fines and suspension of operations. To minimize the risk of failed proficiency testing, we initiated a continuous quality improvement program in our general chemistry laboratory in conjunction with the use of a new survey-validated quality control product. This article describes the quality improvement program and our success in reducing the long-term random error in general chemistry. Despite our improvement program, significant analytical errors (greater than 30% of the CLIA limits) still exist in analytes measured by our chemistry analyzer. These errors are present in nearly the same analytes measured by other common chemistry analyzers indicating the need for improvement in their design and manufacture.
Farrar, S.; Kates, N.; Crustolo, A. M.; Nikolaou, L.
OBJECTIVE: To determine whether health care providers are satisfied with an integrated program of mental health care. DESIGN: Surveys using a mailed questionnaire. Surveys were developed for each of the three disciplines; each survey had 30 questions. SETTING: Thirty-six primary care practices in Hamilton, Ont, participating in the Hamilton-Wentworth Health Service Organization's Mental Health Program. PARTICIPANTS: Family physicians, psychiatrists, and mental health counselors providing mental health care in primary care settings. MAIN OUTCOME MEASURE: Satisfaction as shown on 5-point Likert scales. RESULTS: High levels of satisfaction with the model were recorded. Family physicians increased their skills, felt more comfortable with handling mental health problems, and were satisfied with the benefit to their patients. Psychiatrists and counselors were gratified that they were accepted by other members of the primary care team. Areas for improvement included finding space in primary care settings and better scheduling to allow for optimal communication. CONCLUSION: Family physicians, counselors, and psychiatrists expressed great satisfaction with a shared mental health care program based in primary care. PMID:11785279
Son, Esther; Parish, Susan L; Igdalsky, Leah
There is a dearth of information on the quality of health care for Asian American children and particularly Asian children with special health care needs (CSHCN). The goal of this article was to determine whether there were disparities in quality of health care for Asian CSHCN, whose experiences have not been studied. Data were derived from the 2009-2010 National Survey of Children with Special Health Care Needs (ns = 355 non-Hispanic Asian children and 4,343 non-Hispanic white CSHCN). Bivariate and multivariate logistic regression analyses were conducted to examine the relationship between racial identity (that is, non-Hispanic white and non-Hispanic Asian) and quality of health care. Racial disparities in quality of health care were substantial between Asian and white CSHCN in 2009-2010. Asian parents were significantly less likely than white parents to report that their health care provider provided the specific information they needed, helped them feel like a partner in their child's care, and was sensitive to the family's values and customs. The development and testing of specific, targeted policy and practice interventions to reduce disparities in health care quality for these children are urgently needed.
Sung, Su-Ching; Jeng, Cherng-Jye; Lin, Yen-Chin
Female dyspareunia is a serious impairment with a prevalence of up to 39.5%, imposing a significant burden on women's health, relationship, and quality of life. Because the causes of female dyspareunia are associated with multiple biological, medical, psychological, sociocultural, and interpersonal dimensions, all members of the health team should help fill this gap in the total care of the patient. The nurse is an ideal member of the health team to counsel patients in the sensitive and highly charged area of human sexuality. The purpose of this article was to explore the essential components of female dyspareunia from nursing care perspective to help women suffering from dyspareunia. The article provides a set of tools, including description and clinical presentation, obtaining a history and clinical data for the evaluation of dyspareunia, and a counseling tool of the Permission, Limited Information, Specific Suggestions, and Intensive Therapy model; suggestions are also provided for health care professionals during the treatment process.
Geraedts, Max; Selbmann, Hans-Konrad
The German Health Ministry funded 10 demonstration projects and accompanying research of benchmarking in health care. The accompanying research work aimed to infer generalisable findings and recommendations. We performed a meta-evaluation of the demonstration projects and analysed national and international approaches to benchmarking in health care. It was found that the typical benchmarking sequence is hardly ever realised. Most projects lack a detailed analysis of structures and processes of the best performers as a starting point for the process of learning from and adopting best practice. To tap the full potential of benchmarking in health care, participation in voluntary benchmarking projects should be promoted that have been demonstrated to follow all the typical steps of a benchmarking process.