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Sample records for health systems development

  1. Development of the Choctaw Health Delivery System.

    ERIC Educational Resources Information Center

    Nguyen, Binh N.

    The Choctaw Tribe is the first and only tribe to develop a health delivery system to take over an existing Indian Health Service inpatient facility. The takeover was accomplished in January 1984 under the Indian Self-Determination Act through a contract with the Indian Health Service. The Choctaw Health Delivery System includes a 35-bed general…

  2. Development of the Choctaw Health Delivery System.

    ERIC Educational Resources Information Center

    Nguyen, Binh N.

    The Choctaw Tribe is the first and only tribe to develop a health delivery system to take over an existing Indian Health Service inpatient facility. The takeover was accomplished in January 1984 under the Indian Self-Determination Act through a contract with the Indian Health Service. The Choctaw Health Delivery System includes a 35-bed general…

  3. Health Care System Reforms in Developing Countries

    PubMed Central

    Han, Wei

    2012-01-01

    This article proposes a critical but non-systematic review of recent health care system reforms in developing countries. The literature reports mixed results as to whether reforms improve the financial protection of the poor or not. We discuss the reasons for these differences by comparing three representative countries: Mexico, Vietnam, and China. First, the design of the health care system reform, as well as the summary of its evaluation, is briefly described for each country. Then, the discussion is developed along two lines: policy design and evaluation methodology. The review suggests that i) background differences, such as social development, poverty level, and population health should be considered when taking other countries as a model; ii) although demand-side reforms can be improved, more attention should be paid to supply-side reforms; and iii) the findings of empirical evaluation might be biased due to the evaluation design, the choice of outcome, data quality, and evaluation methodology, which should be borne in mind when designing health care system reforms. PMID:25170464

  4. Integrated System Health Management Development Toolkit

    NASA Technical Reports Server (NTRS)

    Figueroa, Jorge; Smith, Harvey; Morris, Jon

    2009-01-01

    This software toolkit is designed to model complex systems for the implementation of embedded Integrated System Health Management (ISHM) capability, which focuses on determining the condition (health) of every element in a complex system (detect anomalies, diagnose causes, and predict future anomalies), and to provide data, information, and knowledge (DIaK) to control systems for safe and effective operation.

  5. Oral health care systems in developing and developed countries.

    PubMed

    Kandelman, Daniel; Arpin, Sophie; Baez, Ramon J; Baehni, Pierre C; Petersen, Poul E

    2012-10-01

    Health care systems are essential for promoting, improving and maintaining health of the population. Through an efficient health service, patients can be advised of disease that may be present and so facilitate treatment; risks factors whose modification could reduce the incidence of disease and illness in the future can be identified, and further, how controlling such factors can contribute to maintain a good quality of life. In developed countries, clinics or hospitals may be supported by health professionals from various specialties that allow their cooperation to benefit the patient; these institutions or clinics may be equipped with the latest technical facilities. In developing countries, health services are mostly directed to provide emergency care only or interventions towards certain age group population. The most common diseases are dental caries and periodontal disease and frequently intervention procedures aim, at treating existing problems and restore teeth and related structure to normal function. It is unfortunate that the low priority given to oral health hinders acquisition of data and establishment of effective periodontal care programmes in developing countries but also in some developed countries where the periodontal profile is also less than satisfactory. Despite the fact that in several developed countries there are advanced programmes oriented to periodontal disease treatments, the concern is related to the lack of preventive oriented treatments. According to data available on periodontal status of populations from developed countries, despite the number of dentists and trained specialists, dental health professionals do not presently meet adequately the need for prevention, focusing mainly on curative care. The need for strengthening disease prevention and health promotion programmes in order to improve oral health conditions and particularly periodontal status in the majority of countries around the world is evident. Unfortunately, in many

  6. Reviewing Health Manpower Development. A Method of Improving National Health Systems. Public Health Papers No. 83.

    ERIC Educational Resources Information Center

    Fulop, Tamas; Roemer, Milton I.

    This guide is intended to assist countries contemplating a comprehensive, action-oriented review of health labor force development to improve their national health systems. Various aspects of the health system infrastructure are examined (major components, organizational structure, coordinating mechanisms, sources of information, and…

  7. The right to health, health systems development and public health policy challenges in Chad.

    PubMed

    Azétsop, Jacquineau; Ochieng, Michael

    2015-02-15

    There is increasing consensus that the right to health can provide ethical, policy and practical groundings for health systems development. The goals of the right to health are congruent with those of health systems development, which are about strengthening health promotion organizations and actions so as to improve public health. The poor shape and performance of health systems in Chad question the extent of realization of the right to health. Due to its comprehensiveness and inclusiveness, the right to health has the potential of being an organizational and a normative backbone for public health policy and practice. It can then be understood and studied as an integral component of health systems development. This paper uses a secondary data analysis of existing documents by the Ministry of Public Health, Institut National de la Statistique, des Etudes Economiques et Démographiques (INSEED), the Ministry of Economy and Agence Française de Cooperation to analyze critically the shape and performance of health systems in Chad based on key concepts and components of the right to health contained in article 12 of the International Covenant on Economic, Social and Cultural Rights, and on General Comment 14. The non-realization of the right to health, even in a consistently progressive manner, raises concerns about the political commitment of state officials to public health, about the justice of social institutions in ensuring social well-being and about individual and public values that shape decision-making processes. Social justice, democratic rule, transparency, accountability and subsidiarity are important groundings for ensuring community participation in public affairs and for monitoring the performance of public institutions. The normative ideals of health systems development are essentially democratic in nature and are rooted in human rights and in ethical principles of human dignity, equality, non-discrimination and social justice. These ideals are grounded

  8. Emergency preparedness and public health systems lessons for developing countries.

    PubMed

    Kruk, Margaret E

    2008-06-01

    Low- and middle-income countries, where emerging diseases often make their debut, are also likely to bear the harshest consequences of a potential influenza pandemic. Yet public health systems in developing countries are underfunded, understaffed, and in many cases struggling to deal with the existing burden of disease. As a result, developed countries are beginning to expand assistance for emergency preparedness to the developing world. Given developing countries' weak infrastructure and many competing public health priorities, it is not clear how to best direct these resources. Evidence from the U.S. and other developed countries suggests that some investments in bioterror and pandemic emergency preparedness, although initially implemented as vertical programs, have the potential to strengthen the general public health infrastructure. This experience may hold some lessons for how global funds for emergency preparedness could be invested in developing countries to support struggling public health systems in responding to current health priorities as well as potential future public health threats.

  9. A vision for child health information systems: developing child health information systems to meet medical care and public health needs.

    PubMed

    Hinman, Alan R; Saarlas, Kristin N; Ross, David A

    2004-11-01

    In both the medical care and public health arenas, a variety of information systems have been developed to serve providers and program managers. In general, these systems have not been designed to share information with other information systems and provide comprehensive information about a child's health status to the information user. A number of initiatives are underway to develop integrated information systems. In December 2003, All Kids Count hosted an invitational conference "Developing Child Health Information Systems to Meet Medical Care and Public Health Needs." Through a series of plenary presentations and breakout discussion groups, participants developed a series of recommendations about governance, economic issues, information infrastructure, and uses of information from integrated child health information systems (CHIS). Common threads in the recommendations were: (1) development of a national coalition of stakeholders to promote integration of separate child health information systems within the context of ongoing national initiatives such as the National Health Information Infrastructure and the Public Health Information Network, (2) the need to develop the business and policy cases for integrated CHIS, (3) the need to develop agreement on standards for collecting and transferring information, and (4) the need to get the word out about the importance of integrating separate CHIS to improve health and health services.

  10. Reforming "developing" health systems: Tanzania, Mexico, and the United States.

    PubMed

    Chernichovsky, Dov; Martinez, Gabriel; Aguilera, Nelly

    2009-01-01

    Tanzania, Mexico, and the United States are at vastly different points on the economic development scale. Yet, their health systems can be classified as "developing": they do not live up to their potential, considering the resources available to them. The three, representing many others, share a common structural deficiency: a segregated health care system that cannot achieve its basic goals, the optimal health of its people, and their possible satisfaction with the system. Segregation follows and signifies first and foremost the lack of financial integration in the system that prevents it from serving its goals through the objectives of equity, cost containment and sustainability, efficient production of care and health, and choice. The chapter contrasts the nature of the developing health care system with the common goals', objectives, and principles of the Emerging Paradigm (EP) in developed, integrated--yet decentralized--systems. In this context, the developing health care system is defined by its structural deficiencies, and reform proposals are outlined. In spite of the vast differences amongst the three countries, their health care systems share strikingly similar features. At least 50% of their total funding sources are private. The systems comprise exclusive vertically integrated, yet segregated, "silos" that handle all systemic functions. These reflect and promote wide variations in health insurance coverage and levels of benefits--substantial portions of their populations are without adequate coverage altogether; a considerable lack of income protection from medical spending; an inability to formalize and follow a coherent health policy; a lack of financial discipline that threatens sustainability and overall efficiency; inefficient production of care and health; and an dissatisfied population. These features are often promoted by the state, using tax money, and donors. The situation can be rectified by (a) "centralizing"--at any level of development

  11. Economic development and the health care system in Hong Kong.

    PubMed

    Chu, D K

    1994-06-01

    This article describes parallel developments of the Hong Kong economy and its health care system. The purpose is to illustrate how the Hong Kong health system evolved in response to external and internal pressures generated by economic prosperity. The Hong Kong system illustrates the importance of clear policy making in the face of these pressures. In particular, issues of investment, financing and distribution of health services are examined in relation to hospital cost control and service accessibility. In the past, health care costs in Hong Kong have been controlled at the expense of limited accessibility of health services. At present, Hong Kong policy-makers are faced with the challenge of maintaining a sharp focus on cost control as they face pressure to expand and improve health care coverage for the citizens. So far they have responded by emphasizing management efficiency through reorganization. It remains to be seen whether this strategy can be successful without passing increased health care costs to the consumers.

  12. Health systems engineering fellowship: curriculum and program development.

    PubMed

    Watts, Bradley V; Shiner, Brian; Cully, Jeffrey A; Gilman, Stuart C; Benneyan, James C; Eisenhauer, William

    2015-01-01

    Industrial engineering and related disciplines have been used widely in improvement efforts in many industries. These approaches have been less commonly attempted in health care. One factor limiting application is the limited workforce resulting from a lack of specific education and professional development in health systems engineering (HSE). The authors describe the development of an HSE fellowship within the United States Department of Veterans Affairs, Veterans Health Administration (VA). This fellowship includes a novel curriculum based on specifically established competencies for HSE. A 1-year HSE curriculum was developed and delivered to fellows at several VA engineering resource centers over several years. On graduation, a majority of the fellows accepted positions in the health care field. Challenges faced in developing the fellowship are discussed. Advanced educational opportunities in applied HSE have the potential to develop the workforce capacity needed to improve the quality of health care.

  13. Developing a Health Care System for Children in Foster Care.

    PubMed

    Greiner, Mary V; Beal, Sarah J

    2017-09-01

    In 2012, the Comprehensive Health Evaluations for Cincinnati's Kids (CHECK) Center was launched at Cincinnati Children's Hospital Medical Center to provide health care for over 1,000 children placed into foster care each year in the Cincinnati community. This consultation model clinical program was developed because children in foster care have been difficult to manage in the traditional health care setting due to unmet health needs, missing medical records, cumbersome state mandates, and transient and impoverished social settings. This case study describes the history and creation of the CHECK Center, demonstrating the development of a successful foster care health delivery system that is inclusive of all community partners, tailored for the needs and resources of the community, and able to adapt and respond to new information and changing systems.

  14. Development of the Learning Health System Researcher Core Competencies.

    PubMed

    Forrest, Christopher B; Chesley, Francis D; Tregear, Michelle L; Mistry, Kamila B

    2017-08-04

    To develop core competencies for learning health system (LHS) researchers to guide the development of training programs. Data were obtained from literature review, expert interviews, a modified Delphi process, and consensus development meetings. The competencies were developed from August to December 2016 using qualitative methods. The literature review formed the basis for the initial draft of a competency domain framework. Key informant semi-structured interviews, a modified Delphi survey, and three expert panel (n = 19 members) consensus development meetings produced the final set of competencies. The iterative development process yielded seven competency domains: (1) systems science; (2) research questions and standards of scientific evidence; (3) research methods; (4) informatics; (5) ethics of research and implementation in health systems; (6) improvement and implementation science; and (7) engagement, leadership, and research management. A total of 33 core competencies were prioritized across these seven domains. The real-world milieu of LHS research, the embeddedness of the researcher within the health system, and engagement of stakeholders are distinguishing characteristics of this emerging field. The LHS researcher core competencies can be used to guide the development of learning objectives, evaluation methods, and curricula for training programs. © Health Research and Educational Trust.

  15. Strengthening public health surveillance and response using the health systems strengthening agenda in developing countries.

    PubMed

    Nsubuga, Peter; Nwanyanwu, Okey; Nkengasong, John N; Mukanga, David; Trostle, Murray

    2010-12-03

    There is increased interest in strengthening health systems for developing countries. However, at present, there is common uncertainty about how to accomplish this task. Specifically, several nations are faced with an immense challenge of revamping an entire system. To accomplish this, it is essential to first identify the components of the system that require modification. The World Health Organization (WHO) has proposed health system building blocks, which are now widely recognized as essential components of health systems strengthening.With increased travel and urbanization, the threat of emerging diseases of pandemic potential is increasing alongside endemic diseases such as human immunodeficiency virus (HIV), tuberculosis (TB), malaria, and hepatitis virus infections. At the same time, the epidemiologic patterns are shifting, giving rise to a concurrent increase in disease burden due to non-communicable diseases. These diseases can be addressed by public health surveillance and response systems that are operated by competent public health workers in core public health positions at national and sub-national levels with a focus on disease prevention.We describe two ways that health ministries in developing countries could leverage President Obama's Global Health Initiative (GHI) to build public health surveillance and response systems using proven models for public health systems strengthening and to create the public health workforce to operate those systems. We also offer suggestions for how health ministries could strengthen public health systems within the broad health systems strengthening agenda. Existing programs (e.g., the Global Vaccine Alliance [GAVI] and the Global Fund Against Tuberculosis, AIDS, and Malaria [GFTAM]) can also adapt their current health systems strengthening programs to build sustainable public health systems.

  16. Development and Application of a Portable Health Algorithms Test System

    NASA Technical Reports Server (NTRS)

    Melcher, Kevin J.; Fulton, Christopher E.; Maul, William A.; Sowers, T. Shane

    2007-01-01

    This paper describes the development and initial demonstration of a Portable Health Algorithms Test (PHALT) System that is being developed by researchers at the NASA Glenn Research Center (GRC). The PHALT System was conceived as a means of evolving the maturity and credibility of algorithms developed to assess the health of aerospace systems. Comprising an integrated hardware-software environment, the PHALT System allows systems health management algorithms to be developed in a graphical programming environment; to be tested and refined using system simulation or test data playback; and finally, to be evaluated in a real-time hardware-in-the-loop mode with a live test article. In this paper, PHALT System development is described through the presentation of a functional architecture, followed by the selection and integration of hardware and software. Also described is an initial real-time hardware-in-the-loop demonstration that used sensor data qualification algorithms to diagnose and isolate simulated sensor failures in a prototype Power Distribution Unit test-bed. Success of the initial demonstration is highlighted by the correct detection of all sensor failures and the absence of any real-time constraint violations.

  17. Developing the African national health research systems barometer.

    PubMed

    Kirigia, Joses Muthuri; Ota, Martin Okechukwu; Senkubuge, Flavia; Wiysonge, Charles Shey; Mayosi, Bongani M

    2016-07-22

    A functional national health research system (NHRS) is crucial in strengthening a country's health system to promote, restore and maintain the health status of its population. Progress towards the goal of universal health coverage in the post-2015 sustainable development agenda will be difficult for African countries without strengthening of their NHRS to yield the required evidence for decision-making. This study aims to develop a barometer to facilitate monitoring of the development and performance of NHRSs in the African Region of WHO. The African national health research systems barometer algorithm was developed in response to a recommendation of the African Advisory Committee for Health Research and Development of WHO. Survey data collected from all the 47 Member States in the WHO African Region using a questionnaire were entered into an Excel spreadsheet and analysed. The barometer scores for each country were calculated and the performance interpreted according to a set of values ranging from 0% to 100%. The overall NHRS barometer score for the African Region was 42%, which is below the average of 50%. Among the 47 countries, the average NHRS performance was less than 20% in 10 countries, 20-40% in 11 countries, 41-60% in 16 countries, 61-80% in nine countries, and over 80% in one country. The performance of NHRSs in 30 (64%) countries was below 50%. An African NHRS barometer with four functions and 17 sub-functions was developed to identify the gaps in and facilitate monitoring of NHRS development and performance. The NHRS scores for the individual sub-functions can guide policymakers to locate sources of poor performance and to design interventions to address them.

  18. Strategic business planning and development for competitive health care systems.

    PubMed

    Nauert, Roger C

    2005-01-01

    The health care industry has undergone enormous evolutionary changes in recent years. Competitive transitions have accelerated the compelling need for aggressive strategic business planning and dynamic system development. Success is driven by organizational commitments to farsighted market analyses, timely action, and effective management.

  19. Afghanistan's basic package of health services: its development and effects on rebuilding the health system.

    PubMed

    Newbrander, William; Ickx, Paul; Feroz, Ferozuddin; Stanekzai, Hedayatullah

    2014-01-01

    In 2001, Afghanistan's Ministry of Public Health inherited a devastated health system and some of the worst health statistics in the world. The health system was rebuilt based on the Basic Package of Health Services (BPHS). This paper examines why the BPHS was needed, how it was developed, its content and the changes resulting from the rebuilding. The methods used for assessing change were to review health outcome and health system indicator changes from 2004 to 2011 structured along World Health Organisation's six building blocks of health system strengthening. BPHS implementation contributed to success in improving health status by translating policy and strategy into practical interventions, focusing health services on priority health problems, clearly defining the services to be delivered at different service levels and helped the Ministry to exert its stewardship role. BPHS was expanded nationwide by contracting out its provision of services to non-governmental organisations. As a result, access to and utilisation of primary health care services in rural areas increased dramatically because the number of BPHS facilities more than doubled; access for women to basic health care improved; more deliveries were attended by skilled personnel; supply of essential medicines increased; and the health information system became more functional.

  20. Afghanistan's Basic Package of Health Services: Its development and effects on rebuilding the health system

    PubMed Central

    Newbrander, William; Ickx, Paul; Feroz, Ferozuddin; Stanekzai, Hedayatullah

    2014-01-01

    In 2001, Afghanistan's Ministry of Public Health inherited a devastated health system and some of the worst health statistics in the world. The health system was rebuilt based on the Basic Package of Health Services (BPHS). This paper examines why the BPHS was needed, how it was developed, its content and the changes resulting from the rebuilding. The methods used for assessing change were to review health outcome and health system indicator changes from 2004 to 2011 structured along World Health Organisation's six building blocks of health system strengthening. BPHS implementation contributed to success in improving health status by translating policy and strategy into practical interventions, focusing health services on priority health problems, clearly defining the services to be delivered at different service levels and helped the Ministry to exert its stewardship role. BPHS was expanded nationwide by contracting out its provision of services to non-governmental organisations. As a result, access to and utilisation of primary health care services in rural areas increased dramatically because the number of BPHS facilities more than doubled; access for women to basic health care improved; more deliveries were attended by skilled personnel; supply of essential medicines increased; and the health information system became more functional. PMID:24865404

  1. Developing Tomorrow's Integrated Community Health Systems: A Leadership Challenge for Public Health and Primary Care

    PubMed Central

    Welton, William E.; Kantner, Theodore A.; Katz, Sheila Moriber

    1997-01-01

    As the nation's health system moves away from earlier models to one grounded in population health and market-based systems of care, new challenges arise for public health professionals, primary care practitioners, health plan and institutional managers, and community leaders. Among the challenges are the need to develop creative concepts of organization and accountability and to assure that dynamic, system-oriented structures support the new kind of leadership that is required. Developing tomorrow's integrated community health systems will challenge the leadership skills and integrative abilities of public health professionals, primary care practitioners, and managers. These leaders and their new organizations must, in turn, assume increased accountability for improving community health. PMID:9184684

  2. Thoughts on the development of active regional public health systems.

    PubMed

    Reis, Ademar Arthur Chioro Dos; Sóter, Ana Paula Menezes; Furtado, Lumena Almeida Castro; Pereira, Silvana Souza da Silva

    2017-04-01

    Decentralization and regionalization are strategic themes for reforms in the health system. This paper analyzes the complex process of health regionalization being developed in Brazil. This paper identifies that the normative framework from the Brazilian National Health System, SUS has made advances with respect to its institutionalization and overcoming the initial centrality involved in municipalization. This has strengthened the development of regionalization and the intergovernmental agreement on health but the evidence points to the need to promote a revision. Based on document analysis, literature review and the views given by the authors involved in management in SUS as well as generating radically different views, the challenges for the construction of a regionalization that is active, is debated. We also discuss: its relations with planning and the dimensioning of service networks, the production of active care networks and shared management spaces, the inter-federative agreements and regional regulations, the capacity to coordinate regional systems and financing and the impact of the political dimension and electoral cycles. Regionalization (and SUS itself) is an open book, therefore ways and possibilities on how to maintain an active form of regionalization can be recommended.

  3. The Centre for International Mental Health Approach to Mental Health System Development

    PubMed Central

    Minas, Harry

    2012-01-01

    Although mental disorders are a major public health problem, the development of mental health services has been a low priority everywhere, particularly in low- and middle-income countries. Recent years have seen a growing understanding of the importance of population mental health and increased attention to the need to developmental health systems for responding to population mental health service needs. In countries and regions where mental health services are all but nonexistent, and in postconflict and postdisaster settings, there are many impediments to establishing or scaling up mental health services. It is frequently necessary to act simultaneously on multiple fronts: generating local evidence that will inform decision makers; developing a policy framework; securing investment; determining the most appropriate service model for the context; training and supporting mental health workers; establishing or expanding existing services; putting in place systems for monitoring and evaluation; and strengthening leadership and governance capabilities. This article presents the approach of the Centre for International Mental Health in the Melbourne School of Population Health to mental health system development, and illustrates the way in which the elements of the program are integrated by giving a brief case example from Sri Lanka. (harv rev psychiatry 2012;20:37–46.) PMID:22335181

  4. Ten years development of human resources in Serbian health system.

    PubMed

    Krstic, Maja; Grozdanov, Jasmina; Ivanovic, Ivan; Korac, Vesna; Vasic, Milena

    2010-01-01

    A key component of any healthcare reform process is to ensure that the services are delivered by the right numbers of staff with appropriate skills and training. In 2007, public health institutions in Serbia had 2% more employees than before the economic transition. Nevertheless, the trend of the total number of employees in the Serbian health care system still preserved a mild rising trend. The most prominent changes in the structure of human resources were effectuated in the total numbers of physicians, nurses and administrative and technical staff. Development of medical science and practice in Serbia is characterized by more intensive processes of specializations, resulting in increased number of specialists among medical doctors. Health care provided in in-patient institutions still employs most of the doctors. The number of unemployed physicians, dentists and pharmacists has been rising since 2000. Another aspect that explains the rise of unemployed, university educated human resources is the rising number of graduated physicians, dentist and pharmacists. Health care policy makers may recognize the need for more integrated planning of human resources in health care, in particular, making management of human resources responsive to system needs and design, instead of vice versa.

  5. Development of the rural health insurance system in China.

    PubMed

    Liu, Yuanli

    2004-05-01

    Ever since the collapse of the once successful Rural Cooperative Medical System (RCMS) in the early 1980s, when China transformed its system of collective agricultural production to private production, many rural communities, especially the poorer residents, have faced several major problems. In 1993, insurance coverage for rural residents was already low, at 12.8%. By 1998, only 9.5% of the rural population was insured. User charges have effectively blocked access for many rural residents who lack adequate income to purchase basic health care when needed. Impoverishment due to medical expenses is also a serious problem, which begs the question: why has there been no vigorous development of the rural health insurance system in China despite the country's rapid economic growth? This paper analyzes the major underlying reasons for the lack of rural health insurance in China. We found that lack of demand for the voluntary community financing schemes and inadequate government policies are the two major hindrances. Recently, the Chinese government announced a new rural health financing policy that relies on 'matching-funds' by the central and local governments as well as household contributions. The potential for success of this new model might be inferred from China's past experiences, as well as from the pilot projects that are underway.

  6. [Health care systems and aspects of health care economics. Sector ophthalmology - part 1: development of the German health care system].

    PubMed

    Kern, T; Kohnen, T

    2010-11-01

    Although many health care reforms have been enacted in the last few years in Germany, many of the key points in the current social health care system have been retained from former times. All those introductions for an effective health care system from the last 150 years beginning with mandatory guild membership via Bismarck's social laws to the modern health care systems in Germany with the current problems of financing the heavy burden in the German budget are reported. Data and facts on the current health care system are provided. In the following two articles of this series ambulatory and inpatient treatment in the light of economic aspects of health care are reported.

  7. Health policy and systems research agendas in developing countries

    PubMed Central

    Gonzalez-Block, Miguel A

    2004-01-01

    Background Health policy and systems research (HPSR) is an international public good with potential to orient investments and performance at national level. Identifying research trends and priorities at international level is therefore important. This paper offers a conceptual framework and defines the HPSR portfolio as a set of research projects under implementation. The research portfolio is influenced by factors external to the research system as well as internal to it. These last include the capacity of research institutions, the momentum of research programs, funding opportunities and the influence of stakeholder priorities and public opinion. These dimensions can vary in their degree of coordination, leading to a complementary or a fragmented research portfolio. Objective The main objective is to identify the themes currently being pursued in the research portfolio and agendas within developing countries and to quantify their frequency in an effort to identify current research topics and their underlying influences. Methods HPSR topics being pursued by developing country producer institutions and their perceived priorities were identified through a survey between 2000 and 2002. The response to a call for letters of intent issued by the Alliance in 2000 for a broad range of topics was also analyzed. The institutions that were the universe of this study consisted of the 176 institutional partners of the Alliance for Health Policy and Systems Research producing research in low and middle income countries outside Europe. HPSR topics as well as the beneficiaries or issues and the health problems addressed were content analyzed. Topics were classified into 19 categories and their frequency analyzed across groups of countries with similar per capita income. Agendas were identified by analyzing the source of funding and of project initiation for projects under implementation. Results The highest ranking topic at the aggregate level is "Sector analysis", followed by

  8. Health policy and systems research agendas in developing countries.

    PubMed

    Gonzalez-Block, Miguel A

    2004-08-05

    BACKGROUND: Health policy and systems research (HPSR) is an international public good with potential to orient investments and performance at national level. Identifying research trends and priorities at international level is therefore important. This paper offers a conceptual framework and defines the HPSR portfolio as a set of research projects under implementation. The research portfolio is influenced by factors external to the research system as well as internal to it. These last include the capacity of research institutions, the momentum of research programs, funding opportunities and the influence of stakeholder priorities and public opinion. These dimensions can vary in their degree of coordination, leading to a complementary or a fragmented research portfolio. OBJECTIVE: The main objective is to identify the themes currently being pursued in the research portfolio and agendas within developing countries and to quantify their frequency in an effort to identify current research topics and their underlying influences. METHODS: HPSR topics being pursued by developing country producer institutions and their perceived priorities were identified through a survey between 2000 and 2002. The response to a call for letters of intent issued by the Alliance in 2000 for a broad range of topics was also analyzed. The institutions that were the universe of this study consisted of the 176 institutional partners of the Alliance for Health Policy and Systems Research producing research in low and middle income countries outside Europe. HPSR topics as well as the beneficiaries or issues and the health problems addressed were content analyzed. Topics were classified into 19 categories and their frequency analyzed across groups of countries with similar per capita income. Agendas were identified by analyzing the source of funding and of project initiation for projects under implementation. RESULTS: The highest ranking topic at the aggregate level is "Sector analysis", followed

  9. Leadership and governance in seven developed health systems.

    PubMed

    Smith, Peter C; Anell, Anders; Busse, Reinhard; Crivelli, Luca; Healy, Judith; Lindahl, Anne Karin; Westert, Gert; Kene, Tobechukwu

    2012-06-01

    This paper explores leadership and governance arrangements in seven developed health systems: Australia, England, Germany, the Netherlands, Norway, Sweden and Switzerland. It presents a cybernetic model of leadership and governance comprising three fundamental functions: priority setting, performance monitoring and accountability arrangements. The paper uses a structured survey to examine critically current arrangements in the seven countries. Approaches to leadership and governance vary substantially, and have to date been developed piecemeal and somewhat arbitrarily. Although there seems to be reasonable consensus on broad goals of the health system there is variation in approaches to setting priorities. Cost-effectiveness analysis is in widespread use as a basis for operational priority setting, but rarely plays a central role. Performance monitoring may be the domain where there is most convergence of thinking, although countries are at different stages of development. The third domain of accountability is where the greatest variation occurs, and where there is greatest uncertainty about the optimal approach. We conclude that a judicious mix of accountability mechanisms is likely to be appropriate in most settings, including market mechanisms, electoral processes, direct financial incentives, and professional oversight and control. The mechanisms should be aligned with the priority setting and monitoring processes.

  10. Developing of National Accreditation Model for Rural Health Centers in Iran Health System

    PubMed Central

    TABRIZI, Jafar Sadegh; GHARIBI, Farid; PIRAHARY, Samereh

    2013-01-01

    Abstract Background The primary health care has notable effects on community health and accreditation is one of the appropriate evaluation methods that led to health system performance improvement, therefore, this study aims to developing of national accreditation model for rural health centers in Iran Health System. Methods Firstly the suitable accreditation models selected to benchmarking worldwide via systematic review, the related books and medical university’s web site surveyed and some interviews hold with experts. Then the obtain standards surveyed from the experts’ perspectives via Delphi technique. Finally, the obtainedmodel assessedvia the experts’ perspective and pilot study. Results The researchers identified JCAHO and CCHSA as the most excellent models. The obtained standards and their quality accepted from experts’ perspective and pilot study, and finally the number of 55 standards acquired. Conclusion The designed model has standards with acceptable quality and quantity, and researchers’ hopeful that its application in rural health centers led to continues quality improvement. PMID:26060646

  11. Assessing & Developing Primary Care for Children: Reforms in Health Systems.

    ERIC Educational Resources Information Center

    Grason, Holly Allen, Ed.; Guyer, Bernard, Ed.

    This publication is a compilation of papers presented at an April 1994 workshop sponsored by the National Center for Education in Maternal and Child Health and the Bureau-funded Johns Hopkins Child and Adolescent Health Policy Center (CAHPC). The papers are as follows: (1) "Defining the Issues and Planning for Change: Health Care Systems,…

  12. Response of health systems to urbanization in developing countries.

    PubMed

    Tabibzadeh, I; Liisberg, E

    1997-01-01

    Equity in access to health care is now accepted as a basic ethical principle for health development. The glaring inequalities in health suffered by poor people living in slums are a strong justification for urgent action. The problem is rapidly increasing.

  13. Development of smart sensing system for structural health monitoring

    NASA Astrophysics Data System (ADS)

    Lu, Kung-Chun; Loh, Chin-Hsiung; Weng, Jian Huang

    2010-04-01

    The objective of this paper is to upgrade a wireless sensing unit which can meet the following requirements: 1) Improvement of system powering and analog signal processing 2) Enhancement of signal resolution and provide reliable wireless communication data, 3) Enhance capability for continuous long-term monitoring. Based on the prototype of the wireless sensing unit developed by Prof. Lynch at the Stanford University, the following upgrading steps are summarized: 1. Reduce system noise by using SMD passive elements and preventing the coupling digital and analog circuits, and increasing the capacity of power. 2. Improve the ADC sampling resolution and accuracy with a higher resolution Analog-to-Digital Converter (ADC): a 24bits ADC with programmable gain amplifier. 3. Improve wireless communication by using the wireless radio 9XTend which supported by the router (Digi MESH) communication function using 900MHz frequency band. Based on the upgrade wireless sensing unit, verification of the new wireless sensing unit was conducted from the ambient vibration survey of a base-isolated building. This new upgrade wireless sensing unit can provide more reliable data for continuous structural health monitoring. Incorporated with the identification software (modified stochastic subspace identification method) the smart sensing system for SHM is developed.

  14. Development of the Space Station Freedom Environmental Health System

    NASA Technical Reports Server (NTRS)

    Richard, Elizabeth E.; Russo, Dane

    1990-01-01

    The Environmental Health System (EHS), a subsystem of the Space Station Freedom (SSF) Crew Health Care System, was established to ensure that crewmembers will have a safe and healthy environment in which to live and work. EHS is comprised of six subsystems: Microbiology, Toxicology, Water Quality, Radiological Health, Vibroacoustics, and Barothermal Physiology. Each subsystem contributes to the overall functions of the EHS including environmental planning, environmental monitoring, environmental monitoring, environmental health assessments, and operations support. The EHS will provide hardware for monitoring the air, water, and internal surfaces of Freedom, including capabilities for inflight sample collection, processing, and analysis. The closed environment of SSF, and its dependence on recycled air and water, will necessitate a reliable monitoring system to alert crewmembers if contamination levels exceed the maximum allowable limits established to ensure crew health and safety. This paper describes the functions and hardware design status of the EHS.

  15. Development of the Space Station Freedom Environmental Health System

    NASA Technical Reports Server (NTRS)

    Richard, Elizabeth E.; Russo, Dane

    1990-01-01

    The Environmental Health System (EHS), a subsystem of the Space Station Freedom (SSF) Crew Health Care System, was established to ensure that crewmembers will have a safe and healthy environment in which to live and work. EHS is comprised of six subsystems: Microbiology, Toxicology, Water Quality, Radiological Health, Vibroacoustics, and Barothermal Physiology. Each subsystem contributes to the overall functions of the EHS including environmental planning, environmental monitoring, environmental monitoring, environmental health assessments, and operations support. The EHS will provide hardware for monitoring the air, water, and internal surfaces of Freedom, including capabilities for inflight sample collection, processing, and analysis. The closed environment of SSF, and its dependence on recycled air and water, will necessitate a reliable monitoring system to alert crewmembers if contamination levels exceed the maximum allowable limits established to ensure crew health and safety. This paper describes the functions and hardware design status of the EHS.

  16. Developing health system surge capacity: community efforts in jeopardy.

    PubMed

    Felland, Laurie E; Katz, Aaron; Liebhaber, Allison; Cohen, Genna R

    2008-06-01

    Since Sept. 11, 2001, communities have responded to the federal call to enhance health care surge capacity--the space, supplies, staffing and management structure to care for many injured or ill people during a terrorist attack, natural disaster or infectious disease pandemic. Communities with varied experience handling emergencies are building broad surge capacity, including transportation, communication, hospital care and handling mass fatalities, according to a new study by the Center for Studying Health System Change (HSC). Communities rely on federal funding to help coordinate and plan across agencies and providers, conduct training and drills, recruit volunteers, and purchase equipment and stockpile supplies. The current federal focus on pandemic influenza has helped prepare for all types of emergencies, although at times communities struggle with fragmented and restrictive funding requirements. Despite progress, communities face an inherent tension in developing surge capacity. The need for surge capacity has increased at the same time that daily health care capacity has become strained, largely because of workforce shortages, reimbursement pressures and growing numbers of uninsured people. Payers do not subsidize hospitals to keep beds empty for an emergency, nor is it practical for trained staff to sit idle until a disaster hits. To compensate, communities are trying to develop surge capacity in a manner that supports day-to-day activities and stretches existing resources in an emergency. Many of these efforts--including integrating outpatient providers, expanding staff roles and adapting standards of care during a large-scale emergency--require greater coordination, guidance and policy support. As time passes since 9/11 and Hurricane Katrina, federal funding for surge capacity has waned, and communities are concerned about losing surge capacity they have built.

  17. Advancing the application of systems thinking in health: managing rural China health system development in complex and dynamic contexts.

    PubMed

    Zhang, Xiulan; Bloom, Gerald; Xu, Xiaoxin; Chen, Lin; Liang, Xiaoyun; Wolcott, Sara J

    2014-08-26

    This paper explores the evolution of schemes for rural finance in China as a case study of the long and complex process of health system development. It argues that the evolution of these schemes has been the outcome of the response of a large number of agents to a rapidly changing context and of efforts by the government to influence this adaptation process and achieve public health goals. The study draws on several sources of data including a review of official policy documents and academic papers and in-depth interviews with key policy actors at national level and at a sample of localities. The study identifies three major transition points associated with changes in broad development strategy and demonstrates how the adaptation of large numbers of actors to these contextual changes had a major impact on the performance of the health system. Further, it documents how the Ministry of Health viewed its role as both an advocate for the interests of health facilities and health workers and as the agency responsible for ensuring that government health system objectives were met. It is argued that a major reason for the resilience of the health system and its ability to adapt to rapid economic and institutional change was the ability of the Ministry to provide overall strategy leadership. Additionally, it postulates that a number of interest groups have emerged, which now also seek to influence the pathway of health system development. This history illustrates the complex and political nature of the management of health system development and reform. The paper concludes that governments will need to increase their capacity to analyze the health sector as a complex system and to manage change processes.

  18. Clinical engineering development in the Uruguayan public health system.

    PubMed

    Di Virgilio, Valerio; Ambrois, Gonzalo

    2010-01-01

    Establishment of the clinical engineering department with a network of 5 operational centers to strengthen public medical equipment management and maintenance, in the context of the Health System reform with the purpose of ensuring universal access to the health services in the Republic of Uruguay.

  19. What can developing economies learn from health system reforms of developed countries?

    PubMed

    Chernichovsky, D

    1995-01-01

    This paper outlines some general lessons developing nations can draw from the health system reform experiences of developed nations. Using the experiences of developed countries, developing countries should be better able to anticipate socio-economic changes and choose an optimal path for their health systems development to accompany those changes. Most developed countries have adopted rather common objectives and principles in their health systems because of market failure in health care; developing countries may start adopting those principles because they do not have market conditions in the first place. It is suggested that developing countries strengthen what is probably the most fundamental initial systemic asset they have: public finance. They should do so by attracting democratically, possibly through earmarked taxes, resources otherwise channelled through the private sector, competing with public finance for limited real resources. This effort can be promoted by giving consumers, mainly of high income groups and in urban areas, more say (through institutions performing the OMCC function) in the nature of care these groups have access to under auspices of public finance. Where feasible, private insurance as a major source of finance should be seen as a transitional phenomenon, giving way to the emergence of OMCC institutions which require similar financial and managerial market infrastructure. Private and competitive provision of care may be unrealistic in many developing areas because of both scarcity of real resources, mainly manpower, and health needs. The challenge of government is, as resources grow, to divest itself from the provision of care and stay involved in activities and facilities that are of 'public nature'--under specific circumstances--that foster private competitive provision. In general, the government should play an enabling role also by investing in health promotions and management skills for health systems.

  20. Financing of health systems to achieve the health Millennium Development Goals in low-income countries.

    PubMed

    Fryatt, Robert; Mills, Anne; Nordstrom, Anders

    2010-01-30

    Concern that underfunded and weak health systems are impeding the achievement of the health Millennium Development Goals in low-income countries led to the creation of a High Level Taskforce on Innovative International Financing for Health Systems in September, 2008. This report summarises the key challenges faced by the Taskforce and its Working Groups. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health. Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health. The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid. The challenges and disagreements that arose during the work of the Taskforce draw attention to the many issues facing decision makers in low-income countries. International donors and recipient governments should work together to improve the evidence base for strengthening health systems, increase long-term commitments, and improve accountability through transparent and inclusive national approaches. Copyright 2010 Elsevier Ltd. All rights reserved.

  1. Marching toward the Millennium Development Goals: what about health systems, health-seeking behaviours and health service utilization in Pakistan?

    PubMed

    Shaikh, Babar T

    2008-01-01

    Attaining the ambitious targets pronounced in the Millennium Development Goals (MDGs) will necessitate radical changes in policy as well as extensive reforms and strong inter-sectoral coordination in the healthcare system of Pakistan. While aiming for such macro-level achievements, it is imperative to analyze the on-the-ground realities of any health system. Improving health systems has the potential to assist progress toward MDGs in the near term by promoting more equitable access and introducing effective interventions. More money allocation and more health spending would not necessarily mean better health for Pakistanis. The complex composition of the healthcare system drives us to study the intricate phenomena of health service utilization and healthcare-seeking behaviours. Such an approach will thus provide evidence to sensitize health personnel to provide more empathetic care and to encourage the community at large to start seeking appropriate and timely healthcare. This paper advocates thinking beyond health services provision by reaching out to people and understanding their perceptions, practices and health-seeking behaviours. Achieving millennium development goals will necessitate interventions that address health issues of women, children and all other vulnerable groups in Pakistan.

  2. Propulsion Health Management System Development for Affordable and Reliable Operation of Space Exploration Systems

    NASA Technical Reports Server (NTRS)

    Melcher, Kevin J.; Maul, William A.; Garg, Sanjay

    2007-01-01

    The constraints of future Exploration Missions will require unique integrated system health management capabilities throughout the mission. An ambitious launch schedule, human-rating requirements, long quiescent periods, limited human access for repair or replacement, and long communication delays, all require an integrated approach to health management that can span distinct, yet interdependent vehicle subsystems, anticipate failure states, provide autonomous remediation and support the Exploration Mission from beginning to end. Propulsion is a critical part of any space exploration mission, and monitoring the health of the propulsion system is an integral part of assuring mission safety and success. Health management is a somewhat ubiquitous technology that encompasses a large spectrum of physical components and logical processes. For this reason, it is essential to develop a systematic plan for propulsion health management system development. This paper provides a high-level perspective of propulsion health management systems, and describes a logical approach for the future planning and early development that are crucial to planned space exploration programs. It also presents an overall approach, or roadmap, for propulsion health management system development and a discussion of the associated roadblocks and challenges.

  3. [E-health developments in the system of health services in Hungary and the European Union].

    PubMed

    Váradi, Ágnes

    2014-05-25

    The question of electronic solutions in public health care has become a contemporary issue at the European Union level since the action plan of the Commission on the e-health developments of the period between 2012 and 2020 has been published. In Hungary this issue has been placed into the centre of attention after a draft on modifications of regulations in health-care has been released for public discourse, which - if accepted - would lay down the basics of an electronic heath-service system. The aim of this paper is to review the basic features of e-health solutions in Hungary and the European Union with the help of the most important pieces of legislation, documents of the European Union institutions and sources from secondary literature. When examining the definition of the basic goals and instruments of the development, differences between the European Union and national approaches can be detected. Examination of recent developmental programs and existing models seem to reveal difficulties in creating interoperability and financing such projects. Finally, the review is completed by the aspects of jurisdiction and fundamental rights. It is concluded that these issues are mandatory to delineate the legislative, economic and technological framework for the development of the e-health systems.

  4. [New developments in the occupational safety and health management system].

    PubMed

    Kondo, Michisuke

    2004-09-01

    The occupational safety and health management system(OSHMS)has been introduced into many companies and factories in Japan. However, there are certain factories that are considering the introduction of OSHMS, while other factories are not interested in it. In the factories which have introduced OSHMS, occupational health activities are still insufficient. Passage by which OSHMS was introduced into Japan and a basic way to advance OSHMS is described in this paper. In addition, for OSHMS to spread to many companies in the future, and to achieve good results, the themes and prospects which should be examined are described. The themes shown in this paper are as follows: risk assessment, revision of the law and regulation, system auditing, individual management of safety and health rules, evaluation of the low concentration exposure influence, appropriate job suitability system, training of the expert, the support organization, supporting small and medium-sized scale factories.

  5. Development and Refinement of a Learning Health Systems Training Program

    PubMed Central

    Wysham, Nicholas G.; Howie, Lynn; Patel, Krish; Cameron, C. Blake; Samsa, Gregory P.; Roe, Laura; Abernethy, Amy P.; Zaas, Aimee

    2016-01-01

    Context: In the emerging Learning Health System (LHS), the application and generation of medical knowledge are a natural outgrowth of patient care. Achieving this ideal requires a physician workforce adept in information systems, quality improvement methods, and systems-based practice to be able to use existing data to inform future care. These skills are not currently taught in medical school or graduate medical education. Case Description: We initiated a first-ever Learning Health Systems Training Program (LHSTP) for resident physicians. The curriculum builds analytical, informatics and systems engineering skills through an active-learning project utilizing health system data that culminates in a final presentation to health system leadership. Findings: LHSTP has been in place for two years, with 14 participants from multiple medical disciplines. Challenges included scheduling, mentoring, data standardization, and iterative optimization of the curriculum for real-time instruction. Satisfaction surveys and feedback were solicited mid-year in year 2. Most respondents were satisfied with the program, and several participants wished to continue in the program in various capacities after their official completion. Major Themes: We adapted our curriculum to successes and challenges encountered in the first two years. Modifications include a revised approach to teaching statistics, smaller cohorts, and more intensive mentorship. We continue to explore ways for our graduates to remain involved in the LHSTP and to disseminate this program to other institutions. Conclusion: The LHSTP is a novel curriculum that trains physicians to lead towards the LHS. Successful methods have included diverse multidisciplinary educators, just in time instruction, tailored content, and mentored projects with local health system impact. PMID:28154832

  6. Neglected organization and management issues in mental health systems development.

    PubMed

    Greenley, J R

    1992-10-01

    Fragmented and often uncoordinated public services for the more severely mentally ill are often characteristic of the current U.S. mental health system. The creation of local mental health authorities has been promoted as part of a solution, as has happened in Wisconsin at the county level and is championed in the ongoing Robert Wood Johnson Foundation funded innovative service sites for severely mentally ill adults. There are indications that these innovative mental health authorities will fall short of fulfilling their promise. Basic principles from the management and organizations literature are used to identify several organization and management issues that may have been neglected. These include resource management, attention to system goals, monitoring and feedback, and the promotion of desirable interorganizational cultures.

  7. Community health equipment loans: developing a clinical prioritization system.

    PubMed

    Oldman, Crystal; Brodie, David; Nmatsakanova, Naira

    2003-06-01

    This project aimed to develop an objective method for making equipment loans to home-based patients using a prioritisation system based on clinical need. An action research approach was selected as the most appropriate method because of the collaborative nature of the project. It involved working mainly with community nurses using questionnaires, focus groups, telephone and direct interviews. An important part of the process was a workshop with all stakeholders to involve them in decision-making. The resulting unique clinical referral form was implemented successfully. The research also highlighted existing attitudes and perceptions of the equipment loans service among health professionals. The new clinical referral form has improved service provision, is more equitable and now allows decisions to be made using agreed clinical criteria. The results of the research have been disseminated locally in the process of integration of NHS and social services equipment loans. This is a unique example of collaboration between community nursing practitioners, primary care trust managers and researchers producing a measurable difference to patient care.

  8. SAMS--a systems architecture for developing intelligent health information systems.

    PubMed

    Yılmaz, Özgün; Erdur, Rıza Cenk; Türksever, Mustafa

    2013-12-01

    In this paper, SAMS, a novel health information system architecture for developing intelligent health information systems is proposed and also some strategies for developing such systems are discussed. The systems fulfilling this architecture will be able to store electronic health records of the patients using OWL ontologies, share patient records among different hospitals and provide physicians expertise to assist them in making decisions. The system is intelligent because it is rule-based, makes use of rule-based reasoning and has the ability to learn and evolve itself. The learning capability is provided by extracting rules from previously given decisions by the physicians and then adding the extracted rules to the system. The proposed system is novel and original in all of these aspects. As a case study, a system is implemented conforming to SAMS architecture for use by dentists in the dental domain. The use of the developed system is described with a scenario. For evaluation, the developed dental information system will be used and tried by a group of dentists. The development of this system proves the applicability of SAMS architecture. By getting decision support from a system derived from this architecture, the cognitive gap between experienced and inexperienced physicians can be compensated. Thus, patient satisfaction can be achieved, inexperienced physicians are supported in decision making and the personnel can improve their knowledge. A physician can diagnose a case, which he/she has never diagnosed before, using this system. With the help of this system, it will be possible to store general domain knowledge in this system and the personnel's need to medical guideline documents will be reduced.

  9. Knowledge management systems for oral health in developing and developed countries.

    PubMed

    Nattestad, Anders

    2012-10-01

    Knowledge management systems utilize information technology to manage knowledge in organizations with the purpose of creating, supporting, storing and disseminating information. These systems have been around for decades, but have significantly changed over time in complexity and features with the evolution of information technology and the Internet. With the development of these new technologies, the concept of knowledge management has thrived and has had significant impact on the way in which knowledge is accumulated, stored and accessed. This article will describe the historical development of knowledge management systems in oral health, illustrate the technology using examples and explore the future use of these systems with emerging technologies such as Google Wave®. One example of how knowledge management systems may affect the quality of dental education is the DentEd project, where a collaborative website was developed to coordinate dental school visitations and collection of reports from working groups, leading to several important publications. MEDLINE is another example of an effective knowledge management system in health care, providing access to health care-related scientific literature, which is highly organized under the auspices of the United States National Library of Medicine. Another and very differently organized example of an effective knowledge management system is Wikipedia, which is a free, web-based, collaborative, multilingual encyclopedia project supported by a nonprofit foundation. The final example of an effective knowledge management system is all of the social media, including Facebook and Twitter. These tools have proven very powerful in organizing and collaborating. In conclusion, the development of new technologies and the Internet have changed the way in which information is developed and accessed. This development is still ongoing and only the future will reveal how this will continue to change. © 2012 John Wiley & Sons A/S.

  10. The development and maturation of a statewide academic health care system: Clarian Health Partners/Indiana University Health.

    PubMed

    Handel, David J; Kleit, Stuart A; Handel, Daniel A

    2014-02-01

    As health care reform continues, health care organizations are evolving both structurally and operationally to position themselves to meet the challenges ahead. Academic medical centers (i.e., teaching hospitals) particularly need an effective strategy that will allow them to meet their tripartite missions of patient care, education, and research in this time of increasing competition and resource constraints. Clarian Health Partners, recently renamed Indiana University Health, is a health care entity that developed from a partnership of the Indiana University Hospitals and Methodist Hospital of Indiana. This case study explores the history behind the development of Clarian Health Partners, the model employed, and the lessons learned. It discusses the governance and management models implemented, the steps taken to integrate the two partners in the new system, and the specific challenges of physician partnerships and collaborations. As mergers and consolidations continue in an era of health care reform, the lessons learned from previous endeavors, such as that of Clarian Health Partners, may be applicable.

  11. Development and status of health insurance systems in China.

    PubMed

    Barber, Sarah L; Yao, Lan

    2011-01-01

    Health insurance programs have changed rapidly over time in China. Among rural populations, insurance coverage shifted from nearly universal levels in the 1970s to 7% in 1999; it stands at 94% of counties in 2009. This large increase is the result of a series of health reforms that aim to achieve universal access to healthcare and better risk protection, largely through the rollout of the health insurance programs and the gradual increase in subsidies and benefits over time. In this paper, we present the development of the rural and urban health insurance programs, their modes of financing and operation and the benefits and reimbursement schemes at the end of 2009. We discuss some of the problems with the rural and urban residents' schemes including reliance on local government capacity, reimbursement ceilings and rates, and incentives for unnecessary care and waste in the design of the programs. Recommendations include increasing financial support and deepening the benefits packages. Strategies to control cost and improve quality include developing mixed provider payment mechanisms, implementing essential medicines policies and strengthening the quality of primary-care provision. Copyright © 2011 John Wiley & Sons, Ltd.

  12. Health systems strengthening in German development cooperation: making the case for a comprehensive strategy.

    PubMed

    Munir, Khullat; Worm, Ilse

    2016-12-03

    In the aftermath of the Ebola crisis and with renewed attention to resilient health systems, the process of improving approaches of global health actors to health systems strengthening is of great relevance. Despite the increased amount of attention paid to health systems strengthening, there is no standard definition of this concept among global health actors. Germany is no exception. Though there have been recent commitments to increase resources allocated to health systems strengthening, German Development Cooperation has no comprehensive strategy for its pursuit. This article sheds light on how HSS can be more clearly defined in German bilateral health cooperation, and makes a case for the adoption of a comprehensive HSS strategy.A strategic analysis of the German Development Cooperation's orientation towards health systems strengthening reveals the focal areas and cross-cutting approaches of Germany's engagement with the health systems strengthening. These elements are then linked to the building blocks of the health system, as defined by the World Health Organization. The resulting framework should be further elaborated with data from implementation to develop a comprehensive health systems strengthening strategy. Both the U.S. and U.K. have also recently reviewed their own health systems strengthening efforts and concluded with clear statements on the need for well-defined health systems strengthening strategies. We argue that in developing such strategies, a sound base can be provided by a health systems strengthening framework that is based on both strategic inputs from existing health policies as well as implementation experiences.Despite its limitations, the current framework provided in this review shows how the German Development Cooperation intends to enact health systems strengthening, and can thus have several uses: (1) ensure the systemic nature of health systems strengthening planning and implementation (2) guide the consistency of Germany

  13. Development of the National Health Information Systems in Botswana: Pitfalls, prospects and lessons.

    PubMed

    Seitio-Kgokgwe, Onalenna; Gauld, Robin D C; Hill, Philip C; Barnett, Pauline

    2015-01-01

    Studies evaluating development of health information systems in developing countries are limited. Most of the available studies are based on pilot projects or cross-sectional studies. We took a longitudinal approach to analysing the development of Botswana's health information systems. We aimed to: (i) trace the development of the national health information systems in Botswana (ii) identify pitfalls during development and prospects that could be maximized to strengthen the system; and (iii) draw lessons for Botswana and other countries working on establishing or improving their health information systems. This article is based on data collected through document analysis and key informant interviews with policy makers, senior managers and staff of the Ministry of Health and senior officers from various stakeholder organizations. Lack of central coordination, weak leadership, weak policy and regulatory frameworks, and inadequate resources limited development of the national health information systems in Botswana. Lack of attention to issues of organizational structure is one of the major pitfalls. The ongoing reorganization of the Ministry of Health provides opportunity to reposition the health information system function. The current efforts including development of the health information management policy and plan could enhance the health information management system.

  14. Development of the National Health Information Systems in Botswana: Pitfalls, prospects and lessons

    PubMed Central

    Seitio-Kgokgwe, Onalenna; Gauld, Robin D. C.; Hill, Philip C.; Barnett, Pauline

    2015-01-01

    Background: Studies evaluating development of health information systems in developing countries are limited. Most of the available studies are based on pilot projects or cross-sectional studies. We took a longitudinal approach to analysing the development of Botswana’s health information systems. Objectives: We aimed to: (i) trace the development of the national health information systems in Botswana (ii) identify pitfalls during development and prospects that could be maximized to strengthen the system; and (iii) draw lessons for Botswana and other countries working on establishing or improving their health information systems. Methods: This article is based on data collected through document analysis and key informant interviews with policy makers, senior managers and staff of the Ministry of Health and senior officers from various stakeholder organizations. Results: Lack of central coordination, weak leadership, weak policy and regulatory frameworks, and inadequate resources limited development of the national health information systems in Botswana. Lack of attention to issues of organizational structure is one of the major pitfalls. Conclusion: The ongoing reorganization of the Ministry of Health provides opportunity to reposition the health information system function. The current efforts including development of the health information management policy and plan could enhance the health information management system. PMID:26392841

  15. School Health Connection Goes Electronic: Developing a Health Information Management System for New Orleans' School-Based Health Centers. Program Results Report

    ERIC Educational Resources Information Center

    Rastorfer, Darl

    2011-01-01

    From February 2008 through April 2011, School Health Connection, a program of the Louisiana Public Health Institute, developed an electronic health information management system for newly established school-based health centers in Greater New Orleans. School Health Connection was established as part of a broader effort to restore community health…

  16. The development of the U.S. Health Care System and the contemporary role of the public health department.

    PubMed

    Grott, Catherine J

    2006-01-01

    The absence of national health care reform and the growing number of uninsured individuals in the United States have prompted states to develop plans to provide medical care for the low income and the indigent. Many local health departments are not only responsible for the core public health functions; but they are increasingly called upon to provide person health care services for those who cannot afford it. This article chronicles the development of the health care system in the United States and describes the contemporary role of the local public health department.

  17. Enumeration of the public health workforce: developing a system.

    PubMed

    Gebbie, K M; Merrill, J

    2001-07-01

    Although it has been of interest to public health leaders, advocates, and policy planners for many years, decades have passed since the last organized count of public health workers. This article reports on methods used by the Columbia University School of Nursing, Center for Health Policy, to enumerate the public health workforce in 57 states and territories based on existing reports, summaries, and surveys. The complexity of public health workforce data is described and the scheme utilized to characterize the workforce using public agency categories is illustrated. The resulting "best current estimate" provokes many questions regarding future policy about a public health workforce database.

  18. Mobile-health approach: a critical look on its capacity to augment health system of developing countries.

    PubMed

    Davey, Sanjeev; Davey, Anuradha; Singh, Jai Vir

    2014-07-01

    The mobile-health approach is currently knocking the doors of public health to make use of this rapidly advancing technology in developing countries; therefore, it needs a critical look on its capacity in improving health system of developing countries. A systematic review of studies in literature published till 31(st) October 2013 of last 10 years on key search word: Capacity of mobile-health in improving health system of developing countries was done from medical search engines abstracting databases such as Pub-med, WHO, Cochrane database, Google scholar, and Bio-med Central. Both types of studies elucidating utility and no benefit of mobile-health in developing countries were included as main criteria for deciding the capacity of mobile-health approach in health system of developing countries. M-health studies on areas of impact, effectiveness, and evaluation and previous reviews, conferences data, and exploratory studies were the main study designs incorporated. Studies on m-health in developed world, Indian studies as well data from thesis or dissertation were excluded in this review. Multi-faceted mobile-health applications, strategies, and approaches currently lack proper regulation and standardization from health care authorities, and currently their results also vary from good to no beneficial effects as found in this review. Umbrella of mobile-health approaches must be used intelligently, keeping in mind the fact that, it can provide a greater access and quality health care to larger segments of a rural population and its potential to improve the capacity of health system in developing countries.

  19. Tunable Laser Development for In-flight Fiber Optic Based Structural Health Monitoring Systems

    NASA Technical Reports Server (NTRS)

    Richards, Lance; Parker, Allen; Chan, Patrick

    2014-01-01

    The objective of this task is to investigate, develop, and demonstrate a low-cost swept lasing light source for NASA DFRC's fiber optics sensing system (FOSS) to perform structural health monitoring on current and future aerospace vehicles. This is the regular update of the Tunable Laser Development for In-flight Fiber Optic Based Structural Health Monitoring Systems website.

  20. Development and deployment of a health information system in transitional countries (croatian experience).

    PubMed

    Stevanovic, Ranko; Pristas, Ivan; Ivicevic Uhernik, Ana; Stanic, Arsen

    2005-01-01

    Croatian Primary Health Care Information System pilot project, conducted between 2001 and 2003, aimed to develop and deploy a health information system based on the latest technologies which would improve the quality of primary health care and rationalise the consumption. 60 primary health care teams (physician and nurse) were equipped with PCs and connected via central server to the main national health insurer, state treasury and public health institute. Developed information system enabled rapid retrieval of documents, replacement of manual data input and a real-time insight into needed information as well as prompt interventions within the system. The project also introduced electronic smart cards for physicians and nurses, so that at each medical check-up the information system verified both the ensuree's and the physician's or nurse's status and rights.Based on the experiences from the pilot project, plan has been made for comprehensive health information system at national level which would connect primary health care teams, hospitals, laboratories, dentistries, health insurance companies, state treasury, public health institutes and electronic health records database. Its major goals are more rapid diagnostics, accuracy in prescribing therapy, standardisation of the good practice as well as better utilisation of capacities, shorter waiting times and shorter stays in hospitals, which would lead to improvement in overall health care quality and better control over the health care consumption. Estimated 5-year investment for installing such system would be 125 million EUR. However, information system could save substantially more and yield a return of investment in only two years.As information system for primary health care should be a strategic component of every health care reform and development plan, we can recommend our model, based on the results of the pilot project, to other transitional countries.

  1. [Health promotion effectiveness: developing and testing a system for routine evaluation in health education, workplace health promotion and setting approach supplied by the German statutory health insurance agencies].

    PubMed

    Kliche, T; Riemann, K; Bockermann, C; Niederbühl, K; Wanek, V; Koch, U

    2011-04-01

    The aim of the study was to develop and test a routine evaluation system for all health promotion and education activities funded by the German statutory health insurance companies. The system aims at measuring both individual health effects and the complex organisational effects of setting projects. Measurement instruments were developed synoptically and tested in three field tests (2003-2008). In order to assess the impact of individual health training, 212 courses of the health insurance companies were evaluated. To assess the setting approach, 56 schools participating in a health-promotion project were included, and for workplace health-promotion 6 projects of different health insurance companies were included. The research design was an observational study. Instead of control groups, individual data were compared to reference values for gender- and age-matched groups from national health surveys. The studies consisted of baseline and final assessment (T1/T2), complemented by a follow-up (T3), all adapted to the time of intervention (i. e., 3-24 months for T1/T2 and 3-18 months for T2/T3). The evaluation system provides multilevel-measurement based upon validated questionnaires for health-related structures and processes in institutions, and for the participating individual's subjective health, health problems, health-related quality of life, workplace and institutional satisfaction. Controlling for central confounders is also possible (input and dosage, age, gender, educational background). Thus, short but valid measurement instruments of high usability are available to evaluate the effectiveness of prevention, health promotion and education.

  2. Mental health system development in Asia: Does Australia have a role?

    PubMed

    Arandjelovic, Katarina; Eyre, Harris A; Forbes, Malcolm P; Bauer, Renee; Aggarwal, Shilpa; Singh, Ajeet B; Baune, Bernhard T; Everall, Ian; Berk, Michael; Ng, Chee

    2016-09-01

    Socioeconomic trends herald what many describe as the Asian Century, whereby Asian economic, political and cultural influence is in global ascendency. Broadening relevant ties between Australia and Asia is evident and logical and may include strengthening alliances in mental health systems. We argue the importance of strengthening Asian mental health systems and some of the roles Australian mental health workers could have in promoting strengthening the Asian mental health system. This paper is a narrative review which sources data from reputable search databases. A well-articulated Australian strategy to support strengthening the mental health system in Asia is lacking. While there are active initiatives operating in this space, these remain fragmented and underdeveloped. Coordinated, collaborative and culturally respectful efforts to enhance health education, research, policy, leadership and development assistance are key opportunities. Psychiatrists and other mental health professionals have a unique opportunity to contribute to improved mental health outcomes in Asia. © The Royal Australian and New Zealand College of Psychiatrists 2016.

  3. Space Flight Software Development Software for Intelligent System Health Management

    NASA Technical Reports Server (NTRS)

    Trevino, Luis C.; Crumbley, Tim

    2004-01-01

    The slide presentation examines the Marshall Space Flight Center Flight Software Branch, including software development projects, mission critical space flight software development, software technical insight, advanced software development technologies, and continuous improvement in the software development processes and methods.

  4. Improving Disaster Response Efforts Through the Development of a Disaster Health Care Response System.

    PubMed

    Wilson, Jonathan A; McKenzie, L Kendall; McLeod, W Terry; Darsey, Damon A; Craig, Jim

    2017-03-17

    We review the development of a disaster health care response system in Mississippi aimed at improving disaster response efforts. Large-scale disasters generate many injured and ill patients, which causes a significant utilization of emergency health care services and often requires external support to meet clinical needs. Disaster health care services require a solid infrastructure of coordination and collaboration to be effective. Following Hurricane Katrina, the state of Mississippi implemented best practices from around the nation to establish a disaster health care response system. The State Medical Response System of Mississippi provides an all-hazards system designed to support local response efforts at the time, scope, and scale required to successfully manage the incident. Components of this disaster health care response system can be replicated or adapted to meet the dynamic landscape of health care delivery following disasters. (Disaster Med Public Health Preparedness. 2017;page 1 of 5).

  5. Organization of ambulatory care provision: a critical determinant of health system performance in developing countries.

    PubMed

    Berman, P

    2000-01-01

    Success in the provision of ambulatory personal health services, i.e. providing individuals with treatment for acute illness and preventive health care on an ambulatory basis, is the most significant contributor to the health care system's performance in most developing countries. Ambulatory personal health care has the potential to contribute the largest immediate gains in health status in populations, especially for the poor. At present, such health care accounts for the largest share of the total health expenditure in most lower income countries. It frequently comprises the largest share of the financial burden on households associated with health care consumption, which is typically regressively distributed. The "organization" of ambulatory personal health services is a critical determinant of the health system's performance which, at present, is poorly understood and insufficiently considered in policies and programmes for reforming health care systems. This article begins with a brief analysis of the importance of ambulatory care in the overall health system performance and this is followed by a summary of the inadequate global data on ambulatory care organization. It then defines the concept of "macro organization of health care" at a system level. Outlined also is a framework for analysing the organization of health care services and the major pathways through which the organization of ambulatory personal health care services can affect system performance. Examples of recent policy interventions to influence primary care organization--both government and nongovernmental providers and market structure--are reviewed. It is argued that the characteristics of health care markets in developing countries and of most primary care goods result in relatively diverse and competitive environments for ambulatory care services, compared with other types of health care. Therefore, governments will be required to use a variety of approaches beyond direct public provision

  6. Organization of ambulatory care provision: a critical determinant of health system performance in developing countries.

    PubMed Central

    Berman, P.

    2000-01-01

    Success in the provision of ambulatory personal health services, i.e. providing individuals with treatment for acute illness and preventive health care on an ambulatory basis, is the most significant contributor to the health care system's performance in most developing countries. Ambulatory personal health care has the potential to contribute the largest immediate gains in health status in populations, especially for the poor. At present, such health care accounts for the largest share of the total health expenditure in most lower income countries. It frequently comprises the largest share of the financial burden on households associated with health care consumption, which is typically regressively distributed. The "organization" of ambulatory personal health services is a critical determinant of the health system's performance which, at present, is poorly understood and insufficiently considered in policies and programmes for reforming health care systems. This article begins with a brief analysis of the importance of ambulatory care in the overall health system performance and this is followed by a summary of the inadequate global data on ambulatory care organization. It then defines the concept of "macro organization of health care" at a system level. Outlined also is a framework for analysing the organization of health care services and the major pathways through which the organization of ambulatory personal health care services can affect system performance. Examples of recent policy interventions to influence primary care organization--both government and nongovernmental providers and market structure--are reviewed. It is argued that the characteristics of health care markets in developing countries and of most primary care goods result in relatively diverse and competitive environments for ambulatory care services, compared with other types of health care. Therefore, governments will be required to use a variety of approaches beyond direct public provision

  7. Developing an automatic accreditation support system of health websites.

    PubMed

    Lai, Min-Ling; Chang, Polun

    2007-10-11

    The annual national quality and accreditation label awarding approach has been used to identify quality health websites since 2002 in Taiwan. Since the accreditation process has resumed great amount of professional manpower every year, this study was designed to simplify the process by using the text categorization and information extraction approach..

  8. Health region development from the perspective of system theory - an empirical cross-regional case study.

    PubMed

    Volgger, Michael; Mainil, Tomas; Pechlaner, Harald; Mitas, Ondrej

    2015-01-01

    Governments are increasingly establishing health regions to deal with current challenges of public health service. These regions are seen as instruments to balance public and private stakeholders, and offer health care to regional citizens as well as to medical/health tourists. However, it is still unclear how the development of such health regions as well as their governance may be conceptualized. We apply Luhmann's system theory approach in the context of a cross-regional case study that compares health region developments in the Autonomous Province of Bolzano-South Tyrol (Italy) with particular regard to the Eastern Dolomites and in the province of Zeeland (the Netherlands). We suggest that Luhmann's system theory provides a useful set of criteria to evaluate and judge health region development. Fully developed health regions can be understood as auto-poietic systems. By emphasizing programs, personnel, and communication channels, these case studies illustrate the suitability of the system theory toolset to analyze the governance and spatial embeddedness of health regions. Additionally, the study contributes to literature by indicating that health regions are closely related to identity issues and to decision making in regions.

  9. Development of structural health monitoring and early warning system for reinforced concrete system

    SciTech Connect

    Iranata, Data E-mail: data@ce.its.ac.id; Wahyuni, Endah; Murtiadi, Suryawan; Widodo, Amien; Riksakomara, Edwin; Sani, Nisfu Asrul

    2015-04-24

    Many buildings have been damaged due to earthquakes that occurred recently in Indonesia. The main cause of the damage is the large deformation of the building structural component cannot accommodate properly. Therefore, it is necessary to develop the Structural Health Monitoring System (SHMS) to measure precisely the deformation of the building structural component in the real time conditions. This paper presents the development of SHMS for reinforced concrete structural system. This monitoring system is based on deformation component such as strain of reinforcement bar, concrete strain, and displacement of reinforced concrete component. Since the deformation component has exceeded the limit value, the warning message can be sent to the building occupies. This warning message has also can be performed as early warning system of the reinforced concrete structural system. The warning message can also be sent via Short Message Service (SMS) through the Global System for Mobile Communications (GSM) network. Hence, the SHMS should be integrated with internet modem to connect with GSM network. Additionally, the SHMS program is verified with experimental study of simply supported reinforced concrete beam. Verification results show that the SHMS has good agreement with experimental results.

  10. Development of structural health monitoring and early warning system for reinforced concrete system

    NASA Astrophysics Data System (ADS)

    Iranata, Data; Wahyuni, Endah; Murtiadi, Suryawan; Widodo, Amien; Riksakomara, Edwin; Sani, Nisfu Asrul

    2015-04-01

    Many buildings have been damaged due to earthquakes that occurred recently in Indonesia. The main cause of the damage is the large deformation of the building structural component cannot accommodate properly. Therefore, it is necessary to develop the Structural Health Monitoring System (SHMS) to measure precisely the deformation of the building structural component in the real time conditions. This paper presents the development of SHMS for reinforced concrete structural system. This monitoring system is based on deformation component such as strain of reinforcement bar, concrete strain, and displacement of reinforced concrete component. Since the deformation component has exceeded the limit value, the warning message can be sent to the building occupies. This warning message has also can be performed as early warning system of the reinforced concrete structural system. The warning message can also be sent via Short Message Service (SMS) through the Global System for Mobile Communications (GSM) network. Hence, the SHMS should be integrated with internet modem to connect with GSM network. Additionally, the SHMS program is verified with experimental study of simply supported reinforced concrete beam. Verification results show that the SHMS has good agreement with experimental results.

  11. Developing Indicators for the Child and Youth Mental Health System in Ontario.

    PubMed

    Yang, Julie; Kurdyak, Paul; Guttmann, Astrid

    2016-01-01

    When the Government of Ontario launched a comprehensive mental health and addictions strategy, the Institute for Clinical Evaluative Sciences (ICES) was tasked with developing a scorecard for ongoing monitoring of the child and youth mental health system. Using existing administrative and survey-based healthcare and education data, researchers at ICES developed a scorecard consisting of 25 indicators that described at-risk populations, child and youth mental healthcare and relevant outcomes. This scorecard is the first in Canada to report on performance indicators for the child and youth mental health system and provides a model for monitoring child and youth mental health using routinely collected administrative data.

  12. The role and uptake of private health insurance in different health care systems: are there lessons for developing countries?

    PubMed Central

    Odeyemi, Isaac AO; Nixon, John

    2013-01-01

    Background Social and national health insurance schemes are being introduced in many developing countries in moving towards universal health care. However, gaps in coverage are common and can only be met by out-of-pocket payments, general taxation, or private health insurance (PHI). This study provides an overview of PHI in different health care systems and discusses factors that affect its uptake and equity. Methods A representative sample of countries was identified (United States, United Kingdom, The Netherlands, France, Australia, and Latvia) that illustrates the principal forms and roles of PHI. Literature describing each country’s health care system was used to summarize how PHI is utilized and the factors that affect its uptake and equity. Results In the United States, PHI is a primary source of funding in conjunction with tax-based programs to support vulnerable groups; in the UK and Latvia, PHI is used in a supplementary role to universal tax-based systems; in France and Latvia, complementary PHI is utilized to cover gaps in public funding; in The Netherlands, PHI is supplementary to statutory private and social health insurance; in Australia, the government incentivizes the uptake of complementary PHI through tax rebates and penalties. The uptake of PHI is influenced by age, income, education, health care system typology, and the incentives or disincentives applied by governments. The effect on equity can either be positive or negative depending on the type of PHI adopted and its role within the wider health care system. Conclusion PHI has many manifestations depending on the type of health care system used and its role within that system. This study has illustrated its common applications and the factors that affect its uptake and equity in different health care systems. The results are anticipated to be helpful in informing how developing countries may utilize PHI to meet the aim of achieving universal health care. PMID:23494071

  13. Public health laboratory systems development in East Africa through training in laboratory management and field epidemiology

    PubMed Central

    Mosha, Fausta; Oundo, Joseph; Mukanga, David; Njenga, Kariuki; Nsubuga, Peter

    2011-01-01

    Laboratories are integral to the delivery of quality health care and for public health functions; however laboratory systems and services are often neglected in resource-poor settings such as the East African region. In order to sustainably strengthen national laboratory systems in resource-poor countries, there is a need to train laboratory personnel to work in clinical as well as public health laboratories. In 2004,Kenya, Uganda, Tanzania, and South Sudan began training public health laboratory workers jointly with field epidemiologists in the Kenya Field Epidemiology and Laboratory Training Program (FELTP), and later through the Tanzania FELTP, as a strategy to strengthen public health laboratories. These programs train laboratory epidemiologists through a two-year public health leadership development course, and also offer various types of short course training for frontline staff. The FELTP laboratory graduates in Kenya, Tanzania, Uganda, and South Sudan are working in their respective countries to strengthen public health laboratory systems while the short course participants provide a pool of frontline implementers with the capacity to support the lower tiers of health systems, as well as serve as surge capacity for the regions and the national level. Through training competent public health laboratory workers, the East African ministries of health, in collaboration with other regional partners and stakeholders are now engaged in developing and implementing a holistic approach that will guarantee an overall strengthening of the health system by using well-trained public health laboratory leaders to drive the process. Strengthening public health laboratory medicine in East Africa is critical to improve health-care systems. The experience with the FELTP model in East Africa is a step in the right direction towards ensuring a stronger role for the laboratory in public health. PMID:22359702

  14. Analyzing the Historical Development and Transition of the Korean Health Care System.

    PubMed

    Lee, Sang-Yi; Kim, Chul-Woung; Seo, Nam-Kyu; Lee, Seung Eun

    2017-08-01

    Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system. We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation's economic development or governing strategy changes in response to changes in international circumstances such as globalization. The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea's private-dominant health care provision system unchanged over several decades. Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state's power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe.

  15. Integration of user centered design in the development of health monitoring system for elderly.

    PubMed

    Jia, Guifeng; Zhou, Jie; Yang, Pan; Lin, Chengyu; Cao, Xia; Hu, Hua; Ning, Gangmin

    2013-01-01

    This paper presents a health monitoring system by incorporating the approach of user centered design (UCD) for enhancing system usability for the elderly. The system is designed for monitoring cardiovascular diseases (CVD) related physiological signals including electrocardiogram (ECG), pulse wave (PW) and body weight (BW). Ease of use and non-obtrusiveness are two key requirements for design criteria. Our health monitoring system is designed on three levels: personal medical device layer, mobile application layer and remote central service layer. A chair-based apparatus was built for physiological signal acquisition and a mobile application was developed for data delivery and health management. Finally, usability evaluation was conducted and the system efficiency was quantitatively analyzed by system usability scale (SUS). The results demonstrate that the performance of the system is acceptable for the elderly and the UCD principle is helpful for health system design.

  16. Developing Crew Health Care and Habitability Systems for the Exploration Vision

    NASA Technical Reports Server (NTRS)

    Laurini, Kathy; Sawin, Charles F.

    2006-01-01

    This paper will discuss the specific mission architectures associated with the NASA Exploration Vision and review the challenges and drivers associated with developing crew health care and habitability systems to manage human system risks. Crew health care systems must be provided to manage crew health within acceptable limits, as well as respond to medical contingencies that may occur during exploration missions. Habitability systems must enable crew performance for the tasks necessary to support the missions. During the summer of 2005, NASA defined its exploration architecture including blueprints for missions to the moon and to Mars. These mission architectures require research and technology development to focus on the operational risks associated with each mission, as well as the risks to long term astronaut health. This paper will review the highest priority risks associated with the various missions and discuss NASA s strategies and plans for performing the research and technology development necessary to manage the risks to acceptable levels.

  17. Towards responsible system development in health services: a discourse analysis study of design conflict resolution tactics.

    PubMed

    Irestig, Magnus; Timpka, Toomas

    2010-02-01

    We set out to examine design conflict resolution tactics used in development of large information systems for health services and to outline the design consequences for these tactics. Discourse analysis methods were applied to data collected from meetings conducted during the development of a web-based system in a public health context. We found that low risk tactics were characterized by design issues being managed within the formal mandate and competences of the design group. In comparison, high risk tactics were associated with irresponsible compromises, i.e. decisions being passed on to others or to later phases of the design process. The consequence of this collective disregard of issues such as responsibility and legitimacy is that the system design will be impossible to implement in factual health service contexts. The results imply that downstream responsibility issues have to be continuously dealt with in system development in health services.

  18. Developing Crew Health Care and Habitability Systems for the Exploration Vision

    NASA Technical Reports Server (NTRS)

    Laurini, Kathy; Sawin, Charles F.

    2006-01-01

    This paper will discuss the specific mission architectures associated with the NASA Exploration Vision and review the challenges and drivers associated with developing crew health care and habitability systems to manage human system risks. Crew health care systems must be provided to manage crew health within acceptable limits, as well as respond to medical contingencies that may occur during exploration missions. Habitability systems must enable crew performance for the tasks necessary to support the missions. During the summer of 2005, NASA defined its exploration architecture including blueprints for missions to the moon and to Mars. These mission architectures require research and technology development to focus on the operational risks associated with each mission, as well as the risks to long term astronaut health. This paper will review the highest priority risks associated with the various missions and discuss NASA s strategies and plans for performing the research and technology development necessary to manage the risks to acceptable levels.

  19. Developing a decision support system to link health technology assessment (HTA) reports to the health system policies in Iran.

    PubMed

    Yazdani, Shahram; Jadidfard, Mohammad-Pooyan

    2017-05-01

    The recent increase of 'Health Technology Assessment' (HTA)-related activities in Iran has necessitated the clarification of policy-making process based on the HTA reports. This study aimed to develop a Decision Support System (DSS) in order to adopt evidence-informed policies regarding health technologies in Iran. The study can be classified as Health Policy and Systems Research. A core panel of seven experts conducted two separate reviews of relevant literature for: 1- Determining the potential technology-related policies. 2- Listing the criteria influencing those policy decisions. The policies and criteria were separately discussed and subsequently rated for appropriateness and necessity during two expert meetings in 2013. In the next step, The 'Discrete Choice Experiment' (DCE) method was employed to develop the DSS for the final technology-related policies. Accordingly, the core panel members independently rated the appropriateness of each policy for 30 virtual technologies based on the random values assigned to all the criteria for each technology. The obtained data for each policy were separately analysed using stepwise regression model, resulting in a minimal set of independent and statistically significant criteria contributing in the experts' judgments about the appropriateness of that policy. The obtained regression coefficients were used as the relative weights of the different levels of the final criteria of any policy statement, shaping the decision support scoring tool for each policy. The study has outlined 64 policy decisions under 7 macro policy areas concerning a health technology. Also, 34 criteria used for making those policy decisions have been organized within a portfolio. DCE, using stepwise regression, resulted in 64 scoring tools shaping the DSS for all HTA-related policies. Both the results and methodology of the study may serve as a guide for policy makers (researchers), particularly in low and middle income countries, in developing

  20. Development and implementation of a clinical and business intelligence system for the Florida health data warehouse.

    PubMed

    AlHazme, Raed H; Rana, Arif M; De Lucca, Michael

    2014-01-01

    To develop and implement a Clinical and Business Intelligence (CBI) system for the Florida Health Data Warehouse (FHDW) in order to bridge the gap between Florida's healthcare stakeholders and the health data archived in FHWD. A gap analysis study has been conducted to evaluate the technological divide between the relevant users and FHWD health data, which is maintained by the Broward Regional Health Planning Council (BRHPC). The study revealed a gap between the health care data and the decision makers that utilize the FHDW data. To bridge the gap, a CBI system was proposed, developed and implemented by BRHPC as a viable solution to address this issue, using the System Development Life Cycle methodology. The CBI system was successfully implemented and yielded a number of positive outcomes. In addition to significantly shortening the time required to analyze the health data for decision-making processes, the solution also provided end-users with the ability to automatically track public health parameters. A large amount of data is collected and stored by various health care organizations at the local, state, and national levels. If utilized properly, such data can go a long way in optimizing health care services. CBI systems provide health care organizations with valuable insights for improving patient care, tracking trends for medical research, and for controlling costs. The CBI system has been found quite effective in bridging the gap between Florida's healthcare stake holders and FHDW health data. Consequently, the solution has improved in the planning and coordination of health care services for the state of Florida.

  1. Development and Implementation of a Clinical and Business Intelligence System for the Florida Health Data Warehouse

    PubMed Central

    AlHazme, Raed H.; Rana, Arif M.; De Lucca, Michael

    2014-01-01

    Objective To develop and implement a Clinical and Business Intelligence (CBI) system for the Florida Health Data Warehouse (FHDW) in order to bridge the gap between Florida’s healthcare stakeholders and the health data archived in FHWD. Materials and Methods A gap analysis study has been conducted to evaluate the technological divide between the relevant users and FHWD health data, which is maintained by the Broward Regional Health Planning Council (BRHPC). The study revealed a gap between the health care data and the decision makers that utilize the FHDW data. To bridge the gap, a CBI system was proposed, developed and implemented by BRHPC as a viable solution to address this issue, using the System Development Life Cycle methodology. Results The CBI system was successfully implemented and yielded a number of positive outcomes. In addition to significantly shortening the time required to analyze the health data for decision-making processes, the solution also provided end-users with the ability to automatically track public health parameters. Discussion A large amount of data is collected and stored by various health care organizations at the local, state, and national levels. If utilized properly, such data can go a long way in optimizing health care services. CBI systems provide health care organizations with valuable insights for improving patient care, tracking trends for medical research, and for controlling costs. Conclusion The CBI system has been found quite effective in bridging the gap between Florida’s healthcare stake holders and FHDW health data. Consequently, the solution has improved in the planning and coordination of health care services for the state of Florida. PMID:25379128

  2. Coordinating Systems of Care Using Health Information Technology: Development of the ADHD Care Assistant

    ERIC Educational Resources Information Center

    Power, Thomas J.; Michel, Jeremy; Mayne, Stephanie; Miller, Jeffrey; Blum, Nathan J.; Grundmeier, Robert W.; Guevara, James P.; Fiks, Alexander G.

    2016-01-01

    Perhaps the two principal venues for the delivery of mental health services are schools and primary care practices. Unfortunately, these systems of care are poorly connected, which may result in care that is fragmented and suboptimal. This article describes the development and implementation of an electronic health record portal, known as the ADHD…

  3. Coordinating Systems of Care Using Health Information Technology: Development of the ADHD Care Assistant

    ERIC Educational Resources Information Center

    Power, Thomas J.; Michel, Jeremy; Mayne, Stephanie; Miller, Jeffrey; Blum, Nathan J.; Grundmeier, Robert W.; Guevara, James P.; Fiks, Alexander G.

    2016-01-01

    Perhaps the two principal venues for the delivery of mental health services are schools and primary care practices. Unfortunately, these systems of care are poorly connected, which may result in care that is fragmented and suboptimal. This article describes the development and implementation of an electronic health record portal, known as the ADHD…

  4. Combining Global Elimination Of Measles And Rubella With Strengthening Of Health Systems In Developing Countries.

    PubMed

    Andrus, Jon Kim; Cochi, Stephen L; Cooper, Louis Z; Klein, Jonathan D

    2016-02-01

    Global efforts to eliminate measles and rubella can be combined with other actions to accelerate the strengthening of health systems in developing countries. However, there are several challenges standing in the way of successfully combining measles and rubella vaccination campaigns with health systems strengthening. Those challenges include the following: achieving universal vaccine coverage while integrating the initiative with other primary care strategies and developing the necessary health system resilience to confront emergencies, ensuring epidemiological and laboratory surveillance of vaccine-preventable diseases, developing the human resources needed to effectively manage and implement national strategies, increasing community demand for health services, and obtaining long-term political support. We describe lessons learned from the successful elimination of measles and rubella in the Americas and elsewhere that strive to strengthen national health systems to both improve vaccine uptake and confront emerging threats. The elimination of measles and rubella provides opportunities for nations to strengthen health systems and thus to both reduce inequities and ensure national health security. Project HOPE—The People-to-People Health Foundation, Inc.

  5. [Contributions to the development of a public health information system. SESPAS Report 2010].

    PubMed

    García León, Francisco Javier; Fernández Merino, Juan Carlos

    2010-12-01

    New public health laws are a conceptual and methodological adaptation of public health to current social needs, their common link being the incorporation of health in all policies. This represents a new strategic approach that will require different information systems, which should incorporate the rapid advances made in the field of information technology and communication. The aim of this article was to identify the most important aspects to be taken into account in information systems in public health from a technological perspective, both in their development and in the elements that compose them. To overcome the fragmentation of information systems in public health, these systems must be successfully integrated among themselves and with other health and non-health systems. To achieve this task, technical, semantic and organizational interoperability must be ensured. Emerging technologies should be considered to support these new strategies, especially Web 2.0 tools. This new strategic development will pose additional challenges because of its size and the diversity of the departments involved. It is proposed that information systems will include the elements of Web 2.0 and support systems for decision-making technologies in addition to the traditional operational systems. Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

  6. Human rights and health systems development: confronting the politics of exclusion and the economics of inequality.

    PubMed

    Maru, Duncan; Farmer, Paul

    2012-12-15

    The social movements of the last two decades have fostered a rights-based approach to health systems development within the global discourse on national and international health governance. In this piece, we discuss ongoing challenges in the cavernous "implementation gap": translating legislative human rights victories into actual practice and delivery. Using accompaniment as an underlying principle, we focus primarily on constructing effective, equitable, and accountable public sector health systems. Public sector health care delivery is challenged by increasingly exclusive politics and inequitable economic policies that fundamentally limit the participatory power of marginalized citizens. Finally, we discuss the role of implementation science in closing the delivery gap in human rights practice.

  7. Primary Care Behavioral Health Provider Training: Systematic Development and Implementation in a Large Medical System.

    PubMed

    Dobmeyer, Anne C; Hunter, Christopher L; Corso, Meghan L; Nielsen, Matthew K; Corso, Kent A; Polizzi, Nicholas C; Earles, Jay E

    2016-09-01

    The expansion of integrated, collaborative, behavioral health services in primary care requires a trained behavioral health workforce with specific competencies to deliver effective, evidence-informed, team-based care. Most behavioral health providers do not have training or experience working as primary care behavioral health consultants (BHCs), and require structured training to function effectively in this role. This article discusses one such training program developed to meet the needs of a large healthcare system initiating widespread implementation of the primary care behavioral health model of service delivery. It details the Department of Defense's experience in developing its extensive BHC training program, including challenges of addressing personnel selection and hiring issues, selecting a model for training, developing and implementing a phased training curriculum, and improving the training over time to address identified gaps. Future directions for training improvements and lessons learned in a large healthcare system are discussed.

  8. Development of a Bilingual MS-Specific Health Classification System

    PubMed Central

    Bouchard, Vanessa; Moriello, Carolina; Mayo, Nancy E.

    2016-01-01

    Objective: The global aim of this study was to contribute to the development of the Preference-Based Multiple Sclerosis Index (PBMSI). The specific objective of this foundational work was to qualitatively review the items selected for inclusion in the PBMSI using expert and patient feedback. Methods: Cognitive interviews were conducted with patients with multiple sclerosis (MS) in English and French. The verbal probing method was used to conduct the interviews. For each PBMSI item, the interviewer probed for specific information on what types of difficulty participants had with the item and the basis for their response for each item. Furthermore, respondents were asked to provide information on the clarity of the item, the meaning of the item, the appropriateness of the response options, and the recall period. All interviews were recorded using a digital voice recorder and were transcribed onto a computer. Results: The mean age of the 22 respondents was 52 years, and 82% were women. Mean time since diagnosis was 12 years, and the highest level of education completed was university or college for 86% of the sample. Modifications were made to each item in terms of recall period, instructions, and phrasing. Conclusions: Patient and expert feedback allowed us to clarify items, simplify language, and make items more uniform in terms of their instructions and response options. This qualitative review process will increase accuracy of reporting and reduce measurement error for the PBMSI. PMID:27134579

  9. A Population Health Approach to System Transformation for Children's Healthy Development.

    PubMed

    Dworkin, Paul H; Sood, Aradhana Bela

    2016-04-01

    What if the goal of child health services was not "merely" treating, or even preventing, childhood diseases and disorders, but was expanded to that of promoting children's optimal healthy development? Pediatrics has evolved from an exclusive focus on the treatment of illness to the opportunity to promote children's healthy development. This evolution has profound implications for the content of child health services and programs, for system transformation, and for public policy. Enhanced understanding of the impact of social determinants on children's health and developmental outcomes underscores the importance of an evolving framework for system transformation with key policy implications.

  10. Development of a web-based epidemiological surveillance system with health system response for improving maternal and newborn health: Field-testing in Thailand.

    PubMed

    Liabsuetrakul, Tippawan; Prappre, Tagoon; Pairot, Pakamas; Oumudee, Nurlisa; Islam, Monir

    2017-06-01

    Surveillance systems are yet to be integrated with health information systems for improving the health of pregnant mothers and their newborns, particularly in developing countries. This study aimed to develop a web-based epidemiological surveillance system for maternal and newborn health with integration of action-oriented responses and automatic data analysis with results presentations and to assess the system acceptance by nurses and doctors involved in various hospitals in southern Thailand. Freeware software and scripting languages were used. The system can be run on different platforms, and it is accessible via various electronic devices. Automatic data analysis with results presentations in the forms of graphs, tables and maps was part of the system. A multi-level security system was incorporated into the program. Most doctors and nurses involved in the study felt the system was easy to use and useful. This system can be integrated into country routine reporting system for monitoring maternal and newborn health and survival.

  11. Development of a Video Coding Scheme for Analyzing the Usability and Usefulness of Health Information Systems.

    PubMed

    Kushniruk, Andre W; Borycki, Elizabeth M

    2015-01-01

    Usability has been identified as a key issue in health informatics. Worldwide numerous projects have been carried out in an attempt to increase and optimize health system usability. Usability testing, involving observing end users interacting with systems, has been widely applied and numerous publications have appeared describing such studies. However, to date, fewer works have been published describing methodological approaches to analyzing the rich data stream that results from usability testing. This includes analysis of video, audio and screen recordings. In this paper we describe our work in the development and application of a coding scheme for analyzing the usability of health information systems. The phases involved in such analyses are described.

  12. [Assessment system for watershed ecological health in the United States: development and application].

    PubMed

    Zhang, Hua; Luo, Yong-Ming

    2013-07-01

    To meet the water quality goals of the Clean Water Act, the environmental agencies in the United States (U.S.) have developed a comprehensive ecological assessment system of watershed health in the last two decades. The system employs a watershed approach, and includes a large set of hydrological, chemical, and biological indices, having become an essential part of the watershed water quality management system in the U.S. and provided strong support for the protection of water environment and the restoration of aquatic system. In this paper, the development and application of the ecological assessment system of watershed health by the U.S. environmental regulators, especially the U.S. Environmental Protection Agency (US EPA), were overviewed from the aspects of related laws and regulations, ecosystem function analysis, ecological health indicators, comprehensive assessment system, and monitoring and data management systems, and the health assessment systems for the rivers, lakes, estuaries, coasts, and wetlands adopted by the National$t1-1-1 Aquatic Resource Surveys (NARS) were introduced. Some suggestions for the future development of the scientific ecological assessment system of watershed health in China were put forward based on the understanding of the protection and remediation practices of our water environment.

  13. Early Warning System for Disasters within Health Organizations: A Mandatory System for Developing Countries

    PubMed Central

    Zaboli, Rouhollah; Seyedin, SeyedHesam; Malmoon, Zainab

    2013-01-01

    Background: Disaster identification and alert systems can be processed in dif­ferent ways. An early warning system is designed to detect impending danger and send appropriate and clear signals to at risk communities and organizations at the right time and in an unambiguous way. This study aimed to determine early warning system for disaster within health organization in Iran. Methods:This article presents the findings of a mixed-methods study of early warning systems for disaster management within the health organizations in Iran. During the years 2011 to 2012, a sample of 230 health managers was surveyed using a questionnaire and 65 semi-structured interviews were conducted with public health and therapeutic affairs managers who were responsible for disaster management. Results: A range of problems were identified. Although there is a multi-agency alert system within the health organizations, other indicators of early warning system are not satisfactory. Furthermore, standard messages which are used to alert organizations are not used under the current system. Conclusion: Some activities such as memorandum of understanding among different stakeholders of disaster response and education of staff and communities could improve the response to disasters within the health organizations. PMID:24688976

  14. Developing data elements for research information system in health; a starting point for systems integration.

    PubMed

    Ghorbani, Nr; Ahmadi, M; Sadoughi, F; Ghanei, M

    2012-01-01

    This study defines necessary data elements required for the research information system in the domain of health, and its level of accountability to national health research indicators from the experts' perspective is being explored. This qualitative study was conducted based on comparative approach using the focus group method. Data were collected through 6 semi-structured group discussions held at the Undersecretary for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran. For this study, 48 researchers were selected for the group discussions. All interviews and group discussions were recorded and transcribed. The Data analysis was performed simultaneously using Strauss and Corbin method. BASED ON CONTENT ANALYSIS, THE NECESSARY DATA ELEMENTS IDENTIFIED FOR THE NATIONAL HEALTH RESEARCH INFORMATION SYSTEM DESIGNED FOR ALL DATABASES WERE THE FOLLOWING: organizations, researchers, journals, articles, research projects and dissertations. Also, extracted from the focus group discussion were three main themes regarding data elements of these databases for the National Health Research Information System: 1) essential elements for each database 2) the system's data elements accountability to the national indicators in the domain of health research and 3) recommendations in the direction of optimizing the data. The results obtained from this study can serve as a valuable source in designing research information system in the domain of health within the country and in the region as well.

  15. Developing a ubiquitous health management system with healthy diet control for metabolic syndrome healthcare in Taiwan.

    PubMed

    Kan, Yao-Chiang; Chen, Kai-Hong; Lin, Hsueh-Chun

    2017-06-01

    Self-management in healthcare can allow patients managing their health data anytime and everywhere for prevention of chronic diseases. This study established a prototype of ubiquitous health management system (UHMS) with healthy diet control (HDC) for people who need services of metabolic syndrome healthcare in Taiwan. System infrastructure comprises of three portals and a database tier with mutually supportive components to achieve functionality of diet diaries, nutrition guides, and health risk assessments for self-health management. With the diet, nutrition, and personal health database, the design enables the analytical diagrams on the interactive interface to support a mobile application for diet diary, a Web-based platform for health management, and the modules of research and development for medical care. For database integrity, dietary data can be stored at offline mode prior to transformation between mobile device and server site at online mode. The UHMS-HDC was developed by open source technology for ubiquitous health management with personalized dietary criteria. The system integrates mobile, internet, and electronic healthcare services with the diet diary functions to manage healthy diet behaviors of users. The virtual patients were involved to simulate the self-health management procedure. The assessment functions were approved by capturing the screen snapshots in the procedure. The proposed system development was capable for practical intervention. This approach details the expandable framework with collaborative components regarding the self-developed UHMS-HDC. The multi-disciplinary applications for self-health management can support the healthcare professionals to reduce medical resources and improve healthcare effects for the patient who requires monitoring personal health condition with diet control. The proposed system can be practiced for intervention in the hospital. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Developing Data Elements for Research Information System in Health; a Starting Point for Systems Integration

    PubMed Central

    Ghorbani, NR; Ahmadi, M; Sadoughi, F; Ghanei, M

    2012-01-01

    Background: This study defines necessary data elements required for the research information system in the domain of health, and its level of accountability to national health research indicators from the experts’ perspective is being explored. Methods: This qualitative study was conducted based on comparative approach using the focus group method. Data were collected through 6 semi-structured group discussions held at the Undersecretary for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran. For this study, 48 researchers were selected for the group discussions. All interviews and group discussions were recorded and transcribed. The Data analysis was performed simultaneously using Strauss and Corbin method. Results: Based on content analysis, the necessary data elements identified for the National Health Research Information System designed for all databases were the following: organizations, researchers, journals, articles, research projects and dissertations. Also, extracted from the focus group discussion were three main themes regarding data elements of these databases for the National Health Research Information System: 1) essential elements for each database 2) the system’s data elements accountability to the national indicators in the domain of health research and 3) recommendations in the direction of optimizing the data. Conclusions: The results obtained from this study can serve as a valuable source in designing research information system in the domain of health within the country and in the region as well. PMID:23641388

  17. [Experience of the Mexican National Health System in the development of clinical practice guidelines].

    PubMed

    Sosa-García, Jesús Ojino; Nieves-Hernández, Pedro; Puentes-Rosas, Esteban; Pineda-Pérez, Dayana; Viniegra-Osorio, Arturo; Torres-Arreola, Laura del Pilar; Valenzuela-Flores, Adriana Abigail; Barragán-Padilla, Sergio Baltazar; Díaz-González, Ruth; Chávez-Valdez, Lizbeth; Ramírez-López, Juan Carlos

    2016-01-01

    Clinical practice guidelines are tools that have been able to streamline decisions made in health issues and to decrease the gap between clinical action and scientific evidence. The objective of the study is to share the experience in the development and to update the guidelines by the National Health System of Mexico. The methodology in the development of the guidelines consists of 5 phases: prioritisation, establishment of work groups, development by adoption of international guidelines of de novo, validation and integration in the Master catalogue of clinical practice guidelines for its dissemination. The Master catalogue of clinical practice guidelines contains 664 guidelines, distributed in 42% Internal Medicine, 22% Surgery, 24% Pediatrics and 12% Gynecology. From the total of guidelines coverage is granted at an 85% of the Universal catalogue of health services, an 84% of the Catastrophic expenses protection fund and a 61% of the XXI Century Medical Insurance of the National Commission of Social Protection in Health. The result is the sum of a great effort of coordination and cooperation between the institutions of the National Health System, political wills and a commitment of 3,477 health professionals that participate in guidelines' development and update. Master catalogue guidelines' integration, diffusion and implantation improve quality of attention and security of the users of the National Health System. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  18. Development of village doctors in China: financial compensation and health system support.

    PubMed

    Hu, Dan; Zhu, Weiming; Fu, Yaqun; Zhang, Minmin; Zhao, Yang; Hanson, Kara; Martinez-Alvarez, Melisa; Liu, Xiaoyun

    2017-07-01

    Since 1968, China has trained about 1.5 million barefoot doctors in a few years' time to provide basic health services to 0.8 billion rural population. China's Ministry of Health stopped using the term of barefoot doctor in 1985, and changed policy to develop village doctors. Since then, village doctors have kept on playing an irreplaceable role in China's rural health, even though the number of village doctors has fluctuated over the years and they face serious challenges. United Nations declared Sustainable Development Goals in 2015 to achieve universal health coverage by 2030. Under this context, development of Community Health workers (CHWs) has become an emerging policy priority in many resource-poor developing countries. China's experiences and lessons learnt in developing and maintaining village doctors may be useful for these developing countries. This paper aims to synthesis lessons learnt from the Chinese CHW experiences. It summarizes China's experiences in exploring and using strategic partnership between the community and the formal health system to develop CHWs in the two stages, the barefoot doctor stage (1968 -1985) and the village doctor stage (1985-now). Chinese and English literature were searched from PubMed, CNKI and Wanfang. The information extracted from the selected articles were synthesized according to the four partnership strategies for communities and health system to support CHW development, namely 1) joint ownership and design of CHW programmes; 2) collaborative supervision and constructive feedback; 3) a balanced package of incentives, both financial and non-financial; and 4) a practical monitoring system incorporating data from the health system and community. The study found that the townships and villages provided an institutional basis for barefoot doctor policy, while the formal health system, including urban hospitals, county health schools, township health centers, and mobile medical teams provided training to the barefoot

  19. Tuberculosis in Asia and the pacific: the role of socioeconomic status and health system development.

    PubMed

    Wu, Jie; Dalal, Koustuv

    2012-01-01

    To identify the relationship between socioeconomic status, health system development and the incidence, prevalence and mortality of tuberculosis in Asia and the Pacific. Incidence, prevalence and mortality rates of tuberculosis and 20 variables of socioeconomic, health system and biological-behavioral issues were included in the study involving all 46 countries of the Asian Development Bank region (2007 data). Both univariate and multivariate linear regressions were used. The worst three tuberculosis affected countries were Cambodia, India and Indonesia, while the least affected was Australia. Tuberculosis incidence, prevalence and mortality rate were higher in countries with lower human development index, corruption perception index, gross domestic product (GDP) per capita and countries with more people under minimum food supplements. Among the health system variables, total health expenditure per capita, governmental health expenditure per capita, hospital beds, and access to improved water and sanitation were strongly associated with tuberculosis. Socioeconomic determinants and health system development have significant effect on the control of tuberculosis in Asia and the Pacific region. The study has some policy implications by means of lowering the corruption and improving the sanitation.

  20. Tuberculosis in Asia and the Pacific: The Role of Socioeconomic Status and Health System Development

    PubMed Central

    Wu, Jie; Dalal, Koustuv

    2012-01-01

    Objective: To identify the relationship between socioeconomic status, health system development and the incidence, prevalence and mortality of tuberculosis in Asia and the Pacific. Methods: Incidence, prevalence and mortality rates of tuberculosis and 20 variables of socioeconomic, health system and biological–behavioral issues were included in the study involving all 46 countries of the Asian Development Bank region (2007 data). Both univariate and multivariate linear regressions were used. Results: The worst three tuberculosis affected countries were Cambodia, India and Indonesia, while the least affected was Australia. Tuberculosis incidence, prevalence and mortality rate were higher in countries with lower human development index, corruption perception index, gross domestic product (GDP) per capita and countries with more people under minimum food supplements. Among the health system variables, total health expenditure per capita, governmental health expenditure per capita, hospital beds, and access to improved water and sanitation were strongly associated with tuberculosis. Conclusions: Socioeconomic determinants and health system development have significant effect on the control of tuberculosis in Asia and the Pacific region. The study has some policy implications by means of lowering the corruption and improving the sanitation. PMID:22355472

  1. Developing nursing capacity for health systems and services research in Cuba, 2008-2011.

    PubMed

    Martínez, Nelcy

    2012-07-01

    Health systems and services research by nursing personnel could inform decision-making and nursing care, providing evidence concerning quality of and patient satisfaction. Such studies are rather uncommon in Cuban research institutes, where clinical research predominates. Assess the results of a strategy implemented between 2008 and 2011 to develop nursing capacity for health systems and services research in 14 national research institutes based in Havana. The study comprised four stages: description of approaches to health systems and services research by nurses worldwide and in Cuba; analysis of current capacities for such research in Cuba; intervention design and implementation; and evaluation. Various techniques were used including: literature review, bibliometric analysis, questionnaire survey, consultation with experts, focus groups, and workshops for participant orientation and design and followup of research projects. Qualitative information reduction and quantitative information summary methods were used. Initially, 32 nursing managers participated; a further 105 nurses from the institutes were involved in research teams formed during intervention implementation. Of all published nursing research articles retrieved, 8.9% (185 of 2081) concerned health systems and services research, of which 26.5% (49 of 185) dealt with quality assessment. At baseline, 75% of Cuban nurses surveyed had poor knowledge of health systems and services research. Orientation, design and followup workshops for all institute teams developed individual and institutional capacity for health systems and services research. Post-intervention, 84.7% (27) of nurses reached good knowledge and 14.3% (5) fair; institutional research teams were formed and maintained in 9 institutes, and 13 projects designed and implemented (11 institutional, 2 addressing ministerial-level priorities) to research nursing issues at selected centers. A systematic strategy to build nursing capacity for health

  2. Developing a European internet and kiosk-based health information system

    PubMed Central

    Parr, Gerard; Logan, Mark; Neely, Hayley; Roesner, Dietmar; Dürer, Uew

    2001-01-01

    A consortium of partner organisations (universities, health care organisations and information technology companies) from Northern Ireland, Germany, Portugal and Italy have collaborated to develop a multi-lingual, multi-media Internet and kiosk-based health information system in cardiology and skin cancer. The project, CATCH II (Citizens Advisory System based on Telematics for Communication and Health), has been funded by the European Commission under the Fourth Framework Research and Development TELEMATICS Applications Program (TAP), Health Care Sector. In this paper we provide an overview of the system and the methodological approach adopted. Key characteristics with respect to the technical architecture and flexible customisation of different web and kiosk-based versions will be presented. In particular, the development of dedicated software for the procurement, structuring and management of the information knowledge-base is illustrated. Some of the most interesting findings from a cross-national study of 'health information needs on the internet' are presented along with information on the validation of the system by the general public, content providers and health care authorities. PMID:11720948

  3. Developing a European Internet and kiosk-based health information system.

    PubMed

    Moor, A; Parr, G; Logan, M; Neely, H; Roesner, D; Dürer, U

    2001-01-01

    A consortium of partner organisations (universities, health care organisations and information technology companies) from Northern Ireland, Germany, Portugal and Italy have collaborated to develop a multi-lingual, multi-media Internet and kiosk-based health information system in cardiology and skin cancer. The project, CATCH II (Citizens Advisory System based on Telematics for Communication and Health), has been funded by the European Commission under the Fourth Framework Research and Development TELEMATICS Applications Program (TAP), Health Care Sector. In this paper we provide an overview of the system and the methodological approach adopted. Key characteristics with respect to the technical architecture and flexible customisation of different web and kiosk-based versions will be presented. In particular, the development of dedicated software for the procurement, structuring and management of the information knowledge-base is illustrated. Some of the most interesting findings from a cross-national study of health information needs on the internet are presented along with information on the validation of the system by the general public, content providers and health care authorities.

  4. Health information and communication system for emergency management in a developing country, Iran.

    PubMed

    Seyedin, Seyed Hesam; Jamali, Hamid R

    2011-08-01

    Disasters are fortunately rare occurrences. However, accurate and timely information and communication are vital to adequately prepare individual health organizations for such events. The current article investigates the health related communication and information systems for emergency management in Iran. A mixed qualitative and quantitative methodology was used in this study. A sample of 230 health service managers was surveyed using a questionnaire and 65 semi-structured interviews were also conducted with public health and therapeutic affairs managers who were responsible for emergency management. A range of problems were identified including fragmentation of information, lack of local databases, lack of clear information strategy and lack of a formal system for logging disaster related information at regional or local level. Recommendations were made for improving the national emergency management information and communication system. The findings have implications for health organizations in developing and developed countries especially in the Middle East. Creating disaster related information databases, creating protocols and standards, setting an information strategy, training staff and hosting a center for information system in the Ministry of Health to centrally manage and share the data could improve the current information system.

  5. Framework for assessing governance of the health system in developing countries: gateway to good governance.

    PubMed

    Siddiqi, Sameen; Masud, Tayyeb I; Nishtar, Sania; Peters, David H; Sabri, Belgacem; Bile, Khalif M; Jama, Mohamed A

    2009-04-01

    Governance is thought to be a key determinant of economic growth, social advancement and overall development, as well as for the attainment of the MDGs in low- and middle-income countries. Governance of the health system is the least well-understood aspect of health systems. A framework for assessing health system governance (HSG) at national and sub-national levels is presented, which has been applied in countries of the Eastern Mediterranean. In developing the HSG framework key issues considered included the role of the state vs. the market; role of the ministries of health vs. other state ministries; role of actors in governance; static vs. dynamic health systems; and health reform vs. human rights-based approach to health. Four existing frameworks were considered: World Health Organization's (WHO) domains of stewardship; Pan American Health Organization's (PAHO) essential public health functions; World Bank's six basic aspects of governance; and United Nations Development Programme (UNDP) principles of good governance. The proposed HSG assessment framework includes the following 10 principles-strategic vision, participation and consensus orientation, rule of law, transparency, responsiveness, equity and inclusiveness, effectiveness and efficiency, accountability, intelligence and information, and ethics. The framework permits 'diagnoses of the ills' in HSG at the policy and operational levels and points to interventions for its improvement. In the case of Pakistan, where the framework was applied, a positive aspect was the growing participation and consensus orientation among stakeholders, while weaknesses were identified in relation to strategic vision, accountability, transparency, effectiveness and efficiency and rule of law. In using the HSG framework it needs to be recognized that the principles are value driven and not normative and are to be seen in the social and political context; and the framework relies on a qualitative approach and does not follow a

  6. Medical Education Capacity-Building Partnerships for Health Care Systems Development.

    PubMed

    Rabin, Tracy L; Mayanja-Kizza, Harriet; Rastegar, Asghar

    2016-07-01

    Health care workforce development is a key pillar of global health systems strengthening that requires investment in health care worker training institutions. This can be achieved by developing partnerships between training institutions in resource-limited and resource-rich areas and leveraging the unique expertise and opportunities both have to offer. To realize their full potential, however, these relationships must be equitable. In this article, we use a previously described global health ethics framework and our ten-year experience with the Makerere University-Yale University (MUYU) Collaboration to provide an example of an equity-focused global health education partnership. © 2016 American Medical Association. All Rights Reserved. ISSN 2376-6980.

  7. Integrating Continuing Professional Development With Health System Reform: Building Pillars of Support.

    PubMed

    Davis, David A; Rayburn, William F

    2016-01-01

    Clinical failures sparked a widespread desire for health system reform at the beginning of the 21st century, but related efforts have resulted in changes that are either slow or nonexistent. In response, academic medicine has moved in two directions: (1) system-wide reform using electronic health records, practice networks, and widespread data applications (a macro pathway); and (2) professional development of individual clinicians through continuous performance improvement (a micro pathway). Both pathways exist to improve patient care and population health, yet each suffers from limitations in widespread implementation. The authors call for a better union between these two parallel pathways through four pillars of support: (1) an acknowledgment that both pathways are essential to each other and to the final outcome they intend to achieve, (2) a strong faculty commitment to educate about quality improvement and patient safety at all education levels, (3) a reengineering of tools for professional development to serve as effective change agents, and (4) the development of standards to sustain this alignment of pathways. With these pillars of support integrating continuing professional development with health system reform, the authors envision a better functioning system, with improved metrics and value to enhance patient care and population health.

  8. Developing a Health Information Technology Systems Matrix: A Qualitative Participatory Approach

    PubMed Central

    Chavez, Margeaux; Nazi, Kim M; Antinori, Nicole

    2016-01-01

    Background The US Department of Veterans Affairs (VA) has developed various health information technology (HIT) resources to provide accessible veteran-centered health care. Currently, the VA is undergoing a major reorganization of VA HIT to develop a fully integrated system to meet consumer needs. Although extensive system documentation exists for various VA HIT systems, a more centralized and integrated perspective with clear documentation is needed in order to support effective analysis, strategy, planning, and use. Such a tool would enable a novel view of what is currently available and support identifying and effectively capturing the consumer’s vision for the future. Objective The objective of this study was to develop the VA HIT Systems Matrix, a novel tool designed to describe the existing VA HIT system and identify consumers’ vision for the future of an integrated VA HIT system. Methods This study utilized an expert panel and veteran informant focus groups with self-administered surveys. The study employed participatory research methods to define the current system and understand how stakeholders and veterans envision the future of VA HIT and interface design (eg, look, feel, and function). Directed content analysis was used to analyze focus group data. Results The HIT Systems Matrix was developed with input from 47 veterans, an informal caregiver, and an expert panel to provide a descriptive inventory of existing and emerging VA HIT in four worksheets: (1) access and function, (2) benefits and barriers, (3) system preferences, and (4) tasks. Within each worksheet is a two-axis inventory. The VA’s existing and emerging HIT platforms (eg, My HealtheVet, Mobile Health, VetLink Kiosks, Telehealth), My HealtheVet features (eg, Blue Button, secure messaging, appointment reminders, prescription refill, vet library, spotlight, vitals tracker), and non-VA platforms (eg, phone/mobile phone, texting, non-VA mobile apps, non-VA mobile electronic devices, non

  9. Developing a Health Information Technology Systems Matrix: A Qualitative Participatory Approach.

    PubMed

    Haun, Jolie N; Chavez, Margeaux; Nazi, Kim M; Antinori, Nicole

    2016-10-06

    The US Department of Veterans Affairs (VA) has developed various health information technology (HIT) resources to provide accessible veteran-centered health care. Currently, the VA is undergoing a major reorganization of VA HIT to develop a fully integrated system to meet consumer needs. Although extensive system documentation exists for various VA HIT systems, a more centralized and integrated perspective with clear documentation is needed in order to support effective analysis, strategy, planning, and use. Such a tool would enable a novel view of what is currently available and support identifying and effectively capturing the consumer's vision for the future. The objective of this study was to develop the VA HIT Systems Matrix, a novel tool designed to describe the existing VA HIT system and identify consumers' vision for the future of an integrated VA HIT system. This study utilized an expert panel and veteran informant focus groups with self-administered surveys. The study employed participatory research methods to define the current system and understand how stakeholders and veterans envision the future of VA HIT and interface design (eg, look, feel, and function). Directed content analysis was used to analyze focus group data. The HIT Systems Matrix was developed with input from 47 veterans, an informal caregiver, and an expert panel to provide a descriptive inventory of existing and emerging VA HIT in four worksheets: (1) access and function, (2) benefits and barriers, (3) system preferences, and (4) tasks. Within each worksheet is a two-axis inventory. The VA's existing and emerging HIT platforms (eg, My HealtheVet, Mobile Health, VetLink Kiosks, Telehealth), My HealtheVet features (eg, Blue Button, secure messaging, appointment reminders, prescription refill, vet library, spotlight, vitals tracker), and non-VA platforms (eg, phone/mobile phone, texting, non-VA mobile apps, non-VA mobile electronic devices, non-VA websites) are organized by row. Columns

  10. A predictive model of the development of national mental health systems.

    PubMed

    Hudson, Christopher G

    2010-12-01

    An emerging body of research in the field of international mental health, in part stimulated by the World Mental Health Survey Initiative, has made only limited progress in understanding variations in levels of development in mental health services across nations. However, the World Health Organization's recent initiatives involving the Assessment Instrument for Mental Health Systems (WHO-AIMS) and its publication of the Mental Health Atlas now present new opportunities for understanding transnational mental health policy development. This study, thus, aims to increase understanding of the dimensions and conditions associated with the differential levels of development of national mental health. Specifically, it addresses two questions: Are there one or multiple dimensions characteristic of this development? What are the relative contributions of demographic, economic, political, social, cultural, and geographic conditions in predicting the levels of various nations on these dimensions? This study employs a secondary analysis of existing data derived from both WHO's Mental Health Atlas and other archival sources to address the above questions. Analyses of patterns of missing data supported decisions to restrict the sample to 138 nations. The first question on dimensions of development was addressed with a Varimax factor analysis using a matrix of polychoric, tetrachoric, and Pearson correlations. Factor scores were calculated for the resulting three factors, and to address the second question on predictors, these were each analyzed with multiple regression models. Three orthogonal or uncorrelated dimensions were identified that are characteristic of the 138 nations: (i) General Mental Health Services (professionals and inpatient beds), (ii) Public Mental Health Program; and (iii) Community Mental Health that collectively accounted for 45% of the variance in the database of WHO predictors. Only one, General Mental Health Services, was substantially explained (Adj. R

  11. Development and evaluation of a mental health care system at a Japanese company.

    PubMed

    Ariyoshi, Hiromi

    2009-02-01

    Compared with other industrialized countries, the suicide rate in Japan is high. The purpose of this research was to evaluate the mental health care offered at a newspaper facing organizational restructuring and with an aging work force. The Health and Safety Committee played a central role in the creation and application of a new mental health care system. This plan, developed to meet the on-site dynamics of the company, was based on the Ministry of Health, Labour and Welfare's "Guide for Workers' Mental Health Promotion in the Workplace" Executive officers' roles were defined at the directors' meetings, and the Health and Safety Committee held Listening Skills Seminars for executive personnel. As a result, the mental health care system functioned effectively and fostered the care of two presenting employees (i.e., one with slight depression with chronic lumbago and the other with alcohol dependency). In addition, the number of workers who took 4 or more days of sick leave decreased from 31 of 190 in 1996 to 5 of 108 in 2004, with no psychologically related absences. Moreover, the number of industrial injuries declined from 8 cases in 1996 to 0 cases in 2004, and no occupational deaths or early retirements occurred between the fiscal years of 1996 and 2004. As a result of this research at the company, a worksite where repeated large-scale organizational restructuring has occurred, the mental health care system functioned effectively and contributed to a decrease in the rate of sick leave taken by workers.

  12. Ukraine: Health system review.

    PubMed

    Lekhan, Valery; Rudiy, Volodymyr; Richardson, Erica

    2010-01-01

    The HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Ukrainian health system has preserved the fundamental features of the Soviet Semashko system against a background of other changes, which are developed on market economic principles. The transition from centralized financing to its extreme decentralization is the main difference in the health system in comparison with the classic Soviet model. Health facilities are now functionally subordinate to the Ministry of Health, but managerially and financially answerable to the regional and local self-government, which has constrained the implementation of health policy and fragmented health financing. Health care expenditure in Ukraine is low by regional standards and has not increased significantly as a proportion of gross domestic product (GDP) since the mid 1990s; expenditure cannot match the constitutional guarantees of access to unlimited care. Although prepaid schemes such as sickness funds are growing in importance, out-of-pocket payments account for 37.4% of total health expenditure. The core challenges for Ukrainian health care therefore remain the ineffective protection of the population from the risk of catastrophic health care costs and the structural inefficiency of the health system, which is caused by the inefficient system of health care financing. Health system weaknesses are highlighted by increasing rates of avoidable mortality. Recent political impasse has complicated health system reforms and policy-makers face significant challenges in overcoming popular distrust and

  13. Establishing a harmonized haemophilia registry for countries with developing health care systems.

    PubMed

    Alzoebie, A; Belhani, M; Eshghi, P; Kupesiz, A O; Ozelo, M; Pompa, M T; Potgieter, J; Smith, M

    2013-09-01

    Over recent decades tremendous progress has been made in diagnosing and treating haemophilia and, in resource-rich countries, life expectancy of people with haemophilia (PWH) is now close to that of a healthy person. However, an estimated 70% of PWH are not diagnosed or are undertreated; the majority of whom live in countries with developing health care systems. In these countries, designated registries for people with haemophilia are often limited and comprehensive information on the natural history of the disease and treatment outcomes is lacking. Taken together, this means that planning efforts for future treatment and care of affected individuals is constrained in countries where it is most needed. Establishment of standardized national registries in these countries would be a step towards obtaining reliable sociodemographic and clinical data for an entire country. A series of consensus meetings with experts from widely differing countries with different health care systems took place to discuss concerns specific to countries with developing health care systems. As a result of these discussions, recommendations are made on parameters to include when establishing and harmonizing national registries. Such recommendations should enable countries with developing health care systems to establish standardized national haemophilia registries. Although not a primary objective, the recommendations should also help standardized data collation on an international level, enabling treatment and health care trends to be monitored across groups of countries and providing data for advocacy purposes. Greater standardization of data collation should have implications for optimizing resources for haemophilia care both nationally and internationally.

  14. Development and Application of a Structural Health Monitoring System Based on Wireless Smart Aggregates.

    PubMed

    Yan, Shi; Ma, Haoyan; Li, Peng; Song, Gangbing; Wu, Jianxin

    2017-07-17

    Structural health monitoring (SHM) systems can improve the safety and reliability of structures, reduce maintenance costs, and extend service life. Research on concrete SHMs using piezoelectric-based smart aggregates have reached great achievements. However, the newly developed techniques have not been widely applied in practical engineering, largely due to the wiring problems associated with large-scale structural health monitoring. The cumbersome wiring requires much material and labor work, and more importantly, the associated maintenance work is also very heavy. Targeting a practical large scale concrete crack detection (CCD) application, a smart aggregates-based wireless sensor network system is proposed for the CCD application. The developed CCD system uses Zigbee 802.15.4 protocols, and is able to perform dynamic stress monitoring, structural impact capturing, and internal crack detection. The system has been experimentally validated, and the experimental results demonstrated the effectiveness of the proposed system. This work provides important support for practical CCD applications using wireless smart aggregates.

  15. Development of SOVAT: a numerical-spatial decision support system for community health assessment research.

    PubMed

    Scotch, Matthew; Parmanto, Bambang

    2006-01-01

    The development of numerical-spatial routines is frequently required to solve complex community health problems. Community health assessment (CHA) professionals who use information technology need a complete system that is capable of supporting the development of numerical-spatial routines. Currently, there is no decision support system (DSS) that is effectively able to accomplish this task as the majority of public health geospatial information systems (GIS) are based on traditional (relational) database architecture. On-Line Analytical Processing (OLAP) is a multidimensional data warehouse technique that is commonly used as a decision support system in standard industry. OLAP alone is not sufficient for solving numerical-spatial problems that frequently occur in CHA research. Coupling it with GIS technology offers the potential for a very powerful and useful system. A community health OLAP cube was created by integrating health and population data from various sources. OLAP and GIS technologies were then combined to develop the Spatial OLAP Visualization and Analysis Tool (SOVAT). The synergy of numerical and spatial environments within SOVAT is shown through an elaborate and easy-to-use drag and drop and direct manipulation graphical user interface (GUI). Community health problem-solving examples (routines) using SOVAT are shown through a series of screen shots. The impact of the difference between SOVAT and existing GIS public health applications can be seen by considering the numerical-spatial problem-solving examples. These examples are facilitated using OLAP-GIS functions. These functions can be mimicked in existing GIS public applications, but their performance and system response would be significantly worse since GIS is based on traditional (relational) backend. OLAP-GIS system offer great potential for powerful numerical-spatial decision support in community health analysis. The functionality of an OLAP-GIS system has been shown through a series of

  16. [Integration of self-help associations into the health services system--developments and perspectives].

    PubMed

    Trojan, A; Nickel, S

    2011-02-01

    The concept of a special label for "self-help-friendly" institutions was first developed for hospitals. A demonstration project (funded by the BKK BV, the German Federal Association of Company Health Insurance Funds) was launched in Hamburg. Between 2004 and 2007 quality criteria were developed and put into practice. Shortly thereafter, a group of experienced self-help supporters started to integrate self-help friendliness into quality management systems for ambulatory care. Recently similar developments have been initiated in the Public Health Services. After an introduction on the origins and political context of these new developments we present in this article the efforts and experiences in the 3 mentioned areas of the health-care system. It can be shown that user-based quality standards are becoming more and more common in quality development processes of the health-care services. In the last part we introduce the national "Network Self-Help-Friendliness in the Health Services--Together for Self-Help and Patient Orientation" as the new structure for further implementation, and give hints that the organised self-help is facing completely new challenges. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Politics and technology in health information systems development: a discourse analysis of conflicts addressed in a systems design group.

    PubMed

    Irestig, Magnus; Timpka, Toomas

    2008-02-01

    Different types of disagreements must be managed during the development of health information systems. This study examines the antagonisms discussed during the design of an information system for 175,000 users in a public health context. Discourse analysis methods were used for data collection and analysis. Three hundred and twenty-six conflict events were identified from four design meetings and divided into 16 categories. There were no differences regarding the types of conflicts that the different participants brought into the design discussions. Instead, conflict occurrence was primarily affected by the agendas that set the stage for examinations and debates. The results indicate that the selection of design method and the structure used for the meetings are important factors for the manner in which conflicts are brought into consideration during health information system design. Further studies comparing participatory and non-participatory information system design practices in health service settings are warranted.

  18. Development and implementation of a 'Mental Health Finder' software tool within an electronic medical record system.

    PubMed

    Swan, D; Hannigan, A; Higgins, S; McDonnell, R; Meagher, D; Cullen, W

    2017-02-01

    In Ireland, as in many other healthcare systems, mental health service provision is being reconfigured with a move toward more care in the community, and particularly primary care. Recording and surveillance systems for mental health information and activities in primary care are needed for service planning and quality improvement. We describe the development and initial implementation of a software tool ('mental health finder') within a widely used primary care electronic medical record system (EMR) in Ireland to enable large-scale data collection on the epidemiology and management of mental health and substance use problems among patients attending general practice. In collaboration with the Irish Primary Care Research Network (IPCRN), we developed the 'Mental Health Finder' as a software plug-in to a commonly used primary care EMR system to facilitate data collection on mental health diagnoses and pharmacological treatments among patients. The finder searches for and identifies patients based on diagnostic coding and/or prescribed medicines. It was initially implemented among a convenience sample of six GP practices. Prevalence of mental health and substance use problems across the six practices, as identified by the finder, was 9.4% (range 6.9-12.7%). 61.9% of identified patients were female; 25.8% were private patients. One-third (33.4%) of identified patients were prescribed more than one class of psychotropic medication. Of the patients identified by the finder, 89.9% were identifiable via prescribing data, 23.7% via diagnostic coding. The finder is a feasible and promising methodology for large-scale data collection on mental health problems in primary care.

  19. Achieving effective cervical screening coverage in South Africa through human resources and health systems development.

    PubMed

    Kawonga, Mary; Fonn, Sharon

    2008-11-01

    South Africa's cervical screening policy recommends three free Pap smears at ten-year intervals for all women over 30 years of age, aiming to achieve 70% coverage by 2010 by targeting the age group most at risk of developing pre-cancerous cervical lesions. Attaining wide coverage requires an adequate supply of motivated and supported public sector health workers with appropriate training and skills, working in a functional health system. Given the dearth of doctors in South Africa, professional nurses were tasked with performing the bulk of Pap smears at primary care level. Coverage remains sub-optimal and a significant proportion of women with precursor lesions do not receive treatment. Further, health system strengthening - essential for cytology-based screening - has not happened. Research to evaluate alternative screening technologies has proliferated in recent years, but regrettably, strengthening of the health system required to make the new technology work has not received similar attention. Using the South African experience, this article argues that technological interventions and innovations alone are not sufficient to improve cervical screening programmes. Task-shifting is limited unless other human resource concerns (e.g. training, increasing demands on personnel, attrition, and skills mix) are concurrently addressed within a comprehensive workforce development strategy, alongside work to make the health care delivery system functional.

  20. Developing and Implementing Major League Baseball's Health and Injury Tracking System.

    PubMed

    Pollack, Keshia M; D'Angelo, John; Green, Gary; Conte, Stan; Fealy, Stephen; Marinak, Chris; McFarland, Edward; Curriero, Frank C

    2016-03-01

    In 2010, Major League Baseball and the Major League Baseball Players Association reached an agreement regarding the development and implementation of an electronic medical record system and a new league-wide injury surveillance system. The systems were developed to create a more efficient method to track medical histories of players longitudinally as they move across Major and Minor league affiliates, as well as to identify and monitor injury trends in the sport, identify areas of specific concern, and conduct epidemiologic research to better optimize player health and safety. The resulting injury surveillance system, the Health and Injury Tracking System (HITS), is a robust system that includes all players from the both the Major and Minor Leagues. HITS also allows for data linkage with other player- and game-level data to inform the development of injury prevention policies and programs. In the present article, we document the development and implementation of HITS; describe its utility for epidemiologic research; illustrate the potential analytic strength of the surveillance system and its ability to inform policy change; and note the potential for this new surveillance system to advance the field of sports injury epidemiology.

  1. Information and communications technology for future health systems in developing countries.

    PubMed

    Lucas, Henry

    2008-05-01

    There has been much discussion of the role that recent advances in information and communication technologies (ICTs) could play in improving health systems in developing countries, but limited independent analysis of existing applications. Combining a case study approach with a general discussion of the issues, this paper attempts to assess the potential benefits of a diverse range of ICT innovations and some of the constraints they will need to overcome. Four broad areas are considered: improvements in traditional health information systems; computer-aided diagnosis and treatment monitoring; a range of applications generically labelled 'telemedicine'; and the use of ICT to inform general populations on health and healthcare. The final section speculates on the possible medium-term impacts of ICT in terms of improving the performance of existing systems, allowing scope for radical innovations, or even changing basic assumptions about the provider-patient relationship.

  2. Towards a sustainable framework for computer based health information systems (CHIS) for least developed countries (LDCs).

    PubMed

    Gordon, Abekah Nkrumah; Hinson, Robert Ebo

    2007-01-01

    The purpose of this paper is to argue for a theoretical framework by which development of computer based health information systems (CHIS) can be made sustainable. Health Management and promotion thrive on well-articulated CHIS. There are high levels of risk associated with the development of CHIS in the context of least developed countries (LDC), thereby making them unsustainable. This paper is based largely on literature survey on health promotion and information systems. The main factors accounting for the sustainability problem in less developed countries include poor infrastructure, inappropriate donor policies and strategies, poor infrastructure and inadequate human resource capacity. To counter these challenges and to ensure that CHIS deployment in LDCs is sustainable, it is proposed that the activities involved in the implementation of these systems be incorporated into organizational routines. This will ensure and secure the needed resources as well as the relevant support from all stakeholders of the system; on a continuous basis. This paper sets out to look at the issue of CHIS sustainability in LDCs, theoretically explains the factors that account for the sustainability problem and develops a conceptual model based on theoretical literature and existing empirical findings.

  3. The economics of optimal health and productivity in smallholder livestock systems in developing countries.

    PubMed

    McDermott, J J; Randolph, T F; Staal, S J

    1999-08-01

    Livestock kept or produced in smallholder farming systems are an important component of the agricultural economy in the developing world. The role of livestock on smallholder farms varies widely, providing draught power for crop production or as a production activity for subsistence needs or market sale under systems ranging from extensive pastoralist to intensive, peri-urban feeder and dairy systems. A set of unique conditions and features characterise smallholder systems, and these need to be appreciated when assessing the strategies that have evolved for managing animal health in smallholder systems, and evaluating opportunities for improving disease control strategies. To provide a framework for discussing animal health issues and analytical methodogies, a typology of smallholder livestock and crop/livestock systems is developed. The typology considers livestock systems both in terms of the degree of intensification, as measured by market orientation and intensity of factor use, and in terms of importance within the household economy, as measured by contribution to household income. A number of characteristics are identified that distinguish smallholder systems from the commercialised systems of developed countries, including the multiple functions livestock serve, the integrated nature of livestock activities, multiple objectives of producers and lower capacity to bear risk at the household level, as well as poor infrastructure, markets, and access to information at the community level. Three representative smallholder livestock systems from Africa are described in detail, highlighting the relevant characteristics and the implications for analysing disease control strategies. Smallholder dairy systems in Kenya demonstrate the role of individual producer decision-making for animal health management in intensive, market-oriented systems, placing emphasis on farm-level risk and production management aspects of disease control. In extensive pastoralist systems

  4. Developing a tool to assess motivation among health service providers working with public health system in India.

    PubMed

    Purohit, Bhaskar; Maneskar, Abhishek; Saxena, Deepak

    2016-04-14

    Addressing the shortage of health service providers (doctors and nurses) in rural health centres remains a huge challenge. The lack of motivation of health service providers to serve in rural areas is one of the major reasons for such shortage. While many studies have aimed at analysing the reasons for low motivation, hardly any studies in India have focused on developing valid and reliable tools to measure motivation among health service providers. Hence, the objective of the study was to test and develop a valid and reliable instrument to assess the motivation of health service providers working with the public health system in India and the extent to which the motivation factors included in the study motivate health service providers to perform better at work. The present study adapted an already developed tool on motivation. The reliability and validity of the tool were established using different methods. The first stage of the tool development involved content development and assessment where, after a detailed literature review, a predeveloped tool with 19 items was adapted. However, in light of the literature review and pilot test, the same tool was modified to suit the local context by adding 7 additional items so that the final modified tool comprised of 26 items. A correlation matrix was applied to check the pattern of relationships among the items. The total sample size for the study was 154 health service providers from one Western state in India. To understand the sampling adequacy, the Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett's test of sphericity were applied and finally factor analysis was carried out to calculate the eigenvalues and to understand the relative impact of factors affecting motivation. A correlation matrix value of 0.017 was obtained narrating multi-co-linearity among the observations. Based on initial factor analysis, 8 out of 26 study factors were excluded from the study components with a cutoff range of less than

  5. The development and feasibility of a personal health-optimization system for people with bipolar disorder.

    PubMed

    Eiring, Øystein; Nytrøen, Kari; Kienlin, Simone; Khodambashi, Soudabeh; Nylenna, Magne

    2017-07-10

    People with bipolar disorder often experience ill health and have considerably reduced life expectancies. Suboptimal treatment is common and includes a lack of effective medicines, overtreatment, and non-adherence to medical interventions and lifestyle measures. E- and m-health applications support patients in optimizing their treatment but often exhibit conceptual and technical shortcomings. The objective of this work was to develop and test the usability of a system targeting suboptimal treatment and compare the service to other genres and strategies. Based on the frameworks of shared decision-making, multi-criteria decision analysis, and single-subject research design, we interviewed potential users, reviewed research and current approaches, and created a first version using a rapid prototyping framework. We then iteratively improved and expanded the service based on formative usability testing with patients, healthcare providers, and laypeople from Norway, the UK, and Ukraine. The evidence-based health-optimization system was developed using systematic methods. The System Usability Scale and a questionnaire were administered in formative and summative tests. A comparison of the system to current standards for clinical practice guidelines and patient decision aids was performed. Seventy-eight potential users identified 82 issues. Driven by user feedback, the limited first version was developed into a more comprehensive system. The current version encompasses 21 integrated core features, supporting 6 health-optimization strategies. One crucial feature enables patients and clinicians to explore the likely value of treatments based on mathematical integration of self-reported and research data and the patient's preferences. The mean ± SD (median) system usability score of the patient-oriented subsystem was 71 ± 18 (73). The mean ± SD (median) system usability score in the summative usability testing was 78 ± 18 (75), well above the norm score of

  6. [Development of a distance education program in the public health system in Chile, 2004-2009].

    PubMed

    Carabantes C, Jorge; Guerra U, Manuel; Guillou, Michèle

    2010-09-01

    This paper reports the gradual development and results achieved in the distance education program set up in the Public Health System in Chile in 2004. Up to date, more than 22,000 students from 29 different health divisions have been trained. This strategy was designed to provide more flexibility and diversity to the training programs of the Health System within the framework of a deep and complex organizational change promoted by Health Reform. The main results show that the integration of organizational, teaching, logistic and budgetary aspects has turned out to be a key element in its success, validating the relevance of the provided solutions. The access to training by means of e-learning or blended learning (electronic education that includes traditional and distance learning activities) allowed employees to choose more independently what, where and when to study. This fact accounts for the high demand for this program. Through this initiative, the National Health System, introduced a wider scope of responses to training needs, which will mean a better adaptation to the challenges associated to health care.

  7. Latvia: Health system review.

    PubMed

    Mitenbergs, Uldis; Taube, Maris; Misins, Janis; Mikitis, Eriks; Martinsons, Atis; Rurane, Aiga; Quentin, Wilm

    2012-01-01

    This analysis of the Latvian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health-system performance. Latvia has been constantly reforming its health system for over two decades. After independence in 1991, Latvia initially moved to create a social health insurance type system. However, problems with decentralized planning and fragmented and inefficient financing led to this being gradually reversed, and ultimately the establishment in 2011 of a National Health Service type system. These constant changes have taken place against a backdrop of relatively poor health and limited funding, with a heavy burden for individuals; Latvia has one of the highest rates of out-of-pocket expenditure on health in the European Union (EU). The lack of financial resources resulting from the financial crisis has posed an enormous challenge to the government, which struggled to ensure the availability of necessary health care services for the population and to prevent deterioration of health status. Yet this also provided momentum for reforms: previous efforts to centralise the system and to shift from hospital to outpatient care were drastically accelerated, while at the same time a social safety net strategy was implemented (with financial support from the World Bank) to protect the poor from the negative consequences of user charges. However, as in any health system, a number of challenges remain. They include: reducing smoking and cardiovascular deaths; increasing coverage of prescription pharmaceuticals; reducing the excessive reliance on out-of-pocket payments for financing the health system; reducing inequities in access and health status; improving efficiency of hospitals through implementation of DRG-based financing; and monitoring and improving quality. In the face of these challenges at a time of financial crisis, one further challenge emerges: ensuring adequate funding for the health

  8. The health workforce: managing the crisis ethical international recruitment of health professionals: will codes of practice protect developing country health systems?

    PubMed

    Martineau, Tim; Willetts, Annie

    2006-02-01

    Many countries are using the strategy of international recruitment to make up for shortages of health professionals to the detriment of health systems in the poorest parts of the world. This study reviewed the potential impact of eight national level and international codes of practice or similar instruments that are being introduced to encourage ethical recruitment in order to protect these countries. Whilst effective dissemination of the instruments is generally in place, support systems, incentives and sanctions and monitoring systems necessary for effective implementation and sustainability are currently weak or have not been planned. If such codes or instruments are to be used to protect developing country health systems, lessons should be learnt from the early adopters; the focus of protecting developing country health systems needs to be emphasised in instruments with multiple objectives; the process of implementing the instruments strengthened; and internal and external pressure needs to be increased to ensure the codes and instruments lead to ethical recruitment and help to protect developing country health systems.

  9. Developing health, safety & environment management systems for well service operations in the North Sea

    SciTech Connect

    Sealy, I.

    1996-12-31

    A health, safety and environmental management system has been developed to meet the business demands in the North Sea area. After reviewing published best-practice solutions a model that allowed the incorporation of existing programmes was adopted. Particular emphasis was placed on the need to implement a system that would promote continuous improvement, meet customer audit requirements and meet both current and projected future business requirements. In addition to formalizing and documenting a number of existing programmes the system introduced two new programmes; competence assurance of all operational personnel and internal auditing and benchmarking of management system performance. The system and its associated management tools are now being implemented in three countries in the North Sea area. Plans for future development of the system, particularly with respect to the integration of quality management programmes are also described.

  10. The inception and development of basic animal health systems: examples of German development co-operation.

    PubMed

    Leidl, K; Baumann, M P O; Schenkel, F

    2004-04-01

    About thirty years ago the financial, logistic and manpower resources of veterinary and animal production services in the developing world were stretched to the limit. Epizootic disease control was their main and often only field activity, which left livestock owners to manage their daily production and health problems alone. To meet their requirements, Veterinary Services in these countries came under increasing public and political pressure to modify and adjust their approaches. This gave rise to a series of workshops in Africa (e.g. Bujumbura in Burundi and Blantyre in Malawi) and South-East Asia (e.g. Singapore, and Khon Kaen in Thailand), most of which were organised and facilitated by the German Agency for Technical Co-operation (GTZ) in close collaboration with French and British development co-operation agencies and universities. These workshops stimulated discussion with the key stakeholders and, thus, were most beneficial in supporting the process of developing alternative approaches. This paper reports in particular on the outcomes of the regional workshops held in Bujumbura, Burundi, in 1984, Blantyre, Malawi, in 1985, Bangui, Central African Republic, in 1988, Khon Kaen, Thailand, in 1989, Schmitten, Germany, in 1991, and Mzuzu, Malawi, in 1996 and 2000. For more than two decades, concepts of community-based livestock services in general, and primary animal health activities (PAHAs) in particular, have been developed and established in various developing countries. Over the years the PAHA concept has proved to be effective and has shown that livestock-keeping communities clearly benefit from such programmes. In presenting key features from some prominent and successful project examples (GTZ-supported projects in Thailand, Malawi and Somalia) it can be demonstrated that such approaches are not static but rather dynamic, requiring open minded innovative partners on both sides. Over the last few years, the delivery of PAHA has become the domain of non

  11. Filling the Gaps in a Fragmented Health Care System: Development of the Health and Welfare Information Portal (ZWIP)

    PubMed Central

    Huisjes, Mirjam; van Achterberg, Theo; Zuidema, Sytse U; Olde Rikkert, Marcel GM; Schers, Henk J; Heinen, Maud M; Melis, René JF

    2012-01-01

    Background Current health care systems are not optimally designed to meet the needs of our aging populations. First, the fragmentation of care often results in discontinuity of care that can undermine the quality of care provided. Second, patient involvement in care decisions is not sufficiently facilitated. Objective To describe the development and the content of a program aimed at: (1) facilitating self-management and shared decision making by frail older people and informal caregivers, and (2) reducing fragmentation of care by improving collaboration among professionals involved in the care of frail older people through a combined multidisciplinary electronic health record (EHR) and personal health record (PHR). Methods We used intervention mapping to systematically develop our program in six consecutive steps. Throughout this development, the target populations (ie, professionals, frail older people, and informal caregivers) were involved extensively through their participation in semi-structured interviews and working groups. Results We developed the Health and Welfare Information Portal (ZWIP), a personal, Internet-based conference table for multidisciplinary communication and information exchange for frail older people, their informal caregivers, and professionals. Further, we selected and developed methods for implementation of the program, which included an interdisciplinary educational course for professionals involved in the care of frail older people, and planned the evaluation of the program. Conclusions This paper describes the successful development and the content of the ZWIP as well as the strategies developed for its implementation. Throughout the development, representatives of future users were involved extensively. Future studies will establish the effects of the ZWIP on self-management and shared decision making by frail older people as well as on collaboration among the professionals involved. PMID:23611877

  12. Armenia: health system review.

    PubMed

    Richardson, Erica

    2013-01-01

    This analysis of the Armenian health system reviews the developments in organization and governance, health financing, healthcare provision, health reforms and health system performance since 2006. Armenia inherited a Semashko style health system on independence from the Soviet Union in 1991. Initial severe economic and sociopolitical difficulties during the 1990s affected the population health, though strong economic growth from 2000 benefited the populations health. Nevertheless, the Armenian health system remains unduly tilted towards inpatient care concentrated in the capital city despite overall reductions in hospital beds and concerted efforts to reform primary care provision. Changes in health system financing since independence have been more profound, as out-of-pocket (OOP) payments now account for over half of total health expenditure. This reduces access to essential services for the poorest households - particularly for inpatient care and pharmaceuticals - and many households face catastrophic health expenditure. Improving health system performance and financial equity are therefore the key challenges for health system reform. The scaling up of some successful recent programmes for maternal and child health may offer solutions, but require sustained financial resources that will be challenging in the context of financial austerity and the low base of public financing.

  13. Knowledge-based changes to health systems: the Thai experience in policy development.

    PubMed

    Tangcharoensathien, Viroj; Wibulpholprasert, Suwit; Nitayaramphong, Sanguan

    2004-10-01

    Over the past two decades the government in Thailand has adopted an incremental approach to extending health-care coverage to the population. It first offered coverage to government employees and their dependents, and then introduced a scheme under which low-income people were exempt from charges for health care. This scheme was later extended to include elderly people, children younger than 12 years of age and disabled people. A voluntary public insurance scheme was implemented to cover those who could afford to pay for their own care. Private sector employees were covered by the Social Health Insurance scheme, which was implemented in 1991. Despite these efforts, 30% of the population remained uninsured in 2001. In October of that year, the new government decided to embark on a programme to provide universal health-care coverage. This paper describes how research into health systems and health policy contributed to the move towards universal coverage. Data on health systems financing and functioning had been gathered before and after the founding of the Health Systems Research Institute in early 1990. In 1991, a contract capitation model had been used to launch the Social Health Insurance scheme. The advantages of using a capitation model are that it contains costs and provides an acceptable quality of service as opposed to the cost escalation and inefficiency that occur under fee-for-service reimbursement models, such as the one used to provide medical benefits to civil servants. An analysis of the implementation of universal coverage found that politics moved universal coverage onto the policy agenda during the general election campaign in January 2001. The capacity for research on health systems and policy to generate evidence guided the development of the policy and the design of the system at a later stage. Because the reformists who sought to bring about universal coverage (who were mostly civil servants in the Ministry of Public Health and members of

  14. Knowledge-based changes to health systems: the Thai experience in policy development.

    PubMed Central

    Tangcharoensathien, Viroj; Wibulpholprasert, Suwit; Nitayaramphong, Sanguan

    2004-01-01

    Over the past two decades the government in Thailand has adopted an incremental approach to extending health-care coverage to the population. It first offered coverage to government employees and their dependents, and then introduced a scheme under which low-income people were exempt from charges for health care. This scheme was later extended to include elderly people, children younger than 12 years of age and disabled people. A voluntary public insurance scheme was implemented to cover those who could afford to pay for their own care. Private sector employees were covered by the Social Health Insurance scheme, which was implemented in 1991. Despite these efforts, 30% of the population remained uninsured in 2001. In October of that year, the new government decided to embark on a programme to provide universal health-care coverage. This paper describes how research into health systems and health policy contributed to the move towards universal coverage. Data on health systems financing and functioning had been gathered before and after the founding of the Health Systems Research Institute in early 1990. In 1991, a contract capitation model had been used to launch the Social Health Insurance scheme. The advantages of using a capitation model are that it contains costs and provides an acceptable quality of service as opposed to the cost escalation and inefficiency that occur under fee-for-service reimbursement models, such as the one used to provide medical benefits to civil servants. An analysis of the implementation of universal coverage found that politics moved universal coverage onto the policy agenda during the general election campaign in January 2001. The capacity for research on health systems and policy to generate evidence guided the development of the policy and the design of the system at a later stage. Because the reformists who sought to bring about universal coverage (who were mostly civil servants in the Ministry of Public Health and members of

  15. Application of ICT in strengthening health information systems in developing countries in the wake of globalisation.

    PubMed

    Simba, Daudi O; Mwangu, Mughwira

    2004-12-01

    Information Communication Technology (ICT) revolution brought opportunities and challenges to developing countries in their efforts to strengthen the Health Management Information Systems (HMIS). In the wake of globalisation, developing countries have no choice but to take advantage of the opportunities and face the challenges. The last decades saw developing countries taking action to strengthen and modernise their HMIS using the existing ICT. Due to poor economic and communication infrastructure, the process has been limited to national and provincial/region levels leaving behind majority of health workers living in remote/rural areas. Even those with access do not get maximum benefit from ICT advancements due to inadequacies in data quality and lack of data utilisation. Therefore, developing countries need to make deliberate efforts to address constraints threatening to increase technology gap between urban minority and rural majority by setting up favourable policies and appropriate strategies. Concurrently, strategies to improve data quality and utilisation should be instituted to ensure that HMIS has positive impact on people's health. Potential strength from private sector and opportunities for sharing experiences among developing countries should be utilised. Short of this, advancement in ICT will continue to marginalise health workers in developing countries especially those living in remote areas.

  16. Introducing Health Workers for Change: from transformation theory to health systems in developing countries.

    PubMed

    Haaland, A; Vlassoff, C

    2001-09-01

    This introductory paper provides the theoretical basis behind the Health Workers for Change methodology, and the role of interactive, participatory learning approaches in promoting social change. The methodology has its origins in Latin America and Kenya, where participatory research methods have been used widely to raise social consciousness and promote change. The paper discusses the resistance of health institutions to participatory ways of learning and the reasons why this occurs. It also presents the logic for the subsequent papers in this special issue and provides a summary of their respective contributions.

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

    PubMed Central

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

    2014-01-01

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

  18. The untold story: how the health care systems in developing countries contribute to maternal mortality.

    PubMed

    Sundari, T K

    1992-01-01

    This article attempts to put together evidence from maternal mortality studies in developing countries of how an inadequate health care system characterized by misplaced priorities contributes to high maternal mortality rates. Inaccessibility of essential health information to the women most affected, and the physical as well as economic and sociocultural distance separating health services from the vast majority of women, are only part of the problem. Even when the woman reaches a health facility, there are a number of obstacles to her receiving adequate and appropriate care. These are a result of failures in the health services delivery system: the lack of minimal life-saving equipment at the first referral level; the lack of equipment, personnel, and know-how even in referral hospitals; and worst of all, faulty patient management. Prevention of maternal deaths requires fundamental changes not only in resource allocation, but in the very structures of health services delivery. These will have to be fought for as part of a wider struggle for equity and social justice.

  19. Leadership principles for developing a statewide public health and clinical laboratory system.

    PubMed

    Marshall, Steven A; Brokopp, Charles D; Size, Tim

    2010-01-01

    In 1999, the Centers for Disease Control and Prevention (CDC), the Association of Public Health Laboratories (APHL), and the Federal Bureau of Investigation established the national Laboratory Response Network (LRN) for bioterrorism readiness. A more broad application of the LRN is the National Laboratory System (NLS), an effort to promote the 10 Essential Public Health Services and the Core Functions and Capabilities of State Public Health Laboratories (hereafter, Core Functions). State public health laboratories (PHLs) are responsible for leading the development of both the LRN and the NLS in their jurisdictions. Based on the experience of creating a laboratory network in Wisconsin, leadership principles are provided for developing and strengthening statewide laboratory networks of PHLs and clinical laboratories, which can also include point-of-care testing sites. Each state PHL, in the context of these Core Functions and leadership principles, sets its priorities, budgets, and strategic plans. For a limited investment of personnel and funds that will yield a large benefit to public health, a robust state laboratory system can be established.

  20. DEVELOPMENT OF A RURAL COMMUNITY HEALTH CARE MODEL BASED ON INDIAN INDIGENOUS SYSTEM OF MEDICINE

    PubMed Central

    Hyma, B.; Ramesh, A.; Subhadra, N.L.

    1988-01-01

    Based on the principles of primary health care as outlined by WHO at the Alma Ata Conference in 1978, many voluntary organizations in India have been formulating, organizing and experimenting with the comprehensive rural community health Schemes. The goal is to indentify the felt needs at both individual and community levels and facilitate direct participation in decision making, develop suitable alternative, ecologically Sound indigenous models for socioeconomic well-being. In this context the Indian system of medicine has a useful and complementary role to play in the preventive and curative aspects of primary health care programmes. With the above objectives in mind the investigators undertook a brief survey of a “comprehensive rural health” project. The primary aim of this project is to develop a community health care model using innovative alternative methods using Indian indigenous system of medicine and participatory research techniques to improve rural health services of the surrounding under privileged villages. Many gaps exist in the assessment, however, a birds eye-view is presented here. PMID:22557645

  1. Developing purchasing strategy: a case study of a District Health Authority using soft systems methodology.

    PubMed

    Brown, A D

    1997-02-01

    This paper examines the attempt by a District Health Authority (DHA) to create structures (called Purchasing Strategy Groups or PSGs) to facilitate the effective development of its purchasing strategy. The paper is based on a case study design conducted using Soft Systems Methodology (SSM). The research contribution the paper makes is twofold. First, it analyses some of the fundamental management-related difficulties that a DHA can experience when attempting to come to terms with its role and responsibilities in the 1990s. Second, it provides a discussion and evaluation of the utility of SSM for qualitative research in the National Health Service (NHS) in the UK.

  2. Origins and development of the National Laboratory System for public health testing.

    PubMed

    Astles, J Rex; White, Vanessa A; Williams, Laurina O

    2010-01-01

    Although not recognized as such, a National Laboratory System (NLS) has existed since the inception of public health laboratory (PHL) testing more than a century ago. The NLS has always relied upon the participation of clinical laboratories, both to report test results that represent public health threats and to submit specimens and isolates to PHLs for additional or confirmatory testing. Historically, a number of factors have hindered the strengthening of the relationships between clinical laboratories and PHLs, but the reality of bioterrorism and subsequent focus on strengthening public-private relationships has stimulated the development of a more robust NLS. Since 2002, there has been substantial strengthening of the NLS through the sharing of lessons learned from several demonstration projects. There is a growing emphasis on defining critical elements of the NLS, including the State Public Health Laboratory System (SPH Laboratory System) and the functions of the Laboratory Program Advisor, a position that every state should have at the center of its laboratory system's capacity-building. Additional strengthening of the NLS is occurring through (1) national biennial measurement of state PHLs' abilities to meet the Core Functions and Capabilities of State PHLs, (2) the new Laboratory System Improvement Program (L-SIP) for the SPH Laboratory System, and (3) sharing ideas to integrate and improve the SPH Laboratory System (e.g., using the L-SIP Online Resource Center). Public health emergencies, such as the recent H1N1 epidemic, illustrate and reinforce the need for a strong NLS within which federal, public health, and clinical (i.e., hospital and private reference) laboratories function in close collaboration.

  3. Ukraine: health system review.

    PubMed

    Lekhan, Valery; Rudiy, Volodymyr; Shevchenko, Maryna; Nitzan Kaluski, Dorit; Richardson, Erica

    2015-03-01

    This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system. World Health Organization 2015 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  4. Health development in Djibouti.

    PubMed

    Hatem, M M

    1996-01-01

    When the government of Djibouti established its national health development plan for 1991-95, it took into account traditional medicine, services founded in the colonial era, and the need for primary care. Djibouti needs more physicians. As such, students should be encouraged to pursue medical studies. Efforts to train paramedical staff, the need to integrate the traditional sector into the health system, disease prevention programs, the need to modernize the General Peltier Hospital, maternal and child health, measures being taken to increase the level of community participation in health care, and the adverse effect upon service quality of providing free medical care are discussed. Drug supplies have dwindled as population size has grown. In general, the country's health facilities are overburdened and their equipment is breaking down. In this context, the community must assume part of the financial responsibility for health care.

  5. Health information system reform in South Africa: developing an essential data set.

    PubMed Central

    Shaw, Vincent

    2005-01-01

    Health services are increasingly under pressure to develop information systems that are responsive to changing health needs and appropriate to service objectives. Developing an essential data set provides managers with a clearly defined set of indicators for monitoring and evaluating services. This article describes a process that resulted in the creation of an essential data set at district level. This had a significant impact on neighbouring districts and resulted in the development of a regional essential data set, which in turn helped to influence the creation of a provincial and then national essential data set. Four key lessons may be drawn from the process. The development of an essential data set both requires and can contribute to a process that allows the reporting requirements to be adjusted over time in response to changing circumstances. In addition, it contributes to (and requires) the integration of programme reporting requirements into a coherent information system. While the case study describes a bottom-up approach, a top-down consultative process is advocated because it establishes a framework within which information needs can be reviewed. Lastly, the use of surveys can aid efforts to keep the essential elements to a minimum. In conclusion, the development of an essential data set contributes to strengthening health services because it necessitates dialogue between programme managers and defines indicators to be monitored by them. PMID:16184283

  6. [From the experience of development of general medical practice in health system of Voronejskaya oblast].

    PubMed

    2011-01-01

    The promotion of general medical practice is needed to further developing and enhancing of primary medical sanitary care and increasing its availability in Voronejskaya oblast. This approach demands new jobs creation for general practitioners and fitting them out with necessary equipment and facilities under enhanced control of its rational application. The same importance has the improvement of financing, remuneration of labor in primary health care system, stimulation of positive resulting effect motivation, overall preventive trend in medical care.

  7. The development of an oral health charting system for koalas (Phascolarctos cinereus).

    PubMed

    Pettett, Lyndall M; McKinnon, Allan J; Wilson, Gary J; Carrick, Frank N; Sly, Lindsay I; Bird, Philip S

    2012-01-01

    The koala is one of Australia's most highly specialized folivores with a diet exclusively of eucalyptus leaves to provide all nutritive needs and therefore requires to be free of oral disease as they are dependent on good dentition for optimal health and quality of life. We developed an oral examination methodology based on protocols for companion animals and human dentistry to chart the oral health of koalas. Thirty free-ranging koalas from South-East Queensland, Australia were examined for general body and oral health. Inspection of the oral cavity was conducted for the presence or absence of the indicators oforal disease such as caries or periodontal disease. Univariate and multivariate analyses were performed on the examination data and a prototype oral health chart developed. The prototype was then trialled and the methodology validated by the Kappa statistic using ten additional koalas examined by four multidisciplinary personnel involved in koala care. Trauma associated fractures, tooth displacement, abnormal occlusion and tooth wear compacted vegetation, extrinsic stain deposits, periodontal bone loss, gingivitis, tooth mobility, and calculus were present in the oral cavities of the examined koalas. A system of scoring between 0 and 3 was constructed in accordance with current koala general health charting formats. Validation of the charting method using Kappa coefficients of agreement statistics indicated that there was a good agreement among observers on recorded results except for inflammation and calculus scoring. Modifications were made and visual aids and index scales produced to further assist observers. Oral health surveillance has been proven in other species to be significant in diagnosing physiological disturbances derived from environmental genetic, and developmental causes. Veterinarians, dental researchers, and koala husbandry personnel will benefit in using this charting method and reporting the oral health of koala populations in their

  8. Developing a European urban health indicator system: results of EURO-URHIS 1.

    PubMed

    Patterson, Lesley; Heller, Richard; Robinson, Jude; Birt, Christopher A; van Ameijden, Erik; Bocsan, Ioan; White, Chris; Skalkidis, Yannis; Bothra, Vinay; Onyia, Ifeoma; Hellmeier, Wolfgang; Lyshol, Heidi; Gemmell, Isla; Spencer, Angela; Klumbiene, Jurate; Krampac, Igor; Rajnicova, Iveta; Macherianakis, Alexis; Bourke, Michael; Harrison, Annie; Verma, Arpana

    2017-05-01

    More than half of the world's population now live in cities, including over 70% in Europe. Cities bring opportunities but can be unhealthy places to live. The poorest urban dwellers live in the worst environments and are at the greatest risk of poor health outcomes. EURO-URHIS 1 set out to compile a cross-EU inventory of member states use of measures of urban health in order to support policymakers and improve public health policy. Following a literature review to define terms and find an appropriate model to guide urban health research, EURO-URHIS Urban Areas in all EU member states except Luxembourg, as well as Croatia, Turkey, Macedonia, Iceland and Norway, were defined and selected in collaboration with project partners. Following piloting of the survey tool, a the EURO-URHIS 45 data collection tool was sent out to contacts in all countries with identified EUA's, asking for data on 45 Urban Health Indicators (UHI) and 10 other indicators. 60 questionnaires were received from 30 countries, giving information on local health indicator availability, definitions and sources. Telephone interviews were also conducted with 14 respondents about their knowledge of sources of urban health data and barriers or problems experienced when collecting the data. Most participants had little problem identifying the sources of data, though some found that data was not always routinely recorded and was held by diverse sources or not at local level. Some participants found the data collection instrument to not be user-friendly and with UHI definitions that were sometimes unclear. However, the work has demonstrated that urban health and its measurement is of major relevance and importance for Public Health across Europe. The current study has constructed an initial system of European UHIs to meet the objectives of the project, but has also clearly demonstrated that further development work is required. The importance and value of examining UHIs has been confirmed, and the scene has

  9. Lithuania: health system review.

    PubMed

    Murauskiene, Liubove; Janoniene, Raimonda; Veniute, Marija; van Ginneken, Ewout; Karanikolos, Marina

    2013-01-01

    This analysis of the Lithuanian health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance since 2000.The Lithuanian health system is a mixed system, predominantly funded from the National Health Insurance Fund through a compulsory health insurance scheme, supplemented by substantial state contributions on behalf of the economically inactive population amounting to about half of its budget. Public financing of the health sector has gradually increased since 2004 to 5.2 per cent of GDP in 2010.Although the Lithuanian health system was tested by the recent economic crisis, Lithuanias counter-cyclical state health insurance contribution policies (ensuring coverage for the economically inactive population) helped the health system to weather the crisis, and Lithuania successfully used the crisis as a lever to reduce the prices of medicines.Yet the future impact of cuts in public health spending is a cause for concern. In addition, out-of-pocket payments remain high (in particular for pharmaceuticals) and could threaten health access for vulnerable groups.A number of challenges remain. The primary care system needs strengthening so that more patients are treated instead of being referred to a specialist, which will also require a change in attitude by patients. Transparency and accountability need to be increased in resource allocation, including financing of capital investment and in the payer provider relationship. Finally, population health,albeit improving, remains a concern, and major progress can be achieved by reducing the burden of amenable and preventable mortality. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  10. Tajikistan: health system review.

    PubMed

    Khodjamurodov, Ghafur; Rechel, Bernd

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Tajikistan is undergoing a complex transition from a health system inherited from the Soviet period to new forms of management, financing and health care provision. Following independence and the consequences of the civil war, health funding collapsed and informal out-of-pocket payments became the main source of revenue, with particularly severe consequences for the poor. With the aim of ensuring equitable access to health care and formalizing out-of-pocket payments, the Ministry of Health developed a programme that encompassed a basic benefit package (also known as the guaranteed benefit package) for people in need and formal co-payments for other groups of the population. One of the main challenges for the future will be to reorient the health system towards primary care and public health rather than hospital-based secondary and tertiary care. Pilots of primary care reform, introducing per capita financing, are under way in three of the country's oblasts. There are marked geographical imbalances in health care resources and financing, favouring the capital and regional centres over rural areas. There are also significant inequities in health care expenditures across regions. The quality of care is another major concern, owing to the lack of investment in health facilities and technologies, an insufficient supply of pharmaceuticals, poorly trained health care workers, and a lack of medical protocols and systems for quality improvement.

  11. Development of a web database portfolio system with PACS connectivity for undergraduate health education and continuing professional development.

    PubMed

    Ng, Curtise K C; White, Peter; McKay, Janice C

    2009-04-01

    Increasingly, the use of web database portfolio systems is noted in medical and health education, and for continuing professional development (CPD). However, the functions of existing systems are not always aligned with the corresponding pedagogy and hence reflection is often lost. This paper presents the development of a tailored web database portfolio system with Picture Archiving and Communication System (PACS) connectivity, which is based on the portfolio pedagogy. Following a pre-determined portfolio framework, a system model with the components of web, database and mail servers, server side scripts, and a Query/Retrieve (Q/R) broker for conversion between Hypertext Transfer Protocol (HTTP) requests and Q/R service class of Digital Imaging and Communication in Medicine (DICOM) standard, is proposed. The system was piloted with seventy-seven volunteers. A tailored web database portfolio system (http://radep.hti.polyu.edu.hk) was developed. Technological arrangements for reinforcing portfolio pedagogy include popup windows (reminders) with guidelines and probing questions of 'collect', 'select' and 'reflect' on evidence of development/experience, limitation in the number of files (evidence) to be uploaded, the 'Evidence Insertion' functionality to link the individual uploaded artifacts with reflective writing, capability to accommodate diversity of contents and convenient interfaces for reviewing portfolios and communication. Evidence to date suggests the system supports users to build their portfolios with sound hypertext reflection under a facilitator's guidance, and with reviewers to monitor students' progress providing feedback and comments online in a programme-wide situation.

  12. Real-Time Rocket/Vehicle System Integrated Health Management Laboratory For Development and Testing of Health Monitoring/Management Systems

    NASA Technical Reports Server (NTRS)

    Aguilar, R.

    2006-01-01

    Pratt & Whitney Rocketdyne has developed a real-time engine/vehicle system integrated health management laboratory, or testbed, for developing and testing health management system concepts. This laboratory simulates components of an integrated system such as the rocket engine, rocket engine controller, vehicle or test controller, as well as a health management computer on separate general purpose computers. These general purpose computers can be replaced with more realistic components such as actual electronic controllers and valve actuators for hardware-in-the-loop simulation. Various engine configurations and propellant combinations are available. Fault or failure insertion capability on-the-fly using direct memory insertion from a user console is used to test system detection and response. The laboratory is currently capable of simulating the flow-path of a single rocket engine but work is underway to include structural and multiengine simulation capability as well as a dedicated data acquisition system. The ultimate goal is to simulate as accurately and realistically as possible the environment in which the health management system will operate including noise, dynamic response of the engine/engine controller, sensor time delays, and asynchronous operation of the various components. The rationale for the laboratory is also discussed including limited alternatives for demonstrating the effectiveness and safety of a flight system.

  13. Real-Time Rocket/Vehicle System Integrated Health Management Laboratory For Development and Testing of Health Monitoring/Management Systems

    NASA Technical Reports Server (NTRS)

    Aguilar, R.

    2006-01-01

    Pratt & Whitney Rocketdyne has developed a real-time engine/vehicle system integrated health management laboratory, or testbed, for developing and testing health management system concepts. This laboratory simulates components of an integrated system such as the rocket engine, rocket engine controller, vehicle or test controller, as well as a health management computer on separate general purpose computers. These general purpose computers can be replaced with more realistic components such as actual electronic controllers and valve actuators for hardware-in-the-loop simulation. Various engine configurations and propellant combinations are available. Fault or failure insertion capability on-the-fly using direct memory insertion from a user console is used to test system detection and response. The laboratory is currently capable of simulating the flow-path of a single rocket engine but work is underway to include structural and multiengine simulation capability as well as a dedicated data acquisition system. The ultimate goal is to simulate as accurately and realistically as possible the environment in which the health management system will operate including noise, dynamic response of the engine/engine controller, sensor time delays, and asynchronous operation of the various components. The rationale for the laboratory is also discussed including limited alternatives for demonstrating the effectiveness and safety of a flight system.

  14. Health systems in East Asia: what can developing countries learn from Japan and the Asian Tigers?

    PubMed

    Wagstaff, Adam

    2007-05-01

    The health systems of Japan and the Asian Tigers (Hong Kong, Korea, Singapore and Taiwan), and the recent reforms to them, provide many potentially valuable lessons to East Asia's developing countries. All five systems have managed to keep a check on health spending despite their different approaches to financing and delivery. These differences are reflected in the progressivity of health finance, but the precise degree of progressivity of individual sources and the extent to which households are vulnerable to catastrophic health payments depend on the design features of the system - the height of any ceilings on social insurance contributions, the fraction of health spending covered by the benefit package, the extent to which the poor face reduced copayments, whether there are caps on copayments, and so on. On the delivery side, too, Japan and the Tigers offer some interesting lessons. Singapore's experience with corporatizing public hospitals - rapid cost and price inflation, a race for the best technology, and so on - illustrates the difficulties of corporatization. Korea's experience with a narrow benefit package illustrates the danger of providers shifting demand from insured services with regulated prices to uninsured services with unregulated prices. Japan, in its approach to rate setting for insured services, has managed to combine careful cost control with fine-tuning of profit margins on different types of care. Experiences with DRGs in Korea and Taiwan point to cost-savings but also to possible knock-on effects on service volume and total health spending. Korea and Taiwan both offer important lessons for the separation of prescribing and dispensing, including the risks of compensation costs outweighing the cost savings caused by more 'rational' prescribing, and cost-savings never being realized because of other concessions to providers, such as allowing them to have onsite pharmacists.

  15. Israel: Health System Review.

    PubMed

    Rosen, Bruce; Waitzberg, Ruth; Merkur, Sherry

    2015-01-01

    Israel is a small country, with just over 8 million citizens and a modern market-based economy with a comparable level of gross domestic product per capita to the average in the European Union. It has had universal health coverage since the introduction of a progressively financed statutory health insurance system in 1995. All citizens can choose from among four competing, non-profit-making health plans, which are charged with providing a broad package of benefits stipulated by the government. Overall, the Israeli health care system is quite efficient. Health status levels are comparable to those of other developed countries, even though Israel spends a relatively low proportion of its gross domestic product on health care (less than 8%) and nearly 40% of that is privately financed. Factors contributing to system efficiency include regulated competition among the health plans, tight regulatory controls on the supply of hospital beds, accessible and professional primary care and a well-developed system of electronic health records. Israeli health care has also demonstrated a remarkable capacity to innovate, improve, establish goals, be tenacious and prioritize. Israel is in the midst of numerous health reform efforts. The health insurance benefits package has been extended to include mental health care and dental care for children. A multipronged effort is underway to reduce health inequalities. National projects have been launched to measure and improve the quality of hospital care and reduce surgical waiting times, along with greater public dissemination of comparative performance data. Major steps are also being taken to address projected shortages of physicians and nurses. One of the major challenges currently facing Israeli health care is the growing reliance on private financing, with potentially deleterious effects for equity and efficiency. Efforts are currently underway to expand public financing, improve the efficiency of the public system and constrain

  16. Integrating child health information systems.

    PubMed

    Hinman, Alan R; Eichwald, John; Linzer, Deborah; Saarlas, Kristin N

    2005-11-01

    The Health Resources and Services Administration and All Kids Count (a national technical assistance center fostering development of integrated child health information systems) have been working together to foster development of integrated child health information systems. Activities have included: identification of key elements for successful integration of systems; development of principles and core functions for the systems; a survey of state and local integration efforts; and a conference to develop a common vision for child health information systems to meet medical care and public health needs. We provide 1 state (Utah) as an example that is well on the way to development of integrated child health information systems.

  17. Integrating Child Health Information Systems

    PubMed Central

    Hinman, Alan R.; Eichwald, John; Linzer, Deborah; Saarlas, Kristin N.

    2005-01-01

    The Health Resources and Services Administration and All Kids Count (a national technical assistance center fostering development of integrated child health information systems) have been working together to foster development of integrated child health information systems. Activities have included: identification of key elements for successful integration of systems; development of principles and core functions for the systems; a survey of state and local integration efforts; and a conference to develop a common vision for child health information systems to meet medical care and public health needs. We provide 1 state (Utah) as an example that is well on the way to development of integrated child health information systems. PMID:16195524

  18. Development of Wireless Subsurface Microsensors for Health Monitoring of Thermal Protection Systems

    NASA Technical Reports Server (NTRS)

    Pallix, Joan; Milos, Frank; Arnold, James O. (Technical Monitor)

    2000-01-01

    Low cost access to space is a primary goal for both NASA and the U.S. aerospace industry. Integrated subsystem health diagnostics is an area where major improvements have been identified for potential implementation into the design of new reusable launch vehicles (RLVS) in order to reduce life cycle costs, increase safety margins and improve mission reliability. A number of efforts are underway to use existing and emerging technologies to establish new methods for vehicle health monitoring on operational vehicles as well as X-vehicles. This paper summarizes a joint effort between several NASA centers and industry partners to develop rapid wireless diagnostic tools for failure management and long-term TPS performance monitoring of thermal protection systems (TPS) on future RLVS. An embedded wireless microsensor suite is being designed to allow rapid subsurface TPS health monitoring and damage assessment. This sensor suite will consist of both passive overlimit sensors and sensors for continuous parameter monitoring in flight. The on-board diagnostic system can be used to radio in maintenance requirements before landing and the data could also be used to assist in design validation for X-vehicles. For a 3rd generation vehicle, wireless diagnostics should be at a stage of technical development that will allow use for intelligent feedback systems for guidance and navigation control applications and can also serve as feedback for TPS that can intelligently adapt to its environment.

  19. [The development of the public health system between an increasing market orientation (commercialisation) and social responsibility].

    PubMed

    Trabert, G

    2008-02-01

    The development of the public health system between an increasing market orientation (commercialisation) and social responsibility is critically reflected by examining the medical care of those who are deprived. Poverty in Germany is dramatically increasing. There are confirmed findings on the correlation of being poor and being ill. Poverty leads to an increased number of cases of illness and a higher mortality rate. And vice versa, chronic illnesses very often cause impoverishment. This correlation has largely been ignored not only by the public but also by experts, especially when public health-care issues are on the political agenda. With reference to the current discussion about public health-care and the widespread disregard of the living conditions of the poor, the categories of "reasonable behaviour" (Kant) and "communicative behaviour" (Habermas) are reflected on in a philosophical excursion. Further interest groups affecting the political sphere, such as the pharmaceutical industry, the medical profession, patients and scientists are also examined with regard to public health-care. What are the premises of a health-care discussion that is controlled by economic considerations, particularly when keeping in mind the humanistic and Christian ethics of our society? And what does this mean for our responsibility for those who are handicapped and are in need of our help? Do decision makers and participants of the health-care discussion satisfy these ethical challenges? And what are the effects of the so-called "social peace" on social cooperation and economic power of a country? The increasing market orientation (commercialisation) of the public health sector can only be accepted on the basis of practiced humanity and social responsibility. In the light of a human public health-care, deprived people are in need of our solidarity.

  20. Quality evaluation of health information system's architectures developed using the HIS-DF methodology.

    PubMed

    López, Diego M; Blobel, Bernd; Gonzalez, Carolina

    2010-01-01

    Requirement analysis, design, implementation, evaluation, use, and maintenance of semantically interoperable Health Information Systems (HIS) have to be based on eHealth standards. HIS-DF is a comprehensive approach for HIS architectural development based on standard information models and vocabulary. The empirical validity of HIS-DF has not been demonstrated so far. Through an empirical experiment, the paper demonstrates that using HIS-DF and HL7 information models, semantic quality of HIS architecture can be improved, compared to architectures developed using traditional RUP process. Semantic quality of the architecture has been measured in terms of model's completeness and validity metrics. The experimental results demonstrated an increased completeness of 14.38% and an increased validity of 16.63% when using the HIS-DF and HL7 information models in a sample HIS development project. Quality assurance of the system architecture in earlier stages of HIS development presumes an increased quality of final HIS systems, which supposes an indirect impact on patient care.

  1. Professionals with Delivery Skills: Backbone of the Health System and Key to Reaching the Maternal Health Millennium Development Goal

    PubMed Central

    Wirth, Meg

    2008-01-01

    The attainment of the fifth Millennium Development Goal requires adequate national reserves of skilled birth attendants. Nurses, midwives, and their equivalents form the frontline of the formal health system are a critical element of global efforts to reduce ill-health and poverty in the poorest areas of the world. Planning and policies supporting these cadres of workers must be placed high on the development agenda and championed by key international and national players. This article first sets forth an argument for the equity and efficiency of nurses, midwives, and their equivalents as the cadre largely responsible for maternal health. Second, it traces the root causes of neglect of this critical cadre, including a vacuum in political will in the context of poverty, lack of protections for frontline workers, the historical political position of the field of midwifery, lack of a pipeline of secondary school graduates, and gender inequity. Investment in the largely female cadre that cares for the majority of the world’s poorer women has simply not been a high enough priority. Key policy recommendations include harnessing political will and adequate metrics, protection of frontline workers’ safety and livelihoods, ensuring an adequate pipeline with a focus on girls’ education and donor support for training and professional organizations. The fifth and final policy recommendation is a call for unified international support of rapid scale-up of cadres of delivery care workers. PMID:18581610

  2. Development of a measure of health care affordability applicable in a publicly funded universal health care system.

    PubMed

    Haggerty, Jeannie L; Levesque, Jean-Frédéric

    2015-02-04

    Direct measures of health care affordability from the user perspective are needed to monitor equitable access to publicly funded health care in Canada. The objective of our study was to develop a survey-based measure of healthcare affordability applicable to the Canadian context. We developed items after focus group exploration of access and cost barriers in the healthcare trajectory. We administered an initial instrument by telephone to a randomly-selected sample of 750 respondents in metropolitan, rural, and remote settings in Quebec. After analysis we developed a new, self-administered version eliciting the frequency of problem access due to five affordability dimensions. This version was mailed to a subset of participants. We conducted exploratory and confirmatory factor analysis. We used ordinal logistic regression modelling to examine how individual items and the subscale score predicted indicators of difficult access. We looked for effect modification by income categories. The five items load on a single construct with good internal consistency (α = 0.77). The overall score, 0 to 5, reflects the sum of problems with healthcare affordability due to direct and indirect costs. The item and subscale scores are sensitive to income status, with affordability problems more prevalent among low-income than high-income respondents. Each unit increase in the subscale score predicts increased likelihood of unmet needs (OR = 1.54), emergency room use (OR = 1.41), and health problem aggravation (OR = 1.80). This subscale reliably and validly measures cost barriers to medically necessary services in Canada, and can potentially be applied in other settings with publicly funded health systems. It can be used to monitor and compare healthcare equity.

  3. Bridging complexity theory and resilience to develop surge capacity in health systems.

    PubMed

    Therrien, Marie-Christine; Normandin, Julie-Maude; Denis, Jean-Louis

    2017-03-20

    Purpose Health systems are periodically confronted by crises - think of Severe Acute Respiratory Syndrome, H1N1, and Ebola - during which they are called upon to manage exceptional situations without interrupting essential services to the population. The ability to accomplish this dual mandate is at the heart of resilience strategies, which in healthcare systems involve developing surge capacity to manage a sudden influx of patients. The paper aims to discuss these issues. Design/methodology/approach This paper relates insights from resilience research to the four "S" of surge capacity (staff, stuff, structures and systems) and proposes a framework based on complexity theory to better understand and assess resilience factors that enable the development of surge capacity in complex health systems. Findings Detailed and dynamic complexities manifest in different challenges during a crisis. Resilience factors are classified according to these types of complexity and along their temporal dimensions: proactive factors that improve preparedness to confront both usual and exceptional requirements, and passive factors that enable response to unexpected demands as they arise during a crisis. The framework is completed by further categorizing resilience factors according to their stabilizing or destabilizing impact, drawing on feedback processes described in complexity theory. Favorable order resilience factors create consistency and act as stabilizing forces in systems, while favorable disorder factors such as diversity and complementarity act as destabilizing forces. Originality/value The framework suggests a balanced and innovative process to integrate these factors in a pragmatic approach built around the fours "S" of surge capacity to increase health system resilience.

  4. An Advanced Multi-Sensor Acousto-Ultrasonic Structural Health Monitoring System: Development and Aerospace Demonstration

    PubMed Central

    Smithard, Joel; Rajic, Nik; Norman, Patrick; Rosalie, Cedric; Galea, Steve; Mei, Hanfei; Lin, Bin; Giurgiutiu, Victor

    2017-01-01

    A key longstanding objective of the Structural Health Monitoring (SHM) research community is to enable the embedment of SHM systems in high value assets like aircraft to provide on-demand damage detection and evaluation. As against traditional non-destructive inspection hardware, embedded SHM systems must be compact, lightweight, low-power and sufficiently robust to survive exposure to severe in-flight operating conditions. Typical Commercial-Off-The-Shelf (COTS) systems can be bulky, costly and are often inflexible in their configuration and/or scalability, which militates against in-service deployment. Advances in electronics have resulted in ever smaller, cheaper and more reliable components that facilitate the development of compact and robust embedded SHM systems, including for Acousto-Ultrasonics (AU), a guided plate-wave inspection modality that has attracted strong interest due mainly to its capacity to furnish wide-area diagnostic coverage with a relatively low sensor density. This article provides a detailed description of the development, testing and demonstration of a new AU interrogation system called the Acousto Ultrasonic Structural health monitoring Array Module+ (AUSAM+). This system provides independent actuation and sensing on four Piezoelectric Wafer Active Sensor (PWAS) elements with further sensing on four Positive Intrinsic Negative (PIN) photodiodes for intensity-based interrogation of Fiber Bragg Gratings (FBG). The paper details the development of a novel piezoelectric excitation amplifier, which, in conjunction with flexible acquisition-system architecture, seamlessly provides electromechanical impedance spectroscopy for PWAS diagnostics over the full instrument bandwidth of 50 KHz–5 MHz. The AUSAM+ functionality is accessed via a simple hardware object providing a myriad of custom software interfaces that can be adapted to suit the specific requirements of each individual application. PMID:28773193

  5. An Advanced Multi-Sensor Acousto-Ultrasonic Structural Health Monitoring System: Development and Aerospace Demonstration.

    PubMed

    Smithard, Joel; Rajic, Nik; van der Velden, Stephen; Norman, Patrick; Rosalie, Cedric; Galea, Steve; Mei, Hanfei; Lin, Bin; Giurgiutiu, Victor

    2017-07-20

    A key longstanding objective of the Structural Health Monitoring (SHM) research community is to enable the embedment of SHM systems in high value assets like aircraft to provide on-demand damage detection and evaluation. As against traditional non-destructive inspection hardware, embedded SHM systems must be compact, lightweight, low-power and sufficiently robust to survive exposure to severe in-flight operating conditions. Typical Commercial-Off-The-Shelf (COTS) systems can be bulky, costly and are often inflexible in their configuration and/or scalability, which militates against in-service deployment. Advances in electronics have resulted in ever smaller, cheaper and more reliable components that facilitate the development of compact and robust embedded SHM systems, including for Acousto-Ultrasonics (AU), a guided plate-wave inspection modality that has attracted strong interest due mainly to its capacity to furnish wide-area diagnostic coverage with a relatively low sensor density. This article provides a detailed description of the development, testing and demonstration of a new AU interrogation system called the Acousto Ultrasonic Structural health monitoring Array Module⁺ (AUSAM⁺). This system provides independent actuation and sensing on four Piezoelectric Wafer Active Sensor (PWAS) elements with further sensing on four Positive Intrinsic Negative (PIN) photodiodes for intensity-based interrogation of Fiber Bragg Gratings (FBG). The paper details the development of a novel piezoelectric excitation amplifier, which, in conjunction with flexible acquisition-system architecture, seamlessly provides electromechanical impedance spectroscopy for PWAS diagnostics over the full instrument bandwidth of 50 KHz-5 MHz. The AUSAM⁺ functionality is accessed via a simple hardware object providing a myriad of custom software interfaces that can be adapted to suit the specific requirements of each individual application.

  6. Development, use and evaluation of drugs: the dominating technology in the health care system.

    PubMed

    Hansen, E H; Launsø, L

    1987-01-01

    The article presents various perspectives of drug technology and health care policy in Denmark. Drugs dominate as the most widely used treatment technology in the health care system and the use of drugs is steadily increasing. The pharmaceutical industry's development of drugs is based on an economic estimate of developments, expenditures, marketing costs and the anticipated share of the market. Controlled clinical trials have become the main form of documentation required by the health authorities. This method is insufficient to evaluate the (side) effects of the drugs when in actual use. Drugs fit perfectly the technical perception of disease, a perception which prevails in the pharmaceutical industry, medical science and in the treatment of disease. This perception believes that a disease is due to an attack or dysfunction in the biological-mechanical conditions of the individual. Drugs offer a standard solution to health problems independent of the individuals' social life. Thus drugs become a tool which function in agreement with the disintegrated and achievement-orientated approach to disease as it is organized today. In general the statements in this article are not limited to special Danish circumstances but are valid for other countries as well [1, 2]. (Norris R. Pills, Pesticides & Profits. North River Press, 1982; Braithwaite J. Corporate Crime in the Pharmaceutical Industry. Routledge & Kegan Paul, London, 1984) The empirical data in this article derive from Denmark, however.

  7. Guidelines for Analysis of Pharmaceutical Supply System Planning in Developing Countries. Volume 7: Pharmaceutical Supply System Planning. International Health Planning Methods Series.

    ERIC Educational Resources Information Center

    Schaumann, Leif; And Others

    Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this seventh of ten manuals in the Interational Health Planning Methods Series deals with pharmaceutical supply systems planning in developing countries. Following an…

  8. Guidelines for Analysis of Pharmaceutical Supply System Planning in Developing Countries. Volume 7: Pharmaceutical Supply System Planning. International Health Planning Methods Series.

    ERIC Educational Resources Information Center

    Schaumann, Leif; And Others

    Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this seventh of ten manuals in the Interational Health Planning Methods Series deals with pharmaceutical supply systems planning in developing countries. Following an…

  9. Development of a user-centered health information service system for depressive symptom management.

    PubMed

    Bae, Jeongyee; Wolpin, Seth; Kim, Eunjung; Lee, Sowoo; Yoon, Sookhee; An, Kyungeh

    2009-06-01

    A user-centered, Web-based depressive symptoms management system might be particularly useful in Korea, where those who seek mental health care face stigmatizing and where personal computers and the Internet have reached saturation levels. The purpose of this article is to describe the development process of a Web-based system for depressive symptom management through user-centered design principles. Our design process included four distinct phases: a needs assessment, analysis, design/development/testing, and the application release. The final revised website was released with the URL address, "http://www.baejy.com/smiles/". In the 3 years since the site was made available publicly, it is notable that 161,604 Koreans have accessed this website, either for educational purposes or for managing their depressive symptoms. A Web-based depressive symptom management system with a high degree of usability was developed. This website can be used to assess depressive symptoms and to serve as an intervention strategy to improve mental health.

  10. Slovakia: Health System Review.

    PubMed

    Smatana, Martin; Pazitny, Peter; Kandilaki, Daniela; Laktisova, Michaela; Sedlakova, Darina; Paluskova, Monika; van Ginneken, Ewout; Spranger, Anne

    2016-11-01

    This analysis of the Slovak health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The health care system in Slovakia is based on universal coverage, compulsory health insurance, a basic benefit package and a competitive insurance model with selective contracting of health care providers. Containment of health spending became a major policy goal after the 2008 financial crisis. Health spending stabilized after 2010 but remains well below European averages. Some health indicators, such as life expectancy, healthy life years and avoidable deaths are worrisome. Furthermore, weak hospital management, high numbers of unused acute beds, overprescribing pharmaceuticals, and poor gatekeeping of the system all lead to over-utilization of services and system inefficiency. This suggests substantial room for improvement in delivery of care, especially for primary and long-term care. Additionally, there is inequity in the distribution of health providers, resulting in lengthy travelling distances and waiting times for patients. Given the ageing workforce, this trend is likely to continue. Current strategic documents and reform efforts aim to address the lack of efficiency and accountability. There has been a strong will to tackle these challenges but this has often been hindered by a lack of political consensus over issues such as the role of the state, the appropriate role of market mechanisms and profits, as well as the extent of out-of-pocket payments. Successive governments have taken different positions on these issues since the establishment of the current health system in 2002, and major reforms remain to be implemented. World Health Organization 2016 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  11. Risk management systems for health care and safety development on transplantation: a review and a proposal.

    PubMed

    Pretagostini, R; Gabbrielli, F; Fiaschetti, P; Oliveti, A; Cenci, S; Peritore, D; Stabile, D

    2010-05-01

    Starting from the report on medical errors published in 1999 by the US Institute of Medicine, a number of different approaches to risk management have been developed for maximum risk reduction in health care activities. The health care authorities in many countries have focused attention on patient safety, employing action research programs that are based on quite different principles. We performed a systematic Medline research of the literature since 1999. The following key words were used, also combining boolean operators and medical subheading terms: "adverse event," "risk management," "error," and "governance." Studies published in the last 5 years were particularly classified in various groups: risk management in health care systems; safety in specific hospital activities; and health care institutions' official documents. Methods of action researches have been analysed and their characteristics compared. Their suitability for safety development in donation, retrieval, and transplantation processes were discussed in the reality of the Italian transplant network. Some action researches and studies were dedicated to entire national healthcare systems, whereas others focused on specific risks. Many research programs have undergone critical review in the literature. Retrospective analysis has centered on so-called sentinel events to particularly analyze only a minor portion of the organizational phenomena, which can be the origin of an adverse event, an incident, or an error. Sentinel events give useful information if they are studied in highly engineered and standardized organizations like laboratories or tissue establishments, but they show several limits in the analysis of organ donation, retrieval, and transplantation processes, which are characterized by prevailing human factors, with high intrinsic risk and variability. Thus, they are poorly effective to deliver sure elements to base safety management improvement programs, especially regarding

  12. Regional Health Information Systems

    PubMed Central

    Fuller, Sherrilynne

    1997-01-01

    Abstract In general, there is agreement that robust integrated information systems are the foundation for building successful regional health care delivery systems. Integrated Advanced Information Management System (IAIMS) institutions that, over the years, have developed strategies for creating cohesive institutional information systems and services are finding that IAIMS strategies work well in the even more complex regional environment. The key elements of IAIMS planning are described and lessons learned are discussed in the context of regional health information systems developed. The challenges of aligning the various information agencies and agendas in support of a regional health information system are complex ; however, the potential rewards for health care in quality, efficacy, and cost savings are enormous. PMID:9067887

  13. Developing a measure of engagement with telehealth systems: The mHealth Technology Engagement Index.

    PubMed

    Dewar, Alexis R; Bull, Tyler P; Malvey, Donna M; Szalma, James L

    2017-02-01

    Introduction Telehealth systems and mobile health (mHealth) devices allow for the exchange of both physical and mental healthcare data, as well as information from a patient to a practitioner, or care recipient to caregiver; but there has been little research on why users are motivated to engage with telehealth systems. Given this, we sought to create a measure that satisfactorily assesses human motivation to use telehealth devices. Methods 532 survey responses were used in an exploratory factor analysis and confirmatory factor analysis, which tested and retested the feasibility of this new measure. Convergent and divergent validity analyses indicated that the mHealth Technology Engagement Index (mTEI) is a unique measure of motivation. Results The results indicated that autonomy, competence, relatedness, goal attainment, and goal setting underpin motivation to use telehealth systems. Discussion The mTEI shows promise in indexing human motivation to use telehealth technologies. We also discuss the importance of developing measurement tools based on theory and how practitioners can best utilize the mTEI.

  14. Developing a comprehensive pesticide health effects tracking system for an urban setting: New York City's approach.

    PubMed

    Kass, Daniel E; Thier, Audrey L; Leighton, Jessica; Cone, James E; Jeffery, Nancy L

    2004-10-01

    In recent years, there have been substantial investments and improvements in federal and state surveillance systems to track the health effects from pesticide exposure. These surveillance systems help to identify risk factors for occupational exposure to pesticides, patterns in poisonings, clusters of disease, and populations at risk of exposure from pesticide use. Data from pesticide use registries and recent epidemiologic evidence pointing to health risks from urban residential pesticide use make a strong case for understanding better the sale, application, and use of pesticides in cities. In this article, we describe plans for the development of a pesticide tracking system for New York City that will help to elucidate where and why pesticides are used, potential risks to varied populations, and the health consequences of their use. The results of an inventory of data sources are presented along with a description of their relevance to pesticide tracking. We also discuss practical, logistical, and methodologic difficulties of linking multiple secondary data sources with different levels of person, place, and time descriptors.

  15. Austria: health system review.

    PubMed

    Hofmarcher, Maria M; Quentin, Wilm

    2013-01-01

    This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health-system performance. The Austrian health system provides universal coverage for a wide range of benefits and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialist physicians and hospitals) are characteristic features of the system. Unsurprisingly, population satisfaction is well above EU average. Income-related inequality in health has increased since 2005, although it is still relatively low compared to other countries. The health-care system has been shaped by both the federal structure of the state and a tradition of delegating responsibilities to self-governing stakeholders. On the one hand, this enables decentralized planning and governance, adjusted to local norms and preferences. On the other hand, it also leads to fragmentation of responsibilities and frequently results in inadequate coordination. For this reason, efforts have been made for several years to achieve more joint planning, governance and financing of the health-care system at the federal and regional level. As in any health system, a number of challenges remain. The costs of the health-care system are well above the EU15 average, both in absolute terms and as a percentage of GDP. There are important structural imbalances in healthcare provision, with an oversized hospital sector and insufficient resources available for ambulatory care and preventive medicine. This is coupled with stark regional differences in utilization, both in curative services (hospital beds and specialist physicians) and preventative services such as preventive health check-ups, outpatient rehabilitation, psychosocial and psychotherapeutic care and nursing. There are clear social inequalities in the use of medical services, such as preventive health check-ups, immunization or dentistry

  16. Developing Expert System for Tuberculosis Diagnose to Support Knowledge Sharing in the Era of National Health Insurance System

    NASA Astrophysics Data System (ADS)

    Lidya, L.

    2017-03-01

    National Health Insurance has been implemented since 1st January 2014. A number of new policies have been established including multilevel referral system. The multilevel referral system classified health care center into three levels, it determined that the flow of patient treatment should be started from first level health care center. There are 144 kind of diseases that must be treat in the first level which mainly consists of general physicians. Unfortunately, competence of the physician in the first level may not fulfil the standard competence yet. To improved the physisians knowledge, government has created many events to accelerate knowledge sharing. However, it still needs times and many resources to give significan results. Expert system is kind of software that provide consulting services to non-expert users in accordance with the area of its expertise. It can improved effectivity and efficiency of knowledge sharing and learning. This research was developed a model of TB diagnose expert system which comply with the standard procedure of TB diagnosis and regulation. The proposed expert system has characteristics as follows provide facility to manage multimedia clinical data, supporting the complexity of TB diagnosis (combine rule-based and case-based expert system), interactive interface, good usability, multi-platform, evolutionary.

  17. Development prospects of health and reform of the fiscal system in bosnia and herzegovina.

    PubMed

    Salihbasic, Sehzada

    2011-01-01

    The functions of the health system, according to the key objectives and relationships within the sub-systems that are available to the policy makers and managers in the Health Care system in Bosnia and Herzegovina - B&H, have been elaborated in detail, with the analytical overview of relevant indicators, thus confirming the limitations of the health promotion in B&H. The ability to overcome the expressed problems is in the startup of process for structural adjustment of the health sector, reform of the health care system and its financing. The reform in health system implies fundamental changes that need to take place, in B&H, as a state in health policy and institutions in the health care system, in order to improve the functioning of health systems with the aim of ensuring better health of the population. Reform implies the existence of documents with clearly formulated health policy objectives, for which the state stands, and for which a consensus was reached on the national level with all key actors in the political structure: public promotion of the basic principles for carrying out the reform, its implementation within a reasonable time frame, the corresponding effects for providers and customer satisfaction, as well as improving health services' efficacy (i.e. micro and macro) and the quality of healthcare. In this article, we elaborated the criteria for the classification of health systems, whereby the scientifically-based and empirical analysis is conducted on the health system in B&H and elaborated the key levers of the system. Leveraged organizational arrangements relating to the economic and political environment, organization and management functions, in connection with the services of finance, funds, customers and service providers, from which it follows the framework of state legislation related to health policy and health institutions at the state level are responsible for finance, planning, the organization, payment, regulation and conduct. If we

  18. Azerbaijan: health system review.

    PubMed

    Ibrahimov, Fuad; Ibrahimova, Aybaniz; Kehler, Jenni; Richardson, Erica

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Azerbaijan gained independence from the Soviet Union in 1991. Reform of the health care system in Azerbaijan has been incremental so that organizationally it still has many of the key hallmarks of the Soviet model of health care, the Semashko system. However, relatively low levels of government expenditure on health as a proportion of gross domestic product since independence has meant that out of pocket (OOP) payments accounted for almost 62% of total health expenditure in 2007. This has serious implications for access to care and financial risk protection for vulnerable households. The private provision of services is an increasingly important part of the health system, and services provided in parallel by other ministries and state enterprises continue to account for a certain amount of health expenditure. Revenues from the recent oil boom have been used to fund large capital investment projects such as the building of new hospitals with the latest technology and the import of modern equipment. However, future plans include the strengthening of primary care and the introduction of mandatory health insurance as part of major reforms to the health financing system.

  19. Socio-cultural and global health perspectives for the development of future psychiatric diagnostic systems.

    PubMed

    Lee, Sing

    2002-01-01

    Psychiatric diagnosis and classification reflect the social and political context of an era and are embedded in it. In the last few decades, culture-bound syndromes reported in non-Western societies constituted the major focus of contention over the validity and universality of psychiatric diagnosis. In contemporary times, social, economic, and political factors, such as the hegemony of the DSM discourse, the managed care culture, pharmaceutical forces, and the global burden of disease study, have virtually made culture-bound syndromes 'disappear'. Once widely believed to be rare outside of the developed West, depression has rapidly become the master narrative of mental health worldwide. In the context of global mental health, the field of psychiatric classification must go beyond routine debates over categories. In order to address the growing discrepancy between needs and services, international cultural psychiatry must engage key social forces, such as psychiatric epidemiology, primary care psychiatry, integration of diagnostic systems, stigma, and advocacy.

  20. Belgium: Health system review.

    PubMed

    Gerkens, Sophie; Merkur, Sherry

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Belgian population continues to enjoy good health and long life expectancy. This is partly due to good access to health services of high quality. Financing is based mostly on proportional social security contributions and progressive direct taxation. The compulsory health insurance is combined with a mostly private system of health care delivery, based on independent medical practice, free choice of physician and predominantly fee-for-service payment. This Belgian HiT profile (2010) presents the evolution of the health system since 2007, including detailed information on new policies. While no drastic reforms were undertaken during this period, policy-makers have pursued the goals of improving access to good quality of care while making the system sustainable. Reforms to increase the accessibility of the health system include measures to reduce the out-of-pocket payments of more vulnerable populations (low-income families and individuals as well as the chronically ill). Quality of care related reforms have included incentives to better integrate different levels of care and the establishment of information systems, among others. Additionally, several measures on pharmaceutical products have aimed to reduce costs for both the National Institute for Health and Disability Insurance (NIHDI) and patients, while maintaining the quality of care.

  1. Developing a structural health monitoring system for nuclear dry cask storage canister

    NASA Astrophysics Data System (ADS)

    Sun, Xiaoyi; Lin, Bin; Bao, Jingjing; Giurgiutiu, Victor; Knight, Travis; Lam, Poh-Sang; Yu, Lingyu

    2015-03-01

    Interim storage of spent nuclear fuel from reactor sites has gained additional importance and urgency for resolving waste-management-related technical issues. In total, there are over 1482 dry cask storage system (DCSS) in use at US plants, storing 57,807 fuel assemblies. Nondestructive material condition monitoring is in urgent need and must be integrated into the fuel cycle to quantify the "state of health", and more importantly, to guarantee the safe operation of radioactive waste storage systems (RWSS) during their extended usage period. A state-of-the-art nuclear structural health monitoring (N-SHM) system based on in-situ sensing technologies that monitor material degradation and aging for nuclear spent fuel DCSS and similar structures is being developed. The N-SHM technology uses permanently installed low-profile piezoelectric wafer sensors to perform long-term health monitoring by strategically using a combined impedance (EMIS), acoustic emission (AE), and guided ultrasonic wave (GUW) approach, called "multimode sensing", which is conducted by the same network of installed sensors activated in a variety of ways. The system will detect AE events resulting from crack (case for study in this project) and evaluate the damage evolution; when significant AE is detected, the sensor network will switch to the GUW mode to perform damage localization, and quantification as well as probe "hot spots" that are prone to damage for material degradation evaluation using EMIS approach. The N-SHM is expected to eventually provide a systematic methodology for assessing and monitoring nuclear waste storage systems without incurring human radiation exposure.

  2. Social Work Leadership as Ambassadors of Health Care Reform: Developing and Implementing a Health Home Program Within a Large Urban Health System.

    PubMed

    Monti, Kristina; Rosner, Arielle

    2015-10-01

    Beginning in 2011, The Mount Sinai Hospital participated in the New York State Department of Health Medicaid Health Home (HH) program, evolving into what is now the Mount Sinai Health Home (MSHH). The lead HH designation required social work leadership to develop and implement this initiative within a large health system, consisting of five New York City area hospitals. Additionally, strategic partnerships with sub-contracted, community based organizations and Medicaid Managed Care Organizations (MCOs) were essential to the HH's success, and were facilitated by inter- and intra-organization collaboration. This article provides an overview of the HH model and discusses the process by which MSHH was formed, the integral role of social work in its development and success, challenges and lessons learned, and recommendations for the development of the profession's future workforce. The authors intend to leave the reader with a model of social work leadership within the current environment of health care reform, and to exemplify social work care coordination and engagement of a hard to reach patient population.

  3. Challenges and opportunities for policy decisions to address health equity in developing health systems: case study of the policy processes in the Indian state of Orissa

    PubMed Central

    2011-01-01

    Introduction Achieving health equity is a pertinent need of the developing health systems. Though policy process is crucial for planning and attaining health equity, the existing evidences on policy processes are scanty in this regard. This article explores the magnitude, determinants, challenges and prospects of 'health equity approach' in various health policy processes in the Indian State of Orissa - a setting comparable with many other developing health systems. Methods A case-study involving 'Walt-Gilson Policy Triangle' employed key-informant interviews and documentary reviews. Key informants (n = 34) were selected from the departments of Health and Family Welfare, Rural Development, and Women and Child Welfare, and civil societies. The documentary reviews involved various published and unpublished reports, policy pronouncements and articles on health equity in Orissa and similar settings. Results The 'health policy agenda' of Orissa was centered on 'health equity' envisaging affordable and equitable healthcare to all, integrated with public health interventions. However, the subsequent stages of policy process such as 'development, implementation and evaluation' experienced leakage in the equity approach. The impediment for a comprehensive approach towards health equity was the nexus among the national and state health priorities; role, agenda and capacity of actors involved; and existing constraints of the healthcare delivery system. Conclusion The health equity approach of policy processes was incomprehensive, often inadequately coordinated, and largely ignored the right blend of socio-medical determinants. A multi-sectoral, unified and integrated approach is required with technical, financial and managerial resources from different actors for a comprehensive 'health equity approach'. If carefully geared, the ongoing health sector reforms centered on sector-wide approaches, decentralization, communitization and involvement of non-state actors can

  4. Model-centric approaches for the development of health information systems.

    PubMed

    Tuomainen, Mika; Mykkänen, Juha; Luostarinen, Heli; Pöyhölä, Assi; Paakkanen, Esa

    2007-01-01

    Modeling is used increasingly in healthcare to increase shared knowledge, to improve the processes, and to document the requirements of the solutions related to health information systems (HIS). There are numerous modeling approaches which aim to support these aims, but a careful assessment of their strengths, weaknesses and deficiencies is needed. In this paper, we compare three model-centric approaches in the context of HIS development: the Model-Driven Architecture, Business Process Modeling with BPMN and BPEL and the HL7 Development Framework. The comparison reveals that all these approaches are viable candidates for the development of HIS. However, they have distinct strengths and abstraction levels, they require local and project-specific adaptation and offer varying levels of automation. In addition, illustration of the solutions to the end users must be improved.

  5. Development of a FBG based distributed strain sensor system for wind turbine structural health monitoring

    NASA Astrophysics Data System (ADS)

    Arsenault, Tyler J.; Achuthan, Ajit; Marzocca, Pier; Grappasonni, Chiara; Coppotelli, Giuliano

    2013-07-01

    The development of a fiber Bragg grating (FBG) based distributed strain sensor system for real time structural health monitoring of a wind turbine rotor and its validation under a laboratory scale test setup is discussed in this paper. A 1 kW, 1.6 m diameter rotor, horizontal axis wind turbine with three instrumented blades is used in this study. The sensor system consists of strain sensors, surface mounted at various locations on the blade. At first the sensors are calibrated under static loading conditions to validate the FBG mounting and the proposed data collection techniques. Then, the capability of the sensor system coupled with the operational modal analysis (OMA) methods to capture natural frequencies and corresponding mode shapes in terms of distributed strains are validated under various non-rotating dynamic loading conditions. Finally, the sensor system is tested under rotating conditions using the wind flow from an open-jet wind tunnel, for both a baseline wind turbine and a wind turbine with a structurally modified blade. The blade was modified by attaching a lumped mass at the blade tip simulating structural damage or ice accretion. The dynamic characteristics of the baseline (healthy) blade and modified (altered) blade are compared to validate the sensor system’s ability for real time structural health monitoring of the rotor.

  6. Coordinating Systems of Care Using Health Information Technology: Development of the ADHD Care Assistant

    PubMed Central

    Power, Thomas J.; Michel, Jeremy; Mayne, Stephanie; Miller, Jeffrey; Blum, Nathan J.; Grundmeier, Robert W.; Guevara, James P.; Fiks, Alexander G.

    2016-01-01

    Perhaps the two principal venues for the delivery of mental health services are schools and primary care practices. Unfortunately, these systems of care are poorly connected, which may result in care that is fragmented and suboptimal. This article describes the development and implementation of an electronic health record portal, known as the ADHD Care Assistant, to facilitate the sharing of information between schools and primary care offices to promote the use of evidence-based practices for managing children with behavioral health conditions. A feasibility study was conducted across 19 diverse primary care practices with 105 participating providers. Across the practices, 67% of providers activated the system for at least one patient and 32% activated it for five or more cases. Care Assistant use was lower in practices with a relatively high percentage of Medicaid patients (≥ 25%). The article discusses challenges that have arisen among primary care providers, parents, and schools in using the Care Assistant, potential strategies for addressing the challenges, and directions for future research and practice. PMID:28377792

  7. Fetal Health and Development

    MedlinePlus

    ... fetus grows and develops. There are specific prenatal tests to monitor both the mother's health and fetal health during each trimester. With modern technology, health professionals can Detect birth defects Identify problems ...

  8. France: Health System Review.

    PubMed

    Chevreul, Karine; Berg Brigham, Karen; Durand-Zaleski, Isabelle; Hernandez-Quevedo, Cristina

    2015-01-01

    This analysis of the French health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The French population has a good level of health, with the second highest life expectancy in the world for women. It has a high level of choice of providers, and a high level of satisfaction with the health system. However, unhealthy habits such as smoking and harmful alcohol consumption remain significant causes of avoidable mortality. Combined with the significant burden of chronic diseases, this has underscored the need for prevention and integration of services, although these have not historically been strengths of the French system. Although the French health care system is a social insurance system, it has historically had a stronger role for the state than other Bismarckian social insurance systems. Public financing of health care expenditure is among the highest in Europe and out-of-pocket spending among the lowest. Public insurance is compulsory and covers the resident population; it is financed by employee and employer contributions as well as increasingly through taxation. Complementary insurance plays a significant role in ensuring equity in access. Provision is mixed; providers of outpatient care are largely private, and hospital beds are predominantly public or private non-profit-making. Despite health outcomes being among the best in the European Union, social and geographical health inequities remain. Inequality in the distribution of health care professionals is a considerable barrier to equity. The rising cost of health care and the increasing demand for long-term care are also of concern. Reforms are ongoing to address these issues, while striving for equity in financial access; a long-term care reform including public coverage of long-term care is still pending.

  9. Portugal: Health System Review.

    PubMed

    de Almeida Simoes, Jorge; Figueiredo Augusto, Goncalo; Fronteira, Ines; Hernandez-Quevedo, Cristina

    2017-03-01

    This analysis of the Portuguese health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Overall health indicators such as life expectancy at birth and at age 65 years have shown a notable improvement over the last decades. However, these improvements have not been followed at the same pace by other important dimensions of health: child poverty and its consequences, mental health and quality of life after 65. Health inequalities remain a general problem in the country. All residents in Portugal have access to health care provided by the National Health Service (NHS), financed mainly through taxation. Out-of-pocket payments have been increasing over time, not only co-payments, but particularly direct payments for private outpatient consultations, examinations and pharmaceuticals. The level of cost-sharing is highest for pharmaceutical products. Between one-fifth and one-quarter of the population has a second (or more) layer of health insurance coverage through health subsystems (for specific sectors or occupations) and voluntary health insurance (VHI). VHI coverage varies between schemes, with basic schemes covering a basic package of services, whereas more expensive schemes cover a broader set of services, including higher ceilings of health care expenses. Health care delivery is by both public and private providers. Public provision is predominant in primary care and hospital care, with a gate-keeping system in place for access to hospital care. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. In May 2011, the economic crisis led Portugal to sign a Memorandum of Understanding with the International Monetary Fund, the European Commission and the European Central Bank, in exchange for a loan of 78 billion euros. The agreed Economic and Financial Adjustment Programme included

  10. Mental health system development profiles and indicators of scientific and technology innovation.

    PubMed

    Vilela Chaves, Catari; Moro, Sueli

    2009-06-01

    In this paper, mental health is discussed in the context of the system of innovation in health care. A set of mental illnesses is investigated in order to broaden our understanding of how they can be connected to the health innovation system. Two country typologies are investigated. The first typology uses the Grade of Membership approach to group 112 countries with similar policies, programs, legislation, treatment and mental health funding methods for 2001. The second is the hierarchical cluster approach, which uses scientific papers and patents from 118 countries as proxies for science and technology in 2001. The results indicate the presence of some countries in two extreme groups. On the one hand, countries with the best performance in the field of mental health have the best mental health infrastructure and are also ranked first in science and technology in this area. On the other hand, countries with the worst performance in the field of mental health also have the worst mental health infrastructure and are in the worst position in science and technology. By analyzing the international data on scientific publications and mental health systems, we find that as countries become more advanced, they significantly increase their scientific production as well as their focus on the health sector. These two movements make it possible for countries to build their own catching-up processes, focused on the health system. Accordingly, it is expected that mental health care can benefit from that strengthening in the health care sector. IMPLICATION FOR HEALTH CARE PROVISION AND USE: This paper identifies which countries need to improve their mental health and science and technology infrastructures. IMPLICATION FOR HEALTH POLICIES: The main policy recommendation refers to the strengthening of the health innovation system. This policy was chosen because, statistically speaking, according to the crisp sets and the fuzzy sets theories, this evaluation, made with data from

  11. NASA Stennis Space Center Integrated System Health Management Test Bed and Development Capabilities

    NASA Technical Reports Server (NTRS)

    Figueroa, Fernando; Holland, Randy; Coote, David

    2006-01-01

    Integrated System Health Management (ISHM) is a capability that focuses on determining the condition (health) of every element in a complex System (detect anomalies, diagnose causes, prognosis of future anomalies), and provide data, information, and knowledge (DIaK)-not just data-to control systems for safe and effective operation. This capability is currently done by large teams of people, primarily from ground, but needs to be embedded on-board systems to a higher degree to enable NASA's new Exploration Mission (long term travel and stay in space), while increasing safety and decreasing life cycle costs of spacecraft (vehicles; platforms; bases or outposts; and ground test, launch, and processing operations). The topics related to this capability include: 1) ISHM Related News Articles; 2) ISHM Vision For Exploration; 3) Layers Representing How ISHM is Currently Performed; 4) ISHM Testbeds & Prototypes at NASA SSC; 5) ISHM Functional Capability Level (FCL); 6) ISHM Functional Capability Level (FCL) and Technology Readiness Level (TRL); 7) Core Elements: Capabilities Needed; 8) Core Elements; 9) Open Systems Architecture for Condition-Based Maintenance (OSA-CBM); 10) Core Elements: Architecture, taxonomy, and ontology (ATO) for DIaK management; 11) Core Elements: ATO for DIaK Management; 12) ISHM Architecture Physical Implementation; 13) Core Elements: Standards; 14) Systematic Implementation; 15) Sketch of Work Phasing; 16) Interrelationship Between Traditional Avionics Systems, Time Critical ISHM and Advanced ISHM; 17) Testbeds and On-Board ISHM; 18) Testbed Requirements: RETS AND ISS; 19) Sustainable Development and Validation Process; 20) Development of on-board ISHM; 21) Taxonomy/Ontology of Object Oriented Implementation; 22) ISHM Capability on the E1 Test Stand Hydraulic System; 23) Define Relationships to Embed Intelligence; 24) Intelligent Elements Physical and Virtual; 25) ISHM Testbeds and Prototypes at SSC Current Implementations; 26) Trailer

  12. Switzerland: Health System Review.

    PubMed

    De Pietro, Carlo; Camenzind, Paul; Sturny, Isabelle; Crivelli, Luca; Edwards-Garavoglia, Suzanne; Spranger, Anne; Wittenbecher, Friedrich; Quentin, Wilm

    2015-01-01

    This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to

  13. [Essential research in health systems].

    PubMed

    González-Block, M A

    1994-01-01

    Public health research and education in Mexico require further decentralization to improve its availability, quality and relevance for the development of local health systems. This article presents the experience of the Northern Regional Center for Health Systems Development (Nuredess-Norte), a consortium for the decentralization and regionalization of public health research and education of El Colegio de la Frontera Norte and the National Institute of Public Health. Nuredess-Norte initiated its activities in 1990 establishing a binational network of health systems consultants along the border, following a common methodology to improve health system quality through research. Later a Health Systems Development Teaching Program was established at the level of specialization with a high degree of decentralization and linkage with local health systems. Nuredess-Norte undertakes research, design and evaluation of innovations along the US-Mexico border. Emphasis is given to community participation and the development of primary health care.

  14. Slovakia health system review.

    PubMed

    Szalay, Tomás; Pazitný, Peter; Szalayová, Angelika; Frisová, Simona; Morvay, Karol; Petrovic, Marek; van Ginneken, Ewout

    2011-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services, and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Slovak health system is a system in progress. Major health reform in the period 2002 to 2006 introduced a new approach based on managed competition. Although large improvements have been made since the 1990s (for example in life expectancy and infant mortality), health outcomes are generally still substantially worse than the average for the EU15 but close to the other Visegrad Four countries. Per capita health spending (in purchasing power parity [PPP]) was around half the EU15 average. A large share of these resources was absorbed by pharmaceutical spending (28% in 2008, compared to 16% in OECD countries). Some important utilization indicators signal plenty of resources in the system but may also indicate excess bed capacity and overutilization. The number of physicians and nurses per capita has been actively reduced since 2001 but remains above the average of the EU12 (i.e. the 12 countries that joined the EU in 2004 and 2007). An ageing workforce and professional migration may reinforce a shortage of health care workers. People have free choice of general practitioner (GP) and specialist. Their services are provided without cost-sharing from patients, with the notable exception of dental procedures. Inpatient care and specialized ambulatory care are provided in general hospitals and specialized hospitals. Pharmaceutical expenditure per capita accounts for one-third of public expenditure on health care. Long-term care is provided by health care

  15. Strengthening health systems by health sector reforms

    PubMed Central

    Senkubuge, Flavia; Modisenyane, Moeketsi; Bishaw, Tewabech

    2014-01-01

    Background The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. Methods A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. Findings Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging ‘street level’ policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms. Conclusions The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems. PMID:24560261

  16. Poland health system review.

    PubMed

    Sagan, Anna; Panteli, Dimitra; Borkowski, W; Dmowski, M; Domanski, F; Czyzewski, M; Gorynski, Pawel; Karpacka, Dorota; Kiersztyn, E; Kowalska, Iwona; Ksiezak, Malgorzata; Kuszewski, K; Lesniewska, A; Lipska, I; Maciag, R; Madowicz, Jaroslaw; Madra, Anna; Marek, M; Mokrzycka, A; Poznanski, Darius; Sobczak, Alicja; Sowada, Christoph; Swiderek, Maria; Terka, A; Trzeciak, Patrycja; Wiktorzak, Katarzyna; Wlodarczyk, Cezary; Wojtyniak, B; Wrzesniewska-Wal, Iwona; Zelwianska, Dobrawa; Busse, Reinhard

    2011-01-01

    , particularly in areas such as pharmaceuticals, are highly regressive. The health status of the Polish population has improved substantially, with average life expectancy at birth reaching 80.2 years for women and 71.6 years for men in 2009. However, there is still a vast gap in life expectancy between Poland and the western European Union (EU) countries and between life expectancy overall and the expected number of years without illness or disability. Given its modest financial, human and material health care resources and the corresponding outcomes, the overall financial efficiency of the Polish system is satisfactory. Both allocative and technical efficiency leave room for improvement. Several measures, such as prioritizing primary care and adopting new payment mechanisms such as diagnosis-related groups (DRGs), have been introduced in recent years but need to be expanded to other areas and intensified. Additionally, numerous initiatives to enhance quality control and build the required expertise and evidence base for the system are also in place. These could improve general satisfaction with the system, which is not particularly high. Limited resources, a general aversion to cost-sharing stemming from a long experience with broad public coverage and shortages in health workforce need to be addressed before better outcomes can be achieved by the system. Increased cooperation between various bodies within the health and social care sectors would also contribute in this direction. The HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services, and the role of the main actors in health systems; they describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. World

  17. Malta: Health system review.

    PubMed

    Azzopardi Muscat, Natasha; Calleja, Neville; Calleja, Antoinette; Cylus, Jonathan

    2014-01-01

    This analysis of the Maltese health system reviews the developments in its organization and governance, health financing, health-care provision, health reforms and health system performance. The health system in Malta consists of a public sector, which is free at the point of service and provides a comprehensive basket of health services for all its citizens, and a private sector, which accounts for a third of total health expenditure and provides the majority of primary care. Maltese citizens enjoy one of the highest life expectancies in Europe. Nevertheless, non-communicable diseases pose a major concern with obesity being increasingly prevalent among both adults and children. The health system faces important challenges including a steadily ageing population, which impacts the sustainability of public finances. Other supply constraints stem from financial and infrastructural limitations. Nonetheless, there exists a strong political commitment to ensure the provision of a healthcare system that is accessible, of high quality, safe and also sustainable. This calls for strategic investments to underpin a revision of existing processes whilst shifting the focus of care away from hospital into the community.

  18. Development of a Vehicle Health Monitoring System for the Space Shuttle Solid Rocket Booster Program

    NASA Technical Reports Server (NTRS)

    Crawford, Kevin

    2000-01-01

    During their brief flight, the space shuttle solid rocket boosters (SRBs) experience a severe environment. This environment in most cases is unknown. When the design engineers believe they understand the environments, something new occurs. For example, at water impact several SRBs have sustained noticeable structural damage. The severity of the damage is usually dependent upon the waves that the SRB encounter at splashdown. The space shuttle is presently scheduled to fly until 2030. To support the shuttle flight schedule, the avionics on the SRB's will need to be upgraded. The environments on the different sections of the SRB will need to be defined more completely to properly qualify the avionics for multiple flights. The combination of new avionics systems and unknown flight environments led Marshall Space Flight Center's (MSFC) SRB Project Office to request the Science and Engineering (S&E) Directorate to develop a stand-alone data acquisition system that could collect data from any area of the booster. The Enhanced Data Acquisition System (EDAS) was developed to meet this request. However, the EDAS has some technical drawbacks that needed resolved. To answer the EDAS problems, the SRB Project Office has funded MSFC's Avionics Department to begin investigating a new vehicle health monitoring (VHM) system. The major requirements are the system shall have 64 channels, have programmable sample rates up to 10,000 samples per second, have sufficient memory for a twenty minute flight and not interfere with existing operational flight avionics hardware. This paper will describe the effort to develop a VHM system that can meet the SRB requirements.

  19. Development of a Vehicle Health Monitoring System for the Space Shuttle Solid Rocket Booster Program

    NASA Technical Reports Server (NTRS)

    Crawford, Kevin

    2000-01-01

    During their brief flight, the space shuttle solid rocket boosters (SRBs) experience a severe environment. This environment in most cases is unknown. When the design engineers believe they understand the environments, something new occurs. For example, at water impact several SRBs have sustained noticeable structural damage. The severity of the damage is usually dependent upon the waves that the SRB encounter at splashdown. The space shuttle is presently scheduled to fly until 2030. To support the shuttle flight schedule, the avionics on the SRB's will need to be upgraded. The environments on the different sections of the SRB will need to be defined more completely to properly qualify the avionics for multiple flights. The combination of new avionics systems and unknown flight environments led Marshall Space Flight Center's (MSFC) SRB Project Office to request the Science and Engineering (S&E) Directorate to develop a stand-alone data acquisition system that could collect data from any area of the booster. The Enhanced Data Acquisition System (EDAS) was developed to meet this request. However, the EDAS has some technical drawbacks that needed resolved. To answer the EDAS problems, the SRB Project Office has funded MSFC's Avionics Department to begin investigating a new vehicle health monitoring (VHM) system. The major requirements are the system shall have 64 channels, have programmable sample rates up to 10,000 samples per second, have sufficient memory for a twenty minute flight and not interfere with existing operational flight avionics hardware. This paper will describe the effort to develop a VHM system that can meet the SRB requirements.

  20. Evaluation of an Android-based mHealth system for population surveillance in developing countries

    PubMed Central

    Mbugua, Samuel; Amadi, David; Chepnǵeno, Viola; Saleem, Jason J; Anokwa, Yaw; Hartung, Carl; Borriello, Gaetano; Mamlin, Burke W; Ndege, Samson K; Were, Martin C

    2012-01-01

    Objective In parts of the developing world traditionally modeled healthcare systems do not adequately meet the needs of the populace. This can be due to imbalances in both supply and demand—there may be a lack of sufficient healthcare and the population most at need may be unable or unwilling to take advantage of it. Home-based care has emerged as a possible mechanism to bring healthcare to the populace in a cost-effective, useful manner. This study describes the development, implementation, and evaluation of a mobile device-based system to support such services. Materials and Methods Mobile phones were utilized and a structured survey was implemented to be administered by community health workers using Open Data Kit. This system was used to support screening efforts for a population of two million persons in western Kenya. Results Users of the system felt it was easy to use and facilitated their work. The system was also more cost effective than pen and paper alternatives. Discussion This implementation is one of the largest applications of a system utilizing handheld devices for performing clinical care during home visits in a resource-constrained environment. Because the data were immediately available electronically, initial reports could be performed and important trends in data could thus be detected. This allowed adjustments to the programme to be made sooner than might have otherwise been possible. Conclusion A viable, cost-effective solution at scale has been developed and implemented for collecting electronic data during household visits in a resource-constrained setting. PMID:22366295

  1. Psychiatric agriculture: systemic nutritional modification and mental health in the developing world.

    PubMed

    London, Douglas S; Stoll, Andrew L; Manning, Bruce B

    2006-01-01

    Modernization of agricultural systems to increase output causes changes to the nutritional content of food entire populations consume. Human nutritional needs differ from their "food", thus producing healthy agricultural products is not equivalent to providing agricultural products that are healthy for humans. Inclusion of the food production system as a factor in the increase of neuropsychiatric disorders and other chronic diseases helps explain negative trends in modern chronic diseases that remain unchecked despite stunning advances in modern medicine. Diseases in which our own technology plays a significant role include obesity and resulting disorders, such as diabetes, heart disease, hypertension, stroke and arthritis. Modernization's lure leads to importation of modern agricultural practices into a nutritionally vulnerable, malnourished and sometimes starving developing world. Wealthier nations hedge their food portfolio by having access to a wider variety of foods. The developing world's reliance on staple foods means even a minor widespread nutritional modification of one key food can have profound effects. New agricultural techniques may improve or exacerbate neuropsychiatric disorders through nutritional modification in regions where populations walk a nutritional tightrope with little margin for error. In most of the developing world western psychiatric interventions have failed to make inroads. People's consumption of fish has a demonstrated beneficial effect on their mental health and the omega-3 fatty acid content is a significant factor. Epidemiological, biological and agricultural studies implicate a lack of dietary omega-3s as a factor in certain mental disorders. Replenishing omega-3s has improved mental illnesses in controlled clinical trials. This article's detailed tilapia fish-farming model demonstrates how aquaculture/agriculture techniques can function as a public health intervention by increasing dietary omega-3s through creation of

  2. Improving health outcomes through concurrent HIV program scale-up and health system development in Rwanda: 20 years of experience.

    PubMed

    Nsanzimana, Sabin; Prabhu, Krishna; McDermott, Haley; Karita, Etienne; Forrest, Jamie I; Drobac, Peter; Farmer, Paul; Mills, Edward J; Binagwaho, Agnes

    2015-09-09

    The 1994 genocide against the Tutsi destroyed the health system in Rwanda. It is impressive that a small country like Rwanda has advanced its health system to the point of now offering near universal health insurance coverage. Through a series of strategic structural changes to its health system, catalyzed through international assistance, Rwanda has demonstrated a commitment towards improving patient and population health indicators. In particular, the rapid scale up of antiretroviral therapy (ART) has become a great success story for Rwanda. The country achieved universal coverage of ART at a CD4 cell count of 200 cells/mm(3) in 2007 and increased the threshold for initiation of ART to ≤350 cells/mm(3) in 2008. Further, 2013 guidelines raised the threshold for initiation to ≤500 cells/mm(3) and suggest immediate therapy for key affected populations. In 2015, guidelines recommend offering immediate treatment to all patients. By reviewing the history of HIV and the scale-up of treatment delivery in Rwanda since the genocide, this paper highlights some of the key innovations of the Government of Rwanda and demonstrates the ways in which the national response to the HIV epidemic has catalyzed the implementation of interventions that have helped strengthen the overall health system.

  3. Development and Flight Testing of an Autonomous Landing Gear Health-Monitoring System

    NASA Technical Reports Server (NTRS)

    Woodard, Stanley E.; Coffey, Neil C.; Gonzalez, Guillermo A.; Taylor, B. Douglas; Brett, Rube R.; Woodman, Keith L.; Weathered, Brenton W.; Rollins, Courtney H.

    2003-01-01

    Development and testing of an adaptable vehicle health-monitoring architecture is presented. The architecture is being developed for a fleet of vehicles. It has three operational levels: one or more remote data acquisition units located throughout the vehicle; a command and control unit located within the vehicle; and, a terminal collection unit to collect analysis results from all vehicles. Each level is capable of performing autonomous analysis with a trained expert system. Communication between all levels is done with wireless radio frequency interfaces. The remote data acquisition unit has an eight channel programmable digital interface that allows the user discretion for choosing type of sensors; number of sensors, sensor sampling rate and sampling duration for each sensor. The architecture provides framework for a tributary analysis. All measurements at the lowest operational level are reduced to provide analysis results necessary to gauge changes from established baselines. These are then collected at the next level to identify any global trends or common features from the prior level. This process is repeated until the results are reduced at the highest operational level. In the framework, only analysis results are forwarded to the next level to reduce telemetry congestion. The system's remote data acquisition hardware and non-analysis software have been flight tested on the NASA Langley B757's main landing gear. The flight tests were performed to validate the following: the wireless radio frequency communication capabilities of the system, the hardware design, command and control; software operation; and, data acquisition, storage and retrieval.

  4. Circumpolar Inuit health systems

    PubMed Central

    Ellsworth, Leanna; O'Keeffe, Annmaree

    2013-01-01

    methodology and timing of the available data collection. Conclusions Despite the variations in the health systems as well as national, political and economic approaches, none is adequately addressing Inuit health needs. All Inuit populations still have significant gaps between their health status and those of broader national populations. Meaningful measurement and evaluation of the effectiveness of the respective health systems is severely hindered by the lack of relevant, Inuit-specific health data. The inadequacy, and in a number of cases absence of relevant data, hinders the design and development of a better and potentially more effective approach to delivering health services to Inuit. PMID:23984305

  5. Estonia: health system review.

    PubMed

    Lai, Taavi; Habicht, Triin; Kahur, Kristiina; Reinap, Marge; Kiivet, Raul; van Ginneken, Ewout

    2013-01-01

    This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system.

  6. Belarus: health system review.

    PubMed

    Richardson, Erica; Malakhova, Irina; Novik, Irina; Famenka, Andrei

    2013-01-01

    This analysis of the Belarusian health system reviews the developments in organization and governance, health financing, healthcare provision, health reforms and health system performance since 2008. Despite considerable change since independence, Belarus retains a commitment to the principle of universal access to health care, provided free at the point of use through predominantly state-owned facilities, organized hierarchically on a territorial basis. Incremental change, rather than radical reform, has also been the hallmark of health-care policy, although capitation funding has been introduced in some areas and there have been consistent efforts to strengthen the role of primary care. Issues of high costs in the hospital sector and of weaknesses in public health demonstrate the necessity of moving forward with the reform programme. The focus for future reform is on strengthening preventive services and improving the quality and efficiency of specialist services. The key challenges in achieving this involve reducing excess hospital capacity, strengthening health-care management, use of evidence-based treatment and diagnostic procedures, and the development of more efficient financing mechanisms. Involving all stakeholders in the development of further reform planning and achieving consensus among them will be key to its success.

  7. Bulgaria health system review.

    PubMed

    Dimova, Antoniya; Rohova, Maria; Moutafova, Emanuela; Atanasova, Elka; Koeva, Stefka; Panteli, Dimitra; van Ginneken, Ewout

    2012-01-01

    In the last 20 years, demographic development in Bulgaria has been characterized by population decline, a low crude birth rate, a low fertility rate, a high mortality rate and an ageing population. A stabilizing political situation since the early 2000s and an economic upsurge since the mid-2000s were important factors in the slight increase of the birth and fertility rates and the slight decrease in standardized death rates. In general, Bulgaria lags behind European Union (EU) averages in most mortality and morbidity indicators. Life expectancy at birth reached 73.3 years in 2008 with the main three causes of death being diseases of the circulatory system, malignant neoplasms and diseases of the respiratory system. One of the most important risk factors overall is smoking, and the average standardized death rate for smoking-related causes in 2008 was twice as high as the EU15 average. The Bulgarian health system is characterized by limited statism. The Ministry of Health is responsible for national health policy and the overall organization and functioning of the health system and coordinates with all ministries with relevance to public health. The key players in the insurance system are the insured individuals, the health care providers and the third party payers, comprising the National Health Insurance Fund, the single payer in the social health insurance (SHI) system, and voluntary health insurance companies (VHICs). Health financing consists of a publicprivate mix. Health care is financed from compulsory health insurance contributions, taxes, outofpocket (OOP) payments, voluntary health insurance (VHI) premiums, corporate payments, donations, and external funding. Total health expenditure (THE) as a share of gross domestic product (GDP) increased from 5.3% in 1995 to 7.3% in 2008. At the latter date it consisted of 36.5% OOP payments, 34.8% SHI, 13.6% Ministry of Health expenditure, 9.4% municipality expenditure and 0.3% VHI. Informal payments in the health

  8. [Polish health care system].

    PubMed

    Piontkovski, V; Novakovska, L; Pasternak, V

    2013-01-01

    The purpose of the discussion is to evaluate certain aspects of the Polish health care system - its ability to respond to contemporary dynamic social, economic and epidemiological changes (including the spread of chronic diseases, aging population or family crisis - its possibilities for providing care of the sick). The analysis of such a problem was based on a critically-oriented perspective that is developed in the field of the sociology of health and illness. The text pays particular attention to the problem of deepening social inequalities, which can be considered as one of the major factors that hinder access to health care and influence poorer health condition: In this context the mechanism of "saving health" and borrowing in order to satisfy the health needs in the face of financial difficulties was mentioned. Moreover, the text includes the attempt to evaluate the effectiveness of health promo- tion programs in our country as potentially the most effective way of raising the level of public health. There is also the issue of public confidence in health care institutions and the approval of attempts towards reforming the medical system in our country. A separate part of the discussion was devoted to criticism of the idea of reducing the role of the state in the health care sector.

  9. Recent developments in mental health screening and assessment in juvenile justice systems.

    PubMed

    Bailey, Susan; Doreleijers, Theo; Tarbuck, Paul

    2006-04-01

    Developments within health care services for young offenders have traditionally lagged behind those for general child and adolescent populations. Screening and diagnostic assessment instruments commonly used in general child and adolescent mental health care do not meet the special requirements of forensic populations. This article describes some general aspects of screening and assessment in this population, followed by a description of four specific instruments.

  10. Hungary health system review.

    PubMed

    Gaal, Peter; Szigeti, Szabolcs; Csere, Marton; Gaskins, Matthew; Panteli, Dimitra

    2011-01-01

    diversified over the past 15 years, but the current mix has yet to be tested for sustainability. The fit between existing capacities and the health care needs of the population remains less than ideal, but improvements have been made over the past 15 years. In general, the average length of stay and hospital admission rates have decreased since 1990, as have bed occupancy rates. However, capacity for long-term nursing care in both the inpatient and outpatient setting is still considered insufficient. Hungary is currently also facing a health workforce crisis, explained by the fact that it is a net donor country with regard to health care worker migration, and health care professionals on the whole are ageing. Although the overall technical efficiency of the system has increased considerably, mainly due to the introduction of output-based payment systems, allocative efficiency remains a problem. Considerable variations exist in service delivery both geographically and by specialization, and equity of access is far from being realized, a fact which is mirrored in differing health outcomes for different population groups. A key problem is the continuing lack of an overarching, evidence-based strategy for mobilizing resources for health, which leaves the health system vulnerable to broader economic policy objectives and makes good governance hard to achieve. On the other hand, Hungary is a target country for cross-border health care, mainly for dental care but also for rehabilitative services, such as medical spa treatment. The health industry can thus be a potential strategic area for economic development and growth. World Health Organization 2011, on behalf of the European Observatory on health systems and Policies.

  11. Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance.

    PubMed

    Bossert, T

    1998-11-01

    Decentralization has long been advocated as a desirable process for improving health systems. Nevertheless, we still lack a sufficient analytical framework for systematically studying how decentralization can achieve this objective. We do not have adequate means of analyzing the three key elements of decentralization: (1) the amount of choice that is transferred from central institutions to institutions at the periphery of health systems, (2) what choices local officials make with their increased discretion and (3) what effect these choices have on the performance of the health system. This article proposes a framework of analysis that can be used to design and evaluate the decentralization of health systems. It starts from the assumption that decentralization is not an end in itself but rather should be designed and evaluated for its ability to achieve broader objectives of health reform: equity, efficiency, quality and financial soundness. Using a "principal agent" approach as the basic framework, but incorporating insights from public administration, local public choice and social capital approaches, the article presents a decision space approach which defines decentralization in terms of the set of functions and degrees of choice that formally are transferred to local officials. The approach also evaluates the incentives that central government can offer to local decision-makers to encourage them to achieve health objectives. It evaluates the local government characteristics that also influence decision-making and implementation at the local level. Then it determines whether local officials innovate by making choices that are different from those directed by central authorities. Finally, it evaluates whether the local choices have improved the performance of the local health system in achieving the broader health objectives. Examples from Colombia are used to illustrate the approach. The framework will be used to analyze the experience of decentralization in a

  12. Development of Community Based Learning and Education system within Undergraduate Medical Curriculum of Patan Academy of Health Sciences.

    PubMed

    Baral, K P; Upadhyay, S K; Bhandary, S; Gongal, R N; Karki, A

    2016-01-01

    In response to continuing health disparities between rural and urban population, Patan Academy of Health Sciences (PAHS) was established in 2008. It aimed to produce physicians who would be able and willing to serve in the rural areas. In order to empower them with understanding and tools to address health issues of rural population, an innovative curriculum was developed. This paper aims to describe the community based learning and education (CBLE) system within the overall framework of PAHS undergraduate medical curriculum. A Medical School Steering Committee (MSSC) comprising of a group of committed medical educators led the curriculum development process. The committee reviewed different medical curricula, relevant literatures, and held a series of consultative meetings with the stakeholders and experts within and outside Nepal. This process resulted in defining the desirable attributes, terminal competencies of the graduates, and then the actual development of the entire curriculum including CBLE. Given the critical importance of population health, 25% of the curricular weightage was allocated to the Community Health Sciences (CHS). CBLE system was developed as the primary means of delivering CHS curriculum. The details of CBLE system was finalized for implementation with the first cohort of medical students commencing their studies from June 2010. The CBLE, a key educational strategy of PAHS curriculum, is envisaged to improve retention and performance of PAHS graduates and, thereby, health status of rural population. However, whether or not that goal will be achieved needs to be verified after the graduates join the health system.

  13. Romania: Health System Review.

    PubMed

    Vladescu, Cristian; Scintee, Silvia Gabriela; Olsavszky, Victor; Hernandez-Quevedo, Cristina; Sagan, Anna

    2016-08-01

    This analysis of the Romanian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Romanian health care system is a social health insurance system that has remained highly centralized despite recent efforts to decentralize some regulatory functions. It provides a comprehensive benefits package to the 85% of the population that is covered, with the remaining population having access to a minimum package of benefits. While every insured person has access to the same health care benefits regardless of their socioeconomic situation, there are inequities in access to health care across many dimensions, such as rural versus urban, and health outcomes also differ across these dimensions. The Romanian population has seen increasing life expectancy and declining mortality rates but both remain among the worst in the European Union. Some unfavourable trends have been observed, including increasing numbers of new HIV/AIDS diagnoses and falling immunization rates. Public sources account for over 80% of total health financing. However, that leaves considerable out-of-pocket payments covering almost a fifth of total expenditure. The share of informal payments also seems to be substantial, but precise figures are unknown. In 2014, Romania had the lowest health expenditure as a share of gross domestic product (GDP) among the EU Member States. In line with the government's objective of strengthening the role of primary care, the total number of hospital beds has been decreasing. However, health care provision remains characterized by underprovision of primary and community care and inappropriate use of inpatient and specialized outpatient care, including care in hospital emergency departments. The numbers of physicians and nurses are relatively low in Romania compared to EU averages. This has mainly been attributed to the high rates of workers emigrating abroad over the

  14. DEVELOPMENT AND IMPLEMENTATION OF A PRACTICAL PUBLIC HEALTH TRAINING SYSTEM IN CHINA.

    PubMed

    Liu, Changjiang; Zhang, Junyue; Chen, Guoyuan; Yang, Kedi

    2015-03-01

    Public health education is becoming an increasing priority among educators of medicine. In China, little attention has been paid to public health education reform. A new public health training system was introduced in China in 2007. We conducted this study during 2006-2012 to evaluate the graduate core competencies under the new system. Data were collected from 231 graduates and 49 public health agencies. The 144 graduates who enrolled in 2006 and were trained under the old system constituted the control group; the 87 graduates who enrolled in 2007 and were trained under the new system constituted the experimental group. Surveys of graduate core competencies found analyzing and solving problems in the laboratory, conducting on-site practice and learning new technologies were the top three abilities most expected by public health agencies. After 5-year practical ability training, the graduates in the experimental group had better performance; on-site practical ability and laboratory practical ability increased significantly by 24.5% and 20.0%, respectively. Three other important competencies also improved: designing epidemiologic surveys, collecting information from the literature and doing statistical analyses. However, preventing and controlling common diseases and dealing with emergencies remained weak. These results show the new training system should be continued, but revisions are needed to improve this training system, especially in the areas of preventing and controlling common diseases and dealing with emergencies.

  15. Developing and implementing a standardized process for global trigger tool application across a large health system.

    PubMed

    Garrett, Paul R; Sammer, Christine; Nelson, Antoinette; Paisley, Kathleen A; Jones, Cason; Shapiro, Eve; Tonkel, Jackie; Housman, Michael

    2013-07-01

    To complement voluntary adverse event reporting, which may detect only specific categories of harms and may represent merely a fraction of actual adverse events, the Adventist Health System (AHS) began using the Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT) to more accurately gauge the number, types, and severity levels of adverse events and developed a centralized process to do so uniformly. AHS began using the GTT in 2009 in 25 of its 42 hospitals that used a common electronic medical record (EMR). The common EMR and centralized record review enables AHS to apply the GTT uniformly and provides consistency of data collected. AHS sends quarterly reports to participating facilities to communicate findings and provides case studies illustrating the most egregious harms. Case study recipients are encouraged to further examine patient records, explore events leading to harm, and share the information with process/quality improvement committees, medical executive committees, and boards of directors to identify opportunities for quality improvement. AHS staffing and record review processes have evolved since 2009. A GTT review of 17,295 patient records indicated that adverse events clustered as medication-related glycemic events; medication-related delirium, confusion, or oversedation related to analgesics, sedatives, and muscle relaxants; pressure ulcers; medication-related bleeding; and medication-related skin/mucosal reaction/itching. The AHS process demonstrates how a large health system uses the GTT to detect harms. Since 2009 AHS has improved and streamlined its reporting, data entry and review processes. AHS used major harms findings to initiate systemwide collaborative improvement projects for glycemic management and pressure ulcers.

  16. Health systems research in Lao PDR: capacity development for getting research into policy and practice

    PubMed Central

    Jönsson, Kristina; Tomson, Göran; Jönsson, Christer; Kounnavong, Sengchanh; Wahlström, Rolf

    2007-01-01

    Background Lao PDR is a low-income country with an urgent need for evidence-informed policymaking in the healthcare sector. During the last decade a number of Health Systems Research (HSR) projects have been conducted in order to meet this need. However, although knowledge about research is increasing among policymakers, the use of research in policymaking is still limited. Methods This article investigates the relationship between research and policymaking from the perspective of those participating in HSR projects. The study is based on 28 interviews, two group discussions and the responses from 56 questionnaires. Results The interviewees and questionnaire respondents were aware of the barriers to getting research into policy and practice. But while some were optimistic, claiming that there had been a change of attitudes among policymakers in the last two years, others were more pessimistic and did not expect any real changes until years from now. The major barriers to feeding research results into policy and practice included an inability to influence the policy process and to get policymakers and practitioners interested in research results. Another barrier was the lack of continuous capacity development and high-quality research, both of which are related to funding and international support. Many of the interviewees and questionnaire respondents also pointed out that communication between those conducting research and policymakers must be improved. Conclusion The results show that in the case of Lao PDR, research capacity development is at a crucial stage for implementing research into policy and practice. If research is going to make a consistent impact on policymaking in the Lao health care sector, the attitude towards research will need to be changed in order to get research prioritised, both among those conducting research, and among policymakers and practitioners. Our findings indicate that there is awareness about the barriers in this process. PMID

  17. Development of the Inventory Management and Tracking System (IMATS) to Track the Availability of Public Health Department Medical Countermeasures During Public Health Emergencies.

    PubMed

    Sahar, Liora; Faler, Guy; Hristov, Emil; Hughes, Susan; Lee, Leslie; Westnedge, Caroline; Erickson, Benjamin; Nichols, Barbara

    2015-01-01

    To bridge gaps identified during the 2009 H1N1 influenza pandemic by developing a system that provides public health departments improved capability to manage and track medical countermeasures at the state and local levels and to report their inventory levels to the Centers for Disease Control and Prevention (CDC). The CDC Countermeasure Tracking Systems (CTS) program designed and implemented the Inventory Management and Tracking System (IMATS) to manage, track, and report medical countermeasure inventories at the state and local levels. IMATS was designed by CDC in collaboration with state and local public health departments to ensure a "user-centered design approach." A survey was completed to assess functionality and user satisfaction. IMATS was deployed in September 2011 and is provided at no cost to public health departments. Many state and local public health departments nationwide have adopted IMATS and use it to track countermeasure inventories during public health emergencies and daily operations. A successful response to public health emergencies requires efficient, accurate reporting of countermeasure inventory levels. IMATS is designed to support both emergency operations and everyday activities. Future improvements to the system include integrating barcoding technology and streamlining user access. To maintain system readiness, we continue to collect user feedback, improve technology, and enhance its functionality. IMATS satisfies the need for a system for monitoring and reporting health departments' countermeasure quantities so that decision makers are better informed. The "user-centered design approach" was successful, as evident by the many public health departments that adopted IMATS.

  18. The association between health system development and the burden of cardiovascular disease: an analysis of WHO country profiles.

    PubMed

    Liu, Yanmei; Dalal, Koustuv; Stollenwerk, Björn

    2013-01-01

    Several risk factors for cardiovascular disease (CVD) have been identified in recent decades. However, the association between the health system and the burden of CVD has not yet been sufficiently researched. The objective of this study was to analyse the association between health system development and the burden of CVD, in particular CVD-related disability-adjusted life-years (DALYs). Univariate and multivariate generalized linear mixed models were applied to country-level data collected by the World Bank and World Health Organization. Response variables were the age-standardized CVD mortality and age-standardized CVD DALY rates. The amount of available health system resources, indicated by total health expenditures per capita, physician density, nurse density, dentistry density, pharmaceutical density and the density of hospital beds, was associated with reduced CVD DALY rates and CVD mortality. However, in the multivariate models, the density of nurses and midwives was positively associated with CVD. High out-of-pocket costs were associated with increased CVD mortality in both univariate and multivariate analyses. A highly developed health system with a low level of out-of-pocket costs seems to be the most appropriate to reduce the burden of CVD. Furthermore, an efficient balance between human health resources and health technologies is essential.

  19. The Association between Health System Development and the Burden of Cardiovascular Disease: An Analysis of WHO Country Profiles

    PubMed Central

    Liu, Yanmei; Dalal, Koustuv; Stollenwerk, Björn

    2013-01-01

    Background Several risk factors for cardiovascular disease (CVD) have been identified in recent decades. However, the association between the health system and the burden of CVD has not yet been sufficiently researched. The objective of this study was to analyse the association between health system development and the burden of CVD, in particular CVD-related disability-adjusted life–years (DALYs). Methods Univariate and multivariate generalized linear mixed models were applied to country-level data collected by the World Bank and World Health Organization. Response variables were the age-standardized CVD mortality and age-standardized CVD DALY rates. Results The amount of available health system resources, indicated by total health expenditures per capita, physician density, nurse density, dentistry density, pharmaceutical density and the density of hospital beds, was associated with reduced CVD DALY rates and CVD mortality. However, in the multivariate models, the density of nurses and midwives was positively associated with CVD. High out-of-pocket costs were associated with increased CVD mortality in both univariate and multivariate analyses. Conclusion A highly developed health system with a low level of out-of-pocket costs seems to be the most appropriate to reduce the burden of CVD. Furthermore, an efficient balance between human health resources and health technologies is essential. PMID:23637891

  20. Addressing Socio-Emotional Development and Infant Mental Health in Early Childhood Systems: Executive Summary. Building State Early Childhood Comprehensive Systems Series, Number 12

    ERIC Educational Resources Information Center

    Zeanah, Paula; Nagle, Geoffrey; Stafford, Brian; Rice, Thomas; Farrer, Joanna

    2005-01-01

    During the past three decades, there has been an increase in knowledge about early childhood development. Early experiences can function as either risk factors or protective factors for a child's future health and development. This has led to concern about how current health systems contribute to the quality of the earliest experiences of life.…

  1. Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development.

    PubMed

    Noyes, Jane; Brenner, Maria; Fox, Patricia; Guerin, Ashleigh

    2014-05-01

    To report a novel review to develop a health systems model of successful transition of children with complex healthcare needs from hospital to home. Children with complex healthcare needs commonly experience an expensive, ineffectual and prolonged nurse-led discharge process. Children gain no benefit from prolonged hospitalization and are exposed to significant harm. Research to enable intervention development and process evaluation across the entire health system is lacking. Novel mixed-method integrative review informed by health systems theory. DATA  CINAHL, PsychInfo, EMBASE, PubMed, citation searching, personal contact. REVIEW  Informed by consultation with experts. English language studies, opinion/discussion papers reporting research, best practice and experiences of children, parents and healthcare professionals and purposively selected policies/guidelines from 2002-December 2012 were abstracted using Framework synthesis, followed by iterative theory development. Seven critical factors derived from thirty-four sources across five health system levels explained successful discharge (new programme theory). All seven factors are required in an integrated care pathway, with a dynamic communication loop to facilitate effective discharge (new programme logic). Current health system responses were frequently static and critical success factors were commonly absent, thereby explaining ineffectual discharge. The novel evidence-based model, which reconceptualizes 'discharge' as a highly complex longitudinal health system intervention, makes a significant contribution to global knowledge to drive practice development. Research is required to develop process and outcome measures at different time points in the discharge process and future trials are needed to determine the effectiveness of integrated health system discharge models. © 2013 John Wiley & Sons Ltd.

  2. Development of an immunization tracking system in a large health maintenance organization. Group Health Cooperative of Puget Sound.

    PubMed Central

    Payne, T.; Kanvik, S.; Seward, R.; Beeman, D.; Salazar, A.; Miller, Z.; Immanuel, V.; Thompson, R. S.

    1991-01-01

    We have successfully developed a mainframe system for tracking all immunizations administered to enrollees in a large HMO. This system will provide comprehensive immunization records on a population of over 350,000 patients. Data required by the National Childhood Vaccine Injury Act of 1986 are locally entered into terminals, and records of immunization are stored in a database. Preliminary results show that data entry times are practical, but that improvement in data quality is needed. This immunization tracking system will be used for research, and as the foundation of an immunization reminder system under development. PMID:1807572

  3. [The health system of Nicaragua].

    PubMed

    Muiser, Jorine; Sáenz, María del Rocío; Bermúdez, Juan Luis

    2011-01-01

    This paper describes the health conditions in Nicaragua and discusses the characteristics of its national health system including its structure and coverage, its financial sources its physical, material and human resources the stewardship functions developed by the Ministry of Health the participation of citizens in the operation and evaluation of the system and the level of satisfaction of health care users. It also discusses the most recent policy innovations, including the new General Health Law, the decentralization of the regulation of health facilities and the design and implementation of a new health care model known as Family and Community Health Model.

  4. Spain: Health system review.

    PubMed

    García-Armesto, Sandra; Begoña Abadía-Taira, María; Durán, Antonio; Hernández-Quevedo, Cristina; Bernal-Delgado, Enrique

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. This edition of the Spanish HiT focuses on the consequences of the totally devolved status, consolidated in 2002, and the implementation of the road map established by the 2003 SNS Cohesion and Quality Act. Many of the steps already taken underline the improvement path chosen: the SNS Inter-territorial Council (CISNS) comprising the national and regional health ministries was upgraded to the highest SNS authority, paving the way for a brand new consensus-based policy-making process grounded in knowledge management; its effects are progressively starting to be evident. It led the way to the SNS common benefits basket or the SNS human resources policy framework, laying the cornerstones for coordination and the enactment of the SNS Quality Plan. The Plan includes the work in progress to implement the national health information system, the development of a single electronic clinical record (eCR) containing relevant clinical information guaranteeing to patients continuity of care outside their Autonomous Community (AC) of residence or a single patient ID to be used across the country, thus creating the basis for the SNS functional single insurer. It has also become one of the main drivers for the design, implementation and monitoring of quality standards across the SNS, developing national health strategies to tackle both most prevalent chronic diseases (e.g. cancer, cardiovascular diseases, diabetes) and rare diseases, as well as the National Strategy on

  5. Development of an integrated child health information system for children who are deaf or hard of hearing.

    PubMed

    Poon, Brenda T; Hertzman, Clyde

    2010-11-01

    Young children who are deaf or hard of hearing typically participate in health and early intervention service structures involving multiple agencies and service providers, all of whom may be responsive to a child's and family's needs, but remain mutually distinct with minimal interdependence. Lack of coordination may result in fragmented service delivery and may be counterproductive to the provision of family centred services. Increasingly, advancements in technology, such as the development of integrated child health information systems, have facilitated greater coordination and integration of service delivery in multidisciplinary and multisite program contexts. In the present article, the process of developing an integrated child health information system for a new provincial early hearing detection and intervention program in British Columbia is described. Key considerations for system development included the following: the nature of the preprogram structure for information management and sharing; the need for modifications of the structure; and ways that the structure could be improved.

  6. Moving from ideas to action - developing health financing systems towards universal coverage in Africa

    PubMed Central

    2012-01-01

    solved with a more evidence based approach and dialogue based on a clear vision and costed strategic plan articulated by the ministry of health. Improving health in Africa is a driver for long-term economic growth and development and this is the reason why the ministries of health and finance will need to find common ground on how to create policy coherence and how to articulate their respective objectives. PMID:23137065

  7. Moving from ideas to action - developing health financing systems towards universal coverage in Africa.

    PubMed

    Musango, Laurent; Orem, Juliet Nabyonga; Elovainio, Riku; Kirigia, Joses

    2012-11-08

    approach and dialogue based on a clear vision and costed strategic plan articulated by the ministry of health. Improving health in Africa is a driver for long-term economic growth and development and this is the reason why the ministries of health and finance will need to find common ground on how to create policy coherence and how to articulate their respective objectives.

  8. Greece: Health system review.

    PubMed

    Economou, Charalambos

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The health status of the Greek population has strongly improved over the last few decades and seems to compare relatively favourably with other OECD and European Union (EU) countries. The health system is a mixture of public integrated, public contract and public reimbursement models, comprising elements from both the public and private sectors and incorporating principles of different organizational patterns. Access to services is based on citizenship as well as on occupational status.The system is financed by the state budget, social insurance contributions and private payments.The largest share of health expenditure constitutes private expenditure, mainly in the form of out of pocket payments which is also the element contributing most to the overall increase in health expenditure. The delivery of health care services is based on both public and private providers. The presence of private providers is more obvious in primary care,especially in diagnostic technologies, private physicians' practices and pharmaceuticals. Despite success in improving the health of the population, the Greek health care system faces serious structural problems concerning the organization, financing and delivery of services. It suffers from the absence of cost-containment measures and defined criteria for funding, resulting in sickness funds experiencing economic constraints and budget deficits. The high percentage of private expenditure goes against the principle of fair

  9. [Mystic, science, and politics in the development of health systems. The experience of Chile].

    PubMed

    Jiménez de la Jara, J

    2001-01-01

    The combination of inspiration, science, and politics is a cornerstone precept for the common good of humanity, towards the fulfillment of social objectives. Based on this precept, this paper reviews core experiences of the Chilean Health Sector. Health sector key events taking place during the first half of the 20th century were the creation of the National Health Service and the development of mother and child healthcare policies. After the earthquake of 1939, the future President of Chile, Doctor Salvador Allende, set up the Special Sanitation Council, to balance policies. Also, he launched the Social Security reform process, which endured financing restrictions and the animosity of physicians opposing the socialization of medical care. In 1951 the reform was approved, to extend coverage to blue collar workers and their families; separate health provision from healthcare security; emphasize preventive pediatric care in mother's health, and reproductive health. The basic tenets of healthcare reform were the right to health, solidarity, and equity, as the pillars of policy-making and healthcare programming. The question of whether the evolution of social security in Chile has been consistent with the original healthcare reform tenets is raised by the author.

  10. Environmental assessment for the satellite power system concept development and evaluation program: nonmicrowave health and ecological effects

    SciTech Connect

    White, M R

    1980-11-01

    A Concept Development and Evaluation Program is being carried out for a proposed Satellite Power System (SPS). For purposes of this evaluation, a preliminary reference system has been developed. SPS, as described in the reference system, would collect solar energy on satellites in geosychronous orbit in space. The energy would be converted to microwaves and beamed to an earth-receiving antenna (rectenna). One task in the environmental part of the program is the assessment of the nonmicrowave effects on health and the environment. These effects would result from all phases of SPS development and operation. This report covers the current knowledge regarding these effects, and is based on the reference system. The assessment is summarized as to scope, methodology, impacts of terrestrial development, launch and recovery of spacecraft, space activities (including health effects of the space environment, ionizing radiation, electromagnetic exposure, spacecraft charging and environmental interactions, occupational hazards, etc.) and construction and operation of rectenna (ground receiving station).

  11. A data capture system for outcomes studies that integrates with electronic health records: development and potential uses.

    PubMed

    Yamamoto, Keiichi; Matsumoto, Shigemi; Tada, Harue; Yanagihara, Kazuhiro; Teramukai, Satoshi; Takemura, Tadamasa; Fukushima, Masanori

    2008-10-01

    In conventional clinical studies, the costs of data management for quality control tend to be high and collecting paper-based case report forms (CRFs) tends to be burdensome, because paper-based CRFs must be developed and filled out for each clinical study protocol. Use of electronic health records for this purpose could result in reductions in cost and improvements in data quality in clinical studies. The purpose of this study was to develop a data capture system for observational cancer clinical studies (i.e. outcomes studies) that would integrate with an electronic health records system, to enable evaluation of patient prognosis, prognostic factors, outcomes and drug safety. At the Outpatient Oncology Unit of Kyoto University Hospital, we developed a data capture system that includes a cancer clinical database system and a data warehouse for outcomes studies. We expect that our new system will reduce the costs of data management and analysis and improve the quality of data in clinical studies.

  12. Fukushima after the Great East Japan Earthquake: lessons for developing responsive and resilient health systems.

    PubMed

    Fukuma, Shingo; Ahmed, Shahira; Goto, Rei; Inui, Thomas S; Atun, Rifat; Fukuhara, Shunichi

    2017-06-01

    On 11 March 2011, the Great East Japan Earthquake, followed by a tsunami and nuclear-reactor meltdowns, produced one of the most severe disasters in the history of Japan. The adverse impact of this 'triple disaster' on the health of local populations and the health system was substantial. In this study we examine population-level health indicator changes that accompanied the disaster, and discuss options for re-designing Fukushima's health system, and by extension that of Japan, to enhance its responsiveness and resilience to current and future shocks. We used country-level (Japan-average) or prefecture-level data (2005-2014) available from the portal site of Official Statistics of Japan for Fukushima, Miyagi, and Iwate, the prefectures that were most affected by the disaster, to compare trends before (2005-2010) and after (2011-2014) the 'disaster'. We made time-trend line plots to describe changes over time in age-adjusted cause-specific mortality rates in each prefecture. All three prefectures, and in particular Fukushima, had lower socio-economic indicators, an older population, lower productivity and gross domestic product per capita, and less higher-level industry than the Japan average. All three prefectures were 'medically underserved', with fewer physicians, nurses, ambulance calls and clinics per 100 000 residents than the Japan average. Even before the disaster, age-adjusted all-cause mortality in Fukushima was in general higher than the national rates. After the triple disaster we found that the mortality rate due to myocardial infarction increased substantially in Fukushima while it decreased nationwide. Compared to Japan average, spikes in mortality due to lung disease (all three prefectures), stroke (Iwate and Miyagi), and all-cause mortality (Miyagi and Fukushima) were also observed post-disaster. The cause-specific mortality rate from cancer followed similar trends in all three prefectures to those in Japan as a whole. Although we found a sharp

  13. Systems identification and application systems development for monitoring the physiological and health status of crewmen in space

    NASA Technical Reports Server (NTRS)

    Leonard, J. I.; Furukawa, S.; Vannordstrand, P. C.

    1975-01-01

    The use of automated, analytical techniques to aid medical support teams is suggested. Recommendations are presented for characterizing crew health in terms of: (1) wholebody function including physiological, psychological and performance factors; (2) a combination of critical performance indexes which consist of multiple factors of measurable parameters; (3) specific responses to low noise level stress tests; and (4) probabilities of future performance based on present and periodic examination of past performance. A concept is proposed for a computerized real time biomedical monitoring and health care system that would have the capability to integrate monitored data, detect off-nominal conditions based on current knowledge of spaceflight responses, predict future health status, and assist in diagnosis and alternative therapies. Mathematical models could play an important role in this approach, especially when operating in a real time mode. Recommendations are presented to update the present health monitoring systems in terms of recent advances in computer technology and biomedical monitoring systems.

  14. Design and Development of a Linked Open Data-Based Health Information Representation and Visualization System: Potentials and Preliminary Evaluation

    PubMed Central

    Kauppinen, Tomi; Keßler, Carsten; Fritz, Fleur

    2014-01-01

    Background Healthcare organizations around the world are challenged by pressures to reduce cost, improve coordination and outcome, and provide more with less. This requires effective planning and evidence-based practice by generating important information from available data. Thus, flexible and user-friendly ways to represent, query, and visualize health data becomes increasingly important. International organizations such as the World Health Organization (WHO) regularly publish vital data on priority health topics that can be utilized for public health policy and health service development. However, the data in most portals is displayed in either Excel or PDF formats, which makes information discovery and reuse difficult. Linked Open Data (LOD)—a new Semantic Web set of best practice of standards to publish and link heterogeneous data—can be applied to the representation and management of public level health data to alleviate such challenges. However, the technologies behind building LOD systems and their effectiveness for health data are yet to be assessed. Objective The objective of this study is to evaluate whether Linked Data technologies are potential options for health information representation, visualization, and retrieval systems development and to identify the available tools and methodologies to build Linked Data-based health information systems. Methods We used the Resource Description Framework (RDF) for data representation, Fuseki triple store for data storage, and Sgvizler for information visualization. Additionally, we integrated SPARQL query interface for interacting with the data. We primarily use the WHO health observatory dataset to test the system. All the data were represented using RDF and interlinked with other related datasets on the Web of Data using Silk—a link discovery framework for Web of Data. A preliminary usability assessment was conducted following the System Usability Scale (SUS) method. Results We developed an LOD

  15. Design and development of a linked open data-based health information representation and visualization system: potentials and preliminary evaluation.

    PubMed

    Tilahun, Binyam; Kauppinen, Tomi; Keßler, Carsten; Fritz, Fleur

    2014-10-25

    Healthcare organizations around the world are challenged by pressures to reduce cost, improve coordination and outcome, and provide more with less. This requires effective planning and evidence-based practice by generating important information from available data. Thus, flexible and user-friendly ways to represent, query, and visualize health data becomes increasingly important. International organizations such as the World Health Organization (WHO) regularly publish vital data on priority health topics that can be utilized for public health policy and health service development. However, the data in most portals is displayed in either Excel or PDF formats, which makes information discovery and reuse difficult. Linked Open Data (LOD)-a new Semantic Web set of best practice of standards to publish and link heterogeneous data-can be applied to the representation and management of public level health data to alleviate such challenges. However, the technologies behind building LOD systems and their effectiveness for health data are yet to be assessed. The objective of this study is to evaluate whether Linked Data technologies are potential options for health information representation, visualization, and retrieval systems development and to identify the available tools and methodologies to build Linked Data-based health information systems. We used the Resource Description Framework (RDF) for data representation, Fuseki triple store for data storage, and Sgvizler for information visualization. Additionally, we integrated SPARQL query interface for interacting with the data. We primarily use the WHO health observatory dataset to test the system. All the data were represented using RDF and interlinked with other related datasets on the Web of Data using Silk-a link discovery framework for Web of Data. A preliminary usability assessment was conducted following the System Usability Scale (SUS) method. We developed an LOD-based health information representation, querying

  16. Development of a structural health monitoring system for the life assessment of critical transportation infrastructure.

    SciTech Connect

    Roach, Dennis Patrick; Jauregui, David Villegas; Daumueller, Andrew Nicholas

    2012-02-01

    Recent structural failures such as the I-35W Mississippi River Bridge in Minnesota have underscored the urgent need for improved methods and procedures for evaluating our aging transportation infrastructure. This research seeks to develop a basis for a Structural Health Monitoring (SHM) system to provide quantitative information related to the structural integrity of metallic structures to make appropriate management decisions and ensuring public safety. This research employs advanced structural analysis and nondestructive testing (NDT) methods for an accurate fatigue analysis. Metal railroad bridges in New Mexico will be the focus since many of these structures are over 100 years old and classified as fracture-critical. The term fracture-critical indicates that failure of a single component may result in complete collapse of the structure such as the one experienced by the I-35W Bridge. Failure may originate from sources such as loss of section due to corrosion or cracking caused by fatigue loading. Because standard inspection practice is primarily visual, these types of defects can go undetected due to oversight, lack of access to critical areas, or, in riveted members, hidden defects that are beneath fasteners or connection angles. Another issue is that it is difficult to determine the fatigue damage that a structure has experienced and the rate at which damage is accumulating due to uncertain history and load distribution in supporting members. A SHM system has several advantages that can overcome these limitations. SHM allows critical areas of the structure to be monitored more quantitatively under actual loading. The research needed to apply SHM to metallic structures was performed and a case study was carried out to show the potential of SHM-driven fatigue evaluation to assess the condition of critical transportation infrastructure and to guide inspectors to potential problem areas. This project combines the expertise in transportation infrastructure at New

  17. Development of flexural vibration inspection techniques to rapidly assess the structural health of rural bridge systems

    Treesearch

    Brian K. Brashaw; Robert Vatalaro; Xiping Wang; Kevin Sarvela; James P. Wacker

    2008-01-01

    Approximately 4,000 vehicle bridges in the State of Minnesota contain structural timber members. Recent research at the University of Minnesota Duluth Natural Resources Research Institute (UMD NRRI) has been conducted on vibration testing of timber bridges as a means of developing rapid in-place testing techniques for assessing the structural health of bridges. The...

  18. Enhancing Leadership and Governance Competencies to Strengthen Health Systems in Nigeria: Assessment of Organizational Human Resources Development

    PubMed Central

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

    2012-01-01

    The lack of effective leadership and governance in the health sector has remained a major challenge in Nigeria and contributes to the failure of health systems and poor development of human resources. In this cross-sectional intervention study, leadership and governance competencies of policy makers were enhanced through a training workshop, and an assessment was conducted of organizational activities designed to promote evidence-informed leadership and governance to improve human resources for health (HRH). The training workshop increased the understanding of policy makers with regard to leadership and governance factors that ensure the functionality of health systems and improve human resources development, including policy guidance, intelligence and oversight, collaboration and coalition building, regulation, system design and accountability. Findings indicated that systems for human resources development exist in all participants' organizations, but the functionality of these systems was suboptimal. More systematic and standardized processes are required to improve competencies of leadership and governance for better human resources development in low-income settings. PMID:23372582

  19. Enhancing leadership and governance competencies to strengthen health systems in Nigeria: assessment of organizational human resources development.

    PubMed

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

    2012-02-01

    The lack of effective leadership and governance in the health sector has remained a major challenge in Nigeria and contributes to the failure of health systems and poor development of human resources. In this cross-sectional intervention study, leadership and governance competencies of policy makers were enhanced through a training workshop, and an assessment was conducted of organizational activities designed to promote evidence-informed leadership and governance to improve human resources for health (HRH). The training workshop increased the understanding of policy makers with regard to leadership and governance factors that ensure the functionality of health systems and improve human resources development, including policy guidance, intelligence and oversight, collaboration and coalition building, regulation, system design and accountability. Findings indicated that systems for human resources development exist in all participants' organizations, but the functionality of these systems was suboptimal. More systematic and standardized processes are required to improve competencies of leadership and governance for better human resources development in low-income settings.

  20. Wearable Health Monitoring Systems

    NASA Technical Reports Server (NTRS)

    Bell, John

    2015-01-01

    The shrinking size and weight of electronic circuitry has given rise to a new generation of smart clothing that enables biological data to be measured and transmitted. As the variation in the number and type of deployable devices and sensors increases, technology must allow their seamless integration so they can be electrically powered, operated, and recharged over a digital pathway. Nyx Illuminated Clothing Company has developed a lightweight health monitoring system that integrates medical sensors, electrodes, electrical connections, circuits, and a power supply into a single wearable assembly. The system is comfortable, bendable in three dimensions, durable, waterproof, and washable. The innovation will allow astronaut health monitoring in a variety of real-time scenarios, with data stored in digital memory for later use in a medical database. Potential commercial uses are numerous, as the technology enables medical personnel to noninvasively monitor patient vital signs in a multitude of health care settings and applications.

  1. The development and pilot testing of a rapid assessment tool to improve local public health system capacity in Australia

    PubMed Central

    2009-01-01

    Background To operate effectively the public health system requires infrastructure and the capacity to act. Public health's ability to attract funding for infrastructure and capacity development would be enhanced if it was able to demonstrate what level of capacity was required to ensure a high performing system. Australia's public health activities are undertaken within a complex organizational framework that involves three levels of government and a diverse range of other organizations. The question of appropriate levels of infrastructure and capacity is critical at each level. Comparatively little is known about infrastructure and capacity at the local level. Methods In-depth interviews were conducted with senior managers in two Australian states with different frameworks for health administration. They were asked to reflect on the critical components of infrastructure and capacity required at the local level. The interviews were analyzed to identify the major themes. Workshops with public health experts explored this data further. The information generated was used to develop a tool, designed to be used by groups of organizations within discrete geographical locations to assess local public health capacity. Results Local actors in these two different systems pointed to similar areas for inclusion for the development of an instrument to map public health capacity at the local level. The tool asks respondents to consider resources, programs and the cultural environment within their organization. It also asks about the policy environment - recognizing that the broader environment within which organizations operate impacts on their capacity to act. Pilot testing of the tool pointed to some of the challenges involved in such an exercise, particularly if the tool were to be adopted as policy. Conclusion This research indicates that it is possible to develop a tool for the systematic assessment of public health capacity at the local level. Piloting the tool revealed

  2. Health information technology and sociotechnical systems: a progress report on recent developments within the UK National Health Service (NHS).

    PubMed

    Waterson, Patrick

    2014-03-01

    This paper summarises some of the research that Ken Eason and colleagues at Loughborough University have carried out in the last few years on the introduction of Health Information Technologies (HIT) within the UK National Health Service (NHS). In particular, the paper focuses on three examples which illustrate aspects of the introduction of HIT within the NHS and the role played by the UK National Programme for Information Technology (NPfIT). The studies focus on stages of planning and preparation, implementation and use, adaptation and evolution of HIT (e.g., electronic patient records, virtual wards) within primary, secondary and community care settings. Our findings point to a number of common themes which characterise the use of these systems. These include tensions between national and local strategies for implementing HIT and poor fit between healthcare work systems and the design of HIT. The findings are discussed in the light of other large-scale, national attempts to introduce similar technologies, as well as drawing out a set of wider lessons learnt from the NPfIT programme based on Ken Eason's earlier work and other research on the implementation of large-scale HIT.

  3. Development of portable health monitoring system for automatic self-blood glucose measurement

    NASA Astrophysics Data System (ADS)

    Kim, Huijun; Mizuno, Yoshihumi; Nakamachi, Eiji; Morita, Yusuke

    2010-02-01

    In this study, a new HMS (Health Monitoring System) device is developed for diabetic patient. This device mainly consists of I) 3D blood vessel searching unit and II) automatic blood glucose measurement (ABGM) unit. This device has features such as 1)3D blood vessel location search 2) laptop type, 3) puncturing a blood vessel by using a minimally invasive micro-needle, 4) very little blood sampling (10μl), and 5) automatic blood extraction and blood glucose measurement. In this study, ABGM unit is described in detail. It employs a syringe type's blood extraction mechanism because of its high accuracy. And it consists of the syringe component and the driving component. The syringe component consists of a syringe itself, a piston, a magnet, a ratchet and a micro-needle whose inner diameter is about 80μm. And the syringe component is disposable. The driving component consists of body parts, a linear stepping motor, a glucose enzyme sensor and a slider for accurate positioning control. The driving component has the all-in-one mechanism with a glucose enzyme sensor for compact size and stable blood transfer. On designing, required thrust force to drive the slider is designed to be greater than the value of the blood extraction force. Further, only one linear stepping motor is employed for blood extraction and transportation processes. The experimental result showed more than 80% of volume ratio under the piston speed 2.4mm/s. Further, the blood glucose was measured successfully by using the prototype unit. Finally, the availability of our ABGM unit was confirmed.

  4. Economic motives to use a participatory design approach in the development of public-health information systems.

    PubMed

    Vimarlund, V; Eriksson, H; Timpka, T

    2001-01-01

    Within public health, there is a tradition of co-operation between researchers and communities in planning and implementation of health promotion programs. As a consequence, public-health organizations are characterized by having complex multidisciplinary structure and dynamic organizational goals. In this paper, we discuss the economic impacts from the use of Participatory Design for development of public-health information systems. Creation of systems that have both utility and usability is suggested to be highlighted as the central goal. The identified pre-requisites for a positive impact are that the new system should be of high quality, appropriate to the nature of the health promotion tasks, and to how activities are coordinated and integrated both between and within the stakeholder groups involved. We argue further that a method that minimizes the information asymmetry in the development process is necessary for avoiding market failures 1. The conclusion is that participatory design will diminish transaction costs, will help to avoid sunk costs, and will contribute to rich efficient use of human and economic resources in public-health organizations.

  5. Henry Ford Health Systems

    Cancer.gov

    Henry Ford Health Systems evolved from a hospital into a system delivering care to 2.5 million patients and includes the Cancer Epidemiology, Prevention and Control Program, which focuses on epidemiologic and public health aspects of cancer.

  6. [The historical aspects of public health system development in the south Ural region].

    PubMed

    Tiukov, Iu A; Tarasova, I S

    2010-01-01

    The first physician in the south Ural, the healer Knobloch, appeared in 1775. The next physician in this region was Vasili Grigorievich Jukovsky who worked during more than 50 years in Chelyabinsk. Aleksander Franzevich Beiwel, the physician and city mayor, left good memories too. The first hospital appeared in 1823 and in the beginning of XX century the city health care was represented by three hospitals with 175 beds in total and 5 pharmacies. The first dental surgery room appeared in 1905. In 1924 in Chelyabinsk worked 24 physicians, 9 feldshers, 36 nurses, 4 midwives. There were 355 hospital beds, 7 outpatient clinics, children counseling room, 2 day nurseries. The Chelyabinsk first polyclinic functions from 1925 and in 1927 the first stomatologic polyclinic was opened. Ivan Stepanovich Belostotsky was one of active participants of development of Soviet public health on the territory of Ural. In 1941 the foundation for development of base hospitals in Ural during the Great Patriotic war was made ready.

  7. Development of a Health System-Based Nurse-Delivered Aromatherapy Program.

    PubMed

    Joswiak, Denise; Kinney, Mary Ellen; Johnson, Jill R; Kolste, Alison K; Griffin, Kristen H; Rivard, Rachael L; Dusek, Jeffery A

    2016-04-01

    Healthcare systems are increasingly looking to integrate aromatherapy (essential oils) as a safe, low-cost, and nonpharmacologic option for patient care to reduce pain, nausea, and anxiety and to improve sleep. This article describes the development and implementation of a healthcare system-wide program of nurse-delivered essential oil therapeutic interventions to inpatients throughout an acute care setting. In addition, we provide lessons learned for nursing administrators interested in developing similar nurse-delivered aromatherapy programs.

  8. Capacity development in health systems and policy research: a survey of the Canadian context

    PubMed Central

    2014-01-01

    Background Over the past decade, substantial global investment has been made to support health systems and policy research (HSPR), with considerable resources allocated to training. In Canada, signs point to a larger and more highly skilled HSPR workforce, but little is known about whether growth in HSPR human resource capacity is aligned with investments in other research infrastructure, or what happens to HSPR graduates following training. Methods We collected data from the Canadian Institutes of Health Research, Canada’s national health research funding agency, and the Canadian Association for Health Services and Policy Research on recent graduates in the HSPR workforce. We also surveyed 45 Canadian HSPR training programs to determine what information they collect on the career experiences of graduates. Results No university programs are currently engaged in systematic follow-up. Collaborative training programs funded by the national health research funding agency report performing short-term mandated tracking activities, but whether and how data are used is unclear. No programs collected information about whether graduates were using skills obtained in training, though information collected by the national funding agency suggests a minority (<30%) of doctoral-level trainees moving on to academic careers. Conclusions Significant investments have been made to increase HSPR capacity in Canada and around the world but no systematic attempts to evaluate the impact of these investments have been made. As a research community, we have the expertise and responsibility to evaluate our health research human resources and should strive to build a stronger knowledge base to inform future investment in HSPR research capacity. PMID:24502563

  9. Development of a wearable global positioning system for place and health research

    PubMed Central

    Rainham, Daniel; Krewski, Daniel; McDowell, Ian; Sawada, Mike; Liekens, Brian

    2008-01-01

    Background An increasing number of studies suggest that characteristics of context, or the attributes of the places within which we live, work and socialize, are associated with variations in health-related behaviours and outcomes. The challenge for health research is to ensure that these places are accurately represented spatially, and to identify those aspects of context that are related to variations in health and amenable to modification. This study focuses on the design of a wearable global positioning system (GPS) data logger for the purpose of objectively measuring the temporal and spatial features of human activities. Person-specific GPS data provides a useful source of information to operationalize the concept of place. Results We designed and tested a lightweight, wearable GPS receiver, capable of logging location information for up to 70 hours continuously before recharging. The device is accurate to within 7 m in typical urban environments and performs well across a range of static and dynamic conditions. Discussion Rather than rely on static areal units as proxies for places, wearable GPS devices can be used to derive a more complete picture of the different places that influence an individual's wellbeing. The measures are objective and are less subject to biases associated with recall of location or misclassification of contextual attributes. This is important for two reasons. First, it brings a dynamic perspective to place and health research. The influence of place on health is dynamic in that certain places are more or less relevant to wellbeing as determined by the length of time in any location and by the frequency of activity in the location. Second, GPS data can be used to assess whether the characteristics of places at specific times are useful to explaining variations in health and wellbeing. PMID:19032783

  10. Developing Technical Documentation Standards for NOHIMS (Navy Occupational Health Information Management System)

    DTIC Science & Technology

    1985-01-01

    Information Management System (NOHIMS) uses the Massachusetts General Hospital Utility Multi-Programming System (MUMPS) language, which is dynamic in nature, it was felt that new technical documentation standards had to be developed to accommodate its flexibility. This paper describes a transactional approach to documentating the NOHIMS system. Examples of documentation worksheets, as well as a diagram depicting the levels of documentation and their relationship to the transaction center, are provided. This method of documentation may be advantageous for others who are

  11. Development of the Inventory Management and Tracking System (IMATS) to Track the Availability of Public Health Department Medical Countermeasures During Public Health Emergencies

    PubMed Central

    Sahar, Liora; Faler, Guy; Hristov, Emil; Hughes, Susan; Lee, Leslie; Westnedge, Caroline; Erickson, Benjamin; Nichols, Barbara

    2015-01-01

    Objective To bridge gaps identified during the 2009 H1N1 influenza pandemic by developing a system that provides public health departments improved capability to manage and track medical countermeasures at the state and local levels and to report their inventory levels to the Centers for Disease Control and Prevention (CDC). Materials and Methods The CDC Countermeasure Tracking Systems (CTS) program designed and implemented the Inventory Management and Tracking System (IMATS) to manage, track, and report medical countermeasure inventories at the state and local levels. IMATS was designed by CDC in collaboration with state and local public health departments to ensure a “user-centered design approach.” A survey was completed to assess functionality and user satisfaction. Results IMATS was deployed in September 2011 and is provided at no cost to public health departments. Many state and local public health departments nationwide have adopted IMATS and use it to track countermeasure inventories during public health emergencies and daily operations. Discussion A successful response to public health emergencies requires efficient, accurate reporting of countermeasure inventory levels. IMATS is designed to support both emergency operations and everyday activities. Future improvements to the system include integrating barcoding technology and streamlining user access. To maintain system readiness, we continue to collect user feedback, improve technology, and enhance its functionality. Conclusion IMATS satisfies the need for a system for monitoring and reporting health departments’ countermeasure quantities so that decision makers are better informed. The “user-centered design approach” was successful, as evident by the many public health departments that adopted IMATS. PMID:26392843

  12. Inductive System Health Monitoring

    NASA Technical Reports Server (NTRS)

    Iverson, David L.

    2004-01-01

    The Inductive Monitoring System (IMS) software was developed to provide a technique to automatically produce health monitoring knowledge bases for systems that are either difficult to model (simulate) with a computer or which require computer models that are too complex to use for real time monitoring. IMS uses nominal data sets collected either directly from the system or from simulations to build a knowledge base that can be used to detect anomalous behavior in the system. Machine learning and data mining techniques are used to characterize typical system behavior by extracting general classes of nominal data from archived data sets. IMS is able to monitor the system by comparing real time operational data with these classes. We present a description of learning and monitoring method used by IMS and summarize some recent IMS results.

  13. Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries.

    PubMed

    Stenberg, Karin; Hanssen, Odd; Edejer, Tessa Tan-Torres; Bertram, Melanie; Brindley, Callum; Meshreky, Andreia; Rosen, James E; Stover, John; Verboom, Paul; Sanders, Rachel; Soucat, Agnès

    2017-09-01

    The ambitious development agenda of the Sustainable Development Goals (SDGs) requires substantial investments across several sectors, including for SDG 3 (healthy lives and wellbeing). No estimates of the additional resources needed to strengthen comprehensive health service delivery towards the attainment of SDG 3 and universal health coverage in low-income and middle-income countries have been published. We developed a framework for health systems strengthening, within which population-level and individual-level health service coverage is gradually scaled up over time. We developed projections for 67 low-income and middle-income countries from 2016 to 2030, representing 95% of the total population in low-income and middle-income countries. We considered four service delivery platforms, and modelled two scenarios with differing levels of ambition: a progress scenario, in which countries' advancement towards global targets is constrained by their health system's assumed absorptive capacity, and an ambitious scenario, in which most countries attain the global targets. We estimated the associated costs and health effects, including reduced prevalence of illness, lives saved, and increases in life expectancy. We projected available funding by country and year, taking into account economic growth and anticipated allocation towards the health sector, to allow for an analysis of affordability and financial sustainability. We estimate that an additional $274 billion spending on health is needed per year by 2030 to make progress towards the SDG 3 targets (progress scenario), whereas US$371 billion would be needed to reach health system targets in the ambitious scenario-the equivalent of an additional $41 (range 15-102) or $58 (22-167) per person, respectively, by the final years of scale-up. In the ambitious scenario, total health-care spending would increase to a population-weighted mean of $271 per person (range 74-984) across country contexts, and the share of gross

  14. Development of an Electronic Claim System Based on an Integrated Electronic Health Record Platform to Guarantee Interoperability

    PubMed Central

    Kim, Hwa Sun; Cho, Hune

    2011-01-01

    Objectives We design and develop an electronic claim system based on an integrated electronic health record (EHR) platform. This system is designed to be used for ambulatory care by office-based physicians in the United States. This is achieved by integrating various medical standard technologies for interoperability between heterogeneous information systems. Methods The developed system serves as a simple clinical data repository, it automatically fills out the Centers for Medicare and Medicaid Services (CMS)-1500 form based on information regarding the patients and physicians' clinical activities. It supports electronic insurance claims by creating reimbursement charges. It also contains an HL7 interface engine to exchange clinical messages between heterogeneous devices. Results The system partially prevents physician malpractice by suggesting proper treatments according to patient diagnoses and supports physicians by easily preparing documents for reimbursement and submitting claim documents to insurance organizations electronically, without additional effort by the user. To show the usability of the developed system, we performed an experiment that compares the time spent filling out the CMS-1500 form directly and time required create electronic claim data using the developed system. From the experimental results, we conclude that the system could save considerable time for physicians in making claim documents. Conclusions The developed system might be particularly useful for those who need a reimbursement-specialized EHR system, even though the proposed system does not completely satisfy all criteria requested by the CMS and Office of the National Coordinator for Health Information Technology (ONC). This is because the criteria are not sufficient but necessary condition for the implementation of EHR systems. The system will be upgraded continuously to implement the criteria and to offer more stable and transparent transmission of electronic claim data. PMID

  15. Fukushima after the Great East Japan Earthquake: lessons for developing responsive and resilient health systems

    PubMed Central

    Fukuma, Shingo; Ahmed, Shahira; Goto, Rei; Inui, Thomas S; Atun, Rifat; Fukuhara, Shunichi

    2017-01-01

    Background On 11 March 2011, the Great East Japan Earthquake, followed by a tsunami and nuclear–reactor meltdowns, produced one of the most severe disasters in the history of Japan. The adverse impact of this ‘triple disaster’ on the health of local populations and the health system was substantial. In this study we examine population–level health indicator changes that accompanied the disaster, and discuss options for re–designing Fukushima’s health system, and by extension that of Japan, to enhance its responsiveness and resilience to current and future shocks. Methods We used country–level (Japan–average) or prefecture–level data (2005–2014) available from the portal site of Official Statistics of Japan for Fukushima, Miyagi, and Iwate, the prefectures that were most affected by the disaster, to compare trends before (2005–2010) and after (2011–2014) the ‘disaster’. We made time–trend line plots to describe changes over time in age–adjusted cause–specific mortality rates in each prefecture. Findings All three prefectures, and in particular Fukushima, had lower socio–economic indicators, an older population, lower productivity and gross domestic product per capita, and less higher–level industry than the Japan average. All three prefectures were ‘medically underserved’, with fewer physicians, nurses, ambulance calls and clinics per 100 000 residents than the Japan average. Even before the disaster, age–adjusted all–cause mortality in Fukushima was in general higher than the national rates. After the triple disaster we found that the mortality rate due to myocardial infarction increased substantially in Fukushima while it decreased nationwide. Compared to Japan average, spikes in mortality due to lung disease (all three prefectures), stroke (Iwate and Miyagi), and all–cause mortality (Miyagi and Fukushima) were also observed post–disaster. The cause–specific mortality rate from cancer followed similar trends in

  16. Developing a service platform definition to promote evidence-based planning and funding of the mental health service system.

    PubMed

    Lee, Yong Yi; Meurk, Carla S; Harris, Meredith G; Diminic, Sandra; Scheurer, Roman W; Whiteford, Harvey A

    2014-11-26

    Ensuring that a mental health system provides 'value for money' requires policy makers to allocate resources to the most cost-effective interventions. Organizing cost-effective interventions into a service delivery framework will require a concept that can guide the mapping of evidence regarding disorder-level interventions to aggregations of services that are meaningful for policy makers. The 'service platform' is an emerging concept that could be used to this end, however no explicit definition currently exists in the literature. The aim of this study was to develop a service platform definition that is consistent with how policy makers conceptualize the major elements of the mental health service system and to test the validity and utility of this definition through consultation with mental health policy makers. We derived a provisional definition informed by existing literature and consultation with experienced mental health researchers. Using a modified Delphi method, we obtained feedback from nine Australian policy makers. Respondents provided written answers to a questionnaire eliciting their views on the acceptability, comprehensibility and usefulness of a service platform definition which was subject to qualitative analysis. Overall, respondents understood the definition and found it both acceptable and useful, subject to certain conditions. They also provided suggestions for its improvement. Our findings suggest that the service platform concept could be a useful way of aggregating mental health services as a means for presenting priority setting evidence to policy makers in mental health. However, further development and testing of the concept is required.

  17. Developing a Service Platform Definition to Promote Evidence-Based Planning and Funding of the Mental Health Service System

    PubMed Central

    Lee, Yong Yi; Meurk, Carla S.; Harris, Meredith G.; Diminic, Sandra; Scheurer, Roman W.; Whiteford, Harvey A.

    2014-01-01

    Ensuring that a mental health system provides ‘value for money’ requires policy makers to allocate resources to the most cost-effective interventions. Organizing cost-effective interventions into a service delivery framework will require a concept that can guide the mapping of evidence regarding disorder-level interventions to aggregations of services that are meaningful for policy makers. The ‘service platform’ is an emerging concept that could be used to this end, however no explicit definition currently exists in the literature. The aim of this study was to develop a service platform definition that is consistent with how policy makers conceptualize the major elements of the mental health service system and to test the validity and utility of this definition through consultation with mental health policy makers. We derived a provisional definition informed by existing literature and consultation with experienced mental health researchers. Using a modified Delphi method, we obtained feedback from nine Australian policy makers. Respondents provided written answers to a questionnaire eliciting their views on the acceptability, comprehensibility and usefulness of a service platform definition which was subject to qualitative analysis. Overall, respondents understood the definition and found it both acceptable and useful, subject to certain conditions. They also provided suggestions for its improvement. Our findings suggest that the service platform concept could be a useful way of aggregating mental health services as a means for presenting priority setting evidence to policy makers in mental health. However, further development and testing of the concept is required. PMID:25431877

  18. Development of an Information Fusion System for Engine Diagnostics and Health Management

    NASA Technical Reports Server (NTRS)

    Volponi, Allan J.; Brotherton, Tom; Luppold, Robert; Simon, Donald L.

    2004-01-01

    Aircraft gas-turbine engine data are available from a variety of sources including on-board sensor measurements, maintenance histories, and component models. An ultimate goal of Propulsion Health Management (PHM) is to maximize the amount of meaningful information that can be extracted from disparate data sources to obtain comprehensive diagnostic and prognostic knowledge regarding the health of the engine. Data Fusion is the integration of data or information from multiple sources, to achieve improved accuracy and more specific inferences than can be obtained from the use of a single sensor alone. The basic tenet underlying the data/information fusion concept is to leverage all available information to enhance diagnostic visibility, increase diagnostic reliability and reduce the number of diagnostic false alarms. This paper describes a basic PHM Data Fusion architecture being developed in alignment with the NASA C17 Propulsion Health Management (PHM) Flight Test program. The challenge of how to maximize the meaningful information extracted from disparate data sources to obtain enhanced diagnostic and prognostic information regarding the health and condition of the engine is the primary goal of this endeavor. To address this challenge, NASA Glenn Research Center (GRC), NASA Dryden Flight Research Center (DFRC) and Pratt & Whitney (P&W) have formed a team with several small innovative technology companies to plan and conduct a research project in the area of data fusion as applied to PHM. Methodologies being developed and evaluated have been drawn from a wide range of areas including artificial intelligence, pattern recognition, statistical estimation, and fuzzy logic. This paper will provide a broad overview of this work, discuss some of the methodologies employed and give some illustrative examples.

  19. Health, development and the Millennium Development Goals.

    PubMed

    Dodd, R; Cassels, A

    2006-01-01

    The Millennium Development Goals (MDG), which emerged from the United Nations Millennium Summit in 2000, are increasingly recognized as the over-arching development framework. As such, the MDG are increasingly guiding the policies of poor countries and aid agencies alike. This article reviews the challenges and opportunities for health presented by the MDG. The opportunities include that three of the eight MDG relate to health--a recognition that health is central to global agenda of reducing poverty, as well as an important measure of human well-being in its own right. A related point is that the MDG help to focus attention on those health conditions that disproportionally affect the poor (communicable disease, child health and maternal health), which should, in turn, help to strengthen the equity focus of health policies in low-income countries. Further, because the MDG are concrete, it is possible to calculate the cost of achieving them, which in turn strengthens the long-standing calls for higher levels of aid for health. The challenges include that, while the MDG focus on specific diseases and conditions, they cannot be achieved without strengthening health systems. Similarly, progress towards the MDG will require health to be prioritized within overall development and economic policies. In practice, this means applying a health 'lens' to processes such as civil-service reform, decentralization and the drawing-up of frameworks of national expenditure. Finally, the MDG cannot be met with the resources available in low-income countries. While the MDG framework has created pressure for donors to commit to higher levels of aid, the challenge remains to turn these commitments into action. Data are presented to show that, at current rates of progress, the health-related MDG will not be achieved. This disappointing trend could be reversed, however, if the various challenges outlined are met.

  20. A Web-Based, Hospital-Wide Health Care-Associated Bloodstream Infection Surveillance and Classification System: Development and Evaluation.

    PubMed

    Tseng, Yi-Ju; Wu, Jung-Hsuan; Lin, Hui-Chi; Chen, Ming-Yuan; Ping, Xiao-Ou; Sun, Chun-Chuan; Shang, Rung-Ji; Sheng, Wang-Huei; Chen, Yee-Chun; Lai, Feipei; Chang, Shan-Chwen

    2015-09-21

    Surveillance of health care-associated infections is an essential component of infection prevention programs, but conventional systems are labor intensive and performance dependent. To develop an automatic surveillance and classification system for health care-associated bloodstream infection (HABSI), and to evaluate its performance by comparing it with a conventional infection control personnel (ICP)-based surveillance system. We developed a Web-based system that was integrated into the medical information system of a 2200-bed teaching hospital in Taiwan. The system automatically detects and classifies HABSIs. In this study, the number of computer-detected HABSIs correlated closely with the number of HABSIs detected by ICP by department (n=20; r=.999 P<.001) and by time (n=14; r=.941; P<.001). Compared with reference standards, this system performed excellently with regard to sensitivity (98.16%), specificity (99.96%), positive predictive value (95.81%), and negative predictive value (99.98%). The system enabled decreasing the delay in confirmation of HABSI cases, on average, by 29 days. This system provides reliable and objective HABSI data for quality indicators, improving the delay caused by a conventional surveillance system.

  1. [The health system of Ecuador].

    PubMed

    Lucio, Ruth; Villacrés, Nilhda; Henríquez, Rodrigo

    2011-01-01

    This paper describes the health conditions in Ecuador and, in more detail, the characteristics of the Ecuadorian health system, including its structure and coverage, its financial sources, the physical, material and human resources available, and the stewardship activities developed by the Ministry of Public Health. It also describes the structure and content of its health information system, and the participation of citizens in the operation and evaluation of the health system. The paper ends with a discussion of the most recent policy innovations implemented in the Ecuadorian system, including the incorporation of a chapter on health into the new Constitution which recognizes the protection of health as a human right, and the construction of the Comprehensive Public Health Network.

  2. [The health system of Peru].

    PubMed

    Alcalde-Rabanal, Jacqueline Elizabeth; Lazo-González, Oswaldo; Nigenda, Gustavo

    2011-01-01

    This paper describes the health conditions in Peru and, with greater detail, the Peruvian health system, including its structure and coverage, its financial sources, its physical, material and human resources, and its stewardship functions. It also discusses the activities developed in the information and research areas, as well as the participation of citizens in the operation and evaluation of the health system. The article concludes with a discussion of the most recent innovations, including the Comprehensive Health Insurance, the Health Care Enterprises system, the decentralization process and the Local Committees for Health Administration. The main challenge confronted by the Peruvian health system is the extension of coverage to more than I0% of the population presently lacking access to basic health care.

  3. Developing a UMLS-based indexing tool for health science repository system.

    PubMed

    Zhang, Dongming; Roderer, Nancy K; Huang, Guang; Zhao, Xin

    2006-01-01

    One of the important procedures during the operation of an Institutional Repository System (IRS) is to categorize and index the submitted digital objects. Based on current practice, human catalogers are frequently involved in this process to make accurate categorization. Funded by NLM development grant, we are developing an UMLS-based indexing tool. The tool will be integrated or plug-in into most IRS, and categorize and assign MeSH headings and keywords to text-based digital objects automatically.

  4. Supporting community-based prevention and health promotion initiatives: developing effective technical assistance systems.

    PubMed

    Mitchell, Roger E; Florin, Paul; Stevenson, John F

    2002-10-01

    As research evidence for the effectiveness of community-based prevention has mounted, so has recognition of the gap between research and community practice. As a result, state and local governments are taking a more active role in building the capacity of community-based organizations to deliver evidence-based prevention interventions. Innovations are taking place in the establishment of technical assistance or support systems to influence the prevention and health education activities of community-based organizations. Several challenges for technical assistance systems are described: (1) setting prevention priorities and allocating limited technical assistance resources, (2) balancing capacity-building versus program dissemination efforts, (3) collaborating across categorical problem areas, (4) designing technical assistance initiatives with enough "dose strength" to have an effect, (5) balancing fidelity versus adaptation in program implementation, (6) building organizational cultures that support innovation, and (7) building local evaluative capacity versus generalizable evaluation findings.

  5. Thinking shift on health systems: from blueprint health programmes towards resilience of health systems

    PubMed Central

    Blanchet, Karl

    2015-01-01

    International health is still highly dominated by equilibrium approaches. The emergence of systems thinking in international health provides a great avenue to develop innovative health interventions adapted to changing contexts. The public health community, nevertheless, has the responsibility to translate concepts related to systems thinking and complexity into concrete research methods and interventions. One possibility is to consider the properties of systems such as resilience and adaptability as entry points to better understand how health systems react to shocks. PMID:25905481

  6. Development of a Corrosion Sensor for AN Aircraft Vehicle Health Monitoring System

    NASA Astrophysics Data System (ADS)

    Scott, D. A.; Price, D. C.; Edwards, G. C.; Batten, A. B.; Kolmeder, J.; Muster, T. H.; Corrigan, P.; Cole, I. S.

    2010-02-01

    A Rayleigh-wave-based sensor has been developed to measure corrosion damage in aircraft. This sensor forms an important part of a corrosion monitoring system being developed for a major aircraft manufacturer. This system measures the corrosion rate at the location of its sensors, and through a model predicts the corrosion rates in nearby places on an aircraft into which no sensors can be placed. In order to calibrate this model, which yields corrosion rates rather than the accumulated effect, an absolute measure of the damage is required. In this paper the development of a surface wave sensor capable of measuring accumulated damage will be described in detail. This sensor allows the system to measure material loss due to corrosion regardless of the possible loss of historical corrosion rate data, and can provide, at any stage, a benchmark for the predictive model that would allow a good estimate of the accumulated corrosion damage in similar locations on an aircraft. This system may obviate the need for costly inspection of difficult-to-access places in aircraft, where presently the only way to check for corrosion is by periodic dismantling and reassembly.

  7. Croatia: health system review.

    PubMed

    Džakula, Aleksandar; Sagan, Anna; Pavić, Nika; Lonćčarek, Karmen; Sekelj-Kauzlarić, Katarina

    2014-01-01

    of the MHI scheme are broad, patients must pay towards the costs of many goods and services, and the right to free health care services has been systematically reduced since 2003, although with exemptions for vulnerable population groups. Configuration of capital and human resources in the health care sector could be improved: for example, homes for the elderly and infirm persons operate close to maximum capacity; psychiatric care in the community is not well developed; and there are shortages of certain categories of medical professionals, including geographical imbalances. Little research is available on the policy process of health care reforms in Croatia. However, it seems that reforms often lack strategic foundations and or projections that could be analysed and scrutinized by the public, and evaluation of reform outcomes is lacking. The overall performance of the health care system seems to be good, given the amount of resources available. However, there is a lack of data to assess it properly.

  8. Innovative health systems projects.

    PubMed

    Green, Michael; Amad, Mansoor; Woodland, Mark

    2015-02-01

    Residency programmes struggle with the systems-based practice and improvement competency promoted by the Accreditation Council for Graduate Medical Education. The development of Innovative Health Systems Projects (IHelP) was driven by the need for better systems-based initiatives at an institutional level. Our objective was to develop a novel approach that successfully incorporates systems-based practice in our Graduate Medical Education (GME) programmes, while tracking our impact on health care delivery as an academic medical centre. We started the IHelP programme as a 'volunteer initiative' in 2010. A detailed description of the definition, development and implementation of the IHelP programme, along with our experience of the first year, is described. Residents, fellows and faculty mentors all played an important role in establishing the foundation of this initiative. Following the positive response, we have now incorporated IHelP into all curricula as a graduating requirement. IHelP has promoted scholarly activity and faculty mentorship, [and] has improved aspects of patient care and safety A total of 123 residents and fellows, representing 26 specialties, participated. We reviewed 145 projects that addressed topics ranging from administrative and departmental improvements to clinical care algorithms. The projects by area of focus were: patient care - clinical care, 38 per cent; patient care - quality, 27 per cent; resident education, 21 per cent; and a cumulative 16 per cent among pharmacy, department activities, patient education, medical records and clinical facility. We are pleased with the results of our first year of incorporating a systems-based improvement programme into the GME programmes. This initiative has promoted scholarly activity and faculty mentorship, has improved aspects of patient care and safety, and has led to the development of many practical innovations. © 2015 John Wiley & Sons Ltd.

  9. Development and deployment of the Computer Assisted Neighborhood Visual Assessment System (CANVAS) to measure health-related neighborhood conditions.

    PubMed

    Bader, Michael D M; Mooney, Stephen J; Lee, Yeon Jin; Sheehan, Daniel; Neckerman, Kathryn M; Rundle, Andrew G; Teitler, Julien O

    2015-01-01

    Public health research has shown that neighborhood conditions are associated with health behaviors and outcomes. Systematic neighborhood audits have helped researchers measure neighborhood conditions that they deem theoretically relevant but not available in existing administrative data. Systematic audits, however, are expensive to conduct and rarely comparable across geographic regions. We describe the development of an online application, the Computer Assisted Neighborhood Visual Assessment System (CANVAS), that uses Google Street View to conduct virtual audits of neighborhood environments. We use this system to assess the inter-rater reliability of 187 items related to walkability and physical disorder on a national sample of 150 street segments in the United States. We find that many items are reliably measured across auditors using CANVAS and that agreement between auditors appears to be uncorrelated with neighborhood demographic characteristics. Based on our results we conclude that Google Street View and CANVAS offer opportunities to develop greater comparability across neighborhood audit studies.

  10. Development and Deployment of the Computer Assisted Neighborhood Visual Assessment System (CANVAS) to Measure Health-Related Neighborhood Conditions

    PubMed Central

    Bader, Michael D. M.; Mooney, Stephen J.; Lee, Yeon Jin; Sheehan, Daniel; Neckerman, Kathryn M.; Rundle, Andrew G.; Teitler, Julien O.

    2014-01-01

    Public health research has shown that neighborhood conditions are associated with health behaviors and outcomes. Systematic neighborhood audits have helped researchers measure neighborhood conditions that they deem theoretically relevant but not available in existing administrative data. Systematic audits, however, are expensive to conduct and rarely comparable across geographic regions. We describe the development of an online application, the Computer Assisted Neighborhood Visual Assessment System (CANVAS), that uses Google Street View to conduct virtual audits of neighborhood environments. We use this system to assess the inter-rater reliability of 187 items related to walkability and physical disorder on a national sample of 150 street segments in the United States. We find that many items are reliably measured across auditors using CANVAS and that agreement between auditors appears to be uncorrelated with neighborhood demographic characteristics. Based on our results we conclude that Google Street View and CANVAS offer opportunities to develop greater comparability across neighborhood audit studies. PMID:25545769

  11. Development of ship structure health monitoring system based on IOT technology

    NASA Astrophysics Data System (ADS)

    Yang, Sujun; Shi, Lei; Chen, Demin; Dong, Yuqing; Hu, Zhenyi

    2017-06-01

    It is very important to monitor the ship structure, because ships are affected by all kinds of wind wave and current environment factor. At the same time, internet of things (IOT) technology plays more and more important role of in the development of industrial process. In the paper, real-time online monitoring of the ship can be realized by means of IOT technology. Ship stress, vibration and dynamic parameters are measured. Meanwhile, data is transmitted to remote monitoring system through intelligent data gateway. Timely remote support can be realized for dangerous stage of ship. Safe navigation of ships is guaranteed through application of the system.

  12. Health systems in India

    PubMed Central

    Chokshi, M; Patil, B; Khanna, R; Neogi, S B; Sharma, J; Paul, V K; Zodpey, S

    2016-01-01

    Health systems and polices have a critical role in determining the manner in which health services are delivered, utilized and affect health outcomes. ‘Health' being a state subject, despite the issuance of the guidelines by the central government, the final prerogative on implementation of the initiatives on newborn care lies with the states. This article briefly describes the public health structure in the country and traces the evolution of the major health programs and initiatives with a particular focus on newborn health. PMID:27924110

  13. Development of the patient-centered recovery resource system for veterans on long-term mental health medications.

    PubMed

    Finnell, Deborah S; Osborne, Frederick H; Gerard, Vivian K

    2011-08-01

    The aim of this qualitative descriptive study was to develop, with and for Veterans on long-term mental health medication regimens, a resource to promote self-management behavior. Focus groups were conducted with 19 outpatient Veterans who were self-administering their medications. Five themes emerged that informed the structure and content of the Recovery Resource System. Additional focus groups with 15 outpatient Veterans were conducted to evaluate the Recovery Resource System. Veterans assessed it to be flexible, dynamic, adaptable, and user-friendly. The goal of this patient-driven, patient-centered Recovery Resource System is to improve health outcomes and quality of life among those with chronic mental disorders.

  14. Developing a dementia-specific health state classification system for a new preference-based instrument AD-5D.

    PubMed

    Nguyen, Kim-Huong; Mulhern, Brendan; Kularatna, Sanjeewa; Byrnes, Joshua; Moyle, Wendy; Comans, Tracy

    2017-01-25

    With an ageing population, the number of people with dementia is rising. The economic impact on the health care system is considerable and new treatment methods and approaches to dementia care must be cost effective. Economic evaluation requires valid patient reported outcome measures, and this study aims to develop a dementia-specific health state classification system based on the Quality of Life for Alzheimer's disease (QOL-AD) instrument (nursing home version). This classification system will subsequently be valued to generate a preference-based measure for use in the economic evaluation of interventions for people with dementia. We assessed the dimensionality of the QOL-AD to develop a new classification system. This was done using exploratory and confirmatory factor analysis and further assessment of the structure of the measure to ensure coverage of the key areas of quality of life. Secondly, we used Rasch analysis to test the psychometric performance of the items, and select item(s) to describe each dimension. This was done on 13 items of the QOL-AD (excluding two general health items) using a sample of 284 residents living in long-term care facilities in Australia who had a diagnosis of dementia. A five dimension classification system is proposed resulting from the three factor structure (defined as 'interpersonal environment', 'physical health' and 'self-functioning') derived from the factor analysis and two factors ('memory' and 'mood') from the accompanying review. For the first three dimensions, Rasch analysis selected three questions of the QOL-AD ('living situation', 'physical health', and 'do fun things') with memory and mood questions representing their own dimensions. The resulting classification system (AD-5D) includes many of the health-related quality of life dimensions considered important to people with dementia, including mood, global function and skill in daily living. The development of the AD-5D classification system is an important step

  15. Bridge structural health monitoring system using fiber grating sensors: development and preparation for a permanent installation

    NASA Astrophysics Data System (ADS)

    Calvert, Sean G.; Mooney, Jason

    2004-07-01

    Blue Road Research and the University of California at San Diego have been collaborating over the past four years to develop a system employing fiber Bragg grating strain sensors and modal analysis to provide real-time, quantitative information on a bridge"s response to a dynamic input (such as a seismic event), and a fast prediction of the structure"s integrity. This research, being funded by the National Science Foundation, has several publications showing its strong progress. In the latter part of 2004, this system will be installed on the Broadway Bridge in downtown Portland, Oregon, USA. In preparation for this deployment, the system is undergoing testing from the sensors through the readout unit and bridge modeling to ensure its performance once installed. The steps of preparation and testing are discussed here.

  16. Developing an Action Model for Integration of Health System Response to HIV/AIDS and Noncommunicable Diseases (NCDs) in Developing Countries

    PubMed Central

    Haregu, Tilahun Nigatu; Setswe, Geoffrey; Elliott, Julian; Oldenburg, Brian

    2014-01-01

    Introduction: Although there are several models of integrated architecture, we still lack models and theories about the integration process of health system responses to HIV/AIDS and NCDs. Objective: The overall purpose of this study is to design an action model, a systematic approach, for the integration of health system responses to HIV/AIDS and NCDs in developing countries. Methods: An iterative and progressive approach of model development using inductive qualitative evidence synthesis techniques was applied. As evidence about integration is spread across different fields, synthesis of evidence from a broad range of disciplines was conducted. Results: An action model of integration having 5 underlying principles, 4 action fields, and a 9-step action cycle is developed. The INTEGRATE model is an acronym of the 9 steps of the integration process: 1) Interrelate the magnitude and distribution of the problems, 2) Navigate the linkage between the problems, 3) Testify individual level co-occurrence of the problems, 4) Examine the similarities and understand the differences between the response functions, 5) Glance over the health system’s environment for integration, 6) Repackage and share evidence in a useable form, 7) Ascertain the plan for integration, 8) Translate the plan in to action, 9) Evaluate and Monitor the integration. Conclusion: Our model provides a basis for integration of health system responses to HIV/AIDS and NCDs in the context of developing countries. We propose that future empirical work is needed to refine the validity and applicability of the model. PMID:24373260

  17. Information technology systems in public sector health facilities in developing countries: the case of South Africa

    PubMed Central

    2013-01-01

    Background The public healthcare sector in developing countries faces many challenges including weak healthcare systems and under-resourced facilities that deliver poor outcomes relative to total healthcare expenditure. Global references demonstrate that information technology has the ability to assist in this regard through the automation of processes, thus reducing the inefficiencies of manually driven processes and lowering transaction costs. This study examines the impact of hospital information systems implementation on service delivery, user adoption and organisational culture within two hospital settings in South Africa. Methods Ninety-four interviews with doctors, nurses and hospital administrators were conducted in two public sector tertiary healthcare facilities (in two provinces) to record end-user perceptions. Structured questionnaires were used to conduct the interviews with both qualitative and quantitative information. Results Noteworthy differences were observed among the three sample groups of doctors, nurses and administrators as well as between our two hospital groups. The impact of automation in terms of cost and strategic value in public sector hospitals is shown to have yielded positive outcomes with regard to patient experience, hospital staff workflow enhancements, and overall morale in the workplace. Conclusion The research provides insight into the reasons for investing in system automation, the associated outcomes, and organisational factors that impact the successful adoption of IT systems. In addition, it finds that sustainable success in these initiatives is as much a function of the technology as it is of the change management function that must accompany the system implementation. PMID:23347433

  18. Lessons learnt from the development of the Patient Safety Incidents Reporting an Learning System for the Spanish National Health System: SiNASP.

    PubMed

    Vallejo-Gutiérrez, Paula; Bañeres-Amella, Joaquim; Sierra, Eduardo; Casal, Jesús; Agra, Yolanda

    2014-01-01

    To describe the development process and characteristics of a patient safety incidents reporting system to be implemented in the Spanish National Health System, based on the context and the needs of the different stakeholders. Literature review and analysis of most relevant reporting systems, identification of more than 100 stakeholder's (patients, professionals, regional governments representatives) expectations and requirements, analysis of the legal context, consensus of taxonomy, development of the software and pilot test. Patient Safety Events Reporting and Learning system (Sistema de Notificación y Aprendizajepara la Seguridad del Paciente, SiNASP) is a generic reporting system for all types of incidents related to patient safety, voluntary, confidential, non punitive, anonymous or nominative with anonimization, system oriented, with local analysis of cases and based on the WHO International Classification for Patient Safety. The electronic program has an on-line form for reporting, a software to manage the incidents and improvement plans, and a scoreboard with process indicators to monitor the system. The reporting system has been designed to respond to the needs and expectations identified by the stakeholders, taking into account the lessons learned from the previous notification systems, the characteristics of the National Health System and the existing legal context. The development process presented and the characteristics of the system provide a comprehensive framework that can be used for future deployments of similar patient safety systems. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  19. An exploratory study on the health information terms for the development of the consumer health vocabulary system.

    PubMed

    Kim, Jeongeun; Joo, Jeeyoung; Shin, Yoonju

    2009-01-01

    This study is to find out the difference between consumer vocabulary and medical vocabulary. The rate of mapping between the consumer vocabulary for health information and the medical vocabulary was not to be high. The terms that consumers use should be researched to understand their morphology and features, so that it will increase the accessibility of consumers to the medical and health information they need.

  20. Italy: health system review.

    PubMed

    Ferre, Francesca; de Belvis, Antonio Giulio; Valerio, Luca; Longhi, Silvia; Lazzari, Agnese; Fattore, Giovanni; Ricciardi, Walter; Maresso, Anna

    2014-01-01

    Italy is the sixth largest country in Europe and has the second highest average life expectancy, reaching 79.4 years for men and 84.5 years for women in 2011. There are marked regional differences for both men and women in most health indicators, reflecting the economic and social imbalance between the north and south of the country. The main diseases affecting the population are circulatory diseases, malignant tumours and respiratory diseases. Italy's health care system is a regionally based national health service that provides universal coverage largely free of charge at the point of delivery. The main source of financing is national and regional taxes, supplemented by copayments for pharmaceuticals and outpatient care. In 2012, total health expenditure accounted for 9.2 percent of GDP (slightly below the EU average of 9.6 percent). Public sources made up 78.2 percent of total health care spending. While the central government provides a stewardship role, setting the fundamental principles and goals of the health system and determining the core benefit package of health services available to all citizens, the regions are responsible for organizing and delivering primary, secondary and tertiary health care services as well as preventive and health promotion services. Faced with the current economic constraints of having to contain or even reduce health expenditure, the largest challenge facing the health system is to achieve budgetary goals without reducing the provision of health services to patients. This is related to the other key challenge of ensuring equity across regions, where gaps in service provision and health system performance persist. Other issues include ensuring the quality of professionals managing facilities, promoting group practice and other integrated care organizational models in primary care, and ensuring that the concentration of organizational control by regions of health-care providers does not stifle innovation. World Health

  1. [Development of a Conceptual Framework for the Assessment of Chronic Care in the Spanish National Health System].

    PubMed

    Espallargues, Mireia; Serra-Sutton, Vicky; Solans-Domènech, Maite; Torrente, Elena; Moharra, Montse; Benítez, Dolors; Robles, Noemí; Domíngo, Laia; Escarrabill Sanglas, Joan

    2016-07-07

    The aim was to develop a conceptual framework for the assessment of new healthcare initiatives on chronic diseases within the Spanish National Health System. A comprehensive literature review between 2002 and 2013, including systematic reviews, meta-analysis, and reports with evaluation frameworks and/or assessment of initiatives was carried out; integrated care initiatives established in Catalonia were studied and described; and semistructured interviews with key stakeholders were performed. The scope and conceptual framework were defined by using the brainstorming approach.Of 910 abstracts identified, a total of 116 studies were included. They referred to several conceptual frameworks and/or assessment indicators at a national and international level. An overall of 24 established chronic care initiatives were identified (9 integrated care initiatives); 10 in-depth interviews were carried out. The proposed conceptual framework envisages: 1)the target population according to complexity levels; 2)an evaluation approach of the structure, processes, and outcomes considering the health status achieved, the recovery process and the maintenance of health; and 3)the dimensions or attributes to be assessed. The proposed conceptual framework will be helpful has been useful to develop indicators and implement them with a community-based and result-oriented approach and a territorial or population-based perspective within the Spanish Health System. This will be essential to know which are the most effective strategies, what are the key elements that determine greater success and what are the groups of patients who can most benefit.

  2. High-performance work systems in health care management, part 1: development of an evidence-informed model.

    PubMed

    Garman, Andrew N; McAlearney, Ann Scheck; Harrison, Michael I; Song, Paula H; McHugh, Megan

    2011-01-01

    : Although management practices are recognized as important factors in improving health care quality and efficiency, most research thus far has focused on individual practices, ignoring or underspecifying the contexts within which these practices are operating. Research from other industries, which has increasingly focused on systems rather than individual practices, has yielded results that may benefit health services management. : Our goal was to develop a conceptual model on the basis of prior research from health care as well as other industries that could be used to inform important contextual considerations within health care. : Using theoretical frameworks from A. Donabedian (1966), P. M. Wright, T. M. Gardner, and L. M. Moynihan (2003), and B. Schneider, D. B. Smith, and H. W. Goldstein (2000) and review methods adapted from R. Pawson (2006b), we reviewed relevant research from peer-reviewed and other industry-relevant sources to inform our model. The model we developed was then reviewed with a panel of practitioners, including experts in quality and human resource management, to assess the applicability of the model to health care settings. : The resulting conceptual model identified four practice bundles, comprising 14 management practices as well as nine factors influencing adoption and perceived sustainability of these practices. The mechanisms by which these practices influence care outcomes are illustrated using the example of hospital-acquired infections. In addition, limitations of the current evidence base are discussed, and an agenda for future research in health care settings is outlined. : Results may help practitioners better conceptualize management practices as part of a broader system of work practices. This may, in turn, help practitioners to prioritize management improvement efforts more systematically.

  3. Development of a cost-effective and flexible vibration DAQ system for long-term continuous structural health monitoring

    NASA Astrophysics Data System (ADS)

    Nguyen, Theanh; Chan, Tommy H. T.; Thambiratnam, David P.; King, Les

    2015-12-01

    In the structural health monitoring (SHM) field, long-term continuous vibration-based monitoring is becoming increasingly popular as this could keep track of the health status of structures during their service lives. However, implementing such a system is not always feasible due to on-going conflicts between budget constraints and the need of sophisticated systems to monitor real-world structures under their demanding in-service conditions. To address this problem, this paper presents a comprehensive development of a cost-effective and flexible vibration DAQ system for long-term continuous SHM of a newly constructed institutional complex with a special focus on the main building. First, selections of sensor type and sensor positions are scrutinized to overcome adversities such as low-frequency and low-level vibration measurements. In order to economically tackle the sparse measurement problem, a cost-optimized Ethernet-based peripheral DAQ model is first adopted to form the system skeleton. A combination of a high-resolution timing coordination method based on the TCP/IP command communication medium and a periodic system resynchronization strategy is then proposed to synchronize data from multiple distributed DAQ units. The results of both experimental evaluations and experimental-numerical verifications show that the proposed DAQ system in general and the data synchronization solution in particular work well and they can provide a promising cost-effective and flexible alternative for use in real-world SHM projects. Finally, the paper demonstrates simple but effective ways to make use of the developed monitoring system for long-term continuous structural health evaluation as well as to use the instrumented building herein as a multi-purpose benchmark structure for studying not only practical SHM problems but also synchronization related issues.

  4. Improving the measurement of QALYs in dementia: developing patient- and carer-reported health state classification systems using Rasch analysis.

    PubMed

    Mulhern, Brendan; Smith, Sarah C; Rowen, Donna; Brazier, John E; Knapp, Martin; Lamping, Donna L; Loftus, Vanessa; Young, Tracey A; Howard, Robert J; Banerjee, Sube

    2012-01-01

    Cost-utility analysis is increasingly used to inform resource allocation. This requires a means of valuing health states before and after intervention. Although generic measures are typically used to generate values, these do not perform well with people with dementia. We report the development of a health state classification system amenable to valuation for use in studies of dementia, derived from the DEMQOL system, measure of health-related quality of life in dementia by patient self-report (DEMQOL) and carer proxy-report (DEMQOL-Proxy). Factor analysis was used to determine the dimensional structure of DEMQOL and DEMQOL-Proxy. Rasch analysis was subsequently used to investigate item performance across factors in terms of item-level ordering, functioning across subgroups, model fit, and severity-range coverage. This enabled the selection of one item from each factor for the classification system. A sample of people with a diagnosis of mild/moderate dementia (n = 644) and a sample of carers of those with mild/moderate dementia (n = 683) were used. Factor analysis found different five-factor solutions for DEMQOL and DEMQOL-Proxy. Following item reduction and selection by using Rasch analysis, a five-dimension classification for DEMQOL and a four-dimension classification for DEMQOL-Proxy were developed. Each item contained four health state levels. Combining Rasch and classical psychometric analysis is a valid method of selecting items for dementia health state classifications from both the patient and carer perspectives. The next stage is to obtain preference weights so that the measure can be used in the economic evaluation of treatment, care, and support arrangements for dementia. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  5. Estimating Oxygen Needs for Childhood Pneumonia in Developing Country Health Systems: A New Model for Expecting the Unexpected

    PubMed Central

    Bradley, Beverly D.; Howie, Stephen R. C.; Chan, Timothy C. Y.; Cheng, Yu-Ling

    2014-01-01

    Background Planning for the reliable and cost-effective supply of a health service commodity such as medical oxygen requires an understanding of the dynamic need or ‘demand’ for the commodity over time. In developing country health systems, however, collecting longitudinal clinical data for forecasting purposes is very difficult. Furthermore, approaches to estimating demand for supplies based on annual averages can underestimate demand some of the time by missing temporal variability. Methods A discrete event simulation model was developed to estimate variable demand for a health service commodity using the important example of medical oxygen for childhood pneumonia. The model is based on five key factors affecting oxygen demand: annual pneumonia admission rate, hypoxaemia prevalence, degree of seasonality, treatment duration, and oxygen flow rate. These parameters were varied over a wide range of values to generate simulation results for different settings. Total oxygen volume, peak patient load, and hours spent above average-based demand estimates were computed for both low and high seasons. Findings Oxygen demand estimates based on annual average values of demand factors can often severely underestimate actual demand. For scenarios with high hypoxaemia prevalence and degree of seasonality, demand can exceed average levels up to 68% of the time. Even for typical scenarios, demand may exceed three times the average level for several hours per day. Peak patient load is sensitive to hypoxaemia prevalence, whereas time spent at such peak loads is strongly influenced by degree of seasonality. Conclusion A theoretical study is presented whereby a simulation approach to estimating oxygen demand is used to better capture temporal variability compared to standard average-based approaches. This approach provides better grounds for health service planning, including decision-making around technologies for oxygen delivery. Beyond oxygen, this approach is widely

  6. The process of development of a prioritization tool for a clinical decision support build within a computerized provider order entry system: Experiences from St Luke's Health System.

    PubMed

    Wolf, Matthew; Miller, Suzanne; DeJong, Doug; House, John A; Dirks, Carl; Beasley, Brent

    2016-09-01

    To establish a process for the development of a prioritization tool for a clinical decision support build within a computerized provider order entry system and concurrently to prioritize alerts for Saint Luke's Health System. The process of prioritizing clinical decision support alerts included (a) consensus sessions to establish a prioritization process and identify clinical decision support alerts through a modified Delphi process and (b) a clinical decision support survey to validate the results. All members of our health system's physician quality organization, Saint Luke's Care as well as clinicians, administrators, and pharmacy staff throughout Saint Luke's Health System, were invited to participate in this confidential survey. The consensus sessions yielded a prioritization process through alert contextualization and associated Likert-type scales. Utilizing this process, the clinical decision support survey polled the opinions of 850 clinicians with a 64.7 percent response rate. Three of the top rated alerts were approved for the pre-implementation build at Saint Luke's Health System: Acute Myocardial Infarction Core Measure Sets, Deep Vein Thrombosis Prophylaxis within 4 h, and Criteria for Sepsis. This study establishes a process for developing a prioritization tool for a clinical decision support build within a computerized provider order entry system that may be applicable to similar institutions. © The Author(s) 2015.

  7. The development of a statewide continuous evaluation system for the Texas Children's Mental Health Plan: a total quality management approach.

    PubMed

    Rouse, L W; Toprac, M G; MacCabe, N A

    1998-05-01

    The article presents a description of processes involved in developing and implementing a statewide continuous evaluation system for the Texas Children's Mental Health Plan (TCMHP) and quality management tools used to approach implementation challenges. Implementation issues are discussed relating to stakeholder involvement, evaluation design evolution, measurement method modification, evaluation integration, staff training, data quality control, communication of results, and use of results in decision making. A review of implementation processes suggests evaluation design and activities should be seen as constantly evolving in response to ongoing stakeholder input. Involving stakeholders in design and implementation can result in increased data quality, data-informed decision making to improve service delivery, and increased public accountability. The TCMHP evaluation system development demonstrates that quality management tools can provide a useful framework to work through design and implementation problems, and a continuous evaluation system can provide an infrastructure for meeting data needs in a managed care environment.

  8. Developing the Philippines as a Global Hub for Disaster Risk Reduction - A Health Research Initiative as Presented at the 10th Philippine National Health Research System Week Celebration

    PubMed Central

    Banwell, Nicola; Montoya, Jaime; Opeña, Merlita; IJsselmuiden, Carel; Law, Ronald; Balboa, Gloria J.; Rutherford, Shannon; Chu, Cordia; Murray, Virginia

    2016-01-01

    The recent Philippine National Health Research System (PNHRS) Week Celebration highlighted the growing commitment to Disaster Risk Reduction (DRR) in the Philippines. The event was lead by the Philippine Council for Health Research and Development of the Department of Science and Technology and the Department of Health, and saw the participation of national and international experts in DRR, and numerous research consortia from all over the Philippines. With a central focus on the Sendai Framework for Disaster Risk Reduction, the DRR related events recognised the significant disaster risks faced in the Philippines. They also illustrated the Philippine strengths and experience in DRR. Key innovations in science and technology showcased at the conference include the web-base hazard mapping applications ‘Project NOAH’ and ‘FaultFinder’. Other notable innovations include ‘Surveillance in Post Extreme Emergencies and Disasters’ (SPEED) which monitors potential outbreaks through a syndromic reporting system. Three areas noted for further development in DRR science and technology included: integrated national hazard assessment, strengthened collaboration, and improved documentation. Finally, the event saw the proposal to develop the Philippines into a global hub for DRR. The combination of the risk profile of the Philippines, established national structures and experience in DRR, as well as scientific and technological innovation in this field are potential factors that could position the Philippines as a future global leader in DRR. The purpose of this article is to formally document the key messages of the DRR-related events of the PNHRS Week Celebration. PMID:27867737

  9. Developing the Philippines as a Global Hub for Disaster Risk Reduction - A Health Research Initiative as Presented at the 10th Philippine National Health Research System Week Celebration.

    PubMed

    Banwell, Nicola; Montoya, Jaime; Opeña, Merlita; IJsselmuiden, Carel; Law, Ronald; Balboa, Gloria J; Rutherford, Shannon; Chu, Cordia; Murray, Virginia

    2016-10-25

    The recent Philippine National Health Research System (PNHRS) Week Celebration highlighted the growing commitment to Disaster Risk Reduction (DRR) in the Philippines. The event was lead by the Philippine Council for Health Research and Development of the Department of Science and Technology and the Department of Health, and saw the participation of national and international experts in DRR, and numerous research consortia from all over the Philippines. With a central focus on the Sendai Framework for Disaster Risk Reduction, the DRR related events recognised the significant disaster risks faced in the Philippines. They also illustrated the Philippine strengths and experience in DRR. Key innovations in science and technology showcased at the conference include the web-base hazard mapping applications 'Project NOAH' and 'FaultFinder'. Other notable innovations include 'Surveillance in Post Extreme Emergencies and Disasters' (SPEED) which monitors potential outbreaks through a syndromic reporting system. Three areas noted for further development in DRR science and technology included: integrated national hazard assessment, strengthened collaboration, and improved documentation. Finally, the event saw the proposal to develop the Philippines into a global hub for DRR. The combination of the risk profile of the Philippines, established national structures and experience in DRR, as well as scientific and technological innovation in this field are potential factors that could position the Philippines as a future global leader in DRR. The purpose of this article is to formally document the key messages of the DRR-related events of the PNHRS Week Celebration.

  10. Assessment of Environmental and Occupational Health Impacts in Munitions and Weapon Systems Development: A Phased Approach

    DTIC Science & Technology

    2010-12-01

    Human Health Impacts of New Energetic Compounds. • Models – QSARs • In vitro toxicology • In vivo toxicology • Aligned with RDT&E level of...D.A.B.T. Health Effects Research Program Directorate of Toxicology Army Institute of Public Health UNCLASSIFIED Report Documentation Page Form...program. Early in the research stage models are primarily relied upon (e.g. QSAR approaches) and as the technology progresses, a greater reliance is

  11. Using participatory design to develop (public) health decision support systems through GIS.

    PubMed

    Dredger, S Michelle; Kothari, Anita; Morrison, Jason; Sawada, Michael; Crighton, Eric J; Graham, Ian D

    2007-11-27

    Organizations that collect substantial data for decision-making purposes are often characterized as being 'data rich' but 'information poor'. Maps and mapping tools can be very useful for research transfer in converting locally collected data into information. Challenges involved in incorporating GIS applications into the decision-making process within the non-profit (public) health sector include a lack of financial resources for software acquisition and training for non-specialists to use such tools. This on-going project has two primary phases. This paper critically reflects on Phase 1: the participatory design (PD) process of developing a collaborative web-based GIS tool. A case study design is being used whereby the case is defined as the data analyst and manager dyad (a two person team) in selected Ontario Early Year Centres (OEYCs). Multiple cases are used to support the reliability of findings. With nine producer/user pair participants, the goal in Phase 1 was to identify barriers to map production, and through the participatory design process, develop a web-based GIS tool suited for data analysts and their managers. This study has been guided by the Ottawa Model of Research Use (OMRU) conceptual framework. Due to wide variations in OEYC structures, only some data analysts used mapping software and there was no consistency or standardization in the software being used. Consequently, very little sharing of maps and data occurred among data analysts. Using PD, this project developed a web-based mapping tool (EYEMAP) that was easy to use, protected proprietary data, and permit limited and controlled sharing between participants. By providing data analysts with training on its use, the project also ensured that data analysts would not break cartographic conventions (e.g. using a chloropleth map for count data). Interoperability was built into the web-based solution; that is, EYEMAP can read many different standard mapping file formats (e.g. ESRI, MapInfo, CSV

  12. Using participatory design to develop (public) health decision support systems through GIS

    PubMed Central

    Dredger, S Michelle; Kothari, Anita; Morrison, Jason; Sawada, Michael; Crighton, Eric J; Graham, Ian D

    2007-01-01

    Background Organizations that collect substantial data for decision-making purposes are often characterized as being 'data rich' but 'information poor'. Maps and mapping tools can be very useful for research transfer in converting locally collected data into information. Challenges involved in incorporating GIS applications into the decision-making process within the non-profit (public) health sector include a lack of financial resources for software acquisition and training for non-specialists to use such tools. This on-going project has two primary phases. This paper critically reflects on Phase 1: the participatory design (PD) process of developing a collaborative web-based GIS tool. Methods A case study design is being used whereby the case is defined as the data analyst and manager dyad (a two person team) in selected Ontario Early Year Centres (OEYCs). Multiple cases are used to support the reliability of findings. With nine producer/user pair participants, the goal in Phase 1 was to identify barriers to map production, and through the participatory design process, develop a web-based GIS tool suited for data analysts and their managers. This study has been guided by the Ottawa Model of Research Use (OMRU) conceptual framework. Results Due to wide variations in OEYC structures, only some data analysts used mapping software and there was no consistency or standardization in the software being used. Consequently, very little sharing of maps and data occurred among data analysts. Using PD, this project developed a web-based mapping tool (EYEMAP) that was easy to use, protected proprietary data, and permit limited and controlled sharing between participants. By providing data analysts with training on its use, the project also ensured that data analysts would not break cartographic conventions (e.g. using a chloropleth map for count data). Interoperability was built into the web-based solution; that is, EYEMAP can read many different standard mapping file formats

  13. Russian Federation. Health system review.

    PubMed

    Popovich, Larisa; Potapchik, Elena; Shishkin, Sergey; Richardson, Erica; Vacroux, Alexandra; Mathivet, Benoit

    2011-01-01

    The HiT reviews are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. At independence from the Soviet Union in 1991, the Russian health system inherited an extensive, centralized Semashko system, but was quick to reform health financing by adopting a mandatory health insurance (MHI) model in 1993. MHI was introduced in order to open up an earmarked stream of funding for health care in the face of severe fiscal constraints. While the health system has evolved and changed significantly since the early 1990 s, the legacy of having been a highly centralized system focused on universal access to basic care remains. High energy prices on world markets have ensured greater macroeconomic stability, a budget surplus and improvements in living standards for most of the Russian population. However, despite an overall reduction in the poverty rate, there is a marked urban rural split and rural populations have worse health and poorer access to health services than urban populations. The increase in budgetary resources available to policy-makers have led to a number of recent federal-level health programmes that have focused on the delivery of services and increasing funding for priority areas including primary care provision in rural areas. Nevertheless, public health spending in the Russian Federation remains relatively low given the resources available. However, it is also clear that, even with the current level of financing, the performance of the health system could be improved. Provider payment mechanisms are the main obstacle to improving technical efficiency in

  14. A methodology based on openEHR archetypes and software agents for developing e-health applications reusing legacy systems.

    PubMed

    Cardoso de Moraes, João Luís; de Souza, Wanderley Lopes; Pires, Luís Ferreira; do Prado, Antonio Francisco

    2016-10-01

    In Pervasive Healthcare, novel information and communication technologies are applied to support the provision of health services anywhere, at anytime and to anyone. Since health systems may offer their health records in different electronic formats, the openEHR Foundation prescribes the use of archetypes for describing clinical knowledge in order to achieve semantic interoperability between these systems. Software agents have been applied to simulate human skills in some healthcare procedures. This paper presents a methodology, based on the use of openEHR archetypes and agent technology, which aims to overcome the weaknesses typically found in legacy healthcare systems, thereby adding value to the systems. This methodology was applied in the design of an agent-based system, which was used in a realistic healthcare scenario in which a medical staff meeting to prepare a cardiac surgery has been supported. We conducted experiments with this system in a distributed environment composed by three cardiology clinics and a center of cardiac surgery, all located in the city of Marília (São Paulo, Brazil). We evaluated this system according to the Technology Acceptance Model. The case study confirmed the acceptance of our agent-based system by healthcare professionals and patients, who reacted positively with respect to the usefulness of this system in particular, and with respect to task delegation to software agents in general. The case study also showed that a software agent-based interface and a tools-based alternative must be provided to the end users, which should allow them to perform the tasks themselves or to delegate these tasks to other people. A Pervasive Healthcare model requires efficient and secure information exchange between healthcare providers. The proposed methodology allows designers to build communication systems for the message exchange among heterogeneous healthcare systems, and to shift from systems that rely on informal communication of actors to

  15. Tajikistan: Health System Review.

    PubMed

    Khodjamurodov, Ghafur; Sodiqova, Dilorom; Akkazieva, Baktygul; Rechel, Bernd

    2016-01-01

    The pace of health reforms in Tajikistan has been slow and in many aspects the health system is still shaped by the countrys Soviet legacy. The country has the lowest total health expenditure per capita in the WHO European Region, much of it financed privately through out-of-pocket payments. Public financing depends principally on regional and local authorities, thus compounding regional inequalities across the country. The high share of private out-of-pocket payments undermines a range of health system goals, including financial protection, equity, efficiency and quality. The efficiency of the health system is also undermined by outdated provider payment mechanisms and lack of pooling of funds. Quality of care is another major concern, due to factors such as insufficient training, lack of evidence-based clinical guidelines, underuse of generic drugs, poor infrastructure and equipment (particularly at the regional level) and perverse financial incentives for physicians in the form of out-of-pocket payments. Health reforms have aimed to strengthen primary health care, but it still suffers from underinvestment and low prestige. A basic benefit package and capitation-based financing of primary health care have been introduced as pilots but have not yet been rolled out to the rest of the country. The National Health Strategy envisages substantial reforms in health financing, including nationwide introduction of capitation-based payments for primary health care and more than doubling public expenditure on health by 2020; it remains to be seen whether this will be achieved. World Health Organization 2016 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  16. Health, globalization and developing countries.

    PubMed

    Cilingiroglu, Nesrin

    2005-02-01

    In health care today, scientific and technological frontiers are expanding at unprecedented rates, even as economic and financial pressures shrink profit margins, intensify competition, and constrain the funds available for investment. Therefore, the world today has more economic, and social opportunities for people than 10 or 100 years since globalization has created a new ground somewhat characterized by rapid economic transformation, deregulation of national markets by new trade regimes, amazing transport, electronic communication possibilities and high turnover of foreign investment and capital flow as well as skilled labor. These trends can easily mask great inequalities in developing countries such as importation and spreading of infectious and non-communicable diseases; miniaturization of movement of medical technology; health sector trades management driven by economics without consideration to the social and health aspects and its effects, increasing health inequalities and their economic and social burden creation; multinational companies' cheap labor employment promotion in widening income differentials; and others. As a matter of fact, all these factors are major determinants of ill health. Health authorities of developing countries have to strengthen their regulatory framework in order to ensure that national health systems derive maximum benefit in terms of equity, quality and efficiency, while reducing potential social cost to a minimum generated risky side of globalization.

  17. United Kingdom: Health System Review.

    PubMed

    Cylus, Jonathan; Richardson, Erica; Findley, Lisa; Longley, Marcus; O'Neill, Ciaran; Steel, David

    2015-01-01

    This analysis of the United Kingdom health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. It provides an overview of how the national health services operate in the four nations that make up the United Kingdom, as responsibility for organizing health financing and services was devolved from 1997. With devolution, the health systems in the United Kingdom have diverged in the details of how services are organized and paid for, but all have maintained national health services which provide universal access to a comprehensive package of services that are mostly free at the point of use. These health services are predominantly financed from general taxation and 83.5% of total health expenditure in the United Kingdom came from public sources in 2013. Life expectancy has increased steadily across the United Kingdom, but health inequalities have proved stubbornly resistant to improvement, and the gap between the most deprived and the most privileged continues to widen, rather than close. The United Kingdom faces challenges going forward, including how to cope with the needs of an ageing population, how to manage populations with poor health behaviours and associated chronic conditions, how to meet patient expectations of access to the latest available medicines and technologies, and how to adapt a system that has limited resources to expand its workforce and infrastructural capacity so it can rise to these challenges. World Health Organization 2015 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  18. Development of a data warehouse at an academic health system: knowing a place for the first time.

    PubMed

    Dewitt, Jocelyn G; Hampton, Philip M

    2005-11-01

    In 1998, the University of Michigan Health System embarked upon the design, development, and implementation of an enterprise-wide data warehouse, intending to use prioritized business questions to drive its design and implementation. Because of the decentralized nature of the academic health system and the development team's inability to identify and prioritize those institutional business questions, however, a bottom-up approach was used to develop the enterprise-wide data warehouse. Specific important data sets were identified for inclusion, and the technical team designed the system with an enterprise view and architecture rather than as a series of data marts. Using this incremental approach of adding data sets, institutional leaders were able to experience and then further define successful use of the integrated data made available to them. Even as requests for the use and expansion of the data warehouse outstrip the resources assigned for support, the data warehouse has become an integral component of the institution's information management strategy. The authors discuss the approach, process, current status, and successes and failures of the data warehouse.

  19. Dimensions of health system reform.

    PubMed

    Frenk, J

    1994-01-31

    During recent years there has been a growth of worldwide interest in health system reform. Countries at all levels of economic development are engaged in a creative search for better ways of organizing and financing health care, while promoting the goals of equity, effectiveness, and efficiency. Together with economic, political, and ideological reasons, this search has been fueled by the need to find answers to the complexities posed by the epidemiologic transition, whereby many nations are facing the simultaneous burdens of old, unresolved problems and new, emerging challenges. In order to better understand reform attempts, it is necessary to develop a clear conception of the object of reform: the health system. This paper presents the health system as a set of relationships among five major groups of actors: the health care providers, the population, the state as a collective mediator, the organizations that generate resources, and the other sectors that produce services with health effects. The relationships among providers, population, and the state form the basis for a typology of health care modalities. The type and number of modalities present in a country make it possible to characterize its health system. In the last part, the paper proposes that health system reform operates at four policy levels: systemic, which deals with the institutional arrangements for regulation, financing, and delivery of services; programmatic, which specifies the priorities of the system, by defining a universal package of health care interventions; organizational, which is concerned with the actual production of services by focusing on issues of quality assurance and technical efficiency; and instrumental, which generates the institutional intelligence for improving system performance through information, research, technological innovation, and human resource development. The dimensions of reform offer a repertoire of policy options, which need to be enriched by cross

  20. Czech Republic: health system review.

    PubMed

    Alexa, Jan; Recka, Lukas; Votapkova, Jana; van Ginneken, Ewout; Spranger, Anne; Wittenbecher, Friedrich

    2015-01-01

    This analysis of the Czech health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The Czech health-care system is based on compulsory statutory health insurance providing virtually universal coverage and a broad range of benefits, and doing so at 7.7 % of GDP in 2012 - well below the EU average - of which a comparatively high 85 % was publicly funded. Some important health indicators are better than the EU averages (such as mortality due to respiratory disease) or even among the best in the world (in terms of infant mortality, for example). On the other hand, mortality rates for diseases of the circulatory system and malignant neoplasms are well above the EU average, as are a range of health-care utilization rates, such as outpatient contacts and average length of stay in acute care hospitals. In short, there is substantial potential in the Czech Republic for efficiency gains and to improve health outcomes. Furthermore, the need for reform in order to financially sustain the system became evident again after the global financial crisis, but there is as yet no consensus about how to achieve this.

  1. Development of a Web-based tool to collect and display water system customer service areas for public health action.

    PubMed

    Wong, Michelle; Wolff, Craig; Collins, Natalie; Guo, Liang; Meltzer, Dan; English, Paul

    2015-01-01

    Significant illness is associated with biological contaminants in drinking water, but little is known about health effects from low levels of chemical contamination in drinking water. To examine these effects in epidemiological studies, the sources of drinking water of study populations need to be known. The California Environmental Health Tracking Program developed an online application that would collect data on the geographic location of public water system (PWS) customer service areas in California, which then could be linked to demographic and drinking water quality data. We deployed the Water Boundary Tool (WBT), a Web-based geospatial crowdsourcing application that can manage customer service boundary data for each PWS in California and can track changes over time. We also conducted a needs assessment for expansion to other states. The WBT was designed for water system operators, local and state regulatory agencies, and government entities. Since its public launch in 2012, the WBT has collected service area boundaries for about 2300 individual PWS, serving more than 90% of the California population. Results of the needs assessment suggest interest and utility for deploying such a tool among states lacking statewide PWS service area boundary data. Although the WBT data set is incomplete, it has already been used for a variety of applications, including fulfilling legislatively mandated reporting requirements and linking customer service areas to drinking water quality data to better understand local water quality issues. Development of this tool holds promise to assist with outbreak investigations and prevention, environmental health monitoring, and emergency preparedness and response.

  2. Agricultural biodiversity as a link between traditional food systems and contemporary development, social integrity and ecological health.

    PubMed

    Johns, Timothy; Powell, Bronwen; Maundu, Patrick; Eyzaguirre, Pablo B

    2013-11-01

    Traditional food systems offer a key link between the social and economic resilience of smallholder farmers and pastoralists and the sustainable food and nutrition security of global populations. This paper addresses issues related to socio-cultural diversity and the continuing complex engagement of traditional and modern communities with the plants and animals that sustain them. In light of some of the unhealthful consequences of the 'nutrition transition' to globalized modern diets, the authors define and propose a process for a more successful food system transition that balances agro-biodiversity and processed commodities to support diet diversity, health and social equity alongside sustainable economic growth. We review empirical research in support of practice and policy changes in agriculture, economic development and health domains as well as cross-sectoral and community-based innovation. High-value food crops within domestic and global value chains can be an entry point for smallholders' participation as contributors and beneficiaries of development, while sustainable small farms, as purveyors of environmental and public health services, diversify global options for long-term adaptation in the face of environmental uncertainty. © 2013 Society of Chemical Industry.

  3. Resources needed to enhance and develop health services research to improve the oral health status of the aging veteran in the Department of Veterans Affairs System.

    PubMed

    Weyant, R J

    1995-11-01

    Health services research (HSR) in the Department of Veterans Affairs (VA) is one way in which to study the oral health care delivered to aging veterans and to ensure the most effective and efficient methods of meeting their oral health needs. This article details the current resources and infrastructure within VA dentistry that could be used to support a dental HSR agenda, followed by recommendations for improvements. The Department of Veterans Affairs' current situation regarding dental HSR is as follows: Dental health services research within VA needs expansion. Staff dentists have neither the training nor the incentives to conduct dental HSR. Dental clinic administrators are discouraged from being supportive of research due to the high clinical work-load requirements present at most dental services. Dental service affiliations with universities are not structured to support HSR. The HSR personnel outside of the dental services do not have the time nor the inclination to engage in dental HSR. Few recruitment and training initiatives are used to increase the number of VA dental health services researchers. Although funding sources exist that could be used to support dental HSR, the lack of trained and interested research personnel prevents full use. The Department of Veterans Affairs data collection in dentistry are inadequate to support dental HSR. If the required changes occur, VA is uniquely situated to be the largest contributor to dental HSR in the United States and to act as a catalyst for improving dental HSR throughout the nation. Recommendations for improvement of VA dental HSR are as follows: Restructure the Dental Activity System to include detailed diagnostic and treatment data as part of an integrated computerized patient record. Develop and implement a strategic plan with a detailed timeline for increasing dental HSR in VA. Recruit staff dentists with formal research training and provide them protected research time and resources to conduct

  4. Developing a Comprehensive Pesticide Health Effects Tracking System for an Urban Setting: New York City’s Approach

    PubMed Central

    Kass, Daniel E.; Thier, Audrey L.; Leighton, Jessica; Cone, James E.; Jeffery, Nancy L.

    2004-01-01

    In recent years, there have been substantial investments and improvements in federal and state surveillance systems to track the health effects from pesticide exposure. These surveillance systems help to identify risk factors for occupational exposure to pesticides, patterns in poisonings, clusters of disease, and populations at risk of exposure from pesticide use. Data from pesticide use registries and recent epidemiologic evidence pointing to health risks from urban residential pesticide use make a strong case for understanding better the sale, application, and use of pesticides in cities. In this article, we describe plans for the development of a pesticide tracking system for New York City that will help to elucidate where and why pesticides are used, potential risks to varied populations, and the health consequences of their use. The results of an inventory of data sources are presented along with a description of their relevance to pesticide tracking. We also discuss practical, logistical, and methodologic difficulties of linking multiple secondary data sources with different levels of person, place, and time descriptors. PMID:15471736

  5. Developing a health system approach to disaster management: A qualitative analysis of the core literature to complement the WHO Toolkit for assessing health-system capacity for crisis management

    PubMed Central

    Bayntun, Claire; Rockenschaub, Gerald; Murray, Virginia

    2012-01-01

    BACKGROUND The World Health Organisation's (WHO) sixty-fourth World Health Assembly in May 2011 adopted a resolution on ‘strengthening national health emergency and disaster management capacities and resilience of health systems’. Disaster management is a topical issue globally and countries are being encouraged to improve their disaster preparedness, along with growing international commitment to strengthening health systems. Lessons identified from disasters have not been effectively collated; essential experience is forgotten. METHODS This paper describes the analysis of the worldwide experience of disasters through a health systems approach. A systematic search of the core literature from January 2000 to November 2011 was conducted. Components drawn from the WHO’s Global assessment of national health sector emergency preparedness and response baseline survey were combined with WHO’s six health system building blocks (or levers) to act as the initial analysis anchors, with a further grounded theory qualitative analysis of the literature allowing the identification of emerging themes and insights. The priority areas identified by this literature review were then compared with the topics covered by the new expert-consensus-derived Toolkit for assessing health-system capacity for crisis management developed by the WHO Regional Office for Europe. FINDINGS 143 publications identified from a literature search were analysed and appraised. Themes and examples from the literature demonstrate how health system strengthening should contribute to disaster management. Priority areas under-represented in the WHO Toolkit and identified by the qualitative analysis are discussed. INTERPRETATION Collation and analysis of the disaster management literature identifies how health system strengthening can promote resilience and efficient recovery in the face of disasters. These findings support and complement the WHO Toolkit. Countries can use the literature evidence with the

  6. Developing Health Education Programs in Rural Areas.

    ERIC Educational Resources Information Center

    Colle, Royal D.

    If primary medical care is to be provided to remote rural populations in developing countries, alternative and innovative delivery systems emphasizing community participation, use of paraprofessionals, and health education programs must be considered. A recent American Public Health Association study of 180 health projects in developing countries…

  7. Height, health, and development

    PubMed Central

    Deaton, Angus

    2007-01-01

    Adult height is determined by genetic potential and by net nutrition, the balance between food intake and the demands on it, including the demands of disease, most importantly during early childhood. Historians have made effective use of recorded heights to indicate living standards, in both health and income, for periods where there are few other data. Understanding the determinants of height is also important for understanding health; taller people earn more on average, do better on cognitive tests, and live longer. This paper investigates the environmental determinants of height across 43 developing countries. Unlike in rich countries, where adult height is well predicted by mortality in infancy, there is no consistent relationship across and within countries between adult height on the one hand and childhood mortality or living conditions on the other. In particular, adult African women are taller than is warranted by their low incomes and high childhood mortality, not to mention their mothers' educational level and reported nutrition. High childhood mortality in Africa is associated with taller adults, which suggests that mortality selection dominates scarring, the opposite of what is found in the rest of the world. The relationship between population heights and income is inconsistent and unreliable, as is the relationship between income and health more generally. PMID:17686991

  8. Health care systems of developed non-U.S. nations: strengths, weaknesses, and recommendations for the United States--observations from internationally recognized imaging specialists.

    PubMed

    Brubaker, Lauren M; Picano, Eugenio; Breen, David J; Marti-Bonmati, Luis; Semelka, Richard C

    2011-01-01

    The purpose of this article is to survey imaging experts from developed nations on their impression of their own health care system and recommendations for the U.S. health care system as it seeks to enact health care reform. A survey was sent to individual imaging experts from developed nations requesting information on their health care systems (type of system, strengths, and weaknesses) and their recommendations for the United States. Eighteen respondents from 17 developed nations completed the survey. All respondents reported universal health care coverage: four with government-operated health care, one with mixed government and private insurance-operated health care, 10 with predominantly government run with private insurance supplementation health care, and one with predominantly private insurance with government-operated supplementation health care. The most commonly cited strength was universal health care coverage for all citizens. The most commonly cited weakness was prolonged wait times. Notably absent was concern by the respondent physicians about malpractice litigation. The most commonly cited recommendation was the implementation of a universal health care coverage program. In our survey of 18 imaging experts from 17 nations outside the United States, most respondents thought that their nations offered adequate universal health care coverage for their citizens, with the primary drawback of long wait times.

  9. Development and Evaluation of Sensor Concepts for Ageless Aerospace Vehicles: Report 6 - Development and Demonstration of a Self-Organizing Diagnostic System for Structural Health Monitoring

    NASA Technical Reports Server (NTRS)

    Batten, Adam; Edwards, Graeme; Gerasimov, Vadim; Hoschke, Nigel; Isaacs, Peter; Lewis, Chris; Moore, Richard; Oppolzer, Florien; Price, Don; Prokopenko, Mikhail; Scott, Andrew; Wang, Peter

    2010-01-01

    This report describes a significant advance in the capability of the CSIRO/NASA structural health monitoring Concept Demonstrator (CD). The main thrust of the work has been the development of a mobile robotic agent, and the hardware and software modifications and developments required to enable the demonstrator to operate as a single, self-organizing, multi-agent system. This single-robot system is seen as the forerunner of a system in which larger numbers of small robots perform inspection and repair tasks cooperatively, by self-organization. While the goal of demonstrating self-organized damage diagnosis was not fully achieved in the time available, much of the work required for the final element that enables the robot to point the video camera and transmit an image has been completed. A demonstration video of the CD and robotic systems operating will be made and forwarded to NASA.

  10. Development of a fully automated network system for long-term health-care monitoring at home.

    PubMed

    Motoi, K; Kubota, S; Ikarashi, A; Nogawa, M; Tanaka, S; Nemoto, T; Yamakoshi, K

    2007-01-01

    Daily monitoring of health condition at home is very important not only as an effective scheme for early diagnosis and treatment of cardiovascular and other diseases, but also for prevention and control of such diseases. From this point of view, we have developed a prototype room for fully automated monitoring of various vital signs. From the results of preliminary experiments using this room, it was confirmed that (1) ECG and respiration during bathing, (2) excretion weight and blood pressure, and (3) respiration and cardiac beat during sleep could be monitored with reasonable accuracy by the sensor system installed in bathtub, toilet and bed, respectively.

  11. Time distribution of epileptic seizures during video-EEG monitoring. Implications for health insurance systems in developing countries.

    PubMed

    Quiroga, R C; Pirra, L; Podestá, C; Leiguarda, R C; Rabinowicz, A L

    1997-12-01

    An attempt was made to identify guidelines to help establish epilepsy monitoring units in developing countries. We assessed the time distribution of seizures during video-EEG monitoring and we also estimated the minimum time required for such a procedure and the impact of these variables upon the health insurance system. Mean time for recording five stereotyped clinical events was 72 hours, with a significant number of events recorded between midnight and 0600 hours (P < 0.05). This pilot study may help to establish local policies that will warrant an adequate work-up for our patients.

  12. Health Systems Governance for health equity: critical reflections.

    PubMed

    Labonté, Ronald

    2010-01-01

    This article addresses several issues pertinent to health systems governance for health equity. It argues the importance of health systems using measures of positive health (well-being), discriminating in favour of historically less advantaged groups and weighing the costs of health care against investments in the social determinants of health. It cautions that the concept of governance could weaken the role of government, with disequalizing effects, while emphasizing the importance of two elements of good governance (transparency and participation) in health systems decision-making. It distinguishes between participation as volunteer labour and participation as exercising political rights, and questions the assumption that decentralization in health systems is necessarily empowering. It then identifies five health system roles to address issues of equity (educator/watchdog, resource broker, community developer, partnership developer and advocate/catalyst) and the implications of these roles for practice. Drawing on preliminary findings of a global research project on comprehensive primary health care, it discusses political aspects of progressive health system reform and the implications of equity-focused health system governance on health workers' roles, noting the importance of health workers claiming their identity as citizens. The article concludes with a commentary on the inherently political nature of health reforms based on equity; the necessary confrontation with power relations politics involves; and the health systems governance challenge of managing competing health discourses of efficiency and results-based financing, on the one hand, and equity and citizen empowerment, on the other.

  13. Development of Mental Health Indicators in Korea

    PubMed Central

    Han, Hyeree; Ahn, Dong Hyun; Song, Jinhee; Hwang, Tae Yeon

    2012-01-01

    Objective Promoting mental health and preventing mental health problems are important tasks for international organizations and nations. Such goals entail the establishment of active information networks and effective systems and indicators to assess the mental health of populations. This being said, there is a need in Korea develop ways to measure the state of mental health in Korea. Methods This paper reviews the mental health indicator development policies and practices of seven organizations, countries, and regions: WHO, OECD, EU, United States, Australia, UK, and Scotland. Using Delphi method, we conducted two surveys of mental health indicators for experts in the field of mental health. The survey questionnaire included 5 domains: mental health status, mental health factor, mental health system, mental health service, and quality of mental health services. We considered 124 potential mental health indicators out of more than 600 from indicators of international organizations and foreign countries. Results We obtained the top 30 mental health indicators from the surveys. Among them, 10 indicators belong to the mental health system. The most important five mental health indicators are suicide rate, rate of increase in mental disorder treatment, burden caused by mental disorders, adequacy of identifying problems of mental health projects and deriving solutions, and annual prevalence of mental disorders. Conclusion Our study provides information about the process for indicator development and the use of survey results to measure the mental health status of the Korean population. The aim of mental health indicator development is to improve the mental health system by better grasping the current situation. We suggest these mental health indicators can monitor progress in efforts to implement reform policies, provide community services, and involve users, families and other stakeholders in mental health promotion, prevention, care and rehabilitation. PMID:23251193

  14. [Development and validation of a social vulnerability index applied to public policies of the Unified Health System (SUS)].

    PubMed

    Drachler, Maria de Lourdes; Lobato, Marcos Antônio de Oliveira; Lermen, José Inácio; Fagundes, Sandra; Ferla, Alcindo Antonio; Drachler, Carlos Wietzke; Teixeira, Luciana Barcellos; Leite, José Carlos de Carvalho

    2014-09-01

    The article outlines the development and initial validation of a Social Vulnerability Index (SVI) including five social determinants of risk to health and demonstrates its application in the financing of primary care by the Unified Health System (SUS) in the State of Rio Grande do Sul. Municipal indicators of vulnerability relating to poverty and population dispersion were obtained from the 2010 population census of the Brazilian Institute of Geography and Statistics. Both exploratory and confirmatory factor analysis suggests that the five items can constitute a reliable and acceptable measurement scale. The SVI-5 was then generated based on the first main component, measuring municipal inequalities in social vulnerability relating to poverty and population in the territory in Z-scores. The external validity of SVI-5 was examined in relation to health outcomes using DATASUS 2007-2011 data, revealing that infant mortality and hospitalizations for conditions treatable by primary care are greater in more vulnerable municipalities The results suggest that the SVI-5 is a valid measure of inequalities in social vulnerability between municipalities, applicable to socially equitable policies in health.

  15. Onboard System Health Assessment

    NASA Technical Reports Server (NTRS)

    Barry, Tom; Cunningham, Harry

    1990-01-01

    Viewgraphs and discussion of onboard system health assessment are presented. Success of the space station program will be measured by how well it addresses the basic requirements for (1) maintaining the orbiting Space Station Freedom fully operational for its projected life of thirty years, and (2) the cost-effective execution of the overall space station program. Onboard system health assessment must provide complete and thorough testing capabilities along with effective associated redundancy/fault management.

  16. Military Health System: Sustained Senior Leadership Needed to Fully Develop Plans for Achieving Cost Savings

    DTIC Science & Technology

    2014-02-26

    left its existing structure in place, approving instead a shared - services directorate to consolidate common MHS functions (e.g., shared information...has seven main goals: (1) consolidate functions ( shared services ) common to DoD, (2) deliver more-integrated health care in areas with more than one

  17. Health Occupations. Instructional System Development Model for Vermont Area Vocational Centers.

    ERIC Educational Resources Information Center

    The curriculum guide presents a suggested outline for teaching health occupations in secondary schools in Vermont. It consists of a student/teacher curriculum outline for each of the 20 units. It includes a concept statement, the behavioral objective, suggested learning activities, suggested teacher resource needs, and suggested evaluation…

  18. [The health system of Guatemala].

    PubMed

    Becerril-Montekio, Víctor; López-Dávila, Luis

    2011-01-01

    This paper describes the health conditions in Guatemala and, in more detail, the characteristics of the Guatemalan health system, including its structure en coverage, its financial sources, the stewardship functions developed by the Ministry of Health, as well as the generation of health information and the development of research activities. It also discusses the recent efforts to extend coverage of essential health services, mostly to poor rural areas.The most recent innovations also discussed in this paper include the Program for the Expansion of Coverage of Essential Services, the Program to Expand Access to Essential Drugs and the agreements between the Ministry of Health and several non-governmental organizations to provide essential services in rural settings.

  19. [Human resources for local health systems].

    PubMed

    Linger, C

    1989-01-01

    The economic and social crises affecting Latin America have had a profound social and political effect on its structures. This paper analyzes this impact from 2 perspectives: 1) the impact on the apparatus of the state, in particular on its health infra-structures; and 2) the direction of the democratic process in the continent and the participatory processes of civil societies. The institutionalization of the Local Health Systems (SILOS) is an effort to analyze the problem from within the health sector and propose solutions. This paper discusses the issues of human resource development in health systems; training in human resource development and human resource development in local health care systems. There are 3 strategies used to change health systems: 1) The judicial-political system: The state's apparatus 2) The political-administrative system: the national health care system; and 3) the political-operative system: local health care systems. To assure implementation of SILOS there are 4 steps to be followed: 1) create political conditions that allow the transformation and development of local health systems; 2) development of high-level institutional and political initiatives to develop health care networks; 3) offer key players institutional space and social action to develop the SILOS process; 4) rapidly develop SILOS in regions to assure its integration with other development efforts. The labor force in the health sector and organized communities play critical roles in proposing and institutionalizing health programs.

  20. Systems Science for Caribbean Health: the development and piloting of a model for guiding policy on diabetes in the Caribbean.

    PubMed

    Guariguata, L; Guell, C; Samuels, T A; Rouwette, E A J A; Woodcock, J; Hambleton, I R; Unwin, N

    2016-10-26

    Diabetes is highly prevalent in the Caribbean, associated with a high morbidity and mortality and is a recognised threat to economic and social development. Heads of Government in the Caribbean Community came together in 2007 and declared their commitment to reducing the burden of non-communicable diseases (NCDs), including diabetes, by calling for a multi-sectoral, systemic response. To facilitate the development of effective policies, policymakers are being engaged in the development and use of a system dynamics (SD) model of diabetes for Caribbean countries. Previous work on a diabetes SD model from the United States of America (USA) is being adapted to a local context for three countries in the region using input from stakeholders, a review of existing qualitative and quantitative data, and collection of new qualitative data. Three country models will be developed using one-on-one stakeholder engagement and iterative revision. An inter-country model will also be developed following a model-building workshop. Models will be compared to each other and to the USA model. The inter-country model will be used to simulate policies identified as priorities by stakeholders and to develop targets for prevention and control. The model and model-building process will be evaluated by stakeholders and a manual developed for use in other high-burden developing regions. SD has been applied with success for health policy development in high-income country settings. The utility of SD in developing countries as an aid to policy decision-making related to NCDs has not been tested. This study represents the first of its kind.

  1. Rapid Development and Deployment of Ebola Readiness Training Across an Academic Health System: The Critical Role of Simulation Education, Consulting, and Systems Integration.

    PubMed

    Phrampus, Paul E; O'Donnell, John M; Farkas, Deborah; Abernethy, Denise; Brownlee, Katherine; Dongilli, Thomas; Martin, Susan

    2016-04-01

    In this article, we describe an Ebola preparedness initiative with implementation across an academic health system. Key stakeholder centers of various disciplines and clinical experts collaborated in the development and design. Subject matter experts in the areas of Centers for Disease Control and Prevention and World Health Organization protocols for personal protective equipment donning and doffing conducted initial train-the-trainer sessions for program instructors. These trainers represented a cross-section of key clinical responders and environmental services. Through a parallel development process, a blended learning curriculum consisting of online modules followed by on-site training sessions was developed and implemented in both the simulation laboratory and the actual clinical care spaces in preparation for a Department of Health inspection. Lessons learned included identification of the need for iterative refinement based on instructor and trainee feedback, the lack of tolerance of practitioners in wearing full-body personal protective equipment for extended periods, and the ability of a large system to mount a rapid response to a potential public health threat through leveraging of expertise of its Simulation Program, Center for Quality, Safety and Innovation as well as a wide variety of clinical departments.

  2. [The health system of Bolivia].

    PubMed

    Ledo, Carmen; Soria, René

    2011-01-01

    This paper describes the Bolivian health system, including its structure and organization, its financing sources, its health expenditure, its physical, material and humans resources, its stewardship activities and the its health research institutions. It also discusses the most recent policy innovations developed in Bolivia: the Maternal and Child Universal Insurance, the Program for the Extension of Coverage to Rural Areas, the Family, Community and Inter-Cultural Health Model and the cash-transfer program Juana Azurduy intended to strengthen maternal and child care.

  3. Malta: Health System Review.

    PubMed

    Azzopardi-Muscat, Natasha; Buttigieg, Stefan; Calleja, Neville; Merkur, Sherry

    2017-01-01

    Maltese life expectancy is high, and Maltese people spend on average close to 90% of their lifespan in good health, longer than in any other EU country. Malta has recently increased the proportion of GDP spent on health to above the EU average, though the private part of that remains higher than in many EU countries. The total number of doctors and GPs per capita is at the EU average, but the number of specialists remains relatively low; education and training are being further strengthened in order to retain more specialist skills in Malta. The health care system offers universal coverage to a comprehensive set of services that are free at the point of use for people entitled to statutory provision. The historical pattern of integrated financing and provision is shifting towards a more pluralist approach; people already often choose to visit private primary care providers, and in 2016 a new public-private partnership contract for three existing hospitals was agreed. Important priorities for the coming years include further strengthening of the primary and mental health sectors, as well as strengthening the health information system in order to support improved monitoring and evaluation. The priorities of Malta during its Presidency of the Council of the EU in 2017 include childhood obesity, and Structured Cooperation to enhance access to highly specialized and innovative services, medicines and technologies. Overall, the Maltese health system has made remarkable progress, with improvements in avoidable mortality and low levels of unmet need. The main outstanding challenges include: adapting the health system to an increasingly diverse population; increasing capacity to cope with a growing population; redistributing resources and activity from hospitals to primary care; ensuring access to expensive new medicines whilst still making efficiency improvements; and addressing medium-term financial sustainability challenges from demographic ageing. World Health

  4. Existing public health surveillance systems for mental health in China.

    PubMed

    Zhou, Wei; Xiao, Shuiyuan

    2015-01-01

    Mental health is a challenging public health issue worldwide and surveillance is crucial for it. However, mental health surveillance has not been developed until recently in certain developed countries; many other countries, especially developing countries, have poor or even no health information systems. This paper presents surveillance related to mental health in China, a developing country with a large population of patients with mental disorders. Detailed information of seven relevant surveillance systems is introduced respectively. From the perspective of utilization, problems including accessibility, comprehensiveness and data quality are discussed. Suggestions for future development are proposed.

  5. Integrated Systems Health Management for Intelligent Systems

    NASA Technical Reports Server (NTRS)

    Figueroa, Fernando; Melcher, Kevin

    2011-01-01

    The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.

  6. Intelligent Integrated System Health Management

    NASA Technical Reports Server (NTRS)

    Figueroa, Fernando

    2012-01-01

    Intelligent Integrated System Health Management (ISHM) is the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system (Management: storage, distribution, sharing, maintenance, processing, reasoning, and presentation). Presentation discusses: (1) ISHM Capability Development. (1a) ISHM Knowledge Model. (1b) Standards for ISHM Implementation. (1c) ISHM Domain Models (ISHM-DM's). (1d) Intelligent Sensors and Components. (2) ISHM in Systems Design, Engineering, and Integration. (3) Intelligent Control for ISHM-Enabled Systems

  7. The development of a highly constrained health level 7 implementation guide to facilitate electronic laboratory reporting to ambulatory electronic health record systems.

    PubMed

    Sujansky, Walter V; Overhage, J Marc; Chang, Sophia; Frohlich, Jonah; Faus, Samuel A

    2009-01-01

    Electronic laboratory interfaces can significantly increase the value of ambulatory electronic health record (EHR) systems by providing laboratory result data automatically and in a computable form. However, many ambulatory EHRs cannot implement electronic laboratory interfaces despite the existence of messaging standards, such as Health Level 7, version 2 (HL7). Among several barriers to implementing laboratory interfaces is the extensive optionality within the HL7 message standard. This paper describes the rationale for and development of an HL7 implementation guide that seeks to eliminate most of the optionality inherent in HL7, but retain the information content required for reporting outpatient laboratory results. A work group of heterogeneous stakeholders developed the implementation guide based on a set of design principles that emphasized parsimony, practical requirements, and near-term adoption. The resulting implementation guide contains 93% fewer optional data elements than HL7. This guide was successfully implemented by 15 organizations during an initial testing phase and has been approved by the HL7 standards body as an implementation guide for outpatient laboratory reporting. Further testing is required to determine whether widespread adoption of the implementation guide by laboratories and EHR systems can facilitate the implementation of electronic laboratory interfaces.

  8. System health monitoring

    SciTech Connect

    Reneke, J.A.; Fryer, M.O.

    1995-08-01

    Well designed large systems include many instrument taking data. These data are used in a variety of ways. They are used to control the system and its components, to monitor system and component health, and often for historical or financial purposes. This paper discusses a new method of using data from low level instrumentation to monitor system and component health. The method uses the covariance of instrument outputs to calculate a measure of system change. The method involves no complicated modeling since it is not a parameter estimation algorithm. The method is iterative and can be implemented on a computer in real time. Examples are presented for a metal lathe and a high efficiency particulate air (HEPA) filter. It is shown that the proposed method is quite sensitive to system changes such as wear out and failure. The method is useful for low level system diagnostics and fault detection.

  9. A Wireless Health Outcomes Monitoring System (WHOMS): development and field testing with cancer patients using mobile phones

    PubMed Central

    Bielli, Emilia; Carminati, Fabio; La Capra, Stella; Lina, Micaela; Brunelli, Cinzia; Tamburini, Marcello

    2004-01-01

    Background Health-Related Quality of Life assessment is widely used in clinical research, but rarely in clinical practice. Barriers including practical difficulties administering printed questionnaires have limited their use. Telehealth technology could reduce these barriers and encourage better doctor-patient interaction regarding patient symptoms and quality-of-life monitoring. The aim of this study was to develop a new system for transmitting patients' self-reported outcomes using mobile phones or the internet, and to test whether patients can and will use the system via a mobile phone. Methods We have developed a prototype of a Wireless Health Outcomes Monitoring System, which allows structured questionnaires to be sent to the patient by their medical management team. The patients' answers are directly sent to an authorised website immediately accessible by the medical team, and are displayed in a graphic format that highlights the patient's state of health. In the present study, 97 cancer inpatients were asked to complete a ten-item questionnaire. The questionnaire was delivered by display on a mobile phone, and was answered by the patients using the mobile phone keypad. Results Of the 97 patients, 56 (58%) attempted the questionnaire, and all of these 56 completed it. Only 6% of the total number of questions were left unanswered by patients. Forty-one (42%) patients refused to participate, mostly due to their lack of familiarity with mobile phone use. Compared with those who completed the questionnaire, patients who refused to participate were older, had fewer years of education and were less familiar with new communications technology (mobile phone calls, mobile phone SMS, internet, email). Conclusion More than half of the patients self-completed the questionnaire using the mobile phone. This proportion may increase with the use of multichannel communications which can be incorporated into the system. The proportion may also increase if the patient's partner

  10. Should health systems agencies be involved in environmental health planning?

    PubMed Central

    Higgins, C W; Philips, B U; Bruhn, J G; Aker, L T

    1980-01-01

    Public Law 93-641 provides health systems agencies (HSAs) with a broad planning preview which has enabled a number of agencies to address environmental health issues in their health systems plans. Opponents of HSA involvement in environmental health planning charge that these activities overextend agency resources, duplicate efforts of other government agencies and involve HSAs in "issues of public policy." Closer examination of these charges finds them lacking in validity. The planning activities of health systems agencies are cooperative in nature, drawing upon the planning efforts of other institutions and agencies. It is illogical to exclude environmental concerns from general health planning in light of the impact of the environment upon health. Charges that issues of public policy are inappropriate topics for health planning are seen as attempts to avoid scrutiny of inconsistant legislative policies. Cooperative planning between health systems agencies and environmental health agencies is considered both desirable and essential for the development of effective health planning. PMID:7428743

  11. Development of a belt-type wearable sensor system with multi-function for home health care

    NASA Astrophysics Data System (ADS)

    Ban, Yunho; Choi, Samjin; Jiang, Zhongwei; Park, Chanwon

    2005-12-01

    Some reports show that the physiological information measured in hospital is not enough without the one measured in home. The physiological information monitored in home, therefore, is strongly required recently. The goal of this research is to develop a wearable and tractable sensor system for detecting biomedical signals such as cardiac rhythm, respiration, body movement, and percentage of body fat (%BF) and for home health care. A belt type sensor for this purpose is developed, which consists of sensing materials of PVDF film and conductive fabrics. Also several data processing techniques, such as the discrete wavelet transform, cross correlation and adaptive filtering method, were introduced to eliminate noises and base wandering and to extract the specified components. The ECG and respiration signals obtained by the proposed belt type sensor system gave good agreements with commercial medical system. Furthermore, the body fat (%BF) measurement based on the four-electrode BIA was also built in the belt sensor. The body fat was calculated by measuring the body impedance from the belt type sensor and compared with the predicted %BF measured by the commercial adipometer (TBF-607). The results validated also the efficiency of the belt type sensor system.

  12. Development and Management of a Geographic Information System for Health Research in a Developing-country Setting: A Case Study from Bangladesh

    PubMed Central

    Sugimoto, Jonathan D.; Labrique, Alain B.; Salahuddin, Ahmad; Rashid, Mahbubur; Klemm, Rolf D.W.; Christian, Parul; West, Keith P.

    2007-01-01

    In the last decade, geographic information systems (GIS) have become accessible to researchers in developing countries, yet guidance remains sparse for developing a GIS. Drawing on experience in developing a GIS for a large community trial in rural Bangladesh, six stages for constructing, maintaining, and using a GIS for health research purposes were outlined. The system contains 0.25 million landmarks, including 150,000 houses, in an area of 435 sq km with over 650,000 people. Assuming access to reasonably accurate paper boundary maps of the intended working area and the absence of pre-existing digital local-area maps, the six stages are: to (a) digitize and update existing paper maps, (b) join the digitized maps into a large-area map, (c) reference this large-area map to a geographic coordinate system, (d) insert location landmarks of interest, (e) maintain the GIS, and (f) link it to other research databases. These basic steps can produce a household-level, updated, scaleable GIS that can both enhance field efficiency and support epidemiologic analyses of demographic patterns, diseases, and health outcomes. PMID:18402187

  13. Portable Health Algorithms Test System

    NASA Technical Reports Server (NTRS)

    Melcher, Kevin J.; Wong, Edmond; Fulton, Christopher E.; Sowers, Thomas S.; Maul, William A.

    2010-01-01

    A document discusses the Portable Health Algorithms Test (PHALT) System, which has been designed as a means for evolving the maturity and credibility of algorithms developed to assess the health of aerospace systems. Comprising an integrated hardware-software environment, the PHALT system allows systems health management algorithms to be developed in a graphical programming environment, to be tested and refined using system simulation or test data playback, and to be evaluated in a real-time hardware-in-the-loop mode with a live test article. The integrated hardware and software development environment provides a seamless transition from algorithm development to real-time implementation. The portability of the hardware makes it quick and easy to transport between test facilities. This hard ware/software architecture is flexible enough to support a variety of diagnostic applications and test hardware, and the GUI-based rapid prototyping capability is sufficient to support development execution, and testing of custom diagnostic algorithms. The PHALT operating system supports execution of diagnostic algorithms under real-time constraints. PHALT can perform real-time capture and playback of test rig data with the ability to augment/ modify the data stream (e.g. inject simulated faults). It performs algorithm testing using a variety of data input sources, including real-time data acquisition, test data playback, and system simulations, and also provides system feedback to evaluate closed-loop diagnostic response and mitigation control.

  14. Exploring the barriers to rigorous monitoring and evaluation of health systems strengthening activities: qualitative evidence from international development partners.

    PubMed

    Wisniewski, Janna M; Yeager, Valerie A; Diana, Mark L; Hotchkiss, David R

    2016-10-01

    The number of health systems strengthening (HSS) programs has increased in the last decade. However, a limited number of studies providing robust evidence for the value and impact of these programs are available. This study aims to identify knowledge gaps and challenges that impede rigorous monitoring and evaluation (M&E) of HSS, and to ascertain the extent to which these efforts are informed by existing technical guidance. Interviews were conducted with HSS advisors at United States Agency for International Development-funded missions as well as senior M&E advisors at implementing partner and multilateral organizations. Findings showed that mission staff do not use existing technical resources, either because they do not know about them or do not find them useful. Barriers to rigorous M&E included a lack suitable of indicators, data limitations, difficulty in demonstrating an impact on health, and insufficient funding and resources. Consensus and collaboration between international health partners and local governments may mitigate these challenges. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  15. [Approaches for developing a system model for health evaluation based on body constitutions of traditional Chinese medicine and order parameters].

    PubMed

    Huang, Chong; Zhu, Yan-bo; Liu, Zhuo-jun

    2012-04-01

    From the point of view of systems science, human body can be considered as a complex system, and the human health system is a subsystem of it. Systems science conducts investigation in a holistic manner. As a theoretical method, it deals with the operation and evolution of systems from the macroscopic perspective, so this theory is similar to phenomenological theory of traditional Chinese medicine (TCM) in methodology. Naturally, numerous theories of systems science can be used in research of the human health systems of TCM. In this paper, the authors introduced synergetic, a theory of modern systems science, and its slaving principle, and in particular, analyzed the concept of order parameters related to the slaving principle and the relationship between body constitutions of TCM and order parameters. The body constitution of TCM can be treated as a slow variable in the human health systems. By using synergetic, the authors established a model of the human health system based on body constitutions of TCM. As an application of the model, the authors illustrated the argumentation in the theory of constitution being separable, the theory of a relationship between constitution and disease, and the theory of a recuperable constitution. To some extent, this work has made links between the TCM theory of body constitution and modern systems science, and it will offer a new thought for modeling the human health system.

  16. The essence of governance in health development.

    PubMed

    Kirigia, Joses Muthuri; Kirigia, Doris Gatwiri

    2011-03-28

    Governance and leadership in health development are critically important for the achievement of the health Millennium Development Goals (MDGs) and other national health goals. Those two factors might explain why many countries in Africa are not on track to attain the health MDGs by 2015. This paper debates the meaning of 'governance in health development', reviews briefly existing governance frameworks, proposes a modified framework on health development governance (HDG), and develops a HDG index. We argue that unlike 'leadership in health development', 'governance in health development' is the sole prerogative of the Government through the Ministry of Health, which can choose to delegate (but not abrogate) some of the governance tasks. The general governance domains of the UNDP and the World Bank are very pertinent but not sufficient for assessment of health development governance. The WHO six domains of governance do not include effective external partnerships for health, equity in health development, efficiency in resource allocation and use, ethical practises in health research and service provision, and macroeconomic and political stability. The framework for assessing health systems governance developed by Siddiqi et al also does not include macroeconomic and political stability as a separate principle. The Siddiqi et al framework does not propose a way of scoring the various governance domains to facilitate aggregation, inter-country comparisons and health development governance tracking over time.This paper argues for a broader health development governance framework because other sectors that assure human rights to education, employment, food, housing, political participation, and security combined have greater impact on health development than the health systems. It also suggests some amendments to Siddigi et al's framework to make it more relevant to the broader concept of 'governance in health development' and to the WHO African Region context. A strong

  17. The essence of governance in health development

    PubMed Central

    2011-01-01

    Background Governance and leadership in health development are critically important for the achievement of the health Millennium Development Goals (MDGs) and other national health goals. Those two factors might explain why many countries in Africa are not on track to attain the health MDGs by 2015. This paper debates the meaning of 'governance in health development', reviews briefly existing governance frameworks, proposes a modified framework on health development governance (HDG), and develops a HDG index. Discussion We argue that unlike 'leadership in health development', 'governance in health development' is the sole prerogative of the Government through the Ministry of Health, which can choose to delegate (but not abrogate) some of the governance tasks. The general governance domains of the UNDP and the World Bank are very pertinent but not sufficient for assessment of health development governance. The WHO six domains of governance do not include effective external partnerships for health, equity in health development, efficiency in resource allocation and use, ethical practises in health research and service provision, and macroeconomic and political stability. The framework for assessing health systems governance developed by Siddiqi et al also does not include macroeconomic and political stability as a separate principle. The Siddiqi et al framework does not propose a way of scoring the various governance domains to facilitate aggregation, inter-country comparisons and health development governance tracking over time. This paper argues for a broader health development governance framework because other sectors that assure human rights to education, employment, food, housing, political participation, and security combined have greater impact on health development than the health systems. It also suggests some amendments to Siddigi et al's framework to make it more relevant to the broader concept of 'governance in health development' and to the WHO African

  18. Identifying and characterising health policy and system-relevant documents in Uganda: a scoping review to develop a framework for the development of a one-stop shop.

    PubMed

    Mutatina, Boniface; Basaza, Robert; Obuku, Ekwaro; Lavis, John N; Sewankambo, Nelson

    2017-02-06

    Health policymakers in low- and middle-income countries continue to face difficulties in accessing and using research evidence for decision-making. This study aimed to identify and provide a refined categorisation of the policy documents necessary for building the content of a one-stop shop for documents relevant to health policy and systems in Uganda. The on-line resource is to facilitate timely access to well-packaged evidence for decision-making. We conducted a scoping review of Uganda-specific, health policy, and systems-relevant documents produced between 2000 and 2014. Our methods borrowed heavily from the 2005 Arksey and O'Malley approach for scoping reviews and involved five steps, which that include identification of the research question; identification of relevant documents; screening and selection of the documents; charting of the data; and collating, summarising and reporting results. We searched for the documents from websites of relevant government institutions, non-governmental organisations, health professional councils and associations, religious medical bureaus and research networks. We presented the review findings as numerical analyses of the volume and nature of documents and trends over time in the form of tables and charts. We identified a total of 265 documents including policies, strategies, plans, guidelines, rapid response summaries, evidence briefs for policy, and dialogue reports. The top three clusters of national priority areas addressed in the documents were governance, coordination, monitoring and evaluation (28%); disease prevention, mitigation, and control (23%); and health education, promotion, environmental health and nutrition (15%). The least addressed were curative, palliative care, rehabilitative services and health infrastructure, each addressed in three documents (1%), and early childhood development in one document. The volume of documents increased over the past 15 years; however, the distribution of the different

  19. Developing Occupation-Based Preventive Programs for Late-Middle-Aged Latino Patients in Safety-Net Health Systems

    PubMed Central

    Carlson, Mike; Martínez, Jenny; Guzmán, Laura; Mahajan, Anish; Clark, Florence

    2015-01-01

    Latino adults between ages 50 and 60 yr are at high risk for developing chronic conditions that can lead to early disability. We conducted a qualitative pilot study with 11 Latinos in this demographic group to develop a foundational schema for the design of health promotion programs that could be implemented by occupational therapy practitioners in primary care settings for this population. One-on-one interviews addressing routines and activities, health management, and health care utilization were conducted, audiotaped, and transcribed. Results of a content analysis of the qualitative data revealed the following six domains of most concern: Weight Management; Disease Management; Mental Health and Well-Being; Personal Finances; Family, Friends, and Community; and Stress Management. A typology of perceived health-actualizing strategies was derived for each domain. This schema can be used by occupational therapy practitioners to inform the development of health-promotion lifestyle interventions designed specifically for late-middle-aged Latinos. PMID:26565102

  20. Engineering a learning healthcare system: using health information technology to develop an objective nurse staffing tool.

    PubMed

    Harper, Ellen M

    2012-01-01

    Nurses represent the largest proportion of direct healthcare providers. Overstaffed or understaffed units will have implications for the quality, cost, patient, and nurse satisfaction. It is vital that nurses are armed with appropriate instruments and data to help them plan and implement efficient and effective nursing teams. A compelling case is made for the association between nursing care and clinical, quality, and financial outcomes. Even though there is a great body of work on the correlation, there is little agreement on the best approach to determine the correct balance between the patient-to-nurse ratios. The sheer number of variables depicted in the literature suggests why precise evidenced based formulas are difficult to achieve. This paper will describe a practice based knowledge generation mixed methods study using detailed observation and electronic health record abstraction to generate a structural equation for use in predicting staffing needs.

  1. Country ownership and capacity building: the next buzzwords in health systems strengthening or a truly new approach to development?

    PubMed Central

    2012-01-01

    Background During the last decade, donor governments and international agencies have increasingly emphasized the importance of building the capacity of indigenous health care organizations as part of strengthening health systems and ensuring sustainability. In 2009, the U.S. Global Health Initiative made country ownership and capacity building keystones of U.S. health development assistance, and yet there is still a lack of consensus on how to define either of these terms, or how to implement “country owned capacity building”. Discussion Concepts around capacity building have been well developed in the for-profit business sector, but remain less well defined in the non-profit and social sectors in low and middle-income countries. Historically, capacity building in developing countries has been externally driven, related to project implementation, and often resulted in disempowerment of local organizations rather than local ownership. Despite the expenditure of millions of dollars, there is no consensus on how to conduct capacity building, nor have there been rigorous evaluations of capacity building efforts. To shift to a new paradigm of country owned capacity building, donor assistance needs to be inclusive in the planning process and create true partnerships to conduct organizational assessments, analyze challenges to organizational success, prioritize addressing challenges, and implement appropriate activities to build new capacity in overcoming challenges. Before further investments are made, a solid evidence base should be established concerning what works and what doesn’t work to build capacity. Summary Country-owned capacity building is a relatively new concept that requires further theoretical exploration. Documents such as The Paris Declaration on Aid Effectiveness detail the principles of country ownership to which partner and donor countries should commit, but do not identify the specific mechanisms to carry out these principles. More evidence as

  2. On the development of system-theoretic tools for the design of integrated health monitoring and controls for rocket propulsion systems

    NASA Technical Reports Server (NTRS)

    Helmicki, Arthur J.

    1991-01-01

    As NASA continues to develop various advanced propulsion technologies for space exploration, two factors are becoming increasingly dominant in design specifications: increase operational reliability and decrease operational cost. One approach that has been proposed to meet these challenges is to incorporate into current and future rocket propulsion systems some sort of diagnostic/monitoring capability in the form of a Health Monitoring System (HMS). HMS technology offers the promise of increased operational reliability through its ability to assess system performance, detect and isolate degradations and/or failures, and modify system operation so as to minimize negative effects on performance. The purpose of this research is to study, from a systems engineering perspective, the particular issues of analysis and synthesis for generic HMS's.

  3. Environment, health & safety management systems for upstream oil & gas projects in developing countries

    SciTech Connect

    Gossen, R.G.; Mann, G.J.

    1996-11-01

    The international oil and gas exploration and production industry faces a vast array of environmental issues that are global in nature but play an increasingly prominent role in individual project decision making. When placed against a backdrop of socio-political and cultural challenges presented in developing countries, project planners require an enlightened approach to ensure the environmental, economic and social components are appropriately balanced to ensure sustainable business success. Although a relatively new player in the international E & P industry, Canadian Occidental Petroleum Ltd. has developed such an approach to EMS management for projects in developing countries. Drawing from recent experience with a major project in Yemen, and others in the planning stages in several other developing countries, this paper presents a number of positive strategies and actions which are being applied in the many countries in which the company is active. Lessons learned and opportunities for improvement are presented for consideration by responsible operators working internationally toward the goal of environmentally sustainable energy development.

  4. Development of flexural vibration inspection techniques to rapidly assess the structural health of timber bridge systems

    Treesearch

    Xiping Wang; James P. Wacker; Robert J. Ross; Brian K. Brashaw; Robert Vatalaro

    2005-01-01

    This paper describes an effort to develop a global dynamic testing technique for evaluating the overall stiffness of timber bridge superstructures. A forced vibration method was used to measure the natural frequency of single-span timber bridges in the laboratory and field. An analytical model based on simple beam theory was proposed to represent the relationship...

  5. Norway: health system review.

    PubMed

    Ringard, Ånen; Sagan, Anna; Sperre Saunes, Ingrid; Lindahl, Anne Karin

    2013-01-01

    Norways five million inhabitants are spread over nearly four hundred thousand square kilometres, making it one of the most sparsely populated countries in Europe. It has enjoyed several decades of high growth, following the start of oil production in early 1970s, and is now one of the richest countries per head in the world. Overall, Norways population enjoys good health status; life expectancy of 81.53 years is above the EU average of 80.14, and the gap between overall life expectancy and healthy life years is around half the of EU average. The health care system is semi decentralized. The responsibility for specialist care lies with the state (administered by four Regional Health Authorities) and the municipalities are responsible for primary care. Although health care expenditure is only 9.4% of Norways GDP (placing it on the 16th place in the WHO European region), given Norways very high value of GDP per capita, its health expenditure per head is higher than in most countries. Public sources account for over 85% of total health expenditure; the majority of private health financing comes from households out-of-pocket payments.The number of practitioners in most health personnel groups, including physicians and nurses, has been increasing in the last few decades and the number of health care personnel per 100 000 inhabitants is high compared to other EU countries. However, long waiting times for elective care continue to be a problem and are cause of dissatisfaction among the patients. The focus of health care reforms has seen shifts over the past four decades. During the 1970s the focus was on equality and increasing geographical access to health care services; during the 1980s reforms aimed at achieving cost containment and decentralizing health care services; during the 1990s the focus was on efficiency. Since the beginning of the millennium the emphasis has been given to structural changes in the delivery and organization of health care and to policies

  6. Kentucky health system starts online consumer portal program. Web site development aims to drive consumerism and market service lines.

    PubMed

    2007-01-01

    Saint Joseph HealthCare in Lexington, KY, is a three-hospital health system comprised of more than 650 beds serving the state's central and eastern regions. As a leading provider in cardiology, orthopedics, and stroke, it was recognized in 2006 as a top hospital in the nation by U.S. News and World Report.

  7. Integrating complementary and alternative medicine into conventional health care system in developing countries: an example of Amchi.

    PubMed

    Mishra, Shiva Raj; Neupane, Dinesh; Kallestrup, Per

    2015-01-01

    Complementary and alternative medicine has been a part of human life and practices since the beginning of time. The role of complementary and alternative medicine for the health of humans is undisputed particularly in light of its role in health promotion and well-being. This article discusses ways through which complementary and alternative medicine can be promoted and sustained as an integrated element of health care in developing countries. We specifically present the exemplary of Amchi traditional doctors of Northern Himalayas.

  8. Design and development of a meal system for the elderly. [public health - nutrition/diet

    NASA Technical Reports Server (NTRS)

    1975-01-01

    Food preference surveys (taste tests) were performed for 95 food items (which were selected from an original list of 150 items), and 21 menus were developed from the survey results. Each menu contains an entree, two side dishes, dessert, and a beverage. Food manufacturing specifications for freeze dried foods, frozen foods, and beverages are examined, and product labeling and packaging requirements are discussed. The nutritional value of the various foods is listed in tabular form, and sample product labels are shown. Cost estimates per serving are also included.

  9. Modeling of Global BEAM Structure for Evaluation of MMOD Impacts to Support Development of a Health Monitoring System

    NASA Technical Reports Server (NTRS)

    Lyle, Karen H.; Vassilakos, Gregory J.

    2015-01-01

    This report summarizes the initial modeling of the global response of the Bigelow Expandable Activity Module (BEAM) to micrometeorite and orbital debris(MMOD) impacts using a structural, nonlinear, transient dynamic, finite element code. These models complement the on-orbit deployment of the Distributed Impact Detection System (DIDS) to support structural health monitoring studies. Two global models were developed. The first focused exclusively on impacts on the soft-goods (fabric-envelop) portion of BEAM. The second incorporates the bulkhead to support understanding of bulkhead impacts. These models were exercised for random impact locations and responses monitored at the on-orbit sensor locations. The report concludes with areas for future study.

  10. The development of an information system and installation of an Internet web database for the purposes of the occupational health and safety management system.

    PubMed

    Mavrikakis, I; Mantas, J; Diomidous, M

    2007-01-01

    This paper is based on the research on the possible structure of an information system for the purposes of occupational health and safety management. We initiated a questionnaire in order to find the possible interest on the part of potential users in the subject of occupational health and safety. The depiction of the potential interest is vital both for the software analysis cycle and development according to previous models. The evaluation of the results tends to create pilot applications among different enterprises. Documentation and process improvements ascertained quality of services, operational support, occupational health and safety advice are the basics of the above applications. Communication and codified information among intersted parts is the other target of the survey regarding health issues. Computer networks can offer such services. The network will consist of certain nodes responsible to inform executives on Occupational Health and Safety. A web database has been installed for inserting and searching documents. The submission of files to a server and the answers to questionnaires through the web help the experts to perform their activities. Based on the requirements of enterprises we have constructed a web file server. We submit files so that users can retrieve the files which they need. The access is limited to authorized users. Digital watermarks authenticate and protect digital objects.

  11. Challenges for health systems in member countries of the Organisation for Economic Co-operation and Development.

    PubMed Central

    Hurst, J.

    2000-01-01

    For reasons of equity most OECD countries have chosen to base their funding of health care mainly on public sources. There is an almost universal problem of affordability in the health systems of these countries, arising from the tension between the willingness of populations to pay taxes and the eagerness of patients to use health services where these are free or heavily subsidized at the point of use. These tensions are likely to be exacerbated by a surge of new medical technologies adding to demands for health care. Some observers have predicted the breakdown of publicly funded systems of health care under new spending pressures. However, governments can deploy a range of policies for handling new demands. They can also take comfort from the fact that many of them have already coped with successive waves of technological change in health care without abandoning their core commitment to the public funding of health systems. Furthermore, if standards of living continue to rise, public and private insurers should find it easier to obtain the revenues needed to pay for the improved health care expected by consumers. PMID:10916912

  12. M-Health: Emerging Mobile Health Systems

    NASA Astrophysics Data System (ADS)

    Istepanian, Robert; Laxminarayan, Swamy; Pattichis, Constantinos S.

    M-health can be defined as the "emerging mobile communications and network technologies for healthcare systems.' This book paves the path toward understanding the future of m-health technologies and services and also introducing the impact of mobility on existing e-health and commercial telemedical systems. M-Health: Emerging Mobile Health Systems presents a new and forward-looking source of information that explores the present and future trends in the applications of current and emerging wireless communication and network technologies for different healthcare scenaria.

  13. Aircraft structural health monitoring system development: overview of the Air Force/Navy smart metallic structures program

    NASA Astrophysics Data System (ADS)

    Van Way, Craig B.; Kudva, Jayanth N.; Schoess, Jeffrey N.; Zeigler, Michael L.; Alper, James M.

    1995-05-01

    Significant progress in fulfilling the current joint Air Force/Navy `Smart Metallic Structures (SMS)' program primary objective, to demonstrate a viable structural health monitoring system (SHMS) for a large structural aircraft component, is presented. Structural health monitoring and its relation to current Force Management (FM) and Aircraft Structural Integrity Program (ASIP) procedures are first reviewed together with a brief status overview of the relevant sensor technologies (e.g. AE, fiber-optic, corrosion, etc.). Key features of the SHMS architecture are described for the selected F/A-18 bulkhead and T-38 wing spar structural demonstration articles, highlighting sensors, processors, data busses, hardware, and software. Results from acoustic monitoring of the program sub-element structural tests are presented in some detail along with a status review of the SHMS multiplex bus component hardware and software. Finally, structural requirements for an SHMS meeting minimum ASIP guidelines for damage detection are discussed along with foals for future testing and development of the SHMS under the SMS program.

  14. Definition, technology readiness, and development cost of the orbit transfer vehicle engine integrated control and health monitoring system elements

    NASA Technical Reports Server (NTRS)

    Cannon, I.; Balcer, S.; Cochran, M.; Klop, J.; Peterson, S.

    1991-01-01

    An Integrated Control and Health Monitoring (ICHM) system was conceived for use on a 20 Klb thrust baseline Orbit Transfer Vehicle (OTV) engine. Considered for space used, the ICHM was defined for reusability requirements for an OTV engine service free life of 20 missions, with 100 starts and a total engine operational time of 4 hours. Functions were derived by flowing down requirements from NASA guidelines, previous OTV engine or ICHM documents, and related contracts. The elements of an ICHM were identified and listed, and these elements were described in sufficient detail to allow estimation of their technology readiness levels. These elements were assessed in terms of technology readiness level, and supporting rationale for these assessments presented. The remaining cost for development of a minimal ICHM system to technology readiness level 6 was estimated. The estimates are within an accuracy range of minus/plus 20 percent. The cost estimates cover what is needed to prepare an ICHM system for use on a focussed testbed for an expander cycle engine, excluding support to the actual test firings.

  15. Development of a wireless, self-sustaining damage detection sensor system based on chemiluminescence for structural health monitoring

    NASA Astrophysics Data System (ADS)

    Kuang, K. S. C.

    2014-03-01

    A novel application of chemiluminescence resulting from the chemical reaction in a glow-stick as sensors for structural health monitoring is demonstrated here. By detecting the presence of light emitting from these glow-sticks, it is possible to develop a low-cost sensing device with the potential to provide early warning of damage in a variety of engineering applications such as monitoring of cracks or damage in concrete shear walls, detecting of ground settlement, soil liquefaction, slope instability, liquefaction-related damage of underground structure and others. In addition, this paper demonstrates the ease of incorporating wireless capability to the sensor device and the possibility of making the sensor system self-sustaining by means of a renewable power source for the wireless module. A significant advantage of the system compared to previous work on the use of plastic optical fibre (POF) for damage detection is that here the system does not require an electrically-powered light source. Here, the sensing device, embedded in a cement host, is shown to be capable of detecting damage. A series of specimens with embedded glow-sticks have been investigated and an assessment of their damage detection capability will be reported. The specimens were loaded under flexure and the sensor responses were transmitted via a wireless connection.

  16. Cryocooler Prognostic Health Management System

    NASA Astrophysics Data System (ADS)

    Shah, A.; Penswick, L.; Dodson, C.; Roberts, T.

    2008-03-01

    High performance sensors are playing an increasingly important role in all aspects of all critical DoD missions. There is a family of sensors that operate with improved sensitivities if cooled to very low (cryogenic) temperatures. For these sensors, a healthy and reliable mechanical refrigeration system (cryocooler) is required. The ability to accurately predict the "health" or remaining useful life of the cryocooler has significant benefits from the viewpoint of ensuring that mission critical functions can be carried out with a high probability of success. The paper provides an overview and approaches used for the development of a Cryocooler Prognostic Health Management System (CPHMS) capable of assessing the cryocooler "health" from the viewpoint of the level of performance degradation and/or the potential for near term failure. Additionally, it quantifies the reliable remaining useful life of the cryocooler. While the proposed system is focused on the specific application to linear drive cryocoolers, especially for DoD, many of the attributes of the system can be applied to other specialized system hardware in both commercial and U.S. Government agency for situations where it is critical that all aspects of the hardware "health" and "remaining useful life" be fully understood. Several benefits of the health monitoring system are also described in the paper.

  17. [The health system of Dominican Republic].

    PubMed

    Rathe, Magdalena; Moliné, Alejandro

    2011-01-01

    This paper describes the health conditions in Dominican Republic and the characteristics of the Dominican health system, including its structure and coverage, its financial sources, the health expenditure, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health and the generation of health information. The participation of health care users in the operation and evaluation of the system and the most recent policy innovations, including the new General Health Law, the new Social Security Law and the Decennial Health Plan are also discussed.

  18. Developing a system of multi-evaluation of the impact of global climate change on human health in Russia

    NASA Astrophysics Data System (ADS)

    Granberg, I.; Golitsyn, G.; Istoshin, N.; Efimenko, N.; Alekhin, A.; Rogoza, A.; Povolotskaya, N.; Artamonova, M.; Maximenkov, L.; Pogarski, F.

    2009-04-01

    High people sensitivity to weather and space factors, particularly encumbered by various illnesses, was from time immemorial. Now, in terms of global climate change, accompanied by frequent and severe restructuring of atmospheric processes, thermal anomalies, droughts, environmental change through meteorological and heliogeophysical factors affect the human body particularly intense, causing adverse effects to health. There are currently beginning to develop methods for evaluating multifactor of the external environment and prevention of their negative influence on people. For those sensitive to such influences, with adverse weather in response to sudden changes in weather factors pathological of meteopathic reactions may arise. In doing so, even among healthy individuals it is up to 35-45% of meteosensitive. Meteopathic reactions lead to the appearance and progression of pathological disorders, and the associated increase in chronic diseases. In this connection the tasks solution related to assessing the impact of meteorological and climatic variations of different space-time scale on the health of the population of Russia becomes extremely important, especially for the people with cardiovascular disease. This is confirmed by as clinical observations, and the state of vital systems of meteosensitive people. Based on the results of comprehensive research of Pyatigorsk State Research Institute of Curortology (PSRIC), the A. M. Obukhov Institute of Atmospheric Physics of the Russian Academy of Sciences (IAP), and Hydrometeocenter of Russia in the region of Caucasian Mineral Waters (CMW) by scientists of IAP and PSRIC there was established a system of Operational Medical Weather Forecast (OMWF), which aims to have possibility on time to host events for the prevention of meteopathic reactions of people with high meteodependence. Also, we have introduced improved definition of Weather Pathogenicity Index (WPI) for medical weather forecast. As a basis of medical weather

  19. Challenges for health care development in Croatia.

    PubMed

    Ostojić, Rajko; Bilas, Vlatka; Franc, Sanja

    2012-09-01

    The main aim of the research done in this paper was to establish key challenges and perspectives for health care development in the Republic of Croatia in the next two decades. Empirical research was conducted in the form of semi-structured interviews involving 49 subjects, representatives of health care professionals from both, public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). The results have shown that key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: ageing population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and consequential macroeconomic situation must not be neglected. Guidelines for responding to challenges identified in this research are the backbone for developing a strategy for health care development in the Republic of Croatia. Long-term vision, strategy, policies, and a regulatory framework are all necessary preconditions for an efficient health care system and more quality health services.

  20. [The health system of El Salvador].

    PubMed

    Acosta, Mónica; Sáenz, María del Rocío; Gutiérrez, Blanca; Bermúdez, Juan Luis

    2011-01-01

    This paper describes the health conditions in El Salvador and the main característics of the Salvadoran health system, including its structure and coverage, its financial sources, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health, and the participation of health care users in the evaluation of the system. It also discusses the most recent policy innovations including the approval of the Law for the Creation of the National Health System, which intends to expand coverage, reduce health inequalities and improve the coordination of public health institutions.

  1. [Environment, health and sustainable development].

    PubMed

    Rattner, Henrique

    2009-01-01

    Environmental problems and their impact on health and welfare of the population, mainly the most deprived and excluded, from access to material and symbolic goods, provided only to a privileged minority, must be analyzed within the context of the global economic and financial crisis which swept the whole world since 2008. The collapse of the capitalist system and its negative impacts on production, income and employment provide evidence to the predatory nature of the underlying social and political relations which lead humanity to a catastrophic abyss whose consequences are felt on local, national and global levels. Appointing to the main aspects of environmental deterioration - greenhouse gases; pollution of rivers, lakes and oceans; the erosion and intoxication of soils; the lack of basic sanitation and fresh water supply in metropolitan areas, this essay refers to official health indicators published recently by the Ministry of Health of Brazil which documents destructive trends. Discussing the dysfunction and the paradoxes of capital accumulation the essay points out to the need for building a new development paradigm based on cooperation and solidarity; an equitable distribution of the social product and the reform of the political system leading from the present authoritarian patterns of social relations to a participative and a true democratic model.

  2. Development of a health information technology-based data system in community-based hospice and palliative care.

    PubMed

    Abernethy, Amy P; Wheeler, Jane L; Bull, Janet

    2011-05-01

    Few hospice and palliative care organizations use health information technology (HIT) for data collection and management; the feasibility and utility of a HIT-based approach in this multi-faceted, interdisciplinary context is unclear. To develop a HIT-based data infrastructure that serves multiple hospice and palliative care sites, meeting clinical and administrative needs with data, technical, and analytic support. Through a multi-site academic/community partnership, a data infrastructure was collaboratively developed, pilot-tested at a community-based site, refined, and demonstrated for data collection and preliminary analysis. Additional sites, which participated in system development, became prepared to contribute data to the growing aggregate database. Electronic data collection proved feasible in community-based hospice and palliative care. The project highlighted "success factors" for implementing HIT in this field: engagement of site-based project "champions" to promote the system from within; involvement of stakeholders at all levels of the organization, to promote culture change and buy-in; attention to local needs (e.g., data for quality reporting) and requirements (e.g., affordable cost, efficiency); consideration of practical factors (e.g., potential to interfere with clinical flow); provision of adequate software, technical, analytic, and statistical support; availability of flexible HIT options (e.g., different data-collection platforms); and adoption of a consortium approach in which sites can support one another, learn from each others' experiences, pool data, and benefit from economies of scale. In hospice and palliative care, HIT-based data collection/management has potential to generate better understanding of populations and outcomes, support quality assessment/quality improvement, and prepare sites to participate in research. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  3. [Measures developed by the public health system to prevent accidents and violence in children and adolescents in Fortaleza, Ceará, Brazil].

    PubMed

    Pordeus, Augediva Maria Jucá; Fraga, Maria de Nazaré de Oliveira; Facó, Thaís de Paula Pessoa

    2003-01-01

    This article deals with measures developed by the public health system to prevent accidents and violence in children in Fortaleza, Ceará State, Brazil. The program resulted from the need perceived by the authors in light of statistics on mortality from external causes in childhood and adolescence and the fact that there was apparently no preventive action being taken by the public health system. We conducted a questionnaire-based survey of health administrators in the six Regional Executive Secretariats (SERs) corresponding to the geographic districts in which the health system is divided in Fortaleza. According to the survey, existing preventive measures are limited in time and space, and there is no overall policy in this direction; the current measures are organized as health education campaigns focused on prevention of alcohol and drug abuse, violence, household accidents, and juvenile delinquency. SER-I was the only health district that had established partnerships with other sectors in developing such activities. We conclude that the public health system's agenda in Fortaleza needs to incorporate the prevention of childhood and adolescent accidents and violence, taking an inter-sectoral approach and joining efforts in order for the knowledge accumulated on such health problems to be transformed into effective action

  4. [The health system of Uruguay].

    PubMed

    Aran, Daniel; Laca, Hernán

    2011-01-01

    This paper describes the Uruguayan health system, including its structure and coverage, its financial sources, the level and distribution of its health expenditure, the physical, material and human resources available, its stewardship functions, the institutions in charge of information and research, and the level and type of citizen's participation in the operation and evaluation of the system. The most recent policy innovations are also discussed, including the creation of the National Comprehensive Health System, the National Health Insurance, the National Health Fund and the Comprehensive Health Care Program. Finally, the impact of these innovations in health expenditure, fairness of health financing, coverage levels and main health indicators is analyzed.

  5. Development and Experimental Validation of a Numerical Tool for Structural Health and Usage Monitoring Systems Based on Chirped Grating Sensors

    PubMed Central

    Bettini, Paolo; Guerreschi, Erika; Sala, Giuseppe

    2015-01-01

    The interest of the aerospace industries in structural health and usage monitoring systems is continuously increasing. Among the techniques available in literature those based on Fibre Bragg Grating sensors are much promising thanks to their peculiarities. Different Chirped Bragg Grating sensor configurations have been investigated in this paper. Starting from a numerical model capable of simulating the spectral response of a grating subjected to a generic strain profile (direct problem), a new code has been developed, allowing strain reconstruction from the experimental validation of the program, carried out through different loading cases applied on a chirped grating. The wavelength of the reflection spectrum for a chirped FBG has a one-to-one correspondence to the position along the gauge section, thus allowing strain reconstruction over the entire sensor length. Tests conducted on chirped FBGs also evidenced their potential for SHM applications, if coupled with appropriate numerical strain reconstructions tools. Finally, a new class of sensors—Draw Tower Grating arrays—has been studied. These sensors are applicable to distributed sensing and load reconstruction over large structures, thanks to their greater length. Three configurations have been evaluated, having different spatial and spectral characteristics, in order to explore possible applications of such sensors to SHM systems. PMID:25587979

  6. Development and experimental validation of a numerical tool for structural health and usage monitoring systems based on chirped grating sensors.

    PubMed

    Bettini, Paolo; Guerreschi, Erika; Sala, Giuseppe

    2015-01-12

    The interest of the aerospace industries in structural health and usage monitoring systems is continuously increasing. Among the techniques available in literature those based on Fibre Bragg Grating sensors are much promising thanks to their peculiarities. Different Chirped Bragg Grating sensor configurations have been investigated in this paper. Starting from a numerical model capable of simulating the spectral response of a grating subjected to a generic strain profile (direct problem), a new code has been developed, allowing strain reconstruction from the experimental validation of the program, carried out through different loading cases applied on a chirped grating. The wavelength of the reflection spectrum for a chirped FBG has a one-to-one correspondence to the position along the gauge section, thus allowing strain reconstruction over the entire sensor length. Tests conducted on chirped FBGs also evidenced their potential for SHM applications, if coupled with appropriate numerical strain reconstructions tools. Finally, a new class of sensors-Draw Tower Grating arrays-has been studied. These sensors are applicable to distributed sensing and load reconstruction over large structures, thanks to their greater length. Three configurations have been evaluated, having different spatial and spectral characteristics, in order to explore possible applications of such sensors to SHM systems.

  7. Environmental assessment for the satellite power system-concept development and evaluation program-microwave health and ecological effects

    SciTech Connect

    Not Available

    1980-11-01

    This report is concerned with the potential health and ecological effects of the microwave beam from the microwave power transmission system (MPTS) of the satellite power system (SPS). The report is written in the form of a detailed critical review of selected scientific articles from the published literature on the biological effects of nonionizing electromagnetic radiation, followed by an assessment of the possible effects of the SPS, based on exposure values for the reference system (US DOE and NASA, 1978).

  8. Environmental assessment for the satellite power system-concept development and evaluation program-microwave health and ecological effects

    NASA Technical Reports Server (NTRS)

    1980-01-01

    Potential health and ecological effects of the microwave beam from the microwave power transmission system (MPTS) of the satellite power system (SPS) are discussed. A detailed critical review of selected scientific articles from the published literature on the biological effects of nonionizing electromagnetic radiation is provided followed by an assessment of the possible effects of the SPS, based on exposure values for the reference system.

  9. [Development and application of a web-based expert system using artificial intelligence for management of mental health by Korean emigrants].

    PubMed

    Bae, Jeongyee

    2013-04-01

    The purpose of this project was to develop an international web-based expert system using principals of artificial intelligence and user-centered design for management of mental health by Korean emigrants. Using this system, anyone can access the system via computer access to the web. Our design process utilized principles of user-centered design with 4 phases: needs assessment, analysis, design/development/testing, and application release. A survey was done with 3,235 Korean emigrants. Focus group interviews were also conducted. Survey and analysis results guided the design of the web-based expert system. With this system, anyone can check their mental health status by themselves using a personal computer. The system analyzes facts based on answers to automated questions, and suggests solutions accordingly. A history tracking mechanism enables monitoring and future analysis. In addition, this system will include intervention programs to promote mental health status. This system is interactive and accessible to anyone in the world. It is expected that this management system will contribute to Korean emigrants' mental health promotion and allow researchers and professionals to share information on mental health.

  10. Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems

    PubMed Central

    Sittig, Dean F; Ash, Joan S; Feblowitz, Joshua; Meltzer, Seth; McMullen, Carmit; Guappone, Ken; Carpenter, Jim; Richardson, Joshua; Simonaitis, Linas; Evans, R Scott; Nichol, W Paul; Middleton, Blackford

    2011-01-01

    Background Clinical decision support (CDS) is a valuable tool for improving healthcare quality and lowering costs. However, there is no comprehensive taxonomy of types of CDS and there has been limited research on the availability of various CDS tools across current electronic health record (EHR) systems. Objective To develop and validate a taxonomy of front-end CDS tools and to assess support for these tools in major commercial and internally developed EHRs. Study design and methods We used a modified Delphi approach with a panel of 11 decision support experts to develop a taxonomy of 53 front-end CDS tools. Based on this taxonomy, a survey on CDS tools was sent to a purposive sample of commercial EHR vendors (n=9) and leading healthcare institutions with internally developed state-of-the-art EHRs (n=4). Results Responses were received from all healthcare institutions and 7 of 9 EHR vendors (response rate: 85%). All 53 types of CDS tools identified in the taxonomy were found in at least one surveyed EHR system, but only 8 functions were present in all EHRs. Medication dosing support and order facilitators were the most commonly available classes of decision support, while expert systems (eg, diagnostic decision support, ventilator management suggestions) were the least common. Conclusion We developed and validated a comprehensive taxonomy of front-end CDS tools. A subsequent survey of commercial EHR vendors and leading healthcare institutions revealed a small core set of common CDS tools, but identified significant variability in the remainder of clinical decision support content. PMID:21415065

  11. Use of a Balanced Scorecard in strengthening health systems in developing countries: an analysis based on nationally representative Bangladesh Health Facility Survey.

    PubMed

    Khan, M Mahmud; Hotchkiss, David R; Dmytraczenko, Tania; Zunaid Ahsan, Karar

    2013-01-01

    This paper illustrates the importance of collecting facility-based data through regular surveys to supplement the administrative data, especially for developing countries of the world. In Bangladesh, measures based on facility survey indicate that only 70% of very basic medical instruments and 35% of essential drugs were available in health facilities. Less than 2% of officially designated obstetric care facilities actually had required drugs, injections and personnel on-site. Majority of (80%) referral hospitals at the district level were not ready to provide comprehensive emergency obstetric care. Even though the Management Information System reports availability of diagnostic machines in all district-level and sub-district-level facilities, it fails to indicate that 50% of these machines are not functional. In terms of human resources, both physicians and nurses are in short supply at all levels of the healthcare system. The physician-nurse ratio also remains lower than the desirable level of 3.0. Overall job satisfaction index was less than 50 for physicians and 66 for nurses. Patient satisfaction score, however, was high (86) despite the fact that process indicators of service quality were poor. Facility surveys can help strengthen not only the management decision-making process but also the quality of administrative data.

  12. Health Information Systems.

    PubMed

    Sirintrapun, S Joseph; Artz, David R

    2015-06-01

    This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care.

  13. Health Information Systems.

    PubMed

    Sirintrapun, S Joseph; Artz, David R

    2016-03-01

    This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care.

  14. A Review and Framework for Categorizing Current Research and Development in Health Related Geographical Information Systems (GIS) Studies.

    PubMed

    Lyseen, A K; Nøhr, C; Sørensen, E M; Gudes, O; Geraghty, E M; Shaw, N T; Bivona-Tellez, C

    2014-08-15

    The application of GIS in health science has increased over the last decade and new innovative application areas have emerged. This study reviews the literature and builds a framework to provide a conceptual overview of the domain, and to promote strategic planning for further research of GIS in health. The framework is based on literature from the library databases Scopus and Web of Science. The articles were identified based on keywords and initially selected for further study based on titles and abstracts. A grounded theory-inspired method was applied to categorize the selected articles in main focus areas. Subsequent frequency analysis was performed on the identified articles in areas of infectious and non-infectious diseases and continent of origin. A total of 865 articles were included. Four conceptual domains within GIS in health sciences comprise the framework: spatial analysis of disease, spatial analysis of health service planning, public health, health technologies and tools. Frequency analysis by disease status and location show that malaria and schistosomiasis are the most commonly analyzed infectious diseases where cancer and asthma are the most frequently analyzed non-infectious diseases. Across categories, articles from North America predominate, and in the category of spatial analysis of diseases an equal number of studies concern Asia. Spatial analysis of diseases and health service planning are well-established research areas. The development of future technologies and new application areas for GIS and data-gathering technologies such as GPS, smartphones, remote sensing etc. will be nudging the research in GIS and health.

  15. How Do Countries' Health Information Systems Perform in Assessing Asylum Seekers' Health Situation? Developing a Health Information Assessment Tool on Asylum Seekers (HIATUS) and Piloting It in Two European Countries.

    PubMed

    Bozorgmehr, Kayvan; Goosen, Simone; Mohsenpour, Amir; Kuehne, Anna; Razum, Oliver; Kunst, Anton E

    2017-08-08

    Background: Accurate data on the health status, health behaviour and access to health care of asylum seekers is essential, but such data is lacking in many European countries. We hence aimed to: (a) develop and pilot-test an instrument that can be used to compare and benchmark the country health information systems (HIS) with respect to the ability to assess the health status and health care situation of asylum seekers and (b) present the results of that pilot for The Netherlands (NL) and Germany (DE). Materials and Methods: Reviewing and adapting existing tools, we developed a Health Information Assessment Tool on Asylum Seekers (HIATUS) with 50 items to assess HIS performance across three dimensions: (1) availability and detail of data across potential data sources; (2) HIS resources and monitoring capacity; (3) general coverage and timeliness of publications on selected indicators. We piloted HIATUS by applying the tool to the HIS in DE and NL. Two raters per country independently assessed the performance of country HIS and the inter-rater reliability was analysed by Pearson's rho and the intra-class correlation (ICC). We then applied a consensus-based group rating to obtain the final ratings which were transformed into a weighted summary score (range: 0-97). We assessed HIS performance by calculating total and domain-specific HIATUS scores by country as well as absolute and relative gaps in scores within and between countries. Results: In the independent rating, Pearson's rho was 0.14 (NL) and 0.30 (DE), the ICC yielded an estimated reliability of 0.29 (NL) and 0.83 (DE) respectively. In the final consensus-based rating, the total HIATUS score was 47 in NL and 15 in DE, translating into a relative gap in HIS capacity of 52% (NL) and 85% (DE) respectively. Shortfalls in HIS capacity in both countries relate to the areas of HIS coordination, planning and policies, and to limited coverage of specific indicators such as self-reported health, mental health, socio

  16. Dietary Approaches to Stop Hypertension: Lessons Learned From a Case Study on the Development of an mHealth Behavior Change System.

    PubMed

    Mann, Devin M; Quintiliani, Lisa M; Reddy, Shivani; Kitos, Nicole R; Weng, Michael

    2014-10-23

    Evidence-based solutions for changing health behaviors exist but problems with feasibility, sustainability, and dissemination limit their impact on population-based behavior change and maintenance. Our goal was to overcome the limitations of an established behavior change program by using the inherent capabilities of smartphones and wireless sensors to develop a next generation mobile health (mHealth) intervention that has the potential to be more feasible. In response to the clinical need and the growing capabilities of smartphones, our study team decided to develop a behavioral hypertension reduction mHealth system inspired by Dietary Approaches to Stop Hypertension (DASH), a lifestyle modification program. We outline the key design and development decisions that molded the project including decisions about behavior change best practices, coaching features, platform, multimedia content, wireless devices, data security, integration of systems, rapid prototyping, usability, funding mechanisms, and how all of these issues intersect with clinical research and behavioral trials. Over the 12 months, our study team faced many challenges to developing our prototype intervention. We describe 10 lessons learned that will ultimately stimulate more effective and sustainable approaches. The experiences presented in this case study can be used as a reference for others developing mHealth behavioral intervention development projects by highlighting the benefits and challenges facing mHealth research.

  17. Dietary Approaches to Stop Hypertension: Lessons Learned From a Case Study on the Development of an mHealth Behavior Change System

    PubMed Central

    2014-01-01

    Background Evidence-based solutions for changing health behaviors exist but problems with feasibility, sustainability, and dissemination limit their impact on population-based behavior change and maintenance. Objective Our goal was to overcome the limitations of an established behavior change program by using the inherent capabilities of smartphones and wireless sensors to develop a next generation mobile health (mHealth) intervention that has the potential to be more feasible. Methods In response to the clinical need and the growing capabilities of smartphones, our study team decided to develop a behavioral hypertension reduction mHealth system inspired by Dietary Approaches to Stop Hypertension (DASH), a lifestyle modification program. We outline the key design and development decisions that molded the project including decisions about behavior change best practices, coaching features, platform, multimedia content, wireless devices, data security, integration of systems, rapid prototyping, usability, funding mechanisms, and how all of these issues intersect with clinical research and behavioral trials. Results Over the 12 months, our study team faced many challenges to developing our prototype intervention. We describe 10 lessons learned that will ultimately stimulate more effective and sustainable approaches. Conclusions The experiences presented in this case study can be used as a reference for others developing mHealth behavioral intervention development projects by highlighting the benefits and challenges facing mHealth research. PMID:25340979

  18. [Health, marginality and regional development].

    PubMed

    Urbina-Fuentes, M; Narro-Robles, J; Wolpert-Barraza, E; Meljem-Moctezuma, J

    1996-01-01

    The paper discusses the close link between marginality, regional development and health. In order to do so, reference is made to some health indicators like nutrition, causes of death and health infrastructure within the low as well as the high marginality areas. The paper also presents the strategies that the Ministry of Health has established to assist the population living in the high marginality areas. It specifies the related activities that are being carried out through the national institutes of health and the sanitary regulation offices.

  19. Private health insurance: implications for developing countries.

    PubMed Central

    Sekhri, Neelam; Savedoff, William

    2005-01-01

    Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage. PMID:15744405

  20. Private health insurance: implications for developing countries.

    PubMed

    Sekhri, Neelam; Savedoff, William

    2005-02-01

    Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage.

  1. Rasch analysis informed the development of a classification system for a diabetes-specific preference-based measure of health.

    PubMed

    Sundaram, Murali; Smith, Michael J; Revicki, Dennis A; Elswick, Betsy; Miller, Lesley-Ann

    2009-08-01

    To develop a classification system (CS) for a diabetes-specific preference-based measure of health titled the Diabetes Utility Index (DUI). Factor analysis of the Audit of Diabetes-Dependent Quality-of-Life (ADDQoL) items (n=385) identified plausible attributes. An expert panel provided qualitative input, including additional items. Data from three pilot rounds on patients with type 1 or type 2 diabetes were analyzed using Rasch analysis (RA). In a validation survey, the final version of the CS was mailed along with the SF-12v2, Well-Being Questionnaire, and Diabetes Empowerment Scale Short Form to a convenience sample (type 1 or type 2 diabetes). Factor analysis identified two plausible attributes. Experts rated the importance of ADDQoL and additional items, described attributes from item sets and suggested severity levels. Three pilot rounds (n1=52, n2=65, n3=111) tested versions of a CS, containing five attributes with severity levels that were modified using RA and expert input. The final attributes were Physical Ability and Energy, Relationships, Mood and Feelings, Enjoyment of Diet, and Satisfaction with Management of Diabetes. The validation survey (n=396) results indicated satisfactory Rasch fit statistics, reliability, and severity scaling, whereas correspondence of responses to the CS with included measures suggested validity. Results provide initial report of the validity and reliability of the CS of the DUI.

  2. Development of a mother-child database for drug exposure and adverse event detection in the Military Health System.

    PubMed

    Taylor, Lockwood G; Thelus Jean, Rosenie; Gordon, Geoff; Fram, David; Coster, Trinka

    2015-05-01

    The aim of this study was to develop a mother-child linked database consisting of all eligible active duty military personnel, retirees, and their dependents in order to conduct medication-related analyses to improve the safety and quality of care in the Military Health System (MHS). Eligible women of reproductive age with at least one pregnancy-related encounter between January 2005 and December 2013 receiving care in the MHS were included in the study population. Building on previously published algorithms, we used pregnancy-related diagnostic and procedure codes, parameterized temporal constraints, and data elements unique to the MHS to identify pregnancies ending in live births, stillbirth, spontaneous abortion, or ectopic pregnancy. Pregnancies ending in live births were matched to presumptive offspring using birth dates and family-based sponsorship identification. Antidepressant and antiepileptic use during pregnancy was evaluated using electronic pharmacy data. Algorithms identified 755,232 women who experienced 1,099,648 complete pregnancies with both pregnancy care encounter and pregnancy outcome. Of the 924,320 live birth pregnancies, 827,753 (90.0%) were matched to offspring. Algorithms also identified 5,663 stillbirths, 11,358 ectopic pregnancies, and 169,665 spontaneous abortions. Among the matched singleton live birth pregnancies, 7.1% of mothers were dispensed an antidepressant at any point during pregnancy, usually a selective serotonin reuptake inhibitor, (75.3%), whereas 1.3% of mothers were dispensed an antiepileptic drug. Copyright © 2015 John Wiley & Sons, Ltd.

  3. Integrating homoeopathy in health systems.

    PubMed Central

    Poitevin, B.

    1999-01-01

    Homoeopathy is a therapy which involves many components and three main agents: the patient, with his or her condition and personal characteristics; the medication used, with its composition and manufacturing procedure; and the physician, with his or her approach to treatment and concepts of health. The development of research and evaluation structures, combined with a critical education in the discipline, would help to improve practices and define homoeopathy's potential role in relation to the other therapies, both conventional and unconventional, used in Western health systems. PMID:10083716

  4. [The health system of Brazil].

    PubMed

    Montekio, Víctor Becerril; Medina, Guadalupe; Aquino, Rosana

    2011-01-01

    This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.

  5. Learning from developing countries in strengthening health systems: an evaluation of personal and professional impact among global health volunteers at Addis Ababa University's Tikur Anbessa Specialized Hospital (Ethiopia).

    PubMed

    Busse, Heidi; Aboneh, Ephrem A; Tefera, Girma

    2014-09-05

    The positive impact of global health activities by volunteers from the United States in low-and middle-income countries has been recognized. Most existing global health partnerships evaluate what knowledge, ideas, and activities the US institution transferred to the low- or middle-income country. However, what this fails to capture are what kinds of change happen to US-based partners due to engagement in global health partnerships, both at the individual and institutional levels. "Reverse innovation" is the term that is used in global health literature to describe this type of impact. The objectives of this study were to identify what kinds of impact global partnerships have on health volunteers from developed countries, advance this emerging body of knowledge, and improve understanding of methods and indicators for assessing reverse innovation. The study population consisted of 80 US, Canada, and South Africa-based health care professionals who volunteered at Tikur Anbessa Specialized Hospital in Ethiopia. Surveys were web-based and included multiple choice and open-ended questions to assess global health competencies. The data were analyzed using IBRM SPSS® version 21 for quantitative analysis; the open-ended responses were coded using constant comparative analysis to identify themes. Of the 80 volunteers, 63 responded (79 percent response rate). Fifty-two percent of the respondents were male, and over 60 percent were 40 years of age and older. Eighty-three percent reported they accomplished their trip objectives, 95 percent would participate in future activities and 96 percent would recommend participation to other colleagues. Eighty-nine percent reported personal impact and 73 percent reported change on their professional development. Previous global health experience, multiple prior trips, and the desire for career advancement were associated with positive impact on professional development. Professionally and personally meaningful learning happens often

  6. Auto Action Learning: a tool for policy change. Building capacity across the developing regional system to improve health in the North East of England.

    PubMed

    Learmonth, Alyson; Pedler, Mike

    2004-05-01

    Health policy traditionally has tended to focus on health care policy. The World Health Organisation Investment for Health approach aims to influence policy development by locating health as both the outcome of, and an asset for, sustainable economic and social development. The policy context in England offers a range of drivers and opportunities to operationalise the Investment for Health approach through action to improve health and reduce inequalities, nationally and as importantly at a regional and local level. This paper traces developments in the North East of England April 2002-November 2002, from the perspective of an advocate for developing a systemic and systematic approach using an Investment for Health approach. The tool used to track change is based in action learning [M. Pedler, Action Learning for Managers, Lemos and Crane, London, 1996]. The Action Learning Problem Brief identifies why the goal is important, who to, how progress might be identified, difficulties and benefits. Generally, this acts as a starting point for problem solving within an Action Learning Set. This piece of work uses the framework for reflection and tracking, with input from a mentor, at four to eight weekly intervals, 'Auto Action Learning'. The authors pull out key learning points from the process, using a framework 'Towards a model for systematic learning from doing in the North East of England'.

  7. Current Developments in Accreditation and Certification for Health Promotion and Health Education: A Perspective on Systems of Quality Assurance in the United States

    ERIC Educational Resources Information Center

    Cottrell, Randall R.; Lysoby, Linda; King, Laura Rasar; Airhihenbuwa, Collins O.; Roe, Kathleen M.; Allegrante, John P.

    2009-01-01

    The health education profession in the United States employs parallel, and overlapping, systems of voluntary credentialing to ensure quality in professional preparation. The U.S. approach to quality assurance comprises credentialing at the individual level, including certification, and at the institutional level, including regional and…

  8. [The Brazilian Unified Health System (SUS), State Public Policy: its institutionalized and future development and the search for solutions].

    PubMed

    Santos, Nelson Rodrigues Dos

    2013-01-01

    This paper redeems the significance of the health reform movement and the municipal healthcare movement in the context of the 1970s and 1980s, and its social, politic and innovative power in the democratic reconstruction of the day. It then notes that the implementation of the constitutional guidelines, regulated in 1990 by Laws 8080/90 and 8142/90, has been characterized in the last 22 years by four major and mounting obstacles imposed by State policy on all governments: federal underfunding; federal subsidies to the private health plan market; resistance to reform of the State management structure of service provision; and the handing over of administration of public facilities to private entities. The Brazilian Unified Health System (SUS) included half the population that was once excluded in the public health system, though these obstacles keep the coverage of primary care focused below the poverty line and with poor resolution. The conclusion drawn is that the real policy of the state for healthcare in the past 22 years has prioritized the creation and expansion of the private health plan market for consumer rights, and relegated the effectiveness of constitutional guidelines for civic human rights to second place.

  9. Integrated Systems Health Management for Intelligent Systems

    NASA Technical Reports Server (NTRS)

    Figueroa, Fernando; Melcher, Kevin

    2011-01-01

    The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. Management implies storage, distribution, sharing, maintenance, processing, reasoning, and presentation. ISHM is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this chapter, concepts, procedures, and approaches are presented as a foundation for implementing an ISHM capability relevant to intelligent systems. The capability stresses integration of DIaK from all elements of a system, emphasizing an advance toward an on-board, autonomous capability. Both ground-based and on-board ISHM capabilities are addressed. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.

  10. The development and implementation of a health-system-wide evaluation system for education activities: build it and they will come.

    PubMed

    McOwen, Katherine S; Bellini, Lisa M; Morrison, Gail; Shea, Judy A

    2009-10-01

    Academic health centers (AHCs) use education evaluation data for multiple purposes, and they also use multiple methods to collect data in an effort to evaluate the quality of student and faculty performance. Collecting evaluation data in a standardized manner enabling collation and subsequent assessment and interpretation is critically important if the information is to be maximally useful. A case study is presented of PENN Medicine's education evaluation program and the complicated mission of developing a multiprogram, multipurpose evaluation system, developed and implemented from 2003 to 2007. The proposed solution is generalizable to other comparable AHCs. The article begins with a structured analysis of needs, continues with a description of the conceptual evaluation model guiding the system, and offers a summary of the amounts and types of data collected in the years leading to full implementation. The article concludes with a brief list of needs that emerged during implementation and suggestions for future growth. The resulting system is described as supporting the evaluation of clinical teaching of more than 1,200 clinical faculty, students, residents, and fellows across 18 clinical departments with a common set of items. For the 2006-2007 academic year, more than 30,000 faculty evaluations were collected, combined, and then presented in a Web-based teaching dossier. A by-product of this effort was the creation of an ever-expanding data set that supports medical education research.

  11. Diver Health Monitoring System

    DTIC Science & Technology

    2011-09-15

    Software - Small Business Innovative Research (SBIR) Program clause contained in the above identified contract. No restrictions apply after the...safety and effectiveness—their body. The goal of this Small Business Technology Transfer (STTR) Phase II project is the development of a Diver Health...Between DHMS and Biopac -0.47 ± 0.86 -0.57 ± 1.39 -0.52 i 1.16 Across all tests, however, a standard deviation of 1.16 bpm is small and validates the

  12. A Review and Framework for Categorizing Current Research and Development in Health Related Geographical Information Systems (GIS) Studies

    PubMed Central

    Nøhr, C.; Sørensen, E. M.; Gudes, O.; Geraghty, E. M.; Shaw, N. T.; Bivona-Tellez, C.

    2014-01-01

    Summary Objectives The application of GIS in health science has increased over the last decade and new innovative application areas have emerged. This study reviews the literature and builds a framework to provide a conceptual overview of the domain, and to promote strategic planning for further research of GIS in health. Method The framework is based on literature from the library databases Scopus and Web of Science. The articles were identified based on keywords and initially selected for further study based on titles and abstracts. A grounded theory-inspired method was applied to categorize the selected articles in main focus areas. Subsequent frequency analysis was performed on the identified articles in areas of infectious and non-infectious diseases and continent of origin. Results A total of 865 articles were included. Four conceptual domains within GIS in health sciences comprise the framework: spatial analysis of disease, spatial analysis of health service planning, public health, health technologies and tools. Frequency analysis by disease status and location show that malaria and schistosomiasis are the most commonly analyzed infectious diseases where cancer and asthma are the most frequently analyzed non-infectious diseases. Across categories, articles from North America predominate, and in the category of spatial analysis of diseases an equal number of studies concern Asia. Conclusion Spatial analysis of diseases and health service planning are well-established research areas. The development of future technologies and new application areas for GIS and data-gathering technologies such as GPS, smartphones, remote sensing etc. will be nudging the research in GIS and health. PMID:25123730

  13. [Perspectives of the Tunisian health system reform].

    PubMed

    Achouri, H

    2001-05-01

    Perspectives of development of the Tunisian health system are presented, in reference to the conceptual framework recommended by the World Health Organization, while a project of health insurance reform of the social security regimes is submitted to a dialogue with the different concerned parts. Recommended orientations articulate around five axes: 1. The promotion of care provision by improving the accessibility to services, notably in zones under served, by introducing new modes of dispensation, organization and management of care provision in the framework of a continuous quality assurance strategy. 2. The financing of health care, with the implementation of the health insurance reform, has to allow an improvement of the financial accessibility of the population to health care, while supervising the evolution of total health expenditures and by developing the system's management capacities. 3. Proposals relative to the mobilization of resources are advanced in areas of medicine, training of health professionals and research on the health system. 4. Adaptation of the health system governance to the new context is necessary and would have to be developed around evolving standards for the health system, on evaluation of its performances and on information and communication with its users. 5. The health system responsiveness, new motion whose contours are again blurred, would have to be analysed and adapted to the specific context of the country.

  14. [Development and evaluation of an internet-based educational system about herbs and dietary supplements through periodical distribution of information to health professionals].

    PubMed

    Asahina, Yasuko; Hori, Satoko; Ohtani, Hisakazu; Sawada, Yasufumi

    2009-06-01

    Herbs and dietary supplements (HDS) are widely used, and health professionals are in an ideal position to educate patients about them. However, it is sometimes difficult to evaluate their risks and benefits with limited information and what is worse, many health professionals in Japan are unconcerned with HDS. Therefore, we aimed to develop an internet-based educational system to periodically provide information about HDS to medical doctors and pharmacists in order to increase their awareness. Monographs about selected HDS, accompanied with educational quizzes, were prepared to meet pharmacists' needs. Examples of clinical Q&A cases about drug interactions involving HDS were prepared. The material was distributed weekly to registered health professionals by e-mail and via WWW pages. Two hundred and forty-four health professionals evaluated the system by questionnaire. The questionnaire results revealed that 1) more than 75% of responders evaluated the system as useful, 2) compilation of information into educational quizzes and cases encouraged health professionals to learn about HDS with less difficulty, and 3) e-mails led them to learn periodically and to be more concerned about the safety of HDS. In conclusion, the developed information system for HDS was proved to be useful and should serve to improve the understanding of health professionals about this issue.

  15. Health without wealth? Costa Rica's health system under economic crisis.

    PubMed

    Morgan, L M

    1987-01-01

    The recent history of Costa Rica's health system is reviewed, emphasizing the health-related effects of the economic crisis of the 1980s. This economic crisis has stopped and in some instances reversed the marked health improvements Costa Rica realized during the decade of the 1970s. The effects of the economic crisis emerge in 4 areas: deterioration in health status, as poverty contributed to higher disease rates; reductions in the government's ability to maintain public health and medical services; increased reliance on foreign aid to finance the health system; and growing national debate over the role of the state in health care. The result of the economic crisis was a reduction in health services and a questioning of the Costa Rican health model. This occurred following the implementation of an expensive health infrastructure and at a time when people most needed health services. During the 1941-70 period, domestic initiative can account for much of the expansion of Costa Rica's social security system, but also at this time international agencies such as the US Agency for International Development (USAID) and the Inter-American Development began to assist in the expansion of the health system. In 1971 a plan was initiated to create a nationalized health system. By 1980 the success of the health sector reorganization was evident in the statistics: marked improvements in life expectancy, infant mortality, and infectious disease mortality had surpassed the goals set by the Pan American Health Organization (PAHO) and the Ministry of Health. Costa Rica's success was a vindication of both policy goals and funding priorities, for it has been "proved" that primary health care was capable of improving health indices, particularly where the agencies had the active and conscientious support of the national government. By 1977, foreign contracts for aid had expired, and the Ministry declared that the rural health program would be supported totally by the government. The

  16. Bioelectrocatalytic systems for health applications.

    PubMed

    Sekretaryova, Alina N; Eriksson, Mats; Turner, Anthony P F

    2016-01-01

    We present a brief overview of bioelectrocatalytic devices for in vitro health applications, including food safety and environmental analysis, focusing on microelectrode- and microfluidic-based biosensors, paper-based point-of-care devices and wearable biosensors. The main hurdles and future perspectives are discussed. We then consider the role of electron transfer between a biocatalyst and an electrode in biosensor design. Brief descriptions of indirect, direct and mediated mechanisms are given. The principal strategies, as well as recent developments for modulation of electron transfer in biocatalytic systems are summarised. In conclusion, we highlight some of the challenges associated with improving these redox systems.

  17. The Consumer Health Information System Adoption Model.

    PubMed

    Monkman, Helen; Kushniruk, Andre W

    2015-01-01

    Derived from overlapping concepts in consumer health, a consumer health information system refers to any of the broad range of applications, tools, and educational resources developed to empower consumers with knowledge, techniques, and strategies, to manage their own health. As consumer health information systems become increasingly popular, it is important to explore the factors that impact their adoption and success. Accumulating evidence indicates a relationship between usability and consumers' eHealth Literacy skills and the demands consumer HISs place on their skills. Here, we present a new model called the Consumer Health Information System Adoption Model, which depicts both consumer eHealth literacy skills and system demands on eHealth literacy as moderators with the potential to affect the strength of relationship between usefulness and usability (predictors of usage) and adoption, value, and successful use (actual usage outcomes). Strategies for aligning these two moderating factors are described.

  18. Ethical issues in health workforce development.

    PubMed Central

    Cash, Richard

    2005-01-01

    Increasing the numbers of health workers and improving their skills requires that countries confront a number of ethical dilemmas. The ethical considerations in answering five important questions on enabling health workers to deal appropriately with the circumstances in which they must work are described. These include the problems of the standards of training and practice required in countries with differing levels of socioeconomic development and different priority diseases; how a society can be assured that health practitioners are properly trained; how a health system can support its workers; diversion of health workers and training institutions; and the teaching of ethical principles to student health workers. The ethics of setting standards for the skills and care provided by traditional health-care practitioners are also discussed. PMID:15868019

  19. Energy Systems and Population Health

    SciTech Connect

    Ezzati, Majid; Bailis, Rob; Kammen, Daniel M.; Holloway, Tracey; Price, Lynn; Cifuentes, Luis A.; Barnes, Brendon; Chaurey, Akanksha; Dhanapala, Kiran N.

    2004-04-12

    It is well-documented that energy and energy systems have a central role in social and economic development and human welfare at all scales, from household and community to regional and national (41). Among its various welfare effects, energy is closely linked with people s health. Some of the effects of energy on health and welfare are direct. With abundant energy, more food or more frequent meals can be prepared; food can be refrigerated, increasing the types of food items that are consumed and reducing food contamination; water pumps can provide more water and eliminate the need for water storage leading to contamination or increased exposure to disease vectors such as mosquitoes or snails; water can be disinfected by boiling or using other technologies such as radiation. Other effects of energy on public health are mediated through more proximal determinants of health and disease. Abundant energy can lead to increased irrigation, agricultural productivity, and access to food and nutrition; access to energy can also increase small-scale income generation such as processing of agricultural commodities (e.g., producing refined oil from oil seeds, roasting coffee, drying and preserving fruits and meats) and production of crafts; ability to control lighting and heating allows education or economic activities to be shielded from daily or seasonal environmental constraints such as light, temperature, rainfall, or wind; time and other economic resources spent on collecting and/or transporting fuels can be used for other household needs if access to energy is facilitated; energy availability for transportation increases access to health and education facilities and allow increased economic activity by facilitating the transportation of goods and services to and from markets; energy for telecommunication technology (radio, television, telephone, or internet) provides increased access to information useful for health, education, or economic purposes; provision of energy

  20. Accounting for health spending in developing countries.

    PubMed

    Raciborska, Dorota A; Hernández, Patricia; Glassman, Amanda

    2008-01-01

    Data on health system financing and spending, together with information on the disease prevalence and cost-effectiveness of interventions, constitute essential input into health policy. It is particularly critical in developing countries, where resources are scarce and the marginal dollar has a major impact. Yet regular monitoring of health spending tends to be absent from those countries, and the results of international efforts to stimulate estimation activities have been mixed. This paper offers a history of health spending measurement, describes alternative sources of data, and recommends improving international collaboration and advocacy with the private sector for the way forward.

  1. Effectiveness of medical equipment donations to improve health systems: how much medical equipment is broken in the developing world?

    PubMed

    Perry, Lora; Malkin, Robert

    2011-07-01

    It is often said that most of the medical equipment in the developing world is broken with estimates ranging up to 96% out of service. But there is little documented evidence to support these statements. We wanted to quantify the amount of medical equipment that was out of service in resource poor health settings and identify possible causes. Inventory reports were analyzed from 1986 to 2010, from hospitals in sixteen countries across four continents. The UN Human Development Index was used to determine which countries should be considered developing nations. Non-medical hospital equipment was excluded. This study examined 112,040 pieces of equipment. An average of 38.3% (42,925, range across countries: 0.83-47%) in developing countries was out of service. The three main causes were lack of training, health technology management, and infrastructure. We hope that the findings will help biomedical engineers with their efforts toward effective designs for the developing world and NGO's with efforts to design effective healthcare interventions.

  2. Geocoding health data with Geographic Information Systems: a pilot study in northeast Italy for developing a standardized data-acquiring format.

    PubMed

    Baldovin, T; Zangrando, D; Casale, P; Ferrarese, F; Bertoncello, C; Buja, A; Marcolongo, A; Baldo, V

    2015-08-05

    Geographic Information Systems (GIS) have become an innovative and somewhat crucial tool for analyzing relationships between public health data and environment. This study, though focusing on a Local Health Unit of northeastern Italy, could be taken as a benchmark for developing a standardized national data-acquiring format, providing a step-by-step instructions on the manipulation of address elements specific for Italian language and traditions. Geocoding analysis was carried out on a health database comprising 268,517 records of the Local Health Unit of Rovigo in the Veneto region, covering a period of 10 years, starting from 2001 up to 2010. The Map Service provided by the Environmental Research System Institute (ESRI, Redlands, CA), and ArcMap 10.0 by ESRI(®) were, respectively, the reference data and the GIS software, employed in the geocoding process. The first attempt of geocoding produced a poor quality result, having about 40% of the addresses matched. A procedure of manual standardization was performed in order to enhance the quality of the results, consequently a set of guiding principle were expounded which should be pursued for geocoding health data. High-level geocoding detail will provide a more precise geographic representation of health related events. The main achievement of this study was to outline some of the difficulties encountered during the geocoding of health data and to put forward a set of guidelines, which could be useful to facilitate the process and enhance the quality of the results. Public health informatics represents an emerging specialty that highlights on the application of information science and technology to public health practice and research. Therefore, this study could draw the attention of the National Health Service to the underestimated problem of geocoding accuracy in health related data for environmental risk assessment. © Copyright by Pacini Editore SpA, Pisa, Italy.

  3. [The health system of Colombia].

    PubMed

    Guerrero, Ramiro; Gallego, Ana Isabel; Becerril-Montekio, Victor; Vásquez, Johanna

    2011-01-01

    This document briefly describes the health conditions of the Colombian population and, in more detail, the characteristics of the Colombian health system. The description of the system includes its structure and coverage; financing sources; expenditure in health; physical material and human resources available; monitoring and evaluation procedures; and mechanisms through which the population participates in the evaluation of the system. Salient among the most recent innovations implemented in the Colombian health system are the modification of the Compulsory Health Plan and the capitation payment unit, the vertical integration of the health promotion enterprises and the institutions in charge of the provision of services and the mobilization of additional resources to meet the objectives of universal coverage and the homologation of health benefits among health regimes.

  4. Integrating child health information systems in public health agencies.

    PubMed

    Bara, Debra; McPhillips-Tangum, Carol; Wild, Ellen L; Mann, Marie Y

    2009-01-01

    Public health agencies at state and local levels are integrating information systems to improve health outcomes for children. An assessment was conducted to describe the extent to which public health agencies are currently integrating child health information systems (CHIS). Using online technology information was collected, to assess completed and planned activities related to integration of CHIS, maturity of these systems, and factors that influence decisions by public health agencies to pursue integration activities. Of the 39 public health agencies that participated, 18 (46%) reported already integrating some or all of their CHIS, and 13 (33%) reported to be planning to integrate during the next 3 years. Information systems most commonly integrated include Early Hearing Detection and Intervention (EHDI), immunization, vital records, and Newborn Dried Bloodspot Screening (NDBS). Given the high priority that has been placed on using technology to improve health status in the United States, the emphasis on expanding the capability for the electronic exchange of health information, and federal support for electronic health records by 2014, public health agencies should be encouraged and supported in their efforts to develop, implement, and maintain integrated CHIS to facilitate the electronic exchange of health information with the clinical healthcare sector.

  5. Health System Vision of Iran in 2025

    PubMed Central

    Rostamigooran, N; Esmailzadeh, H; Rajabi, F; Majdzadeh, R; Larijani, B; Dastgerdi, M Vahid

    2013-01-01

    Background: Vast changes in disease features and risk factors and influence of demographic, economical, and social trends on health system, makes formulating a long term evolutionary plan, unavoidable. In this regard, to determine health system vision in a long term horizon is a primary stage. Method: After narrative and purposeful review of documentaries, major themes of vision statement were determined and its context was organized in a work group consist of selected managers and experts of health system. Final content of the statement was prepared after several sessions of group discussions and receiving ideas of policy makers and experts of health system. Results: Vision statement in evolutionary plan of health system is considered to be :“a progressive community in the course of human prosperity which has attained to a developed level of health standards in the light of the most efficient and equitable health system in visionary region1 and with the regarding to health in all policies, accountability and innovation”. An explanatory context was compiled either to create a complete image of the vision. Conclusion: Social values and leaders’ strategic goals, and also main orientations are generally mentioned in vision statement. In this statement prosperity and justice are considered as major values and ideals in society of Iran; development and excellence in the region as leaders’ strategic goals; and also considering efficiency and equality, health in all policies, and accountability and innovation as main orientations of health system. PMID:23865011

  6. Health information systems: the foundations of public health.

    PubMed Central

    AbouZahr, Carla; Boerma, Ties

    2005-01-01

    Public health decision-making is critically dependent on the timely availability of sound data. The role of health information systems is to generate, analyse and disseminate such data. In practice, health information systems rarely function systematically. The products of historical, social and economic forces, they are complex, fragmented and unresponsive to needs. International donors in health are largely responsible for the problem, having prioritized urgent needs for data over longer-term country capacity-building. The result is painfully apparent in the inability of most countries to generate the data needed to monitor progress towards the Millennium Development Goals. Solutions to the problem must be comprehensive; money alone is likely to be insufficient unless accompanied by sustained support to country systems development coupled with greater donor accountability and allocation of responsibilities. The Health Metrics Network, a global collaboration in the making, is intended to help bring such solutions to the countries most in need. PMID:16184276

  7. Development of a health effects-based priority ranking system for air emissions reductions from oil refineries in Canada.

    PubMed

    Gower, Stephanie; Hicks, John; Shortreed, John; Craig, Lorraine; McColl, Stephen

    2008-01-01

    In Canada, the Canadian Council of Ministers for the Environment (CCME) is currently engaged in a process to determine how best to reduce air emissions from oil refineries. The National Framework for Petroleum Refineries Emissions Reduction (NFPRER) is being developed with the input of stakeholders, including nongovernment organizations (NGOs), industry, and regulatory jurisdictions. One component of this framework is the development of a tool to prioritize emissions for reduction based on estimated health impacts. HEIDI II (Health Effects Indicators Decision Index II) is a spreadsheet-based model that prioritizes a series of carcinogenic and noncarcinogenic air toxicicants and criteria air contaminants commonly emitted from Canadian oil refineries. A generic meteorological dispersion model was applied to reported annual emissions data for each of Canada's 20 refineries. Photodegradation rates and ambient levels of each substance were accounted for, and air concentrations were calculated for 20 geographic zones around each refinery. These were coupled to toxicity data derived mainly from Health Canada and the U.S. Environmental Protection Agency (EPA), and applied to target populations of children, adults and seniors. HEIDI II predicts incidence of relevant disease endpoints from each substance emitted, except for benzene, toluene, ethylbenzene, and xylene (BTEX) and polycyclic aromatic hydrocarbons (PAH), which were treated as chemical mixtures. Rankings were based on predicted case incidence or the application of a common health impact metric, disability-adjusted life years (DALYs), to the predicted incidence. Using the DALY approach, priority rankings can be made within each of the chemical classes, or across all three classes together. HEIDI II incorporates several switches that allow the user to investigate alternate scenarios based on stack height, average daily sunlight hours (for calculating photodegradation), and the possibility of emissions below

  8. [Relations between health and development].

    PubMed

    Musgrove, P

    1993-02-01

    The relationship between the health of a population and the state of development of a society is complex and varies over time. Throughout history, improved health has been one of the main benefits of development. This benefit results partly from an increase in income and partly from scientific progress in the fight against disease and disability. This second factor is increasingly important compared to simple economic growth. Reciprocally, health could be expected to have a favorable effect on development, although this effect is more difficult to detect. Nevertheless, health can be considered part of a society's capital stock, as long as the essential differences between this type of capital and physical capital are recognized. These differences, in turn, provide an insight into the health services market and, in particular, into the tendency to spend more and more resources on health. It is necessary to respect the intrinsic value of human capital, rather than focusing strictly on the economic productivity that may be derived from it, in order to prevent discrimination against children, the elderly, the poor, or the disabled.

  9. [The health system of Mexico].

    PubMed

    Gómez Dantés, Octavio; Sesma, Sergio; Becerril, Victor M; Knaul, Felicia M; Arreola, Héctor; Frenk, Julio

    2011-01-01

    This paper describes the Mexican health system. In part one, the health conditions of the Mexican population are discussed, with emphasis in those emerging diseases that are now the main causes of death, both in men and women: diabetes, ischaemic heart disease, cerebrovascular diseases and cancer. Part two is devoted to the description of the basic structure of the system: its main institutions, the population coverage, the health benefits of those affiliated to the different heath institutions, its financial sources, the levels of financial protection in health, the availability of physical, material and human resources for health, and the stewardship functions displayed by the Ministry of Health and other actors. This part also discusses the role of citizens in the monitorization and evaluation of the health system, as well as the levels of satisfaction with the rendered health services. In part three the most recent innovations and its impact on the performance of the health system are discussed. Salient among them are the System of Social Protection in Health and the Popular Health Insurance. The paper concludes with a brief analysis of the short- and middle-term challenges faced by the Mexican health system.

  10. The use of qualitative methods in developing the descriptive systems of preference-based measures of health-related quality of life for use in economic evaluation.

    PubMed

    Stevens, Katherine; Palfreyman, Simon

    2012-12-01

    To describe how qualitative methods can be used in the development of descriptive systems of preference-based measures (PBMs) of health-related quality of life. The requirements of the National Institute for Health and Clinical Excellence and other agencies together with the increasing use of patient-reported outcome measures has led to an increase in the demand for PBMs. Recently, interest has grown in developing new PBMs and while previous research on PBMs has mainly focused on the methods of valuation, research into the methods of developing descriptive systems is an emerging field. Traditionally, descriptive systems of PBMs were developed by using top-down methods, where content was derived from existing measures, the literature, or health surveys. A contrasting approach is a bottom-up methodology, which takes the views of patients or laypeople on how their life is affected by their health. This approach generally requires the use of qualitative methods. Qualitative methods lend themselves well to the development of PBMs. They also ensure that the measure has appropriate language, content validity, and responsiveness to change. While the use of qualitative methods in the development of non-PBMs is fairly standard, their use in developing PBMs was until recently nonexistent. In this article, we illustrate the use of qualitative methods by presenting two case studies of recently developed PBMs, one generic and one condition specific. We outline the stages involved, discuss the strengths and weaknesses of the approach, and compare with the top-down approach used in the majority of PBMs to date. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  11. Developing capacity-building activities for mental health system strengthening in low- and middle-income countries for service users and caregivers, service planners, and researchers.

    PubMed

    Semrau, M; Alem, A; Abdulmalik, J; Docrat, S; Evans-Lacko, S; Gureje, O; Kigozi, F; Lempp, H; Lund, C; Petersen, I; Shidhaye, R; Thornicroft, G; Hanlon, C

    2017-10-02

    There is increasing international recognition of the need to build capacity to strengthen mental health systems. This is a fundamental goal of the 'Emerging mental health systems in low- and middle-income countries' (Emerald) programme, which is being implemented in six low- and middle-income countries (LMICs) (Ethiopia, India, Nepal, Nigeria, South Africa, Uganda). This paper discusses Emerald's capacity-building approaches and outputs for three target groups in mental health system strengthening: (1) mental health service users and caregivers, (2) service planners and policy-makers, and (3) mental health researchers. When planning the capacity-building activities, the approach taken included a capabilities/skills matrix, needs assessments, a situational analysis, systematic reviews, qualitative interviews and stakeholder meetings, as well as the application of previous theory, evidence and experience. Each of the Emerald LMIC partners was found to have strengths in aspects of mental health system strengthening, which were complementary across the consortium. Furthermore, despite similarities across the countries, capacity-building interventions needed to be tailored to suit the specific needs of individual countries. The capacity-building outputs include three publicly and freely available short courses/workshops in mental health system strengthening for each of the target groups, 27 Masters-level modules (also open access), nine Emerald-linked PhD students, two MSc studentships, mentoring of post-doctoral/mid-level researchers, and ongoing collaboration and dialogue with the three groups. The approach taken by Emerald can provide a potential model for the development of capacity-building activities across the three target groups in LMICs.

  12. The concept of "intercultural opening": the development of an assessment tool for the appraisal of its current implementation in the mental health care system.

    PubMed

    Penka, S; Kluge, U; Vardar, A; Borde, T; Ingleby, D

    2012-06-01

    The German concept of "intercultural opening" is an approach to facilitating migrants' access to the health care system and improving the care they receive. No data exist concerning the current status of the implementation of this approach in Germany, and the concept has never been analysed in practice. To assess the status of "intercultural opening" in the German mental health care system and to further analyse the concept, we developed a tool by combining pre-existing instruments. In order to review the preliminary tool we combined experts' knowledge by carrying out a consensusoriented, expert-based Delphi process with actual practice by piloting the instrument in each type of institution to be assessed. The assessment tool thus developed(1) is the first one to evaluate the current status of "intercultural opening" in the community mental health care system in Germany from a broad perspective. This paper is intended to present the development process of our assessment tool for demonstrating the benefits of this approach and as a model for future studies, as well as to increase transparency in relation to the current German approach to health care structures in dealing with migrants. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  13. Information technology for health in developing countries.

    PubMed

    Bukachi, Frederick; Pakenham-Walsh, Neil

    2007-11-01

    Poverty has deepened the crisis in health-care delivery in developing countries, particularly sub-Saharan Africa, which is a region facing a disease burden that is unmatched in the world. Whether access to proven and powerful information and communication technologies (ICTs) can improve health indicators is an ongoing debate. However, this brief review shows that in the last decade there has been significant growth in Internet access in urban areas; health-care workers now use it for communication, access to relevant health-care information, and international collaboration. The central message learned during this period about the application of ICTs is that infrastructural and cultural contexts vary and require different models and approaches. Thus, to harness the full potential of ICTs to the benefit of health systems, health workers, and patients will demand an intricate mix of old and new technologies.

  14. Climbing the Ladder: Experience with Developing a Large Group Genetic Counselor Career Ladder at Children's National Health System.

    PubMed

    Kofman, Laura; Seprish, Mary Beth; Summar, Marshall

    2016-08-01

    Children's National Health System (CNHS) is a not-for-profit pediatric hospital that employs around twenty genetic counselors in a range of specialties, including clinical pediatric, neurology, fetal medicine, research, and laboratory. CNHS lacked a structured system of advancement for their genetic counselors; therefore, a formal career ladder was proposed by the genetic counselors based on years of experience, responsibility, and job performance. This career ladder utilized monetary, academic, and seniority incentives to encourage advancement and continue employment at CNHS. The creation and ultimate approval of the career ladder required direct input from genetic counselors, Department Chairs, and Human Resource personnel. The establishment of a genetic counselor career ladder at CNHS will hopefully benefit the profession of genetic counselors as a whole and allow other facilities to create and maintain their own career ladder to meet the needs of the growing, competitive, field of genetic counseling.

  15. Health research systems: promoting health equity or economic competitiveness?

    PubMed Central

    Loff, Bebe

    2012-01-01

    Abstract International collaborative health research is justifiably expected to help reduce global health inequities. Investment in health policy and systems research in developing countries is essential to this process but, currently, funding for international research is mainly channelled towards the development of new medical interventions. This imbalance is largely due to research legislation and policies used in high-income countries. These policies have increasingly led these countries to invest in health research aimed at boosting national economic competitiveness rather than reducing health inequities. In the United States of America and the United Kingdom of Great Britain and Northern Ireland, the regulation of research has encouraged a model that: leads to products that can be commercialized; targets health needs that can be met by profitable, high-technology products; has the licensing of new products as its endpoint; and does not entail significant research capacity strengthening in other countries. Accordingly, investment in international research is directed towards pharmaceutical trials and product development public–private partnerships for neglected diseases. This diverts funding away from research that is needed to implement existing interventions and to strengthen health systems, i.e. health policy and systems research. Governments must restructure their research laws and policies to increase this essential research in developing countries. PMID:22271965

  16. Health research systems: promoting health equity or economic competitiveness?

    PubMed

    Pratt, Bridget; Loff, Bebe

    2012-01-01

    International collaborative health research is justifiably expected to help reduce global health inequities. Investment in health policy and systems research in developing countries is essential to this process but, currently, funding for international research is mainly channelled towards the development of new medical interventions. This imbalance is largely due to research legislation and policies used in high-income countries. These policies have increasingly led these countries to invest in health research aimed at boosting national economic competitiveness rather than reducing health inequities. In the United States of America and the United Kingdom of Great Britain and Northern Ireland, the regulation of research has encouraged a model that: leads to products that can be commercialized; targets health needs that can be met by profitable, high-technology products; has the licensing of new products as its endpoint; and does not entail significant research capacity strengthening in other countries. Accordingly, investment in international research is directed towards pharmaceutical trials and product development public-private partnerships for neglected diseases. This diverts funding away from research that is needed to implement existing interventions and to strengthen health systems, i.e. health policy and systems research. Governments must restructure their research laws and policies to increase this essential research in developing countries.

  17. A retrospective health policy analysis of the development and implementation of the voluntary health insurance system in Lebanon: learning from failure.

    PubMed

    El-Jardali, Fadi; Bou-Karroum, Lama; Ataya, Nour; El-Ghali, Hana Addam; Hammoud, Rawan

    2014-12-01

    Public policymaking is complex and suffers from limited uptake of research evidence, particularly in the Eastern Mediterranean Region (EMR). In-depth case studies examining health policymaking in the EMR are lacking. This retrospective policy analysis aims at generating insights about how policies are being made, identifying factors influencing policymaking and assessing to what extent evidence is used in this process by using the Lebanese Voluntary Health Insurance policy as a case study. The study examined the policymaking process through a policy tracing technique that covered a period of 12 years. The study employed a qualitative research design using a case study approach and was conducted in two phases over the course of two years. Data was collected using multiple sources including: 1) a comprehensive and chronological media review; 2) twenty-two key informant interviews with policymakers, stakeholders, and journalists; and 3) a document review of legislations, minutes of meetings, actuarial studies, and official documents. Data was analyzed and validated using thematic analysis. Findings showed that the voluntary health insurance policy was a political decision taken by the government to tackle an urgent political problem. Evidence was not used to guide policy development and implementation and policy implementers and other stakeholders were not involved in policy development. Factors influencing policymaking were political interests, sectarianism, urgency, and values of policymakers. Barriers to the use of evidence were lack of policy-relevant research evidence, political context, personal interests, and resource constraints. Findings suggest that policymakers should be made more aware of the important role of evidence in informing public policymaking and the need for building capacity to develop, implement and evaluate policies. Study findings are likely to matter in light of the changes that are unfolding in some Arab countries and the looming

  18. Chinese health care system and clinical epidemiology.

    PubMed

    Sun, Yuelian; Gregersen, Hans; Yuan, Wei

    2017-01-01

    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.

  19. Chinese health care system and clinical epidemiology

    PubMed Central

    Sun, Yuelian; Gregersen, Hans; Yuan, Wei

    2017-01-01

    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

  20. [Wawared Peru: reducing health inequities and improving maternal health by improving information systems in health].

    PubMed

    Pérez-Lu, José E; Iguiñiz Romero, Ruth; Bayer, Angela M; García, Patricia J

    2015-01-01

    In developing countries, there are no high quality data to support decision-making and governance due to inadequate information collection and transmission processes. Our project WawaRed-Peru: "Reducing health inequities and improving maternal health by improving health information systems" aims to improve maternal health processes and indicators through the implementation of interoperability standards for maternal health information systems in order for decision makers to have timely, high quality information. Through this project, we hope to support the development of better health policies and to also contribute to reducing problems of health equity among Peruvian women and potentially women in other developing countries. The aim of this article is to present the current state of information systems for maternal health in Peru.