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Sample records for improving service delivery

  1. 76 FR 24339 - Streamlining Service Delivery and Improving Customer Service

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-02

    ... Delivery and Improving Customer Service By the authority vested in me as President by the Constitution and...). However, with advances in technology and service delivery systems in other sectors, the public's... Federal Government has a responsibility to streamline and make more efficient its service delivery...

  2. Models To Improve Service Delivery. Chapter 8.

    ERIC Educational Resources Information Center

    1996

    This collection of papers presented at a 1996 conference on children's mental health focuses on models to improve service delivery. Papers have the following titles and authors: (1) "Empirical Evaluation of an Alternative to Hospitalization for Youth Presenting Psychiatric Emergencies" (Scott W. Henggeler); (2) "An Experimental Study of the…

  3. Improving the delivery of preventive care services.

    PubMed

    Hung, Dorothy Y

    2007-05-01

    Performance of preventive services is an important indicator of high-quality health care, but many recommended services are not regularly offered in primary care practices. Health risk assessments, counseling, and referral to community-based programs help address risk behaviors, many of which are leading causes of preventable death and disability in the United States. This study examined various influences on the delivery of preventive services designed to address smoking, excessive consumption of alcohol, unhealthy diets, and sedentary lifestyles. More than 300 health care providers in 52 practices nationwide have contributed data to this study. Staff participation in quality improvement enhanced work relationships and also diminished the effect of practice size on the performance of preventive care. The use of nurse practitioners, allied health professionals, clinician reminders, and patient registries were positively associated with care delivery.

  4. From service delivery to solution delivery: commissioning for health improvement.

    PubMed

    Shircore, Richard; Ladbury, Patrick

    2009-11-01

    The further division of responsibilities between commissioners and providers in England will have far-reaching consequences and opportunities for developing and enhancing health improvement. Commissioners will have the opportunity to craft local solutions to local issues. To be effective, these local responses need to tackle the core determinants of health and to build the social capital that is at the heart of all communities that enjoy high standards of health. This paper argues that the new arrangements mark an evolution of the Beveridge model of healthcare (centralized, top down and professionally prescribed) to a post-Beveridge model characterized by it being decentralized, localized and utilizing professional skills in the pursuit of client and community satisfaction and engagement rather than a narrowly defined professional perspective. This paper indicates some of the key conceptual changes commissioners need to employ to take advantage of the emerging opportunities. It is argued that the new arrangements will only be fully effective if commissioners of health improvement programmes ensure they factor in health promotion and social marketing expertise, both in the strategic and operational phases of commissioning. Finally, predictions are made about changes in the values and characteristics of current health improvement organizations.

  5. Improving the delivery of veterinary services in India.

    PubMed

    Rao, S V N; Rasheed Sulaiman, V; Natchimuthu, K; Ramkumar, S; Sasidhar, P V K

    2015-12-01

    In pursuit of effective veterinary service delivery, the objectives of this study were threefold: (i) reduce the shortage of technical personnel in veterinary universities (VUs) and animal husbandry departments (AHDs), (ii) identify collaborative areas between VUs and AHDs, and (iii) build the capacity of the veterinary and animal husbandry sector. Primary data were collected from all the 16 veterinary colleges and AHDs in five south Indian states on: (i) student intake and the out-turn of veterinary graduates, (ii) technical personnel--existing and required at various levels, (iii) specific areas of collaboration where VUs and AHDs need each other and can extend support to each other, and (iv) areas in which university faculty and field veterinarians would benefit from further training. Two focus group discussions were held with top administrators of VUs and AHDs to collect qualitative data. The results revealed that there are not enough veterinary graduates to meet the needs of the system and that there is a shortage of faculty, field veterinarians and para-veterinarians. Both focus groups identified areas for collaboration and capacity building to improve veterinary service delivery. The results conclusively demonstrated that India's veterinary service delivery is constrained, not due to a lack of organisations or programmes, but due to the inability of the organisations to collaborate with each other. To improve the effectiveness of veterinary service delivery it will be necessary to: admit more graduate students, support the establishment of new colleges; recruit faculty, field veterinarians and para-veterinarians; remandate the Directorates of Extension at VUs to develop linkages with AHDs; allocate funds ('special central grants') for infrastructure development to all AHDs and veterinary colleges; establish one model veterinary college that follows international standards on veterinary education and create four regional academic staff training colleges

  6. Improving service delivery for relapse management in multiple sclerosis.

    PubMed

    Warner, Richard; Thomas, Del; Martin, Roswell

    This action research study was conducted over an 18 month period within a district general hospital. The study has improved the quality of the service provided to people experiencing a relapse of multiple sclerosis. The authors now identify and treat a three-fold increase in relapse patients. At least 85% of these patients are treated within 10 days of reporting symptoms to a specialist nurse. Before the study, only 12% of patients received treatment within this time. The authors' data identify what patients valued about this service and also inform debate around distress associated with relapse and how services should develop to respond to this. The study is of particular importance to the UK because the National Institute for Clinical Excellence (NICE) has published guidance to the NHS about the management of this specific patient group (NICE, 2003). This study also clearly demonstrates how specialist nursing services can combine a substantial clinical role with instigating and managing change in service delivery that results in improvements in patient care.

  7. 22 CFR 96.41 - Procedures for responding to complaints and improving service delivery.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... improving service delivery. 96.41 Section 96.41 Foreign Relations DEPARTMENT OF STATE LEGAL AND RELATED SERVICES ACCREDITATION OF AGENCIES AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA... Management § 96.41 Procedures for responding to complaints and improving service delivery. (a) The agency...

  8. Towards improving service delivery in screening and intervention services in community pharmacies: a case study of an alcohol IBA service.

    PubMed

    Mackridge, A J; Krska, J; Stokes, E C; Heim, D

    2016-03-01

    Previous studies have demonstrated positive outcomes from a range of pharmacy public health services, but barriers to delivery remain. This paper explores the processes of delivering an alcohol screening and intervention service, with a view to improving service delivery. A mixed-methods, multi-perspective approach was used, comprising in-pharmacy observations and recording of service provision, follow-up interviews with service users and interactive feedback sessions with service providers. Observations and recordings indicate that staff missed opportunities to offer the service and that both availability and delivery of the service were inconsistent, partly owing to unavailability of trained staff and service restrictions. Most service users gave positive accounts of the service and considered pharmacies to be appropriate places for this service. Respondents also described positive impacts, ranging from thinking more about alcohol consumption generally to substantial reductions in consumption. Key facilitators to service provision included building staff confidence and service champions. Barriers included commissioning issues and staff perception of alcohol as a sensitive topic. Findings support expansion of pharmacies' role in delivering public health services and highlight benefits of providing feedback to pharmacy staff on their service provision as a possible avenue for service improvement. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. In-flight food delivery and waste collection service: the passengers’ perspective and potential improvement

    NASA Astrophysics Data System (ADS)

    Romli, F. I.; Rahman, K. Abdul; Ishak, F. D.

    2016-10-01

    Increased competition in the commercial air transportation industry has made service quality of the airlines as one of the key competitive measures to attract passengers against their rivals. In-flight services, particularly food delivery and waste collection, have a notable impact on perception of the overall airline's service quality because they are directly and interactively provided to passengers during flight. An online public survey is conducted to explore general passengers' perception of current in-flight food delivery and waste collection services, and to identify potential rooms for improvement. The obtained survey results indicate that in-flight service does have an effect on passengers' choice of airlines. Several weaknesses of the current service method and possible improvements have been established from the collected responses.

  10. Post-Soviet transition: improving health services delivery and management.

    PubMed

    Antoun, Joseph; Phillips, Frank; Johnson, Tricia

    2011-01-01

    During the post-Soviet transition of the last 2 decades, ex-Communist countries of the Eastern Bloc, including eastern and central Europe, the Soviet Union, and its satellite and aligned states, have undergone major health system reforms. Many health systems of those countries--previously adopting a Soviet-type Semashko model--are currently called "in transition," as reform agendas, such as shifting to a Bismarck, Beveridge, or mixed financing scheme or adopting new health delivery management policies, are still in development. In this article, we first review common characteristics of Semashko health systems (the predominant health system of Communist countries during the Soviet era) and then discuss the "new public management" principles that ex-Communist countries have recently started to adopt with various degrees of success. We then illustrate experiences with these principles using 2 case studies, from Russia and Albania, and propose health policy options for both cases. Based on a review of the literature and on the our work experience in Russia and Albania, we found that the 2 ex-Semashko systems have not fully capitalized on expected positive outcomes of new public management principles due to low local healthcare financing levels, depreciated healthcare infrastructure and operational capacities, overlapping and contradicting ideology and policies of the former and newer health systems, and finally, lack of leadership that has successful experience with these principles. In the case of pharmaceutical pricing, reimbursement, and access in Russia, we show how a well-intentioned but suboptimally designed and managed pharmaceutical coverage scheme has suffered moral hazard and adverse selection and has adversely impacted the new public management promise of efficient medicine coverage. In the case of Albania, the delayed investment in human resource reform within a depreciated and underfinanced delivery system has adversely affected the implementation of new

  11. Improving Bilingual Service Delivery in Catholic Schools through Two-Way Immersion

    ERIC Educational Resources Information Center

    Scanlan, Martin; Zehrbach, Gareth

    2010-01-01

    Catholic elementary schools underserve Latino students, especially those who are bilingual. This paper presents a conceptual argument for Catholic elementary schools to improve this by pursuing the two-way immersion model of bilingual service delivery in Spanish and English. The argument is presented in three stages. First, we show that Catholic…

  12. Efficacy of a Process Improvement Intervention on Delivery of HIV Services to Offenders: A Multisite Trial

    PubMed Central

    Shafer, Michael S.; Dembo, Richard; del Mar Vega-Debién, Graciela; Pankow, Jennifer; Duvall, Jamieson L.; Belenko, Steven; Frisman, Linda K.; Visher, Christy A.; Pich, Michele; Patterson, Yvonne

    2014-01-01

    Objectives. We tested a modified Network for the Improvement of Addiction Treatment (NIATx) process improvement model to implement improved HIV services (prevention, testing, and linkage to treatment) for offenders under correctional supervision. Methods. As part of the Criminal Justice Drug Abuse Treatment Studies, Phase 2, the HIV Services and Treatment Implementation in Corrections study conducted 14 cluster-randomized trials in 2011 to 2013 at 9 US sites, where one correctional facility received training in HIV services and coaching in a modified NIATx model and the other received only HIV training. The outcome measure was the odds of successful delivery of an HIV service. Results. The results were significant at the .05 level, and the point estimate for the odds ratio was 2.14. Although overall the results were heterogeneous, the experiments that focused on implementing HIV prevention interventions had a 95% confidence interval that exceeded the no-difference point. Conclusions. Our results demonstrate that a modified NIATx process improvement model can effectively implement improved rates of delivery of some types of HIV services in correctional environments. PMID:25322311

  13. Constraints in animal health service delivery and sustainable improvement alternatives in North Gondar, Ethiopia.

    PubMed

    Kebede, Hassen; Melaku, Achenef; Kebede, Elias

    2014-11-12

    Poor livestock health services remain one of the main constraints to livestock production in many developing countries, including Ethiopia. A study was carried out in 11 districts of North Gondar, from December 2011 to September 2012, with the objective of identifying the existing status and constraints of animal health service delivery, and thus recommending possible alternatives for its sustainable improvement. Data were collected by using pre-tested questionnaires and focus group discussion. Findings revealed that 46.34% of the responding farmers had taken their animals to government veterinary clinics after initially trying treatments with local medication. More than 90.00% of the clinical cases were diagnosed solely on clinical signs or even history alone. The antibacterial drugs found in veterinary clinics were procaine penicillin (with or without streptomycin), oxytetracycline and sulphonamides, whilst albendazole, tetramisole and ivermectin were the only anthelmintics. A thermometer was the only clinical aid available in all clinics, whilst only nine (45.00%) clinics had a refrigerator. In the private sector, almost 95.00% were retail veterinary pharmacies and only 41.20% fulfilled the requirement criteria set. Professionals working in the government indicated the following problems: lack of incentives (70.00%), poor management and lack of awareness (60.00%) and inadequate budget (40.00%). For farmers, the most frequent problems were failure of private practitioners to adhere to ethical procedures (74.00%) and lack of knowledge of animal diseases and physical distance from the service centre (50.00%). Of all responding farmers, 58.54% preferred the government service, 21.14% liked both services equally and 20.33% preferred the private service. Farmers' indiscriminate use of drugs from the black market (23.00%) was also mentioned as a problem by private practitioners. Sustainable improvement of animal health service delivery needs increased awareness for all

  14. Improving consistency and quality of service delivery: implications for the addiction treatment field.

    PubMed

    Knott, Anne Marie; Corredoira, Rafael; Kimberly, John

    2008-09-01

    Addiction treatment providers face serious problems in delivering consistent, high-quality services over time. Among those providers with multiple treatment sites, there is also intersite variability. This is a serious problem in the addiction field, likely to be made worse as new technologies are introduced and/or as there is industry consolidation (Corredoira, R., Kimberly, J. (2006) Industry evolution through consolidation: Implications for addiction treatment. Journal of Substance Abuse Treatment 31, 255-265.). Although serious, these problems in managing and monitoring to assure consistent service quality have been faced by many other industries. Here, we review evidence from research in other industries regarding three different forms of management (vertical integration, franchising, and licensing) across a chain of individual service providers. We show how each management form affects the level, consistency, and improvement of service delivery over time. In addition, we discuss how such performance advantages affect customer demand as well as regulatory endorsement of the consolidated firm and its approach.

  15. Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care.

    PubMed

    MacPherson, Peter; Munthali, Chigomezgo; Ferguson, Jane; Armstrong, Alice; Kranzer, Katharina; Ferrand, Rashida A; Ross, David A

    2015-08-01

    Adolescents living with HIV face substantial difficulties in accessing HIV care services and have worse treatment outcomes than other age groups. The objective of this review was to evaluate the effectiveness of service delivery interventions to improve adolescents' linkage from HIV diagnosis to antiretroviral therapy (ART) initiation, retention in HIV care and adherence to ART. We systematically searched the Medline, SCOPUS and Web of Sciences databases and conference abstracts from the International AIDS Conference and International Conference on AIDS and STIs in Africa (ICASA). Studies published in English between 1st January 2001 and 9th June 2014 were included. Two authors independently evaluated reports for eligibility, extracted data and assessed methodological quality using the Cochrane risk of bias tool and Newcastle-Ottawa Scale. Eleven studies from nine countries were eligible for review. Three studies were randomised controlled trials. Interventions assessed included individual and group counselling and education; peer support; directly observed therapy; financial incentives; and interventions to improve the adolescent-friendliness of clinics. Most studies were of low to moderate methodological quality. This review identified limited evidence on the effectiveness of service delivery interventions to support adolescents' linkage from HIV diagnosis to ART initiation, retention on ART and adherence to ART. Although recommendations are qualified because of the small numbers of studies and limited methodological quality, offering individual and group education and counselling, financial incentives, increasing clinic accessibility and provision of specific adolescent-tailored services appear promising interventions and warrant further investigation. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  16. Performance-based financing for improving HIV/AIDS service delivery: a systematic review.

    PubMed

    Suthar, Amitabh B; Nagata, Jason M; Nsanzimana, Sabin; Bärnighausen, Till; Negussie, Eyerusalem K; Doherty, Meg C

    2017-01-04

    Although domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Providing incentives for the health system (i.e. performance-based financing [PBF]) may help countries achieve more with available resources. We systematically reviewed effects of PBF on HIV/AIDS service delivery to inform WHO guidelines. PubMed, WHO Index Medicus, conference databases, and clinical trial registries were searched in April 2015 for randomised trials, comparative contemporaneous studies, or time-series studies. Studies evaluating PBF in people with HIV were included when they reported service quality, access, or cost. Meta-analyses were not possible due to limited data. This study is registered with PROSPERO, number CRD42015023207. Four studies, published from 2009 to 2015 and including 173,262 people, met the eligibility criteria. All studies were from Sub-Saharan Africa. PBF did not improve individual testing coverage (relative risk [RR], 1.00, 95% confidence interval [CI] 0.89 to 1.13), improved couples testing coverage (RR 1.11, 95% CI 1.02 to 1.20), and improved pregnant women testing coverage (RR 1.29, 95% CI 1.28-1.30). PBF improved coverage of antiretrovirals in pregnant women (RR 1.55, 95% CI 1.50 to 1.59), infants (RR 1.92, 95% CI 1.84 to 2.01), and adults (RR 1.74, 1.64 to 1.85). PBF reduced attrition (RR 0.84, 95% CI 0.74 to 0.96) and treatment failure (odds ratio 0.55, 95% CI 0.32 to 0.97). Potential harms were not reported. Although the limited data suggests PBF positively affected HIV service access and quality, critical health system and governance knowledge gaps remain. More research is needed to inform national policymaking.

  17. Aligning health information technologies with effective service delivery models to improve chronic disease care.

    PubMed

    Bauer, Amy M; Thielke, Stephen M; Katon, Wayne; Unützer, Jürgen; Areán, Patricia

    2014-09-01

    Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care, have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Aligning health information technologies with effective service delivery models to improve chronic disease care

    PubMed Central

    Bauer, Amy M.; Thielke, Stephen M.; Katon, Wayne; Unützer, Jürgen; Areán, Patricia

    2014-01-01

    Objective Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. Method A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Results Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. Conclusion HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. PMID:24963895

  19. Improving the effectiveness of service delivery in the public healthcare sector: the case of ophthalmology services in Malaysia.

    PubMed

    Foo, Chee Yoong; Lim, Ka Keat; Sivasampu, Sheamini; Dahian, Kamilah Binti; Goh, Pik Pin

    2015-08-28

    Rising demand of ophthalmology care is increasingly straining Malaysia's public healthcare sector due to its limited human and financial resources. Improving the effectiveness of ophthalmology service delivery can promote national policy goals of population health improvement and system sustainability. This study examined the performance variation of public ophthalmology service in Malaysia, estimated the potential output gain and investigated several factors that might explain the differential performance. Data for 2011 and 2012 on 36 ophthalmology centres operating in the Ministry of Health hospitals were used in this analysis. We first consulted a panel of ophthalmology service managers to understand the production of ophthalmology services and to verify the production model. We then assessed the relative performance of these centres using Data Envelopment Analysis (DEA). Efficiency scores (ES) were decomposed into technical, scale, and congestion component. Potential increase in service output was estimated. Sensitivity analysis of model changes was performed and stability of the result was assessed using bootstrap approach. Second stage Tobit regression was conducted to determine if hospital type, availability of day services and population characteristics were related to the DEA scores. In 2011, 33% of the ophthalmology centres were found to have ES > 1 (mean ES = 1.10). Potential output gains were 10% (SE ± 2.92), 7.4% (SE ± 2.06), 6.9% (SE ± 1.97) if the centres could overcome their technical, scale and congestion inefficiencies. More centres moved to the performance frontier in 2012 (mean ES = 1.07), with lower potential output gain. The model used has good stability. Robustness checks show that the DEA correctly identified low performing centres. Being in state hospital was significantly associated with better performance. Using DEA to benchmarking service performance of ophthalmology care could provide insights for policy

  20. Improving the quality of workers' compensation health care delivery: the Washington State Occupational Health Services Project.

    PubMed

    Wickizer, T M; Franklin, G; Plaeger-Brockway, R; Mootz, R D

    2001-01-01

    This article has summarized research and policy activities undertaken in Washington State over the past several years to identify the key problems that result in poor quality and excessive disability among injured workers, and the types of system and delivery changes that could best address these problems in order to improve the quality of occupational health care provided through the workers' compensation system. Our investigations have consistently pointed to the lack of coordination and integration of occupational health services as having major adverse effects on quality and health outcomes for workers' compensation. The Managed Care Pilot Project, a delivery system intervention, focused on making changes in how care is organized and delivered to injured workers. That project demonstrated robust improvements in disability reduction; however, worker satisfaction suffered. Our current quality improvement initiative, developed through the Occupational Health Services Project, synthesizes what was learned from the MCP and other pilot studies to make delivery system improvements. This initiative seeks to develop provider incentives and clinical management processes that will improve outcomes and reduce the burden of disability on injured workers. Fundamental to this approach are simultaneously preserving workers' right to choose their own physician and maintaining flexibility in the provision of individualized care based on clinical need and progress. The OHS project then will be a "real world" test to determine if aligning provider incentives and giving physicians the tools they need to optimize occupational health delivery can demonstrate sustainable reduction in disability and improvements in patient and employer satisfaction. Critical to the success of this initiative will be our ability to: (1) enhance the occupational health care management skills and expertise of physicians who treat injured workers by establishing community-based Centers of Occupational

  1. Improving health service delivery organisational performance in health systems: a taxonomy of strategy areas and conceptual framework for strategy selection.

    PubMed

    Pallas, Sarah W; Curry, Leslie; Bashyal, Chhitij; Berman, Peter; Bradley, Elizabeth H

    2012-03-01

    Health systems strengthening (HSS) is a priority for global health funders, policy-makers and practitioners. Although many HSS efforts have focused on policy levers such as financing approaches, payment schemes or regulatory reforms, less attention has been directed to targeting the organisations that deliver health services such as hospitals, health centres and clinics. Evidence suggests that the impact of organisation-level interventions varies by context; however, we lack a general framework for integrating organisational context into performance improvement strategies for health service delivery organisations. Drawing on open systems theories from organisational behaviour and management as well as a review of 181 empirical studies of health service delivery organisations in low- and middle-income countries, we propose a taxonomy of seven strategy areas for improving organisational performance as well as a multistage conceptual framework for selecting among them. We propose that the choice of strategy for improving health service delivery organisational performance should be informed by: (i) the root cause of the organisation's performance gap; (ii) the environmental conditions facing the organisation; and (iii) the implementation capability of the organisation. We also highlight conditions under which different strategy areas may be expected to be optimally effective. The approaches presented in this paper offer a way for health system decision-makers and researchers to systematically assess and incorporate organisational context in the process of developing strategies to improve the performance of health service delivery organisations and, ultimately, of health systems.

  2. Improving Service Delivery: Investigating the Role of Information Sharing, Job Characteristics, and Employee Satisfaction

    ERIC Educational Resources Information Center

    Bontis, Nick; Richards, David; Serenko, Alexander

    2011-01-01

    Purpose: The purpose of this study is to propose and test a model designed to investigate the impact of job characteristics, employee satisfaction, and information sharing on two key indicators of quality service delivery, such as worker perceptions of their efficiency and customer focus. Design/methodology/approach: During the project, 9,060…

  3. Improving Service Delivery: Investigating the Role of Information Sharing, Job Characteristics, and Employee Satisfaction

    ERIC Educational Resources Information Center

    Bontis, Nick; Richards, David; Serenko, Alexander

    2011-01-01

    Purpose: The purpose of this study is to propose and test a model designed to investigate the impact of job characteristics, employee satisfaction, and information sharing on two key indicators of quality service delivery, such as worker perceptions of their efficiency and customer focus. Design/methodology/approach: During the project, 9,060…

  4. Improving the Human Services Delivery System for At-Risk Children and Families.

    ERIC Educational Resources Information Center

    Davis, William E.

    In recent years, demand has increased for the development and implementation of a better overall human service delivery system for the United State's at-risk children and their families. Critics condemn the current system as being fragmented, too narrowly focused, beset with bureaucratic red tape and harmful restrictive regulations, difficult to…

  5. Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia.

    PubMed

    Dawson, Angela; Bateson, Deborah; Estoesta, Jane; Sullivan, Elizabeth

    2016-10-22

    Improving access to safe abortion is an essential strategy in the provision of universal access to reproductive health care. Australians are largely supportive of the provision of abortion and its decriminalization. However, the lack of data and the complex legal and service delivery situation impacts upon access for women seeking an early termination of pregnancy. There are no systematic reviews from a health services perspective to help direct health planners and policy makers to improve access comprehensive medical and early surgical abortion in high income countries. This review therefore aims to identify quality studies of abortion services to provide insight into how access to services can be improved in Australia. We undertook a structured search of six bibliographic databases and hand-searching to ascertain peer reviewed primary research in English between 2005 and 2015. Qualitative and quantitative study designs were deemed suitable for inclusion. A deductive content analysis methodology was employed to analyse selected manuscripts based upon a framework we developed to examine access to early abortion services. This review identified the dimensions of access to surgical and medical abortion at clinic or hospital-outpatient based abortion services, as well as new service delivery approaches utilising a remote telemedicine approach. A range of factors, mostly from studies in the United Kingdom and United States of America were found to facilitate improved access to abortion, in particular, flexible service delivery approaches that provide women with cost effective options and technology based services. Standards, recommendations and targets were also identified that provided services and providers with guidance regarding the quality of abortion care. Key insights for service delivery in Australia include the: establishment of standards, provision of choice of procedure, improved provider education and training and the expansion of telemedicine for medical

  6. 3 CFR 13571 - Executive Order 13571 of April 27, 2011. Streamlining Service Delivery and Improving Customer...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... at law or in equity by any party against the United States, its departments, agencies, or entities... Customer Service By the authority vested in me as President by the Constitution and the laws of the United States of America, and in order to improve the quality of service to the public by the Federal Government...

  7. Improving patient experience in a pediatric ambulatory clinic: a mixed method appraisal of service delivery.

    PubMed

    Soeteman, Marijn; Peters, Vera; Busari, Jamiu O

    2015-01-01

    In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infrastructural changes to our clinic's waiting room, consultation rooms, and back offices were performed, and schedules were redesigned to reduce wait time to 10 minutes and increase consultation time to 20 minutes. Our objective was to identify if this would improve 1) accessibility to caregivers and 2) quality of service and available amenities. We conducted a multi-method survey using 1) a patient flow analysis to analyze the flow of service and understand the impact of our interventions on patient flow and 2) specially designed questionnaires to investigate patients' perceptions of our wait time and how to improve our services. The results showed that 79% of our respondents were called in to see a doctor within 20 minutes upon arrival. More patients (55%) felt that 10-20 minutes was an acceptable wait time. We also observed a perceived increase in satisfaction with wait time (94%). Finally, a large number of patients (97%) were satisfied with the quality of service and with the accessibility to caregivers (94%). The majority of our patients were satisfied with the accessibility to our ambulatory clinics and with the quality of services provided. The appraisal of our operational processes using a patient flow analysis also demonstrated how this strategy could effectively be applied to investigate and improve quality of service in patients.

  8. Improving patient experience in a pediatric ambulatory clinic: a mixed method appraisal of service delivery

    PubMed Central

    Soeteman, Marijn; Peters, Vera; Busari, Jamiu O

    2015-01-01

    Objective In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infrastructural changes to our clinic’s waiting room, consultation rooms, and back offices were performed, and schedules were redesigned to reduce wait time to 10 minutes and increase consultation time to 20 minutes. Our objective was to identify if this would improve 1) accessibility to caregivers and 2) quality of service and available amenities. Design We conducted a multi-method survey using 1) a patient flow analysis to analyze the flow of service and understand the impact of our interventions on patient flow and 2) specially designed questionnaires to investigate patients’ perceptions of our wait time and how to improve our services. Results The results showed that 79% of our respondents were called in to see a doctor within 20 minutes upon arrival. More patients (55%) felt that 10–20 minutes was an acceptable wait time. We also observed a perceived increase in satisfaction with wait time (94%). Finally, a large number of patients (97%) were satisfied with the quality of service and with the accessibility to caregivers (94%). Conclusion The majority of our patients were satisfied with the accessibility to our ambulatory clinics and with the quality of services provided. The appraisal of our operational processes using a patient flow analysis also demonstrated how this strategy could effectively be applied to investigate and improve quality of service in patients. PMID:25848303

  9. Improving the Delivery of Guidance and Counseling Services at Metropolitan Center. Final Report.

    ERIC Educational Resources Information Center

    Little Rock School District, AR.

    A 3-year project (July 1, 1988 to June 30, 1991) aimed to improve the quality of guidance and counseling services delivered to secondary students eligible to attend the Metropolitan Center, and area vocational center serving students in a four-county area around Little Rock, Arkansas. The focus of the program was to provide supplementary services…

  10. Improving service delivery of water, sanitation, and hygiene in primary schools: a cluster-randomized trial in western Kenya.

    PubMed

    Alexander, Kelly T; Dreibelbis, Robert; Freeman, Matthew C; Ojeny, Betty; Rheingans, Richard

    2013-09-01

    Water, sanitation, and hygiene (WASH) programs in schools have been shown to improve health and reduce absence. In resource-poor settings, barriers such as inadequate budgets, lack of oversight, and competing priorities limit effective and sustained WASH service delivery in schools. We employed a cluster-randomized trial to examine if schools could improve WASH conditions within existing administrative structures. Seventy schools were divided into a control group and three intervention groups. All intervention schools received a budget for purchasing WASH-related items. One group received no further intervention. A second group received additional funding for hiring a WASH attendant and making repairs to WASH infrastructure, and a third group was given guides for student and community monitoring of conditions. Intervention schools made significant improvements in provision of soap and handwashing water, treated drinking water, and clean latrines compared with controls. Teachers reported benefits of monitoring, repairs, and a WASH attendant, but quantitative data of WASH conditions did not determine whether expanded interventions out-performed our budget-only intervention. Providing schools with budgets for WASH operational costs improved access to necessary supplies, but did not ensure consistent service delivery to students. Further work is needed to clarify how schools can provide WASH services daily.

  11. Redesigning service delivery for hypertensive patients: a methodological guideline to improve the management of chronic diseases.

    PubMed

    Ippolito, Adelaide; Cannavacciuolo, Lorella; Ponsiglione, Cristina; De Luca, Nicola; Iaccarino, Guido; Illario, Maddalena

    2014-04-01

    Best care is not necessarily the most expensive, but the most appropriate, and prevention is the most powerful tool to promote health. A novel approach might envision the reduction of hospital admittance (thus meeting a requirement from long term condition patients: they would rather not being hospitalized!) and the enforcement of peripheral (both on the territory and at home) assistance. In this direction, experiences of reshaping new service deliveries towards an integrated disease management, namely clinical pathways, can be observed in Europe and in different parts of the world. Aim of this paper is to provide a methodological guideline to support the management in planning clinical pathways, also outlining the main barriers limiting the process. In particular, we present the results of planning a clinical pathway at the Centre for Hypertension of the Federico II University Hospital (Naples, Italy). The case study showed that the introduction of a similar service impacts on the organisation of the structure. An analysis of organizational processes "as are" and the re-design of processes "to be" are necessary to integrate the clinical pathway into the actual activities.

  12. Redesigning Service Delivery for Hypertensive Patients: A Methodological Guideline to Improve the Management of Chronic Diseases

    PubMed Central

    Ippolito, Adelaide; Cannavacciuolo, Lorella; Ponsiglione, Cristina; De Luca, Nicola; Iaccarino, Guido; Illario, Maddalena

    2014-01-01

    Best care is not necessarily the most expensive, but the most appropriate, and prevention is the most powerful tool to promote health. A novel approach might envision the reduction of hospital admittance (thus meeting a requirement from long term condition patients: they would rather not being hospitalized!) and the enforcement of peripheral (both on the territory and at home) assistance. In this direction, experiences of reshaping new service deliveries towards an integrated disease management, namely clinical pathways, can be observed in Europe and in different parts of the world. Aim of this paper is to provide a methodological guideline to support the management in planning clinical pathways, also outlining the main barriers limiting the process. In particular, we present the results of planning a clinical pathway at the Centre for Hypertension of the Federico II University Hospital (Naples, Italy). The case study showed that the introduction of a similar service impacts on the organisation of the structure. An analysis of organizational processes “as are” and the re-design of processes “to be” are necessary to integrate the clinical pathway into the actual activities. PMID:24809028

  13. Designing a theory-informed, contextually appropriate intervention strategy to improve delivery of paediatric services in Kenyan hospitals

    PubMed Central

    2013-01-01

    Background District hospital services in Kenya and many low-income countries should deliver proven, effective interventions that could substantially reduce child and newborn mortality. However such services are often of poor quality. Researchers have therefore been challenged to identify intervention strategies that go beyond addressing knowledge, skill, or resource inadequacies to support health systems to deliver better services at scale. An effort to develop a system-oriented intervention tailored to local needs and context and drawing on theory is described. Methods An intervention was designed to improve district hospital services for children based on four main strategies: a reflective process to distill root causes for the observed problems with service delivery; developing a set of possible intervention approaches to address these problems; a search of literature for theory that provided the most appropriate basis for intervention design; and repeatedly moving backwards and forwards between identified causes, proposed interventions, identified theory, and knowledge of the existing context to develop an overarching intervention that seemed feasible and likely to be acceptable and potentially sustainable. Results and discussion In addition to human and resource constraints key problems included failures of relevant professionals to take responsibility for or ownership of the challenge of pediatric service delivery; inadequately prepared, poorly supported leaders of service units (mid-level managers) who are often professionally and geographically isolated and an almost complete lack of useful information for routinely monitoring or understanding service delivery practice or outcomes. A system-oriented intervention recognizing the pivotal role of leaders of service units but addressing the outer and inner setting of hospitals was designed to help shape and support an appropriate role for these professionals. It aims to foster a sense of ownership while

  14. The role of the International Classification of Functioning, Disability, and Health and quality criteria for improving assistive technology service delivery in Europe.

    PubMed

    Steel, Emily J; Gelderblom, Gert Jan; de Witte, Luc P

    2012-02-01

    People with disabilities are entitled to access assistive technology (AT) to facilitate their full and effective participation in society and may reasonably expect to be central to the decision-making processes of services that provide these technologies. European projects have improved the knowledge and resources available for AT service delivery in many countries, but the outputs are not consistently implemented or published in scientific literature. This article examines European developments in AT service delivery and the barriers to its effective provision. Specifically, it analyzes the role of the International Classification of Functioning, Disability, and Health in service delivery improvement. Published scientific papers, as well as reports from and descriptions of European projects related to AT service delivery, were reviewed. The publications were analyzed in relation to six criteria for AT service delivery described in an earlier, major European project. The findings and recommendations from the publications are synthesized in this article to identify advances and gaps in AT service delivery and to assess the current status and direction of AT service delivery improvement in Europe. Multicountry projects have brought together AT researchers from across Europe to work together and produced promising results that are contextually relevant. Access to AT information and training of practitioners has improved, and efforts are being made to facilitate user involvement. More effort should be put into integrating research and resources from European projects into practice. Use of the International Classification of Functioning, Disability, and Health model and terminology may support coordination of service delivery systems. The AT research and practice communities in Europe may be able to learn from developments in North America, while continuing to work together, sharing resources and strategies, and communicating results internationally.

  15. Sustaining and improving an international service-learning partnership: Evaluation of an evidence-based service delivery model.

    PubMed

    Hayward, Lorna M; Li, Li

    2017-06-01

    International service learning (ISL) is an instructional method used by physical therapist educators in the United States (US) to prepare students for rendering culturally competent care. ISL is a faculty led student learning opportunity that includes academic instruction and community service in an international context. Research exists that explores student experiences with ISL, but studies that evaluate ISL partnerships and include global stakeholder feedback are lacking. The purposes of this study were to: 1) integrate a partnership evaluation component into an existing curriculum-based ISL model and 2) through evaluation identify benefits, drawbacks, and suggestions for improving and sustaining the academic-community partnership. Community-based participatory research design using a mixed methods approach was used to evaluate a ISL partnership between a US-based physical therapy program and a service site in Ecuador. Participants were 31 staff working at the global service site. Over three years, 11 interviews were conducted and 26 surveys were administered to global partner staff. Data were analyzed using qualitative thematic content analysis and descriptive statistics. Partnership benefits included the following: continuity of ISL team leadership, targeted rehabilitative efforts, sensitivity to cultural norms, respectful communication, and interaction with local community. Drawbacks were as follows: deficits in cultural awareness, language barriers, and poor treatment carryover. Suggestions for sustaining the relationship incorporated: additional pre-trip communication, education of staff, and improved language skills. As more US teams deliver clinical services abroad, intentional evaluation approaches must include the global stakeholder in the planning, implementation, and evaluation phases to maximize partnerships benefits.

  16. Chemical Abstracts' Document Delivery Service.

    ERIC Educational Resources Information Center

    Rollins, Stephen

    1984-01-01

    The Document Delivery Service offered by Chemical Abstracts is described in terms of the DIALORDER option on the Dialog information retrieval system, mail requests, and requests transmitted through OCLC's Interlibrary Loan system. Transmission costs, success rates, delivery rates, and other considerations in utilizing the service are included.…

  17. Computer Assisted Rehabilitation Service Delivery.

    ERIC Educational Resources Information Center

    West Virginia Rehabilitation Research and Training Center, Dunbar.

    This volume consisting of state of the art reviews, suggestions and guidelines for practitioners, and program descriptions deals with the current and potential applications of computers in the delivery of services for vocational rehabilitation (VR). Discussed first are current applications of computer technology in rehabilitative service delivery.…

  18. Chemical Abstracts' Document Delivery Service.

    ERIC Educational Resources Information Center

    Rollins, Stephen

    1984-01-01

    The Document Delivery Service offered by Chemical Abstracts is described in terms of the DIALORDER option on the Dialog information retrieval system, mail requests, and requests transmitted through OCLC's Interlibrary Loan system. Transmission costs, success rates, delivery rates, and other considerations in utilizing the service are included.…

  19. A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness

    PubMed Central

    2013-01-01

    Background The Wagner Model provides a framework that can help to facilitate health system transition towards a chronic care oriented model. Drawing on elements of this framework as well as health policy related to patient centred care, we describe the health needs of patients with chronic illness and compare these with services which should ideally be provided by a patient-centred health system. This paper aims to increase understanding of the challenges faced by chronically ill patients and family carers in relation to their experiences with the health care system and health service providers. Method We interviewed patients, carers and health care professionals (HCPs) about the challenges faced by people living with complicated diabetes, chronic heart failure or chronic obstructive pulmonary disease. Results Patients indicated that they had a range of concerns related to the quality of health care encounters with health care professionals (HCPs), with these concerns being expressed as needs or wants. These included: 1) the need for improved communication and information delivery on the part of HCPs; 2) well organised health services and reduced waiting times to see HCPs; 3) help with self care; 4) greater recognition among professionals of the need for holistic and continuing care; and 5) inclusion of patients and carers in the decision making processes. Conclusions In order to address the challenges faced by people with chronic illness, health policy must be more closely aligned with the identified needs and wants of people affected by chronic illness than is currently the case. PMID:23819721

  20. Advanced practice physiotherapy in paediatric orthopaedics: innovation and collaboration to improve service delivery.

    PubMed

    Ó Mír, M; O'Sullivan, C

    2017-05-06

    One in eight paediatric primary care presentations is for a musculoskeletal (MSK) disorder. These patients are frequently referred to paediatric orthopaedic surgeons; however, up to 50% of referrals are for normal variants. This results in excessive wait-times and impedes access for urgent surgical cases. Adult MSK medicine has successfully utilised advanced practice physiotherapists (APP) managing non-surgical candidates, with documented benefits both to patients and services. There is a gap in the literature with regard to APP in paediatric orthopaedics. In this review, we investigate demands on paediatric orthopaedic services, examine the literature regarding APP in paediatric orthopaedics and explore the value the role has to offer current outpatient services. Paediatric orthopaedic services are under-resourced with concurrent long wait times. Approximately 50% of referrals are for normal variants, which do not require specialist intervention. Poor musculoskeletal examination skills and low diagnostic confidence amongst primary care physicians have been identified as a cause of inappropriate referrals. APP clinics for normal variants have reported independent management rate and discharge rates of 95% and marked reduction in patient wait times. There is limited evidence to support the APP in paediatric orthopaedics. Further studies are needed investigating diagnostic agreement, patient/stakeholder satisfaction, patient outcomes and economic evaluation. Paediatric orthopaedics is in crisis as to how to effectively manage the overwhelming volume of referrals. Innovative multidisciplinary solutions are required so that the onus is not solely on physicians to provide all services. The APP in paediatric orthopaedics may be part of the solution.

  1. Using and understanding consumer satisfaction to effect an improvement in mental health service delivery.

    PubMed

    Brunero, S; Lamont, S; Fairbrother, G

    2009-04-01

    Consumer satisfaction is today, widely accepted as a measure of the level and quality of service received by consumers. The aim of this survey-based study is to explore consumer satisfaction with quality of care, staff, environment and discharge in a south eastern Sydney adult acute inpatient mental health unit. A cross-sectional analysis is pursued in order to identify aspects of the patient stay, which form an associative relationship with an overall rating of consumer satisfaction on a 10-point scale. During the survey period, there were 182 discharges. Seventy questionnaires (38.5%) were returned from this group. The survey results highlight a number of areas of identified need, enabling the service to prioritize organizational systems around meeting these needs. Multiple regression analysis identified three items in the survey, which were independently significant associates of overall consumer satisfaction. They included being happy with the service provided by the consumer support worker, having support for services on discharge and feeling safe and secure on the ward. The model containing these three items accounted for 50% of the variation in overall satisfaction. Two primary interventions have been developed because survey administration which, it is hoped, will address issues raised in the survey. The interventions were the development of an admission and discharge pathway and a ward-based psychosocial intervention programme, which includes the involvement of consumer support workers.

  2. Federal Educational Assistance Programs Available to Service Members: Program Features and Recommendations for Improved Delivery

    DTIC Science & Technology

    2015-01-01

    students enrolled in higher education institutions. Students who are in higher education full time and are under age 24 are typically defined as...traditional. Nontraditional students enrolled in institu- tions of higher education can offer a relevant point of comparison for service members because they...possible hurdles to achievement. Characteristics of Nontraditional Students Students who enter higher education immediately after

  3. Prairie strips improve biodiversity and the delivery of multiple ecosystem services from corn–soybean croplands

    Treesearch

    Lisa A. Schulte; Jarad Niemib; Matthew J. Helmers; Matt Liebmand; J. Gordon Arbuckle; David E. James; Randall K. Kolka; Matthew E. O’Neal; Mark D. Tomer; John C. Tyndall; Heidi Asbjornsen; Pauline Drobney; Jeri Neal; Gary Van Ryswyk; Chris Witte

    2017-01-01

    Loss of biodiversity and degradation of ecosystem services from agricultural lands remain important challenges in the United States despite decades of spending on natural resource management. To date, conservation investment has emphasized engineering practices or vegetative strategies centered on monocultural plantings of nonnative plants, largely excluding native...

  4. The research agenda for improving health policy, systems performance, and service delivery for tuberculosis control: a WHO perspective.

    PubMed Central

    Nunn, Paul; Harries, Anthony; Godfrey-Faussett, Peter; Gupta, Raj; Maher, Dermot; Raviglione, Mario

    2002-01-01

    The development of WHO's DOTS strategy for the control of tuberculosis (TB) in 1995 led to the expansion, adaptation and improvement of operational research in this area. From being a patchwork of small-scale studies concerned with aspects of service delivery, TB operational research shifted to larger-scale, often multicountry projects that were also concerned with health policy and the needs of health systems. The results are now being put into practice by national TB control programmes. In 1998 an ad hoc committee identified the chief factors inhibiting the expansion of DOTS: lack of political will and commitment, poor financial support for TB control, poor organization and management of health services, inadequate human resources, irregular drug supplies, the HIV epidemic, and the rise of multidrug resistance. An analysis of current operational research on TB is presented on the basis of these constraints, and examples of successful projects are outlined in the article. We discuss the prerequisites for success, the shortcomings of this WHO- supported programme, and future challenges and needs. PMID:12132005

  5. Prairie strips improve biodiversity and the delivery of multiple ecosystem services from corn-soybean croplands.

    PubMed

    Schulte, Lisa A; Niemi, Jarad; Helmers, Matthew J; Liebman, Matt; Arbuckle, J Gordon; James, David E; Kolka, Randall K; O'Neal, Matthew E; Tomer, Mark D; Tyndall, John C; Asbjornsen, Heidi; Drobney, Pauline; Neal, Jeri; Van Ryswyk, Gary; Witte, Chris

    2017-10-02

    Loss of biodiversity and degradation of ecosystem services from agricultural lands remain important challenges in the United States despite decades of spending on natural resource management. To date, conservation investment has emphasized engineering practices or vegetative strategies centered on monocultural plantings of nonnative plants, largely excluding native species from cropland. In a catchment-scale experiment, we quantified the multiple effects of integrating strips of native prairie species amid corn and soybean crops, with prairie strips arranged to arrest run-off on slopes. Replacing 10% of cropland with prairie strips increased biodiversity and ecosystem services with minimal impacts on crop production. Compared with catchments containing only crops, integrating prairie strips into cropland led to greater catchment-level insect taxa richness (2.6-fold), pollinator abundance (3.5-fold), native bird species richness (2.1-fold), and abundance of bird species of greatest conservation need (2.1-fold). Use of prairie strips also reduced total water runoff from catchments by 37%, resulting in retention of 20 times more soil and 4.3 times more phosphorus. Corn and soybean yields for catchments with prairie strips decreased only by the amount of the area taken out of crop production. Social survey results indicated demand among both farming and nonfarming populations for the environmental outcomes produced by prairie strips. If federal and state policies were aligned to promote prairie strips, the practice would be applicable to 3.9 million ha of cropland in Iowa alone.

  6. Improving Service Delivery for Children Affected by Trauma: An Implementation Study of Children's Institute, Inc.

    ERIC Educational Resources Information Center

    Manno, Michelle S.; Treskon, Louisa

    2016-01-01

    There is overwhelming evidence that traumatic experiences in childhood--such as physical or sexual assault, gang violence, domestic violence, or sudden loss of a loved one--can lead to poor outcomes in adulthood. Research has identified evidence-based practices that improve outcomes for these children and families, and there has been a push at the…

  7. The effectiveness of service delivery initiatives at improving patients' waiting times in clinical radiology departments: a systematic review.

    PubMed

    Olisemeke, B; Chen, Y F; Hemming, K; Girling, A

    2014-12-01

    We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95%) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.

  8. A GIS-based methodology for improving needle exchange service delivery.

    PubMed

    Davidson, Peter J; Scholar, Shoshanna; Howe, Mary

    2011-03-01

    A variety of legal, social and logistical factors can prevent individuals from accessing formal needle exchange programmes. One common solution to this problem is satellite exchange, which involves collaborating with people who already use an exchange to deliver needles and other supplies to those unable to access the exchange. While this approach can be very successful, one potential problem is that those most willing to deliver needles to their peers are often members of social networks that are already well connected with the needle exchange, leading to duplication of effort. In this paper we describe a simple and novel method for identifying groups of people who are demonstrably in need of improved access to needles, and for re-targeting efforts to meet the needs of those people. The method described was piloted at the Homeless Youth Alliance, San Francisco, USA, and further refined at Clean Needles Now, Los Angeles, USA. People accessing needle exchange sites were asked to participate in a survey with two questions: "where were you and what time was it last time someone borrowed a needle from you?" and "where were you and what time was it last time you had to borrow a needle from someone else?" Responses were geocoded, and maps produced showing 'hotspots' where people were frequently finding themselves without needles. Satellite needle exchange was refined from an ad-hoc activity into one which focused on delivering needles to those with empirically demonstrable need. Maps produced in the process also proved valuable in discussions with local officials and other agencies about funding, as well as needle provision policy and practices. We describe a method for rapidly assessing, describing, and responding to unmet and under-met need among injecting drug users. The method is particularly well-suited to organizations with extremely limited resources. Copyright © 2010 Elsevier B.V. All rights reserved.

  9. A GIS-based methodology for improving needle exchange service delivery

    PubMed Central

    Davidson, Peter J.; Scholar, Shoshanna; Howe, Mary

    2010-01-01

    Background A variety of legal, social and logistical factors can prevent individuals from accessing formal needle exchange programs. One common solution to this problem is satellite exchange, which involves collaborating with people who already use an exchange to deliver needles and other supplies to those unable to access the exchange. While this approach can be very successful, one potential problem is that those most willing to deliver needles to their peers are often members of social networks that are already well connected with the needle exchange, leading to duplication of effort. In this paper we describe a simple and novel method for identifying groups of people who are demonstrably in need of improved access to needles, and for re-targeting efforts to meet the needs of those people. The method described was piloted at the Homeless Youth Alliance, San Francisco, USA, and further refined at Clean Needles Now, Los Angeles, USA. Methods People accessing needle exchange sites were asked to participate in a survey with two questions: “where were you and what time was it last time someone borrowed a needle from you?” and “where were you and what time was it last time you had to borrow a needle from someone else?” Responses were geocoded, and maps produced showing ‘hotspots’ where people were frequently finding themselves without needles. Results Satellite needle exchange was refined from an ad-hoc activity into one which focused on delivering needles to those with empirically demonstrable need. Maps produced in the process also proved valuable in discussions with local officials and other agencies about funding, as well as needle provision policy and practices. Conclusion We describe a method for rapidly assessing, describing, and responding to unmet and under-met need among injecting drug users. The method is particularly well-suited to organizations with extremely limited resources. PMID:21112757

  10. A systematic review of interventions to improve prevention of mother-to-child HIV transmission service delivery and promote retention.

    PubMed

    Ambia, Julie; Mandala, Justin

    2016-01-01

    The success of prevention of mother-to-child transmission of HIV (PMTCT) is dependent upon high retention of mother-infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps. Selected databases were searched for studies published in English (up to September 2015). Outcomes of interest included antiretroviral (ARV) drugs or antiretroviral therapy (ART) initiation among HIV-positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID) of HIV and infant HIV status. Risk ratios and random-effect meta-analysis were used in the analysis. Interventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs), mobile phone-based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized) that evaluated mobile phone-based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I(2)=83%) in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I(2)=0%) in four studies (one randomized). Four studies (three randomized) that were grounded on psychological interventions reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I(2)=69%) in increasing ARV/ART uptake among HIV-positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I(2)=45%). The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings. Our findings indicate that mobile phone-based reminders may increase the uptake

  11. A systematic review of interventions to improve prevention of mother-to-child HIV transmission service delivery and promote retention

    PubMed Central

    Ambia, Julie; Mandala, Justin

    2016-01-01

    Introduction The success of prevention of mother-to-child transmission of HIV (PMTCT) is dependent upon high retention of mother-infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps. Methods Selected databases were searched for studies published in English (up to September 2015). Outcomes of interest included antiretroviral (ARV) drugs or antiretroviral therapy (ART) initiation among HIV-positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID) of HIV and infant HIV status. Risk ratios and random-effect meta-analysis were used in the analysis. Results Interventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs), mobile phone-based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized) that evaluated mobile phone-based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I2=83%) in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I2=0%) in four studies (one randomized). Four studies (three randomized) that were grounded on psychological interventions reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I2=69%) in increasing ARV/ART uptake among HIV-positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I2=45%). The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings. Conclusions Our findings indicate that mobile phone

  12. Improving the delivery of veterinary services in Africa: insights from the empirical application of transaction costs theory in Uganda and Kenya.

    PubMed

    Ilukor, J

    2017-04-01

    This paper presents a summary of findings from a research project that examined institutional arrangements for providing animal health services in Uganda and Kenya. Given the need to find solutions to the pervasive governance challenges encountered in the delivery of veterinary services in Africa, the study applied transaction economics theory to generate recommendations on how to improve the delivery of these services and minimise livestock production risks, including those that pose a risk to human health, e.g. zoonoses. The most notable recommendations are as follows: i) lower- and middle-income countries should invest in creating an enabling environment that supports the relationship between professional veterinarians and para-professionals, to ensure the timely reporting, treatment and control of animal diseases; ii) the provision of veterinary extension services should not focus solely on household 'heads', but also on other household members, such as wives and children, and on herdsmen; iii) strong government engagement is required in the provision of veterinary services for pastoral or extensive livestock production systems, because normal market forces have failed to attract professional veterinarians and trained para-professionals from the private sector to work in these sectors; iv) farmers must be empowered to hold service providers accountable, by the development and trialling of tools that would enable them to measure the quality of services that they receive and to verify the qualifications of different service providers; v) investment in veterinary education is vital, to ensure that enough qualified veterinary staff are available to offer veterinary services to farmers.

  13. Improving access to emergency contraception pills through strengthening service delivery and demand generation: a systematic review of current evidence in low and middle-income countries.

    PubMed

    Dawson, Angela; Tran, Nguyen-Toan; Westley, Elizabeth; Mangiaterra, Viviana; Festin, Mario

    2014-01-01

    Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP. A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping. Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP.

  14. Improving Access to Emergency Contraception Pills through Strengthening Service Delivery and Demand Generation: A Systematic Review of Current Evidence in Low and Middle-Income Countries

    PubMed Central

    Dawson, Angela; Tran, Nguyen-Toan; Westley, Elizabeth; Mangiaterra, Viviana; Festin, Mario

    2014-01-01

    Objectives Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP. Methods A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping. Findings Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. Conclusion There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP. PMID:25285438

  15. 78 FR 15797 - Service Delivery Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-12

    ... ADMINISTRATION Service Delivery Plan AGENCY: Social Security Administration (SSA). ACTION: Notice; request for comments. SUMMARY: We are requesting public input as we finalize our Service Delivery Plan (SDP). We... Nation's economy. Today, the challenge of service delivery is greater than at any other point in...

  16. Leisure Service Delivery Systems: Are They Adequate

    Treesearch

    Rene Fukuhara Dahl

    1992-01-01

    This presentation explores a model of service delivery ranging from direct service provision to advocacy and reports findings on the delivery mode most prevalent in park and recreation departments that serve Asian groups in their community. The implications of the role of the professional, the range of service delivery, and the manner in which ethnic groups are...

  17. Genetic service delivery: infrastructure, assessment and information.

    PubMed

    Kaye, C I

    2012-01-01

    Identification of genomic determinants of complex disorders such as cancer, diabetes and cardiovascular disease has prompted public health systems to focus on genetic service delivery for prevention of these disorders, adding to their previous efforts in birth defects prevention and newborn screening. This focus is consistent with previously identified obligations of the public health system as well as the core functions of public health identified by the Institute of Medicine. Models of service delivery include provision of services by the primary care provider in conjunction with subspecialists, provision of services through the medical home with co-management by genetics providers, provision of services in conjunction with disorder-specific treatment centers, and provision of services through a network of genetics clinics linked to medical homes. Whatever the model for provision of genetic services, tools to assist providers include facilities for outreach and telemedicine, information technology, just-in-time management plans, and emergency management tools. Assessment tools to determine which care is best are critical for quality improvement and development of best practices. Because the workforce of genetics providers is not keeping pace with the need for services, an understanding of the factors contributing to this lag is important, as is the development of an improved knowledge base in genomics for primary care providers. Copyright © 2012 S. Karger AG, Basel.

  18. Improving oceanographic data delivery through pipeline processing in a Commercial Cloud Services environment: the Australian Integrated Marine Observing System

    NASA Astrophysics Data System (ADS)

    Besnard, Laurent; Blain, Peter; Mancini, Sebastien; Proctor, Roger

    2017-04-01

    The Integrated Marine Observing System (IMOS) is a national project funded by the Australian government established to deliver ocean observations to the marine and climate science community. Now in its 10th year its mission is to undertake systematic and sustained observations and to turn them into data, products and analyses that can be freely used and reused for broad societal benefits. As IMOS has matured as an observing system expectation on the system's availability and reliability has also increased and IMOS is now seen as delivering 'operational' information. In responding to this expectation, IMOS has relocated its services to the commercial cloud service Amazon Web Services. This has enabled IMOS to improve the system architecture, utilizing more advanced features like object storage (S3 - Simple Storage Service) and autoscaling features, and introducing new checking procedures in a pipeline approach. This has improved data availability and resilience while protecting against human errors in data handling and providing a more efficient ingestion process.

  19. Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo

    PubMed Central

    2009-01-01

    Background Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP). Methods Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities. Results None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC. Conclusions Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for

  20. Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo.

    PubMed

    Casey, Sara E; Mitchell, Kathleen T; Amisi, Immaculée Mulamba; Haliza, Martin Migombano; Aveledi, Blandine; Kalenga, Prince; Austin, Judy

    2009-12-21

    Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP). Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities. None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC. Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for health providers in RH and infection

  1. An innovation for improving maternal, newborn and child health (MNCH) service delivery in Jigawa State, northern Nigeria: a qualitative study of stakeholders' perceptions about clinical mentoring.

    PubMed

    Okereke, Ekechi; Tukur, Jamilu; Aminu, Amina; Butera, Jean; Mohammed, Bello; Tanko, Mustapha; Yisa, Ibrahim; Obonyo, Benson; Egboh, Mike

    2015-02-15

    An effective capacity building process for healthcare workers is required for the delivery of quality health care services. Work-based training can be applied for the capacity building of health care workers while causing minimum disruption to service delivery within health facilities. In 2012, clinical mentoring was introduced into the Jigawa State Health System through collaboration between the Jigawa State Ministry of Health and the Partnership for Transforming Health Systems Phase 2 (PATHS2). This study evaluates the perceptions of different stakeholders about clinical mentoring as a strategy for improving maternal, newborn and child health service delivery in Jigawa State, northern Nigeria. Interviews were conducted in February 2013 with different stakeholders within Jigawa State in Northern Nigeria. There were semi-structured interviews with 33 mentored health care workers as well as the health facility departmental heads for Obstetrics and Pediatrics in the selected clinical mentoring health facilities. In-depth interviews were also conducted with the clinical mentors and two senior government health officials working within the Jigawa State Ministry of Health. The qualitative data were audio-recorded; transcribed and thematically analysed. The study findings suggest that clinical mentoring improved service delivery within the clinical mentoring health facilities. Significant improvements in the professional capacity of mentored health workers were observed by clinical mentors, heads of departments and the mentored health workers. Best practices were introduced with the support of the clinical mentors such as appropriate baseline investigations for pediatric patients, the use of magnesium sulphate and misoprostol for the management of eclampsia and post-partum hemorrhage respectively. Government health officials indicate that clinical mentoring has led to more emphasis on the need for the provision of better quality health services. Stakeholders report that

  2. 77 FR 44306 - Service Delivery Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-27

    ... ADMINISTRATION Service Delivery Plan AGENCY: Social Security Administration (SSA). ACTION: Notice; request for comments. SUMMARY: We are requesting public input as we develop our Service Delivery Plan (SDP). We...) Deliver quality disability decisions and services; (2) provide quality service to the public; (3)...

  3. How creation of a parent satisfaction questionnaire improved multidisciplinary service delivery in a paediatric day surgery unit.

    PubMed

    Bradley, Alison

    2013-01-01

    Auditing patient satisfaction has become a keystone of quality patient centred healthcare. A plethora of patient satisfaction studies exist but only a few studies have been evaluated for their validity, reliability, specificity or psychometric properties. And the majority focus on adult health care. However, if validated tools are not utilised, then inaccurate results could stymie service improvement. The level of satisfaction with the paediatric day surgery service at Tayside Children's Hospital was unknown. Our objective was to measure parent satisfaction with the paediatric day surgery by creating a parent satisfaction questionnaire which has undergone satisfactory testing for validity, reliability, specificity and psychometric properties. A Likert-style questionnaire was constructed through literature review and focus group meetings with professionals, parents and patient groups to establish content validity. Statements worded in positive phrasing were re-worded in negative phrasing to ensure intra-rater reliability. A pilot study was conducted and responses analysed for construct validity and inter-rater agreement. Internal reliability was established using Chronbach's alpha analysis, which produced scores for each part of the questionnaire between 0.7 and 0.9. Overall parent satisfaction was high. 95.48% either strongly agreed or agreed with positively worded statements regarding pre-operative clinic service. In particular 100% satisfaction was reported with the pre-operative phone call which only 70% of participants received. 96.60% strongly agreed or agreed with positive statements regarding service provided on the ward and 87.50% strongly agreed or agreed with positive statements regarding the discharge process. 5% specifically requested improved information giving. In conclusion the parent satisfaction questionnaire was found to have proven validity, reliability, specificity and psychometric properties. Overall parent satisfaction was found to be high

  4. 22 CFR 228.55 - Delivery services.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Delivery services. 228.55 Section 228.55... COMMODITIES AND SERVICES FINANCED BY USAID Waivers § 228.55 Delivery services. (a) Ocean transportation. A... case of bulk cargoes and large cargoes carried by liners; (2) Eligible vessels provide liner...

  5. Evaluating Cellular Instrumentation on Rural Handpumps to Improve Service Delivery-A Longitudinal Study in Rural Rwanda.

    PubMed

    Nagel, Corey; Beach, Jack; Iribagiza, Chantal; Thomas, Evan A

    2015-12-15

    In rural sub-Saharan Africa, where handpumps are common, 10-67% are nonfunctional at any one time, and many never get repaired. Increased reliability requires improved monitoring and responsiveness of maintenance providers. In 2014, 181 cellular enabled water pump use sensors were installed in three provinces of Rwanda. In three arms, the nominal maintenance model was compared against a "best practice" circuit rider model, and an "ambulance" service model. In only the ambulance model was the sensor data available to the implementer, and used to dispatch technicians. The study ran for seven months in 2014-2015. In the study period, the nominal maintenance group had a median time to successful repair of approximately 152 days, with a mean per-pump functionality of about 68%. In the circuit rider group, the median time to successful repair was nearly 57 days, with a per-pump functionality mean of nearly 73%. In the ambulance service group, the successful repair interval was nearly 21 days with a functionality mean of nearly 91%. An indicative cost analysis suggests that the cost per functional pump per year is approximately similar between the three models. However, the benefits of reliable water service may justify greater focus on servicing models over installation models.

  6. 42 CFR 460.98 - Service delivery.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Service delivery. 460.98 Section 460.98 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... medical, health, and social services that integrate acute and long-term care. (2) These services must...

  7. Health Service Delivery in Developing Countries

    ERIC Educational Resources Information Center

    Benyoussef, Amor

    1977-01-01

    Reviews recent work dealing with methodological and technical issues in health and development; presents examples of the application of social sciences, including health demography and economics, in questions of health services delivery; and analyzes delivery of health services to rural and nomadic populations in Africa, Asia, and Latin America.…

  8. 78 FR 16753 - Service Delivery Plan; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-18

    ... ADMINISTRATION Service Delivery Plan; Correction AGENCY: Social Security Administration. ACTION: Notice; request... SUMMARY caption insert the following hyper-links. In the first sentence after the words, ``Service Delivery Plan (SDP) insert http://www.ssa.gov/open/SDP . In ] addition, in the third sentence after...

  9. Health Service Delivery in Developing Countries

    ERIC Educational Resources Information Center

    Benyoussef, Amor

    1977-01-01

    Reviews recent work dealing with methodological and technical issues in health and development; presents examples of the application of social sciences, including health demography and economics, in questions of health services delivery; and analyzes delivery of health services to rural and nomadic populations in Africa, Asia, and Latin America.…

  10. Potential use of mobile phones in improving animal health service delivery in underserved rural areas: experience from Kilosa and Gairo districts in Tanzania.

    PubMed

    Karimuribo, Esron D; Batamuzi, Emmanuel K; Massawe, Lucas B; Silayo, Richard S; Mgongo, Frederick O K; Kimbita, Elikira; Wambura, Raphael M

    2016-10-07

    Sub-optimal performance of the animal health delivery system in rural areas is common in developing countries including Tanzania. However, penetration of mobile phones and availability of good road network and public transport systems offer opportunities for improving the access of rural communities to diagnostic and advisory services from facilities and expertise located in urban areas. A questionnaire survey on possession and use of mobile phones by pastoral and agro-pastoral communities in Kilosa and Gairo districts was carried out between November and December 2015. A total number of 138 livestock keepers from three villages of Chakwale (54), Mvumi (41) and Parakuyo (43) participated in the study. An e-based system was designed and tested to link rural communities with urban diagnostic facilities. It was observed that the average number of phones possessed by individuals interviewed and household families was 1.1 ± 0.26 (1-2) and 3.5 ± 2.23 (1-10), respectively. It was further observed that out of 138 livestock keepers interviewed, 133 (96.4 %) had feature phones while 10 (7.2 %) of them possessed smartphones. Mobile phone is currently used to support livestock production by communicating on animal health in Parakuyo (18, 41.9 %), Mvumi (18, 43.9 %) and Chakwale (14, 25.9 %). Other contributions of mobile phones in livestock and crop agriculture observed in the study area include: exchange of livestock price information, crop price information, communicating on plant health/diseases, livestock extension and advisory services as well as crop farming extension and advisory services. We also designed and tested an e-based SUAVetDiag® system to support timely diagnosis of infectious disease conditions and prompt advice on case management in veterinary underserved areas. Availability of mobile phones in rural areas, in combination with supporting infrastructure and facilities in urban areas, has potential to stimulate local development and improving

  11. Using a registry to improve immunization delivery.

    PubMed

    Kairys, Steven W; Gubernick, Ruth S; Millican, Adrienne; Adams, William G

    2006-07-01

    The NJIPSP was successful in encouraging a group of small urban practices to adopt the use of immunization registry and to transform immunization delivery from a mechanistic well-child service to a visible, monitored process of care. The project represents a unique combination of technology, public-private collaboration, and well-established quality improvement techniques. The change process involved the whole office as a team in adopting new immunization delivery roles and services. The greatest barrier to acceptance of the registry was (and continues to be) the need for manual data entry as the primary source of data collection, rather than electronic data transfer from other systems. The manual entry of data was labor intensive for participating practices and affected data measurement. Despite this barrier, however, the majority of practices substantially improved the quality of their immunization delivery practices in multiple areas. The rapid movement of primary care practices toward some form of electronic record may reduce this barrier and increase the percentage of practices willing to use a community registry. Practices that engaged collectively in the change process gained momentum from the group effort. Equally important was the public health partnership that helped identify and reduce improvement obstacles. Sustainability of practice-based immunization changes will rely, in part, on the registry's ease of use and the continued visibility of public health at the practice level. Active practice level collaboration by public health adds great value to change efforts. We believe that the best possible immunization delivery relies on both technology (registries and the EMR) and effective office systems. Projects like the NJIPSP are models for systems that integrate technology, practice change, and quality improvement, and their success has the potential to foster the spread of this approach to other primary care practices (especially in New Jersey). The

  12. A case study using a patient satisfaction survey to improve the delivery and effectiveness of drug addiction treatment services: marketing implications and organizational impact.

    PubMed

    Hogan, Beth; Hershey, Lewis; Ritchey, Steven

    2007-01-01

    Drug abuse and addiction continues to negatively impact many lives in this country. The United States health care system has grappled with how to best serve this vulnerable population. Since the personal and societal costs of addiction are high, all recent iterations of the United States strategic health plans (such as Healthy People 2010) have prioritized this area for improvement. At the local level, health care providers who care for those with addictions are challenged with shrinking insurance coverage for services, a difficult patient population, lack of treatment options, growing ranks of indigent patients, as well as a plethora of additional management challenges. It is known that successful treatment is integrally linked with patient satisfaction with services. The most critical factors in successful addiction treatment (from a patient's perspective) are (1) their belief that the counselor cares about them and, (2) their belief that they can recover. This paper reports a case study in the use of a patient satisfaction survey as a quality management/service refinement tool within a methadone treatment setting. Results indicate that the use of the survey itself provides patients with a tangible cue supporting the presence of the critical success factors. Further, the use of a survey provides a baseline for future measurements and trending. The paper concludes with a discussion of the marketing and organizational implications of incorporating the patient satisfaction survey into the ongoing delivery program for addiction services.

  13. Commercial Document Delivery Services "Challenged" as EBSCO Drops Service.

    ERIC Educational Resources Information Center

    Machovec, George S.

    1998-01-01

    Discusses the EBSCO decision to stop its traditional commercial document delivery business. High prices for copyright clearance, government subsidized services, electronic formats available on the Internet, Web-based services, and consortium-based licensing activities are discussed as influencing the market for document delivery. (LRW)

  14. Commercial Document Delivery Services "Challenged" as EBSCO Drops Service.

    ERIC Educational Resources Information Center

    Machovec, George S.

    1998-01-01

    Discusses the EBSCO decision to stop its traditional commercial document delivery business. High prices for copyright clearance, government subsidized services, electronic formats available on the Internet, Web-based services, and consortium-based licensing activities are discussed as influencing the market for document delivery. (LRW)

  15. Improving Transportation Services for the University of the Thai Chamber of Commerce: A Case Study on Solving the Mixed-Fleet Vehicle Routing Problem with Split Deliveries

    NASA Astrophysics Data System (ADS)

    Suthikarnnarunai, N.; Olinick, E.

    2009-01-01

    We present a case study on the application of techniques for solving the Vehicle Routing Problem (VRP) to improve the transportation service provided by the University of The Thai Chamber of Commerce to its staff. The problem is modeled as VRP with time windows, split deliveries, and a mixed fleet. An exact algorithm and a heuristic solution procedure are developed to solve the problem and implemented in the AMPL modeling language and CPLEX Integer Programming solver. Empirical results indicate that the heuristic can find relatively good solutions in a small fraction of the time required by the exact method. We also perform sensitivity analysis and find that a savings in outsourcing cost can be achieved with a small increase in vehicle capacity.

  16. A preliminary model of wheelchair service delivery.

    PubMed

    Eggers, Sara L; Myaskovsky, Larissa; Burkitt, Kelly H; Tolerico, Michelle; Switzer, Galen E; Fine, Michael J; Boninger, Michael L

    2009-06-01

    To integrate and expand on previously published models of wheelchair service delivery, and provide a preliminary framework for developing more comprehensive, descriptive models of wheelchair service delivery for adults with spinal cord injury within the U.S. health care system. Literature review and a qualitative analysis of in-depth interviews. Not applicable. Ten academic, clinical, regulatory, and industry experts (Department of Veterans Affairs [VA] and non-VA) in wheelchair service delivery. Not applicable. Interviewees were asked to discuss the full range of variables and stakeholders involved in wheelchair service delivery, and to limit their scope to the provision of primary subsequent or replacement chairs (not backup chairs) to adults within the United States. Most experts we interviewed stressed that clients who require a wheelchair play a central role in the wheelchair service delivery process. Providers (including clinicians, rehabilitation engineers, and rehabilitation counselors) are also critical stakeholders. More so than in other health care settings, suppliers play an integral role in the provision of wheelchairs to clients and may significantly influence the appropriateness of the wheelchair provided. Suppliers often have a direct role in wheelchair service delivery through their interactions with the clinician and/or client. This model also identified a number of system-level factors (including facility administration and standards, policies, and regulations) that influence wheelchair service delivery and ultimately the appropriateness of the wheelchair provided. We developed a detailed, descriptive model of wheelchair service delivery that integrates the delivery process and device outcomes, and includes the patient-level, provider-level, and system-level factors that may directly influence those processes and outcomes. We believe that this detailed model can help clinicians and researchers describe and consider the complexities of wheelchair

  17. 78 FR 8596 - Hartford Financial Services Group, Inc., Commercial/Actuarial/ Information Delivery Services (IDS...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-06

    .../ Information Delivery Services (IDS)/Corporate & Financial Reporting Group, Hartford, CT; Notice of Negative... Services Group, Inc., Commercial/Actuarial/Information Delivery Services (IDS)/Corporate & Financial... Hartford Financial Services Group, Inc., Commercial/Actuarial/Information Delivery Services...

  18. The prevention of mother-to-child transmission of HIV cascade analysis tool: supporting health managers to improve facility-level service delivery.

    PubMed

    Gimbel, Sarah; Voss, Joachim; Mercer, Mary Anne; Zierler, Brenda; Gloyd, Stephen; Coutinho, Maria de Joana; Floriano, Florencia; Cuembelo, Maria de Fatima; Einberg, Jennifer; Sherr, Kenneth

    2014-10-21

    The objective of the prevention of Mother-to-Child Transmission (pMTCT) cascade analysis tool is to provide frontline health managers at the facility level with the means to rapidly, independently and quantitatively track patient flows through the pMTCT cascade, and readily identify priority areas for clinic-level improvement interventions. Over a period of six months, five experienced maternal-child health managers and researchers iteratively adapted and tested this systems analysis tool for pMTCT services. They prioritized components of the pMTCT cascade for inclusion, disseminated multiple versions to 27 health managers and piloted it in five facilities. Process mapping techniques were used to chart PMTCT cascade steps in these five facilities, to document antenatal care attendance, HIV testing and counseling, provision of prophylactic anti-retrovirals, safe delivery, safe infant feeding, infant follow-up including HIV testing, and family planning, in order to obtain site-specific knowledge of service delivery. Seven pMTCT cascade steps were included in the Excel-based final tool. Prevalence calculations were incorporated as sub-headings under relevant steps. Cells not requiring data inputs were locked, wording was simplified and stepwise drop-offs and maximization functions were included at key steps along the cascade. While the drop off function allows health workers to rapidly assess how many patients were lost at each step, the maximization function details the additional people served if only one step improves to 100% capacity while others stay constant. Our experience suggests that adaptation of a cascade analysis tool for facility-level pMTCT services is feasible and appropriate as a starting point for discussions of where to implement improvement strategies. The resulting tool facilitates the engagement of frontline health workers and managers who fill out, interpret, apply the tool, and then follow up with quality improvement activities. Research on

  19. Transition age youth in publicly funded systems: identifying high-risk youth for policy planning and improved service delivery.

    PubMed

    Heflinger, Craig Anne; Hoffman, Cheri

    2008-10-01

    Youth with Serious Emotional Disturbances (SED) face many challenges as they approach the transition to adulthood and adult services. This study examines publicly funded transition-age youth in order to describe the numbers and type of youth in need of policy and service planning in one state. Using Medicaid enrollment and claims/encounter data, youth with high risk of transition difficulties were identified in the following groups: SED, state custody/foster care or risk of custody, users of intensive or frequent mental health services, or having diagnoses of major mental disorders, conduct disorders, or developmental disabilities. Almost one quarter of all enrolled 14 to 17-year olds met criteria for at least one of the high risk groups, and three-quarters of these were youth with SED. High risk youth are described, with greater detail on those with SED, and implications for policy, services, and research are discussed.

  20. An Integrated Tiered Service Delivery Model (ITSDM) Based on Local CD4 Testing Demands Can Improve Turn-Around Times and Save Costs whilst Ensuring Accessible and Scalable CD4 Services across a National Programme

    PubMed Central

    Glencross, Deborah K.; Coetzee, Lindi M.; Cassim, Naseem

    2014-01-01

    Background The South African National Health Laboratory Service (NHLS) responded to HIV treatment initiatives with two-tiered CD4 laboratory services in 2004. Increasing programmatic burden, as more patients access anti-retroviral therapy (ART), has demanded extending CD4 services to meet increasing clinical needs. The aim of this study was to review existing services and develop a service-model that integrated laboratory-based and point-of-care testing (POCT), to extend national coverage, improve local turn-around/(TAT) and contain programmatic costs. Methods NHLS Corporate Data Warehouse CD4 data, from 60–70 laboratories and 4756 referring health facilities was reviewed for referral laboratory workload, respective referring facility volumes and related TAT, from 2009–2012. Results An integrated tiered service delivery model (ITSDM) is proposed. Tier-1/POCT delivers CD4 testing at single health-clinics providing ART in hard-to-reach areas (<5 samples/day). Laboratory-based testing is extended with Tier-2/POC-Hubs (processing ≤30–40 CD4 samples/day), consolidating POCT across 8–10 health-clinics with other HIV-related testing and Tier-3/‘community’ laboratories, serving ≤40 health-clinics, processing ≤150 samples/day. Existing Tier-4/‘regional’ laboratories serve ≤100 facilities and process <350 samples/day; Tier-5 are high-volume ‘metro’/centralized laboratories (>350–1500 tests/day, serving ≥200 health-clinics). Tier-6 provides national support for standardisation, harmonization and quality across the organization. Conclusion The ITSDM offers improved local TAT by extending CD4 services into rural/remote areas with new Tier-3 or Tier-2/POC-Hub services installed in existing community laboratories, most with developed infrastructure. The advantage of lower laboratory CD4 costs and use of existing infrastructure enables subsidization of delivery of more expensive POC services, into hard-to-reach districts without reasonable access to

  1. Clinical Issues in Mental Health Service Delivery to Refugees.

    ERIC Educational Resources Information Center

    Gong-Guy, Elizabeth; And Others

    1991-01-01

    Serious limitations exist in the delivery of mental health services to refugees throughout the resettlement process: fragmentation, instability, language barriers, culturally inappropriate treatment methods, and severe staff shortages. Suggested improvements for refugee mental health services emphasize outreach, prevention, treatment approaches,…

  2. The leadership of communities in HIV service delivery.

    PubMed

    Barr, David; Odetoyinbo, Morolake; Mworeko, Lillian; Greenberg, Julia

    2015-07-01

    HIV treatment and prevention strategies are life-long endeavours, requiring not only comprehensive, high-quality, consistent and equitable medical services but also appropriate political and cultural milieus to be effective. Communities directly affected by HIV offer a unique expertise and understanding in developing services to meet the needs of people seeking out and utilizing HIV treatment, prevention and support services. Through their organizations and networks, and through partnerships with health systems, these communities provide leadership, services and advocacy to ensure the delivery of high-quality, comprehensive services to meet the needs of diverse populations affected by HIV. This article describes integrated approaches to service delivery in which affected communities play a key role in the development and implementation of HIV programmes. Further scale-up of these approaches to care can improve overall quality, reduce stigma and discrimination, increase demand for services and improve retention in care.

  3. Using Quality Concepts to Improve Reference Services.

    ERIC Educational Resources Information Center

    Brown, Janet Dagenais

    1994-01-01

    Discusses how to improve library reference service, especially the effective delivery of accurate answers, based on a program at Wichita State University (Kansas) that used concepts of quality from business and organizational management. Topics addressed include customers and customer service, and methods of reference service evaluation. (Contains…

  4. Automation of the CAS Document Delivery Service.

    ERIC Educational Resources Information Center

    Steensland, M. C.; Soukup, K. M.

    1986-01-01

    The automation of online order retrieval for Chemical Abstracts Service Document Delivery Service was accomplished by shifting to an order retrieval/dispatch process linked to a Unix network. The Unix-based environment, its terminal emulation, page-break, and user-friendly interface software, and later enhancements are reviewed. Resultant increase…

  5. Automation of the CAS Document Delivery Service.

    ERIC Educational Resources Information Center

    Steensland, M. C.; Soukup, K. M.

    1986-01-01

    The automation of online order retrieval for Chemical Abstracts Service Document Delivery Service was accomplished by shifting to an order retrieval/dispatch process linked to a Unix network. The Unix-based environment, its terminal emulation, page-break, and user-friendly interface software, and later enhancements are reviewed. Resultant increase…

  6. Improving Access to Primary Care for Adolescents: School Health Centers as a Service Delivery Strategy. MCH Policy Research Brief.

    ERIC Educational Resources Information Center

    Santelli, John; Morreale, Madlyn; Wigton, Alyssa; Grason, Holly

    Recognizing that school-based health centers are one of the most promising recent innovations to address the health and related needs of adolescents, this report provides information on these centers as a strategy to improve the access of adolescents to primary care. The report is intended to assist state and local Maternal and Child Health (MCH)…

  7. Development of a multi stakeholder partnership to improve access to and delivery of neurosurgical services in Ontario.

    PubMed

    Sharma, Sunjay; Bohn, Des; Mikroyiannakis, Iphigenia; Trowbridge, Joslyn; Thompson, Donna; Bell, Robert; Rutka, James

    2017-02-01

    Neurosurgical emergencies require expedient access to definitive care at neurosurgical centers. Neurosurgical resources in province of Ontario are highly centralized, and subsequently, most patients with neurosurgical emergencies will present to non-neurosurgical centers. From 2000-2010, metrics demonstrated the organization of neurosurgical resources might not be optimal. In response to this a program entitled Provincial Neurosurgery Ontario (PNO)- was formed to address these issues in cooperation with neurosurgeons, hospitals and the provincial government. PNO worked with multiple stakeholders to implement interventions to not only prevent out of country transfer, but to also improve the flow of neurosurgical patients in the province and potentially improve outcome. The main interventions undertaken by PNO were: 1) implementation and development of a province-wide tele-radiology system; 2) development of neurosurgery as a provincially-funded program; 3) significant outreach to non-neurosurgical centers; and 4) specialized funding packages for highly specialized level care. This report provides background on the challenges faced by neurosurgery in the province of Ontario and the process developed to address these challenges. Finally, we describe the impact provincial strategies have had on improving access to emergency neurosurgical care in the Ontario.

  8. Improving the performance of the health service delivery system? Lessons from the Towards Unity for Health projects.

    PubMed

    Groene, Oliver; Branda, Luis A

    2006-11-01

    The World Health Organization developed the Towards Unity for Health (TUFH) strategy in 2000 for the improvement of health system performance. Twelve projects worldwide were supported to put this strategy into practice. A standard evaluation and monitoring framework was developed on the basis of which project coordinators prepared technical progress reports. To review the utility and effectiveness of the evaluation criteria recommended by TUFH and their application in four of the original twelve projects. We reviewed status reports provided by European project coordinators and developed a standardized reporting template to extract information using original TUFH evaluation criteria. The original TUFH evaluation framework is very comprehensive and has only partly been followed by the field projects. The evaluation strategies employed by the projects were insufficient to demonstrate the connections between the intervention and the desired process improvements, and few of the evaluation measures address outcomes. The evaluation strategies employed by the projects are limited in allowing us to associate the intervention with the desired process improvements. Few measures address outcomes. The evaluation of complex community interventions poses many challenges, however, tools are available to assess impact on structures and process, and selected outcome indicators may be identified to monitor progress in future projects. Based on the review of evaluation status of the TUFH projects and resources available we recommend moving away from uniform evaluation and towards monitoring minimal, context-specific performance indicators criteria.

  9. 20 CFR 628.405 - Service delivery areas.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Service delivery areas. 628.405 Section 628... TITLE II OF THE JOB TRAINING PARTNERSHIP ACT Local Service Delivery System § 628.405 Service delivery... evaluate the degree to which a proposed service delivery area meets criteria established by the...

  10. 20 CFR 628.405 - Service delivery areas.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Service delivery areas. 628.405 Section 628... TITLE II OF THE JOB TRAINING PARTNERSHIP ACT Local Service Delivery System § 628.405 Service delivery... evaluate the degree to which a proposed service delivery area meets criteria established by the...

  11. Satellite delivery of B-ISDN services

    NASA Technical Reports Server (NTRS)

    Kwan, R. K.; Price, K. M.; Chitre, D. M.; White, L. W.; Henderson, T. R.

    1992-01-01

    This paper will address the role of technology in the satellite delivery of B-ISDN services. Satellites excel in serving remote users and in providing multicast and broadcast services. Benefits to potential users employing these satellite broadband services will be examined together with their respective network architecture. Two application requirements are then proposed. The critical technologies needed in the realization of these architectures will be identified.

  12. Improving quality of care using a diabetes registry and disease management services in an integrated delivery network.

    PubMed

    Campion, Francis X; Tully, George L; Barrett, Jo-Ann; Andre, Paulo; Sweeney, Ann

    2005-08-01

    Disease management for chronic conditions is a call for collaboration among all parties of the health care system. The Caritas Christi Health Care System established a unified American Diabetes Association (ADA) recognized outpatient diabetes self-management education program (DSME) in each of its six hospital communities and has established an Internet data portal with managed care organizations to improve preventive care for thousands of patients with diabetes. This article describes the stepwise process of building the successful Caritas Diabetes Care Program and the central role of the Caritas Diabetes Registry over a 5-year period.

  13. Delivery of Clinical Preventive Services in Family Medicine Offices

    PubMed Central

    Crabtree, Benjamin F.; Miller, William L.; Tallia, Alfred F.; Cohen, Deborah J.; DiCicco-Bloom, Barbara; McIlvain, Helen E.; Aita, Virginia A.; Scott, John G.; Gregory, Patrice B.; Stange, Kurt C.; McDaniel, Reuben R.

    2005-01-01

    BACKGROUND This study aimed to elucidate how clinical preventive services are delivered in family practices and how this information might inform improvement efforts. METHODS We used a comparative case study design to observe clinical preventive service delivery in 18 purposefully selected Midwestern family medicine offices from 1997 to 1999. Medical records, observation of outpatient encounters, and patient exit cards were used to calculate practice-level rates of delivery of clinical preventive services. Field notes from direct observation of clinical encounters and prolonged observation of the practice and transcripts from in-depth interviews of practice staff and physicians were systematically examined to identify approaches to delivering clinical preventive services recommended by the US Preventive Services Task Force. RESULTS Practices developed individualized approaches for delivering clinical preventive services, with no one approach being successful across practices. Clinicians acknowledged a 3-fold mission of providing acute care, managing chronic problems, and prevention, but only some made prevention a priority. The clinical encounter was a central focus for preventive service delivery in all practices. Preventive services delivery rates often appeared to be influenced by competing demands within the clinical encounter (including between different preventive services), having a physician champion who prioritized prevention, and economic concerns. CONCLUSIONS Practice quality improvement efforts that assume there is an optimal approach for delivering clinical preventive services fail to account for practices’ propensity to optimize care processes to meet local contexts. Interventions to enhance clinical preventive service delivery should be tailored to meet the local needs of practices and their patient populations. PMID:16189059

  14. Local Staff Enhances Service Delivery.

    ERIC Educational Resources Information Center

    Schlaht, Dell H.

    1986-01-01

    Describes how the Blackfeet Head Start Program uses professionals to train local residents as screeners and home trainers for preschool handicapped children. Notes that numbers of handicapped children and their families who receive services have increased as a result of using local home trainers and teachers as direct care providers. (JHZ)

  15. Personalizing knowledge delivery services: a conceptual framework

    NASA Technical Reports Server (NTRS)

    Majchrzak, Ann; Chelleppa, Ramnath K.; Cooper, Lynne P.; Hars, Alexander

    2003-01-01

    Consistent with the call of the Minnesota Symposium for new theory in knowledge management, we offer a new conceptualization of Knowledge Management Systems (KMS) as a portfolio of personalized knowledge delivery services. Borrowing from research on online consumer behavior, we describe the challenges imposed by personalized knowledge delivery services, and suggest design parameters that can help to overcome these challenges. We develop our design constructs through a set of hypotheses and discuss the research implications of our new conceptualization. Finally, we describe practical implications suggested by our conceptualization - practical suggestions that we hope to gain some experience with as part of an ongoing action research project at our partner organization.

  16. Personalizing knowledge delivery services: a conceptual framework

    NASA Technical Reports Server (NTRS)

    Majchrzak, Ann; Chelleppa, Ramnath K.; Cooper, Lynne P.; Hars, Alexander

    2003-01-01

    Consistent with the call of the Minnesota Symposium for new theory in knowledge management, we offer a new conceptualization of Knowledge Management Systems (KMS) as a portfolio of personalized knowledge delivery services. Borrowing from research on online consumer behavior, we describe the challenges imposed by personalized knowledge delivery services, and suggest design parameters that can help to overcome these challenges. We develop our design constructs through a set of hypotheses and discuss the research implications of our new conceptualization. Finally, we describe practical implications suggested by our conceptualization - practical suggestions that we hope to gain some experience with as part of an ongoing action research project at our partner organization.

  17. 22 CFR 228.24 - Other delivery services.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Other delivery services. 228.24 Section 228.24... for USAID Financing § 228.24 Other delivery services. No source or nationality rules apply to other delivery services, such as export packing, loading, commodity inspection services, and services of...

  18. 22 CFR 228.24 - Other delivery services.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Other delivery services. 228.24 Section 228.24... for USAID Financing § 228.24 Other delivery services. No source or nationality rules apply to other delivery services, such as export packing, loading, commodity inspection services, and services of...

  19. The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis

    PubMed Central

    Free, Caroline; Phillips, Gemma; Watson, Louise; Galli, Leandro; Felix, Lambert; Edwards, Phil; Patel, Vikram; Haines, Andy

    2013-01-01

    Background Mobile health interventions could have beneficial effects on health care delivery processes. We aimed to conduct a systematic review of controlled trials of mobile technology interventions to improve health care delivery processes. Methods and Findings We searched for all controlled trials of mobile technology based health interventions using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990–Sept 2010). Two authors independently extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and we used random effects meta-analysis to give pooled estimates. We identified 42 trials. None of the trials had low risk of bias. Seven trials of health care provider support reported 25 outcomes regarding appropriate disease management, of which 11 showed statistically significant benefits. One trial reported a statistically significant improvement in nurse/surgeon communication using mobile phones. Two trials reported statistically significant reductions in correct diagnoses using mobile technology photos compared to gold standard. The pooled effect on appointment attendance using text message (short message service or SMS) reminders versus no reminder was increased, with a relative risk (RR) of 1.06 (95% CI 1.05–1.07, I 2 = 6%). The pooled effects on the number of cancelled appointments was not significantly increased RR 1.08 (95% CI 0.89–1.30). There was no difference in attendance using SMS reminders versus other reminders (RR 0.98, 95% CI 0.94–1.02, respectively). To address the limitation of the older search, we also reviewed more recent literature. Conclusions The results for health care provider support interventions on diagnosis and management outcomes are generally consistent with modest benefits. Trials using mobile technology-based photos reported reductions in correct diagnoses when compared to the gold

  20. The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis.

    PubMed

    Free, Caroline; Phillips, Gemma; Watson, Louise; Galli, Leandro; Felix, Lambert; Edwards, Phil; Patel, Vikram; Haines, Andy

    2013-01-01

    Mobile health interventions could have beneficial effects on health care delivery processes. We aimed to conduct a systematic review of controlled trials of mobile technology interventions to improve health care delivery processes. We searched for all controlled trials of mobile technology based health interventions using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990-Sept 2010). Two authors independently extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and we used random effects meta-analysis to give pooled estimates. We identified 42 trials. None of the trials had low risk of bias. Seven trials of health care provider support reported 25 outcomes regarding appropriate disease management, of which 11 showed statistically significant benefits. One trial reported a statistically significant improvement in nurse/surgeon communication using mobile phones. Two trials reported statistically significant reductions in correct diagnoses using mobile technology photos compared to gold standard. The pooled effect on appointment attendance using text message (short message service or SMS) reminders versus no reminder was increased, with a relative risk (RR) of 1.06 (95% CI 1.05-1.07, I(2) = 6%). The pooled effects on the number of cancelled appointments was not significantly increased RR 1.08 (95% CI 0.89-1.30). There was no difference in attendance using SMS reminders versus other reminders (RR 0.98, 95% CI 0.94-1.02, respectively). To address the limitation of the older search, we also reviewed more recent literature. The results for health care provider support interventions on diagnosis and management outcomes are generally consistent with modest benefits. Trials using mobile technology-based photos reported reductions in correct diagnoses when compared to the gold standard. SMS appointment reminders have modest

  1. 22 CFR 201.13 - Eligibility of delivery services.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Eligibility of delivery services. 201.13... for USAID Financing § 201.13 Eligibility of delivery services. (a) General. Delivery of USAID-financed commodities may be financed under the implementing document provided the delivery services meet...

  2. 22 CFR 201.13 - Eligibility of delivery services.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Eligibility of delivery services. 201.13... for USAID Financing § 201.13 Eligibility of delivery services. (a) General. Delivery of USAID-financed commodities may be financed under the implementing document provided the delivery services meet...

  3. 39 CFR 761.6 - Delivery of Postal Service securities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 39 Postal Service 1 2011-07-01 2011-07-01 false Delivery of Postal Service securities. 761.6 Section 761.6 Postal Service UNITED STATES POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.6 Delivery of Postal Service securities. A Reserve Bank which has received Postal Service...

  4. Delivery of health services to migrant and seasonal farmworkers.

    PubMed

    Arcury, Thomas A; Quandt, Sara A

    2007-01-01

    Farmworkers are low-paid, uninsured employees in an extremely hazardous industry, and they provide an essential service for U.S. society. This review evaluates the delivery of health services to farmworkers. It describes the farmworker population in the United States, noting characteristics (e.g., migratory and immigration status) that limit their access to and utilization of health services. It describes the health services needs of this population, including occupational health, mental health, oral health, and chronic disease treatment. Cultural, structural, legal, financial, and geographic barriers to health services utilization are described. Existing research on health services utilization among farmworkers is discussed. Programs that have been developed to address the barriers to health services utilization among farmworkers are reviewed. Finally, research needed to improve knowledge of farmworker health services utilization is suggested. These research needs include formal evaluations of existing programs and basic research to characterize the health services utilization patterns of farmworkers.

  5. Document Delivery Services: Today's Electronic Scriptoria.

    ERIC Educational Resources Information Center

    Sabosik, Patricia E.

    1992-01-01

    Discusses document delivery services in the light of new technology. Topics addressed include the historical influences of the printing press; the influence of microcomputers on the publishing industry; copyright issues; the changing role of publishers, researchers, and academic librarians; information partnerships among publishers, librarians,…

  6. Service Delivery Models: DEC Recommended Practices.

    ERIC Educational Resources Information Center

    McWilliam, R. A.; Strain, Phillip S.

    This paper lists practices recommended by the Council for Exceptional Children's Division for Early Childhood concerning service delivery models in early intervention and early childhood special education (EI/ECSE) programs for infants and young children with special needs and their families. An introductory section discusses five principles that…

  7. Document Delivery Services: Today's Electronic Scriptoria.

    ERIC Educational Resources Information Center

    Sabosik, Patricia E.

    1992-01-01

    Discusses document delivery services in the light of new technology. Topics addressed include the historical influences of the printing press; the influence of microcomputers on the publishing industry; copyright issues; the changing role of publishers, researchers, and academic librarians; information partnerships among publishers, librarians,…

  8. Students' community health service delivery: experiences of involved parties.

    PubMed

    Greeff, M; van der Walt, E; Strydom, C; Wessels, C; Schutte, P J

    2009-03-01

    For several years the School of Nursing Science and the School of Psychosocial Behavioural Science, of a specific university, have been offering health care services in response to some of the health needs of a disadvantaged community as part of their students' experiential learning. However, these health care services were rendered independently by these two schools, implying that no feedback system existed to evaluate the worth and quality of these student-rendered health care services. The objectives of this research were to explore and describe the experiences of senior nursing and social work students, the experiences of health service delivery organisations concerned and the experiences of the disadvantaged community members receiving such health care services, as well as to investigate which communication models were apparent with regard to the major factors within health communication. An exploratory descriptive qualitative research design was used. Focus group discussions were held, interviews were conducted and field notes taken. Focus group discussions and interviews were transcribed and analysed by the research team to determine themes and sub-themes using the open coding technique. The results of the three groups showed similarities. The health service delivery organisations also identified a communication barrier, although the students were prepared to bridge it. The health service delivery organisations and the community felt positive towards the students and what they offered to the organisations and to the patients. A greater need for multi-disciplinary team work was recognised by al parties concerned. Recommendations focus on improved student accompaniment by lecturers; extending health care delivery to include a multi-disciplinary team approach by students; as well as improving the delivery of health care services.

  9. 22 CFR 201.32 - Suppliers of delivery services.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Suppliers of delivery services. 201.32 Section... COMMODITY TRANSACTIONS FINANCED BY USAID Responsibilities of Suppliers § 201.32 Suppliers of delivery services. (a) Performance of the service contract. The supplier of delivery services financed by...

  10. 39 CFR 761.6 - Delivery of Postal Service securities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Delivery of Postal Service securities. 761.6... POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.6 Delivery of Postal Service securities. A Reserve Bank... obligations under this part by the delivery of Postal Service securities in definitive form to its...

  11. 42 CFR 136a.15 - Health Service Delivery Areas.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Health Service Delivery Areas. 136a.15 Section 136a... Receive Care? § 136a.15 Health Service Delivery Areas. (a) The Indian Health Service will designate and... Federal Indian reservations and areas surrounding those reservations as Health Service Delivery Areas....

  12. Service delivery, community development, and disability.

    PubMed

    Murphy, John W

    2010-01-01

    Service delivery has traditionally been based on market forces. When this is the case, the community becomes a silent partner in this process. Services, accordingly, are directed mostly to correcting personal ills and have little to do with community uplift. Another model, based on the work of Amartya Sen, is available that conceptualizes interventions in a very different way. If understood in the context of community development, the focus of services is social change, rather than merely personal rehabilitation. This reorientation is discussed in this article.

  13. A Comparison of Service Delivery Models for Special Education Middle School Students Receiving Moderate Intervention Services

    ERIC Educational Resources Information Center

    Jones-Mason, Keely S.

    2012-01-01

    In an effort to improve academic performance for students receiving special education services, a large urban school district in Tennessee has implemented Integrated Service Delivery Model. The purpose of this study was to compare the performance of students receiving instruction in self-contained classrooms to the performance of students…

  14. Tackling Quality Improvement in the Delivery Room.

    PubMed

    Lapcharoensap, Wannasiri; Lee, Henry C

    2017-09-01

    Implementation of standardized practices in the delivery room fosters a safe environment to ensure that newborn infants are cared for optimally, whether or not they require extensive resuscitation. Quality improvement (QI) is an excellent methodology for implementation of standardized practices due to the multidisciplinary nature of the delivery room, complexity of tasks involved, and opportunities to track processes and outcomes. This article discusses how the delivery room is a unique environment and presents examples on how to approach delivery room QI. Key areas of potential focus for teams pursuing delivery QI include thermal regulation, optimizing respiratory support, and facilitating team communication. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Telerehabilitation: An Adjunct Service Delivery Model For Early Intervention Services

    PubMed Central

    Cason, Jana

    2011-01-01

    Early Intervention (EI) services for children birth through two years of age are mandated by Part C of the Individuals with Disabilities Education Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telerehabilitation has the potential to build capacity among caregivers and local providers as well as promote family-centered services through remote consultation. This article provides an overview of research related to telerehabilitation and early intervention services; discusses the feasibility of telerehabilitation within traditional EI service delivery models; examines telecommunications technology associated with telerehabilitation; and provides hypothetical case examples designed to illustrate potential applications of telerehabilitation in early intervention. PMID:25945179

  16. Effectiveness of Ng'adakarin Bamocha model in improving access to ante-natal and delivery services among nomadic pastoralist communities of Turkana West and Turkana North Sub-Counties of Kenya

    PubMed Central

    Jillo, Jillo Ali; Ofware, Peter Obonyo; Njuguna, Susan; Mwaura-Tenambergen, Wanja

    2015-01-01

    Introduction Access to maternal and child health care services among the nomadic pastoralists community in Kenya and African continent in general is unacceptably low. In Turkana, only 18.1% of the women had seen a nurse or a midwife for antenatal care during pregnancy while only 1.3% of pregnant women reported delivery at health facilities in 2005. Ng'adakarin BAMOCHA model, based on migratory routes of the Turkana pastoralists and container clinics was adopted in 2007 to improve access to maternal and child health services by the nomads. Methods A cross-sectional study design was used to establish the effectiveness of Ng'adakarin BAMOCHA model on accessibility and uptake of ante-natal care and delivery services. A total of 360 households and 400 households were interviewed for pre-intervention and post-intervention respectively. The study compared the pre-intervention and post-intervention findings. Structured questionnaires and focus group discussion were used for data collection. Results There was no improvement in the fourth ante-natal care visits between pre-intervention and post-intervention groups at 119(51.5%) and 111(41.9%) respectively (p < 0.05). Knowledge of the community on the importance of ANC visits improved from 60%-72% with significance level of p < 0.05. There was a significant increase 6%-17% of deliveries under a skilled health worker (p < 0.05). TBA assisted deliveries increased from 7.5%- 20.2% with a p < 0.05. There was significant reduction in home deliveries from 89.5%-79.5% with a p < 0.05. Conclusion The Ng'adakarin Bamocha model had a positive effect on the improving maternal health care among the nomadic pastoralist community in Turkana. PMID:26301007

  17. 3 CFR 13522 - Executive Order 13522 of December 9, 2009. Creating Labor-Management Forums To Improve Delivery...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Labor-Management Forums To Improve Delivery of Government Services 13522 Order 13522 Presidential... Forums To Improve Delivery of Government Services By the authority vested in me as President by the... improve delivery of services and products to the public while cutting costs and advancing...

  18. Improving: Services for Children

    ERIC Educational Resources Information Center

    Her Majesty's Inspectorate of Education, 2008

    2008-01-01

    This guide to self-evaluation and improvement builds upon the advice given in the publication "A Guide to Evaluating Services for Children and Young People Using Quality Indicators" (HMIE, 2006) (A summary of the quality indicators is reproduced in Appendix I). Local authorities, agencies and professionals who have responsibilities for…

  19. 7 CFR 652.6 - Department delivery of technical services.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Department delivery of technical services. 652.6... General Provisions § 652.6 Department delivery of technical services. (a) The Department may enter into a... technical assistance services that accelerate conservation program delivery. Related technical...

  20. 77 FR 10033 - Advisory Committee International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-21

    ... Committee International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice; FACA... Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of the 2006... related to international postal and delivery services of interest to Advisory Committee members and...

  1. Funhaler spacer: improving adherence without compromising delivery

    PubMed Central

    Watt, P; Clements, B; Devadason, S; Chaney, G

    2003-01-01

    A novel asthma spacer device, the "Funhaler", incorporates incentive toys which are isolated from the main inspiratory circuit by a valve. Here we show that its use does not compromise drug delivery. Improved adherence combined with satisfactory delivery characteristics suggest that the Funhaler may be useful for management of young asthmatics. PMID:12818901

  2. Improving STD services worldwide.

    PubMed

    Frahn, A L

    1998-01-01

    The number of new sexually transmitted disease (STD) cases worldwide continues to rise annually. Many people, however, do not know that they are infected with a STD because STD infection may often remain asymptomatic until the disease reaches an advanced stage. Up to half of STD-infected women either have no symptoms of infection or do not realize that the symptoms they have indicate a need to seek medical care. Many people are uncomfortable discussing STDs. AVSC is helping providers of family planning and other health care services to become more comfortable discussing STDs with their clients and more skilled in diagnosing and treating them. AVSC has been organizing training activities, developing training materials, and conducting research around the world to help improve the quality and availability of STD services. Examples of AVSC work in Bangladesh and the development of training materials to improve STD service providers' counseling and clinical skills are cited. AVSC's STD-related research is designed to help improve the quality and safety of family planning and STD services worldwide. Activities are noted in Russia, South Africa, and some other developing countries.

  3. Assessing family planning service-delivery skills in Kenya.

    PubMed

    Valadez, J J; Transgrud, R; Mbugua, M; Smith, T

    1997-06-01

    This report demonstrates the use of Lot Quality Assurance Sampling (LQAS) to evaluate the technical competence of two cohorts of family planning service providers in Kenya trained with a new curriculum. One cohort had just finished training within two months of the study. The other cohort was the first group trained with the new curriculum about one year before the study. LQAS was adapted from industrial and other public health applications to assess both the individual competence of 30 service providers and the competence of each cohort. Results show that Cohorts One and Two did not differ markedly in the number of tasks needing improvement. However, both cohorts exhibited more tasks needing improvement in counseling skills as compared with physical examination skills or with all other skills. Care-givers who were not currently providing services accounted for most service-delivery problems. This result suggests that providers' use of their skills explains their ability to retain service-delivery skills learned in training to a greater degree than does the amount of time elapsed since they were trained. LQAS proved to be a rapid, easy-to-use empirical method for management decisionmaking for improvement of a family planning training curriculum and services.

  4. Steering healthcare service delivery: a regulatory perspective.

    PubMed

    Prakash, Gyan

    2015-01-01

    The purpose of this paper is to explore regulation in India's healthcare sector and makes recommendations needed for enhancing the healthcare service. The literature was reviewed to understand healthcare's regulatory context. To understand the current healthcare system, qualitative data were collected from state-level officials, public and private hospital staff. A patient survey was performed to assess service quality (QoS). Regulation plays a central role in driving healthcare QoS. India needs to strengthen market and institutional co-production based approaches for steering its healthcare in which delivery processes are complex and pose different challenges. This study assesses current healthcare regulation in an Indian state and presents a framework for studying and strengthening regulation. Agile regulation should be based on service delivery issues (pull approach) rather than monitoring and sanctions based regulatory environment (push approach). Healthcare pitfalls across the world seem to follow similar follies. India's complexity and experience is useful for emerging and developed economies. The author reviewed around 70 publications and synthesised them in healthcare regulatory contexts. Patient's perception of private providers could be a key input towards steering regulation. Identifying gaps across QoS dimensions would be useful in taking corrective measures.

  5. Making Decisions about Service Delivery in Early Childhood Programs

    ERIC Educational Resources Information Center

    Case-Smith, Jane; Holland, Terri

    2009-01-01

    Purpose: This article presents a rationale for specialized services personnel to use fluid models of service delivery and explains how specialized services personnel make decisions about the blend of service delivery methods that will best serve a child. Method: The literature on occupational therapy, physical therapy, and speech-language…

  6. Making Decisions about Service Delivery in Early Childhood Programs

    ERIC Educational Resources Information Center

    Case-Smith, Jane; Holland, Terri

    2009-01-01

    Purpose: This article presents a rationale for specialized services personnel to use fluid models of service delivery and explains how specialized services personnel make decisions about the blend of service delivery methods that will best serve a child. Method: The literature on occupational therapy, physical therapy, and speech-language…

  7. Improving health service delivery for women with diabetes in pregnancy in remote Australia: survey of care in the Northern Territory Diabetes in Pregnancy Partnership.

    PubMed

    Edwards, Laura; Connors, Christine; Whitbread, Cherie; Brown, Alex; Oats, Jeremy; Maple-Brown, Louise

    2014-12-01

    In the Northern Territory (NT), 38% of 3500 births each year are to Indigenous women, 80% of whom live in regional and remote areas. Compared with the general Australian population, rates of pre-existing type 2 diabetes in pregnancy are 10-fold higher and rates of gestational diabetes are 1.5-fold higher among Indigenous women. Current practices in screening for diabetes in pregnancy in remote Australia are not known. To assess current health service delivery for NT women with diabetes in pregnancy (DIP) by surveying healthcare professionals' views and practices in DIP screening and management. A cross-sectional survey of NT healthcare professionals providing clinical care for women with DIP was conducted based on pre-identified themes of communication, care-coordination, education, orientation and guidelines, logistics and access, and information technology. Of the 116 responders to the survey, 78% were primary healthcare professionals, 32% midwives and 25% general practitioners. High staff turnover was evident: of Central Australian professionals, only 33% (urban) and 18% (regional/remote) had been in their current position over 5 years. DIP screening was conducted at first antenatal visit by 66% and at 24-28-week gestation by 81%. Only 50% of respondents agreed that most women at their health service received appropriate care for DIP, and 41% of primary care practitioners were neutral or not confident in their skills to manage DIP. It is promising that many healthcare professionals report following new guidelines in conducting early pregnancy screening for DIP in high risk women. Several challenges were identified in healthcare delivery to a high risk population in remote Australia. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  8. Formulation strategies to improve oral peptide delivery.

    PubMed

    Maher, Sam; Ryan, Ben; Duffy, Aoife; Brayden, David J

    2014-05-01

    Delivery of peptides by the oral route greatly appeals due to commercial, patient convenience and scientific arguments. While there are over 60 injectable peptides marketed worldwide, and many more in development, most delivery strategies do not yet adequately overcome the barriers to oral delivery. Peptides are sensitive to chemical and enzymatic degradation in the intestine, and are poorly permeable across the intestinal epithelium due to sub-optimal physicochemical properties. A successful oral peptide delivery technology should protect potent peptides from presystemic degradation and improve epithelial permeation to achieve a target oral bioavailability with acceptable intra-subject variability. This review provides a comprehensive up-to-date overview of the current status of oral peptide delivery with an emphasis on patented formulations that are yielding promising clinical data.

  9. Potential Impact of Integrated Stigma Mitigation Interventions in Improving HIV/AIDS Service Delivery and Uptake for Key Populations in Senegal

    PubMed Central

    Ketende, Sosthenes; Diouf, Daouda; Drame, Fatou M.; Liestman, Benjamin; Coly, Karleen; Ndour, Cheikh; Turpin, Gnilane; Mboup, Souleymane; Diop, Karim; Toure-Kane, Coumba; Castor, Delivette; Leye-Diouf, Nafissatou; Baral, Stefan

    2017-01-01

    Background: Men who have sex with men (MSM) and female sex workers (FSW) are consistently shown to have a higher burden of HIV compared with other adults in Senegal. This study, HIV Prevention 2.0, evaluates the impact of the 3-tiered integrated stigma mitigation interventions (ISMIs) approach to optimizing HIV service delivery for key populations in Senegal. Methods: Baseline assessment includes a questionnaire and biological testing for HIV. A proportion of participants enrolled into a 24-month longitudinal cohort with questionnaires and biological testing every 3 months. In these preliminary analyses, ISMIs are evaluated from participants in the cohort through uptake of HIV services and implementation outcomes. Results: Overall, 724 MSM and 758 FSW participated in the baseline assessment. HIV prevalence is 30.2% (n = 219/724) among MSM and 5.3% (n = 40/758) among FSW. Fear of seeking health services among MSM is 17.7% (n = 128/724) at baseline, 10.5% (n = 18/172) at month 3, and 9.8% (n = 10/102) at month 6 (P < 0.004); and among FSW is 21.9% (n = 166/758) at baseline, 8.1% (n = 15/185) at month 3, and 10.7% (n = 18/168) at month 6 (P < 0.001). Overall, 63.9% (n = 62/97) of MSM and 82.5% (n = 118/143) of FSW agreed that the intervention is effective in addressing stigma; however, loss to follow-up was 41.1% among MSM and 10% among FSW. Conclusion: Baseline data reinforce the need for stigma mitigation interventions, combined with enhanced linkage and retention to optimize HIV treatment. Preliminary results show high levels of HIV-related risk determinants and suggest the potential utility of the ISMI to decrease perceived stigma relating to engagement in HIV prevention, treatment, and care services among key populations in Senegal. PMID:27930612

  10. 42 CFR 136a.15 - Health Service Delivery Areas.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible To...

  11. 42 CFR 136a.15 - Health Service Delivery Areas.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible To...

  12. 42 CFR 136a.15 - Health Service Delivery Areas.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible...

  13. 42 CFR 136a.15 - Health Service Delivery Areas.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible...

  14. Assistive/rehabilitation technology, disability, and service delivery models.

    PubMed

    Adya, Meera; Samant, Deepti; Scherer, Marcia J; Killeen, Mary; Morris, Michael W

    2012-08-01

    The United Nation's Millennium Development Goals do not explicitly articulate a focus on disability; similar failures in the past resulted in research, policy, and practice that are not generalizable and did not meet the needs of persons with disabilities since they were developed for an "average" population. Academics and professionals in health and other disciplines should have a knowledge base in evidence-based practices that improve well-being and participation of people with disabilities through effective service delivery of assistive technology. Grounded by a theoretical framework that incorporates a multivariate perspective of disability that is acknowledged in the convention on the rights of persons with disabilities and the World Health Organization's International Classification of Functioning, Disability and Health, we present a review of models of assistive technology service delivery and call for future syntheses of the fragmented evidence base that would permit a comparative effectiveness approach to evaluation.

  15. Systematic review of pathways for the delivery of allergy services

    PubMed Central

    Cummins, Carole; Lilford, Richard; Roberts, Tracy

    2017-01-01

    Objectives The incidence and prevalence of allergies worldwide has been increasing and allergy services globally are unable to keep up with this increase in demand. This systematic review aims to understand the delivery of allergy services worldwide, challenges faced and future directions for service delivery. Methods A systematic scoping review of Ovid, EMBASE, HMIC, CINAHL, Cochrane, DARE, NHS EED and INAHTA databases was carried out using predefined inclusion and exclusion criteria. Data on the geographical region, study design and treatment pathways described were collected, and the findings were narratively reported. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results 205 publications were screened and 27 selected for review. Only 3 were prospective studies, and none included a control group. There were no eligible publications identified from North America, Africa, Australia and most parts of Asia. Most publications relate to allergy services in the UK. In general, allergy services globally appear not to have kept pace with increasing demand. The review suggests that primary care practitioners are not being adequately trained in allergy and that there is a paucity of appropriately trained specialists, especially in paediatric allergy. There appear to be considerable barriers to service improvement, including lack of political will and reluctance to allocate funds from local budgets. Conclusions Demand for allergy services appears to have significantly outpaced supply. Primary and secondary care pathways in allergy seem inadequate leading to poor referral practices, delays in patient management and consequently poor outcomes. Improvement of services requires strong public and political engagement. There is a need for well-planned, prospective studies in this area and a few are currently underway. There is no evidence to suggest that any given pathway of service provision is better than

  16. 7 CFR 652.6 - Department delivery of technical services.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 6 2011-01-01 2011-01-01 false Department delivery of technical services. 652.6 Section 652.6 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE SUPPORT ACTIVITIES TECHNICAL SERVICE PROVIDER ASSISTANCE General Provisions § 652.6 Department delivery...

  17. 22 CFR 201.32 - Suppliers of delivery services.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... COMMODITY TRANSACTIONS FINANCED BY USAID Responsibilities of Suppliers § 201.32 Suppliers of delivery services. (a) Performance of the service contract. The supplier of delivery services financed by USAID... Financial Management, USAID, Washington, DC 20523-7792, all adjustments in the purchase price in favor of...

  18. Graduate Student Services: A Study of the Delivery of Services at the Location Where Students Matriculate

    ERIC Educational Resources Information Center

    Burlison, John G.

    2010-01-01

    This dissertation investigates and explores the best method for the delivery of graduate student services. Essentially, there are two methods for delivery of these services. They can be delivered by virtue of centralization or decentralization. Decentralized delivery, for the purpose of this dissertation is the delivery of graduate student…

  19. Engaging children and parents in service design and delivery.

    PubMed

    Bedford Russell, A R; Passant, M; Kitt, H

    2014-12-01

    The involvement of all user groups, including children, young people (CYP) and their parents, encourages people to take responsibility for healthier lifestyle behaviours, improves treatment compliance and leads to more appropriate use of healthcare resources. Initiatives to engage CYP in the UK are gathering momentum, but significant improvements are still needed. There is a national drive from the department of health (DH) and NHS England, strategic clinical networks, operational delivery networks (including newborn networks), charities, parent groups and a number of other bodies to embed CYP involvement in service design and delivery. User engagement and patient choice, is underpinned by the NHS outcomes framework, and a myriad of other DH and NHS England policies and practice frameworks. It is now everybody's business.

  20. Delivery of satellite based broadband services

    NASA Astrophysics Data System (ADS)

    Chandrasekhar, M. G.; Venugopal, D.

    2007-06-01

    Availability of speedy communication links to individuals and organizations is essential to keep pace with the business and social requirements of this modern age. While the PCs have been continuously growing in processing speed and memory capabilities, the availability of broadband communication links still has not been satisfactory in many parts of the world. Recognizing the need to give fillip to the growth of broadband services and improve the broadband penetration, the telecom policies of different counties have placed special emphasis on the same. While emphasis is on the use of fiber optic and copper in local loop, satellite communications systems will play an important role in quickly establishing these services in areas where fiber and other communication systems are not available and are not likely to be available for a long time to come. To make satellite communication systems attractive for the wide spread of these services in a cost effective way special emphasis has to be given on factors affecting the cost of the bandwidth and the equipment. As broadband services are bandwidth demanding, use of bandwidth efficient modulation technique and suitable system architecture are some of the important aspects that need to be examined. Further there is a need to re-look on how information services are provided keeping in view the user requirements and broadcast capability of satellite systems over wide areas. This paper addresses some of the aspects of delivering broadband services via satellite taking Indian requirement as an example.

  1. Improving implementation of evidence-based practice in mental health service delivery: protocol for a cluster randomised quasi-experimental investigation of staff-focused values interventions.

    PubMed

    Williams, Virginia; Oades, Lindsay G; Deane, Frank P; Crowe, Trevor P; Ciarrochi, Joseph; Andresen, Retta

    2013-07-02

    There is growing acceptance that optimal service provision for individuals with severe and recurrent mental illness requires a complementary focus on medical recovery (i.e., symptom management and general functioning) and personal recovery (i.e., having a 'life worth living'). Despite significant research attention and policy-level support, the translation of this vision of healthcare into changed workplace practice continues to elude. Over the past decade, evidence-based training interventions that seek to enhance the knowledge, attitudes, and skills of staff working in the mental health field have been implemented as a primary redress strategy. However, a large body of multi-disciplinary research indicates disappointing rates of training transfer. There is an absence of empirical research that investigates the importance of worker-motivation in the uptake of desired workplace change initiatives. 'Autonomy' is acknowledged as important to human effectiveness and as a correlate of workplace variables like productivity, and wellbeing. To our knowledge, there have been no studies that investigate purposeful and structured use of values-based interventions to facilitate increased autonomy as a means of promoting enhanced implementation of workplace change. This study involves 200 mental health workers across 22 worksites within five community-managed organisations in three Australian states. It involves cluster-randomisation of participants within organisation, by work site, to the experimental (values) condition, or the control (implementation). Both conditions receive two days of training focusing on an evidence-based framework of mental health service delivery. The experimental group receives a third day of values-focused intervention and 12 months of values-focused coaching. Well-validated self-report measures are used to explore variables related to values concordance, autonomy, and self-reported implementation success. Audits of work files and staff work samples

  2. Improving implementation of evidence-based practice in mental health service delivery: protocol for a cluster randomised quasi-experimental investigation of staff-focused values interventions

    PubMed Central

    2013-01-01

    Background There is growing acceptance that optimal service provision for individuals with severe and recurrent mental illness requires a complementary focus on medical recovery (i.e., symptom management and general functioning) and personal recovery (i.e., having a ‘life worth living’). Despite significant research attention and policy-level support, the translation of this vision of healthcare into changed workplace practice continues to elude. Over the past decade, evidence-based training interventions that seek to enhance the knowledge, attitudes, and skills of staff working in the mental health field have been implemented as a primary redress strategy. However, a large body of multi-disciplinary research indicates disappointing rates of training transfer. There is an absence of empirical research that investigates the importance of worker-motivation in the uptake of desired workplace change initiatives. ‘Autonomy’ is acknowledged as important to human effectiveness and as a correlate of workplace variables like productivity, and wellbeing. To our knowledge, there have been no studies that investigate purposeful and structured use of values-based interventions to facilitate increased autonomy as a means of promoting enhanced implementation of workplace change. Methods This study involves 200 mental health workers across 22 worksites within five community-managed organisations in three Australian states. It involves cluster-randomisation of participants within organisation, by work site, to the experimental (values) condition, or the control (implementation). Both conditions receive two days of training focusing on an evidence-based framework of mental health service delivery. The experimental group receives a third day of values-focused intervention and 12 months of values-focused coaching. Well-validated self-report measures are used to explore variables related to values concordance, autonomy, and self-reported implementation success. Audits of work

  3. 20 CFR 652.208 - How are core services and intensive services related to the methods of service delivery described...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... related to the methods of service delivery described in § 652.207(b)(2)? 652.208 Section 652.208... FUNCTIONING OF STATE EMPLOYMENT SERVICES Wagner-Peyser Act Services in a One-Stop Delivery System Environment § 652.208 How are core services and intensive services related to the methods of service...

  4. Integrated delivery systems focus on service delivery after capitation efforts stall.

    PubMed

    2005-03-01

    Integrated delivery systems focus on service delivery after capitation efforts stall. Integrated delivery systems are going through changes that are focusing the provider organizations more on delivering care than managing risk, says Dean C. Coddington, one of the leading researchers into capitated organizations and a senior consultant with McManis Consulting in Denver.

  5. Shaping Tumor Microenvironment for Improving Nanoparticle Delivery.

    PubMed

    Gao, Huile

    2016-01-01

    Tumor microenvironment is so complex that involves in many factors of tumor. Although enhanced permeability and retention effect is a main driving force of tumor targeted nanoparticles, the tumor microenvironment greatly affects the delivery efficiency of nanoparticles. A careful search of the scientific database was performed to find the tumor microenvironment related papers. Then the papers were concluded and reviewed. In tumor, elevated interstitial fluid pressure, abnormal tumor vasculature, dense tumor extracellular matrix and elevated solid stress considerably hinder the extravasation and intratumor penetration of nanoparticles. Therefore, shaping the tumor microenvironment could improve nanoparticle delivery, including vascular normalization, vasculature promotion therapy, lymph normalization, reducing tumor stroma components, elevating blood pressure, elevating receptor expression, cell cycle arrest and priming by cytotoxic therapy. Shaping the tumor microenvironment could considerably enhance the nanoparticles delivery.

  6. Leadership Dynamics Promoting Systemic Reform for Inclusive Service Delivery

    ERIC Educational Resources Information Center

    Scanlan, Martin

    2009-01-01

    This article presents a multicase study of two systems of schools striving to reform service delivery systems for students with special needs. Considering these systems as institutional actors, the study examines what promotes the understanding and implementation of special education service delivery within a system of schools in a manner that…

  7. Addressing Service Delivery in Remote/Rural Areas.

    ERIC Educational Resources Information Center

    Chezik, Kathryn H.; And Others

    1989-01-01

    The article describes ways in which selected grant funds can and are being applied to delivery of speech and language services in remote/rural areas. Effects of Public Law 99-457 and the Catastrophic Health Care Bill are noted. Examples of alternative forms of service delivery and personnel preparation are given. (DB)

  8. Rehabilitation Technology Service Delivery, 1: A Practical Guide.

    ERIC Educational Resources Information Center

    RESNA: Association for the Advancement of Rehabilitation Technology, Washington, DC.

    The guide consists of six author contributed chapters and is intended to aid in the development of new rehabilitation technology service delivery programs as well as increasing the effectiveness of existing programs. The first chapter, by Roger Smith, describes and evaluates seven models of service delivery in rehabilitation technology. Chapter 2,…

  9. Development, Implementation, and Evaluation of the Apollo Model of Pediatric Rehabilitation Service Delivery

    ERIC Educational Resources Information Center

    Camden, Chantal; Swaine, Bonnie; Tetreault, Sylvie; Bergeron, Sophie; Lambert, Carole

    2013-01-01

    This article presents the experience of a rehabilitation program that undertook the challenge to reorganize its services to address accessibility issues and improve service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical…

  10. Development, Implementation, and Evaluation of the Apollo Model of Pediatric Rehabilitation Service Delivery

    ERIC Educational Resources Information Center

    Camden, Chantal; Swaine, Bonnie; Tetreault, Sylvie; Bergeron, Sophie; Lambert, Carole

    2013-01-01

    This article presents the experience of a rehabilitation program that undertook the challenge to reorganize its services to address accessibility issues and improve service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical…

  11. Combating health care fragmentation through integrated health services delivery networks

    PubMed Central

    Ramagem, Caroline; Urrutia, Soledad; Griffith, Tephany; Cruz, Mario; Fabrega, Ricardo; Holder, Reynaldo; Montenegro, Hernán

    2011-01-01

    Introduction Despite existing initiatives to integrate health services in the Americas Health Care fragmentation remains a significant challenge. Excessive fragmentation leads to difficulties in access to services, delivery of services of poor technical quality, inefficient use of resources, increases in production costs, and low user satisfaction. To address this problem, the Pan American Health Organization (PAHO) has launched the Integrated Health Services Delivery Networks (IHSDN) Initiative to support the development of more accessible, equitable and efficient health care models in the Region [1]. Theory/conceptual framework IHSDN are defined as a network of organizations that provides, or makes arrangements to provide, equitable, comprehensive, and integrated health services to a defined population and is willing to be held accountable for its clinical and economic outcomes and the health status of the population served. IHSDN require 14 essential attributes for their adequate operation grouped according to four principal domains: model of care, governance and strategy, organization and management, and financial allocation and incentives [1]. Methods An extensive literature review, expert meetings and country consultations (national, subregional and regional) in the Americas resulted in a set of consensus-based essential attributes and policy options for implementing IHSDN. Results and conclusions The research and evidence on health services integration remains limited; however, several studies suggest that IHSDN could improve health systems performance. Principal lessons learned include: i) integration processes are difficult, complex and long term; ii) integration requires extensive systemic changes and a commitment by health workers, health service managers and policymakers; and iii) multiple modalities and degrees of integration can coexist within a single system. The public policy objective is to propose a design that meets each system’s specific

  12. Neurofibromatosis type 2 service delivery in England.

    PubMed

    Lloyd, S K; Evans, D G

    2016-01-27

    Neurofibromatosis type 2 (NF2) is a complex disease characterized by the development of multiple schwannomas, especially vestibular schwannomas, as well as other types of benign tumours including meningioma and spinal ependymoma. Due to its multisystem nature, the management of NF2 requires a multidisciplinary approach. In England, the delivery of care for NF2 patients has been centralized to four-"hub" centres in Manchester, Cambridge, Oxford and London each having associated "spoke" centres. Each centre has a core multidisciplinary team consisting of genetics, otolaryngology, neurosurgery, paediatrics, neurology, audiology, radiology, psychology, physiotherapy, specialist nurses and administrative staff. In addition, the core team has access to plastic surgery, ophthalmology, peripheral nerve surgery and adult and paediatric oncology. There are weekly multidisciplinary clinics each with six to eight patients. Each patient is discussed during a team meeting and the management decisions that are made are then discussed with the patients. All patients are reviewed at least annually and have annual head magnetic resonance imaging (MRI) and three yearly spinal MRI. Annual audiological assessment is performed. Cochlear implantation and auditory brainstem implantation are offered if indicated. Surgery, stereotactic radiosurgery and bevacizumab therapy are available for the management of intracranial and spinal tumours. The integration of the service in England has provided significant benefits to patient care and, in the long term, will provide robust patient outcome data that will provide an evidence base to assist in optimizing management of patients with NF2.

  13. Analyzing IT Service Delivery in an ISP from Nicaragua

    NASA Astrophysics Data System (ADS)

    Flores, Johnny; Rusu, Lazar; Johanneson, Paul

    This paper presents a method for analyzing IT service delivery and its application in an Internet Service Provider (ISP). The method proposed is based on ITIL-processes and case study technique; it includes questionnaires for gathering information, semi-structured interviews, focus groups and documents as sources of information for recognition of factual information. The method application allows to the ISP determines its practices and limitations of the IT Service Delivery.

  14. Making government work: Electronic delivery of Federal services

    NASA Astrophysics Data System (ADS)

    1993-09-01

    Federal, State, and local governments face the challenge of delivering better services faster and at less cost at a time when demand is growing and budgets are tighter. Computer and telecommunication technologies offer a number of near-term opportunities for delivering Federal services electronically in partnership with State/local agencies and the private sector. To assure that these technologies benefit all citizens - not just the affluent and highly educated - will require Congress to pay special attention to policy and oversight. It will also require agencies to be innovative and skillful in introducing new electronic delivery systems. The Office of Technology Assessment's (OTA's) assessment of electronic service delivery was requested by Senator John Glenn, Chairman, Senate Committee on Governmental Affairs. This report provides Congress with alternative strategies for improving the performance of government by using modern information technologies. The report offers new perspectives to Congress as it considers reauthorizing the Paperwork Reduction Act and responds to the Administration's 'National Performance Review' and 'National Information Infrastructure' initiatives. More broadly, the report will contribute to the public debate over the role of information technology in reinventing government.

  15. User engagement in the delivery and design of maternity services.

    PubMed

    Patel, Nashita; Rajasingam, Daghni

    2013-08-01

    User engagement is defined as a mutual exchange of information between the patient and the health professional, which has shown to improve patient experience as well as outcomes. Engaging the patient is vital for the healthcare system to remain sustainable. The National Health Service has attempted to incorporate and enhance patient engagement in the delivery of maternity services for the last decade. The financial crisis, changing socio-demographic status, increase in birth rate and public expectations-engaging the patient to take responsibility of their own health has not been achieved. Through in-depth examinations of these barriers we are able to draw conclusions as to why current policies have failed and recommend potential solutions.

  16. Spatial service delivery system for smart licensing & enforcement management

    NASA Astrophysics Data System (ADS)

    Wahap, N. A.; Ismail, N. M.; Nor, N. M.; Ahmad, N.; Omar, M. F.; Termizi, A. A. A.; Zainal, D.; Noordin, N. M.; Mansor, S.

    2016-06-01

    Spatial information has introduced a new sense of urgency for a better understanding of the public needs in term of what, when and where they need services and through which devices, platform or physical locations they need them. The objective of this project is to value- add existing license management process for business premises which comes under the responsibility of Local Authority (PBT). Manipulation of geospatial and tracing technology via mobile platform allows enforcement officers to work in real-time, use a standardized system, improve service delivery, and optimize operation management. This paper will augment the scope and capabilities of proposed concept namely, Smart Licensing/Enforcement Management (SLEm). It will review the current licensing and enforcement practice of selected PBT in comparison to the enhanced method. As a result, the new enhanced system is expected to offer a total solution for licensing/enforcement management whilst increasing efficiency and transparency for smart city management and governance.

  17. Communication Delivery Services in Developing Nations.

    ERIC Educational Resources Information Center

    Lindsay, Robert; And Others

    These five papers discuss the use of communication delivery systems in developing nations. Four of the papers stress the need for developing nations to adapt delivery systems to their national and cultural interests, to receive training in the management and use of the systems, without undue influence from the developing nations whose technology…

  18. User/consumer involvement in mental health service delivery.

    PubMed

    Chamberlin, Judi

    2005-01-01

    The involvement of mental health service users in service delivery is a new and growing phenomenon. Such involvement is complex, given the history of paternalism in the mental health system, the power differential between service providers and service users, and the very differing views each group holds on multiple issues. Unless such differences are addressed, there can be no meaningful involvement. Service user involvement needs to apply to all aspects of the service delivery system, including professional training, service design, delivery, evaluation, and research. User/survivors, and their organizations, have developed a body of experience and knowledge that needs to be recognized and respected. Unless there are multiple opportunities for ongoing and open dialogue on these many difficult issues, real user involvement will not occur.

  19. Inspection program improves bulk cement system delivery

    SciTech Connect

    O'Bannion, T. ); Guidroz, B.; Morris, G. )

    1993-12-20

    A recently implemented survey of pneumatically operated bulk cement-handling equipment offshore has improved bulk cement deliverability on several Gulf of Mexico rigs. The 30-point survey helps ensure an adequate rate of bulk cement delivery throughout the cement job. The inspection survey was developed because the source of many cement job failures was a lack of adequate, steady delivery of bulk cement to the cementing unit during the job. The job failures caused by flow interruptions, plugging of tools by chunks of set cement, and erratic flow resulted in poor primary cement jobs, many of which required remedial cementing jobs. A better-controlled flow of cement may help prevent these types of failure, thereby reducing the number of remedial cement operations. The paper describes the inspection procedures.

  20. An Information Technology Framework for Strengthening Telehealthcare Service Delivery

    PubMed Central

    Chen, Chi-Wen; Weng, Yung-Ching; Shang, Rung-Ji; Yu, Hui-Chu; Chung, Yufang; Lai, Feipei

    2012-01-01

    Abstract Objective: Telehealthcare has been used to provide healthcare service, and information technology infrastructure appears to be essential while providing telehealthcare service. Insufficiencies have been identified, such as lack of integration, need of accommodation of diverse biometric sensors, and accessing diverse networks as different houses have varying facilities, which challenge the promotion of telehealthcare. This study designs an information technology framework to strengthen telehealthcare delivery. Materials and Methods: The proposed framework consists of a system architecture design and a network transmission design. The aim of the framework is to integrate data from existing information systems, to adopt medical informatics standards, to integrate diverse biometric sensors, and to provide different data transmission networks to support a patient's house network despite the facilities. The proposed framework has been evaluated with a case study of two telehealthcare programs, with and without the adoption of the framework. Results: The proposed framework facilitates the functionality of the program and enables steady patient enrollments. The overall patient participations are increased, and the patient outcomes appear positive. The attitudes toward the service and self-improvement also are positive. Conclusions: The findings of this study add up to the construction of a telehealthcare system. Implementing the proposed framework further assists the functionality of the service and enhances the availability of the service and patient acceptances. PMID:23061641

  1. Futures of Service Delivery Systems for Handicapped Individuals. No. 12.

    ERIC Educational Resources Information Center

    Stedman, Donald J.; Wiegerink, Ronald

    Seventeen issues relating to service delivery systems for the handicapped are discussed, including the following: integration of human service systems; meshinq of planning, service, research, and training; installing a monitoring, evaluation, and feedback activity into the planning process; evaluating public education programs; coordinating…

  2. 42 CFR 460.98 - Service delivery.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... services. (3) Restorative therapies, including physical therapy and occupational therapy. (4) Personal care and supportive services. (5) Nutritional counseling. (6) Recreational therapy. (7) Meals. (d) Pace...

  3. 22 CFR 201.13 - Eligibility of delivery services.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... COMMODITY TRANSACTIONS FINANCED BY USAID Conditions Governing the Eligibility of Procurement Transactions for USAID Financing § 201.13 Eligibility of delivery services. (a) General. Delivery of USAID-financed...) Transportation costs. USAID will not finance transportation costs: (1) For shipment beyond the point of entry in...

  4. 22 CFR 201.13 - Eligibility of delivery services.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... COMMODITY TRANSACTIONS FINANCED BY USAID Conditions Governing the Eligibility of Procurement Transactions for USAID Financing § 201.13 Eligibility of delivery services. (a) General. Delivery of USAID-financed...) Transportation costs. USAID will not finance transportation costs: (1) For shipment beyond the point of entry in...

  5. 22 CFR 201.13 - Eligibility of delivery services.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... COMMODITY TRANSACTIONS FINANCED BY USAID Conditions Governing the Eligibility of Procurement Transactions for USAID Financing § 201.13 Eligibility of delivery services. (a) General. Delivery of USAID-financed...) Transportation costs. USAID will not finance transportation costs: (1) For shipment beyond the point of entry in...

  6. Delivery Speed, Timeliness and Satisfaction: Patrons' Perceptions About ILL Service.

    ERIC Educational Resources Information Center

    Weaver-Meyers, Pat L.; Stolt, Wilbur A.

    1996-01-01

    Library users' perceptions of the quality of interlibrary loan service are examined. Ten Greater Midwest Research Libraries Consortium members distributed surveys to patrons. Findings indicate patrons' satisfaction is minimally related to actual delivery speed; satisfaction and perceptions of timeliness are strongly correlated; a delivery speed of…

  7. A Universal Design Approach to Government Service Delivery: The Case of ChileAtiende.

    PubMed

    Sandoval, Leonardo

    2016-01-01

    A common challenge for government administrations that aim to improve the delivery of information and services to citizens is to go beyond a government-centred approach. By focusing on citizens and the needs of a wide range of citizens, Universal Design (UD) can help to increase the effectiveness, efficiency and satisfaction of government services. This paper examines the case of an internationally recognised Chilean government service delivery programme inspired by UD principles known as ChileAtiende ("ChileService"). A brief account of its creation and current status is provided.

  8. Process Improvement: Customer Service.

    PubMed

    Cull, Donald

    2015-01-01

    Utilizing the comment section of patient satisfaction surveys, Clark Memorial Hospital in Jeffersonville, IN went through a thoughtful process to arrive at an experience that patients said they wanted. Two Lean Six Sigma tools were used--the Voice of the Customer (VoC) and the Affinity Diagram. Even when using these tools, a facility will not be able to accomplish everything the patient may want. Guidelines were set and rules were established for the Process Improvement Team in order to lessen frustration, increase focus, and ultimately be successful. The project's success is driven by the team members carrying its message back to their areas. It's about ensuring that everyone is striving to improve the patients' experience by listening to what they say is being done right and what they say can be done better. And then acting on it.

  9. Improving Student Services in Secondary Schools.

    ERIC Educational Resources Information Center

    Maddy-Bernstein, Carolyn; Cunanan, Esmeralda S.

    1995-01-01

    No single comprehensive student services delivery model exists, and "student services" terminology remains problematic. The Office of Student Services has defined student services as those services provided by educational institutions to facilitate learning and the successful transition from school to work, military, or more education. To be…

  10. The Role of Libraries in eHealth Service Delivery in Australia

    ERIC Educational Resources Information Center

    Rao, Sarada

    2009-01-01

    eHealth is an emerging service sector which has great potential to improve health care delivery to rural and remote communities, facilitate health surveillance, and promote health education and research. Despite the critical need for eHealth services in Australia based on the challenges of distance and human resources, its utility has yet to be…

  11. The Role of Libraries in eHealth Service Delivery in Australia

    ERIC Educational Resources Information Center

    Rao, Sarada

    2009-01-01

    eHealth is an emerging service sector which has great potential to improve health care delivery to rural and remote communities, facilitate health surveillance, and promote health education and research. Despite the critical need for eHealth services in Australia based on the challenges of distance and human resources, its utility has yet to be…

  12. Improvement of Job Placement Services.

    ERIC Educational Resources Information Center

    Mount San Antonio Community Coll. District, Walnut, CA.

    The Improvement of Job Placement Services Project was undertaken to examine and strengthen job placement services and programs in the California community colleges. Specific objectives of the project were to: (1) select and convene a 12-member representative advisory committee to oversee project operations working with the California Placement…

  13. Improvement of Job Placement Services.

    ERIC Educational Resources Information Center

    Mount San Antonio Community Coll. District, Walnut, CA.

    The Improvement of Job Placement Services Project was undertaken to examine and strengthen job placement services and programs in the California community colleges. Specific objectives of the project were to: (1) select and convene a 12-member representative advisory committee to oversee project operations working with the California Placement…

  14. 78 FR 55731 - Notice of Service Delivery Area Designation for the Wilton Rancheria

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... HUMAN SERVICES Indian Health Service Notice of Service Delivery Area Designation for the Wilton... Indian Health Service (IHS) proposes the geographic boundaries of the Service Delivery Area (SDA) for the... Contract Health Service Delivery Area (CHSDA), for the purpose of operating a Contract Health Service...

  15. The economics of the delivery of veterinary services.

    PubMed

    Holden, S

    1999-08-01

    Low livestock productivity in many developing countries is commonly considered to reflect, among other factors, the inadequate supply of services to control disease. Veterinary services have traditionally been provided by the state, but public finance constraints have limited the availability and effectiveness of public services. The author explains how economic theory can be used to identify alternative delivery systems (beyond the state) for providing animal health care and proposes new roles for the state and private sector in service delivery. The author highlights a number of barriers that currently limit the potential contribution of the private sector to service delivery, and describes a variety of approaches that have been used by the state to create an enabling environment for the private sector.

  16. Combining Systems and Teamwork Approaches to Enhance the Effectiveness of Safety Improvement Interventions in Surgery: The Safer Delivery of Surgical Services (S3) Program.

    PubMed

    McCulloch, Peter; Morgan, Lauren; New, Steve; Catchpole, Ken; Roberston, Eleanor; Hadi, Mohammed; Pickering, Sharon; Collins, Gary; Griffin, Damian

    2017-01-01

    Patient safety improvement interventions usually address either work systems or team culture. We do not know which is more effective, or whether combining approaches is beneficial. To compare improvement in surgical team performance after interventions addressing teamwork culture, work systems, or both. Suite of 5 identical controlled before-after intervention studies, with preplanned analysis of pooled data for indirect comparisons of strategies. Operating theatres in 5 UK hospitals performing elective orthopedic, plastic, or vascular surgery PARTICIPANTS:: All operating theatres staff, including surgeons, nurses, anaesthetists, and others INTERVENTIONS:: 4-month safety improvement interventions, using teamwork training (TT), systems redesign and standardization (SOP), Lean quality improvement, SOP + TT combination, or Lean + TT combination. Team technical and nontechnical performance and World Health Organization (WHO) checklist compliance, measured for 3 months before and after intervention using validated scales. Pooled data analysis of before-after change in active and control groups, comparing combined versus single and systems versus teamwork interventions, using 2-way ANOVA. We studied 453 operations, (255 intervention, 198 control). TT improved nontechnical skills and WHO compliance (P < 0.001), but not technical performance; systems interventions (Lean & SOP, 2 & 3) improved nontechnical skills and technical performance (P < 0.001) but improved WHO compliance less. Combined interventions (4 & 5) improved all performance measures except WHO time-out attempts, whereas single approaches (1 & 2 & 3) improved WHO compliance less (P < 0.001) and failed to improve technical performance. Safety interventions combining teamwork training and systems rationalization are more effective than those adopting either approach alone. This has important implications for safety improvement strategies in hospitals.

  17. Challenges in immunisation service delivery for refugees in Australia: A health system perspective.

    PubMed

    Mahimbo, A; Seale, H; Smith, M; Heywood, A

    2017-09-12

    Refugees are at risk of being under-immunised in their countries of origin, in transit and post-resettlement in Australia. Whilst studies have focused on identifying barriers to accessibility of health services among refugees, few focus on providers' perspectives on immunisation service delivery to this group. Health service providers are well placed to provide insights into the pragmatic challenges associated with refugee health service delivery, which can be useful in identifying strategies aimed at improving immunisation coverage among this group. A qualitative study involving 30 semi-structured interviews was undertaken with key stakeholders in immunisation service delivery across all States and Territories in Australia between December 2014 and December 2015. Thematic analysis was undertaken. Variability in accessing program funding and vaccines, lack of a national policy for catch-up vaccination, unclear roles and responsibilities for catch-up, a lack of a central immunisation register and insufficient training among general practitioners were seen as the main challenges impacting on immunisation service delivery for refugees. This study provides insight into the challenges that impact on effective immunisation service delivery for refugees. Deliberate strategies such as national funding for relevant vaccines, improved data collection nationally and increased guidance for general practitioners on catch-up immunisation for refugees would help to ensure equitable access across all age groups. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. University Educational Service Delivery Strategy in a Changing World: Implications for Ethical Values and Leadership Integrity in Nigeria

    ERIC Educational Resources Information Center

    Akintayo, D. I.

    2008-01-01

    This paper examined university educational service delivery strategy in a changing world as it affects ethical values and leadership integrity in Nigeria. This was for the purpose of determining appropriate strategies for improving the quality of service delivery system in Nigerian universities. The paper submits that the quality and quantity of…

  19. United Parcel Service Evaluates Hybrid Electric Delivery Vans (Fact Sheet)

    SciTech Connect

    Not Available

    2010-02-01

    This fact sheet describes how the National Renewable Energy Laboratory's Fleet Test and Evaluation team evaluated the 12-month, in-service performance of six Class 4 hybrid electric delivery vans - fueled by regular diesel - and six comparable conventional diesel vans operated by the United Parcel Service.

  20. Service Delivery to Persons with Communication Disorders in Micronesia.

    ERIC Educational Resources Information Center

    Stewart, Jean L.; Martinez, Velma A.

    1986-01-01

    Summarizes factors which make delivery of human services extremely difficult in Micronesia, noting problems of geographic distance and isolation and cultural and linguistic diversity. Presents a plan for providing services to persons with communication disorders using a speech-language pathologist and an audiologist with doctorates to supervise…

  1. The Ghana community-based health planning and services initiative for scaling up service delivery innovation.

    PubMed

    Nyonator, Frank K; Awoonor-Williams, J Koku; Phillips, James F; Jones, Tanya C; Miller, Robert A

    2005-01-01

    Research projects demonstrating ways to improve health services often fail to have an impact on what national health programmes actually do. An approach to evidence-based policy development has been launched in Ghana which bridges the gap between research and programme implementation. After nearly two decades of national debate and investigation into appropriate strategies for service delivery at the periphery, the Community-based Health Planning and Services (CHPS) Initiative has employed strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care. Over a 2-year period, 104 out of the 110 districts in Ghana started CHPS. This paper reviews the development of the CHPS initiative, describes the processes of implementation and relates the initiative to the principles of scaling up organizational change which it embraces. Evidence from the national monitoring and evaluation programme provides insights into CHPS' success and identifies constraints on future progress.

  2. 20 CFR 652.202 - May local Employment Service Offices exist outside of the One-Stop service delivery system?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... outside of the One-Stop service delivery system? 652.202 Section 652.202 Employees' Benefits EMPLOYMENT... SERVICES Wagner-Peyser Act Services in a One-Stop Delivery System Environment § 652.202 May local Employment Service Offices exist outside of the One-Stop service delivery system? (a) No, local...

  3. Collaborative Service Delivery: From Instruction to Implementation

    ERIC Educational Resources Information Center

    Lundblom, Erin Elizabeth Gill

    2012-01-01

    Legal mandates, educational reform, and professional policy changes, have emphasized the need to promote the integration of services for students with communication impairments within the general education curriculum. However, speech-language pathologists (SLPs) continue to report the provision of primarily pull-out services with intervention…

  4. Case Studies in Exemplary Service Delivery

    ERIC Educational Resources Information Center

    Wollard, Karen Kelly

    2008-01-01

    Twelve exemplary service providers from three highly acclaimed resorts discuss and demonstrate what it takes to deliver award-winning service consistently. This research, using a qualitative, explanatory case study method, sought to investigate how they do it. Three themes emerged from the data that should have a profound impact on HRD (human…

  5. Linking pharmacists to the delivery of public health services.

    PubMed

    Strand, Mark A; Davidson, Kaylee M; Schulze, Natalie

    2017-09-23

    To describe components fundamental to the process of linking pharmacy to the delivery of public health services in a sustainable way. Pharmacists deliver public health services with varying frequency. A literature review was conducted to create a set of fundamental links necessary for pharmacists to deliver public health services in a sustainable way. The service needed to be in alignment with public health priorities, be incorporated in the pharmacy curriculum, have postgraduate training opportunities, have a policy or legal platform supporting the service, and have a business model for financial sustainability. Immunization delivery was identified as an exemplary public health service delivered by pharmacists. Additional services evaluated were tobacco cessation counseling, transitions of care, hypertension screening, and substance abuse counseling. Pharmacists are well positioned to provide public health services. Although pharmacists can offer these services, their delivery is variable because of unclearly defined links in the process necessary for their implementation. This article identifies actionable steps to establish sustainable methods for community pharmacists to deliver public health services. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  6. 20 CFR 669.310 - What are the basic components of an NFJP service delivery strategy?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... service delivery strategy? 669.310 Section 669.310 Employees' Benefits EMPLOYMENT AND TRAINING... the basic components of an NFJP service delivery strategy? The NFJP service delivery strategy must... activities, which include core services, intensive services, and training services, as described in WIA...

  7. Can branding by health care provider organizations drive the delivery of higher technical and service quality?

    PubMed

    Snihurowych, Roman R; Cornelius, Felix; Amelung, Volker Eric

    2009-01-01

    Despite the widespread use of branding in nearly all other major industries, most health care service delivery organizations have not fully embraced the practices and processes of branding. Facilitating the increased and appropriate use of branding among health care delivery organizations may improve service and technical quality for patients. This article introduces the concepts of branding, as well as making the case that the use of branding may improve the quality and financial performance of organizations. The concepts of branding are reviewed, with examples from the literature used to demonstrate their potential application within health care service delivery. The role of branding for individual organizations is framed by broader implications for health care markets. Branding strategies may have a number of positive effects on health care service delivery, including improved technical and service quality. This may be achieved through more transparent and efficient consumer choice, reduced costs related to improved patient retention, and improved communication and appropriateness of care. Patient satisfaction may be directly increased as a result of branding. More research into branding could result in significant quality improvements for individual organizations, while benefiting patients and the health system as a whole.

  8. Factors associated with institutional delivery service utilization in Ethiopia

    PubMed Central

    Kebede, Alemi; Hassen, Kalkidan; Nigussie Teklehaymanot, Aderajew

    2016-01-01

    Background Most obstetric complications occur unpredictably during the time of delivery, but they can be prevented with proper medical care in the health facilities. Despite the Ethiopian government’s efforts to expand health service facilities and promote health institution-based delivery service in the country, an estimated 85% of births still take place at home. Objective The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia. Methods The reviewed studies were accessed through electronic web-based search strategy from PubMed, HINARI, Mendeley reference manager, Cochrane Library for Systematic Reviews, and Google Scholar. Review Manager V5.3 software was used for meta-analysis. Mantel–Haenszel odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Heterogeneity of the study was assessed using I2 test. Results People living in urban areas (OR =13.16, CI =1.24, 3.68), with primary and above educational level of the mother and husband (OR =4.95, CI =2.3, 4. 8, and OR =4.43, CI =1.14, 3.36, respectively), who encountered problems during pregnancy (OR =2.83, CI =4.54, 7.39), and living at a distance <5 km from nearby health facility (OR =2.6, CI =3.33, 6.57) showed significant association with institutional delivery service utilization. Women’s autonomy was not significantly associated with institutional delivery service utilization. Conclusion and recommendation Distance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary education regarding the danger signs of pregnancy and benefits of institutional delivery through available communication networks such as health development army and promotion of antenatal care visits and completion of four standard visits by pregnant women were recommended. PMID:27672342

  9. Using patients' experiences of adverse events to improve health service delivery and practice: protocol of a data linkage study of Australian adults age 45 and above.

    PubMed

    Walton, Merrilyn; Jorm, Christine; Smith-Merry, Jennifer; Harrison, Reema; Manias, Elizabeth; Iedema, Rick; Kelly, Patrick

    2014-10-13

    Evidence of patients' experiences is fundamental to creating effective health policy and service responses, yet is missing from our knowledge of adverse events. This protocol describes explorative research redressing this significant deficit; investigating the experiences of a large cohort of recently hospitalised patients aged 45 years and above in hospitals in New South Wales (NSW), Australia. The 45 and Up Study is a cohort of 265,000 adults aged 45 years and above in NSW. Patients who were hospitalised between 1 January and 30 June 2014 will be identified from this cohort using data linkage and a random sample of 20,000 invited to participate. A cross-sectional survey (including qualitative and quantitative components) will capture patients' experiences in hospital and specifically of adverse events. Approximately 25% of respondents are likely to report experiencing an adverse event. Quantitative components will capture the nature and type of events as well as common features of patients' experiences. Qualitative data provide contextual knowledge of their condition and care and the impact of the event on individuals. Respondents who do not report an adverse event will report their experience in hospital and be the control group. Statistical and thematic analysis will be used to present a patient perspective of their experiences in hospital; the characteristics of patients experiencing an adverse event; experiences of information sharing after an event (open disclosure) and the other avenues of redress pursued. Interviews with key policymakers and a document analysis will be used to create a map of the current practice. Dissemination via a one-day workshop, peer-reviewed publications and conference presentations will enable effective clinical responses and service provision and policy responses to adverse events to be developed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. The influences of patient's satisfaction with medical service delivery, assessment of medical service, and trust in health delivery system on patient's life satisfaction in China

    PubMed Central

    2012-01-01

    Background Patient’s satisfaction with medical service delivery/assessment of medical service/trust in health delivery system may have significant influence on patient’s life satisfaction in China’s health delivery system/in various kinds of hospitals. The aim of this study was to test whether and to what extent patient’s satisfaction with medical service delivery/patient’s assessments of various major aspects of medical service/various major aspects of patient’s trust in health delivery system influenced patient’s life satisfaction in China’s health delivery system/in various kinds of hospitals. Methods This study collaborated with National Bureau of Statistics of China to carry out a 2008 national urban resident household survey in 17 provinces, autonomous regions, and municipalities directly under the central government (N = 3,386), and specified ordered probit models were established to analyze dataset from this household survey. Results The key considerations in generating patient’s life satisfaction involved patient’s overall satisfaction with medical service delivery, assessment of doctor-patient communication, assessment of medical cost, assessment of medical treatment process, assessment of medical facility and hospital environment, assessment of waiting time for medical service, trust in prescription, trust in doctor, and trust in recommended medical examination. But the major considerations in generating patient’s life satisfaction were different among low level public hospital, high level public hospital, and private hospital. Conclusion The promotion of patient’s overall satisfaction with medical service delivery, the improvement of doctor-patient communication, the reduction of medical cost, the improvement of medical treatment process, the promotion of medical facility and hospital environment, the reduction of waiting time for medical service, the promotion of patient’s trust in prescription, the promotion of patient

  11. 77 FR 65581 - Verizon Business Networks Services, Inc., Senior Analyst, Service Program Delivery (SA-SPD...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-29

    ... Employment and Training Administration Verizon Business Networks Services, Inc., Senior Analyst, Service Program Delivery (SA-SPD), Including Workers Whose Wages Were Paid Under MCI Communication Services, Inc..., 2012, applicable to workers and former workers of Verizon Business Network Services, Inc., Senior...

  12. Implementation and Operational Research: An Integrated and Comprehensive Service Delivery Model to Improve Pediatric and Maternal HIV Care in Rural Africa

    PubMed Central

    Glass, Tracy R.; Luwanda, Lameck B.; Mapesi, Herry; Samson, Leila; Mtoi, Tom; Nyamtema, Angelo; Muri, Lukas; Ntamatungiro, Alex; Tanner, Marcel; Hatz, Christoph; Battegay, Manuel; Letang, Emilio

    2016-01-01

    Background: Strategies to improve HIV diagnosis and linkage into care, antiretroviral treatment coverage, and treatment outcomes of mothers and children are urgently needed in sub-Saharan Africa. Methods: From December 2012, we implemented an intervention package to improve prevention of mother-to-child transmission (PMTCT) and pediatric HIV care in our rural Tanzanian clinic, consisting of: (1) creation of a PMTCT and pediatric unit integrated within the reproductive and child health clinic; (2) implementation of electronic medical records; (3) provider-initiated HIV testing and counseling in the hospital wards; and (4) early infant diagnosis test performed locally. To assess the impact of this strategy, clinical characteristics and outcomes were compared between the period before (2008–2012) and during/after the implementation (2013–2014). Results: After the intervention, the number of mothers and children enrolled into care almost doubled. Compared with the pre-intervention period (2008–2012), in 2013–2014, children presented lower CD4% (16 vs. 16.8, P = 0.08) and more advanced disease (World Health Organization stage 3/4 72% vs. 35%, P < 0.001). The antiretroviral treatment coverage rose from 80% to 98% (P < 0.001), the lost-to-follow-up rate decreased from 20% to 11% (P = 0.002), and mortality ascertainment improved. During 2013–2014, 261 HIV-exposed infants were enrolled, and the early mother-to-child transmission rate among mother–infant pairs accessing PMTCT was 2%. Conclusions: This strategy resulted in an increased number of mothers and children diagnosed and linked into care, a higher detection of children with AIDS, universal treatment coverage, lower loss to follow-up, and an early mother-to-child transmission rate below the threshold of elimination. This study documents a feasible and scalable model for family-centered HIV care in sub-Saharan Africa. PMID:27846070

  13. Implementation and Operational Research: An Integrated and Comprehensive Service Delivery Model to Improve Pediatric and Maternal HIV Care in Rural Africa.

    PubMed

    Gamell, Anna; Glass, Tracy R; Luwanda, Lameck B; Mapesi, Herry; Samson, Leila; Mtoi, Tom; Nyamtema, Angelo; Muri, Lukas; Ntamatungiro, Alex; Tanner, Marcel; Hatz, Christoph; Battegay, Manuel; Letang, Emilio

    2016-12-15

    Strategies to improve HIV diagnosis and linkage into care, antiretroviral treatment coverage, and treatment outcomes of mothers and children are urgently needed in sub-Saharan Africa. From December 2012, we implemented an intervention package to improve prevention of mother-to-child transmission (PMTCT) and pediatric HIV care in our rural Tanzanian clinic, consisting of: (1) creation of a PMTCT and pediatric unit integrated within the reproductive and child health clinic; (2) implementation of electronic medical records; (3) provider-initiated HIV testing and counseling in the hospital wards; and (4) early infant diagnosis test performed locally. To assess the impact of this strategy, clinical characteristics and outcomes were compared between the period before (2008-2012) and during/after the implementation (2013-2014). After the intervention, the number of mothers and children enrolled into care almost doubled. Compared with the pre-intervention period (2008-2012), in 2013-2014, children presented lower CD4% (16 vs. 16.8, P = 0.08) and more advanced disease (World Health Organization stage 3/4 72% vs. 35%, P < 0.001). The antiretroviral treatment coverage rose from 80% to 98% (P < 0.001), the lost-to-follow-up rate decreased from 20% to 11% (P = 0.002), and mortality ascertainment improved. During 2013-2014, 261 HIV-exposed infants were enrolled, and the early mother-to-child transmission rate among mother-infant pairs accessing PMTCT was 2%. This strategy resulted in an increased number of mothers and children diagnosed and linked into care, a higher detection of children with AIDS, universal treatment coverage, lower loss to follow-up, and an early mother-to-child transmission rate below the threshold of elimination. This study documents a feasible and scalable model for family-centered HIV care in sub-Saharan Africa.

  14. Wheeled mobility (wheelchair) service delivery: scope of the evidence.

    PubMed

    Greer, Nancy; Brasure, Michelle; Wilt, Timothy J

    2012-01-17

    Identifying the appropriate wheelchair for a person who needs one has implications for both disabled persons and society. For someone with severe locomotive problems, the right wheelchair can affect mobility and quality of life. However, policymakers are concerned about the increasing demand for unnecessarily elaborate chairs. The Office of Inspector General, U.S. Department of Health and Human Services, issued 4 reports between 2009 and 2011 detailing fraud and misapplication of Medicare funds for powered wheelchairs, more than a decade after similar concerns were first raised by 4 contractors who process claims for durable medical equipment. Subsequent concerns have arisen about whether some impaired persons who need wheeled mobility devices may now be inappropriately denied coverage. A transparent, evidence-based approach to wheeled mobility service delivery (the matching of mobility-impaired persons to appropriate devices and supporting services) might lessen these concerns. This review describes the process of wheeled mobility service delivery for long-term wheelchair users with complex rehabilitation needs and presents findings from a survey of the literature (published and gray) and interviews with key informants. Recommended steps in the delivery process were identified in textbooks, guidelines, and published literature. Delivery processes shared many commonalities; however, no research supports the recommended approaches. A search of bibliographic databases through March 2011 identified 24 studies that evaluated aspects of wheeled mobility service delivery. Most were observational, exploratory studies designed to determine consumer use of and satisfaction with the process. The evidence base for the effectiveness of approaches to wheeled mobility service delivery is insufficient, and additional research is needed to develop standards and guidelines.

  15. Impact of critical care outreach services on the delivery and organization of hospital care.

    PubMed

    Baker-McClearn, Denise; Carmel, Simon

    2008-07-01

    To evaluate the impact of critical care outreach services on the delivery and organization of hospital care from the perspective of staff working in acute hospitals. One hundred semi-structured interviews were undertaken with hospital staff who were either members of, or who came into contact with, the outreach service in eight hospitals in England. Outreach services had two main impacts on the delivery and organization of hospital care, reflecting the organizational and educational aims of the policy. First, on the organization of patient care: it was suggested that care was more timely, there were fewer referrals to the intensive care unit (ICU) and ICUs felt more able to discharge patients to hospital wards. There were also perceived to be improved links between ward nurses and medical teams and improved morale among ICU nurses. Second, on the confidence and skills of ward staff (nurses and junior doctors): increased contact on the wards resulted in more opportunities to share critical care skills. However, there remained concerns about the sustainability of improved skills and some respondents felt that junior doctors were becoming de-skilled. Critical care outreach services have had a positive impact on the delivery and organization of hospital care. In attempting to share critical care skills, however, these services can experience a tension between the aims of service delivery and education - a tension which is partly resolved by sharing skills in the clinical and organizational context of direct patient care.

  16. 78 FR 55743 - Notice of Service Delivery Area Designation for the Shinnecock Indian Nation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... HUMAN SERVICES Indian Health Service Notice of Service Delivery Area Designation for the Shinnecock... boundaries of the Service Delivery Area (SDA) for the newly recognized Shinnecock Indian Nation. The... Delivery Area (CHSDA), for the purposes of operating a Contract Health Service (CHS) program pursuant...

  17. 78 FR 55737 - Notice of Service Delivery Area Designation for the Tejon Indian Tribe

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... HUMAN SERVICES Indian Health Service Notice of Service Delivery Area Designation for the Tejon Indian... of the Service Delivery Area (SDA) for the Tejon Indian Tribe. The Tribe's federal recognition was... administratively as the SDA, to function as a Contract Health Service Delivery Area (CHSDA), for the purpose...

  18. 75 FR 60141 - International Business Machines (IBM), Global Technology Services Delivery Division, Including On...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-29

    ... Employment and Training Administration International Business Machines (IBM), Global Technology Services... of International Business Machines (IBM), Global Technology Services Delivery Division, Greenville... International Business Machines (IBM), Global Technology Services Delivery Division, including on-site...

  19. Role of village practitioners in family planning service delivery system.

    PubMed

    Rahman, S

    1985-12-01

    The acceptability of village practitioners (VPs) as providers of family planning service and their efficiency in delivery of such services is assessed. 120 VPs were selected on stratified random sample basis from 4 Thanas in Malaysia and were trained for 21 days on different aspects of family planning, MCH diagnosis and treatment of common ailments. Regular monthly meetings at the respective Thana Health Complexes were held to assess the progress of work on clinical discussion and for problem solving. The VPs showed interest in the training program and opined that such training programs should be organized on a continual basis. After training, the VPs were actively involved in distribution of contraceptives and referral of patients for clinical methods for 1 year. The compiled progress report on distribution of contraceptives in monthly meetings shows that the VPs contributed to 37% of the total performances of the population control division in the 4 Thanas. The use of contraceptives improved during the experimental project. 50% of the males and 36% of the females reported current use of contraceptives compared to 23% in the National Program.

  20. Nursing Services Delivery Theory: an open system approach.

    PubMed

    Meyer, Raquel M; O'Brien-Pallas, Linda L

    2010-12-01

    This paper is a discussion of the derivation of the Nursing Services Delivery Theory from the application of open system theory to large-scale organizations. The underlying mechanisms by which staffing indicators influence outcomes remain under-theorized and unmeasured, resulting in a 'black box' that masks the nature and organization of nursing work. Theory linking nursing work, staffing, work environments, and outcomes in different settings is urgently needed to inform management decisions about the allocation of nurse staffing resources in organizations. A search of CINAHL and Business Source Premier for the years 1980-2008 was conducted using the following terms: theory, models, organization, organizational structure, management, administration, nursing units, and nursing. Seminal works were included. The healthcare organization is conceptualized as an open system characterized by energy transformation, a dynamic steady state, negative entropy, event cycles, negative feedback, differentiation, integration and coordination, and equifinality. The Nursing Services Delivery Theory proposes that input, throughput, and output factors interact dynamically to influence the global work demands placed on nursing work groups at the point of care in production subsystems. THE Nursing Services Delivery Theory can be applied to varied settings, cultures, and countries and supports the study of multi-level phenomena and cross-level effects. The Nursing Services Delivery Theory gives a relational structure for reconciling disparate streams of research related to nursing work, staffing, and work environments. The theory can guide future research and the management of nursing services in large-scale healthcare organizations. © 2010 Blackwell Publishing Ltd.

  1. SLS Booster Engine Service Platforms Delivery

    NASA Image and Video Library

    2017-07-31

    A flatbed truck carrying one of two new service platforms for NASA's Space Launch System booster engines makes its way along the NASA Causeway to the agency's Kennedy Space Center in Florida. The platforms were transported from fabricator Met-Con Inc. in Cocoa, Florida. They will be delivered to the Vehicle Assembly Building, where they will be stored and used for processing and checkout of the engines for the rocket's twin five-segment solid rocket boosters for Exploration Mission-1. EM-1 will launch an uncrewed Orion spacecraft to a stable orbit beyond the Moon and bring it back to Earth for a splashdown in the Pacific Ocean.

  2. SLS Booster Engine Service Platforms Delivery

    NASA Image and Video Library

    2017-07-31

    New service platforms for NASA's Space Launch System booster engines, secured on two flatbed trucks, are on their way to the agency's Kennedy Space Center in Florida. They are being transported from fabricator Met-Con Inc. in Cocoa, Florida. The platforms will be delivered to the Vehicle Assembly Building, where they will be stored and used for processing and checkout of the engines for the rocket's twin five-segment solid rocket boosters for Exploration Mission-1. EM-1 will launch an uncrewed Orion spacecraft to a stable orbit beyond the Moon and bring it back to Earth for a splashdown in the Pacific Ocean.

  3. Nursing Services Delivery Theory: an open system approach

    PubMed Central

    Meyer, Raquel M; O’Brien-Pallas, Linda L

    2010-01-01

    meyer r.m. & o’brien-pallas l.l. (2010)Nursing services delivery theory: an open system approach. Journal of Advanced Nursing66(12), 2828–2838. Aim This paper is a discussion of the derivation of the Nursing Services Delivery Theory from the application of open system theory to large-scale organizations. Background The underlying mechanisms by which staffing indicators influence outcomes remain under-theorized and unmeasured, resulting in a ‘black box’ that masks the nature and organization of nursing work. Theory linking nursing work, staffing, work environments, and outcomes in different settings is urgently needed to inform management decisions about the allocation of nurse staffing resources in organizations. Data sources A search of CINAHL and Business Source Premier for the years 1980–2008 was conducted using the following terms: theory, models, organization, organizational structure, management, administration, nursing units, and nursing. Seminal works were included. Discussion The healthcare organization is conceptualized as an open system characterized by energy transformation, a dynamic steady state, negative entropy, event cycles, negative feedback, differentiation, integration and coordination, and equifinality. The Nursing Services Delivery Theory proposes that input, throughput, and output factors interact dynamically to influence the global work demands placed on nursing work groups at the point of care in production subsystems. Implications for nursing The Nursing Services Delivery Theory can be applied to varied settings, cultures, and countries and supports the study of multi-level phenomena and cross-level effects. Conclusion The Nursing Services Delivery Theory gives a relational structure for reconciling disparate streams of research related to nursing work, staffing, and work environments. The theory can guide future research and the management of nursing services in large-scale healthcare organizations. PMID:20831573

  4. Delivery of Geriatric Services to Black Senior Citizens

    PubMed Central

    Portnoi, Valery A.

    1981-01-01

    Society in this century faces an unprecedented rapid increase in both the absolute number and the relative proportion of senior citizens among the general population. The problems and needs of the elderly should be addressed by a comprehensive, holistic health and social services delivery system. The care of the black elderly requires not only a better quality of services than is available at the present time, but also a particular sensitivity to this population's unique and specific needs. PMID:7277517

  5. Community-based approaches and partnerships: innovations in health-service delivery in Bangladesh.

    PubMed

    El Arifeen, Shams; Christou, Aliki; Reichenbach, Laura; Osman, Ferdous Arfina; Azad, Kishwar; Islam, Khaled Shamsul; Ahmed, Faruque; Perry, Henry B; Peters, David H

    2013-12-14

    In Bangladesh, rapid advancements in coverage of many health interventions have coincided with impressive reductions in fertility and rates of maternal, infant, and childhood mortality. These advances, which have taken place despite such challenges as widespread poverty, political instability, and frequent natural disasters, warrant careful analysis of Bangladesh's approach to health-service delivery in the past four decades. With reference to success stories, we explore strategies in health-service delivery that have maximised reach and improved health outcomes. We identify three distinctive features that have enabled Bangladesh to improve health-service coverage and health outcomes: (1) experimentation with, and widespread application of, large-scale community-based approaches, especially investment in community health workers using a doorstep delivery approach; (2) experimentation with informal and contractual partnership arrangements that capitalise on the ability of non-governmental organisations to generate community trust, reach the most deprived populations, and address service gaps; and (3) rapid adoption of context-specific innovative technologies and policies that identify country-specific systems and mechanisms. Continued development of innovative, community-based strategies of health-service delivery, and adaptation of new technologies, are needed to address neglected and emerging health challenges, such as increasing access to skilled birth attendance, improvement of coverage of antenatal care and of nutritional status, the effects of climate change, and chronic disease. Past experience should guide future efforts to address rising public health concerns for Bangladesh and other underdeveloped countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. A Multi-organisational Approach to Service Delivery

    NASA Astrophysics Data System (ADS)

    Purchase, Valerie; Mills, John; Parry, Glenn

    Who is involved in delivering a service? There has been growing recognition in a wide variety of contexts that service is increasingly being delivered by multi-rather than single-organisational entities. Such recognition is evident not only in our experience but in a number of areas of literature including strategy development, core competence analysis, operations and supply chain management, and is reflected in and further facilitated by ICT developments. Customers have always been involved in some degree in the process of value delivery and such involvement is increasing to include complex co-creation of value. Such interactions are challenging when they involve individual customers, however, this becomes ever more challenging when the 'customer' is another organisation or when there are multiple 'customers'. Within this chapter we will consider some of the key drivers for a multi-organisational approach to service delivery; examine the ways in which the parties involved in service co-creation have expanded to include multiple service providers and customers; and finally, identify some of the challenges created by a multi-organisational approach to service delivery.

  7. Learning To Listen: Cross-Ethnic Therapeutic Recreation Service Delivery.

    ERIC Educational Resources Information Center

    Dieser, Rodney B.; Wilson, Joe

    2002-01-01

    Suggests that is it important for therapeutic recreation organizations, training institutions, and certifying bodies to require cross-ethnic understanding in their curriculums and professional organizations, describing system directed service delivery and presenting several approaches, which include the bridging approach, multicultural agency…

  8. California Integrated Service Delivery Evaluation Report. Phase I

    ERIC Educational Resources Information Center

    Moore, Richard W.; Rossy, Gerard; Roberts, William; Chapman, Kenneth; Sanchez, Urte; Hanley, Chris

    2010-01-01

    This study is a formative evaluation of the OneStop Career Center Integrated Service Delivery (ISD) Model within the California Workforce System. The study was sponsored by the California Workforce Investment Board. The study completed four in-depth case studies of California OneStops to describe how they implemented the ISD model which brings…

  9. The Effect of Leadership on Service Delivery in Universities

    ERIC Educational Resources Information Center

    Zvavahera, Promise

    2013-01-01

    This study was aimed at assessing leadership effectiveness on service delivery at the University of Namibia and all its campuses throughout the country. The study was carried out during the month of February 2013. The methodology consisted of document analysis, interviews through face to face, video and tele-conferencing. Purposive sampling was…

  10. Lessons Learned from a Tiered Service Delivery Implementation Project

    ERIC Educational Resources Information Center

    Johnson, Evelyn S.; Pool, Juli L.; Carter, Deborah R.

    2012-01-01

    Tiered models of service delivery for both academics and behavior are being increasingly adopted across the nation, and discussions of how to implement these models effectively and simultaneously are growing. In this article, the authors share some lessons learned from a 2-year implementation project to implement a comprehensive (both academic and…

  11. 22 CFR 201.32 - Suppliers of delivery services.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Financial Management, USAID, Washington, DC 20523-7792, all adjustments in the purchase price in favor of... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Suppliers of delivery services. 201.32 Section 201.32 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT RULES AND PROCEDURES APPLICABLE TO...

  12. The Delivery of Alcoholism Services: Meeting Whose Needs?

    ERIC Educational Resources Information Center

    Christmas, June J.

    Of grave concern to all who are involved in the delivery of health and mental health services are two recently-observed trends in the drug and alcohol abusing population: the emergence of formerly hidden individuals in need of treatment (among them women, children and the elderly), and the increasing incidence and severity of emotional problems…

  13. Consultation: Enhancing Leisure Service Delivery to Handicapped Children and Youth.

    ERIC Educational Resources Information Center

    Goldstein, Judith E., Ed.

    The document provides guidelines for consultants in the area of consultation in delivery of leisure services for handicapped children and youth. Included are chapters with the following titles and authors: "The Consultant-Consultee Relationship" (G. O'Morrow), "A Special Education Viewpoint: Consultation in the Public Schools" (S. Brannan),…

  14. The Rural Itinerant Special Physical Education Service Delivery Model.

    ERIC Educational Resources Information Center

    Lavay, Barry

    1990-01-01

    Describes the multiple roles and special challenges experienced by rural itinerant teachers delivering special physical education services. Provides a breakdown of time spent in various job functions by two itinerant special physical educators (ISPEs) studied in north central Kansas. Suggests strategies for successful delivery using the ISPE…

  15. Federal Information Policy and Management for Electronic Services Delivery.

    ERIC Educational Resources Information Center

    McClure, Charles R.; And Others

    To assist the Office of Technology Assessment of the U.S. Congress in identifying and resolving policy issues related to the electronic delivery of government services, this study examined selected innovative information technology applications, management practices, and policies that promote experimentation and integration with new electronic…

  16. Electronic Delivery of Federal Government Services: Policy Issues and Recommendations.

    ERIC Educational Resources Information Center

    McClure, Charles R.; And Others

    1993-01-01

    Describes a study commissioned by the Office of Technology Assessment that was conducted to identify innovative information technology applications, management practices, and policies to help integrate the electronic delivery of federal government services. Highlights include the information infrastructure, existing federal information policy,…

  17. Teaching for Competence in the Delivery of Direct Services.

    ERIC Educational Resources Information Center

    Council on Social Work Education, New York, NY.

    Enhancing practitioner competence in the delivery of direct services continues to be a prime concern of social work practitioners and educators alike. This document contains 11 articles that pertain to teaching direct intervention theories and skills. Joseph D. Anderson writes on games social work educators' play in teaching practice theories;…

  18. The Risk Climate and the Delivery of Child Welfare Services.

    ERIC Educational Resources Information Center

    Cornelius, Sandra; Baker, Timothy

    Based on the assumption that a relationship exists between public county-based child welfare agencies in Pennsylvania and their environments, this study draws clues as to the nature of this relationship from (1) a review of the literature, and (2) a multivariate analysis of agency service delivery measures and social and demographic variables.…

  19. Implementing a Service Delivery Program: Experiences in Pennsylvania.

    ERIC Educational Resources Information Center

    Brady, Mary E.

    This paper describes one approach to providing communication aids, environmental controls, and computer access systems to handicapped children. The paper begins by defining "assistive device" and "rehabilitation technology." Service delivery issues include funding of high-cost device systems and provision of ongoing student…

  20. 77 FR 56652 - Notice of Service Delivery Area Designation for the Mashpee Wampanoag Indian Tribe

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-13

    ... Service Delivery Area Designation for the Mashpee Wampanoag Indian Tribe AGENCY: Indian Health Service...) established the geographic boundaries of the Service Delivery Area (SDA) for the newly recognized Mashpee... administratively as the SDA, to function as a Contract Health Service Delivery Area (CHSDA), for the purposes...

  1. 42 CFR 136.22 - Establishment of contract health service delivery areas.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Establishment of contract health service delivery... Services § 136.22 Establishment of contract health service delivery areas. (a) In accordance with the..., contract health service delivery areas are established as follows: (1) The State of Alaska; (2) The...

  2. 41 CFR 60-300.84 - Responsibilities of appropriate employment service delivery system.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... appropriate employment service delivery system. 60-300.84 Section 60-300.84 Public Contracts and Property... of appropriate employment service delivery system. By statute, appropriate employment service... referrals. The employment service delivery systems shall provide OFCCP, upon request, information...

  3. Overview of States' Use of Telehealth for the Delivery of Early Intervention (IDEA Part C) Services.

    PubMed

    Cason, Jana; Behl, Diane; Ringwalt, Sharon

    2012-01-01

    Early intervention (EI) services are designed to promote the development of skills and enhance the quality of life of infants and toddlers who have been identified as having a disability or developmental delay, enhance capacity of families to care for their child with special needs, reduce future educational costs, and promote independent living (NECTAC, 2011). EI services are regulated by Part C of the Individuals with Disabilities Education Improvement Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telehealth is an emerging delivery model demonstrating potential to deliver EI services effectively and efficiently, thereby improving access and ameliorating the impact of provider shortages in underserved areas. The use of a telehealth delivery model facilitates inter-disciplinary collaboration, coordinated care, and consultation with specialists not available within a local community. A survey sent by the National Early Childhood Technical Assistance Center (NECTAC) to IDEA Part C coordinators assessed their utilization of telehealth within states' IDEA Part C programs. Reimbursement for provider type and services and barriers to implement a telehealth service delivery model were identified. Representatives from 26 states and one jurisdiction responded to the NECTAC telehealth survey. Of these, 30% (n=9) indicated that they are either currently using telehealth as an adjunct service delivery model (n=6) or plan to incorporate telehealth within the next 1-2 years (n=3). Identified telehealth providers included developmental specialists, teachers of the Deaf/Hard of Hearing (DHH), speech-language pathologists, occupational therapists, physical therapists, behavior specialists, audiologists, and interpreters. Reimbursement was variable and included use of IDEA Part C funding, Medicaid, and private insurance. Expressed barriers and concerns for the implementation of telehealth as a delivery model within Part

  4. Delivery of a Clinical Genomics Service

    PubMed Central

    Newman, William G.; Black, Graeme C.

    2014-01-01

    Over the past five years, next generation sequencing has revolutionised the discovery of genes responsible for rare inherited diseases previously resistant to traditional discovery techniques. This review considers how this new technology is being introduced into clinical practice to aid diagnosis and improve the clinical management of individuals and families affected by rare diseases where access to genetic testing was previously limited. We compare and contrast the different approaches that have been adopted including panel based tests, exome and genome sequencing. We provide insights from our own clinical practice demonstrating the challenges and benefits of this new technology. PMID:25383561

  5. The Resource Hub: an innovative e-information service delivery model addressing mental health knowledge management.

    PubMed

    O'Sullivan, Julie; Powell, Jacinta; Gibbon, Peter; Emmerson, Brett

    2009-01-01

    This paper outlines the development of the Resource Hub, an intranet-based electronic information service designed to improve knowledge management and staff satisfaction in the Inner North Brisbane Mental Health Service, Royal Brisbane and Women's Hospital, Metro North Health Service District. The Resource Hub was launched in April 2007. It encompasses a large range of electronically stored resources and clinically relevant information, including direct links to approved internet sites, psychoeducation resources, fact sheets, resource lists and details of current service research projects. The Hub will continue to expand over time, improving access to clinical service delivery resources. A significant review conducted in April 2008 resulted in modifications to further improve the content and design of the Hub. Ongoing evaluation incorporates regular usage monitoring and stakeholder satisfaction surveys. The Resource Hub is a service delivery innovation that effectively addresses mental health service knowledge management issues. It is a strategy that could readily be transferred to other district mental health services and to health services in general.

  6. Quality improvement in physiotherapy services.

    PubMed

    Boak, George; Sephton, Ruth; Hough, Elaine; Ten Hove, Ruth

    2017-06-12

    Purpose The purpose of this paper is to evaluate a process change in physiotherapy services and to explore factors that may have influenced the outcomes. Design/methodology/approach This is a multiple case study and information was gathered from eight physiotherapy teams over 24 months. Findings The process change was successfully implemented in six teams. It had a clear, positive effect on service quality provided to patients in three teams. Whilst quality also improved in three other teams, other issues make changes difficult to assess. Factors that enabled process change to be effective are suggested. Research limitations/implications The findings are based on results achieved by only eight English teams. Practical implications This process change may be appropriate for other teams providing therapy services if attention is paid to potential enabling factors, and a learning approach is adopted to designing and introducing the change. Originality/value To the best of the authors' knowledge, no other longitudinal process change study in therapy services has been published.

  7. Contracting for Management: Assessing Management Capacity under Alternative Service Delivery Arrangements

    ERIC Educational Resources Information Center

    Brown, Trevor; Potoski, Matt

    2006-01-01

    Contracting critics suggest that when governments outsource, they reduce their capacity to produce services and manage service delivery. In this paper, we decompose the service delivery decision into service production and service management components. When governments contract for service production, they may also choose to contract for a…

  8. Contracting for Management: Assessing Management Capacity under Alternative Service Delivery Arrangements

    ERIC Educational Resources Information Center

    Brown, Trevor; Potoski, Matt

    2006-01-01

    Contracting critics suggest that when governments outsource, they reduce their capacity to produce services and manage service delivery. In this paper, we decompose the service delivery decision into service production and service management components. When governments contract for service production, they may also choose to contract for a…

  9. Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria

    PubMed Central

    Dahiru, Tukur; Oche, Oche Mansur

    2015-01-01

    Introduction Utilization of antenatal care, institutional delivery and postnatal care services in Nigeria are poor even by african average. Methods We analysed the 2013 Nigeria DHS to determine factors associated with utilization of these health MCH indicators by employing both bivariate and multivariate logistic regressions. Results Overall, 54% of women had at least four ANC visits, 37% delivered in health facility and 29% of new born had postnatal care within two of births. Factors that consistently predict the utilization of the three MCH services are maternal and husband's level education, place of residence, wealth level and parity. Antenatal care strongly predicts both health facility delivery (OR = 2.16, 95%CI: 1.99-2.34) and postnatal care utilization (OR = 4.67, 95%CI: 3.95-5.54); while health facility delivery equally predicting postnatal care (OR = 2.84, 95%CI: 2.20-2.80). Conclusion Improving utilization of these three MCH indicators will require targeting women in the rural areas and those with low level of education as well as creating demand for health facility delivery. Improving ANC use by making it available and accessible will have a multiplier effect of improving facility delivery which will lead to improved postnatal care utilization. PMID:26587168

  10. Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria.

    PubMed

    Dahiru, Tukur; Oche, Oche Mansur

    2015-01-01

    Utilization of antenatal care, institutional delivery and postnatal care services in Nigeria are poor even by african average. We analysed the 2013 Nigeria DHS to determine factors associated with utilization of these health MCH indicators by employing both bivariate and multivariate logistic regressions. Overall, 54% of women had at least four ANC visits, 37% delivered in health facility and 29% of new born had postnatal care within two of births. Factors that consistently predict the utilization of the three MCH services are maternal and husband's level education, place of residence, wealth level and parity. Antenatal care strongly predicts both health facility delivery (OR = 2.16, 95%CI: 1.99-2.34) and postnatal care utilization (OR = 4.67, 95%CI: 3.95-5.54); while health facility delivery equally predicting postnatal care (OR = 2.84, 95%CI: 2.20-2.80). Improving utilization of these three MCH indicators will require targeting women in the rural areas and those with low level of education as well as creating demand for health facility delivery. Improving ANC use by making it available and accessible will have a multiplier effect of improving facility delivery which will lead to improved postnatal care utilization.

  11. Libraries and E-Commerce: Improving Information Services and Beyond.

    ERIC Educational Resources Information Center

    Harris, Lesley Ellen

    2000-01-01

    Explains e-commerce and discusses how it can be used by special libraries. Highlights include library goals; examples of successful uses of e-commerce; how e-commerce can improve information services, including access to information, new information resources, delivery of information, and broadening information markets; and developing an…

  12. Libraries and E-Commerce: Improving Information Services and Beyond.

    ERIC Educational Resources Information Center

    Harris, Lesley Ellen

    2000-01-01

    Explains e-commerce and discusses how it can be used by special libraries. Highlights include library goals; examples of successful uses of e-commerce; how e-commerce can improve information services, including access to information, new information resources, delivery of information, and broadening information markets; and developing an…

  13. Software Process Improvement Journey: IBM Australia Application Management Services

    DTIC Science & Technology

    2005-03-01

    See Section 5.1.2) - Client Relationship Management ( CRM ) processes-specifically, Solution Design and Solution Delivery - Worldwide Project Management ...plex systems life-cycle management , rapid solutions development, custom development, package selection and implementation, maintenance, minor...CarnegieMellon ___ Software Engineering Institute Software Process Improvement Journey: IBM Australia Application Management Services Robyn Nichols

  14. STI service delivery in British Columbia, Canada; providers' views of their services to youth.

    PubMed

    Masaro, Cindy L; Johnson, Joy; Chabot, Cathy; Shoveller, Jean

    2012-08-06

    Little is known about service providers' knowledge, attitudes, and experiences in relation to the assessment, diagnosis, and treatment of individuals seeking care for sexually transmitted infections (STIs), and how they influence the delivery of services. The purpose of this study was to explore the perceptions of STI care providers and the ways they approached their practice. We used a qualitative approach drawing on methods used in thematic analysis. Individual semi-structured in-depth interviews were conducted with 21 service providers delivering STI services in youth clinics, STI clinics, reproductive health clinics, and community public health units in British Columbia (BC), Canada. Service providers' descriptions of their activities and roles were shaped by a number of themes including specialization, scarcity, and maintaining the status quo. The analysis suggests that service providers perceive, at times, the delivery of STI care to be inefficient and inadequate. Findings from this study identify deficits in the delivery of STI services in BC. To understand these deficits, more research is needed to examine the larger health care structure within which service providers work, and how this structure not only informs and influences the delivery of services, but also how particular structural barriers impinge on and/or restrict practice.

  15. Capacity, pressure, demand, and flow: A conceptual framework for analyzing ecosystem service provision and delivery

    USGS Publications Warehouse

    Villamagna, Amy M.; Angermeier, Paul L.; Bennett, Elena M.

    2013-01-01

    Ecosystem services provide an instinctive way to understand the trade-offs associated with natural resource management. However, despite their apparent usefulness, several hurdles have prevented ecosystem services from becoming deeply embedded in environmental decision-making. Ecosystem service studies vary widely in focal services, geographic extent, and in methods for defining and measuring services. Dissent among scientists on basic terminology and approaches to evaluating ecosystem services create difficulties for those trying to incorporate ecosystem services into decision-making. To facilitate clearer comparison among recent studies, we provide a synthesis of common terminology and explain a rationale and framework for distinguishing among the components of ecosystem service delivery, including: an ecosystem's capacity to produce services; ecological pressures that interfere with an ecosystem's ability to provide the service; societal demand for the service; and flow of the service to people. We discuss how interpretation and measurement of these four components can differ among provisioning, regulating, and cultural services. Our flexible framework treats service capacity, ecological pressure, demand, and flow as separate but interactive entities to improve our ability to evaluate the sustainability of service provision and to help guide management decisions. We consider ecosystem service provision to be sustainable when demand is met without decreasing capacity for future provision of that service or causing undesirable declines in other services. When ecosystem service demand exceeds ecosystem capacity to provide services, society can choose to enhance natural capacity, decrease demand and/or ecological pressure, or invest in a technological substitute. Because regulating services are frequently overlooked in environmental assessments, we provide a more detailed examination of regulating services and propose a novel method for quantifying the flow of

  16. Transforming health care service delivery and provider selection.

    PubMed

    Reiner, Bruce I

    2011-06-01

    Commoditization pressures in medicine have risked transforming service provider selection from "survival of the fittest" to "survival of the cheapest." Quality- and safety-oriented mandates by the Institute of Medicine have led to the creation of a number of data-driven quality-centric initiatives including Pay for Performance and Evidence-Based Medicine. A synergistic approach to creating quantitative accountability in medical service delivery is through the creation of consumer-oriented performance metrics which provide patients with objective data related to individual service provider quality, safety, cost-efficacy, efficiency, and customer service. These performance metrics could in turn be customized to the individual preferences and health care needs of each individual patient, thereby providing an objective methodology for service provider selection while empowering health care consumers.

  17. Improving Instructional Delivery: Reflections on Student Feedback

    ERIC Educational Resources Information Center

    Oliveira, Lisa C.

    2013-01-01

    Teachers work countless hours preparing instruction for their students with the best intentions in mind. Each day many students enter into these classrooms to experience the delivery of the prepared instruction, yet their perceptions do not always match those of their teachers. The purpose of this research study is to develop and pilot a student…

  18. Improving Instructional Delivery: Reflections on Student Feedback

    ERIC Educational Resources Information Center

    Oliveira, Lisa C.

    2013-01-01

    Teachers work countless hours preparing instruction for their students with the best intentions in mind. Each day many students enter into these classrooms to experience the delivery of the prepared instruction, yet their perceptions do not always match those of their teachers. The purpose of this research study is to develop and pilot a student…

  19. 76 FR 59768 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-27

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE Advisory Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice... the meeting of the Advisory Committee on International Postal and Delivery Services scheduled...

  20. Investigation of the mediating effects of IT governance-value delivery on service quality and ERP performance

    NASA Astrophysics Data System (ADS)

    Tsai, Wen-Hsien; Chou, Yu-Wei; Leu, Jun-Der; Chao Chen, Der; Tsaur, Tsen-Shu

    2015-02-01

    This study aimed to explore the mediating effects of IT governance (ITG)-value delivery in the relationships among the quality of vendor service, the quality of consultant services, ITG-value delivery and enterprise resource planning (ERP) performance. The sampling of this research was acquired from a questionnaire survey concerning ERP implementations in Taiwan. In this survey, 4366 questionnaires were sent to manufacturing and service companies listed in the TOP 5000: The Largest Corporations in Taiwan 2009. The results showed that an ERP system will exhibit a decreased error rate and improved performance if ERP system vendors and consultants provide good service quality. The results also demonstrated that significant relationships exist among the quality of vendor service, the quality of consultant services and value delivery. The contribution of this article is twofold. First, it found that value delivery provides an effective measure of ERP performance under an ITG framework. Second, it provides evidence of the partial mediating effects of value delivery between service quality and ERP performance. In other words, if enterprises want to improve ERP performance, they need to consider factors such as value delivery and the quality of a vendor/consultant's service.

  1. Service Provider Combinations and the Delivery of Early Intervention Services to Children and Families

    ERIC Educational Resources Information Center

    Raspa, Melissa; Hebbeler, Kathleen; Bailey, Donald B., Jr.; Scarborough, Anita A.

    2010-01-01

    Using data from the National Early Intervention Longitudinal Study, this study provides a framework for characterizing the delivery of early intervention services based on the combinations of service providers who work with infants and toddlers with disabilities and their families. Five groups of providers were identified. Results showed that the…

  2. Service Provider Combinations and the Delivery of Early Intervention Services to Children and Families

    ERIC Educational Resources Information Center

    Raspa, Melissa; Hebbeler, Kathleen; Bailey, Donald B., Jr.; Scarborough, Anita A.

    2010-01-01

    Using data from the National Early Intervention Longitudinal Study, this study provides a framework for characterizing the delivery of early intervention services based on the combinations of service providers who work with infants and toddlers with disabilities and their families. Five groups of providers were identified. Results showed that the…

  3. Women's perceptions of antenatal, delivery, and postpartum services in rural Tanzania

    PubMed Central

    Mahiti, Gladys Reuben; Mkoka, Dickson Ally; Kiwara, Angwara Dennis; Mbekenga, Columba Kokusiima; Hurtig, Anna-Karin; Goicolea, Isabel

    2015-01-01

    Background Maternal health care provision remains a major challenge in developing countries. There is agreement that the provision of quality clinical services is essential if high rates of maternal death are to be reduced. However, despite efforts to improve access to these services, a high number of women in Tanzania do not access them. The aim of this study is to explore women's views about the maternal health services (pregnancy, delivery, and postpartum period) that they received at health facilities in order to identify gaps in service provision that may lead to low-quality maternal care and increased risks associated with maternal morbidity and mortality in rural Tanzania. Design We gathered qualitative data from 15 focus group discussions with women attending a health facility after child birth and transcribed it verbatim. Qualitative content analysis was used for analysis. Results ‘Three categories emerged that reflected women's perceptions of maternal health care services: “mothers perceive that maternal health services are beneficial,” “barriers to accessing maternal health services” such as availability and use of traditional birth attendants (TBAs) and the long distances between some villages, and “ambivalence regarding the quality of maternal health services” reflecting that women had both positive and negative perceptions in relation to quality of health care services offered’. Conclusions Mothers perceived that maternal health care services are beneficial during pregnancy and delivery, but their awareness of postpartum complications and the role of medical services during that stage were poor. The study revealed an ambivalence regarding the perceived quality of health care services offered, partly due to shortages of material resources. Barriers to accessing maternal health care services, such as the cost of transport and the use of TBAs, were also shown. These findings call for improvement on the services provided. Improvements

  4. Institutional Change in Delivery of Dental Services: A Marketing Perspective

    PubMed Central

    Capon, Noel

    1982-01-01

    The recent appearance and growth of new delivery systems for dental services is examined from a marketing perspective. Analysis reveals that the growth of low priced, high throughput operations is consistent not only with marketing principles, but with the development of American retail institutions in general. Options for independent dentists in the face of this new competitive environment are discussed. (Am J Public Health 1982; 72:679-683.) PMID:7091457

  5. 75 FR 57102 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-17

    ... Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice; FACA... Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of the 2006... related to international postal and delivery services of interest to Advisory Committee members and the...

  6. 29 CFR 4000.26 - What if I use a commercial delivery service?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false What if I use a commercial delivery service? 4000.26... § 4000.26 What if I use a commercial delivery service? (a) In general. Your filing or issuance date is the date you deposit your submission or issuance with the commercial delivery service if you meet the...

  7. 76 FR 54829 - Advisory Committee On International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-02

    ... Committee On International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice... International Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of... related to international postal and delivery services that are of interest to Advisory Committee...

  8. 76 FR 15028 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-18

    ... Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice; FACA... Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of the 2006... related to international postal and delivery services of interest to Advisory Committee members and...

  9. 45 CFR 50.5 - Waivers for the delivery of health care service.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Waivers for the delivery of health care service... for the delivery of health care service. In determining whether to request a waiver for an Exchange... the delivery of health care service: (a) The Exchange Visitor must submit a statement that he or...

  10. 78 FR 57671 - Advisory Committee on International Postal and Delivery Services; Membership Renewals

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-19

    ... Committee on International Postal and Delivery Services; Membership Renewals AGENCY: Department of State... international postal and private-sector delivery services. The Advisory Committee on International Postal and Delivery Services was created in accordance with the Federal Advisory Committee Act (Pub. L. 92-463)....

  11. Student Delivery of Health Services to Students: A Longitudinal Analysis.

    ERIC Educational Resources Information Center

    Martin, Gary L.; And Others

    1981-01-01

    Student health aide programs for college students have been instrumental in nutrition improvement, medication compliance, general preventive medicine, and in aiding in the mental health delivery system. In this study, headaches and upper respiratory infections constituted a significant percentage of the total visits to the health aide. (JN)

  12. Global fund financing of tuberculosis services delivery in prisons.

    PubMed

    Lee, Donna; Lal, S S; Komatsu, Ryuichi; Zumla, Alimuddin; Atun, Rifat

    2012-05-15

    Despite concerted efforts to scale up tuberculosis control with large amounts of international financing in the last 2 decades, tuberculosis continues to be a social issue affecting the world's most marginalized and disadvantaged communities. This includes prisoners, estimated at about 10 million globally, for whom tuberculosis is a leading cause of mortality and morbidity. The Global Fund to Fight AIDS, Tuberculosis and Malaria has emerged as the single largest international donor for tuberculosis control, including funding support in delivering tuberculosis treatment for the confined population. The Global Fund grants database, with an aggregate approved investment of $21.7 billion in 150 countries by the end of 2010, was reviewed to identify tuberculosis and human immunodeficiency virus/tuberculosis grants and activities that monitored the delivery of tuberculosis treatment and support activities in penitentiary settings. The distribution and trend of number of countries with tuberculosis prison support was mapped by year, geographic region, tuberculosis or multidrug-resistant tuberculosis burden, and prison population rate. We examined the types of grant recipients managing program delivery, their performance, and the nature and range of services provided. Fifty-three of the 105 countries (50%) with Global Fund-supported tuberculosis programs delivered services within prison settings. Thirty-two percent (73 of 228) of tuberculosis grants, representing $558 million of all disbursements of Global Fund tuberculosis support by the end of 2010, included output indicators related to tuberculosis services delivered in prisons. Nearly two-thirds (64%) of these grants were implemented by governments, with the remaining by civil society and other partners. In terms of services, half (36 of 73) of grants provided diagnosis and treatment and an additional 27% provided screening and monitoring of tuberculosis for prisoners. The range of services tracked was limited in scope

  13. Technological developments and approaches to improving service quality.

    PubMed

    Blumberg, M R

    1999-01-01

    In summary, major paradigm shifts in the health care industry are altering the way technology is maintained and supported. Service organizations are now responsible for maintaining a broader base of technology within the health care delivery network and must to this on an extremely rapid, efficient, and productive basis. A number of new technologies are coming on-line, which can allow a health care technology service organization to experience significant improvements in profitability, efficiency, and productivity. To realize maximum benefit from these technologies, service organizations may find themselves re-engineering their service processes. The author believes that this is a requirement for many service organizations, regardless of whether new technology is implemented. The traditional approaches to service delivery are ineffective in managing the new structural realities and service requirements of today's health care environment. New strategies and tactics are required for ensuring that these requirements are met. These approaches will no doubt improve the overall quality, productivity, and efficiency of service and are based on best practices utilized by leading OEMs and ISOs in the medical electronics and other high technology service industry such as information technology and telecommunications, where the service organization is responsible for supporting a broad array of the technology over a large geography with a densely populated installed base, not unlike the typical health care delivery service environment. Once operational improvements are made, a service organization can take advantage of the productivity and efficiency gains brought on by new technology. Organizations interested in doing so are urged to thoroughly research the current state-of-the-art and best practices, because there are numerous systems currently available off-the-shelf. The author believes that new technology will be a basic requirement for competing in the health care

  14. Improved overall delivery documentation following implementation of a standardized shoulder dystocia delivery form.

    PubMed

    Moragianni, Vasiliki A; Hacker, Michele R; Craparo, Frank J

    2011-10-24

    Our objective was to evaluate whether using a standardized shoulder dystocia delivery form improved documentation. A standardized delivery form was added to our institution's obstetrical record in August 2003. A retrospective cohort study was conducted comparing 100 vaginal deliveries complicated by shoulder dystocia before, and 81 after implementation of the standardized delivery form. The two groups were compared in terms of obstetric characteristics, neonatal outcomes and documentation components. Charts that included the standardized delivery form were more likely to contain documentation of estimated fetal weight (82.7% vs. 39.0% without the form, P<0.001) and head-to-shoulder delivery interval (76.5% vs. 15.0% without the form, P<0.001). Both groups were statistically similar in terms of documenting estimated blood loss and fetal weight, umbilical cord pH, type and order of maneuvers utilized to relieve the shoulder dystocia, and second stage duration. Inclusion of a standardized form in the delivery record improves the rate of documentation of both shoulder dystocia-specific and general delivery components.

  15. Improved overall delivery documentation following implementation of a standardized shoulder dystocia delivery form

    PubMed Central

    Moragianni, Vasiliki A.; Hacker, Michele R.; Craparo, Frank J.

    2013-01-01

    Objective Our objective was to evaluate whether using a standardized shoulder dystocia delivery form improved documentation. A standardized delivery form was added to our institution’s obstetrical record in August 2003. Methods A retrospective cohort study was conducted comparing 100 vaginal deliveries complicated by shoulder dystocia before, and 81 after implementation of the standardized delivery form. The two groups were compared in terms of obstetric characteristics, neonatal outcomes and documentation components. Results Charts that included the standardized delivery form were more likely to contain documentation of estimated fetal weight (82.7% vs. 39.0% without the form, P<0.001) and head-to-shoulder delivery interval (76.5% vs. 15.0% without the form, P<0.001). Both groups were statistically similar in terms of documenting estimated blood loss and fetal weight, umbilical cord pH, type and order of maneuvers utilized to relieve the shoulder dystocia, and second stage duration. Conclusions Inclusion of a standardized form in the delivery record improves the rate of documentation of both shoulder dystocia-specific and general delivery components. PMID:22017330

  16. Quality of the delivery services in health facilities in Northern Ethiopia.

    PubMed

    Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen

    2017-03-09

    Substantial improvements have been observed in the coverage of and access to maternal health service, especially in skilled birth attendants, in Ethiopia. However, the quality of care has been lagging behind. Therefore, this study investigated the status of the quality of delivery services in Northern Ethiopia. A facility based survey was conducted from December 2014 to February 2015 in Northern Ethiopia. The quality of delivery service was assessed in 32 health facilities using a facility audit checklist, by reviewing delivery, by conducting in-depth interview and observation, and by conducting exit interviews with eligible mothers. Facilities were considered as 'good quality' if they scored positively on 75% of the quality indicators set in the national guidelines for all the three components; input (materials, infrastructure, and human resource), process (adherence to standard care procedures during intrapartum and immediate postpartum periods) and output (the mothers' satisfaction and utilization of lifesaving procedures). Overall 2 of 32 (6.3%) of the study facilities fulfilled all the three quality components; input, process and output. Two of the three components were assessed as good in 11 of the 32 (34.4%) health facilities. The input quality was the better of the other quality components; which was good in 21 out of the 32 (65.6%) health facilities. The process and output quality was good in only 10 of the 32 (31.3%) facilities. Only 6.3% of the studied health facilities had good quality in all three dimensions of quality measures that was done in accordance to the national delivery service guidelines. The most compromised quality component was the process. Systematic and sustained efforts need to be strengthened to improve all dimensions of quality in order to achieve the desired quality of delivery services and increase the proportion of births occurring in health facilities.

  17. Moving towards Universal Health Coverage through the Development of Integrated Service Delivery Packages for Primary Health Care in the Solomon Islands.

    PubMed

    Whiting, Stephen; Dalipanda, Tenneth; Postma, Sjoerd; Jamshaid de Lorenzo, Ayesha; Aumua, Audrey

    2016-03-30

    The Solomon Islands Government is pursuing integrated care with the goal of improving the quality of health service delivery to rural populations. Under the auspices of Universal Health Coverage, integrated service delivery packages were developed which defined the clinical and public health services that should be provided at different levels of the health system. The process of developing integrated service delivery packages helped to identify key policy decisions the government needed to make in order to improve service quality and efficiency. The integrated service delivery packages have instigated the revision of job descriptions and are feeding into the development of a human resource plan for health. They are also being used to guide infrastructure development and health system planning and should lead to better management of resources. The integrated service delivery packages have become a key tool to operationalise the government's policy to move towards a more efficient, equitable, quality and sustainable health system.

  18. Moving towards Universal Health Coverage through the Development of Integrated Service Delivery Packages for Primary Health Care in the Solomon Islands

    PubMed Central

    Whiting, Stephen; Postma, Sjoerd; Jamshaid de Lorenzo, Ayesha; Aumua, Audrey

    2016-01-01

    The Solomon Islands Government is pursuing integrated care with the goal of improving the quality of health service delivery to rural populations. Under the auspices of Universal Health Coverage, integrated service delivery packages were developed which defined the clinical and public health services that should be provided at different levels of the health system. The process of developing integrated service delivery packages helped to identify key policy decisions the government needed to make in order to improve service quality and efficiency. The integrated service delivery packages have instigated the revision of job descriptions and are feeding into the development of a human resource plan for health. They are also being used to guide infrastructure development and health system planning and should lead to better management of resources. The integrated service delivery packages have become a key tool to operationalise the government’s policy to move towards a more efficient, equitable, quality and sustainable health system. PMID:28321177

  19. Improvement in the Geofencing Service Interface Using Indoor Positioning Systems and Mobile Sensors

    NASA Astrophysics Data System (ADS)

    Nakagawa, M.

    2013-11-01

    The current state of location-based services provides spatial information delivery for mobile users based on position data taken from GPS sensors. However, sometimes the spatial information delivery service includes unwanted information. In particular, push-based or passive information delivery has a high probability that users receive unwanted information. We propose a new spatial information delivery to improve the integrity of spatial information delivery. We conducted an experiment using an Indoor Messaging System and an accelerometer, and concluded that our methodology can detect user behavior without accessing personal information and reduce the amount of spam information.

  20. Bespoke program design for school-aged therapy disability service delivery.

    PubMed

    Weatherill, Pamela; Bahn, Susanne; Cooper, Trudi

    2012-01-01

    This article uses the evaluation of a school-aged therapy service for children with disabilities in Western Australia to investigate models of service delivery. The current literature on family-centered practice, multidisciplinary and transdisciplinary approaches, and 4 models of service are reviewed. The models include the life needs model, the relational goal-orientated model of optimal service delivery to children and families, the quality of life model, and the collaborative model of service delivery. Analysis of the data is presented together with a bespoke model of service delivery for children with disabilities, arguing that local contexts benefit from custom-made service design.

  1. Cost effectiveness and efficiency in assistive technology service delivery.

    PubMed

    Warren, C G

    1993-01-01

    In order to develop and maintain a viable service delivery program, the realities of cost effectiveness and cost efficiency in providing assistive technology must be addressed. Cost effectiveness relates to value of the outcome compared to the expenditures. Cost efficiency analyzes how a provider uses available resources to supply goods and services. This paper describes how basic business principles of benefit/cost analysis can be used to determine cost effectiveness. In addition, basic accounting principles are used to illustrate methods of evaluating a program's cost efficiency. Service providers are encouraged to measure their own program's effectiveness and efficiency (and potential viability) in light of current trends. This paper is meant to serve as a catalyst for continued dialogue on this topic.

  2. Viability of healthcare service delivery alternatives for the Australian mining sector.

    PubMed

    Williams, Patricia A H; Giles, Margaret

    2012-01-01

    The changing and demanding nature of the mining workforce in rural and remote Australia brings unique challenges to the delivery of healthcare services. In an attempt to control costs whilst delivering cost effective and quality healthcare, new models of delivery must be considered. For a workforce that is fly-in/fly-out, the provision of healthcare is problematic given the lack of consistency in location. A cost-benefit framework is analysed comparing three models of service provision using travel to a major location, locum services and remote health monitoring. Ultimately, new models of care must be considered to address the issues of increasing workforce turnover, to cater for rising healthcare costs, and to improve the health of such communities.

  3. Important change in service for international Eos delivery

    NASA Astrophysics Data System (ADS)

    Treby, Jill

    2012-01-01

    In direct response to member feedback about delays in delivery time and an overwhelming preference to read Eos online, print issues of Eos will no longer be mailed to members who have a delivery address outside the United States, effective with the 10 January 2012 issue. Our international members will continue to have access to the Eos electronic edition as well as recently introduced Web-only content. In addition, members who no longer receive a print copy of Eos will receive weekly e-alerts telling them when the newest issue is available online (several days before the cover date). Members with a mailing address in the United States also have the choice to opt out of the printed copy. Not only will this change allow us to better serve the needs of our international members, but also the cost savings will permit AGU to significantly increase investment in the other programs, products, and services that members value.

  4. Exploring barriers to the delivery of cervical cancer screening and early treatment services in Malawi: some views from service providers

    PubMed Central

    Munthali, Alister C; Ngwira, Bagrey M; Taulo, Frank

    2015-01-01

    Background Cervical cancer is the most common reproductive health cancer in Malawi. In most cases, women report to health facilities when the disease is in its advanced stage. In this study, we investigate service providers’ perceptions about barriers for women to access cervical cancer screening and early treatment services in Malawi. Methods We conducted in-depth interviews with 13 district coordinators and 40 service providers of cervical cancer screening and early treatment services in 13 districts in Malawi. The study was conducted in 2012. The district coordinators helped the research team identify the health facilities which were providing cervical cancer screening and early treatment services. Results Almost all informants reported that cervical cancer was a major public health problem in their districts and that prevention efforts for this disease were being implemented. They were aware of the test and treat approach using visual inspection with acetic acid (VIA). They, however, said that the delivery of cervical cancer screening and early treatment services was compromised because of factors such as gross shortage of staff, lack of equipment and supplies, the lack of supportive supervision, and the use of male service providers. Informants added that the lack of awareness about the disease among community members, long distances to health facilities, the lack of involvement of husbands, and prevailing misperceptions about the disease (eg, that it is caused by the exposure to the VIA process) affect the uptake of these services. Conclusion While progress has been made in the provision of cervical cancer screening and early treatment services in Malawi, a number of factors affect service delivery and uptake. There is a need to continue creating awareness among community members including husbands and also addressing identified barriers such as shortage of staff and supplies in order to improve uptake of services. PMID:25848229

  5. Pricing: A Normative Strategy in the Delivery of Human Services.

    ERIC Educational Resources Information Center

    Moore, Stephen T.

    1995-01-01

    Discusses a normative strategy toward pricing human services, which will allow providers to develop pricing strategies within the context of organizational missions, goals, and values. Pricing is an effective tool for distributing resources and improving efficiency, and can be used as a tool for encouraging desired patterns of service utilization.…

  6. Multistage Nanoparticles for Improved Delivery into Tumor Tissue

    PubMed Central

    Stylianopoulos, Triantafyllos; Wong, Cliff; Bawendi, Moungi G.; Jain, Rakesh K.; Fukumura, Dai

    2013-01-01

    The enhanced permeability and retention (EPR) effect has been a key rationale for the development of nanoscale carriers to solid tumors. As a consequence of EPR, nanotherapeutics are expected to improve drug and detection probe delivery, have less adverse effects than conventional chemotherapy, and thus result in improved detection and treatment of tumors. Physiological barriers posed by the abnormal tumor microenvironment, however, can hinder the homogeneous delivery of nanomedicine in amounts sufficient to eradicate cancer. To effectively enhance the therapeutic outcome of cancer patients by nanotherapeutics, we have to find ways to overcome these barriers. One possibility is to exploit the abnormal tumor microenvironment for selective and improved delivery of therapeutic agents to tumors. Recently, we proposed a multistage nanoparticle delivery system as a potential means to enable uniform delivery throughout the tumor and improve the efficacy of anticancer therapy. Here, we describe the synthesis of a novel multistage nanoparticle formulation that shrinks in size once it enters the tumor interstitial space to optimize the delivery to tumors as well as within tumors. Finally, we provide detailed experimental methods for the characterization of such nanoparticles. PMID:22449923

  7. Critical Issues in the Delivery of Local Government Services in Rural America.

    ERIC Educational Resources Information Center

    Doeksen, Gerald A.; Peterson, Janet

    Technological changes, an increase in demand for quality community services, and environmental controls have created conditions of continual change in the delivery of rural services. This report summarizes economic theory on community service delivery, reviews economic literature on specific community services, and identifies research gaps and…

  8. Microencapsulation for the improved delivery of bioactive compounds into foods.

    PubMed

    Champagne, Claude P; Fustier, Patrick

    2007-04-01

    The development of functional foods through the addition of bioactive compounds holds many technological challenges. Microencapsulation is a useful tool to improve the delivery of bioactive compounds into foods, particularly probiotics, minerals, vitamins, phytosterols, lutein, fatty acids, lycopene and antioxidants. Several microencapsulation technologies have been developed for use in the food industry and show promise for the production of functional foods. Moreover, these technologies could promote the successful delivery of bioactive ingredients to the gastrointestinal tract. Future research is likely to focus on aspects of delivery and the potential use of co-encapsulation methodologies, where two or more bioactive ingredients can be combined to have a synergistic effect.

  9. From Data to Improved Decisions: Operations Research in Healthcare Delivery.

    PubMed

    Capan, Muge; Khojandi, Anahita; Denton, Brian T; Williams, Kimberly D; Ayer, Turgay; Chhatwal, Jagpreet; Kurt, Murat; Lobo, Jennifer Mason; Roberts, Mark S; Zaric, Greg; Zhang, Shengfan; Schwartz, J Sanford

    2017-11-01

    The Operations Research Interest Group (ORIG) within the Society of Medical Decision Making (SMDM) is a multidisciplinary interest group of professionals that specializes in taking an analytical approach to medical decision making and healthcare delivery. ORIG is interested in leveraging mathematical methods associated with the field of Operations Research (OR) to obtain data-driven solutions to complex healthcare problems and encourage collaborations across disciplines. This paper introduces OR for the non-expert and draws attention to opportunities where OR can be utilized to facilitate solutions to healthcare problems. Decision making is the process of choosing between possible solutions to a problem with respect to certain metrics. OR concepts can help systematically improve decision making through efficient modeling techniques while accounting for relevant constraints. Depending on the problem, methods that are part of OR (e.g., linear programming, Markov Decision Processes) or methods that are derived from related fields (e.g., regression from statistics) can be incorporated into the solution approach. This paper highlights the characteristics of different OR methods that have been applied to healthcare decision making and provides examples of emerging research opportunities. We illustrate OR applications in healthcare using previous studies, including diagnosis and treatment of diseases, organ transplants, and patient flow decisions. Further, we provide a selection of emerging areas for utilizing OR. There is a timely need to inform practitioners and policy makers of the benefits of using OR techniques in solving healthcare problems. OR methods can support the development of sustainable long-term solutions across disease management, service delivery, and health policies by optimizing the performance of system elements and analyzing their interaction while considering relevant constraints.

  10. Evaluating Fidelity to a Modified NIATx Process Improvement Strategy for Improving HIV Services in Correctional Facilities.

    PubMed

    Pankow, Jennifer; Willett, Jennifer; Yang, Yang; Swan, Holly; Dembo, Richard; Burdon, William M; Patterson, Yvonne; Pearson, Frank S; Belenko, Steven; Frisman, Linda K

    2017-04-24

    In a study aimed at improving the quality of HIV services for inmates, an organizational process improvement strategy using change teams was tested in 14 correctional facilities in 8 US states and Puerto Rico. Data to examine fidelity to the process improvement strategy consisted of quantitative ratings of the structural and process components of the strategy and qualitative notes that explicate challenges in maintaining fidelity to the strategy. Fidelity challenges included (1) lack of communication and leadership within change teams, (2) instability in team membership, and (3) issues with data utilization in decision-making to implement improvements to services delivery.

  11. Imaging informatics: essential tools for the delivery of imaging services.

    PubMed

    Mendelson, David S; Rubin, Daniel L

    2013-10-01

    There are rapid changes occurring in the health care environment. Radiologists face new challenges but also new opportunities. The purpose of this report is to review how new informatics tools and developments can help the radiologist respond to the drive for safety, quality, and efficiency. These tools will be of assistance in conducting research and education. They not only provide greater efficiency in traditional operations but also open new pathways for the delivery of new services and imaging technologies. Our future as a specialty is dependent on integrating these informatics solutions into our daily practice. Copyright © 2013. Published by Elsevier Inc.

  12. Knowledgeable antenatal care as a pathway to skilled delivery: modelling the interactions between use of services and knowledge in Zambia.

    PubMed

    Ensor, Tim; Quigley, Paula; Green, Cathy; Razak Badru, Abdul; Kaluba, Dynes; Siziya, Seter

    2014-08-01

    The link between antenatal care (ANC) and facility delivery is a specific example of the effect of early medical contacts on later use of essential services. The role of ANC in improving maternal health remains unclear. High levels of ANC are reported in a number of countries where skilled delivery remains uncommon. ANC may influence the use of services by increasing willingness to use services and educating about maternal health. The objective of this study is to understand the interaction between use of skilled and unskilled ANC, knowledge of obstetric complications and danger signs, and the eventual use of a facility for delivery. The study makes use of data from a survey of around 1700 women who had recently given birth across 11 districts of Zambia in 2011. Multivariate analysis is used to explore the associations between ANC use, knowledge and place of delivery. The results suggest that place of care and number of visits is strongly associated with the eventual use of a facility for delivery; an effect that is stronger in remote areas. Both skilled and unskilled ANC and obstetric knowledge is linked to higher use of facility delivery care while care provided at home appears to have an opposite effect. The research suggests that ANC influences later use of delivery care in two ways: by developing a habit to use formal care services and in increasing maternal knowledge. The work might be generalized to other health seeking behaviour to explore how the quantity and quality of initial contacts influence later use of services.

  13. Innovative Service or Proselytizing: Exploring when Services Delivery Becomes a Platform for Unwanted Religious Persuasion

    ERIC Educational Resources Information Center

    Sherr, Michael E.; Singletary, Jon E.; Rogers, Robin K.

    2009-01-01

    In this article, the authors explore the question: When does services delivery cross the line and become an opportunity for proselytizing? The authors posit that social workers have a justifiable concern for usurping their professional and privileged roles to influence such an important part of their clients' lives. A case study of one Christian…

  14. Innovative Service or Proselytizing: Exploring when Services Delivery Becomes a Platform for Unwanted Religious Persuasion

    ERIC Educational Resources Information Center

    Sherr, Michael E.; Singletary, Jon E.; Rogers, Robin K.

    2009-01-01

    In this article, the authors explore the question: When does services delivery cross the line and become an opportunity for proselytizing? The authors posit that social workers have a justifiable concern for usurping their professional and privileged roles to influence such an important part of their clients' lives. A case study of one Christian…

  15. Effects of Neighborhood Consensus on Services Delivery. Human Services Bibliography Series. Project SHARE.

    ERIC Educational Resources Information Center

    Aspen Systems Corp., Germantown, MD.

    This Project SHARE bibliography lists 43 documents that are representative of the literature concerning the effects of neighborhood consensus on human services delivery. It is divided into three sections: abstracts, an alphabetical list of personal or corporate authors, and a title index. The abstracts are preceded by citation data to aid in…

  16. Improving Tradecraft of Services Acquisition

    DTIC Science & Technology

    2015-08-01

    System” by focusing solely on services. 2. Portfolio Management: Uniform portfolio groups (Knowledge Based Services, Transportation Ser- vices...July–August 2015 24 Services) and Functional Domain Experts (FDEs) for each portfolio group provide enterprise-level oversight and policy across...all DoD agencies within their respec- tive portfolios . 3. Training and Tools: The DoD is identifying the training requirements for both Defense

  17. Rethinking Library Service: Improving the User Experience with Service Blueprinting

    ERIC Educational Resources Information Center

    Pretlow, Cassi; Sobel, Karen

    2015-01-01

    Service blueprinting is a process that businesses use for analyzing and improving service. Originally presented in the Harvard Business Review in 1984, it has retained a strong following ever since. At present, it is experiencing a revival at numerous academic institutions. The authors of this article present the process of service blueprinting.…

  18. Rethinking Library Service: Improving the User Experience with Service Blueprinting

    ERIC Educational Resources Information Center

    Pretlow, Cassi; Sobel, Karen

    2015-01-01

    Service blueprinting is a process that businesses use for analyzing and improving service. Originally presented in the Harvard Business Review in 1984, it has retained a strong following ever since. At present, it is experiencing a revival at numerous academic institutions. The authors of this article present the process of service blueprinting.…

  19. Customer's Perceptions and Intentions on Online Travel Service Delivery: An Empirical Study in China

    NASA Astrophysics Data System (ADS)

    Li, Hongxiu; Suomi, Reima

    With the wide adoption of e-commerce in travel and tourism industry, the Internet has become an important travel service delivery channel, and traditional travel agency has been under severe disintermediation threat. This paper reports on a survey conducted to explore the Chinese consumer's current usage of the Internet as the channel to search travel information and to book travel services. It also investigates customer's future intentions on using the Internet to book travel services. This paper aims to examine whether there are difference between different consumer segments in terms of gender and age, and to find the hypothesis of disintermediation or intermediation in travel industry. The results indicates that online travel service delivery has grown as a popular direct distribution channel in travel industry, but more of the customers still turn to the traditional travel agencies, which support both the disintermediation and intermediation in travel industry. The results also reveal that online travel services provided by travel service providers still need to be improved since the number of online bookers is declined. This paper concludes by discussing the limitation of this study and highlighting areas for the future research in online travel service field.

  20. Voice of the customer---a roadmap for service improvement.

    PubMed

    Uberoi, Ravinder S; Nayak, Yogamaya; Sachdeva, Pritindira; Sibal, Anupam

    2013-01-01

    Patient satisfaction surveys help a great deal in identifying ways of improving a hospital's services. Ultimately, that translates into better care and happier patients. Moreover, it shows the staff and the community that the hospital is serious about quality and is looking for ways to improve. This article describes how the Voice of the Customer (VOC) Survey can be used as a tool for improving services. Regular monitoring of VOC scores is essential for minimizing the gaps between service delivery and patient expectations. The present study showcases the various initiatives undertaken to improve the VOC scores from an original 4.40 to 4.77 (on a 5 point scale) at the hospital under study.

  1. Applying Systems Engineering Principles in Improving Health Care Delivery

    PubMed Central

    Kopach-Konrad, Renata; Criswell, Mike; Hasan, Imran; Chakraborty, Santanu; Pekny, Joseph; Doebbeling, Bradley N.

    2007-01-01

    Background In a highly publicized joint report, the National Academy of Engineering and the Institute of Medicine recently recommended the systematic application of systems engineering approaches for reforming our health care delivery system. For this to happen, medical professionals and managers need to understand and appreciate the power that systems engineering concepts and tools can bring to redesigning and improving health care environments and practices. Objective To present and discuss fundamental concepts and tools of systems engineering and important parallels between systems engineering, health services, and implementation research as it pertains to the care of complex patients. Design An exploratory, qualitative review of systems engineering concepts and overview of ongoing applications of these concepts in the areas of hemodialysis, radiation therapy, and patient flow modeling. Results In this paper, we describe systems engineering as the process of identifying the system of interest, choosing appropriate performance measures, selecting the best modeling tool, studying model properties and behavior under a variety of scenarios, and making design and operational decisions for implementation. Conclusions We discuss challenges and opportunities for bringing people with systems engineering skills into health care. PMID:18026813

  2. AOD treatment agencies: does religious affiliation influence service delivery?

    PubMed

    McIlwraith, Fairlie; Kinner, Stuart A; Najman, Jake M

    2011-11-01

    Religious organisations have been involved in delivering alcohol and other drug (AOD) services since Australian colonial times and are a familiar presence in the AOD sector. However, there is concern in some sectors that AOD services delivered by religious organisations might be influenced by religious ideology, at the expense of evidence-based service provision. A national, cross-sectional survey of non-government AOD agencies was undertaken using a mailed questionnaire. All non-government AOD agencies in Australia, providing at least one face-to-face specialist AOD service, were invited to participate. Agency goals and activities were assessed using the Drug and Alcohol Program Treatment Inventory, which has eight distinct treatment orientations: 12-step, therapeutic community, cognitive behavioural therapy, psychodynamic, family, rehabilitation, dual diagnosis and medical. There was a high degree of uniformity in treatment orientations with religiously affiliated agencies having similar goals and activities to non-religiously affiliated agencies. Cognitive behavioural therapy was most commonly provided and 12-step the least provided. Religiously affiliated agencies were significantly more likely to favour the 12-step orientation in both goals and activities. Concerns that the religious affiliation of non-government organisations might influence AOD service delivery in Australia appear to be overstated. Factors contributing to the observed uniformity of care may include a more strategic, federal approach; and an increasing emphasis on best practice within the sector. The lack of discernable differentiation between religiously affiliated and non-religiously affiliated non-government organisations may also be attributable to changes in the way services are delivered by many religious organisations. © 2011 Australasian Professional Society on Alcohol and other Drugs.

  3. Addressing health system barriers to access to and use of skilled delivery services: perspectives from Ghana.

    PubMed

    Ganle, John Kuumuori; Fitzpatrick, Raymond; Otupiri, Easmon; Parker, Michael

    2016-10-01

    Poor access to and use of skilled delivery services have been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. However, many previous studies that examine norms of childbirth and care-seeking behaviours have focused on identifying the norms of non-use of services, rather than factors, that can promote service use. Based on primary qualitative research with a total of 185 expectant and lactating mothers, and 20 healthcare providers in six communities in Ghana, this paper reports on strategies that can be used to overcome health system barriers to the use of skilled delivery services. The strategies identified include expansion and redistribution of existing maternal health resources and infrastructure, training of more skilled maternity caregivers, instituting special programmes to target women most in need, improving the quality of maternity care services provided, improving doctor-patient relationships in maternity wards, promotion of choice, protecting privacy and patient dignity in maternity wards and building partnerships with traditional birth attendants and other non-state actors. The findings suggest the need for structural changes to maternity clinics and routine nursing practices, including an emphasis on those doctor-patient relational practices that positively influence women's healthcare-seeking behaviours. Copyright © 2015 John Wiley & Sons, Ltd.

  4. Improving oral healthcare delivery systems through workforce innovations: an introduction.

    PubMed

    Mertz, Elizabeth A; Finocchio, Len

    2010-06-01

    The objective of this paper is to describe the purpose, rationale and key elements of the special issue, Improving Oral Healthcare Delivery Systems through Workforce Innovations. The purpose of the special issue is to further develop ideas presented at the 2009 Institute of Medicine (IOM) workshop, Sufficiency of the U.S. Oral Health Workforce in the Coming Decade. Using the IOM discussions as their starting point, the authors evaluate oral health care delivery system performance for specific populations' needs and explore the roles that the workforce can play in improving the care delivery model. The contributing articles provide a broad framework for stimulating and evaluating innovation and change in the oral health care delivery system. The articles in this special issue point to many deficits in the current oral health care delivery system and provide compelling arguments and proposals for improvements. The issues presented and solutions recommended are not entirely new, but add to a growing body of work that is of critical importance given the context of wider health care reform.

  5. Service quality of delivered care from the perception of women with caesarean section and normal delivery.

    PubMed

    Tabrizi, Jafar S; Askari, Samira; Fardiazar, Zahra; Koshavar, Hossein; Gholipour, Kamal

    2014-01-01

    Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 - (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women's perspective.A hierarchical regression analysis was applied in two steps using the enter method to examine the associations between demographics and SQ scores. Data were analysed using the SPSS-17 software. "Confidentiality", "autonomy", "choice of care provider" and "communication" achieved scores at the highest level of quality; and "support group", "prompt attention", "prevention and early detection", "continuity of care", "dignity", "safety", "accessibility and "basic amenities" got service quality score less than eight. Statistically significant relationship was found between service quality score and continuity of care (P=0.008). A notable gap between the participants‟ expectations and what they have actually received in most aspects of provided care. So, there is an opportunityto improve the quality of delivered care.

  6. 34 CFR 303.525 - Delivery of services in a timely manner.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Delivery of services in a timely manner. 303.525... Matters § 303.525 Delivery of services in a timely manner. Each lead agency is responsible for the... SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM...

  7. 77 FR 2340 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-17

    ... Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice of... the renewal of the charter of the Advisory Committee on International Postal and Delivery Services in... oversight of foreign policy related to international postal services and other international...

  8. 45 CFR 50.5 - Waivers for the delivery of health care service.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Waivers for the delivery of health care service... for the delivery of health care service. In determining whether to request a waiver for an Exchange Visitor to deliver health care service, the Board will consider information from and coordinate with State...

  9. 45 CFR 50.5 - Waivers for the delivery of health care service.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Waivers for the delivery of health care service... for the delivery of health care service. In determining whether to request a waiver for an Exchange Visitor to deliver health care service, the Board will consider information from and coordinate with State...

  10. 45 CFR 50.5 - Waivers for the delivery of health care service.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Waivers for the delivery of health care service... for the delivery of health care service. In determining whether to request a waiver for an Exchange Visitor to deliver health care service, the Board will consider information from and coordinate with State...

  11. Nanoemulsion: for improved oral delivery of repaglinide.

    PubMed

    Akhtar, Juber; Siddiqui, Hefazat Hussain; Fareed, Sheeba; Badruddeen; Khalid, Mohammad; Aqil, Mohammed

    2016-07-01

    Repaglinide (RPG) is a fast-acting prandial glucose regulator. It acts by stimulating insulin release from pancreatic β-cells. Recurrent dosing of RPG before each meal is burdensome remedy. Hence the plan of the present study was to evaluate nanoemulsion as a hopeful carrier for RPG for persistent hypoglycemic effect. The drug was incorporated into oil phase of nanoemulsion to give improved biopharmaceutical properties as compared to the lipid-based systems. Pseudo ternary phase diagrams were prepared by aqueous titration method. Formulations were selected at a difference of 5% w/w of oil from the o/w nanoemulsion region of phase diagrams. The optimized nanoemulsion formulation constituted sefsol-218 (5% v/v) as an oil phase, 30% v/v of Tween-80 and transcutol as a surfactant and co-surfactant to restrain nanodroplet size and low viscosity and distilled water (65%). In vitro dissolution studies showed higher drug release (98.22%), finest droplet size (76.23 nm), slightest polydispersity value (0.183), least viscosity (21.45 cps) and immeasurable dilution capability from the nanoemulsion as compared with existing oral tablet formulation. The optimized RPG nanoemulsion formulation showed better hypoglycemic effect in comparison to tablet formulation in experimental diabetic rats. No significant variations were also observed in the optimized formulation when subjected to accelerated stability study at different temperature and relative humidity over a period of 3 months.

  12. Cost efficiency in maternal and child health and family planning service delivery in Bangladesh: implications for NGOs.

    PubMed

    Routh, Subrata; Thwin, Aye Aye; Barb, Nadia; Begum, Anwara

    2004-01-01

    The main goal of the health reform programme recently initiated in Bangladesh is to reduce costs and improve cost efficiency of the service delivery systems, and thereby ensure the sustainable provision of essential health and family planning services. With significant dependency on external funding, attainment of this objective is more critical for non-government organization (NGO) programmes. The paper analyzes costs of the NGO service delivery systems for maternal and child health and family planning, and identifies areas for increasing efficiency, especially through reducing labour costs and increasing service outputs. The operations research on cost analyses was conducted within the health and family planning programmes of a leading NGO, using the 'ingredients approach'. The findings demonstrated a significantly high proportion of personnel costs in field (outreach) service delivery systems, ranging between 70-85%. More than two-thirds of the working time of providers was spent on support activities, personal preoccupations and idle time. Simulations of various cost reduction options showed that considerable efficiency gains were possible through the combined effects of lowering personnel costs for field activities, increasing service outputs at the clinics, and ensuring more efficient use of providers' time. However, these factors, neither separately nor in combination, resulted in any substantive decrease for certain clinic services (e.g. antenatal care), implying the need to subsidize these services. The findings of the operations research indicated that cost analyses could be an effective decision-making tool for NGOs in developing cost-efficient service delivery strategies.

  13. Strategies to improve drug delivery in bladder cancer therapy.

    PubMed

    Wirth, M; Plattner, V E; Gabor, F

    2009-07-01

    Bladder cancer is the ninth most common malignancy in the world featuring very high gender variability in occurrence. Current options for bladder cancer therapy include surgery, immunotherapy, chemotherapy and radiotherapy with a trend towards multimodal treatments. However, successful management remains a challenge for urologists and oncologists because of the high risk for recurrence and progression. Particularly in the field of bladder cancer chemotherapy, efficacy of treatment might be improved by advanced drug delivery strategies aimed at prolonged residence time within the bladder cavity and increased permeability of the bladder wall during intravesical instillation. Moreover, a deeper understanding of the biology of bladder carcinogenesis and malignant progression stimulated the development of a new generation of anticancer drugs for targeted therapies that might result in increased treatment specificity together with lower toxic potential and higher therapeutic indices. This review discusses the available strategies for 'targeted therapy', focusing on molecular targets, and for 'controlled delivery', comprising all other approaches towards improved drug delivery.

  14. Continue Service Improvement at CERN Computing Centre

    NASA Astrophysics Data System (ADS)

    Barroso Lopez, M.; Everaerts, L.; Meinhard, H.; Baehler, P.; Haimyr, N.; Guijarro, J. M.

    2014-06-01

    Using the framework of ITIL best practises, the service managers within CERN-IT have engaged into a continuous improvement process, mainly focusing on service operation. This implies an explicit effort to understand and improve all service management aspects in order to increase efficiency and effectiveness. We will present the requirements, how they were addressed and share our experiences. We will describe how we measure, report and use the data to continually improve both the processes and the services being provided. The focus is not the tool or the process, but the results of the continuous improvement effort from a large team of IT experts providing services to thousands of users, supported by the tool and its local team. This is not an initiative to address user concerns in the way the services are managed but rather an on-going working habit of continually reviewing, analysing and improving the service management processes and the services themselves, having in mind the currently agreed service levels and whose results also improve the experience of the users about the current services.

  15. ['Our future selves'. Comments on "Human services and delivery systems'].

    PubMed

    Sipsma, D H

    1979-05-01

    A description is given of the recommended research topics on Human Services and Delivery Systems for the Aging. Fifteen different fields of research attention are described. It is stated that there is a lack of a frame of reference for the different attention fields. This frame of reference is necessary for a more systematic approach towards the age specific problems and the age specific services, needed to solve those problems. The systematic approach can be found in a three-dimensional scheme in which the fifteen attention fields have their logical place. The recommanded research topics have to be assessed in this frame: 1. Socio-cultural aspects. Culture, religion, ethics, communication, education, recreation, civic participation. 2. Socio-economic aspects. Economic support, employment, legal services, commerce. 3. Physical environment. Physical Environment, nutrition, transportation. 4. Human environment. This aspect is not mentioned in the report. 5. Psychological aspects. 6. Physical aspects. These aspects are not explicitly mentioned in the report, but implicitly in the chapter about Health. Some of the recommendations are also relevant for the situation in the Netherlands. The recommended research on the health care system is critisized, because the items are too complex. For the Netherlands it is more worthwhile to do fundamental research on the age-specific vulnerability in relation to social, psychological and physical aspects. The results of that research can be used for a reconstruction of the whole health care system for the aged.

  16. Characteristics of Indigenous primary health care models of service delivery: a scoping review protocol.

    PubMed

    Harfield, Stephen; Davy, Carol; Kite, Elaine; McArthur, Alexa; Munn, Zachary; Brown, Ngiare; Brown, Alex

    2015-11-01

    Alaska Native people". The IHS "grew out of a special government-to-government relationship between the federal government and Indian Tribes".Evidence suggests that "a strong primary health care sector is essential to the health and wellbeing of a population, and that a strong primary health care sector is associated with better population health, reduced costs of health care provision, and greater efficiency within the system". A study of Aboriginal Canadians shows that poor access and ineffective primary health care services were directly related to increased avoidable hospital admissions. In addition, a recent study in Australia focusing on the costs and the health outcomes associated with primary care use by Indigenous people with diabetes in remote communities in the Northern Territory demonstrates that improved access to primary health care which is responsive to the needs of Aboriginal and Torres Strait Islander people is both cost-effective and associated with better health outcomes.Given the strong link between primary health care and health outcomes and the significant contribution Indigenous health services make towards reducing the health disadvantage experienced by Indigenous people, it is important to understand the characteristics that support the delivery of health provided by Indigenous health services and their unique models. While there is not a clear definition in the literature about what a model of care or model of service delivery is, for the purpose of this review, it will encompass all factors involved in the delivery of care including but not limited to the vision, values and strategies that underpin the delivery of care, healthcare services and programs, governance and leadership, workforce, organization and supply, and infrastructure and other resources.The aim of this scoping review is to determine the characteristics of Indigenous primary health care models of service delivery by drawing on existing literature that look at the way in which

  17. Recommendations for Improving Intervener Services

    ERIC Educational Resources Information Center

    National Consortium on Deaf-Blindness, 2012

    2012-01-01

    The U.S. Department of Education's Office of Special Education Programs (OSEP) recognizes the current challenges faced by states and schools relative to the provision of high-quality intervener services for children who are deaf-blind. To respond to these challenges, OSEP asked the National Consortium on Deaf-Blindness (NCDB) to conduct an…

  18. Mental Health and Service Delivery Systems for Black Women.

    ERIC Educational Resources Information Center

    Smith, Elsie H.

    1981-01-01

    Examines mental health issues, especially alcoholism, suicide, and social depression, related to the counseling of Black women. Recommends improved mental health services, counselor/clinical training programs, and additional research focusing on the causes of stress among Black women. (Author/MW)

  19. Monitoring and evaluation of contracts for health service delivery in Costa Rica.

    PubMed

    Abramson, W B

    2001-12-01

    The Costa Rican Social Security Fund (CCSS) has been purchasing primary health care services from the Costa Rican Cooperative, COOPESALUD. The CCSS has made significant progress in establishing performance indicators and conducting evaluations of progress against those indicators. After laying out a general framework for developing performance indicators, this paper analyzes the CCSS's evaluation of its 1998 contract with COOPESALUD in terms of objectives, performance indicators, evaluation results, and use of the evaluation results. The objectives of the COOPESALUD contract, as they are stated within the body of the contract, are to increase coverage, improve quality and increase efficiency. Contract performance is measured through three categories of indicators: organization, service delivery and quality. Service delivery targets are set in terms of volume of services based upon geographic population. A 'yes' or a 'no' rating to indicate whether a particular system is in place is used for scoring organization and quality targets. While the CCSS contract is one of the most advanced in the region, many aspects could be improved. By setting indicator targets based upon population estimates, it is difficult for the CCSS to accurately assess COOPESALUD's performance. Although the CCSS conducts periodic evaluations through formal mechanisms, and some data on volume of service delivery are available, the data gathered in all three categories do not provide the purchaser with information directly related to all of the contract objectives nor to contractor performance. The indicators spelled out in the contract, and the evaluation of those indicators, do not seek to measure quantifiable results or impact through numerical data. There are no process or result indicators in place. The evaluation results could therefore tend to be fairly superficial - based upon population coverage and not on effectiveness of treatment, quality of treatment or efficient resource use.

  20. Urban governance and spatial inequality in service delivery: a case study of solid waste management in Abuja, Nigeria.

    PubMed

    Adama, Onyanta

    2012-09-01

    Spatial inequality in service delivery is a common feature in African cities. Several factors account for the phenomenon but there is growing attention towards urban governance and the role of the state. Urban governance policies such as privatization serve as key strategies through which the state regulates and (re)produces spatial inequality in service delivery. This study examined how governance practices related to privatization and the regulatory role of the state reinforce spatial inequalities in the delivery of solid waste services in Abuja, Nigeria. It focused primarily on the issue of cost recovery. Privatization became a major focus in Abuja in 2003 when the government launched a pilot scheme. Although it has brought improvements in service delivery, privatization has also increased the gap in the quality of services delivered in different parts of the city. Drawing on empirical data, the study revealed that little sensitivity to income and affordability, and to income differentials between neighbourhoods in the fixing of user charges and in the choice of the billing method is contributing to spatial inequalities in service delivery. Furthermore, the study suggests that these practices are linked to a broader issue, a failure of the government to see the people as partners. It therefore calls for more inclusive governance especially in decision-making processes. The study also emphasizes the need for a policy document on solid waste management, as this would encourage a critical assessment of vital issues including how privatization is to be funded, especially in low-income areas.

  1. Interventions to improve delivery of isoniazid preventive therapy: an overview of systematic reviews

    PubMed Central

    2014-01-01

    Background Uptake of isoniazid preventive therapy (IPT) to prevent tuberculosis has been poor, particularly in the highest risk populations. Interventions to improve IPT delivery could promote implementation. The large number of existing systematic reviews on treatment adherence has made drawing conclusions a challenge. To provide decision makers with the evidence they need, we performed an overview of systematic reviews to compare different organizational interventions to improve IPT delivery as measured by treatment completion among those at highest risk for the development of TB disease, namely child contacts or HIV-infected individuals. Methods We searched the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects (DARE), and MEDLINE up to August 15, 2012. Two authors used a standardized data extraction form and the AMSTAR instrument to independently assess each review. Results Six reviews met inclusion criteria. Interventions included changes in the setting/site of IPT delivery, use of quality monitoring mechanisms (e.g., directly observed therapy), IPT delivery integration into other healthcare services, and use of lay health workers. Most reviews reported a combination of outcomes related to IPT adherence and treatment completion rate but without a baseline or comparison rate. Generally, we found limited evidence to demonstrate that the studied interventions improved treatment completion. Conclusions While most of the interventions were not shown to improve IPT completion, integration of tuberculosis and HIV services yielded high treatment completion rates in some settings. The lack of data from high burden TB settings limits applicability. Further research to assess different IPT delivery interventions, including those that address barriers to care in at-risk populations, is urgently needed to identify the most effective practices for IPT delivery and TB control in high TB burden settings. PMID:24886159

  2. Huddles and Debriefings: Improving Communication on Labor and Delivery.

    PubMed

    McQuaid-Hanson, Emily; Pian-Smith, May C M

    2017-03-01

    Interprofessional teams work together on the labor and delivery unit, where clinical care is often unscheduled, rapidly evolving, and fast paced. Effective communication is key for coordinated delivery of optimal care and for fostering a culture of community and safety in the workplace. The preoperative huddle allows for information sharing, cross-checking, and preparation before the start of surgery. Postoperative debriefings allow the operative team to engage in ongoing process improvement. Debriefings after adverse events allow for shared understanding, mutual healing, and help mitigating the harm to potential "second victims."

  3. Alternate Service Delivery Models in Cancer Genetic Counseling: A Mini-Review

    PubMed Central

    Buchanan, Adam Hudson; Rahm, Alanna Kulchak; Williams, Janet L.

    2016-01-01

    Demand for cancer genetic counseling has grown rapidly in recent years as germline genomic information has become increasingly incorporated into cancer care, and the field has entered the public consciousness through high-profile celebrity publications. Increased demand and existing variability in the availability of trained cancer genetics clinicians place a priority on developing and evaluating alternate service delivery models for genetic counseling. This mini-review summarizes the state of science regarding service delivery models, such as telephone counseling, telegenetics, and group counseling. Research on comparative effectiveness of these models in traditional individual, in-person genetic counseling has been promising for improving access to care in a manner acceptable to patients. Yet, it has not fully evaluated the short- and long-term patient- and system-level outcomes that will help answer the question of whether these models achieve the same beneficial psychosocial and behavioral outcomes as traditional cancer genetic counseling. We propose a research agenda focused on comparative effectiveness of available service delivery models and how to match models to patients and practice settings. Only through this rigorous research can clinicians and systems find the optimal balance of clinical quality, ready and secure access to care, and financial sustainability. Such research will be integral to achieving the promise of genomic medicine in oncology. PMID:27242960

  4. Health workforce governance: Processes, tools and actors towards a competent workforce for integrated health services delivery.

    PubMed

    Barbazza, Erica; Langins, Margrieta; Kluge, Hans; Tello, Juan

    2015-12-01

    A competent health workforce is a vital resource for health services delivery, dictating the extent to which services are capable of responding to health needs. In the context of the changing health landscape, an integrated approach to service provision has taken precedence. For this, strengthening health workforce competencies is an imperative, and doing so in practice hinges on the oversight and steering function of governance. To aid health system stewards in their governing role, this review seeks to provide an overview of processes, tools and actors for strengthening health workforce competencies. It draws from a purposive and multidisciplinary review of literature, expert opinion and country initiatives across the WHO European Region's 53 Member States. Through our analysis, we observe distinct yet complementary roles can be differentiated between health services delivery and the health system. This understanding is a necessary prerequisite to gain deeper insight into the specificities for strengthening health workforce competencies in order for governance to rightly create the institutional environment called for to foster alignment. Differentiating between the contribution of health services and the health system in the strengthening of health workforce competencies is an important distinction for achieving and sustaining health improvement goals.

  5. Global Document Delivery, User Studies, and Service Evaluation: The Gateway Experience

    ERIC Educational Resources Information Center

    Miller, Rush; Xu, Hong; Zou, Xiuying

    2008-01-01

    This study examines user and service data from 2002-2006 at the East Asian Gateway Service for Chinese and Korean Academic Journal Publications (Gateway Service), the University of Pittsburgh. Descriptive statistical analysis reveals that the Gateway Service has been consistently playing the leading role in global document delivery service as well…

  6. Perspectives of Indigenous people in the Pilbara about the delivery of healthcare services.

    PubMed

    Walker, Bruce F; Stomski, Norman J; Price, Anne; Jackson-Barrett, Elizabeth

    2014-02-01

    To identify Indigenous people's views about gaps and practical solutions for the delivery of healthcare services in the Pilbara. A structured guide was used to interview three Indigenous language groups from the Pilbara region of Western Australia. The responses were analysed with the use of content analysis. In the first stage, codes were developed by assigning names to small sections of the interview transcripts. Next, the most salient incisive codes were identified and developed into themes that captured the most important issues. Many respondents said that there were insufficient health professionals near country, which was compounded by a lack of adequate transport to reach healthcare services. Moreover, respondents commonly indicated that they would be unable to secure adequate accommodation for themselves and any carer when needing to leave country to undergo medical care. The importance of secondary healthcare interventions was highlighted, particularly health promotion initiatives that improved diet and exercise levels and reduced substance abuse. Assuming responsibility for one's own health was seen as integral to improving the overall health of communities. The respondents saw role models as the most important influence in leading people to take responsibility for improving their own health. This study provides Indigenous perspectives about gaps and solutions in healthcare service delivery in the Pilbara region of Western Australia. Although initiatives have commenced to address the shortfall in health professionals and inadequate transport to healthcare, there are still gaps in service provision. Mobile health services were strongly supported as an integral measure to address these gaps. WHAT IS KNOWN ABOUT THIS TOPIC? About two out of every three Indigenous adults in the Pilbara experience a chronic health condition. Moreover, compared with non-Indigenous people in the region, Indigenous people experience a significantly higher mortality rate for

  7. Drug delivery systems improve pharmaceutical profile and facilitate medication adherence.

    PubMed

    Wertheimer, Albert I; Santella, Thomas M; Finestone, Albert J; Levy, Richard A

    2005-01-01

    Innovations in dosage forms and dose delivery systems across a wide range of medications offer substantial clinical advantages, including reduced dosing frequency and improved patient adherence; minimized fluctuation of drug concentrations and maintenance of blood levels within a desired range; localized drug delivery; and the potential for reduced adverse effects and increased safety. The advent of new large-molecule drugs for previously untreatable or only partially treatable diseases is stimulating the development of suitable delivery systems for these agents. Although advanced formulations may be more expensive than conventional dosage forms, they often have a more favorable pharmacologic profile and can be cost-effective. Inclusion of these dosage forms on drug formulary lists may help patients remain on therapy and reduce the economic and social burden of care.

  8. Exploring new paths to service delivery in Palestine.

    PubMed

    1994-01-01

    From 1963 to 1987, the Palestinian Family Planning (FP) and Protection Association (FPA) set up 11 urban clinics and branches. As the result of a needs survey in 1985, the FPA was planning to provide more services in rural areas. The political situation and the 1987 start of the Intifada, however, made delivery of even existing services more difficult and helped create a pronatalist atmosphere which was fueled by religious opposition to FP. In order to continue its work, the FPA took advantage of interagency cooperation with the nongovernmental organizations which had existing health clinics and which agreed to provide contraceptives in exchange for a percentage of the sales revenue. The role of the FPA was to provide the supplies and to train staff in service provision. The FPA also used this cooperative system to funnel FP information, education, and communication to women's groups. Through these efforts the FPA reached 60% more new clients in 1992 than it had in 1991. This successful cooperative method had its roots in the efforts the FPA had made since the 1970s to provide FP services in the maternal and child care clinics for refugees set up by the UN Relief and Works Agency (UNRWA). In 1993, the FPA received funding to open its own clinic in Gaza (where 75% of the people are refugees). The FPA is also actively seeking the involvement of religious leaders in discussions about the incorporation of FP in refugee health programs. Meanwhile, in 1990, the UNRWA began to offer FP as part of its maternal health program and to refer clients to the FPA where they were served free of charge. When the UNRWA began to provide FP services directly, the FPA provided the training for the UNRWA personnel. By remaining flexible, the FPA has been able to use appropriate channels to deliver its own expertise to women in need. Creative new approaches will continue to be called for to reach the thousands of women who remain in need of FP services.

  9. Total quality management in the delivery of public health services: a focus on North Carolina WIC programs.

    PubMed

    Green, C G; Harrison, M; Henderson, K; Lenihan, A

    1998-09-01

    Principles of quality improvement have been successfully implemented in the for-profit sector of the United States economy. The purpose of this study is to test the use of quality improvement strategies including development of leadership skills, a focus on internal quality, ongoing training and staff development, and efficient use of resources in the delivery of services in the public sector. The emphasis of this study is strategies for improving the delivery of nutrition education and supplemental foods to high-risk women, infants, and children through a federally funded program called WIC.

  10. Perspectives of men on antenatal and delivery care service utilisation in rural western Kenya: a qualitative study.

    PubMed

    Kwambai, Titus K; Dellicour, Stephanie; Desai, Meghna; Ameh, Charles A; Person, Bobbie; Achieng, Florence; Mason, Linda; Laserson, Kayla F; Ter Kuile, Feiko O

    2013-06-21

    Poor utilisation of facility-based antenatal and delivery care services in Kenya hampers reduction of maternal mortality. Studies suggest that the participation of men in antenatal and delivery care is associated with better health care seeking behaviour, yet many reproductive health programs do not facilitate their involvement. This qualitative study conducted in rural Western Kenya, explored men's perceptions of antenatal and delivery care services and identified factors that facilitated or constrained their involvement. Eight focus group discussions were conducted with 68 married men between 20-65 years of age in May 2011. Participants were of the Luo ethnic group residing in Asembo, western Kenya. The area has a high HIV-prevalence and polygamy is common. A topic guide was used to guide the discussions and a thematic framework approach for data analysis. Overall, men were positive in their views of antenatal and delivery care, as decision makers they often encouraged, some even 'forced', their wives to attend for antenatal or delivery care. Many reasons why it was beneficial to accompany their wives were provided, yet few did this in practice unless there was a clinical complication. The three main barriers relating to cultural norms identified were: 1) pregnancy support was considered a female role; and the male role that of provider; 2) negative health care worker attitudes towards men's participation, and 3) couple unfriendly antenatal and delivery unit infrastructure. Although men reported to facilitate their wives' utilisation of antenatal and delivery care services, this does not translate to practice as adherence to antenatal-care schedules and facility based delivery is generally poor. Equally, reasons proffered why they should accompany their wives are not carried through into practice, with barriers outweighing facilitators. Recommendations to improve men involvement and potentially increase services utilisation include awareness campaigns targeting

  11. Improving drug delivery to solid tumors: priming the tumor microenvironment.

    PubMed

    Khawar, Iftikhar Ali; Kim, Jung Ho; Kuh, Hyo-Jeong

    2015-03-10

    Malignant transformation and growth of the tumor mass tend to induce changes in the surrounding microenvironment. Abnormality of the tumor microenvironment provides a driving force leading not only to tumor progression, including invasion and metastasis, but also to acquisition of drug resistance, including pharmacokinetic (drug delivery-related) and pharmacodynamic (sensitivity-related) resistance. Drug delivery systems exploiting the enhanced permeability and retention (EPR) effect and active targeting moieties were expected to be able to cope with delivery-related drug resistance. However, recent evidence supports a considerable barrier role of tumors via various mechanisms, which results in imperfect or inefficient EPR and/or targeting effect. The components of the tumor microenvironment such as abnormal tumor vascular system, deregulated composition of the extracellular matrix, and interstitial hypertension (elevated interstitial fluid pressure) collectively or cooperatively hinder the drug distribution, which is prerequisite to the efficacy of nanoparticles and small-molecule drugs used in cancer medicine. Hence, the abnormal tumor microenvironment has recently been suggested to be a promising target for the improvement of drug delivery to improve therapeutic efficacy. Strategies to modulate the abnormal tumor microenvironment, referred to here as "solid tumor priming" (vascular normalization and/or solid stress alleviation leading to improvement in blood perfusion and convective molecular movement), have shown promising results in the enhancement of drug delivery and anticancer efficacy. These strategies may provide a novel avenue for the development of new chemotherapeutics and combination chemotherapeutic regimens as well as reassessment of previously ineffective agents. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Using attachment theory to inform the design and delivery of mental health services: a systematic review of the literature.

    PubMed

    Bucci, Sandra; Roberts, Nicola H; Danquah, Adam N; Berry, Katherine

    2015-03-01

    The aim of this review was to propose and describe the design and delivery of an attachment-informed general mental health service. We systematically searched the PsycINFO, MEDLINE, Web of Knowledge, COPAC, CINAHL, and Science Direct databases from 1960 to 2013. We also searched reference lists of relevant papers and directly contacted authors in the field. Literature describing attachment theory and its applicability in designing and delivering general mental health services was synthesized using thematic analysis. Papers published in English, books or chapters in edited books that described applying attachment theory in designing and delivering mental health services for adults and adolescents were included in the review. Of the 1,105 articles identified, 14 met inclusion criteria for the review. Eight key themes, and four subthemes, were extracted and organized to reflect the experience of a service user moving through the mental health system. Key themes extracted were as follows: service policy and evaluation; referrals; assessment and formulation; intervention; support for staff; support for carers; moving on; and potential service benefits. Papers reviewed suggested that service users with severe mental health problems have attachment needs that should be met in general mental health services. Attachment theory provides a useful framework to inform the design and delivery of general mental health services. The resource implications for services are discussed, as are limitations of the review and recommendations for future research. Attachment theory should be used to inform the design and delivery of general mental health services. Mental health services should evaluate the extent to which they meet service users' attachment needs. Attachment-informed mental health services should assess outcomes, including cost-effectiveness over time. Papers included in this review focus on long-stay residential care or secure services and there is a limited experimental

  13. Expanding services in a shrinking economy: desktop document delivery in a dental school library

    PubMed Central

    Gushrowski, Barbara A

    2011-01-01

    Question: How can library staff develop and promote a document delivery service and then expand the service to a wide audience? Setting: The setting is the library at the Indiana University School of Dentistry (IUSD), Indianapolis. Method: A faculty survey and a citation analysis were conducted to determine potential use of the service. Volume of interlibrary loan transactions and staff and equipment capacity were also studied. Main results: IUSD Library staff created a desktop delivery service (DDSXpress) for faculty and then expanded the service to practicing dental professionals and graduate students. The number of faculty using DDSXpress remains consistent. The number of practicing dental professionals using the service is low. Graduate students have been quick to adopt the service. Conclusion: Through careful analysis of capacity and need for the service, staff successfully expanded document delivery service without incurring additional costs. Use of DDSXpress is continually monitored, and opportunities to market the service to practicing dental professionals are being investigated. PMID:21753911

  14. Expanding services in a shrinking economy: desktop document delivery in a dental school library.

    PubMed

    Gushrowski, Barbara A

    2011-07-01

    How can library staff develop and promote a document delivery service and then expand the service to a wide audience? The setting is the library at the Indiana University School of Dentistry (IUSD), Indianapolis. A faculty survey and a citation analysis were conducted to determine potential use of the service. Volume of interlibrary loan transactions and staff and equipment capacity were also studied. IUSD Library staff created a desktop delivery service (DDSXpress) for faculty and then expanded the service to practicing dental professionals and graduate students. The number of faculty using DDSXpress remains consistent. The number of practicing dental professionals using the service is low. Graduate students have been quick to adopt the service. Through careful analysis of capacity and need for the service, staff successfully expanded document delivery service without incurring additional costs. Use of DDSXpress is continually monitored, and opportunities to market the service to practicing dental professionals are being investigated.

  15. Breaking down the barriers to clinical service delivery: walk-in family therapy.

    PubMed

    Miller, John K; Slive, Arnold

    2004-01-01

    This article provides a description of a unique walk-in family therapy service designed to overcome barriers to clinical delivery, as well as a survey of client experiences with the therapy. This therapy modality is aimed at providing an immediately accessible, affordable, nonstigmatizing, single-session-focused resource. The service operates from a systemic, collaborative, consumer oriented, pragmatic, non-pathology perspective. Follow-up telephone interviews were conducted with 43 clients 3 to 6 months after they received treatment. Generally, former clients reported satisfaction with the service. The majority (67%) indicated some level of improvement, and 43% of participants found their single session sufficient to address their concerns. At the time of the session, the majority (86%) of clients were rated by their therapists as "customers" regarding their motivational readiness for change.

  16. Nanosuspension improves tretinoin photostability and delivery to the skin.

    PubMed

    Lai, Francesco; Pireddu, Rosa; Corrias, Francesco; Fadda, Anna Maria; Valenti, Donatella; Pini, Elena; Sinico, Chiara

    2013-12-15

    The aims of this work were to improve cutaneous targeting and photostability of tretinoin by using nanosuspension formulation. Tretinoin is a drug widely used in the topical treatment of various dermatological diseases. The tretinoin nanosuspension was prepared by precipitation method and then characterized by photo correlation spectroscopy for mean size and size distribution, and by transmission electron microscopy for morphological studies. An oil in water tretinoin nanoemulsion was also prepared and used as a control. Dermal and transdermal delivery of both tretinoin nanosuspension and nanoemulsion were tested in vitro by using Franz diffusion cells and newborn pig skin. Photodegradation studies were carried out by UV irradiation (1h, λ=366 nm) of the tretinoin nanosuspension in comparison with the nanoemulsion and a methanolic solution of the drug. During 8h percutaneous experiments, the nanosuspesion was able to localize the drug into the pig skin with a very low transdermal drug delivery, whereas the nanoemulsion greatly improved drug permeation. UV irradiation of the nanosuspension showed a great improvement of tretinoin stability in comparison with both controls. Overall results show that nanosuspension might be a useful formulation for improving tretinoin dermal delivery and stability.

  17. Look Through Patients' Eyes to Improve the Delivery of Care.

    PubMed

    2016-07-01

    By developing and implementing a method for seeing the healthcare experience from the standpoint of patients and family members, the University of Pittsburgh Medical Center has improved care delivery, lowered costs, and improved patient satisfaction. Cross-functional, multidisciplinary teams use a six-step patient and family-centered care methodology to identify gaps and develop changes that will improve the patient experience and clinical outcomes. Committee members shadow patients and family members to get firsthand knowledge about what they are going through and what goes wrong and what goes right. The teams proposed minor and major changes, but none involve adding more staff and few involve more expenditures.

  18. 78 FR 55773 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice; FACA... Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of the 2006... Committee Act. Date and Time: The meeting will be held on Monday, September 30, from 10:00 a.m. to 12:00 p.m...

  19. 5 CFR 2429.22 - Additional time after service by mail or commercial delivery.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... REQUIREMENTS General Requirements § 2429.22 Additional time after service by mail or commercial delivery... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Additional time after service by mail or commercial delivery. 2429.22 Section 2429.22 Administrative Personnel FEDERAL LABOR RELATIONS AUTHORITY...

  20. 77 FR 41877 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-16

    ... Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice, FACA... Postal and Delivery Services (the Advisory Committee). This Committee has been formed in fulfillment of... accordance with the Federal Advisory Committee Act. Date and Time: The meeting will be held on Thursday...

  1. The Whole PIC Catalog: Organization, Planning and Service Delivery Options under JTPA.

    ERIC Educational Resources Information Center

    National Alliance of Business, Inc., Washington, DC.

    This handbook illustrates and discusses organizational options for the delivery of employment and training services within service delivery areas (SDAs) mandated by the Job Training Partnership Act (JTPA) of 1982. Addressed primarily to members of private industry councils (PICs), representatives of local governments, and employment and training…

  2. 5 CFR 2429.22 - Additional time after service by mail or commercial delivery.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Additional time after service by mail or... REQUIREMENTS General Requirements § 2429.22 Additional time after service by mail or commercial delivery... such party by mail or commercial delivery, 5 days shall be added to the prescribed period:...

  3. 5 CFR 2429.22 - Additional time after service by mail or commercial delivery.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Additional time after service by mail or... REQUIREMENTS General Requirements § 2429.22 Additional time after service by mail or commercial delivery... such party by mail or commercial delivery, 5 days shall be added to the prescribed period:...

  4. Identifying Service Delivery Strategies for Ethnically Diverse Users of a Wildland-Urban Recreation Site

    Treesearch

    John M. Baas

    1992-01-01

    Service delivery has become an increasingly important part of managing public lands for recreation. The range of preferences held by ethnically diverse users of recreation sites may warrant the development of more than one service delivery strategy. Two questions were examined: (1) Are there differences in site perceptions that can be identified on the basis on...

  5. 41 CFR 60-300.84 - Responsibilities of appropriate employment service delivery system.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 41 Public Contracts and Property Management 1 2014-07-01 2014-07-01 false Responsibilities of... § 60-300.84 Responsibilities of appropriate employment service delivery system. By statute, appropriate employment service delivery systems are required to refer qualified protected veterans to fill...

  6. Pharmacist and physician perspectives on diabetes service delivery within community pharmacies in Indonesia: a qualitative study.

    PubMed

    Wibowo, Yosi; Sunderland, Bruce; Hughes, Jeffery

    2016-05-01

    To explore perspectives of physicians and pharmacists on diabetes service delivery within community pharmacies in Indonesia. In depth interviews were conducted with 10 physicians and 10 community pharmacists in Surabaya, Indonesia, using a semi-structured interview guide. Nvivo version 9 was used to facilitate thematic content analysis to identify barriers/facilitators for community pharmacists to provide diabetes services. The identified themes indicating barriers/facilitators for diabetes service delivery within Indonesian community pharmacies included: (1) pharmacist factors - i.e. positive views (facilitator) and perceived lack of competence (barrier); (2) pharmacist-physician relationships - i.e. physicians' lack of support and accessibility (barriers); (3) pharmacist-patient relationships - i.e. perceived patients' lack of support and accessibility (barriers); (4) pharmacy environment - i.e. business orientation (barrier), lack of staff and poor pharmacist availability (barriers), and availability of supporting resources, such as counselling areas/rooms, procedures/protocols and IT systems for labelling and patient records (facilitators); and (5) external environment - i.e. a health system to support pharmacist roles, remuneration, marketing and professional assistance (facilitators). Issues related to the pharmacist-physician-patient relationships, pharmacy environment and external environment need to be addressed before Indonesian community pharmacists can provide additional pharmacy services for type 2 diabetes patients. Collaboration between the Government, Ikatan Apoteker Indonesia (Indonesian Pharmacists Association) and Ikatan Dokter Indonesia (Indonesian Medical Association) is required to improve the pharmacy professional environment and facilities. © 2015 Royal Pharmaceutical Society.

  7. Informal learning processes in support of clinical service delivery in a service-oriented community pharmacy.

    PubMed

    Patterson, Brandon J; Bakken, Brianne K; Doucette, William R; Urmie, Julie M; McDonough, Randal P

    The evolving health care system necessitates pharmacy organizations' adjustments by delivering new services and establishing inter-organizational relationships. One approach supporting pharmacy organizations in making changes may be informal learning by technicians, pharmacists, and pharmacy owners. Informal learning is characterized by a four-step cycle including intent to learn, action, feedback, and reflection. This framework helps explain individual and organizational factors that influence learning processes within an organization as well as the individual and organizational outcomes of those learning processes. A case study of an Iowa independent community pharmacy with years of experience in offering patient care services was made. Nine semi-structured interviews with pharmacy personnel revealed initial evidence in support of the informal learning model in practice. Future research could investigate more fully the informal learning model in delivery of patient care services in community pharmacies. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Improving Service Management in Campus IT Operations

    ERIC Educational Resources Information Center

    Wan, Stewart H. C.; Chan, Yuk-Hee

    2008-01-01

    Purpose: This paper aims at presenting the benefits from implementing IT service management (ITSM) in an organization for managing campus-wide IT operations. In order to improve the fault correlation from business perspectives, we proposed a framework to automate network and system alerts with respect to its business service impact for proactive…

  9. Improving Service Management in Campus IT Operations

    ERIC Educational Resources Information Center

    Wan, Stewart H. C.; Chan, Yuk-Hee

    2008-01-01

    Purpose: This paper aims at presenting the benefits from implementing IT service management (ITSM) in an organization for managing campus-wide IT operations. In order to improve the fault correlation from business perspectives, we proposed a framework to automate network and system alerts with respect to its business service impact for proactive…

  10. Overcoming cellular and tissue barriers to improve liposomal drug delivery

    NASA Astrophysics Data System (ADS)

    Kohli, Aditya G.

    Forty years of liposome research have demonstrated that the anti-tumor efficacy of liposomal therapies is, in part, driven by three parameters: 1) liposome formulation and lipid biophysics, 2) accumulation and distribution in the tumor, and 3) release of the payload at the site of interest. This thesis outlines three studies that improve on each of these delivery steps. In the first study, we engineer a novel class of zwitterlipids with an inverted headgroup architecture that have remarkable biophysical properties and may be useful for drug delivery applications. After intravenous administration, liposomes accumulate in the tumor by the enhanced permeability and retention effect. However, the tumor stroma often limits liposome efficacy by preventing distribution into the tumor. In the second study, we demonstrate that depletion of hyaluronan in the tumor stroma improves the distribution and efficacy of DoxilRTM in murine 4T1 tumors. Once a liposome has distributed to the therapeutic site, it must release its payload over the correct timescale. Few facile methods exist to quantify the release of liposome therapeutics in vivo. In the third study, we outline and validate a simple, robust, and quantitative method for tracking the rate and extent of release of liposome contents in vivo. This tool should facilitate a better understanding of the pharmacodynamics of liposome-encapsulated drugs in animals. This work highlights aspects of liposome behavior that have prevented successful clinical translation and proposes alternative approaches to improve liposome drug delivery.

  11. RBC Transfusion Improves Cerebral Oxygen Delivery in Subarachnoid Hemorrhage.

    PubMed

    Dhar, Rajat; Zazulia, Allyson R; Derdeyn, Colin P; Diringer, Michael N

    2017-04-01

    Impaired oxygen delivery due to reduced cerebral blood flow is the hallmark of delayed cerebral ischemia following subarachnoid hemorrhage. Since anemia reduces arterial oxygen content, it further threatens oxygen delivery increasing the risk of cerebral infarction. Thus, subarachnoid hemorrhage may constitute an important exception to current restrictive transfusion practices, wherein raising hemoglobin could reduce the risk of ischemia in a critically hypoperfused organ. In this physiologic proof-of-principle study, we determined whether transfusion could augment cerebral oxygen delivery, particularly in vulnerable brain regions, across a broad range of hemoglobin values. Prospective study measuring cerebral blood flow and oxygen extraction fraction using O-PET. Vulnerable brain regions were defined as those with baseline oxygen delivery less than 4.5 mL/100 g/min. PET facility located within the Neurology/Neurosurgery ICU. Fifty-two patients at risk for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage with hemoglobin 7-13 g/dL. Transfusion of one unit of RBCs over 1 hour. Baseline hemoglobin was 9.7 g/dL (range, 6.9-12.9), and cerebral blood flow was 43 ± 11 mL/100 g/min. After transfusion, hemoglobin rose from 9.6 ± 1.4 to 10.8 ± 1.4 g/dL (12%; p < 0.001) and oxygen delivery from 5.0 (interquartile range, 4.4-6.6) to 5.5 mL/100 g/min (interquartile range, 4.8-7.0) (10%; p = 0.001); the response was comparable across the range of hemoglobin values. In vulnerable brain regions, transfusion resulted in a greater (16%) rise in oxygen delivery associated with reduction in oxygen extraction fraction, independent of Hgb level (p = 0.002 vs normal regions). This study demonstrates that RBC transfusion improves cerebral oxygen delivery globally and particularly to vulnerable regions in subarachnoid hemorrhage patients at risk for delayed cerebral ischemia across a wide range of hemoglobin values and suggests that

  12. Enhancing service delivery through title x funding: findings from California.

    PubMed

    de Bocanegra, Heike Thiel; Maguire, Fran; Hulett, Denis; Horsley, Kathryn; Puffer, Maryjane; Brindis, Claire D

    2012-12-01

    The federal Title X grant program provides funding for family planning services for low-income women and men. In California, all clinics receiving Title X funds participate in the state's family planning program, Family PACT, along with other public and private providers. The relative extent to which Title X-funded clinics and other Family PACT providers have incorporated enhancements beyond their core medical services has never been studied. In 2010, a survey was sent to public- and private-sector Family PACT clinicians to assess whether funding streams were associated with the availability of special services: extended clinic hours, outreach to vulnerable populations, services for clients not proficient in English and use of advanced clinic-based technologies. Bivariate and logistic regression analyses controlling for potentially confounding factors were conducted. Greater proportions of Title X-funded clinics than of other public and private providers had Spanish-speaking unlicensed clinical staff (89% vs. 71% and 58%, respectively) and Spanish-language signs (95% vs. 85% and 82%). Title X-funded providers were more likely than other public providers to offer extended clinic hours, provide outreach to at least three vulnerable or hard-to-reach populations, and use three or more advanced technologies (odds ratios, 2.0-2.9). Compared with other Family PACT providers, clinics that receive Title X funding have implemented greater infrastructure enhancements to promote access and improve the quality of service for underserved populations. This may be because Title X-funded providers have more financial opportunities to provide the array of services that best respond to their clients' needs. Copyright © 2012 by the Guttmacher Institute.

  13. Strategies for integrating primary health services in middle- and low-income countries at the point of delivery.

    PubMed

    Briggs, C J; Garner, P

    2006-04-19

    Strategies to integrate primary health care aim to bring together inputs, organisation, management and delivery of particular service functions to make them more efficient, and accessible to the service user. In some middle and low income countries, services have been fragmented by separate vertical programmes established to ensure delivery of particular technologies. We examined the effectiveness of integration strategies at the point of delivery. To assess the effects of strategies to integrate primary health care services on producing a more coherent product and improving health care delivery and health status. We searched the Cochrane Effective Practice and Organisation of Care Group specialised register (August 2005), MEDLINE (1966 to September 2005), EMBASE (1988 to 2005), Socio Files (1974 to September 2005), Popline (1970 to September 2005), HealthStar (1975 to September 2005), Cinahl (1982 to September 2005); Cab Health (1972 to 1999), International Bibliography of the Social Sciences (1970 to 1999), and reference lists of articles. We also searched the Internet and World Health Organization (WHO) library database, hand searched relevant WHO publications and contacted experts in the field. Randomised trials, controlled before and after studies, and interrupted time series analyses of integration strategies in primary health care services. Health services in high-income countries were excluded. The primary outcomes were indicators of health care delivery, user views on any measure of service coherence, and health status. We also sought information on comparative costs. Two authors independently extracted data and assessed study quality. Three cluster randomised trials and two controlled before and after studies were included, with three types of comparison: integration by adding on an additional component to an existing service (family planning); integrated services versus single special services (for sex workers); integrated delivery systems versus a

  14. Using a Transdisciplinary Service Delivery Model to Increase Parental Involvement with Special Education Students

    ERIC Educational Resources Information Center

    Cross, Robert J.

    2007-01-01

    Too often special education services are provided in a piece-by-piece fashion with individual support staff members each scheduling service to the child once or twice a week. Travel time and case-load numbers prohibit getting significant service time and frequency to the student. The literature suggests that transdisciplinary service delivery is…

  15. Patient service navigator: improving quality and services and reducing cost under the Affordable Care Act.

    PubMed

    Piper, Llewellyn E

    2014-01-01

    This article proposes the implementation of a Patient Service Navigator to improve quality, service, and the patient and family experience and to reduce costs in caring for patients in a hospital setting. Under the Affordable Care Act, the Patient Service Navigator is a means to address value-based purchasing whereby hospitals will be reimbursed based on quality and Hospital Consumer Assessment of Healthcare Providers and System scores for Medicare patients. In this article, the reader will learn the history, background, purpose, and role of the Patient Service Navigator as a critical component of a multidisciplinary health care team in supporting inpatient care with a human touch. Navigating for the patient and family in a confusing and complex health care delivery environment is critical today in order to survive the mandates of the Affordable Care Act.

  16. What impact will shortened training have on urological service delivery?

    PubMed Central

    Payne, S. R.; Shaw, M. B. K.

    2005-01-01

    INTRODUCTION: Modernisation of Medical Careers dictates a shortening of the training required to achieve consultant status. Precisely what type of work these consultants could be expected to accomplish, and be trained to do, is not clear. The objective of this study was to demonstrate a method of stratifying urological workload so as to determine what a urological trainee, undergoing shortened training, might be expected to do as a consultant and to use this stratification to help manpower planning within the specialty. PATIENTS AND METHODS: A cohort study of all urological activity undertaken over a 3-year period in a single teaching hospital in the UK was performed. All out-patient, in-patient or day-case activity within the urological department was analysed in the years 2000-2002. Urological activity was stratified according to the absolute numbers of patients presenting for different types of out-patient consultation, the grade of complexity of any surgical intervention undertaken, and the theatre resource consumed by the study population. RESULTS: Utilising prospectively collected data, it was possible to aggregate information about the contributions generalist and sub-specialty activity made to the overall workload of a urological unit. Whilst the majority of out-patient activity, and almost 88% of the surgical workload, could be accomplished by consultants undergoing shortened training, 11.9% of specialised urological activity, consuming nearly 43% of the available theatre resource, was outwith the remit of such a specialist. CONCLUSIONS: Shortened training seems able to satisfy the service delivery needs of the majority of out-patient and day-case urological activity. It will not, however, fulfil the need for subspecialty-based training required to cope with the large minority of patients necessitating complex surgical intervention. Specialist training programmes, promoting advanced operative skills, need to be evolved in parallel to shortened training so

  17. Aligning provider incentives to improve primary healthcare delivery in the United States

    PubMed Central

    DeVoe, JE; Stenger, R

    2016-01-01

    Background The United States (US) is reforming primary care delivery systems, including the implementation of ‘patient-centered medical homes.’ Alignment of provider incentives with desired outcomes will likely be important to the success of these delivery system reforms. Methods This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create ‘prisoner’s dilemmas’ that have stalled past reform efforts. It then uses this framework to illustrate, hypothetically, how advantages from different models could be blended together to encourage cooperation and improve the quality of primary care services delivered, thus providing an escape from current prisoner’s dilemmas faced by providers. Findings Improvements in primary care delivery will largely hinge on blended payment mechanisms that can effectively combine the advantageous elements of fee-for-service, capitation, and incentive payments into a balanced equation that enables providers to escape the perverse financial incentives of current payment mechanisms and overcome collective action problems. Conclusions If balanced appropriately, a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved. PMID:27942388

  18. Can paraprofessional home visitation enhance early intervention service delivery?

    PubMed

    Vogler, Stephen D; Davidson, Arthur J; Crane, Lori A; Steiner, John F; Brown, Jeffrey M

    2002-08-01

    A 1-year randomized trial compared intensive case management (ICM) versus basic case management (BCM) in facilitating early intervention (EI) service use among children in an urban health system. Of 159 participating families with delayed or at-risk preschool-aged children, 88 received ICM from paraprofessionals versus 71 families who received less comprehensive BCM from a nurse. In the ICM versus BCM group, a shorter interval to assessment (98 vs 140 d, p =.05) but similar assessment rate (86% vs 80%, p =.29) was observed. The ICM group had more services recommended per child (1.64 vs 1.16, p < .004) and initiated (1.20 vs 0.85, p < .04). There was no difference in median time to EI program initiation for ICM versus BCM (228 vs 200 d, p = .88) or initiation and visit compliance rate for EI services. Specific efforts to improve outcomes (e.g., decrease initiation time and increase use of EI services) are still needed.

  19. Strengthening district health service management and delivery through internal contracting: lessons from pilot projects in Cambodia.

    PubMed

    Khim, Keovathanak; Annear, Peter Leslie

    2013-11-01

    Following a decade of piloting different models of contracting, in mid-2009 the Cambodian Ministry of Health began to test a form of 'internal contracting' for health care delivery in selected health districts (including hospitals and health centers) contracted by the provincial health department as Special Operating Agencies (SOAs) and provided with greater management autonomy. This study assesses the internal contracting approach as a means for improving the management of district health services and strengthening service delivery. While the study may contribute to the emerging field now known as performance-based financing, the lessons deal more broadly with the impact of management reform and increased autonomy in contrast to traditional public sector line-management and budgeting. Carried out during 2011, the study was based on: (i) a review of the literature and of operational documents; (ii) primary data from semi-structured key informant interviews with 20 health officials in two provinces involved in four SOA pilot districts; and (iii) routine data from the 2011 SOA performance monitoring report. Five prerequisites were identified for effective contract management and improved service delivery: a clear understanding of roles and responsibilities by the contracting parties; implementation of clear rules and procedures; effective management of performance; effective monitoring of the contract; and adequate and timely provision of resources. Both the level and allocation of incentives and management bottlenecks at various levels continue to impede implementation. We conclude that, in contracted arrangements like these, the clear separation of contracting functions (purchasing, commissioning, monitoring and regulating), management autonomy where responsibilities are genuinely devolved and accepted, and the provision of resources adequate to meet contract demands are necessary conditions for success.

  20. The organization and delivery of family planning services in community health centers.

    PubMed

    Goldberg, Debora Goetz; Wood, Susan F; Johnson, Kay; Mead, Katherine Holly; Beeson, Tishra; Lewis, Julie; Rosenbaum, Sara

    2015-01-01

    Family planning and related reproductive health services are essential primary care services for women. Access is limited for women with low incomes and those living in medically underserved areas. Little information is available on how federally funded health centers organize and provide family planning services. This was a mixed methods study of the organization and delivery of family planning services in federally funded health centers across the United States. A national survey was developed and administered (n = 423) and in-depth case studies were conducted of nine health centers to obtain detailed information on their approach to family planning. Study findings indicate that health centers utilize a variety of organizational models and staffing arrangements to deliver family planning services. Health centers' family planning offerings are organized in one of two ways, either a separate service with specific providers and clinic times or fully integrated with primary care. Health centers experience difficulties in providing a full range of family planning services. Major challenges include funding limitations; hiring obstetricians/gynecologists, counselors, and advanced practice clinicians; and connecting patients to specialized services not offered by the health center. Health centers play an integral role in delivering primary care and family planning services to women in medically underserved communities. Improving the accessibility and comprehensiveness of family planning services will require a combination of additional direct funding, technical assistance, and policies that emphasize how health centers can incorporate quality family planning as a fundamental element of primary care. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  1. Please understand when I cry out in pain: women's accounts of maternity services during labour and delivery in Ghana

    PubMed Central

    D'Ambruoso, Lucia; Abbey, Mercy; Hussein, Julia

    2005-01-01

    Background This study was undertaken to investigate women's accounts of interactions with health care providers during labour and delivery and to assess the implications for acceptability and utilisation of maternity services in Ghana. Methods Twenty-one individual in-depth interviews and two focus group discussions were conducted with women of reproductive age who had delivered in the past five years in the Greater Accra Region. The study investigated women's perceptions and experiences of care in terms of factors that influenced place of delivery, satisfaction with services, expectations of care and whether they would recommend services. Results One component of care which appeared to be of great importance to women was staff attitudes. This factor had considerable influence on acceptability and utilisation of services. Otherwise, a successful labour outcome and non-medical factors such as cost, perceived quality of care and proximity of services were important. Our findings indicate that women expect humane, professional and courteous treatment from health professionals and a reasonable standard of physical environment. Women will consciously change their place of delivery and recommendations to others if they experience degrading and unacceptable behaviour. Conclusion The findings suggest that inter-personal aspects of care are key to women's expectations, which in turn govern satisfaction. Service improvements which address this aspect of care are likely to have an impact on health seeking behaviour and utilisation. Our findings suggest that user-views are important and warrant further investigation. The views of providers should also be investigated to identify channels by which service improvements, taking into account women's views, could be operationalised. We also recommend that interventions to improve delivery care should not only be directed to the health professional, but also to general health system improvements. PMID:16372911

  2. Four ways geographic information systems can help to enhance health service planning and delivery for infectious diseases in low-income countries.

    PubMed

    Brijnath, Bianca; Ansariadi; de Souza, Dziedzom K

    2012-11-01

    Focusing specifically on infectious diseases in low-income countries, this paper discusses four ways Geographic Information Systems (GIS) can facilitate health service planning and delivery: (1) deeper insight into where health care services should be located; (2) improved health surveillance and real-time planning for disease control and population health; (3) stronger accountability and evidence-informed dialogue between funders and the service providers and; (4) greater opportunities to translate complex data into more accessible formats which policymakers can quickly interpret and act on. Taking its use beyond just a research instrument, GIS is a way to undertake multidisciplinary work and improve health service planning and delivery.

  3. Equity and financing for sexual and reproductive health service delivery: current innovations.

    PubMed

    Montagu, Dominic; Graff, Maura

    2009-07-01

    National and international decisions on financing for sexual and reproductive health (SRH) services have profound effects on the type, unit costs and distribution of SRH commodities and services produced, and on their availability and consumption. Much international and national funding is politically driven and is doing little for equity and quality improvement. Financing remains a significant challenge in most developing countries and demands creative responses. While no "one-size-fits-all" solution exists, there are numerous ongoing examples of successful innovations, many of which are focusing on resource pooling and on purchasing or subsidising SRH services. In this article we have used interviews, grey literature and presentations made at a range of recent public fora to identify new and innovative ways of financing SRH services so as to increase equity in developing countries. Because SRH services are often of low value as a personal good but high value as a public good, we summarise the issues from a societal perspective, highlighting the importance of financing and policy decisions for SRH services. We provide a structured overview of what novel approaches to financing appear to have positive effects in a range of developing countries. Targeting, government payment mechanisms, subsidy delivery and co-financing for sustainability are highlighted as showing particular promise. Examples are used throughout the article to illustrate innovative strategies.

  4. Reengineering a surgical service line: focusing on core process improvement.

    PubMed

    Kelly, D L; Pestotnik, S L; Coons, M C; Lelis, J W

    1997-01-01

    Integrating principles from a variety of theory has led to the development of a conceptual framework for reengineering in a clinical care delivery setting to improve the value of services provided to the customer. A conceptual framework involving the identification of three high level core processes to reengineer can provide clarity and focus for clinicians to begin directing reengineering efforts. Those core processes are: clinical management of the patient's medical needs, patient operational processes to support the clinical processes, and administrative decision-making processes to support the implementation of the clinical and operational processes. Improvement in any one of these areas has the potential to increase value, but the concurrent targeting of these core processes for reengineering has provided a synergy that has accelerated the achievement of the desired outcomes in the area of surgical services.

  5. Delivery of high quality stroke and vision care: experiences of UK services.

    PubMed

    Rowe, Fiona; Walker, Marion; Rockliffe, Janet; Pollock, Alex; Noonan, Carmel; Howard, Claire; Currie, Jim

    2015-07-02

    We sought to identify exemplars of high quality care provision from established stroke vision services. We identified areas of high quality services across the UK, judged as having integrated stroke/vision care provision for stroke survivors. Healthcare professionals were selected to participate in 1:1 interviews or focus groups. A strengths-weaknesses-opportunities-threats (SWOT) framework was used to lead the discussion in a semi-structured format. Thematic analysis was undertaken. Interviewees (n = 24) from 14 NHS Trusts included eye clinic managers, nurses, orthoptists, occupational therapists and physiotherapists. Identified strengths of their services included established communication, training provision for stroke team staff, "open access" for referrals, use of standardised screening/referral forms, provision of lay summaries and information sheets, patients assessed on the stroke unit with continued follow-up and initial visual assessments made within 1 week of stroke onset. Weaknesses included lack of funding, insufficient orthoptic cover, and time consuming retraining of stroke staff because of staff rotation and changes. Opportunities included increasing the number (or length) of orthoptic sessions and training of stroke staff. Perceived threats related to funding and increased appointment waiting times. Practical elements for improved stroke and vision care provision are highlighted which can be implemented with relatively little financial inputs. Implications for Rehabilitation Integrated vision services within stroke units can improve the detection of visual problems in stroke survivors leading to earlier visual rehabilitation. Orthoptists within core stroke teams are beneficial to the delivery of a high quality service. This study illustrates clear practical elements to support the provision of high quality integrated stroke and vision services. Relatively little financial inputs are required to fund such services but with larger potential to

  6. The Leadership Role in Transitioning an Urban Secondary School from a Traditional Service Delivery Model to a Co-Teaching Service Delivery Model for Students with Disabilities: A Phenomenological Case Study

    ERIC Educational Resources Information Center

    McDonald, Ginni E.

    2013-01-01

    This research studies the leadership role in transitioning from a traditional service delivery model to a co-teaching service delivery model for students with disabilities. While there is an abundant amount of information on the service delivery model of co-teaching, sustaining co-teaching programs, and effective co-teaching programs for students…

  7. Stuttering Intervention in Three Service Delivery Models (Direct, Hybrid, and Telepractice): Two Case Studies

    PubMed Central

    VALENTINE, DANIEL T.

    2015-01-01

    This study assessed outcomes in stuttering intervention across three service delivery models: direct, hybrid, and telepractice for two 11-year old children who stutter. The goal of the study was to investigate whether short-term goals were maintained through the telepractice sessions. The Stuttering Severity Instrument, Fourth Edition (SSI-4) was administered to each child before and after each intervention period and weekly fluency samples (percentage of stuttered syllables in a monologue) were obtained in each of the 10-week intervention periods. In addition, the Communication Attitudes Test-Revised was used to assess the children’s attitudes toward speaking. Following the telepractice period, parents and children completed a questionnaire concerning the therapy experience via telepractice. Both children continued to improve fluency as measured by the weekly fluency samples. SSI-4 severity ratings improved for one child and remained consistent for the other. These outcomes appear to demonstrate that telepractice is viable for improving and maintaining fluency. PMID:25945229

  8. Highlighting a Common Quality of Care Delivery Problem: Overuse of Low-Value Healthcare Services.

    PubMed

    MacLeod, Stephanie; Musich, Shirley; Hawkins, Kevin; Schwebke, Kay

    2017-08-25

    Low-value healthcare services (LVHS) are defined as procedures delivered that provide little or no clinical benefit. Overuse of LVHS, or delivery when the risks exceed the benefits, contributes to excessive spending without improved outcomes. Furthermore, overuse contributes to healthcare waste. The primary purpose of this commentary is to (1) examine the problem of LVHS overuse and its impacts on quality care delivery and (2) propose factors to consider in developing quality measures to help reduce overuse and waste and thus improve patient outcomes. To inform and support this commentary, we conducted a limited review of the literature related to LVHS overuse, its consequences, and suggested solutions. Online search engines were used to identify research related to our primary areas of interest. This commentary demonstrates that overuse and associated healthcare waste is growing among selected LVHS. The factors of overuse are multidimensional and poorly understood. Meanwhile, overuse of LVHS has financial consequences and impacts quality of care and outcomes. Overuse of LVHS is common in the United States, leading to waste and suboptimal patient outcomes. Thus a need exists to address overuse and develop measures to capture a larger scope of services.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  9. A Short-Term Delivery Model for Counseling Services.

    ERIC Educational Resources Information Center

    Knott, J. Eugene

    The author discusses a short-term delivery model which forms the essential mode of operation at the counseling center at Rhode Island College. He prefaces his discription of the model by indicating that not all clients, problems or counselors are amenable to this short-term approach. There are three steps or elements in the delivery model: 1)…

  10. How do organisational characteristics influence teamwork and service delivery in lung cancer diagnostic assessment programmes? A mixed-methods study.

    PubMed

    Honein-AbouHaidar, Gladys N; Stuart-McEwan, Terri; Waddell, Tom; Salvarrey, Alexandra; Smylie, Jennifer; Dobrow, Mark J; Brouwers, Melissa C; Gagliardi, Anna R

    2017-02-23

    Diagnostic assessment programmes (DAPs) can reduce wait times for cancer diagnosis, but optimal DAP design is unknown. This study explored how organisational characteristics influenced multidisciplinary teamwork and diagnostic service delivery in lung cancer DAPs. A mixed-methods approach integrated data from descriptive qualitative interviews and medical record abstraction at 4 lung cancer DAPs. Findings were analysed with the Integrated Team Effectiveness Model. 4 DAPs at 2 teaching and 2 community hospitals in Canada. 22 staff were interviewed about organisational characteristics, target service benchmarks, and teamwork processes, determinants and outcomes; 314 medical records were reviewed for actual service benchmarks. Formal, informal and asynchronous team processes enabled service delivery and yielded many perceived benefits at the patient, staff and service levels. However, several DAP characteristics challenged teamwork and service delivery: referral volume/workload, time since launch, days per week of operation, rural-remote population, number and type of full-time/part-time human resources, staff colocation, information systems. As a result, all sites failed to meet target benchmarks (from referral to consultation median 4.0 visits, median wait time 35.0 days). Recommendations included improved information systems, more staff in all specialties, staff colocation and expanded roles for patient navigators. Findings were captured in a conceptual framework of lung cancer DAP teamwork determinants and outcomes. This study identified several DAP characteristics that could be improved to facilitate teamwork and enhance service delivery, thereby contributing to knowledge of organisational determinants of teamwork and associated outcomes. Findings can be used to update existing DAP guidelines, and by managers to plan or evaluate lung cancer DAPs. Ongoing research is needed to identify ideal roles for navigators, and staffing models tailored to case volumes

  11. Control of polymeric nanoparticle size to improve therapeutic delivery.

    PubMed

    Hickey, John W; Santos, Jose Luis; Williford, John-Michael; Mao, Hai-Quan

    2015-12-10

    As nanoparticle (NP)-mediated drug delivery research continues to expand, understanding parameters that govern NP interactions with the biological environment becomes paramount. The principles identified from the study of these parameters can be used to engineer new NPs, impart unique functionalities, identify novel utilities, and improve the clinical translation of NP formulations. One key design parameter is NP size. New methods have been developed to produce NPs with increased control of NP size between 10 and 200nm, a size range most relevant to physical and biochemical targeting through both intravascular and site-specific deliveries. Three notable techniques best suited for generating polymeric NPs with narrow size distributions are highlighted in this review: self-assembly, microfluidics-based preparation, and flash nanoprecipitation. Furthermore, the effect of NP size on the biological fate and transport properties at the molecular scale (protein-NP interactions) and the tissue and systemic scale (convective and diffusive transport of NPs) are analyzed here. These analyses underscore the importance of NP size control in considering clinical translation and assessment of therapeutic outcomes of NP delivery vehicles.

  12. Exploring Service Providers' Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia.

    PubMed

    Cyril, Sheila; Green, Julie; Nicholson, Jan M; Agho, Kingsley; Renzaho, Andre M N

    2016-01-01

    Childhood obesity rates have been increasing disproportionately among disadvantaged communities including culturally and linguistically diverse (CALD) migrant groups in Australia due to their poor participation in the available obesity prevention initiatives. We sought to explore service providers' perceptions of the key factors influencing the participation of CALD communities in the existing obesity prevention services and the service requirements needed to improve CALD communities' participation in these services. We conducted a qualitative study using focus group discussions involving fifty-nine service providers from a range of services, who are involved in the health and wellbeing of children from CALD groups living in four socioeconomically disadvantaged areas in Victoria, Australia. Thematic analysis of the data showed three major themes including community-level barriers to CALD engagement in childhood obesity prevention services; service-level barriers to the delivery of these services; and proposed changes to current childhood obesity prevention approaches. Integrating obesity prevention messages within existing programs, better coordination between prevention and treatment services and the establishment of a childhood obesity surveillance system, were some of the important changes suggested by service providers. This study has found that low CALD health literacy, lack of knowledge of cultural barriers among service providers and co-existing deficiencies in the structure and delivery of obesity prevention services negatively impacted the participation of CALD communities in obesity prevention services. Cultural competency training of service providers would improve their understanding of the cultural influences of childhood obesity and incorporate them into the design and development of obesity prevention initiatives. Service providers need to be educated on the pre-migratory health service experiences and health conditions of CALD communities to ensure

  13. Exploring Service Providers' Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia

    PubMed Central

    Cyril, Sheila; Green, Julie; Nicholson, Jan M.; Agho, Kingsley; Renzaho, Andre M. N.

    2016-01-01

    Background Childhood obesity rates have been increasing disproportionately among disadvantaged communities including culturally and linguistically diverse (CALD) migrant groups in Australia due to their poor participation in the available obesity prevention initiatives. We sought to explore service providers’ perceptions of the key factors influencing the participation of CALD communities in the existing obesity prevention services and the service requirements needed to improve CALD communities’ participation in these services. Methods We conducted a qualitative study using focus group discussions involving fifty-nine service providers from a range of services, who are involved in the health and wellbeing of children from CALD groups living in four socioeconomically disadvantaged areas in Victoria, Australia. Results Thematic analysis of the data showed three major themes including community-level barriers to CALD engagement in childhood obesity prevention services; service-level barriers to the delivery of these services; and proposed changes to current childhood obesity prevention approaches. Integrating obesity prevention messages within existing programs, better coordination between prevention and treatment services and the establishment of a childhood obesity surveillance system, were some of the important changes suggested by service providers. Conclusion This study has found that low CALD health literacy, lack of knowledge of cultural barriers among service providers and co-existing deficiencies in the structure and delivery of obesity prevention services negatively impacted the participation of CALD communities in obesity prevention services. Cultural competency training of service providers would improve their understanding of the cultural influences of childhood obesity and incorporate them into the design and development of obesity prevention initiatives. Service providers need to be educated on the pre-migratory health service experiences and health

  14. 26 CFR 31.3121(b)(14)-1 - Services in delivery or distribution of newspapers, shopping news, or magazines.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Services in delivery or distribution of... (Chapter 21, Internal Revenue Code of 1954) General Provisions § 31.3121(b)(14)-1 Services in delivery or... subsequent delivery or distribution, are excepted from employment. Thus, the services performed by...

  15. 26 CFR 31.3306(c)(15)-1 - Services in delivery or distribution of newspapers, shopping news, or magazines.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Services in delivery or distribution of..., Internal Revenue Code of 1954) § 31.3306(c)(15)-1 Services in delivery or distribution of newspapers...-house delivery, such as services in assembling newspapers, are considered to be within the...

  16. 75 FR 20608 - Notice of Re-Designation of the Service Delivery Area for the Cowlitz Indian Tribe

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-20

    ... HUMAN SERVICES Indian Health Service Notice of Re-Designation of the Service Delivery Area for the... Service Delivery Area (CHSDA) as the geographic area within which CHS will be made available by the IHS to... of Management and Budget under the Paperwork Reduction Act of 1980. Contract Health Service...

  17. Managerial process improvement: a lean approach to eliminating medication delivery.

    PubMed

    Hussain, Aftab; Stewart, LaShonda M; Rivers, Patrick A; Munchus, George

    2015-01-01

    Statistical evidence shows that medication errors are a major cause of injuries that concerns all health care oganizations. Despite all the efforts to improve the quality of care, the lack of understanding and inability of management to design a robust system that will strategically target those factors is a major cause of distress. The paper aims to discuss these issues. Achieving optimum organizational performance requires two key variables; work process factors and human performance factors. The approach is that healthcare administrators must take in account both variables in designing a strategy to reduce medication errors. However, strategies that will combat such phenomena require that managers and administrators understand the key factors that are causing medication delivery errors. The authors recommend that healthcare organizations implement the Toyota Production System (TPS) combined with human performance improvement (HPI) methodologies to eliminate medication delivery errors in hospitals. Despite all the efforts to improve the quality of care, there continues to be a lack of understanding and the ability of management to design a robust system that will strategically target those factors associated with medication errors. This paper proposes a solution to an ambiguous workflow process using the TPS combined with the HPI system.

  18. The effectiveness of the PRISMA integrated service delivery network: preliminary report on methods and baseline data.

    PubMed

    Hébert, Réjean; Dubois, Marie-France; Raîche, Michel; Dubuc, Nicole

    2008-02-14

    The PRISMA study analyzes an innovative coordination-type integrated service delivery (ISD) system developed to improve continuity and increase the effectiveness and efficiency of services, especially for older and disabled populations. The objective of the PRISMA study is to evaluate the effectiveness of this system to improve health, empowerment and satisfaction of frail older people, modify their health and social services utilization, without increasing the burden of informal caregivers. The objective of this paper is to present the methodology and give baseline data on the study participants. A quasi-experimental study with pre-test, multiple post-tests, and a comparison group was used to evaluate the impact of PRISMA ISD. Elders at risk of functional decline (501 experimental, 419 control) participated in the study. At entry, the two groups were comparable for most variables. Over the first year, when the implementation rate was low (32%), participants from the control group used fewer services than those from the experimental group. After the first year, no significant statistical difference was observed for functional decline and changes in the other outcome variables. This first year must be considered a baseline year, showing the situation without significant implementation of PRISMA ISD systems. Results for the following years will have to be examined with consideration of these baseline results.

  19. 76 FR 77483 - Nationwide Change in Postal Delivery Service Standards

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-13

    ... Service proposes to revise service standards for First- Class Mail, ] Periodicals, Package Services, and... significant portions of First-Class Mail and Periodicals. Within First- Class Mail, 3-digit origin-destination...

  20. Patient Satisfaction with Methadone Maintenance Treatment in Vietnam: A Comparison of Different Integrative-Service Delivery Models

    PubMed Central

    Tran, Bach Xuan; Nguyen, Long Hoang; Phan, Huong Thu Thi; Latkin, Carl A.

    2015-01-01

    Background Patient satisfaction is an important component of quality in healthcare delivery. To inform the expansion of Methadone Maintenance Treatment (MMT) services in Vietnam, we examined the satisfaction of patients with regards to different services delivery models and identified its associated factors. Methods We interviewed 1,016 MMT patients at 5 clinics in Hanoi and Nam Dinh province. The modified SATIS instrument, a 10-item scale, was used to measure three dimensions: “Services quality and convenience”, “Health workers’ capacity and responsiveness” and “Inter-professional care”. Results The average score was high across three SATIS dimensions. However, only one third of patients completely satisfied with general health services and treatment outcomes. Older age, higher education, having any problem in self-care and anxiety/depression were negatively associated with patient’s satisfaction. Meanwhile, patients receiving MMT at clinics, where more comprehensive HIV and general health care services were available, were more likely to report a complete satisfaction. Conclusion Patients were highly satisfied with MMT services in Vietnam. However, treatment for drug users should go beyond methadone maintenance to address complicated health demands of drug users. Integrating MMT with comprehensive HIV and general health services together with improving the capacity of health workers and efficiency of services organisation to provide interconnected health care for drug users are critical for improving the outcomes of the MMT program. PMID:26556036

  1. Citizen Satisfaction with Public Service Delivery: A Comparative Study of Citywide vs. Subarea Analysis.

    ERIC Educational Resources Information Center

    Keeton, Kato B.

    The facts that most public services are delivered by subarea and that subareas can be identified by the socioeconomic status of the residents, often lead to discrimination in service delivery based on the wealth or prestige of the subareas. It follows that citizen satisfaction with services delivered might vary from sector to sector within a city.…

  2. A Relational Goal-Oriented Model of Optimal Service Delivery to Children and Families

    ERIC Educational Resources Information Center

    King, Gillian

    2009-01-01

    This article presents a Relational Goal-Oriented Model of Service Delivery to Children with physical or mental health difficulties and their families. This research-informed and practice-relevant model provides a broad understanding of what effective service provision entails and requires from practitioners and service organizations. The model…

  3. A Relational Goal-Oriented Model of Optimal Service Delivery to Children and Families

    ERIC Educational Resources Information Center

    King, Gillian

    2009-01-01

    This article presents a Relational Goal-Oriented Model of Service Delivery to Children with physical or mental health difficulties and their families. This research-informed and practice-relevant model provides a broad understanding of what effective service provision entails and requires from practitioners and service organizations. The model…

  4. Legal Guidelines for the Delivery of Special Health Care Services in Schools.

    ERIC Educational Resources Information Center

    Rapport, Mary Jane K.

    1996-01-01

    The Individuals with Disabilities Education Act includes school health services among possible related services. A review of relevant documents and court decisions from the past 10 years provides insight into congressional intent, federal regulations, and local implementation of service delivery related to children with extensive health care…

  5. Gigabit network-based three-dimensional trial service on media delivery platform

    NASA Astrophysics Data System (ADS)

    Kim, Nac-Woo; Son, Seung-Chul; Lee, Byung-Tak

    2011-09-01

    Recently, as effective demand for high-quality, large-capacity content such as three-dimensional (3D), multiangle, and gigabit-web has increased, a network infrastructure capable of satisfying future broadcast and communication service requirements is required. In this paper, we introduce a convergence service based on a gigabit network and then propose a technique for delivering gigabit 3D content. Here, the term 3D content delivery technique refers to an overlay-multicast-based distributed service platform that is comprised of a media relay agent and a management server. The service platform is designed to back up both live video and file-based video streaming. Using this platform, we can provide 3D remote education and 3D multiangle services via 3D-based video streaming between a service provider and service consumers dispersed at different locations. To evaluate our 3D content delivery technique, we run a series of trials of gigabit network-based 3D trial services to service subscribers. Then, we conduct a survey to measure user satisfaction with the 3D delivery service and simulated network and service quality. From experimental results, we confirm that this type of distributed service platform can be used as the delivery framework for applications such as realistic 3D-based seminars or 3D video conferences.

  6. Improving P2P live-content delivery using SVC

    NASA Astrophysics Data System (ADS)

    Schierl, T.; Sánchez, Y.; Hellge, C.; Wiegand, T.

    2010-07-01

    P2P content delivery techniques for video transmission have become of high interest in the last years. With the involvement of client into the delivery process, P2P approaches can significantly reduce the load and cost on servers, especially for popular services. However, previous studies have already pointed out the unreliability of P2P-based live streaming approaches due to peer churn, where peers may ungracefully leave the P2P infrastructure, typically an overlay networks. Peers ungracefully leaving the system cause connection losses in the overlay, which require repair operations. During such repair operations, which typically take a few roundtrip times, no data is received from the lost connection. While taking low delay for fast-channel tune-in into account as a key feature for broadcast-like streaming applications, the P2P live streaming approach can only rely on a certain media pre-buffer during such repair operations. In this paper, multi-tree based Application Layer Multicast as a P2P overlay technique for live streaming is considered. The use of Flow Forwarding (FF), a.k.a. Retransmission, or Forward Error Correction (FEC) in combination with Scalable video Coding (SVC) for concealment during overlay repair operations is shown. Furthermore the benefits of using SVC over the use of AVC single layer transmission are presented.

  7. Micro-fractional epidermal powder delivery for improved skin vaccination

    PubMed Central

    Chen, Xinyuan; Kositratna, Garuna; Zhou, Chang; Manstein, Dieter; Wu, Mei X.

    2014-01-01

    Skin vaccination has gained increasing attention in the last two decades due to its improved potency compared to intramuscular vaccination. Yet, the technical difficulty and frequent local reactions hamper its broad application in the clinic. In the current study, micro-fractional epidermal powder delivery (EPD) is developed to facilitate skin vaccination and minimize local adverse effects. EPD is based on ablative fractional laser or microneedle treatment of the skin to generate microchannel (MC) arrays in the epidermis followed by topical application of powder drug/vaccine-coated array patches to deliver drug/vaccine into the skin. The novel EPD delivered more than 80% sulforhodamine b (SRB) and model antigen ovalbumin (OVA) into murine, swine, and human skin within 1 hour. EPD of OVA induced anti-OVA antibody titer at a level comparable to intradermal (ID) injection and was much more efficient than tape stripping in both delivery efficiency and immune responses. Strikingly, the micro-fractional delivery significantly reduced local side effects of LPS/CpG adjuvant and BCG vaccine, leading to complete skin recovery. In contrast, ID injection induced severe local reactions that persisted for weeks. While reducing local reactogenicity, EPD of OVA/LPS/CpG and BCG vaccine generated a comparable humoral immune response to ID injection. EPD of vaccinia virus encoding OVA induced significantly higher and long-lasting interferon γ-secreting CD8+ T cells than ID injection. In conclusion, EPD represents a promising technology for needle-free, painless skin vaccination with reduced local reactogenicity and improved immunogenicity. PMID:25135790

  8. How do organisational characteristics influence teamwork and service delivery in lung cancer diagnostic assessment programmes? A mixed-methods study

    PubMed Central

    Honein-AbouHaidar, Gladys N; Stuart-McEwan, Terri; Waddell, Tom; Salvarrey, Alexandra; Smylie, Jennifer; Dobrow, Mark J; Brouwers, Melissa C; Gagliardi, Anna R

    2017-01-01

    Objectives Diagnostic assessment programmes (DAPs) can reduce wait times for cancer diagnosis, but optimal DAP design is unknown. This study explored how organisational characteristics influenced multidisciplinary teamwork and diagnostic service delivery in lung cancer DAPs. Design A mixed-methods approach integrated data from descriptive qualitative interviews and medical record abstraction at 4 lung cancer DAPs. Findings were analysed with the Integrated Team Effectiveness Model. Setting 4 DAPs at 2 teaching and 2 community hospitals in Canada. Participants 22 staff were interviewed about organisational characteristics, target service benchmarks, and teamwork processes, determinants and outcomes; 314 medical records were reviewed for actual service benchmarks. Results Formal, informal and asynchronous team processes enabled service delivery and yielded many perceived benefits at the patient, staff and service levels. However, several DAP characteristics challenged teamwork and service delivery: referral volume/workload, time since launch, days per week of operation, rural–remote population, number and type of full-time/part-time human resources, staff colocation, information systems. As a result, all sites failed to meet target benchmarks (from referral to consultation median 4.0 visits, median wait time 35.0 days). Recommendations included improved information systems, more staff in all specialties, staff colocation and expanded roles for patient navigators. Findings were captured in a conceptual framework of lung cancer DAP teamwork determinants and outcomes. Conclusions This study identified several DAP characteristics that could be improved to facilitate teamwork and enhance service delivery, thereby contributing to knowledge of organisational determinants of teamwork and associated outcomes. Findings can be used to update existing DAP guidelines, and by managers to plan or evaluate lung cancer DAPs. Ongoing research is needed to identify ideal roles for

  9. Astrobotic: Commercial Service for Lunar Resource Payload Delivery

    NASA Astrophysics Data System (ADS)

    Thornton, J.; Huber, S.; Peterson, K.; Hendrickson, D.

    2015-10-01

    This paper describes how commercial delivery is enabling access to the Moon for resource payloads. Topics addressed: impediments to resource development, commercial approaches to delivering resource payloads, and traction seen with the market.

  10. Toward a Blueprint for Trauma-Informed Service Delivery in Schools

    ERIC Educational Resources Information Center

    Chafouleas, Sandra M.; Johnson, Austin H.; Overstreet, Stacy; Santos, Natascha M.

    2016-01-01

    Recognition of the benefits to trauma-informed approaches is expanding, along with commensurate interest in extending delivery within school systems. Although information about trauma-informed approaches has quickly burgeoned, systematic attention to integration within multitiered service delivery frameworks has not occurred yet is essential to…

  11. Educational Audiology: A Comparison of Service Delivery Systems Utilized by Missouri Schools.

    ERIC Educational Resources Information Center

    Allard, J. Brad; Golden, Diane Cordry

    1991-01-01

    Comparison of three audiology service delivery systems--(1) school-based audiology within the district, (2) non-school-based audiology in the community, and (3) school-based audiology in a remote community--found the local school-based delivery system superior on various quality indicators. (Author/DB)

  12. 34 CFR 303.525 - Delivery of services in a timely manner.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... INFANTS AND TODDLERS WITH DISABILITIES State Administration Policies and Procedures Related to Financial Matters § 303.525 Delivery of services in a timely manner. Each lead agency is responsible for the...

  13. Improving Care Delivery and Outcomes in Pediatric Rheumatic Diseases

    PubMed Central

    Harris, Julia G.; Bingham, Catherine A.; Morgan, Esi M.

    2016-01-01

    Purpose of review To highlight efforts in pediatric rheumatology related to optimizing the care provided to patients with pediatric rheumatic diseases and describe various approaches to improve health outcomes. Recent findings Recent studies report low rates of remission, frequent occurrence of comorbidities, disease damage, and decreased health-related quality of life in pediatric rheumatic diseases. Pediatric Rheumatology Care and Outcomes Improvement Network is a quality improvement learning network that has demonstrated improvement in process of care measures through use of a centralized patient registry, and interventions including pre-visit planning, population management, shared decision making, and patient/parent engagement. A pediatric rheumatology patient-powered research network was established to enable patient and caregiver participation in setting research priorities and to facilitate data sharing to answer research questions. Quality measure development and benchmarking is proceeding in multiple pediatric rheumatic diseases. Summary This review summarizes the current efforts to improve care delivery and outcomes in pediatric rheumatic diseases through a learning health system approach that harnesses knowledge from the clinical encounter to serve quality improvement, research and discovery. Incorporating standard approaches to medication treatment plans may reduce variation in care. Including the patient voice to design of research studies brings focus on more patient relevant outcomes. (See Video, Supplemental Digital Content 1). PMID:26780426

  14. Improving Services to Gay and Lesbian Clients.

    ERIC Educational Resources Information Center

    Dulaney, Diana D.; Kelly, James

    1982-01-01

    Examines the gap in the theoretical and clinical training of social workers in helping the homosexual client. Proposes specific approaches for improving services to clients who are gay or lesbian. Discusses other neglected clients including heterosexual spouses, children of a homosexual parent, and aging homosexuals. (Author/RC)

  15. Improving Services to Gay and Lesbian Clients.

    ERIC Educational Resources Information Center

    Dulaney, Diana D.; Kelly, James

    1982-01-01

    Examines the gap in the theoretical and clinical training of social workers in helping the homosexual client. Proposes specific approaches for improving services to clients who are gay or lesbian. Discusses other neglected clients including heterosexual spouses, children of a homosexual parent, and aging homosexuals. (Author/RC)

  16. Achieve inventory reduction and improve customer service?

    PubMed

    Moody, M C

    2000-05-01

    Is it really possible to achieve significant reductions in your manufacturing inventories while improving customer service? If you really want to achieve significant inventory reductions, focus on the root causes, and develop countermeasures and a work plan, to execute your countermeasures. Include measurements for recording your progress, and deploy your countermeasures until they are no longer required, or until new ones are needed.

  17. A Brief Introduction of Assistive Technology Service Delivery System in Republic of Korea.

    PubMed

    Lim, MyungJoon; Jung, SungMin

    2015-01-01

    Social participation of People with Disability in Republic of Korea has been grown last few years. Also demand of Assistive Technology has been increased as well. Responding these needs, the public benefits of Assistive Technology Device in Republic of Korea in 2014 was USD 1.7 billion which had been increased by 27 percent during the last five years. Despite an increase in the budget, effort to build Assistive Technology Service Delivery System (ATSDS) was not enough. Therefore, Ministry of Health and Welfare in Korea decided to build ATSDS in Republic of Korea in 2009. In this paper, the process of establishing ATSDS and 2014 outcomes of ATSDS are presented in details. For more than six years efforts of establishing national-wide ATSDS, nine Assistive Technology Centers were actively running in their delivery of service in 2014. As of 2014 outcomes of ATSDS, 14,056 cases were delivered through nine Assistive Technology Centers. The presence of ATSDS proved increase in accessibility for Assistive Technology for People with Disability followed by improvement of the quality of life of them.

  18. What experts think about integrating mobile health into routine immunization service delivery in Nigeria

    PubMed Central

    Okojie, Obehi Hilda

    2016-01-01

    Background Routine immunization (RI), like other essential health services, could benefit from mobile telephony and especially from the current trend of their increased use in health service delivery. SMS text messages have been recorded to be highly effective in many settings around the world and could be used for reminders and recalls to improve RI performance in Nigeria. This qualitative study assessed the state of RI services, obtained expert opinion on integration of mobile health (mHealth) into RI, and also identified potential threats to such an initiative. Methods In-depth Interviews were held with experts in RI and Primary Health Care from different arms of the health sector in Edo State Nigeria. Their responses were summarized and coded to allow for easy synthesis and interpretation of information. Results Among the experts, there was widespread support for the adoption of mHealth services into RI delivery but with a caution on threats to its success, including inconsistent supply of electricity, poor mobile telephone networks, and the possibility of a lack of political will and funding support from the government. Conclusions Although RI performance appears fairly satisfactory in the study setting, adoption of mHealth is highly encouraged to sustain the gains. User-friendliness, interoperability and adaptations to fit peculiar financial and health care models must be kept in view while customizing software solutions for this setting. Also, the store and forward system for handling health information appears more appropriate in this setting to maximize the effectiveness of mHealth despite the shortfall in infrastructure. PMID:28293579

  19. Utilization of institutional delivery service at Wukro and Butajera districts in the Northern and South Central Ethiopia

    PubMed Central

    2014-01-01

    Background Ethiopia has one of the highest maternal mortality in the world. Institutional delivery is the key intervention in reducing maternal mortality and complications. However, the uptake of the service has remained low and the factors which contribute to this low uptake appear to vary widely. Our study aims to determine the magnitude and identify factors affecting delivery at health institution in two districts in Ethiopia. Methods A community based cross sectional household survey was conducted from January to February 2012 in 12 randomly selected villages of Wukro and Butajera districts in the northern and south central parts of Ethiopia, respectively. Data were collected using a pretested questionnaire from 4949 women who delivered in the two years preceding the survey. Results One in four women delivered the index child at a health facility. Among women who delivered at health facility, 16.1% deliveries were in government hospitals and 7.8% were in health centers. The factors that significantly affected institutional delivery in this study were district in which the women lived (AOR: 2.21, 95% CI: 1.28, 3.82), women age at interview (AOR: 1.96, 95% CI: 1.05, 3.62), women’s education (AOR: 3.53, 95% CI: 1.22, 10.20), wealth status (AOR: 16.82, 95% CI: 7.96, 35.54), women’s occupation (AOR: 1.50, 95% CI: 1.01, 2.24), antenatal care (4+) use (AOR: 1.77, 95% CI: 1.42, 2.20), and number of pregnancies (AOR: 0.25, 95% CI: 0.18,0.35). We found that women who were autonomous in decision making about place of delivery were less likely to deliver in health facility (AOR: 0.38, 95% CI: 0.23,0.63). Conclusions Institutional delivery is still low in the Ethiopia. The most important factors that determine use of institutional delivery appear to be women education and household economic status. Women’s autonomy in decision making on place of delivery did not improve health facility delivery in our study population. Actions targeting the disadvantaged, improving

  20. Service readiness, health facility management practices, and delivery care utilization in five states of Nigeria: a cross-sectional analysis.

    PubMed

    Gage, Anastasia J; Ilombu, Onyebuchi; Akinyemi, Akanni Ibukun

    2016-10-06

    Existing studies of delivery care in Nigeria have identified socioeconomic and cultural factors as the primary determinants of health facility delivery. However, no study has investigated the association between supply-side factors and health facility delivery. Our study analyzed the role of supply-side factors, particularly health facility readiness and management practices for provision of quality maternal health services. Using linked data from the 2005 and 2009 health facility and household surveys in the five states in which the Community Participation for Action in the Social Sector (COMPASS) project was implemented, indices of health service readiness and management were developed based on World Health Organization guidelines. Multilevel logistic regression models were run to determine the association between these indices and health facility delivery among 2710 women aged 15-49 years whose last child was born within the five years preceding the surveys and who lived in 51 COMPASS LGAs. The health facility delivery rate increased from 25.4 % in 2005 to 44.1 % in 2009. Basic amenities for antenatal care provision, readiness to deliver basic emergency obstetric and newborn care, and management practices supportive of quality maternal health services were suboptimal in health facilities surveyed and did not change significantly between 2005 and 2009. The LGA mean index of basic amenities for antenatal care provision was more positively associated with the odds of health facility delivery in 2009 than in 2005, and in rural than in urban areas. The LGA mean index of management practices was associated with significantly lower odds of health facility delivery in rural than in urban areas. The LGA mean index of facility readiness to deliver basic emergency obstetric and neonatal care declined slightly from 5.16 in 2005 to 3.98 in 2009 and was unrelated to the odds of health facility delivery. Supply-side factors appeared to play a role in health facility delivery

  1. Improving service quality in primary care.

    PubMed

    Kennedy, Denise M; Nordrum, Jon T; Edwards, Frederick D; Caselli, Richard J; Berry, Leonard L

    2015-01-01

    A framework for improving health care service quality was implemented at a 12-provider family medicine practice in 2010. A national patient satisfaction research vendor conducted weekly telephone surveys of 840 patients served by that practice: 280 patients served in 2009, and 560 served during 2010 and 2011. After the framework was implemented, the proportion of "excellent" ratings of provider service (the highest rating on a 5-point scale) increased by 5% to 9%, most notably thoroughness (P = .04), listening (P = .04), and explaining (P = .04). Other improvements included prompt test result notification and telephone staff courtesy (each by 10%, P = .02), as well as teamwork (by 8%, P = .04). Overall quality increased by 10% (P = .01), moving the practice from the 68th to the 91st percentile of medical practices in the research vendor's database. Improvements in patient satisfaction suggest that this framework may be useful in value-based payment models.

  2. Physician and patient gender concordance and the delivery of comprehensive clinical preventive services.

    PubMed

    Flocke, Susan A; Gilchrist, Valerie

    2005-05-01

    Understanding the role of patient- and physician-gender on delivery of preventive services has important implications for identifying strategies to increase preventive service delivery. We attempt to overcome methodological limitations of previous studies in examining the association of the patient-physician gender interaction on the delivery of preventive screening, counseling, and immunization services. In this cross-sectional study, research nurses directly observed 3256 consecutive adult patient visits to 138 family physicians. Delivery of gender neutral US Preventive Services Task Force (USPSTF) recommended screening, health behavior counseling, and immunization services was assessed by direct observation and medical record review. Multilevel regression analyses were used to test the interaction effect of physician and patient gender with preventive service delivery, controlling for patient age, insurance type, number of office visits in the past 2 years and physician age. The interaction effect of physician and patient gender was not significantly associated with delivery of gender neutral screening, counseling, or immunizations. Patients of female physicians were more up-to-date on counseling services (P < 0.01) and immunizations (P < 0.05) than patients of male physicians. Male patients, independent of physician gender, were more up-to-date on counseling and immunizations (P < 0.01). Physician-patient gender concordance is not associated with delivery of more preventive services. Rather, female physicians provide more counseling and immunization services to all of their patients. Previous research showing higher rates of gender-specific screening achieved by women physicians may have been an indication of an overall greater prevention orientation among women physicians rather than a specific benefit of gender concordance.

  3. Characteristics of hospitals providing preventive services: does delivery system integration make a difference?

    PubMed

    Kellie, S E; Robertson, J W; VanOstenberg, P R; Schyve, P M; Buck, A S

    1996-01-01

    As health care organizations consolidate into integrated delivery systems, increased delivery of preventive services is expected. The study objective was to evaluate the impact of hospitals' participation in multiorganizational arrangements and managed care on their delivery of preventive services. The study is a secondary data analysis of data in the American Hospital Association 1993 Annual Survey of Hospitals Data Base. Two primary prevention variables (health promotion services to patients and to community members), and one secondary prevention variable (screening mammography) were included. Hospital characteristics included ownership, bed-size, and integration-participation in a multiorganizational arrangement and having managed care (HMO and PPO) contracts. The 5,387 general medical and surgical hospitals responding to the 1993 survey were included in the analysis. Proportions of hospitals reporting delivery of health promotion services to patients, and to community members, and screening mammography services were respectively 90%, 83%, and 88%. Hospitals reporting participation in multiorganizational arrangements were more likely to report delivery of preventive services after adjusting for bed-size. The bed-adjusted odds ratios for providing health promotion services to inpatients, and to members of the community, and screening mammography services in hospitals with managed care contracts versus those without managed care contracts were respectively: 2.72 (95% CI: 1.65, 2.50), 2.03 (1.63, 2.53), and 1.51 (1.26, 1.81). Preliminary findings from this secondary data analysis support the expectation that current changes in the health care delivery system may expand the delivery of preventive services.

  4. Commentary: the role of mentored internships for systems engineering in improving health care delivery.

    PubMed

    Day, T Eugene; Goldlust, Eric J; True, William R

    2010-09-01

    The authors advise the adoption of mentored internships in systems engineering, conducted at academic hospitals, directed by physicians, epidemiologists, and health administrators and overseen by faculty at attendant schools of engineering. Such internships are anticipated to directly address the immediate objectives of administrators and clinicians. Additionally, this affords future generations of health care engineers the opportunity to learn the language and methodology of the medical sciences to provide a common ground for the analysis and understanding of medical systems. In turn, this should foster collaboration between the principal stakeholders in health care delivery--practitioners, administrators, engineers, and researchers--in the collective efforts to improve the quality of services provided.

  5. The Association Between Disaster Vulnerability and Post-disaster Psychosocial Service Delivery Across Europe.

    PubMed

    Dückers, Michel L A; Witteveen, Anke B; Bisson, Jonathan I; Olff, Miranda

    2017-07-01

    This study confirms that the developmental stage of post-disaster psychosocial support planning and delivery systems in Europe is associated with countries' level of disaster vulnerability. Lower vulnerability is accompanied by more evolved planning and delivery systems. Countries in north, west and central regions have more developed planning and delivery systems and lower vulnerability levels than those in the south, southeast and east. The highest proportion of variance in vulnerability is located at the regional level, most of the variance in planning and delivery systems is at the individual level. Possible implications and chances for the optimization of psychosocial services are discussed.

  6. Carrier-based delivery mechanism for enhanced services on passive optical networks

    NASA Astrophysics Data System (ADS)

    Compton, Mark K.; Rosher, Paul A.

    1992-02-01

    Passive optical networking is being considered for the provision of digital services in the local loop. In the UK, TPON is under investigation for the delivery of telephony and other narrowband services. This paper describes a carrier based system which is being considered as a short term overlay to TPON. Both broadband and narrowband services may be supported, representing an evolutionary path to the provision of integrated services for the information intensive customer.

  7. Service provider perceptions of telerehabilitation as an additional service delivery option within an Australian neurosurgical and orthopaedic physiotherapy screening clinic: A qualitative study.

    PubMed

    Cottrell, Michelle A; Hill, Anne J; O'Leary, Shaun P; Raymer, Maree E; Russell, Trevor G

    2017-08-01

    The Neurosurgical & Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service (N/OPSC&MDS) originated as a complementary, non-surgical pathway for patients referred to public neurosurgical and orthopaedic specialist services. Patient access to the N/OPSC&MDS could potentially be improved with the implementation of telerehabilitation as an additional method of service delivery. To evaluate service provider's views on (1) current barriers to patients' accessing N/OPSC & MD services, and (2) the implementation of telerehabilitation within the N/OPSC&MDS. Qualitative descriptive study design. Healthcare providers (n = 26) were recruited from six N/OPSC&MD services located throughout Queensland, Australia. Semi-structured interviews were conducted to explore service providers' views with respect to existing barriers to patients accessing the N/OPSC&MDS, and if telerehabilitation could be feasibly adopted to address current barriers. Template analysis resulted in six themes: (1) barriers to some patients' accessing current N/OPSC&MD services are complex & multifaceted; (2) telerehabilitation could improve patient access to appropriate management for their musculoskeletal condition; (3) telerehabilitation may have limitations when compared to face-to-face healthcare; (4) the delivery of telerehabilitation needs to be flexible; (5) perceived barriers, and (6) facilitators to the successful implementation of telerehabilitation within the N/OPSC&MDS. This study represents a critical step in determining the readiness of service providers for the implementation of telerehabilitation within the N/OPSC&MDS. Although cautious, service providers are overall accepting of the implementation of telerehabilitation, acknowledging that it could eliminate several current barriers, subsequently achieving more equitable access to the service. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  8. 22 CFR 228.23 - Other delivery services.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... FINANCED BY USAID Conditions Governing the Eligibility of Commodity-Related Services for USAID Financing... services are eligible when provided as part of a commodity procurement financed by USAID. ...

  9. 22 CFR 228.23 - Other delivery services.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... FINANCED BY USAID Conditions Governing the Eligibility of Commodity-Related Services for USAID Financing... services are eligible when provided as part of a commodity procurement financed by USAID. ...

  10. 22 CFR 228.23 - Other delivery services.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... FINANCED BY USAID Conditions Governing the Eligibility of Commodity-Related Services for USAID Financing... services are eligible when provided as part of a commodity procurement financed by USAID. ...

  11. Environmental Monitoring System for Home-Delivery Service of Packages by Using MEMS Sensors

    NASA Astrophysics Data System (ADS)

    Fujita, Takayuki; Masaki, Kentaro; Maenaka, Kazusuke

    Nowadays, home-delivery services of packages are imperative in everyday life. These service industries are trying to provide cheaper, faster and safer service. However, package condition and handling during transportation are not disclosed to a customer. In this study, we realized a prototype system by MEMS technology for measuring the environmental conditions around a package for home-delivery service. The system includes barometric pressure, temperature, relative humidity and three dimensional acceleration (shock) sensing devices, as well as an interface circuitry. The system is a size of 115 × 54 × 10 mm3 and a weight of 50 g. We measured the package conditions during the transportation by three Japanese domestic home-delivery services, and using data mining, we were able to obtain a representation of the package's circumstances.

  12. AAV Hybrid Serotypes: Improved Vectors for Gene Delivery

    PubMed Central

    Choi, Vivian W.; McCarty, Douglas M.; Samulski, R. Jude

    2006-01-01

    In recent years, significant efforts have been made on studying and engineering adeno-associated virus (AAV) capsid, in order to increase efficiency in targeting specific cell types that are non-permissive to wild type (wt) viruses and to improve efficacy in infecting only the cell type of interest. With our previous knowledge of the viral properties of the naturally occurring serotypes and the elucidation of their capsid structures, we can now generate capsid mutants, or hybrid serotypes, by various methods and strategies. In this review, we summarize the studies performed on AAV retargeting, and categorize the available hybrid serotypes to date, based on the type of modification: 1) transcapsidation, 2) adsorption of bi-specific antibody to capsid surface, 3) mosaic capsid, and 4) chimeric capsid. Not only these hybrid serotypes could achieve high efficiency of gene delivery to a specific targeted cell type, which can be better-tailored for a particular clinical application, but also serve as a tool for studying AAV biology such as receptor binding, trafficking and genome delivery into the nucleus. PMID:15975007

  13. Functionalized gold nanoparticles improve afatinib delivery into cancer cells.

    PubMed

    Coelho, Sílvia Castro; Almeida, Gabriela M; Pereira, Maria Carmo; Santos-Silva, Filipe; Coelho, Manuel A N

    2016-01-01

    A drug delivery system based on colloidal pegylated gold nanoparticles (PEGAuNPs) conjugated with the tyrosine kinase inhibitor afatinib was designed and tested for enhancing the drug activity against pancreatic and NSCLC cells. PEGAuNPs were synthesized and characterized physicochemically. Confocal imaging was performed to evaluate the nanoparticle (NP) internalization in cancer cells. For cell-cycle distribution analysis, conjugated NPs and afatinib alone were incubated with cells and alterations on the cell-cycle profile subsequently analyzed by total DNA staining. Cancer cell survival and growth inhibition following incubation with afatinib and PEGAuNPs-afatinib (concentrations between 0.007 and 0.500 µM afatinib) were evaluated. A higher cellular uptake of PEGAuNPs was observed by cancer cells. Our data suggest an efficient conjugation of PEGAuNPs with the drug, enhancing the afatinib activity in comparison with afatinib alone. In fact, IC50 and GI50 results obtained show that the PEGAuNPs-afatinib conjugate is ca. 5 and 20 times more potent than afatinib alone in S2-013 and A549 cell lines, respectively. Conjugating PEGAuNPs with afatinib is a promising antitumor delivery system for cancer therapy as it improves drug efficacy, allowing a reduction in drug dose used and minimizing possible toxicity-related side effects.

  14. Factors impacting the use of antenatal care and hospital child delivery services: a case study of rural residents in the Enshi Autonomous Prefecture, Hubei Province, China.

    PubMed

    Zhang, Yin; Chen, Minxing; Lu, Jun; Hao, Mo; Zhang, Changli; Sun, Mei; Li, Xiaohong; Chang, Fengshui

    2015-01-01

    This study was undertaken to understand the factors that impact whether rural women obtain antenatal care (ANC) and choose to use hospital delivery services in central and western China. We chose to conduct field research with the rural residents in Hubei Province through a combination of random sampling and purposive sampling methods. A mixed method approach was taken to analyze the factors impacting the use of ANC and hospital delivery services from the perspective of the villagers. Our results indicate that the quality of the available ANC services is poor. In particular, women who have special circumstances and unplanned pregnancies or who become pregnant prior to marriage are confronted with inadequate ANC and hospital child delivery services. The factors that impact whether women use or not use ANC and hospital delivery services and that cause women to choose hospital or home delivery can be understood at three levels: macro, middle, and micro. We strongly suggest that the policies and projects that promote maternal healthcare in rural areas be sustained with an added focus on including women with special circumstances. Village doctors can be enlisted to regularly visit pregnant women at home and to provide extra explanation about the ANC services available and the purpose of maternal healthcare. These findings and suggestions can be used by local health providers and decision-makers to improve the quality of ANC and hospital delivery services.

  15. Closing the delivery gaps in pediatric HIV care in Togo, West Africa: using the care delivery value chain framework to direct quality improvement

    PubMed Central

    Fiori, Kevin; Schechter, Jennifer; Dey, Monica; Braganza, Sandra; Rhatigan, Joseph; Houndenou, Spero; Gbeleou, Christophe; Palerbo, Emmanuel; Tchangani, Elfamozo; Lopez, Andrew; Bensen, Emily; Hirschhorn, Lisa R.

    2016-01-01

    ABSTRACT Providing quality care for all children living with HIV/AIDS remains a global challenge and requires the development of new healthcare delivery strategies. The care delivery value chain (CDVC) is a framework that maps activities required to provide effective and responsive care for a patient with a particular disease across the continuum of care. By mapping activities along a value chain, the CDVC enables managers to better allocate resources, improve communication, and coordinate activities. We report on the successful application of the CDVC as a strategy to optimize care delivery and inform quality improvement (QI) efforts with the overall aim of improving care for Pediatric HIV patients in Togo, West Africa. Over the course of 12 months, 13 distinct QI activities in Pediatric HIV/AIDS care delivery were monitored, and 11 of those activities met or exceeded established targets. Examples included: increase in infants receiving routine polymerase chain reaction testing at 2 months (39–95%), increase in HIV exposed children receiving confirmatory HIV testing at 18 months (67–100%), and increase in patients receiving initial CD4 testing within 3 months of HIV diagnosis (67–100%). The CDVC was an effective approach for evaluating existing systems and prioritizing gaps in delivery for QI over the full cycle of Pediatric HIV/AIDS care in three specific ways: (1) facilitating the first comprehensive mapping of Pediatric HIV/AIDS services, (2) identifying gaps in available services, and (3) catalyzing the creation of a responsive QI plan. The CDVC provided a framework to drive meaningful, strategic action to improve Pediatric HIV care in Togo. PMID:27391996

  16. Closing the delivery gaps in pediatric HIV care in Togo, West Africa: using the care delivery value chain framework to direct quality improvement.

    PubMed

    Fiori, Kevin; Schechter, Jennifer; Dey, Monica; Braganza, Sandra; Rhatigan, Joseph; Houndenou, Spero; Gbeleou, Christophe; Palerbo, Emmanuel; Tchangani, Elfamozo; Lopez, Andrew; Bensen, Emily; Hirschhorn, Lisa R

    2016-03-01

    Providing quality care for all children living with HIV/AIDS remains a global challenge and requires the development of new healthcare delivery strategies. The care delivery value chain (CDVC) is a framework that maps activities required to provide effective and responsive care for a patient with a particular disease across the continuum of care. By mapping activities along a value chain, the CDVC enables managers to better allocate resources, improve communication, and coordinate activities. We report on the successful application of the CDVC as a strategy to optimize care delivery and inform quality improvement (QI) efforts with the overall aim of improving care for Pediatric HIV patients in Togo, West Africa. Over the course of 12 months, 13 distinct QI activities in Pediatric HIV/AIDS care delivery were monitored, and 11 of those activities met or exceeded established targets. Examples included: increase in infants receiving routine polymerase chain reaction testing at 2 months (39-95%), increase in HIV exposed children receiving confirmatory HIV testing at 18 months (67-100%), and increase in patients receiving initial CD4 testing within 3 months of HIV diagnosis (67-100%). The CDVC was an effective approach for evaluating existing systems and prioritizing gaps in delivery for QI over the full cycle of Pediatric HIV/AIDS care in three specific ways: (1) facilitating the first comprehensive mapping of Pediatric HIV/AIDS services, (2) identifying gaps in available services, and (3) catalyzing the creation of a responsive QI plan. The CDVC provided a framework to drive meaningful, strategic action to improve Pediatric HIV care in Togo.

  17. The Effects of Collaborative Care Training on Case Managers' Perceived Depression-Related Services Delivery.

    PubMed

    Landry, Craig M; Jackson, Aurora P; Tang, Lingqi; Miranda, Jeanne; Chung, Bowen; Jones, Felica; Ong, Michael K; Wells, Kenneth

    2017-02-01

    This study examined the effects of a depression care quality improvement (QI) intervention implemented by using Community Engagement and Planning (CEP), which supports collaboration across health and community-based agencies, or Resources for Services (RS), which provides technical assistance, on training participation and service delivery by primarily unlicensed, racially and ethnically diverse case managers in two low-income communities in Los Angeles. The study was a cluster-randomized trial with program-level assignment to CEP or RS for implementation of a QI initiative for providing training for depression care. Staff with patient contact in 84 health and community-based programs that were eligible for the provider outcomes substudy were invited to participate in training and to complete baseline and one-year follow-up surveys; 117 case managers (N=59, RS; N=58, CEP) from 52 programs completed follow-up. Primary outcomes were time spent providing services in community settings and use of depression case management and problem-solving practices. Secondary outcomes were depression knowledge and attitudes and perceived system barriers. CEP case managers had greater participation in depression training, spent more time providing services in community settings, and used more problem-solving therapeutic approaches compared with RS case managers (p<.05). Training participation, time spent providing services in community settings, and use of problem-solving skills among primarily unlicensed, racially and ethnically diverse case managers were greater in programs that used CEP rather than RS to implement depression care QI, suggesting that CEP offers a model for including case managers in communitywide depression care improvement efforts.

  18. Overview on gastroretentive drug delivery systems for improving drug bioavailability.

    PubMed

    Lopes, Carla M; Bettencourt, Catarina; Rossi, Alessandra; Buttini, Francesca; Barata, Pedro

    2016-08-20

    In recent decades, many efforts have been made in order to improve drug bioavailability after oral administration. Gastroretentive drug delivery systems are a good example; they emerged to enhance the bioavailability and effectiveness of drugs with a narrow absorption window in the upper gastrointestinal tract and/or to promote local activity in the stomach and duodenum. Several strategies are used to increase the gastric residence time, namely bioadhesive or mucoadhesive systems, expandable systems, high-density systems, floating systems, superporous hydrogels and magnetic systems. The present review highlights some of the drugs that can benefit from gastroretentive strategies, such as the factors that influence gastric retention time and the mechanism of action of gastroretentive systems, as well as their classification into single and multiple unit systems.

  19. Conceptions of patients and their roles in healthcare: Insights from everyday practice and service improvement.

    PubMed

    McDermott, Aoife M; Pedersen, Anne Reff

    2016-01-01

    The purpose of this paper is two-fold. First, it sets the context for the special issue by considering conceptions of patients and their roles in service delivery and improvement. Second, it introduces the contributions to the special issue, and identifies thematic resonance. The paper utilises a literature synthesis and thematic analysis of the special issue submissions. These emanated from the Ninth International Organisational Behaviour in Healthcare Conference, hosted by Copenhagen Business School on behalf of the Learned Society for Studies in Organizing Healthcare. The articles evidence a range of perspectives on patients' roles in healthcare. These range from their being subject to, a mobilising focus for, and active participants in service delivery and improvement. Building upon the potential patient roles identified, this editorial develops five "ideal type" patient positions in healthcare delivery and improvement. These recognise that patients' engagement with health care services is influenced both by personal characteristics and circumstances, which affect patients' openness to engaging with health services, as well as the opportunities afforded to patients to engage, by organisations and their employees. The paper explores the relationally embedded nature of patient involvement in healthcare, inherent in the interdependence between patient and providers' roles. The typology aims to prompt discussion regarding the conceptualisation patients' roles in healthcare organisations, and the individual, employee, organisational and contextual factors that may help and hinder their involvement in service delivery and improvement. The authors close by noting four areas meriting further research attention, and potentially useful theoretical lenses.

  20. Measuring the Delivery of Special Education Services in a Large Urban District: Lessons from the Los Angeles Unified School District

    ERIC Educational Resources Information Center

    Harr, Jenifer J.; Oliver, Deborah F.; Ramanathan, Arun; Socias, Miguel

    2008-01-01

    Special education service delivery is often the source of disputes between parents and districts and an issue in special education class-action lawsuits. Despite these controversies, there has been little large-scale research on the delivery of services. This study represents a large-scale assessment of the delivery of special education services…

  1. Could changes in the wheelchair delivery system improve safety?

    PubMed Central

    Kirby, R L; Coughlan, S G; Christie, M

    1995-01-01

    Despite emerging evidence about the high incidence and severity of wheelchair-related injuries, regulations governing wheelchair safety are almost nonexistent in Canada. The authors believe that, to improve wheelchair safety, a concerted effort by government, manufacturers, purchasing groups, users and clinicians is needed. Health Canada's Health Protection Branch should treat wheelchairs as medical devices (as defined in the Food and Drugs Act 1985) and improve its injury-reporting network. Manufacturers should give a higher priority to safety in wheelchair design, improve their educational materials and formalize postmarketing surveillance. Purchasing groups should try to ensure that they do not stifle innovation in wheelchair design by setting unrealistic reimbursement ceilings and should use their market power more effectively. Users should obtain their wheelchairs in specialized settings, heed safety warnings and make more effective use of litigation when such action is warranted. Clinicians should ensure that patients are equipped with the most appropriate wheelchair for their needs, that they are given adequate training in safe wheelchair use and that they understand the dangers involved. Rapid changes in wheelchair technology and emerging evidence about the high incidence and severity of injuries related to wheelchair use suggest that such changes are needed in the wheelchair delivery system. PMID:7489551

  2. Dynamic Control of Service Delivery for Ad Hoc Systems

    DTIC Science & Technology

    2006-10-01

    solutions for Localisation of mobile entities and propagation of information for routing the service in a mobile environment. Ad hoc Data Dissemination...available on the topology, the configuration of the network (SLA, user profiles, …), the localisation of the users in order to deliver the services...services. HCDR sub-networks are based on Adhoc technologies. • The enhanced civilian radio sub-networks (S- WIFI , S-WIMAX) : These technologies will

  3. Perceptions of International Students on Service Quality Delivery in a Malaysian Public University

    ERIC Educational Resources Information Center

    Njie, Baboucarr; Asimiran, Soaib; Baki, Roselan

    2012-01-01

    Purpose: The purpose of this study is to explore the perceptions of international students of service quality delivery (SQD) in a Malaysian public university. Design/methodology/approach: The study was limited to the University's immediate physical environment and its associated human and systems-based services. The physical environment in this…

  4. Step by Step--Creating a Strategic Management System for Career Services Delivery.

    ERIC Educational Resources Information Center

    Jones, Cynthia F.

    2002-01-01

    At the University of Connecticut, the career services staff developed a dynamic strategic management system to do business in, and respond to, the fluid conditions of its environment. This system will help the department to achieve and maintain cutting-edge status in the delivery of career services in accordance with the need of its client groups.…

  5. Perceptions of International Students on Service Quality Delivery in a Malaysian Public University

    ERIC Educational Resources Information Center

    Njie, Baboucarr; Asimiran, Soaib; Baki, Roselan

    2012-01-01

    Purpose: The purpose of this study is to explore the perceptions of international students of service quality delivery (SQD) in a Malaysian public university. Design/methodology/approach: The study was limited to the University's immediate physical environment and its associated human and systems-based services. The physical environment in this…

  6. When Special Education Trumps ESL: An Investigation of Service Delivery for ELLs with Disabilities

    ERIC Educational Resources Information Center

    Kangas, Sara E. N.

    2014-01-01

    Through an ethnographic study of one suburban elementary school, the delivery of services to English language learners (ELLs) with disabilities was investigated. The data analysis revealed that often disability-related and English as a Second Language (ESL) services were in contention, as scheduling, teacher expertise, school culture, and ESL…

  7. Going the Extra Mile: Designing a Delivery Service for Remote Borrowers

    ERIC Educational Resources Information Center

    Long, Dallas

    2009-01-01

    This article documents the development of delivery services of library materials to remote borrowers at Milner Library, Illinois State University. Responding to a university mandate and guidelines for distance learning authored by the Association of College and Research Libraries, the Access Services librarians at Milner Library investigated the…

  8. Mental Health Service Delivery in Rural Areas: Organizational and Clinical Issues.

    ERIC Educational Resources Information Center

    Wagenfeld, Morton O.; Murray, J. Dennis; Mohatt, Dennis F.; DeBruyn, Jeanne C.

    The rural community mental health center tends to serve a large geographic area, have decentralized service delivery, require its professionals to function as generalists, and coordinate closely with other agencies. The last decade has seen an increasing strain placed on this pattern. As block grant and fee-for-service shifts resulting from the…

  9. A Consultative Itinerant Approach to Service Delivery: Considerations for the Early Childhood Community

    ERIC Educational Resources Information Center

    Dinnebeil, Laurie; Pretti-Frontczak, Kristie; McInerney, William

    2009-01-01

    Purpose: This article, written by experts in itinerant early childhood special education, describes and differentiates approaches to itinerant early childhood special education as a primary service delivery option. Consultative itinerant early childhood special education services, in particular, are a means of ensuring that young children with…

  10. Mental Health Services for People with Intellectual Disability: Challenges to Care Delivery

    ERIC Educational Resources Information Center

    Chaplin, Eddie; O'Hara, Jean; Holt, Geraldine; Bouras, Nick

    2009-01-01

    The commissioning and provision of mental health services for people with intellectual disability is often complex and characterised by different service delivery models. This paper looks at the current situation 7 years after the White Paper, Valuing People (From words into action: London learning disabilities strategic framework, Department of…

  11. Northeast Conference on Rural HIV Service Delivery (Burlington, Vermont, October 23-24, 2000). Summary Report.

    ERIC Educational Resources Information Center

    McKinney, Martha M.

    The Northeast Conference on Rural HIV Service Delivery was attended by 51 health and social service professionals, people with HIV, and federal and state health officials with expertise or interest in developing HIV care capacity in rural areas. Low population density, low prevalence of HIV/AIDS, rugged topography and climate, and limited health…

  12. Service Delivery for Native American Children in Los Angeles County, 1996.

    ERIC Educational Resources Information Center

    Champagne, Duane; Goldberg-Ambrose, Carole; Machamer, Amber; Phillips, Bethany; Evans, Tessa

    A study explored the human services delivery system for American Indian children in Los Angeles County (California). Telephone interviews were conducted with 29 Indian organizations, 19 members of the American Indian community, and 14 government agencies that provide services for children. Topics discussed included Indian child welfare, education,…

  13. 20 CFR 669.310 - What are the basic components of an NFJP service delivery strategy?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) NATIONAL FARMWORKER JOBS PROGRAM UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT The National Farmworker Jobs Program Customers and Available Program Services § 669.310 What... Investment Boards for the delivery of the services available through the One-Stop system to MSFW's; and (d...

  14. 20 CFR 669.310 - What are the basic components of an NFJP service delivery strategy?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF LABOR NATIONAL FARMWORKER JOBS PROGRAM UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT The National Farmworker Jobs Program Customers and Available Program Services § 669.310 What are... Investment Boards for the delivery of the services available through the One-Stop system to MSFW's; and (d...

  15. 20 CFR 669.310 - What are the basic components of an NFJP service delivery strategy?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) NATIONAL FARMWORKER JOBS PROGRAM UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT The National Farmworker Jobs Program Customers and Available Program Services § 669.310 What... Investment Boards for the delivery of the services available through the One-Stop system to MSFW's; and (d...

  16. 20 CFR 669.310 - What are the basic components of an NFJP service delivery strategy?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) NATIONAL FARMWORKER JOBS PROGRAM UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT The National Farmworker Jobs Program Customers and Available Program Services § 669.310 What... Investment Boards for the delivery of the services available through the One-Stop system to MSFW's; and (d...

  17. Planning Regional Document-Delivery Services for the Water Decade: The Latin American and Caribbean Region.

    ERIC Educational Resources Information Center

    Bartone, Carl R.

    1982-01-01

    Presents objectives, scope, structure, operations, principal products, and bibliographic services of the Regional Network for Information and Documentation (REPIDISCA) sponsored by the Pan American Health Organization. Planning of a regional document delivery service (basic parameters, microform technology, network procedures, payment,…

  18. Mechanisms of Service-Delivery Systems of Adult Education in Non-University Institutions in Canada.

    ERIC Educational Resources Information Center

    Weva, Kabule W.

    A study was conducted to identify and describe the different mechanisms of adult education services provided by non-university institutions in Canada. Specifically, the study sought to determine which institutions were involved in adult education, which service-delivery modes were most widely used, current trends, and which institutions and…

  19. Early Childhood Service Delivery for Families Living with Childhood Disability: Disabling Families through Problematic Implicit Ideology

    ERIC Educational Resources Information Center

    Breen, Lauren J.

    2009-01-01

    The aim of this paper is to unpack the implicit ideology underpinning early childhood service delivery for families living with childhood disability. The family as the unit of care is central to the philosophy and practice of early childhood services. However, the practice of family-centred care can be problematic; it is based upon neo-liberal…

  20. When Special Education Trumps ESL: An Investigation of Service Delivery for ELLs with Disabilities

    ERIC Educational Resources Information Center

    Kangas, Sara E. N.

    2014-01-01

    Through an ethnographic study of one suburban elementary school, the delivery of services to English language learners (ELLs) with disabilities was investigated. The data analysis revealed that often disability-related and English as a Second Language (ESL) services were in contention, as scheduling, teacher expertise, school culture, and ESL…

  1. Online Information Services, Document Delivery Systems, and Libraries in the Federal Republic of Germany.

    ERIC Educational Resources Information Center

    Neubauer, K. W.

    1984-01-01

    This overview of the information market and services available in the Federal Republic of Germany highlights online information systems (hosts, databases, networks); relation of Europe to United States and Germany; the German library system (problems and advantages of document delivery, online services); and telecommunication technology.…

  2. What Family Support Specialists Do: Examining Service Delivery

    PubMed Central

    Wisdom, Jennifer P.; Lewandowski, R. Eric; Pollock, Michele; Acri, Mary; Shorter, Priscilla; Olin, S. Serene; Armusewicz, Kelsey; Horwitz, Sarah; Hoagwood, Kimberly E.

    2013-01-01

    This study describes services provided by family support specialists (FSS), peer advocates in programs for children with serious psychiatric conditions, to delineate differences between recommended components of FSS services and services actually provided. An analysis of qualitative interview and observational data and quantitative survey data from 63 staff at 21 mental health programs in New York identified that FSS and other staff have generally similar ideas about FSS services, and that these perceptions of activities are generally congruent with what FSS actually did. Implications of findings are discussed in the context of developing competencies and quality indicators for FSS. PMID:24174330

  3. A community mental health service delivery model: integrating the evidence base within existing clinical models.

    PubMed

    Flannery, Frank; Adams, Danielle; O'Connor, Nick

    2011-02-01

    A model of care for community mental health services was developed by reviewing the available literature, surveying ?best practice? and evaluating the performance of existing services in a metropolitan area mental health service servicing a population of approximately 1.1 million people. A review of relevant academic literature and recognized ?good practice? service delivery models was undertaken in conjunction with a review of local activity data and consultation with key stakeholders (not addressed in this paper). A model was developed identifying the core functions of community mental health service delivery. The components of a comprehensive, integrated model of community mental health service (CMHS) are outlined. The essential components of a comprehensive, integrated model of CMHSs include: acute and emergency response, community continuing care services, assertive rehabilitation teams, partnerships with general practitioners and other human services agencies. We propose a comprehensive integrated model of community mental health service. Clarity of role, required outputs and expected outcomes will assist the development of effective and appropriate community mental health services. Outreach to the community is a key success factor for these services and their associated inpatient services. Gap analysis can assist in the planning and costing of community mental health services.

  4. Speech and language therapy service delivery: overcoming limited provision for children.

    PubMed

    Jesus, L M T; Martinez, J; Valente, A R; Costa, M C

    2017-10-01

    To test an alternative Speech and Language Therapy (SLT) service delivery model based on partnerships between a University and local schools and charities, and to report on the impact and feasibility of intervention based on long-term outcome measures and three case studies with individual analysis of Reliable Change. The following six-step model was tested: 1-establishing partnerships; 2-flagging children; 3-pre-treatment SLT assessment; 4-reporting and discussion with parents and teachers; 5-treatment; 6-post-treatment assessment. Case studies are presented. A partnership was established with one kindergarten in a pre-test and a total of 25 kindergartens during the second phase of the process. A group of 139 children were then flagged and assessed. The following long-term outcomes (18 months post-therapy) were investigated: phonetic-phonological standardised test percentiles and raw scores; receptive and expressive language percentiles and raw scores according to a standardised language test; percentage of syllables stuttered; duration of stuttering moments; academic achievement in norm-tests' core areas (mathematics, Portuguese language and social studies). Case studies and a 95% credible interval analysis to assess Reliable Change are presented. Seventy five (54%) children needed SLT support. Fifty (67%) of those children returned to the clinic for long-term assessments and the analysis of all outcome measures showed significant improvements in their performance, 18 months post-therapy. Case Studies Reliable Change analysis revealed a statistically significant improvement, which also clearly shows the feasibility and the positive impact of the intervention. This specialised and differentiated care network constitutes an alternative delivery system of SLT services that addresses the lack of support currently experienced by children and their families. The long-term outcome measures and the 95% credible interval analysis are reliable methods to determine the

  5. Promoting Infant Development: A Coalition Model for Community Service Delivery.

    ERIC Educational Resources Information Center

    Badger, Earladeen; Burns, Donna

    United Services for Effective Parenting (USEP), a program coordinating agency in Ohio, was begun in 1974 as an advocacy group for infants, their families, and the program providers who served them. Staff from health care, education, and social service agencies met informally because of common problems. A formal organization was established when it…

  6. Impact of the Integration of Water Treatment, Hygiene, Nutrition, and Clean Delivery Interventions on Maternal Health Service Use.

    PubMed

    Fagerli, Kirsten; O'Connor, Katherine; Kim, Sunkyung; Kelley, Maureen; Odhiambo, Aloyce; Faith, Sitnah; Otieno, Ronald; Nygren, Benjamin; Kamb, Mary; Quick, Robert

    2017-05-01

    AbstractReducing barriers associated with maternal health service use, household water treatment, and improved hygiene is important for maternal and neonatal health outcomes. We surveyed a sample of 201 pregnant women who participated in a clinic-based intervention in Kenya to increase maternal health service use and improve household hygiene and nutrition through the distribution of water treatment products, soap, protein-fortified flour, and clean delivery kits. From multivariable logistic regression analyses, the adjusted odds of ≥ 4 antenatal care (ANC4+) visits (odds ratio [OR] = 3.0, 95% confidence interval [CI] = 1.9-4.5), health facility delivery (OR = 5.3, 95% CI = 3.4-8.3), and any postnatal care visit (OR = 2.8, 95% CI = 1.9-4.2) were higher at follow-up than at baseline, adjusting for demographic factors. Women who completed primary school had higher odds of ANC4+ visits (OR = 1.8, 95% CI = 1.1-2.9) and health facility delivery (OR = 4.2, 95% CI = 2.5-7.1) than women with less education. For women who lived ≤ 2.5 km from the health facility, the estimated odds of health facility delivery (OR = 2.4, 95% CI = 1.5-4.1) and postnatal care visit (OR = 1.6, 95% CI = 1.0-2.6) were higher than for those who lived > 2.5 km away. Compared with baseline, a higher percentage of survey participants at follow-up were able to demonstrate proper handwashing (P = 0.001); water treatment behavior did not change. This evaluation suggested that hygiene, nutritional, clean delivery incentives, higher education level, and geographical contiguity to health facility were associated with increased use of maternal health services by pregnant women.

  7. Home delivery of medication - the role of a patient information leaflet on maximising service uptake.

    PubMed

    Watson, L; Ahmed, N; Mccall, H; Minton, J; Benn, P; Edwards, S; Waters, L

    2014-12-01

    There are currently over 30,000 HIV-positive individuals in London and over 25,000 on anti-retroviral therapy. In 2009/2010, this equated to £170m spent by London's NHS on anti-retroviral drugs. Ways employed to reduce this cost include standardising the drugs patients are on and delivering medication to patients at home. Home delivery (HD) medication is exempt from value-added tax. The savings made from 10 patients using the home delivery service would free up resources to provide anti-retroviral therapy to one further patient. Studies have shown that concerns surrounding potential breaches of confidentiality are a potential barrier to some people using the home delivery service. In order to challenge these concerns, a leaflet was devised highlighting the major benefits to both the patient and the NHS of home delivery and addressing concerns over confidentiality. The leaflet was handed out to patients at the Mortimer Market Centre who were currently on anti-retroviral medication but not on home delivery. They were asked to complete a survey on their views of the service before and after reading the leaflet, whether they had been previously aware of the service and whether their concerns had been addressed. Some 79% felt that the patient information leaflet addressed all of their concerns, and it helped 11% decide whether to consider using home delivery. However, as more patients were opposed to the service after reading the patient information leaflet than those considering it, more work needs to be done to explore patients' concerns and other factors influencing home delivery service uptake. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  8. Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services.

    PubMed

    Silver, Julie K; Raj, Vishwa S; Fu, Jack B; Wisotzky, Eric M; Smith, Sean Robinson; Kirch, Rebecca A

    2015-12-01

    Palliative care and rehabilitation practitioners are important collaborative referral sources for each other who can work together to improve the lives of cancer patients, survivors, and caregivers by improving both quality of care and quality of life. Cancer rehabilitation and palliative care involve the delivery of important but underutilized medical services to oncology patients by interdisciplinary teams. These subspecialties are similar in many respects, including their focus on improving cancer-related symptoms or cancer treatment-related side effects, improving health-related quality of life, lessening caregiver burden, and valuing patient-centered care and shared decision-making. They also aim to improve healthcare efficiencies and minimize costs by means such as reducing hospital lengths of stay and unanticipated readmissions. Although their goals are often aligned, different specialized skills and approaches are used in the delivery of care. For example, while each specialty prioritizes goal-concordant care through identification of patient and family preferences and values, palliative care teams typically focus extensively on using patient and family communication to determine their goals of care, while also tending to comfort issues such as symptom management and spiritual concerns. Rehabilitation clinicians may tend to focus more specifically on functional issues such as identifying and treating deficits in physical, psychological, or cognitive impairments and any resulting disability and negative impact on quality of life. Additionally, although palliative care and rehabilitation practitioners are trained to diagnose and treat medically complex patients, rehabilitation clinicians also treat many patients with a single impairment and a low symptom burden. In these cases, the goal is often cure of the underlying neurologic or musculoskeletal condition. This report defines and describes cancer rehabilitation and palliative care, delineates their

  9. Climate services to improve public health.

    PubMed

    Jancloes, Michel; Thomson, Madeleine; Costa, María Mánez; Hewitt, Chris; Corvalan, Carlos; Dinku, Tufa; Lowe, Rachel; Hayden, Mary

    2014-04-25

    A high level expert panel discussed how climate and health services could best collaborate to improve public health. This was on the agenda of the recent Third International Climate Services Conference, held in Montego Bay, Jamaica, 4-6 December 2013. Issues and challenges concerning a demand led approach to serve the health sector needs, were identified and analysed. Important recommendations emerged to ensure that innovative collaboration between climate and health services assist decision-making processes and the management of climate-sensitive health risk. Key recommendations included: a move from risk assessment towards risk management; the engagement of the public health community with both the climate sector and development sectors, whose decisions impact on health, particularly the most vulnerable; to increase operational research on the use of policy-relevant climate information to manage climate- sensitive health risks; and to develop in-country capacities to improve local knowledge (including collection of epidemiological, climate and socio-economic data), along with institutional interaction with policy makers.

  10. Climate Services to Improve Public Health

    PubMed Central

    Jancloes, Michel; Thomson, Madeleine; Costa, María Máñez; Hewitt, Chris; Corvalan, Carlos; Dinku, Tufa; Lowe, Rachel; Hayden, Mary

    2014-01-01

    A high level expert panel discussed how climate and health services could best collaborate to improve public health. This was on the agenda of the recent Third International Climate Services Conference, held in Montego Bay, Jamaica, 4–6 December 2013. Issues and challenges concerning a demand led approach to serve the health sector needs, were identified and analysed. Important recommendations emerged to ensure that innovative collaboration between climate and health services assist decision-making processes and the management of climate-sensitive health risk. Key recommendations included: a move from risk assessment towards risk management; the engagement of the public health community with both the climate sector and development sectors, whose decisions impact on health, particularly the most vulnerable; to increase operational research on the use of policy-relevant climate information to manage climate- sensitive health risks; and to develop in-country capacities to improve local knowledge (including collection of epidemiological, climate and socio-economic data), along with institutional interaction with policy makers. PMID:24776719

  11. Use of a straight, side-hole delivery sheath for improved delivery of Amplatzer ASD occluder.

    PubMed

    Kutty, Shelby; Asnes, Jeremy D; Srinath, Gowdagere; Preminger, Tamar J; Prieto, Lourdes R; Latson, Larry A

    2007-01-01

    The Amplatzer ASD occluder may be difficult to position in some patients with a large atrial septal defect (ASD) or deficiency of one or more atrial septal rims. We developed a method to modify a Mullins transseptal sheath to enhance delivery. The resulting sheath is straight and has an exit orifice essential in the side of the distal portion of the sheath-a straight, side-hole (SSH) delivery sheath. We have used this modified delivery sheath in 140 successive patients with excellent results. The techniques of sheath modification and delivery of the device using the modified sheath are described.

  12. The LIFEspan model of transitional rehabilitative care for youth with disabilities: healthcare professionals' perspectives on service delivery.

    PubMed

    Hamdani, Yani; Proulx, Meghann; Kingsnorth, Shauna; Lindsay, Sally; Maxwell, Joanne; Colantonio, Angela; Macarthur, Colin; Bayley, Mark

    2014-01-01

    LIFEspan is a service delivery model of continuous coordinated care developed and implemented by a cross-organization partnership between a pediatric and an adult rehabilitation hospital. Previous work explored enablers and barriers to establishing the partnership service. This paper examines healthcare professionals' (HCPs') experiences of 'real world' service delivery aimed at supporting transitional rehabilitative care for youth with disabilities. This qualitative study - part of an ongoing mixed method longitudinal study - elicited HCPs' perspectives on their experiences of LIFEspan service delivery through in-depth interviews. Data were categorized into themes of service delivery activities, then interpreted from the lens of a service integration/coordination framework. Five main service delivery themes were identified: 1) addressing youth's transition readiness and capacities; 2) shifting responsibility for healthcare management from parents to youth; 3) determining services based on organizational resources; 4) linking between pediatric and adult rehabilitation services; and, 5) linking with multi-sector services. LIFEspan contributed to service delivery activities that coordinated care for youth and families and integrated inter-hospital services. However, gaps in service integration with primary care, education, social, and community services limited coordinated care to the rehabilitation sector. Recommendations are made to enhance service delivery using a systems/sector-based approach.

  13. Stepping up primary health care and family planning service delivery through IEC.

    PubMed

    1986-11-01

    There has been a marked improvement in the rate of family planning practice and a lowering of the parasite infection in Korea where the Integrated Project on Family Planning, Nutrition and Parasite Control was introduced. In 1984, primary health care was added to the project. Community health practitioners (CHPs) were posted in 11 primary health posts (PHPs). CHPs were selected from licensed nurses. They have provided various health services including maternal child health, family planning, tuberculosis control, dental care and sanitation. The PHPs operate on a self-paying basis. A final evaluation seminar was held to assess the effectiveness of the project implementation and to develop a strategy applicable worldwide. To promote its population policy, the government has been taking a series of incentive/disincentive measures such as: providing free sterilization surgery, and giving priority to sterilization acceptors who have 2 children or less. Home delivery of health care services in rural areas still remains at about 40%. The government has set up 89 MCH centers and plans to publish an MCH handbook for a more thorough management of MCH care. The government has also conducted compulsory stool examinations twice a year for all the students of primary and 2ndary schools. Projects conducted as part of a new community movement include: latrine renovation; kitchen renovation; insect-protection netting; running water supply; and the water quality test. The IEC activities for a 1-child family should be improved to give children better care.

  14. Limited Service Availability, Readiness, and Use of Facility-Based Delivery Care in Haiti: A Study Linking Health Facility Data and Population Data

    PubMed Central

    Wang, Wenjuan; Winner, Michelle; Burgert-Brucker, Clara R

    2017-01-01

    Background: Understanding the barriers that women in Haiti face to giving birth at a health facility is important for improving coverage of facility delivery and reducing persistently high maternal mortality. We linked health facility survey data and population survey data to assess the role of the obstetric service environment in affecting women's use of facility delivery care. Methods: Data came from the 2012 Haiti Demographic and Health Survey (DHS) and the 2013 Haiti Service Provision Assessment (SPA) survey. DHS clusters and SPA facilities were linked with their geographic coordinate information. The final analysis sample from the DHS comprised 4,921 women who had a live birth in the 5 years preceding the survey. Service availability was measured with the number of facilities providing delivery services within a specified distance from the cluster (within 5 kilometers for urban areas and 10 kilometers for rural areas). We measured facility readiness to provide obstetric care using 37 indicators defined by the World Health Organization. Random-intercept logistic regressions were used to model the variation in individual use of facility-based delivery care and cluster-level service availability and readiness, adjusting for other factors. Results: Overall, 39% of women delivered their most recent birth at a health facility and 61% delivered at home, with disparities by residence (about 60% delivered at a health facility in urban areas vs. 24% in rural areas). About one-fifth (18%) of women in rural areas and one-tenth (12%) of women in nonmetropolitan urban areas lived in clusters where no facility offered delivery care within the specified distances, while nearly all women (99%) in the metropolitan area lived in clusters that had at least 2 such facilities. Urban clusters had better service readiness compared with rural clusters, with a wide range of variation in both areas. Regression models indicated that in both rural and nonmetropolitan urban areas

  15. Limited Service Availability, Readiness, and Use of Facility-Based Delivery Care in Haiti: A Study Linking Health Facility Data and Population Data.

    PubMed

    Wang, Wenjuan; Winner, Michelle; Burgert-Brucker, Clara R

    2017-06-27

    Understanding the barriers that women in Haiti face to giving birth at a health facility is important for improving coverage of facility delivery and reducing persistently high maternal mortality. We linked health facility survey data and population survey data to assess the role of the obstetric service environment in affecting women's use of facility delivery care. Data came from the 2012 Haiti Demographic and Health Survey (DHS) and the 2013 Haiti Service Provision Assessment (SPA) survey. DHS clusters and SPA facilities were linked with their geographic coordinate information. The final analysis sample from the DHS comprised 4,921 women who had a live birth in the 5 years preceding the survey. Service availability was measured with the number of facilities providing delivery services within a specified distance from the cluster (within 5 kilometers for urban areas and 10 kilometers for rural areas). We measured facility readiness to provide obstetric care using 37 indicators defined by the World Health Organization. Random-intercept logistic regressions were used to model the variation in individual use of facility-based delivery care and cluster-level service availability and readiness, adjusting for other factors. Overall, 39% of women delivered their most recent birth at a health facility and 61% delivered at home, with disparities by residence (about 60% delivered at a health facility in urban areas vs. 24% in rural areas). About one-fifth (18%) of women in rural areas and one-tenth (12%) of women in nonmetropolitan urban areas lived in clusters where no facility offered delivery care within the specified distances, while nearly all women (99%) in the metropolitan area lived in clusters that had at least 2 such facilities. Urban clusters had better service readiness compared with rural clusters, with a wide range of variation in both areas. Regression models indicated that in both rural and nonmetropolitan urban areas availability of delivery services was

  16. Improving European Wildfire Emergency Information Services

    NASA Astrophysics Data System (ADS)

    Bielski, Conrad; Whitmore, Ceri; O'Brien, Victoria; Zeug, Gunter; Kalas, Milan; Porras, Ignasi; Solé, Josep Maria; Gálvez, Pedro; Navarro, Maria; Nurmi, Pertti; Kilpinen, Juha; Ylinen, Kaisa; Furllanelo, Cesare; Maggio, Valerio; Alikadic, Azra; Dolci, Claudia

    2017-04-01

    European wildfires are a seasonal natural hazard that many regions must battle regularly. However, as European urbanization continues to encroach on natural areas and the climate changes it is likely that the frequency of wildfires will increase likewise the number of areas prone to wildfires. It is therefore paramount not only to increase public awareness of this natural hazard but also to be prepared by improving wildfire hazard forecasting, monitoring, and mapping. As part of the H2020 funded project entitled Improving Resilience to Emergencies through Advanced Cyber Technologies: I-REACT (Grant Agreement #700256) , there is a task with the goal to develop models and implement technologies to improve the support around the entire emergency management cycle with respect to wildfire hazards. Based on operational weather forecasts, pan-European geospatial data as well as regularly acquired Earth Observation imagery through the Copernicus program, and other sources of information such as social media channels a European wildfire service is being developed. This will be achieved by improving on the successes of the European Forest Fire Information Service (EFFIS) and the guidance of emergency managers experienced in wildfire hazards. Part of the research will be to reduce the number of false alarms. However, once a wildfire has been identified, the system focuses on the disaster region to provide situational information to the decision makers applying state-of-the-art approaches to improve disaster response. Post-wildfire information will continue to be produced for damage and recovery assessments. Ultimately, I-REACT expects to reduce wildfire costs to life, property and livelihood. This work will improve wildfire disaster emergency management through the development and integration of new data and technologies respectively as well as the knowledge from emergency managers who not only understand the hazard itself but also can provide insights into the information

  17. Improving thermocouple service life in slagging gasifiers

    SciTech Connect

    Bennett, James P.; Kwong, Kyei-Sing; Powell, Cynthia A.; Thomas, Hugh; Krabbe, Rick

    2005-01-01

    The measurement of temperature within slagging gasifiers for long periods of time is difficult/impossible because of sensor failure or blockage of inputs used to monitor gasifier temperature. One of the most common means of temperature measurement in a gasifier is physically, through the use of thermocouples in a gasifier sidewall. These units can fail during startup, standby, or during the first 40-90 days of gasifier service. Failure can be caused by a number of issues; including thermocouple design, construction, placement in the gasifier, gasifier operation, and molten slag attack of the materials used in a thermocouple assembly. Lack of temperature control in a gasifier can lead to improper preheating, slag buildup on gasifier sidewalls, slag attack of gasifier refractories used to line a gasifier, or changes in desired gas output from a gasifier. A general outline of thermocouple failure issues and attempts by the Albany Research Center to improve the service life of thermocouples will be discussed.

  18. How does context influence collaborative decision-making for health services planning, delivery and evaluation?

    PubMed

    Gagliardi, Anna R; Webster, Fiona; Brouwers, Melissa C; Baxter, Nancy N; Finelli, Antonio; Gallinger, Steven

    2014-11-19

    Collaboration among researchers (clinician, non-clinician) and decision makers (managers, policy-makers, clinicians), referred to as integrated knowledge translation (IKT), enhances the relevance and use of research, leading to improved decision-making, policies, practice, and health care outcomes. However IKT is not widely practiced due to numerous challenges. This research explored how context influenced IKT as a means of identifying how IKT could be strengthened. This research investigated IKT in three health services programs for colon cancer screening, prostate cancer diagnosis, and the treatment of pancreatic cancer. Qualitative methods were used to explore contextual factors that influenced how IKT occurred, and its impact. Data were collected between September 1, 2012 and May 15, 2013 from relevant documents, observation of meetings, and interviews with researchers and decision-makers, analyzed using qualitative methods, and integrated. Data were analyzed from 39 documents, observation of 6 meetings, and 36 interviews. IKT included interaction at meetings, joint undertaking of research, and development of guidelines. IKT was most prevalent in one program with leadership, clear goals, dedicated funding and other infrastructural resources, and an embedded researcher responsible for, and actively engaged in IKT. This program achieved a variety of social, research and health service outcomes despite mixed individual views about the value of IKT and the absence of a programmatic culture of IKT. Participants noted numerous challenges including lack of time and incentives, and recommendations to support IKT. A conceptual framework of factors that influence IKT and associated outcomes was generated, and can be used by others to plan or evaluate IKT. The findings can be applied by researchers, clinicians, managers or policy-makers to plan or improve collaborative decision-making for health services planning, delivery, evaluation or quality improvement. Further

  19. Optimizing information technology to improve sexual health-care delivery: public and patient preferences.

    PubMed

    Ross, J D C; Copas, A; Stephenson, J; Fellows, L; Gilleran, G

    2007-07-01

    Information and communication technology (ICT) has the potential to improve the quality of care and efficiency in sexual health clinics, but its introduction requires input not only from health-care professionals and ICT specialists but also from service users and potential future users. In this study, views on ICT in relation to the delivery of sexual health services were assessed using a structured interview in two groups - a community sample of young people and a clinic sample of existing patients. In all, 542 community interviewees and 202 clinic patients participated. About 75% of respondents had access to the Internet and overall 60% reported that the self-collection of a sexual history on an electronic form was acceptable. Black Caribbean individuals had significantly less access to the Internet and a lower acceptance of electronic data collection. For booking an appointment, the majority of patients reported the telephone (community sample 93%, clinic sample 96%) or attending in person (community sample 77%, clinic sample 54%) to be acceptable, with a smaller proportion choosing email (community sample 10%, clinic sample 27%) or the Internet (community sample 7%, clinic sample 11%). Electronic booking was significantly less acceptable to Black Caribbean respondents. Although new technologies offer the opportunity to improve the quality of sexual health services, patient preferences and differences between groups in access to technology also need to be considered when services are reconfigured.

  20. Explaining inequity in the use of institutional delivery services in selected countries.

    PubMed

    Do, Mai; Soelaeman, Rieza; Hotchkiss, David R

    2015-04-01

    Wealth-related disparities in the use of reproductive health services remain a substantial problem in many low- and middle-income countries. Very few studies have attempted to explain such inequalities through decomposition of the contributions made by various individual- and household-level factors. This study aims to: (1) assess the degree of wealth-related inequality and inequity in the use of institutional delivery services in selected low- and middle-income countries, and (2) to explain wealth-related inequity through decomposition by the contributions made by various components, including health insurance coverage. Data come from Demographic and Health Surveys in three countries: Ghana, Rwanda, and the Philippines. Concentration indices are used to calculate inequality and horizontal inequity in service utilization. Multivariate methods are used to decompose inequity. Findings indicate a moderate to high degree of inequity in institutional delivery service use in all study countries. The study provides some evidence of the contribution of health insurance to increased wealth-related inequity in the use of institutional delivery services, although having health insurance was also associated with increased utilization of services. Results suggest that increased health insurance coverage does not automatically translate to lower wealth-related inequity in service utilization. Inequities in service utilization exist if there are still inequities in the health insurance status. The study advocates for expanding health insurance coverage, particularly among the poor to reduce inequity in insurance coverage and increase service utilization.

  1. Supporting Early Childhood Special Education Personnel for Itinerant Service Delivery through a State-Level Technical Assistance Project

    ERIC Educational Resources Information Center

    Nelson, Chelie; Lindeman, David P.; Stroup-Rentier, Vera Lynne

    2011-01-01

    An itinerant service delivery model takes early intervention and special education services to environments where young children with disabilities participate in their communities. Reconciliation of the mismatch that often occurs between recommended and actual practice requires support at all levels of the service delivery system, including…

  2. Supporting Early Childhood Special Education Personnel for Itinerant Service Delivery through a State-Level Technical Assistance Project

    ERIC Educational Resources Information Center

    Nelson, Chelie; Lindeman, David P.; Stroup-Rentier, Vera Lynne

    2011-01-01

    An itinerant service delivery model takes early intervention and special education services to environments where young children with disabilities participate in their communities. Reconciliation of the mismatch that often occurs between recommended and actual practice requires support at all levels of the service delivery system, including…

  3. Corticosteroid transdermal delivery significantly improves arthritis pain and functional disability.

    PubMed

    Iannitti, Tommaso; McDermott, Michael F; Laurino, Carmen; Malagoli, Andrea; Palmieri, Beniamino

    2017-02-01

    Arthritis is characterized by pain and functional limitation affecting the patients' quality of life. We performed a clinical study to investigate the efficacy of a betamethasone valerate medicated plaster (Betesil) in improving pain and functional disability in patients with arthritis and osteoarthritis. We enrolled 104 patients affected by osteoarthritis (n = 40) or arthritis (n = 64) in different joints. Patients received diclofenac sodium cream (2 g, four times a day) or a 2.25-mg dose of Betesil applied to the painful joint every night before bedtime for 10 days. Pain and functional disability were assessed, by the Visual Analogue Scale (VAS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores. Redness was assessed by clinical inspection, and edema by the "fovea sign" method. C-reactive protein (CRP) was also measured; CRP can be used to cost-effectively monitor the pharmacological treatment efficacy and is increased during the acute-phase response, returning to physiological values after tissue recovery and functional restoration. All measurements were at baseline and at 10-day follow-up. At 10-day follow-up, a greater improvement in VAS and WOMAC pain and WOMAC stiffness and functional limitation scores from baseline was observed in patients treated with Betesil compared with diclofenac (all p < 0.01). At 10-day follow-up, improvement in redness, edema, and CRP levels from baseline was also greater in patients treated with Betesil compared with diclofenac (all p < 0.01). This study demonstrates the safety and efficacy of transdermal delivery of betamethasone valerate in patients affected by arthritis and osteoarthritis.

  4. Maternal Satisfaction on Delivery Service and Its Associated Factors among Mothers Who Gave Birth in Public Health Facilities of Debre Markos Town, Northwest Ethiopia

    PubMed Central

    Bitew, Kurabachew; Ayichiluhm, Mekonnen; Yimam, Kedir

    2015-01-01

    Introduction. The existence of maternal health service does not guarantee its use by women; neither does the use of maternal health service guarantee optimal outcomes for women. The World Health Organization recommends monitoring and evaluation of maternal satisfaction to improve the quality and efficiency of health care during childbirth. Thus, this study aimed at assessing maternal satisfaction on delivery service and factors associated with it. Methods. Community based cross-sectional study was conducted in Debre Markos town from March to April 2014. Systematic random sampling technique were used to select 398 mothers who gave birth within one year. The satisfaction of mothers was measured using 19 questions which were adopted from Donabedian quality assessment framework. Binary logistic regression was fitted to identify independent predictors. Result. Among mothers, the overall satisfaction on delivery service was found to be 318 (81.7%). Having plan to deliver at health institution (AOR = 3.30, 95% CI: 1.38–7.9) and laboring time of less than six hours (AOR = 4.03, 95% CI: 1.66–9.79) were positively associated with maternal satisfaction on delivery service. Those mothers who gave birth using spontaneous vaginal delivery (AOR = 0.11, 95% CI: 0.023–0.51) were inversely related to maternal satisfaction on delivery service. Conclusion. This study revealed that the overall satisfaction of mothers on delivery service was found to be suboptimal. Reasons for delivery visit, duration of labor, and mode of delivery are independent predictors of maternal satisfaction. Thus, there is a need of an intervention on the independent predictors. PMID:26347882

  5. Maternal Satisfaction on Delivery Service and Its Associated Factors among Mothers Who Gave Birth in Public Health Facilities of Debre Markos Town, Northwest Ethiopia.

    PubMed

    Bitew, Kurabachew; Ayichiluhm, Mekonnen; Yimam, Kedir

    2015-01-01

    The existence of maternal health service does not guarantee its use by women; neither does the use of maternal health service guarantee optimal outcomes for women. The World Health Organization recommends monitoring and evaluation of maternal satisfaction to improve the quality and efficiency of health care during childbirth. Thus, this study aimed at assessing maternal satisfaction on delivery service and factors associated with it. Community based cross-sectional study was conducted in Debre Markos town from March to April 2014. Systematic random sampling technique were used to select 398 mothers who gave birth within one year. The satisfaction of mothers was measured using 19 questions which were adopted from Donabedian quality assessment framework. Binary logistic regression was fitted to identify independent predictors. Among mothers, the overall satisfaction on delivery service was found to be 318 (81.7%). Having plan to deliver at health institution (AOR = 3.30, 95% CI: 1.38-7.9) and laboring time of less than six hours (AOR = 4.03, 95% CI: 1.66-9.79) were positively associated with maternal satisfaction on delivery service. Those mothers who gave birth using spontaneous vaginal delivery (AOR = 0.11, 95% CI: 0.023-0.51) were inversely related to maternal satisfaction on delivery service. This study revealed that the overall satisfaction of mothers on delivery service was found to be suboptimal. Reasons for delivery visit, duration of labor, and mode of delivery are independent predictors of maternal satisfaction. Thus, there is a need of an intervention on the independent predictors.

  6. Using family and staff experiences of a botulinum toxin-A service to improve service quality.

    PubMed

    Burton, K L O; Bau, K; Lewis, J; Aroyan, K R; Botha, B; Botman, A G M; Stewart, K; Waugh, M-C A; Paget, S P

    2017-07-26

    The decision for families to proceed with botulinum toxin-A (BoNT-A) injections for managing childhood conditions involving hypertonia can be complex. Family-centred care is a service model that facilitates supporting families in this decision-making process. Understanding families' experiences of services is critical to developing family-centred care. The aim of this project was therefore to increase understanding of the experiences of families of children attending a BoNT-A service in order to improve the service and its family-centred approach to care. Sixteen staff of a BoNT-A service participated in a patient journey mapping exercise. Nine families of the service participated in in-depth interviews. Interviews were audio-recorded and transcribed verbatim. Data from the staff session and interviews were analysed independently using grounded, hermeneutic thematic analysis. Staff sessions revealed 5 core themes that related to impacting on the family experience. Family interviews revealed 4 core themes, with 7 subthemes and 1 latent theme. Areas of importance identified by families relating to BoNT-A treatment included acknowledgement of individual needs, care coordination, empowerment of families and patients, consistency in service delivery, and the distressing nature of appointment and decision-making. Comparison of the data from the staff patient journey mapping and family interviews suggested that staff have a good but incomplete understanding of the factors important to families, highlighting the need for consumer engagement in establishing family-centred care. The themes identified can guide the provision of family-centred BoNT-A injection clinics. © 2017 John Wiley & Sons Ltd.

  7. Costs and outcomes of VCT delivery models in the context of scaling up services in Indonesia.

    PubMed

    Siregar, Adiatma Y M; Komarudin, Dindin; Wisaksana, Rudi; van Crevel, Reinout; Baltussen, Rob

    2011-02-01

    To evaluate costs and outcomes of voluntary counselling and testing (VCT) service delivery models in urban Indonesia. We collected primary data on utilization, costs and outcomes of VCT services in a hospital clinic (568 clients), HIV community clinic (28 clients), sexually transmitted infection (STI) community clinic (784 clients) and prison clinic (574 clients) in Bandung, Indonesia, in the period January 2008-April 2009. The hospital clinic diagnosed the highest proportion and absolute number of HIV infections, but with the lowest average CD4 cell count and with the highest associated travelling and waiting time. The prison clinic detected fewer cases, but at an earlier stage, and all enrolled in HIV care. The community clinics detected the smallest number of cases, and only 0-8% enrolled in HIV care. The unit cost per VCT was highest in the hospital clinic (US$74), followed by the STI community clinic (US$65), the HIV community clinic (US$39) and the prison (US$23). We propose a reorientation of the delivery models for VCT and related HIV/AIDS treatment in this setting. We call for the scaling up of community clinics for VCT to improve access, promote earlier detection and to perform (early) treatment activities. This would reduce the burden of the hospital clinic to orient itself towards the treatment of AIDS patients. This is one of very few studies addressing this issue in Asia and the first of its kind in Indonesia, which has a rapidly growing HIV epidemic. The conceptual framework and overall conclusions may be relevant to other low-income settings. © 2010 Blackwell Publishing Ltd.

  8. Improving Access to Institutional Delivery through Janani Shishu Suraksha Karyakram: Evidence from Rural Haryana, North India.

    PubMed

    Salve, Harshal R; Charlette, Lena; Kankaria, Ankita; Rai, Sanjay K; Krishnan, Anand; Kant, Shashi

    2017-01-01

    In India, Janani Shishu Suraksha Karyakaram (JSSK) was launched in the year 2011 to assure cashless institutional delivery to pregnant women, including free transport and diet. To assess the impact of JSSK on institutional delivery. A record review was done at the primary health care facility in Faridabad district of Haryana from August 2010 to March 2013. Focus group discussion/ informal interviews were carried out to get an insight about various factors determining use / non-use of health facilities for delivery. Institutional delivery increased by almost 2.7 times (197 Vs 537) after launch of JSSK (p < 0.001). For institutional deliveries, the most important facilitator as well as barrier was identified as ambulance service under JSSK and pressure by elders in the family respectively. JSSK scheme had a positive impact on institutional deliveries. It should be supported with targeted intervention designed to facilitate appropriate decision-making at family level in order to address barriers to institutional delivery.

  9. Bringing the Life Needs Model to life: implementing a service delivery model for pediatric rehabilitation.

    PubMed

    King, Gillian A; Tucker, Mary Ann; Baldwin, Patricia J; LaPorta, John A

    2006-01-01

    This article describes the use and utility of the Life Needs Model of Pediatric Service Delivery at a regional children's rehabilitation center. The model is a transdisciplinary, evidence-based model that guides pediatric service delivery to meet the long-range goals of community participation and quality of life for children and youth with disabilities. The article describes the use of the model as a tool to assist with the development of organizational culture, strategic and operational planning, the development of therapists' expertise, and the development of community partnerships. The model also has influenced human resources practices, community relations activities, and research. The model provides needed direction to service planners about the types of services that are important to provide in a geographical region, and fills a gap in outlining the nature of services that can be encompassed in pediatric rehabilitation.

  10. Collaboration for the integration of HIV prevention at Title X family planning service delivery sites.

    PubMed

    Tran, Nhan T; Hallerdin, Jule M; Flowers-Maple, Charon; Moskosky, Susan B

    2010-01-01

    Since 2001, the U.S. Department of Health and Human Services' Office of Family Planning (OFP), in collaboration with the Minority AIDS Initiative, has provided supplemental grant funds to Title X-funded family planning service delivery sites to expand the availability of human immunodeficiency virus (HIV) prevention services. This work has resulted in three major outcomes: (1) increased institutional capacity for the delivery of HIV-prevention services at Title X family planning service delivery sites, (2) the successful implementation of HIV-prevention services at these sites, and (3) the identification of HIV-positive individuals who were referred to care services. These efforts resulted in a total of 539,667 unduplicated individuals being tested for HIV. These tests resulted in the identification of 1,692 HIV-positive individuals who otherwise may not have been tested for HIV. More than 85% of the HIV-positive cases were detected among clients who self-identified as members of racial/ethnic minority groups. The integration of HIV-prevention services is a feasible and effective strategy for detecting HIV infection among women, including women in racial/ethnic minority groups.

  11. Safety of labour and delivery following closures of obstetric services in small community hospitals

    PubMed Central

    Hutcheon, Jennifer A.; Riddell, Corinne A.; Strumpf, Erin C.; Lee, Lily; Harper, Sam

    2017-01-01

    BACKGROUND: In recent decades, many smaller hospitals in British Columbia, Canada, have stopped providing planned obstetric services. We examined the effect of these service closures on the labour and delivery outcomes of pregnant women living in affected communities. METHODS: We used maternal postal codes to identify delivery records (1998–2014) of women residing in a community affected by service closure. The records were obtained from the British Columbia Perinatal Data Registry. We examined the effect of the closures using a within-communities fixed-effects framework and included similar-sized communities without service closures to control for underlying time trends. The primary outcome was a previously published composite measure of labour and delivery safety, the Adverse Outcome Index, which includes adverse events such as birth injury and unanticipated operative procedures, and includes weights for severity of adverse events. Secondary outcomes included maternal or newborn transfer, and use of obstetric interventions. RESULTS: We found little evidence that closure of planned obstetric services affected the risk of composite adverse maternal–newborn outcome (−0.4 excess adverse events per 100 deliveries, 95% confidence interval [CI] −2.0 to 1.1), or most other secondary outcomes. The severity of composite outcome events decreased following the closures (rate ratio 0.58, 95% CI 0.36 to 0.89). Closures were associated with increases in use of epidural analgesia (3.4 excess events per 100 deliveries, 95% CI 0.4 to 6.3) and length of antepartum stay (0.6 h, 95% CI 0.1 to 1.0 h). INTERPRETATION: Closure of planned obstetric services in low-volume hospitals was not associated with an increase or decrease in frequency of adverse events during labour and delivery. PMID:27821464

  12. Safety of labour and delivery following closures of obstetric services in small community hospitals.

    PubMed

    Hutcheon, Jennifer A; Riddell, Corinne A; Strumpf, Erin C; Lee, Lily; Harper, Sam

    2017-03-20

    In recent decades, many smaller hospitals in British Columbia, Canada, have stopped providing planned obstetric services. We examined the effect of these service closures on the labour and delivery outcomes of pregnant women living in affected communities. We used maternal postal codes to identify delivery records (1998-2014) of women residing in a community affected by service closure. The records were obtained from the British Columbia Perinatal Data Registry. We examined the effect of the closures using a within-communities fixed-effects framework and included similar-sized communities without service closures to control for underlying time trends. The primary outcome was a previously published composite measure of labour and delivery safety, the Adverse Outcome Index, which includes adverse events such as birth injury and unanticipated operative procedures, and includes weights for severity of adverse events. Secondary outcomes included maternal or newborn transfer, and use of obstetric interventions. We found little evidence that closure of planned obstetric services affected the risk of composite adverse maternal-newborn outcome (-0.4 excess adverse events per 100 deliveries, 95% confidence interval [CI] -2.0 to 1.1), or most other secondary outcomes. The severity of composite outcome events decreased following the closures (rate ratio 0.58, 95% CI 0.36 to 0.89). Closures were associated with increases in use of epidural analgesia (3.4 excess events per 100 deliveries, 95% CI 0.4 to 6.3) and length of antepartum stay (0.6 h, 95% CI 0.1 to 1.0 h). Closure of planned obstetric services in low-volume hospitals was not associated with an increase or decrease in frequency of adverse events during labour and delivery. © 2017 Canadian Medical Association or its licensors.

  13. 78 FR 41305 - Collect on Delivery (COD)-Service Features

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-10

    ... Mail Manual (DMM ) 503.13, 507.4 and 508.1 to provide new standards for the automatic holding period.... Additionally, these revisions will retire the current manual PS Form 3849-D, Notice to Sender of Undelivered... changes. List of Subjects in 39 CFR Part 111 Administrative practice and procedure, Postal Service...

  14. 78 FR 32612 - Collect on Delivery (COD)-Service Features

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-31

    ... States Postal Service, Domestic Mail Manual (DMM ) 503.13, 507.4 and 508.1 to provide new standards for... days. Additionally, these revisions, if adopted, will retire the current manual PS Form 3849-D, Notice... requirements of the Administrative Procedure Act (5 U.S.C. 553(b), (c)) regarding proposed rulemaking by 39 U.S...

  15. Service Delivery Complexities: Early Intervention for Children with Physical Disabilities

    ERIC Educational Resources Information Center

    Ziviani, Jenny; Darlington, Yvonne; Feeney, Rachel; Rodger, Sylvia; Watter, Pauline

    2013-01-01

    Early intervention (EI) for children with physical disabilities is advocated as a means of enhancing child outcomes and family functioning. The issues confronted by service providers in delivering this support have received relatively little attention. The purpose of this study was to gain an understanding of the experiences of frontline EI staff…

  16. Charles R. Spain Career Enrichment Center, Delivery of Services Evaluation.

    ERIC Educational Resources Information Center

    McDaniel, Patrick L.

    The Career Enrichment Center (CEC) provides a year-round, voluntary career education program for all Albuquerque high school students. It offers courses; provides special services; manages and coordinates enrichment opportunities, alternate programs, and satellite stations; and provides liaison with businesses, community, and universities. This…

  17. Uses of Document Delivery Services. SPEC Kit 204.

    ERIC Educational Resources Information Center

    Jackson, Mary E., Comp.; Croneis, Karen, Comp.

    This document summarizes the results of a 1994 survey regarding the use of document suppliers by 90 ARL (Association of Research Libraries) members. A document supplier was defined as "a company or service that supplies documents for a fee." Document suppliers are increasingly used by research libraries as cost-effective solutions to the…

  18. Service Learning Projects in Online Courses: Delivery Strategies

    ERIC Educational Resources Information Center

    Hervani, Aref Agahei; Helms, Marilyn M.; Rutti, Raina M.; LaBonte, Joanne; Sarkarat, Sy

    2015-01-01

    As more college courses are taught online, maintaining course deliverables and learning to mirror face-to-face offerings is important to faculty, students, and accrediting agencies. Offering experiential and service learning is an increasingly important way to connect students to their local communities. This article presents a case study…

  19. Integrating Technology into Service Delivery (ITSD) Project: Final Report.

    ERIC Educational Resources Information Center

    Schoech, Dick; And Others

    The emerging field of assistive technology offers employment and independent living for people with disabilities. However, agency staff, people with disabilities, and their guardians often spend substantial time finding appropriate technological solutions. The integration of technology into the existing service system is needed to maximize scarce…

  20. Service Delivery Complexities: Early Intervention for Children with Physical Disabilities

    ERIC Educational Resources Information Center

    Ziviani, Jenny; Darlington, Yvonne; Feeney, Rachel; Rodger, Sylvia; Watter, Pauline

    2013-01-01

    Early intervention (EI) for children with physical disabilities is advocated as a means of enhancing child outcomes and family functioning. The issues confronted by service providers in delivering this support have received relatively little attention. The purpose of this study was to gain an understanding of the experiences of frontline EI staff…

  1. A Critical Discourse Analysis of Provincial Policies Impacting Shelter Service Delivery to Women Exposed to Violence.

    PubMed

    Burnett, Camille; Ford-Gilboe, Marilyn; Berman, Helene; Ward-Griffin, Cathy; Wathen, Nadine

    2015-01-01

    Shelters for abused women function within a broad context that includes intersecting social structures, policies, and resources, which may constrain and limit the options available to abused women and tacitly reinforce the cycle of abuse. This feminist, qualitative study combined in-depth interviews and focus groups conducted with 37 staff and four executive directors from four shelters in Ontario, Canada, along with a critical discourse analysis of salient policy texts. Together, the interviews and critical discourse analysis formed an integrated analysis of the dialectic between policy as written and enacted. The study findings illuminate the complexity of the system and its impact on women, shelters, and the community and highlight how specific types of social policies and various social system subsystems and structures, and system configuration, shape the day to day reality of shelter service delivery and impact outcomes for abused women and their children. Collectively, these findings offer direction regarding where these policies could be improved and provide a basis for shelters, policy makers, advocates, and the community to strengthen current services and policies, potentially enhancing outcomes for women.

  2. Ecosystem-Based Management and the Sustainable Delivery of Marine Ecosystem Services

    NASA Astrophysics Data System (ADS)

    Fogarty, M.; Schwing, F. B.

    2016-02-01

    Ecosystem-Based Management can provide an essential framework for the sustainable delivery of a broad spectrum of marine Ecosystem Services (ES) essential to human well being. Key elements of the approach involve the specification of clearly articulated goals for EBM; the development of an accompanying Marine Ecosystem Services Assessment (MESA) designed to evaluate the status of delivery of these services; and strategies for the implementation of management options designed to achieve the stated goals of the program. The specification of goals is the purview of managers. In the United States under the provisions of the National Ocean Policy, Regional Planning Bodies are charged with the responsibility of articulating goals and developing strategies to meet these goals. Government agencies, in concert with the broader scientific community, hold the responsibility for assessing the status of the delivery of ecosystem services in relation to designated objectives and advising on appropriate management strategies. In this presentation, I will illustrate the specification of a MESA for the Northwest U.S Continental Shelf Large Marine Ecosystem (NES LME). The approach focuses on the evaluation of ES indicators and additional metrics related to threats and impacts to the sustainable delivery of these services. Results are combined into an overall index of status of the NES LME.

  3. Towards sustainable delivery of health services in Afghanistan: options for the future.

    PubMed

    Sabri, B; Siddiqi, S; Ahmed, A M; Kakar, F K; Perrot, J

    2007-01-01

    Disruption caused by decades of war and civil strife in Afghanistan has led many international and national nongovernmental organizations (NGOs) to assume responsibility for the delivery of health services through contracts with donor agencies. Recently the Afghan Government has pursued the policy of contracting for a basic package of health services (BPHS) supported by funds from three major donors-the World Bank, the United States Agency for International Development (USAID) and the European Commission. With the gradual strengthening of the public health ministry, options for the future include pursuing the contracting option or increasing public provision of health services. Should contracting with NGOs be pursued, a clear strategy is required that includes developing accreditation instruments, better contracting mechanisms and a system for monitoring and evaluating the entire process. Should the government opt for an increasing role, problems to be solved include securing the transition to public provision, optining guarantees that appropriate financing will be provided and reconfiguration of the public health delivery system. Large-scale contracting with the private for-profit sector cannot be recommended at this stage, although this option could be explored via subcontracting by larger NGOs or small-scale trial contracts initiated by the public health ministry. Irrespective of the option chosen, an important challenge remaining is the recalcitrant problem of high out-of-pocket payments. Sustainable delivery of health services in Afghanistan can only be achieved with a clear national strategy in which all stakeholders have roles to play in the financing, regulation and delivery of services.

  4. Towards sustainable delivery of health services in Afghanistan: options for the future.

    PubMed

    Sabri, B; Siddiqi, S; Ahmed, A M; Kakar, F K; Perrot, J

    2007-09-01

    Disruption caused by decades of war and civil strife in Afghanistan has led many international and national nongovernmental organizations (NGOs) to assume responsibility for the delivery of health services through contracts with donor agencies. Recently the Afghan Government has pursued the policy of contracting for a basic package of health services (BPHS) supported by funds from three major donors - the World Bank, the United States Agency for International Development (USAID) and the European Commission. With the gradual strengthening of the public health ministry, options for the future include pursuing the contracting option or increasing public provision of health services. Should contracting with NGOs be pursued, a clear strategy is required that includes developing accreditation instruments, better contracting mechanisms and a system for monitoring and evaluating the entire process. Should the government opt for an increasing role, problems to be solved include securing the transition to public provision, obtaining guarantees that appropriate financing will be provided and reconfiguration of the public health delivery system. Large-scale contracting with the private for-profit sector cannot be recommended at this stage, although this option could be explored via subcontracting by larger NGOs or small-scale trial contracts initiated by the public health ministry. Irrespective of the option chosen, an important challenge remaining is the recalcitrant problem of high out-of-pocket payments. Sustainable delivery of health services in Afghanistan can only be achieved with a clear national strategy in which all stakeholders have roles to play in the financing, regulation and delivery of services.

  5. Ecosystem-Based Management and the Sustainable Delivery of Marine Ecosystem Services

    NASA Astrophysics Data System (ADS)

    Fogarty, M.; Schwing, F. B.

    2016-12-01

    Ecosystem-Based Management can provide an essential framework for the sustainable delivery of a broad spectrum of marine Ecosystem Services (ES) essential to human well being. Key elements of the approach involve the specification of clearly articulated goals for EBM; the development of an accompanying Marine Ecosystem Services Assessment (MESA) designed to evaluate the status of delivery of these services; and strategies for the implementation of management options designed to achieve the stated goals of the program. The specification of goals is the purview of managers. In the United States under the provisions of the National Ocean Policy, Regional Planning Bodies are charged with the responsibility of articulating goals and developing strategies to meet these goals. Government agencies, in concert with the broader scientific community, hold the responsibility for assessing the status of the delivery of ecosystem services in relation to designated objectives and advising on appropriate management strategies. In this presentation, I will illustrate the specification of a MESA for the Northwest U.S Continental Shelf Large Marine Ecosystem (NES LME). The approach focuses on the evaluation of ES indicators and additional metrics related to threats and impacts to the sustainable delivery of these services. Results are combined into an overall index of status of the NES LME.

  6. User involvement in service delivery predicts outcomes of assistive technology use: A cross-sectional study in Bangladesh

    PubMed Central

    2012-01-01

    Background Knowledge about the relation between user involvement in the provision of assistive technology and outcomes of assistive technology use is a prerequisite for the development of efficient service delivery strategies. However, current knowledge is limited, particularly from low-income countries where affordability is an issue. The objective was therefore to explore the relation between outcomes of assistive technology use and user involvement in the service delivery process in Bangladesh. Methods Using structured interviews, data from 136 users of hearing aids and 149 users of manual wheelchairs were collected. Outcomes were measured using the International Outcome Inventory for Hearing Aids (IOI-HA), which was adapted for wheelchair users. Predictors of user involvement included preference, measurement and training. Results Users reported outcomes comparable to those found in other high- and low-income countries. User involvement increased the likelihood for reporting better outcomes except for measurement among hearing aid users. Conclusions The findings support the provision of assistive technology as a strategy to improve the participation of people with disabilities in society. They also support current policies and guidelines for user-involvement in the service delivery process. Simplified strategies for provision of hearing aids may be explored. PMID:22995203

  7. Timeliness of Service Delivery for Children with Later-identified Mild to Severe Hearing Loss

    PubMed Central

    Walker, Elizabeth A.; Holte, Lenore; Spratford, Meredith; Oleson, Jacob; Welhaven, Anne; Harrison, Melody

    2013-01-01

    Purpose This study examined diagnostic and intervention services for children identified with hearing loss (HL) after the newborn period. Method We compared ages at service delivery and length of delays between service delivery steps for 57 later-identified children with HL and 193 children who referred for assessment from the newborn hearing screen (NHS). For only later-identified children, regression models were used to investigate relationships among predictor variables and dependent variables related to service delivery. Results Children who referred from the NHS received follow-up services at younger ages than later-identified children. Later-identified children had significantly longer delays between entry into early intervention to HL confirmation, compared to children who referred from the NHS. For later-identified children, degree of HL predicted ages at follow-up clinical services. Children with more severe HL received services at younger ages compared to children with milder HL. Gender predicted the length of the delay between confirmation to entry into early intervention, with females demonstrating shorter delays. Conclusions The current results lend support to the need for ongoing hearing monitoring programs after the neonatal period, particularly when children enter early intervention programs because of language/developmental delays. PMID:24018573

  8. Magnitude and factors associated with institutional delivery service utilization among childbearing mothers in Cheha district, Gurage zone, SNNPR, Ethiopia: a community based cross sectional study.

    PubMed

    Habte, Feleke; Demissie, Meaza

    2015-11-17

    ; working to improve women's economic status; counseling women to give birth at health institution during their ANC visit and exploring the overall quality of ANC service are some of the areas where much work is needed to improve institutional delivery.

  9. An Evaluation of Alternative Delivery Modes for Information Services.

    ERIC Educational Resources Information Center

    Short, Craig; Christal, Melodie E.

    The use of the floppy disk as an alternative mode for delivering Information Services reports was evaluated for fiscal year 1985 by the National Center for Higher Education Management Systems (NCHEMS). A 5.25 inch, 8/9 sector, 40 track ASCII floppy disk used under PC-DOS on the IBM PC and IBM PC compatible hardware was tested. Tabular data but not…

  10. Improving the monitoring of immunization services in Kyrgyzstan.

    PubMed

    Weeks, R M; Svetlana, F; Noorgoul, S; Valentina, G

    2000-09-01

    Following the disbanding of the Soviet Union in 1991, the government of Kyrgyzstan was unable to maintain the previous level of health services. To revitalize the health services, the Ministry of Health (MOH) first focused on improving their immunization services, including the immunization component of the Health Management Information System (HMIS). Secondly, to increase immunization coverage, the MOH set as a priority the elimination of prescribing false contraindications to immunization. To accomplish both goals, the MOH updated the national immunization policies and established a more effective structure for managing immunization services. To support the MOH, the US Agency for International Development (USAID) Resources for Child Health (REACH) and Basic Support for Institutionalizing Child Survival (BASICS) projects provided technical assistance through a resident coordinator and consultants, and by organizing an international seminar. The improvements extended beyond systems and forms, but, instead, emphasized monitoring by the frontline health worker and supervising the quality of health information. To accomplish their objectives, the MOH appointed a Working Group to define the problems, revise record-keeping procedures, and develop monitoring tools. This group, representing both national and local levels, was composed of MOH epidemiologists, paediatricians and a management information specialist. To reduce the burden of excessive record-keeping and reporting requirements, the Working Group identified four key indicators for the service delivery level: (1) DPT3 immunization coverage rates for children less than 1 year of age; (2) contraindication rates for DPT; (3) usage of DPT vaccine; and (4) daily refrigerator temperatures. Additional indicators were included at district and provincial levels. After a successful 1-year trial, the MOH implemented the revised HMIS nationally. Not only did the quality of the information system improve, but the new approach

  11. Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction

    PubMed Central

    Warner, Courtney J.; Horvath, Alexander J.; Powell, Richard J.; Columbo, Jesse A.; Walsh, Teri R.; Goodney, Philip P.; Walsh, Daniel B.; Stone, David H.

    2017-01-01

    Objective Endovascular aneurysm repair (EVAR) is now a mainstay of therapy for abdominal aortic aneurysm, although it remains associated with significant expense. We performed a comprehensive analysis of EVAR delivery at an academic medical center to identify targets for quality improvement and cost reduction in light of impending health care reform. Methods All infrarenal EVARs performed from April 2011 to March 2012 were identified (N = 127). Procedures were included if they met standard commercial instructions for use guidelines, used a single manufacturer, and were billed to Medicare diagnosis-related group 238 (n = 49). By use of DMAIC (define, measure, analyze, improve, and control) quality improvement methodology (define, measure, analyze, improve, control), targets for EVAR quality improvement were identified and high-yield changes were implemented. Procedure technical costs were calculated before and after process redesign. Results Perioperative services and clinic visits were identified as targets for quality improvement efforts and cost reduction. Mean technical costs before the intervention were $31,672, with endograft implants accounting for 52%. Pricing redesign in collaboration with hospital purchasing reduced mean EVAR technical costs to $28,607, a 10% reduction in overall cost, with endograft implants now accounting for 46%. Perioperative implementation of instrument tray redesign reduced instrument use by 32% (184 vs 132 instruments), saving $50,000 annually. Unnecessary clinic visits were reduced by 39% (1.6 vs 1.1 clinic visits per patient) through implementation of a preclinic imaging protocol. There was no difference in mean length of stay after the intervention. Conclusions Comprehensive EVAR delivery redesign leads to cost reduction and waste elimination while preserving quality. Future efforts to achieve more competitive and transparent device pricing will make EVAR more cost neutral and enhance its financial sustainability for health care

  12. Abundance of common species, not species richness, drives delivery of a real-world ecosystem service.

    PubMed

    Winfree, Rachael; Fox, Jeremy W; Williams, Neal M; Reilly, James R; Cariveau, Daniel P

    2015-07-01

    Biodiversity-ecosystem functioning experiments have established that species richness and composition are both important determinants of ecosystem function in an experimental context. Determining whether this result holds for real-world ecosystem services has remained elusive, however, largely due to the lack of analytical methods appropriate for large-scale, associational data. Here, we use a novel analytical approach, the Price equation, to partition the contribution to ecosystem services made by species richness, composition and abundance in four large-scale data sets on crop pollination by native bees. We found that abundance fluctuations of dominant species drove ecosystem service delivery, whereas richness changes were relatively unimportant because they primarily involved rare species that contributed little to function. Thus, the mechanism behind our results was the skewed species-abundance distribution. Our finding that a few common species, not species richness, drive ecosystem service delivery could have broad generality given the ubiquity of skewed species-abundance distributions in nature.

  13. Participatory Management: An Alternative in Human Service Delivery Systems

    ERIC Educational Resources Information Center

    Fallon, Kenneth P., Jr.

    1974-01-01

    Studies show that participatory management in the business field tends to improve employees' attitudes and performance, to lower costs, and to increase production. This paper describes the process of setting up democratic decision making in the welfare field. (SDH)

  14. 48 CFR 1552.216-73 - Fixed rates for services-indefinite delivery/indefinite quantity contract.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...-indefinite delivery/indefinite quantity contract. 1552.216-73 Section 1552.216-73 Federal Acquisition... CLAUSES Texts of Provisions and Clauses 1552.216-73 Fixed rates for services—indefinite delivery... rates for services in indefinite delivery/indefinite quantity contracts. When the contract contains...

  15. Telehealth: A Rapidly Developing Service Delivery Model For Occupational Therapy

    PubMed Central

    Cason, Jana

    2014-01-01

    Over the past decade, the practice of occupational therapy has been increasingly influenced by technological advances in the use of information and communication technologies (ICT) and associated changes in health care policy. Emergent from this evolution is the application of telehealth to deliver occupational therapy services to a client who is in a different physical location than the provider. This article furnishes an overview of the evidence for telehealth use in occupational therapy, discusses key policy considerations, and provides resources to guide practitioners in the ethical use of telehealth. PMID:25945220

  16. Improving queuing service at McDonald's

    NASA Astrophysics Data System (ADS)

    Koh, Hock Lye; Teh, Su Yean; Wong, Chin Keat; Lim, Hooi Kie; Migin, Melissa W.

    2014-07-01

    Fast food restaurants are popular among price-sensitive youths and working adults who value the conducive environment and convenient services. McDonald's chains of restaurants promote their sales during lunch hours by offering package meals which are perceived to be inexpensive. These promotional lunch meals attract good response, resulting in occasional long queues and inconvenient waiting times. A study is conducted to monitor the distribution of waiting time, queue length, customer arrival and departure patterns at a McDonald's restaurant located in Kuala Lumpur. A customer survey is conducted to gauge customers' satisfaction regarding waiting time and queue length. An android app named Que is developed to perform onsite queuing analysis and report key performance indices. The queuing theory in Que is based upon the concept of Poisson distribution. In this paper, Que is utilized to perform queuing analysis at this McDonald's restaurant with the aim of improving customer service, with particular reference to reducing queuing time and shortening queue length. Some results will be presented.

  17. Interim Project Results: United Parcel Service's Second-Generation Hybrid-Electric Delivery Vans (Fact Sheet)

    SciTech Connect

    Not Available

    2012-01-01

    This fact sheet describes the performance evaluation of United Parcel Service's second-generation hybrid-electric delivery vans. The Fleet Test and Evaluation Team at the National Renewable Energy Laboratory (NREL) is evaluating the 18-month, in-service performance of 11 of these vans along with 11 comparable conventional diesel vans operating in Minneapolis, Minnesota. As a complement to the field study, the team recently completed fuel economy and emissions testing at NREL's Renewable Fuels and Lubricants (ReFUEL) laboratory.

  18. Medicaid and managed care: opportunities for innovative service delivery to vulnerable populations.

    PubMed

    Monack, D R

    1995-01-01

    The crisis in state "safety-net" funding for high-need, high-risk, high-cost vulnerable populations has led to the development of creative strategies and financing mechanisms by the states for delivering essential community-based services. This is also an opportunity for private-sector providers who can recognize the special needs of these populations, form links with other key constituencies and apply managed care concepts to long-term health and human service delivery.

  19. Improving the Efficiency of Physical Examination Services

    PubMed Central

    Chih, Mingchang; Bair, Aaron E.

    2009-01-01

    The objective of our project was to improve the efficiency of the physical examination screening service of a large hospital system. We began with a detailed simulation model to explore the relationships between four performance measures and three decision factors. We then attempted to identify the optimal physician inquiry starting time by solving a goal-programming problem, where the objective function includes multiple goals. One of our simulation results shows that the proposed optimal physician inquiry starting time decreased patient wait times by 50% without increasing overall physician utilization. Electronic supplementary material  The online version of this article (doi:10.1007/s10916-009-9271-z) contains supplementary material, which is available to authorized users. PMID:20703912

  20. Building Service Delivery Networks: Partnership Evolution Among Children's Behavioral Health Agencies in Response to New Funding.

    PubMed

    Bunger, Alicia C; Doogan, Nathan J; Cao, Yiwen

    2014-12-01

    Meeting the complex needs of youth with behavioral health problems requires a coordinated network of community-based agencies. Although fiscal scarcity or retrenchment can limit coordinated services, munificence can stimulate service delivery partnerships as agencies expand programs, hire staff, and spend more time coordinating services. This study examines the 2-year evolution of referral and staff expertise sharing networks in response to substantial new funding for services within a regional network of children's mental health organizations. Quantitative network survey data were collected from directors of 22 nonprofit organizations that receive funding from a county government-based behavioral health service fund. Both referral and staff expertise sharing networks changed over time, but results of a stochastic actor-oriented model of network dynamics suggest the nature of this change varies for these networks. Agencies with higher numbers of referral and staff expertise sharing partners tend to maintain these ties and/or develop new relationships over the 2 years. Agencies tend to refer to agencies they trust, but trust was not associated with staff expertise sharing ties. However, agencies maintain or form staff expertise sharing ties with referral partners, or with organizations that provide similar services. In addition, agencies tend to reciprocate staff expertise sharing, but not referrals. Findings suggest that during periods of resource munificence and service expansion, behavioral health organizations build service delivery partnerships in complex ways that build upon prior collaborative history and coordinate services among similar types of providers. Referral partnerships can pave the way for future information sharing relationships.

  1. Improving physiotherapy services to Indigenous children with physical disability: Are client perspectives missed in the continuous quality improvement approach?

    PubMed

    Greenstein, Caroline; Lowell, Anne; Thomas, David Piers

    2016-06-01

    To compare the outcomes of two cycles of continuous quality improvement (CQI) at a paediatric physiotherapy service with findings from interviews with clients and their carers using the service. Case study based at one paediatric physiotherapy service Community-based paediatric allied health service in Northern Australia. Forty-nine clinical records and four staff at physiotherapy service, five Indigenous children with physical disability aged 8-21 years, and nine carers of Indigenous children aged 0-21 years (current or previous clients). The CQI process based on the Audit and Best Practice for Chronic Disease involved a clinical audit; a workshop where clinicians assessed their health care systems, identified weaknesses and strengths, and developed goals and strategies for improvement; and reassessment through a second audit and workshop. Twelve open-ended, in-depth interviews were conducted with previous or current clients selected through purposive and theoretical sampling. CQI and interview results were then compared. Comparison of findings from the two studies Both CQI and interview results highlighted service delivery flexibility and therapists' knowledge, support and advocacy as service strengths, and lack of resources and a child-friendly office environment as weaknesses. However, the CQI results reported better communication and client input into the service than the interview results. The CQI process, while demonstrating improvements in clinical and organisational aspects of the service, did not always reflect or address the primary concerns of Indigenous clients and underlined the importance of including clients in the CQI process. © 2015 National Rural Health Alliance Inc.

  2. Factors associated with the utilization of institutional delivery services in Bangladesh.

    PubMed

    Yaya, Sanni; Bishwajit, Ghose; Ekholuenetale, Michael

    2017-01-01

    Bangladesh has made remarkable progress towards reducing its maternal mortality rate (MMR) over the last two decades and is one of the few countries on track to achieving the MMR-related Millennium Development Goals (MDG-5A). However, the provision of universal access to reproductive healthcare (MDG-5B) and the utilization of maternal healthcare services (MHS) such as institutional delivery, which are crucial to the reduction of maternal mortality, are far behind the internationally agreed-upon target. Effective policymaking to promote the utilization of MHS can be greatly facilitated by the identification of the factors that hinder service uptake. In this study, we therefore aim to measure the prevalence of institutional delivery services and explore the factors associated with their utilization in Bangladesh. Data for this study were extracted from the 2011 Bangladesh Demographic and Health Survey (BDHS, 2011); participants were 7,313 women between the ages of 15 and 49 years, selected from both urban and rural households. Data were analyzed using Chi-square analysis, and conditional logistic regression. According to the findings, fewer than one in three women reported delivering at a health facility. The multivariable regression analysis showed that participants from rural areas were 46.9% less likely to have institutional deliveries compared to urban dwellers (OR = 0.531; p<0.001; 95%CI: 0.467-0.604), and participants aged between 30 and 49 years had a 23.6% higher prevalence of institutional delivery service utilization compared to those aged 15 to 29 years (OR = 1.236; p = 0.006; 95%CI: 1.062-1.437). Moreover, participants with higher educational attainment were about twice as likely to deliver at a standard health facility when compared to those without formal education (OR = 2.081; p<0.001; 95%CI: 1.650-2.624), and similarly, husbands with higher educational attainment exhibited an approximately 71% higher service utilization of institutional delivery

  3. Factors associated with the utilization of institutional delivery services in Bangladesh

    PubMed Central

    Bishwajit, Ghose; Ekholuenetale, Michael

    2017-01-01

    Introduction Bangladesh has made remarkable progress towards reducing its maternal mortality rate (MMR) over the last two decades and is one of the few countries on track to achieving the MMR-related Millennium Development Goals (MDG-5A). However, the provision of universal access to reproductive healthcare (MDG-5B) and the utilization of maternal healthcare services (MHS) such as institutional delivery, which are crucial to the reduction of maternal mortality, are far behind the internationally agreed-upon target. Effective policymaking to promote the utilization of MHS can be greatly facilitated by the identification of the factors that hinder service uptake. In this study, we therefore aim to measure the prevalence of institutional delivery services and explore the factors associated with their utilization in Bangladesh. Methods Data for this study were extracted from the 2011 Bangladesh Demographic and Health Survey (BDHS, 2011); participants were 7,313 women between the ages of 15 and 49 years, selected from both urban and rural households. Data were analyzed using Chi-square analysis, and conditional logistic regression. Results According to the findings, fewer than one in three women reported delivering at a health facility. The multivariable regression analysis showed that participants from rural areas were 46.9% less likely to have institutional deliveries compared to urban dwellers (OR = 0.531; p<0.001; 95%CI: 0.467–0.604), and participants aged between 30 and 49 years had a 23.6% higher prevalence of institutional delivery service utilization compared to those aged 15 to 29 years (OR = 1.236; p = 0.006; 95%CI: 1.062–1.437). Moreover, participants with higher educational attainment were about twice as likely to deliver at a standard health facility when compared to those without formal education (OR = 2.081; p<0.001; 95%CI: 1.650–2.624), and similarly, husbands with higher educational attainment exhibited an approximately 71% higher service

  4. The perceived impact of the National Health Service on personalised nutrition service delivery among the UK public.

    PubMed

    Fallaize, Rosalind; Macready, Anna L; Butler, Laurie T; Ellis, Judi A; Berezowska, Aleksandra; Fischer, Arnout R H; Walsh, Marianne C; Gallagher, Caroline; Stewart-Knox, Barbara J; Kuznesof, Sharon; Frewer, Lynn J; Gibney, Mike J; Lovegrove, Julie A

    2015-04-28

    Personalised nutrition (PN) has the potential to reduce disease risk and optimise health and performance. Although previous research has shown good acceptance of the concept of PN in the UK, preferences regarding the delivery of a PN service (e.g. online v. face-to-face) are not fully understood. It is anticipated that the presence of a free at point of delivery healthcare system, the National Health Service (NHS), in the UK may have an impact on end-user preferences for deliverances. To determine this, supplementary analysis of qualitative data obtained from focus group discussions on PN service delivery, collected as part of the Food4Me project in the UK and Ireland, was undertaken. Irish data provided comparative analysis of a healthcare system that is not provided free of charge at the point of delivery to the entire population. Analyses were conducted using the 'framework approach' described by Rabiee (Focus-group interview and data analysis. Proc Nutr Soc 63, 655-660). There was a preference for services to be led by the government and delivered face-to-face, which was perceived to increase trust and transparency, and add value. Both countries associated paying for nutritional advice with increased commitment and motivation to follow guidelines. Contrary to Ireland, however, and despite the perceived benefit of paying, UK discussants still expected PN services to be delivered free of charge by the NHS. Consideration of this unique challenge of free healthcare that is embedded in the NHS culture will be crucial when introducing PN to the UK.

  5. Health services delivery networks: what do we know and where should we be headed?

    PubMed

    Provan, Keith G; Milward, H Brinton

    2006-01-01

    Networks of collaborating organizations have become critical mechanisms for the effective delivery of healthcare and related human services. Despite their importance, there is much about health networks that is not understood. The article by Huerta, Casebeer and VanderPlaat is an effort to discuss the importance of health services delivery networks and to point out ways in which such networks might best be studied. Their article offers a number of useful and interesting ideas for both practice and research. Many of these ideas are not, however, well organized, integrated or fully developed. This commentary provides a critique of their work, while offering some of our own suggestions about how the study of health delivery networks might be advanced.

  6. Online-to-offline models in HIV service delivery.

    PubMed

    Anand, Tarandeep; Nitpolprasert, Chattiya; Phanuphak, Nittaya

    2017-09-01

    Half the world's population has access to Internet and technologies, and utilization is near-ubiquitous among providers and key populations. Despite being so well connected; identifying, reaching and linking vulnerable populations to HIV clinical services remains a global challenge. This review highlights the emerging online-to-offline (O2O) models, their potential in scaling up services, and evaluating impact, and implications for future research. Globally, four major types of O2O models have been implemented, primarily in the West and Asia, especially among MSM and transgender women. These models have varying levels of impact in terms of reach, engagement, participation, linkage, and ability to track and monitor participants, and assess outcomes. Those integrated with offline sites enable seamless transition, dramatically reduce the O2O linkage time and demonstrate high linkage success (>73%). O2O models are ideal for at-risk, stigmatized, criminalized populations and for scaling-up biomedical prevention interventions such as preexposure and postexposure prophylaxis. O2O models represent novel and powerful solutions to reverse the pandemic and could help fill significant programmatic gaps in tracking individuals through HIV cascades. Providers, especially in resource-limited settings, could choose between a variety of current approaches highlighted in this review and employ no-cost or cost-effective technologies to transform their traditional models and leverage O2O models.

  7. Recommendations for headache service organisation and delivery in Europe.

    PubMed

    Steiner, T J; Antonaci, F; Jensen, R; Lainez, M J A; Lanteri-Minet, M; Valade, D

    2011-08-01

    Headache disorders are a major public-health priority, and there is pressing need for effective solutions to them. Better health care for headache-and ready access to it-are central to these solutions; therefore, the organisation of headache-related services within the health systems of Europe becomes an important focus. These recommendations are the result of collaboration between the European Headache Federation and Lifting The Burden: the Global Campaign against Headache. The process of development included wide consultation. To meet the very high level of need for headache care both effectively and efficiently, the recommendations formulate a basic three-level model of health-care organisation rationally spread across primary and secondary health-care sectors, taking account of the different skills and expertise in these sectors. They recognise that health services are differently structured in countries throughout Europe, and not always adequately resourced. Therefore, they aim to be adaptable to suit these differences. They are set out in five sections: needs assessment, description of the model, adaptation, standards and educational implications.

  8. Evaluating and improving patient-specific QA for IMRT delivery

    NASA Astrophysics Data System (ADS)

    Yan, Guanghua

    2009-12-01

    Modern radiation therapy techniques such as intensity-modulated radiation therapy (IMRT) and newly-emerging volumetric modulated arc therapy (VMAT) aim to deliver highly conformal radiation dose to the target volume while sparing nearby critical organs as much as possible with the complex motion of multi-leaf collimator (MLC) leaves. Pre-treatment patient specific quality assurance (QA) has become an essential part of IMRT in making sure the delivered dose distributions agree with the planned ones. This dissertation evaluates the performance of current patient-specific QA process and proposes solutions to improve its sensitivity, accuracy and efficiency. In step and shoot IMRT, the study on the sensitivity of patient-specific QA to minor MLC errors reveals tighter criterion such as 2%/2mm must be employed to detect systematic MLC positioning errors of 2 mm. However, such criterion results in low average passing rate which leads to excessive false alarms, mainly due to inadequate treatment planning system (TPS) beam modeling on beam penumbra. An analytical deconvolution approach is proposed to recover true photon beam profiles to obtain a true beam model which significantly improves agreement between calculated and measured dose distributions. Thus a tighter criterion could be employed to enhance the sensitivity of patient-specific QA to minor errors in the delivery system. Measurement based patient-specific IMRT QA is a time-consuming process. A fast and accurate independent planar dose calculation algorithm is proposed to replace measurement based QA. The algorithm analytically models photons coming out from the accelerator and computes dose distribution from first principles. Accuracy of the algorithm is validated against 2D diode array measurements. The algorithm is found to be fast and accurate enough to replace time consuming measurement based QA. Patient-specific QA for VMAT differs significantly from step and shoot IMRT due to the increased use of dynamic

  9. The ethics of imperfect cures: models of service delivery and patient vulnerability.

    PubMed

    Lanoix, Monique

    2013-11-01

    A rising number of patients require continuing or palliative services and this means that they will need to transition from one model of healthcare delivery to another. If it is generally recognised that patient vulnerability to inadequate services increases when the setting in which patient receives care changes, it is usually taken to be the result of poor coordination of services or personnel. Recognising that an integrated system is essential to adequate access, the point that I put forward in this paper is that the centrality of acute care services affects the way in which chronic and palliative services are structured and, consequently, their availability. I argue that the problem originates in the manner in which some of the foundational concepts of the acute care model are imported into the other models of care delivery. In order to make this case, I review the three main models of healthcare service delivery by focusing my analysis along three axes: the goal of the care model; the predominant understanding of autonomy implicit in the model; and, the main actors in the care relationship. By examining how the various concepts translate from one model to the next, I discuss what I identify to be one of the main conceptual obstacles to less problematic transitioning, the notion of autonomy and the corresponding view of the patient as an isolated agent.

  10. A Collaborative Naturalistic Service Delivery Program for Enhancing Pragmatic Language and Participation in Preschoolers

    ERIC Educational Resources Information Center

    Demchick, Barbara B.; Day, Karen H.

    2016-01-01

    We describe a speech-language pathology and occupational therapy service delivery program for preschoolers with developmental delays and communication and related impairments. Key features included interprofessional collaboration; parent professional partnerships; naturalistic environment; opportunities for choice and control; use of a…

  11. Moral, Legal, and Functional Dimensions of Inclusive Service Delivery in Catholic Schools

    ERIC Educational Resources Information Center

    Scanlan, Martin

    2009-01-01

    Catholic school educators are morally compelled by Catholic social teaching to foster inclusive service delivery for students who have traditionally been marginalized in schools, including students in poverty, students of color, English language learners, and students with special needs. This article applies this moral context to analyze the legal…

  12. The "P" Word: Productivity in the Delivery of Career Guidance Services

    ERIC Educational Resources Information Center

    Watts, A. G.; Dent, Gareth

    2006-01-01

    The case for more attention to productivity in career guidance delivery is related to the pressures both for greater public accountability and for increasing access to services without massive increases in resources. The term "productivity" is defined and its applications in a career guidance context are explored. Possible strategies for enhancing…

  13. Speech-Language Pathologist and General Educator Collaboration: A Model for Tier 2 Service Delivery

    ERIC Educational Resources Information Center

    Watson, Gina D.; Bellon-Harn, Monica L.

    2014-01-01

    Tier 2 supplemental instruction within a response to intervention framework provides a unique opportunity for developing partnerships between speech-language pathologists and classroom teachers. Speech-language pathologists may participate in Tier 2 instruction via a consultative or collaborative service delivery model depending on district needs.…

  14. Current Practices in Special Education Service Delivery and Differences between Instructional Settings

    ERIC Educational Resources Information Center

    Platt, Marguerite D.

    2013-01-01

    Despite nationwide advances in special education service delivery practices, disparities exist between the educational outcomes of students with disabilities versus students without disabilities. There is often disparity in teachers' roles and instructional practices in coteaching classrooms, as well as in their pullout resource classroom…

  15. Program Intensity and Service Delivery Models in the Schools: SLP Survey Results

    ERIC Educational Resources Information Center

    Brandel, Jayne; Loeb, Diane Frome

    2011-01-01

    Purpose: School-based speech-language pathologists (SLPs) routinely work with team members to make recommendations regarding an intervention program's intensity and method of service delivery for children with speech and language impairments. In this study, student, SLP, and workplace characteristics that may influence SLPs' recommendations were…

  16. Speech-Language Pathologists' Comfort Levels in English Language Learner Service Delivery

    ERIC Educational Resources Information Center

    Kimble, Carlotta

    2013-01-01

    This study examined speech-language pathologists' (SLPs) comfort levels in providing service delivery to English language learners (ELLs) and limited English proficient (LEP) students. Participants included 192 SLPs from the United States and Guam. Participants completed a brief, six-item questionnaire that investigated their perceptions regarding…

  17. Contribution of Professional School Counselors' Values and Leadership Practices to Their Programmatic Service Delivery

    ERIC Educational Resources Information Center

    Shillingford, M. Ann; Lambie, Glenn W.

    2010-01-01

    School counselors are called to be leaders to support the development of all students. The study in this article investigated the contributions of the values (Schwartz, 1992) and leadership practices (Posner & Kouzes, 1988) of 163 school counselors to their programmatic service delivery (Scarborough, 2005). Leadership practices made…

  18. A Collaborative Naturalistic Service Delivery Program for Enhancing Pragmatic Language and Participation in Preschoolers

    ERIC Educational Resources Information Center

    Demchick, Barbara B.; Day, Karen H.

    2016-01-01

    We describe a speech-language pathology and occupational therapy service delivery program for preschoolers with developmental delays and communication and related impairments. Key features included interprofessional collaboration; parent professional partnerships; naturalistic environment; opportunities for choice and control; use of a…

  19. Service Delivery to Parents with an Intellectual Disability: Family-Centred or Professionally Centred?

    ERIC Educational Resources Information Center

    Wade, Catherine M.; Mildon, Robyn L.; Matthews, Jan M.

    2007-01-01

    Background: Studies support the use of family-centred practices in service delivery to families where a parent has an intellectual disability. This paper examines the importance of such practices to parents. Materials and Methods: Interview responses from 32 parents with intellectual disability were coded by two independent raters as reflecting…

  20. Numbers That Count: Exploring Special Education and Paraprofessional Service Delivery in Inclusion-Oriented Schools

    ERIC Educational Resources Information Center

    Suter, Jesse C.; Giangreco, Michael F.

    2009-01-01

    This study explores key indicators of special education service delivery based on responses from 92 special educators and 36 administrators in 19 Vermont schools. Special educators reported on their work, the work of paraprofessionals they supervised, and 103 students with disabilities who were receiving one-to-one paraprofessional supports within…