Coping with changing conditions: alternative strategies for the delivery of maternal and child health and family planning services in Dhaka, Bangladesh.

PubMed Central

Routh, S.; el Arifeen, S.; Jahan, S. A.; Begum, A.; Thwin, A. A.; Baqui, A. H.

2001-01-01

The door-to-door distribution of contraceptives and information on maternal and child health and family planning (MCH-FP) services, through bimonthly visits to eligible couples by trained fieldworkers, has been instrumental in increasing the contraceptive prevalence rate and immunization coverage in Bangladesh. The doorstep delivery strategy, however, is labour-intensive and costly. More cost-effective service delivery strategies are needed, not only for family planning services but also for a broader package of reproductive and other essential health services. Against this backdrop, operations research was conducted by the Centre for Health and Population Research at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from January 1996 to May 1997, in collaboration with government agencies and a leading national nongovernmental organization, with a view to developing and field-testing alternative approaches to the delivery of MCH-FP services in urban areas. Two alternative strategies featuring the withdrawal of home-based distribution and the delivery of basic health care from fixed-site facilities were tested in two areas of Dhaka. The clinic-based service delivery strategy was found to be a feasible alternative to the resource-intensive doorstep system in urban Dhaka. It did not adversely affect programme performance and it allowed the needs of clients to be addressed holistically through a package of essential health and family planning services. PMID:11242821

Institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Sekela District, North West of Ethiopia: A community - based cross sectional study

PubMed Central

2012-01-01

Background Reduction of maternal mortality is a global priority particularly in developing countries including Ethiopia where maternal mortality ratio is one of the highest in the world. The key to reducing maternal mortality ratio and improving maternal health is increasing attendance by skilled health personnel throughout pregnancy and delivery. However, delivery service is significantly lower in Amhara Regional State, Ethiopia. Therefore, this study aimed to assess factors affecting institutional delivery service utilization among mothers who gave birth in the last 12 months in Sekela District, Amhara Region, Ethiopia. Methods Community-based cross-sectional study was conducted among mothers with birth in the last 12 months during August, 2010. Multistage sampling technique was used to select 371 participants. A pre tested and structured questionnaire was used to collect data. Bivariate and multivariate data analysis was performed using SPSS version 16.0 software. Results The study indicated that 12.1% of the mothers delivered in health facilities. Of 87.9% mothers who gave birth at home, 80.0% of them were assisted by family members and relatives. The common reasons for home delivery were closer attention from family members and relatives (60.9%), home delivery is usual practice (57.7%), unexpected labour (33.4%), not being sick or no problem at the time of delivery (21.6%) and family influence (14.4%). Being urban resident (AOR [95% CI] = 4.6 [1.91, 10.9]), ANC visit during last pregnancy (AOR [95% CI] = 4.26 [1.1, 16.4]), maternal education level (AOR [95%CI] =11.98 [3.36, 41.4]) and knowledge of mothers on pregnancy and delivery services (AOR [95% CI] = 2.97[1.1, 8.6]) had significant associations with institutional delivery service utilization. Conclusions Very low institutional delivery service utilization was observed in the study area. Majority of the births at home were assisted by family members and relatives. ANC visit and lack of knowledge on pregnancy and delivery services were found to be associated with delivery service utilization. Strategies with focus on increasing ANC uptake and building knowledge of the mothers and their partners would help to increase utilization of the service. Training and assigning skilled attendants at Health Posta level to provide skilled home delivery would improve utilization of the service. PMID:22849421

Institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Sekela District, north west of Ethiopia: a community-based cross sectional study.

PubMed

Teferra, Alemayehu Shimeka; Alemu, Fekadu Mazengia; Woldeyohannes, Solomon Meseret

2012-07-31

Reduction of maternal mortality is a global priority particularly in developing countries including Ethiopia where maternal mortality ratio is one of the highest in the world. The key to reducing maternal mortality ratio and improving maternal health is increasing attendance by skilled health personnel throughout pregnancy and delivery. However, delivery service is significantly lower in Amhara Regional State, Ethiopia. Therefore, this study aimed to assess factors affecting institutional delivery service utilization among mothers who gave birth in the last 12 months in Sekela District, Amhara Region, Ethiopia. Community-based cross-sectional study was conducted among mothers with birth in the last 12 months during August, 2010. Multistage sampling technique was used to select 371 participants. A pre tested and structured questionnaire was used to collect data. Bivariate and multivariate data analysis was performed using SPSS version 16.0 software. The study indicated that 12.1% of the mothers delivered in health facilities. Of 87.9% mothers who gave birth at home, 80.0% of them were assisted by family members and relatives. The common reasons for home delivery were closer attention from family members and relatives (60.9%), home delivery is usual practice (57.7%), unexpected labour (33.4%), not being sick or no problem at the time of delivery (21.6%) and family influence (14.4%). Being urban resident (AOR [95% CI] = 4.6 [1.91, 10.9]), ANC visit during last pregnancy (AOR [95% CI] = 4.26 [1.1, 16.4]), maternal education level (AOR [95%CI] =11.98 [3.36, 41.4]) and knowledge of mothers on pregnancy and delivery services (AOR [95% CI] = 2.97[1.1, 8.6]) had significant associations with institutional delivery service utilization. Very low institutional delivery service utilization was observed in the study area. Majority of the births at home were assisted by family members and relatives. ANC visit and lack of knowledge on pregnancy and delivery services were found to be associated with delivery service utilization. Strategies with focus on increasing ANC uptake and building knowledge of the mothers and their partners would help to increase utilization of the service. Training and assigning skilled attendants at Health Posta level to provide skilled home delivery would improve utilization of the service.

Business Models in Emerging Online Services

NASA Astrophysics Data System (ADS)

Lyons, Kelly; Playford, Corrie; Messinger, Paul R.; Niu, Run H.; Stroulia, Eleni

Due to advances in technology and the rapid growth of online services, a significant number of new and inventive web-based service models and delivery methods have been introduced. Although online resources and services are having an impact on more traditional service delivery mechanisms, it is not yet clear how these emerging mechanisms for online service delivery will result in profitable business models. In this paper, we consider emerging business models for online services and their implications for how services are delivered, used, and paid for.We demonstrate the changing roles of user / consumer and provider / seller. We also discuss the applicability of different business models for various domains.

Outcomes for Youth with Severe Emotional Disturbance: A Repeated Measures Longitudinal Study of a Wraparound Approach of Service Delivery in Systems of Care

ERIC Educational Resources Information Center

Painter, Kirstin

2012-01-01

Background: Systems of care is a family centered, strengths-based service delivery model for treating youth experiencing a serious emotional disturbance. Wraparound is the most common method of service delivery adopted by states and communities as a way to adhere to systems of care philosophy. Objective: The purpose of this study was to evaluate…

The use of reproductive healthcare at commune health stations in a changing health system in Vietnam.

PubMed

Ngo, Anh D; Hill, Peter S

2011-09-27

With health sector reform in Vietnam moving towards greater pluralism, commune health stations (CHSs) have been subject to growing competition from private health services and increasing numbers of patients bypassing CHSs for higher-level health facilities. This study describes the pattern of reproductive health (RH) and family planning (FP) service utilization among women at CHSs and other health facilities, and explores socio-demographic determinants of RH service utilization at the CHS level. This study was based on a cross-sectional survey conducted in Thua Thien Hue and Vinh Long provinces, using a multi-stage cluster sampling technique. Questionnaire-based interviews with 978 ever-married women at reproductive age provided data on socio-demographic characteristics, current use of FP methods, history of RH service use, and the health facility attended for their most recent services. Multiple logistic regression analyses were used to identify socio-demographic determinants of their use of CHS RH services. Eighty nine percent of ever-married women reported current use of birth control with 49% choosing intra-uterine device (IUD). Eighty nine percent of pregnant women attended facility-based antenatal care (ANC) with 62% having at least 3 check-ups during their latest pregnancy. Ninety one percent of mothers had their last delivery in a health facility. Seventy-one percent of respondents used CHS for IUD insertion, 55% for antenatal check-ups, and 77% gynecological examination. District and provincial/central hospitals dominated the provision of delivery service, used by 57% of mothers for their latest delivery. The percentage of women opting for private ANC services was reported at 35%, though the use of private delivery services was low (11%). Women who were farmers, earning a lower income, having more than 2 children, and living in a rural area were more likely than others to use ANC, delivery, and/or gynecological check-up services at the CHS. Women choice of providers for FP and RH services that help them plan and protect their pregnancies is driven by socio-economic factors. While the CHS retains significant utilization rates, it is under challenge by preferences for hospital-based delivery and the growing use of private ANC services.

Non-linear assessment and deficiency of linear relationship for healthcare industry

NASA Astrophysics Data System (ADS)

Nordin, N.; Abdullah, M. M. A. B.; Razak, R. C.

2017-09-01

This paper presents the development of the non-linear service satisfaction model that assumes patients are not necessarily satisfied or dissatisfied with good or poor service delivery. With that, compliment and compliant assessment is considered, simultaneously. Non-linear service satisfaction instrument called Kano-Q and Kano-SS is developed based on Kano model and Theory of Quality Attributes (TQA) to define the unexpected, hidden and unspoken patient satisfaction and dissatisfaction into service quality attribute. A new Kano-Q and Kano-SS algorithm for quality attribute assessment is developed based satisfaction impact theories and found instrumentally fit the reliability and validity test. The results were also validated based on standard Kano model procedure before Kano model and Quality Function Deployment (QFD) is integrated for patient attribute and service attribute prioritization. An algorithm of Kano-QFD matrix operation is developed to compose the prioritized complaint and compliment indexes. Finally, the results of prioritized service attributes are mapped to service delivery category to determine the most prioritized service delivery that need to be improved at the first place by healthcare service provider.

Standards for Libraries Within Regional Library Systems in Saskatchewan.

ERIC Educational Resources Information Center

Saskatchewan Library Association, Regina.

These quantitative standards for the delivery of library services to a dispersed population, which were developed by the Saskatchewan Library Association, are based on the decentralized delivery of library services backed up by the centralized provision of technical services, resource people, and special collections in Saskatchewan. The roles of…

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…

42 CFR 1003.101 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., such as a prospective payment system; and (b) In the case of a claim based on costs, any entry or...; or (4) Incentives given to individuals to promote the delivery of preventive care services where the delivery of such services is not tied (directly or indirectly) to the provision of other services...

42 CFR 1003.101 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., such as a prospective payment system; and (b) In the case of a claim based on costs, any entry or...; or (4) Incentives given to individuals to promote the delivery of preventive care services where the delivery of such services is not tied (directly or indirectly) to the provision of other services...

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.

School-based service delivery for homeless students: relevant laws and overcoming access barriers.

PubMed

Sulkowski, Michael L; Joyce-Beaulieu, Diana K

2014-11-01

Schools in the United States are facing a record number of homeless students. These students are highly at-risk for experiencing negative life outcomes, and they face considerable academic and social-emotional functional impairments. To help address the complex needs of homeless students, this article reviews the intersection of laws and practices that impact homeless students, as well as contemporary school-based service delivery efforts to support the academic and social-emotional needs of these students. In addition, this article also reviews several barriers to school-based service delivery for homeless students and ways to overcome these barriers. These barriers include confusion regarding consent and record-sharing procedures, ineffectively utilizing homeless liaisons, and misapplying tenants of Multitiered Systems of Support (MTSS), which is a school-based service-delivery framework that has been adopted by and implemented in many U.S. schools. Ultimately, this article aims to provide members of school communities with practical information that they can use to support the homeless youth they encounter and serve. (c) 2014 APA, all rights reserved.

Factors associated with institutional delivery service utilization in Ethiopia.

PubMed

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

2016-01-01

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. The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia. 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 I (2) test. 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. 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.

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

Health Care Delivery.

ERIC Educational Resources Information Center

Starfield, Barbara

1987-01-01

The article reviews emerging health care delivery options for handicapped children. Cost structures, quality of care, and future prospects are considered for Health Maintenance Organizations, Preferred Provider Organizations, Tax Supported Direct Service Programs, Hospital-Based Services, and Ambulatory Care Organizations. (Author/DB)

Enhancing palliative care delivery in a regional community in Australia.

PubMed

Phillips, Jane L; Davidson, Patricia M; Jackson, Debra; Kristjanson, Linda; Bennett, Margaret L; Daly, John

2006-08-01

Although access to palliative care is a fundamental right for people in Australia and is endorsed by government policy, there is often limited access to specialist palliative care services in regional, rural and remote areas. This article appraises the evidence pertaining to palliative care service delivery to inform a sustainable model of palliative care that meets the needs of a regional population on the mid-north coast of New South Wales. Expert consultation and an eclectic literature review were undertaken to develop a model of palliative care service delivery appropriate to the needs of the target population and resources of the local community. On the basis of this review, a local palliative care system that is based on a population-based approach to service planning and delivery, with formalized integrated network agreements and role delineation between specialist and generalist providers, has the greatest potential to meet the palliative care needs of this regional coastal community.

Health service delivery in China: a literature review.

PubMed

Eggleston, Karen; Ling, Li; Qingyue, Meng; Lindelow, Magnus; Wagstaff, Adam

2008-02-01

We report the results of a review of the Chinese- and English-language literatures on service delivery in China, asking how well China's health-care providers perform and what determines their performance. Although data and methodological limitations suggest caution in drawing conclusions, a critical reading of the available evidence suggests that current health service delivery in China leaves room for improvement, in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector or by simply encouraging providers -- public and private -- to compete with one another for individual patients. By contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid -- shifting away from fee-for-service and the distorted price schedule. Other elements of 'active purchasing' by insurers could further improve outcomes. Rigorous evaluations, based on richer micro-level data, could considerably strengthen the evidence base for service delivery policy in China.

The Clinical Delivery of Pharmacogenetic Testing Services: A Proposed Partnership between Genetic Counselors and Pharmacists

PubMed Central

Mills, Rachel; Haga, Susanne B.

2013-01-01

One of the basic questions in the early uses of pharmacogenetic (PGx) testing revolves around the clinical delivery of testing. Because multiple health professionals may play a role in the delivery of PGx testing, various clinical delivery models have begun to be studied. We propose that a partnership between genetic counselors and pharmacists can assist clinicians in the delivery of comprehensive PGx services. Based on their expert knowledge of pharmacokinetics and pharmacodynamics, pharmacists can facilitate the appropriate application of PGx test results to adjust medication use as warranted and act as a liaison to the healthcare team recommending changes in medication based on test results and patient input. Genetic counselors are well-trained in genetics as well as risk communication and counseling methodology, but have limited knowledge of pharmaceuticals. The complementary knowledge and skill set supports the partnership between genetic counselors and pharmacists to provide effective PGx testing services. PMID:23746189

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…

Consumer-Directed Goal Planning in the Delivery of Assistive Technology Services for People Who Are Ageing with Intellectual Disabilities

ERIC Educational Resources Information Center

Mirza, Mansha; Hammel, Joy

2009-01-01

Background: A consumer-directed service-delivery approach to assistive technology and environmental modification intervention was examined with people who were ageing with intellectual disabilities. Material and Methods: The intervention was based on a collaborative approach involving consumers, their social supports and service deliverers. Thirty…

Internet-Based Intervention Training for Parents of Young Children with Disabilities: A Promising Service-Delivery Model

ERIC Educational Resources Information Center

Meadan, Hedda; Daczewitz, Marcus E.

2015-01-01

Efficient early intervention (EI) services are required to serve the needs of young children with disabilities and the needs of their families. Effective EI includes family-centred practices, evidence-based interventions, parent involvement/training, and delivery in children's natural environments. Due to the challenges of providing…

Proposal of a service delivery integration index of home care for older persons: application in several European cities

PubMed Central

Henrard, Jean-Claude; Ankri, Joël; Frijters, Dinnus; Carpenter, Iain; Topinkova, Eva; Garms-Homolova, Vjenka; Finne-Soveri, Harriett; Sørbye, Liv Wergeland; Jónsson, Palmi V.; Ljunggren, Gunnar; Schroll, Marianne; Wagner, Cordula; Bernabei, Roberto

2006-01-01

Abstract Purpose To propose an integration index of home care delivery to older persons, to study its validity and to apply it to home care services of European cities. Theory Home care delivery integration was based on two dimensions referring to process-centred integration and organisational structure approach. Method Items considered as part of both dimensions according to an expert consensus (face validity) were extracted from a standardised questionnaire used in “Aged in Home care” (AdHoc) study to capture basic characteristics of home care services. Their summation leads to a services' delivery integration index. This index was applied to AdHoc services. A factor analysis was computed in order to empirically test the validity of the theoretical constructs. The plot of the settings was performed. Results Application of the index ranks home care services in four groups according to their score. Factor analysis identifies a first factor which opposes working arrangement within service to organisational structure bringing together provisions for social care. A second factor corresponds to basic nursing care and therapies. Internal consistency for those three domains ranges from 0.78 to 0.93. When plotting the different settings different models of service delivery appear. Conclusion The proposed index shows that behind a total score several models of care delivery are hidden. Comparison of service delivery integration should take into account this heterogeneity. PMID:17006549

Outplacement Services for Displaced Employees: Attitudes of Human Resource Managers Based on Differences in Internal and External Delivery

ERIC Educational Resources Information Center

Kilcrease, Kelly M.

2013-01-01

The results from a survey of 238 human resources executives from organizations that offer outplacement counseling (OPC) internally and 168 that offer it externally suggest that internal OPC delivery is inferior to external OPC delivery. The author found that most internal OPC organizations did not offer the 13 traditional OPC services, even when…

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.

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

Ethiopia is one of the six countries that contributes' to more than 50 % of worldwide maternal deaths. While it is revealed that delivery attended by skilled provider at health facility reduced maternal deaths, more than half of all births in Ethiopia takes place at home. According to EDHS 2011 report nine women in every ten deliver at home in Ethiopia. The situation is much worse in southern region. The aim of our study is to measure the prevalence and to identify factors associated with institutional delivery service utilization among childbearing mothers in Cheha District, SNNPR, Ethiopia. A community based cross sectional survey was conducted in Cheha District from Dec 22, 2012 to Jan 11, 2013. Multistage sampling method was employed and 816 women who gave birth within the past 2 years and lived in Cheha district for minimum of one year prior to the survey were involved in the study. Data was entered and analyzed using Epi Info Version 7 and SPSS Version 16. Frequencies and binary logistic regression were done. Factors affecting institutional delivery were determined using multivariate logistic regression. A total of 31 % of women gave birth to their last child at health facility. Place of residence, ability to afford for the whole process to get delivery service at health facility, traveling time that takes to reach to health institution which provides delivery service, husband's attitude towards institutional delivery, counseling about where to deliver during ANC visit and place of birth of the 2(nd) youngest child were found to have statistically significant association with institutional delivery. Institutional delivery is low in the study area. Access to health service was found to be the most important predictor of institutional delivery among others. Accessing health facility within reasonable travel time; providing health education and BCC services to husbands and the community at large on importance of using health institution for delivery service; 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.

Impact of mobile phone-based technology to improve health, population and nutrition services in Rural Bangladesh: a study protocol.

PubMed

Uddin, Jasim; Biswas, Tuhin; Adhikary, Gourab; Ali, Wazed; Alam, Nurul; Palit, Rajesh; Uddin, Nizam; Uddin, Aftab; Khatun, Fatema; Bhuiya, Abbas

2017-07-06

Mobile phone-based technology has been used in improving the delivery of healthcare services in many countries. However, data on the effects of this technology on improving primary healthcare services in resource-poor settings are limited. The aim of this study is to develop and test a mobile phone-based system to improve health, population and nutrition services in rural Bangladesh and evaluate its impact on service delivery. The study will use a quasi-experimental pre-post design, with intervention and comparison areas. Outcome indicators will include: antenatal care (ANC), delivery care, postnatal care (PNC), neonatal care, expanded programme on immunization (EPI) coverage, and contraceptive prevalence rate (CPR). The study will be conducted over a period of 30 months, using the existing health systems of Bangladesh. The intervention will be implemented through the existing service-delivery personnel at various primary-care levels, such as community clinic, union health and family welfare centre, and upazila health complex. These healthcare providers will be given mobile phones equipped with Apps for sending text and voice messages, along with the use of Internet and device for data-capturing. Training on handling of the Smartphones, data-capturing and monitoring will be given to selected service providers. They will also be trained on inputs, editing, verifying, and monitoring the outcome variables. Mobile phone-based technology has the potential to improve primary healthcare services in low-income countries, like Bangladesh. It is expected that our study will contribute to testing and developing a mobile phone-based intervention to improve the coverage and quality of services. The learning can be used in other similar settings in the low-and middle-income countries.

Distance from health facility and mothers' perception of quality related to skilled delivery service utilization in northern Ethiopia.

PubMed

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

2017-01-01

Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem.

Distance from health facility and mothers’ perception of quality related to skilled delivery service utilization in northern Ethiopia

PubMed Central

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

2017-01-01

Background Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. Subjects and methods A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). Results A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. Conclusion Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem. PMID:29042819

The use of reproductive healthcare at commune health stations in a changing health system in Vietnam

PubMed Central

2011-01-01

Background With health sector reform in Vietnam moving towards greater pluralism, commune health stations (CHSs) have been subject to growing competition from private health services and increasing numbers of patients bypassing CHSs for higher-level health facilities. This study describes the pattern of reproductive health (RH) and family planning (FP) service utilization among women at CHSs and other health facilities, and explores socio-demographic determinants of RH service utilization at the CHS level. Methods This study was based on a cross-sectional survey conducted in Thua Thien Hue and Vinh Long provinces, using a multi-stage cluster sampling technique. Questionnaire-based interviews with 978 ever-married women at reproductive age provided data on socio-demographic characteristics, current use of FP methods, history of RH service use, and the health facility attended for their most recent services. Multiple logistic regression analyses were used to identify socio-demographic determinants of their use of CHS RH services. Results Eighty nine percent of ever-married women reported current use of birth control with 49% choosing intra-uterine device (IUD). Eighty nine percent of pregnant women attended facility-based antenatal care (ANC) with 62% having at least 3 check-ups during their latest pregnancy. Ninety one percent of mothers had their last delivery in a health facility. Seventy-one percent of respondents used CHS for IUD insertion, 55% for antenatal check-ups, and 77% gynecological examination. District and provincial/central hospitals dominated the provision of delivery service, used by 57% of mothers for their latest delivery. The percentage of women opting for private ANC services was reported at 35%, though the use of private delivery services was low (11%). Women who were farmers, earning a lower income, having more than 2 children, and living in a rural area were more likely than others to use ANC, delivery, and/or gynecological check-up services at the CHS. Conclusions Women choice of providers for FP and RH services that help them plan and protect their pregnancies is driven by socio-economic factors. While the CHS retains significant utilization rates, it is under challenge by preferences for hospital-based delivery and the growing use of private ANC services. PMID:21943073

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.

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…

Comparing Service Delivery Models for Children with Developmental Delays in Canada: Adaptive and Maladaptive Behaviours, Parental Perceptions of Stress and of Care

ERIC Educational Resources Information Center

Sladeczek, Ingrid E.; Fontil, Laura; Miodrag, Nancy; Karagiannakis, Anastasia; Amar, Daniel; Amos, Janet

2017-01-01

This study compares two service delivery models (community-based and centre-based), examining them in light of children's adaptive and maladaptive behaviours, and parental perceptions of stress and of care. More specifically, parents of 96 children with developmental delays assessed their children's adaptive and maladaptive behaviours and rated…

Pregnant Women's Intentions and Subsequent Behaviors Regarding Maternal and Neonatal Service Utilization: Results from a Cohort Study in Nyanza Province, Kenya.

PubMed

Creanga, Andreea A; Odhiambo, George Awino; Odera, Benjamin; Odhiambo, Frank O; Desai, Meghna; Goodwin, Mary; Laserson, Kayla; Goldberg, Howard

2016-01-01

Higher use of maternal and neonatal health (MNH) services may reduce maternal and neonatal mortality in Kenya. This study aims to: 1) prospectively explore women's intentions to use MNH services (antenatal care, delivery in a facility, postnatal care, neonatal care) at <20 and 30-35 weeks' gestation and their actual use of these services; 2) identify predictors of intention-behavior discordance among women with positive service use intentions; 3) examine associations between place of delivery, women's reasons for choosing it, and birthing experiences. We used data from a 2012-2013 population-based cohort of pregnant women in the Demographic Surveillance Site in Nyanza province, Kenya. Of 1,056 women completing the study (89.1% response rate), 948 had live-births and 22 stillbirths, and they represent our analytic sample. Logistic regression analysis identified predictors of intention-behavior discordance regarding delivery in a facility and use of postnatal and neonatal care. At <20 and 30-35 weeks' gestation, most women intended to seek MNH services (≥93.9% and ≥87.5%, respectively, for all services assessed). Actual service use was high for antenatal (98.1%) and neonatal (88.5%) care, but lower for delivery in a facility (76.9%) and postnatal care (51.8%). Woman's age >35 and high-school education were significant predictors of intention-behavior discordance regarding delivery in a facility; several delivery-related factors were significantly associated with intention-behavior discordance regarding use of postnatal and neonatal care. Delivery facilities were chosen based on proximity to women's residence, affordability, and service quality; among women who delivered outside a health facility, 16.3% could not afford going to a facility. Good/very good birth experiences were reported by 93.6% of women who delivered in a facility and 32.6% of women who did not. We found higher MNH service utilization than previously documented in Nyanza province. Further increasing the number of facility deliveries and use of postnatal care may improve MNH in Kenya.

Family-centred care delivery: comparing models of primary care service delivery in Ontario.

PubMed

Mayo-Bruinsma, Liesha; Hogg, William; Taljaard, Monica; Dahrouge, Simone

2013-11-01

To determine whether models of primary care service delivery differ in their provision of family-centred care (FCC) and to identify practice characteristics associated with FCC. Cross-sectional study. Primary care practices in Ontario (ie, 35 salaried community health centres, 35 fee-for-service practices, 32 capitation-based health service organizations, and 35 blended remuneration family health networks) that belong to 4 models of primary care service delivery. A total of 137 practices, 363 providers, and 5144 patients. Measures of FCC in patient and provider surveys were based on the Primary Care Assessment Tool. Statistical analyses were conducted using linear mixed regression models and generalized estimating equations. Patient-reported FCC scores were high and did not vary significantly by primary care model. Larger panel size in a practice was associated with lower odds of patients reporting FCC. Provider-reported FCC scores were significantly higher in community health centres than in family health networks (P = .035). A larger number of nurse practitioners and clinical services on-site were both associated with higher FCC scores, while scores decreased as the number of family physicians in a practice increased and if practices were more rural. Based on provider and patient reports, primary care reform strategies that encourage larger practices and more patients per family physician might compromise the provision of FCC, while strategies that encourage multidisciplinary practices and a range of services might increase FCC.

Multidimensional Measurement of Household Water Poverty in a Mumbai Slum: Looking Beyond Water Quality.

PubMed

Subbaraman, Ramnath; Nolan, Laura; Sawant, Kiran; Shitole, Shrutika; Shitole, Tejal; Nanarkar, Mahesh; Patil-Deshmukh, Anita; Bloom, David E

2015-01-01

A focus on bacterial contamination has limited many studies of water service delivery in slums, with diarrheal illness being the presumed outcome of interest. We conducted a mixed methods study in a slum of 12,000 people in Mumbai, India to measure deficiencies in a broader array of water service delivery indicators and their adverse life impacts on the slum's residents. Six focus group discussions and 40 individual qualitative interviews were conducted using purposeful sampling. Quantitative data on water indicators-quantity, access, price, reliability, and equity-were collected via a structured survey of 521 households selected using population-based random sampling. In addition to negatively affecting health, the qualitative findings reveal that water service delivery failures have a constellation of other adverse life impacts-on household economy, employment, education, quality of life, social cohesion, and people's sense of political inclusion. In a multivariate logistic regression analysis, price of water is the factor most strongly associated with use of inadequate water quantity (≤20 liters per capita per day). Water service delivery failures and their adverse impacts vary based on whether households fetch water or have informal water vendors deliver it to their homes. Deficiencies in water service delivery are associated with many non-health-related adverse impacts on slum households. Failure to evaluate non-health outcomes may underestimate the deprivation resulting from inadequate water service delivery. Based on these findings, we outline a multidimensional definition of household "water poverty" that encourages policymakers and researchers to look beyond evaluation of water quality and health. Use of multidimensional water metrics by governments, slum communities, and researchers may help to ensure that water supplies are designed to advance a broad array of health, economic, and social outcomes for the urban poor.

Multidimensional Measurement of Household Water Poverty in a Mumbai Slum: Looking Beyond Water Quality

PubMed Central

Subbaraman, Ramnath; Nolan, Laura; Sawant, Kiran; Shitole, Shrutika; Shitole, Tejal; Nanarkar, Mahesh; Patil-Deshmukh, Anita; Bloom, David E.

2015-01-01

Objective A focus on bacterial contamination has limited many studies of water service delivery in slums, with diarrheal illness being the presumed outcome of interest. We conducted a mixed methods study in a slum of 12,000 people in Mumbai, India to measure deficiencies in a broader array of water service delivery indicators and their adverse life impacts on the slum’s residents. Methods Six focus group discussions and 40 individual qualitative interviews were conducted using purposeful sampling. Quantitative data on water indicators—quantity, access, price, reliability, and equity—were collected via a structured survey of 521 households selected using population-based random sampling. Results In addition to negatively affecting health, the qualitative findings reveal that water service delivery failures have a constellation of other adverse life impacts—on household economy, employment, education, quality of life, social cohesion, and people’s sense of political inclusion. In a multivariate logistic regression analysis, price of water is the factor most strongly associated with use of inadequate water quantity (≤20 liters per capita per day). Water service delivery failures and their adverse impacts vary based on whether households fetch water or have informal water vendors deliver it to their homes. Conclusions Deficiencies in water service delivery are associated with many non-health-related adverse impacts on slum households. Failure to evaluate non-health outcomes may underestimate the deprivation resulting from inadequate water service delivery. Based on these findings, we outline a multidimensional definition of household “water poverty” that encourages policymakers and researchers to look beyond evaluation of water quality and health. Use of multidimensional water metrics by governments, slum communities, and researchers may help to ensure that water supplies are designed to advance a broad array of health, economic, and social outcomes for the urban poor. PMID:26196295

Equity in access to maternal and child health services in five developing countries: what works.

PubMed

Talukder, M D Noorunnabi; Rob, Ubaidur

2010-01-01

People living in rural areas are yet to have equitable access to maternal and child health services in many developing countries. This article examines selected health service delivery models that improved access to services in five developing countries. The article is based on the review of background papers on Bangladesh, Pakistan, Cambodia, Ghana, and Tanzania, prepared as part of a multi-country study on health systems and maternal and child health. Findings suggest that equity in access to health services largely depends on a system that ensures a combination of facility-based service delivery and outreach services with a functioning referral network. A key factor is the availability of health workforce at the community level. Community-based deployment of service providers or recruitment and training of community health workers is critical in enhancing service coverage and linking local populations to a health facility. Incentive is necessary to keep community health workers' interest in providing services. However, health workforce alone cannot ensure good health outcomes. They must be embedded in a functioning service delivery network to transform structural inputs into outcomes. Moreover, local-level health systems should have the ability to allocate resources in strategic ways addressing the pressing health needs of the people.

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 abortion. However, to implement such directives leadership is required from Australian medical, nursing, midwifery and pharmacy practitioners, academic faculties and their associated professional associations. In addition, political will is needed to nationally decriminalise abortion and ensure dedicated public provision that is based on comprehensive models tailored for all populations.

TIDE: an intelligent home-based healthcare information & diagnostic environment.

PubMed

Abidi, S S

1999-01-01

The 21st century promises to usher in an era of Internet based healthcare services--Tele-Healthcare. Such services augur well with the on-going paradigm shift in healthcare delivery patterns, i.e. patient centred services as opposed to provider centred services and wellness maintenance as opposed to illness management. This paper presents a Tele-Healthcare info-structure TIDE--an 'intelligent' wellness-oriented healthcare delivery environment. TIDE incorporates two WWW-based healthcare systems: (1) AIMS (Automated Health Monitoring System) for wellness maintenance and (2) IDEAS (Illness Diagnostic & Advisory System) for illness management. Our proposal comes from an attempt to rethink the sources of possible leverage in improving healthcare; vis-à-vis the provision of a continuum of personalised home-based healthcare services that emphasise the role of the individual in self health maintenance.

A Systematic Review and Summarization of the Recommendations and Research Surrounding Curriculum-Based Measurement of Oral Reading Fluency (CBM-R) Decision Rules

ERIC Educational Resources Information Center

Ardoin, Scott P.; Christ, Theodore J.; Morena, Laura S.; Cormier, Damien C.; Klingbeil, David A.

2013-01-01

Research and policy have established that data are necessary to guide decisions within education. Many of these decisions are made within problem solving and response to intervention frameworks for service delivery. Curriculum-Based Measurement in Reading (CBM-R) is a widely used data collection procedure within those models of service delivery.…

78 FR 5780 - Agency Information Collection Activities: Proposed Collection, Comment Request: Generic Clearance...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-28

... could change significantly based on the collection method ultimately used in the research. Estimated..., Comment Request: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery... qualitative consumer and stakeholder feedback in an efficient, timely manner to facilitate service delivery...

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

PubMed Central

Osaro, Erhabor; Chima, Njemanze

2014-01-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the “engine room” of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness. PMID:25182941

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England.

PubMed

Osaro, Erhabor; Chima, Njemanze

2014-06-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the "engine room" of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

[Methods and Applications to estimate the conversion factor of Resource-Based Relative Value Scale for nurse-midwife's delivery service in the national health insurance].

PubMed

Kim, Jinhyun; Jung, Yoomi

2009-08-01

This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services. A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services. Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.

Evaluating a De-Centralized Regional Delivery System for Breast Cancer Screening and Patient Navigation for the Rural Underserved.

PubMed

Inrig, Stephen J; Tiro, Jasmin A; Melhado, Trisha V; Argenbright, Keith E; Craddock Lee, Simon J

2014-01-01

Providing breast cancer screening services in rural areas is challenging due to the fractured nature of healthcare delivery systems and complex reimbursement mechanisms that create barriers to access for the under- and uninsured. Interventions that reduce structural barriers to mammography, like patient navigation programs, are effective and recommended, especially for minority and underserved women. Although the literature on rural healthcare is significant, the field lacks studies of adaptive service delivery models and rigorous evaluation of evidence-based programs that facilitate routine screening and appropriate follow-up across large geographic areas. To better understand how to implement a decentralized regional delivery "hub & spoke" model for rural breast cancer screening and patient navigation, we have designed a rigorous, structured, multi-level and mixed-methods evaluation based on Glasgow's RE-AIM model (Reach, Effectiveness, Adoption, Implementation, and Maintenance). The program is comprised of three core components: 1) Outreach to underserved women by partnering with county organizations; 2) Navigation to guide patients through screening and appropriate follow-up; and 3) Centralized Reimbursement to coordinate funding for screening services through a central contract with Medicaid Breast and Cervical Cancer Services (BCCS). Using Glasgow's RE-AIM model, we will: 1) assess which counties have the resources and capacity to implement outreach and/or navigation components, 2) train partners in each county on how to implement components, and 3) monitor process and outcome measures in each county at regular intervals, providing booster training when needed. This evaluation strategy will elucidate how the heterogeneity of rural county infrastructure impacts decentralized service delivery as a navigation program expands. In addition to increasing breast cancer screening access, our model improves and maintains time to diagnostic resolution and facilitates timely referral to local cancer treatment services. We offer this evaluation approach as an exemplar for scientific methods to evaluate the translation of evidence-based federal policy into sustainable health services delivery in a rural setting.

Evaluating a De-Centralized Regional Delivery System for Breast Cancer Screening and Patient Navigation for the Rural Underserved

PubMed Central

Inrig, Stephen J.; Tiro, Jasmin A.; Melhado, Trisha V.; Argenbright, Keith E.; Craddock Lee, Simon J.

2017-01-01

Providing breast cancer screening services in rural areas is challenging due to the fractured nature of healthcare delivery systems and complex reimbursement mechanisms that create barriers to access for the under- and uninsured. Interventions that reduce structural barriers to mammography, like patient navigation programs, are effective and recommended, especially for minority and underserved women. Although the literature on rural healthcare is significant, the field lacks studies of adaptive service delivery models and rigorous evaluation of evidence-based programs that facilitate routine screening and appropriate follow-up across large geographic areas. Objectives To better understand how to implement a decentralized regional delivery “hub & spoke” model for rural breast cancer screening and patient navigation, we have designed a rigorous, structured, multi-level and mixed-methods evaluation based on Glasgow’s RE-AIM model (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Methods and Design The program is comprised of three core components: 1) Outreach to underserved women by partnering with county organizations; 2) Navigation to guide patients through screening and appropriate follow-up; and 3) Centralized Reimbursement to coordinate funding for screening services through a central contract with Medicaid Breast and Cervical Cancer Services (BCCS). Using Glasgow’s RE-AIM model, we will: 1) assess which counties have the resources and capacity to implement outreach and/or navigation components, 2) train partners in each county on how to implement components, and 3) monitor process and outcome measures in each county at regular intervals, providing booster training when needed. Discussion This evaluation strategy will elucidate how the heterogeneity of rural county infrastructure impacts decentralized service delivery as a navigation program expands. In addition to increasing breast cancer screening access, our model improves and maintains time to diagnostic resolution and facilitates timely referral to local cancer treatment services. We offer this evaluation approach as an exemplar for scientific methods to evaluate the translation of evidence-based federal policy into sustainable health services delivery in a rural setting. PMID:28713882

Exploiting Domain Knowledge to Forecast Heating Oil Consumption

NASA Astrophysics Data System (ADS)

Corliss, George F.; Sakauchi, Tsuginosuke; Vitullo, Steven R.; Brown, Ronald H.

2011-11-01

The GasDay laboratory at Marquette University provides forecasts of energy consumption. One such service is the Heating Oil Forecaster, a service for a heating oil or propane delivery company. Accurate forecasts can help reduce the number of trucks and drivers while providing efficient inventory management by stretching the time between deliveries. Accurate forecasts help retain valuable customers. If a customer runs out of fuel, the delivery service incurs costs for an emergency delivery and often a service call. Further, the customer probably changes providers. The basic modeling is simple: Fit delivery amounts sk to cumulative Heating Degree Days (HDDk = Σmax(0,60 °F—daily average temperature)), with wind adjustment, for each delivery period: sk≈ŝk = β0+β1HDDk. For the first few deliveries, there is not enough data to provide a reliable estimate K = 1/β1 so we use Bayesian techniques with priors constructed from historical data. A fresh model is trained for each customer with each delivery, producing daily consumption forecasts using actual and forecast weather until the next delivery. In practice, a delivery may not fill the oil tank if the delivery truck runs out of oil or the automatic shut-off activates prematurely. Special outlier detection and recovery based on domain knowledge addresses this and other special cases. The error at each delivery is the difference between that delivery and the aggregate of daily forecasts using actual weather since the preceding delivery. Out-of-sample testing yields MAPE = 21.2% and an average error of 6.0% of tank capacity for Company A. The MAPE and an average error as a percentage of tank capacity for Company B are 31.5 % and 6.6 %, respectively. One heating oil delivery company who uses this forecasting service [1] reported instances of a customer running out of oil reduced from about 250 in 50,000 deliveries per year before contracting for our service to about 10 with our service. They delivered slightly more oil with 20 % fewer trucks and drivers, citing 250,000 annual savings in operational costs.

A multi-method review of home-based chemotherapy.

PubMed

Evans, J M; Qiu, M; MacKinnon, M; Green, E; Peterson, K; Kaizer, L

2016-09-01

This study summarises research- and practice-based evidence on home-based chemotherapy, and explores existing delivery models. A three-pronged investigation was conducted consisting of a literature review and synthesis of 54 papers, a review of seven home-based chemotherapy programmes spanning four countries, and two case studies within the Canadian province of Ontario. The results support the provision of home-based chemotherapy as a safe and patient-centred alternative to hospital- and outpatient-based service. This paper consolidates information on home-based chemotherapy programmes including services and drugs offered, patient eligibility criteria, patient views and experiences, delivery structures and processes, and common challenges. Fourteen recommendations are also provided for improving the delivery of chemotherapy in patients' homes by prioritising patient-centredness, provider training and teamwork, safety and quality of care, and programme management. The results of this study can be used to inform the development of an evidence-informed model for the delivery of chemotherapy and related care, such as symptom management, in patients' homes. © 2015 John Wiley & Sons Ltd.

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…

Community-Based Occupational Therapy Services for Children: A Quebec Survey on Service Delivery

ERIC Educational Resources Information Center

Cotellesso, Annie; Mazer, Barbara; Majnemer, Annette

2009-01-01

Community-based occupational therapy (OT) services are intended to promote social integration and minimize disability. The objective of this study was to describe community-based OT services for children in the province of Quebec, Canada. Specific aims included (a) to determine the proportion of Centres Locaux de Services Communautaires (CLSCs)…

How do we capture the emergency nurse practitioners' contribution to value in health service delivery?

PubMed

Jennings, Natasha; Lutze, Matthew; Clifford, Stuart; Maw, Michael

2017-03-01

The emergency nurse practitioner is now a well established and respected member of the healthcare team. Evaluation of the role has focused on patient safety, effectiveness and quality of care outcomes. Comparisons of the role continue to focus on cost, with findings based on incomplete and almost impossible to define, recognition of contribution to service delivery by paralleled practitioners. Currently there is no clear definition as to how nurse practitioners contribute to value in health service delivery. Robust and rigorous research needs to be commissioned taking into consideration the unique hybrid nature of the emergency nurse practitioner role and focusing on the value they contribute to health care delivery.

Facilitators and barriers of implementing and delivering social prescribing services: a systematic review.

PubMed

Pescheny, Julia Vera; Pappas, Yannis; Randhawa, Gurch

2018-02-07

Social Prescribing is a service in primary care that involves the referral of patients with non-clinical needs to local services and activities provided by the third sector (community, voluntary, and social enterprise sector). Social Prescribing aims to promote partnership working between the health and the social sector to address the wider determinants of health. To date, there is a weak evidence base for Social Prescribing services. The objective of the review was to identify factors that facilitate and hinder the implementation and delivery of SP services based in general practice involving a navigator. We searched eleven databases, the grey literature, and the reference lists of relevant studies to identify the barriers and facilitators to the implementation and delivery of Social Prescribing services in June and July 2016. Searches were limited to literature written in English. No date restrictions were applied. Findings were synthesised narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. Eight studies were included in the review. The synthesis identified a range of factors that facilitate and hinder the implementation and delivery of SP services. Facilitators and barriers were related to: the implementation approach, legal agreements, leadership, management and organisation, staff turnover, staff engagement, relationships and communication between partners and stakeholders, characteristics of general practices, and the local infrastructure. The quality of most included studies was poor and the review identified a lack of published literature on factors that facilitate and hinder the implementation and delivery of Social Prescribing services. The review identified a range of factors that facilitate and hinder the implementation and delivery of Social Prescribing services. Findings of this review provide an insight for commissioners, managers, and providers to guide the implementation and delivery of future Social Prescribing services. More high quality research and transparent reporting of findings is needed in this field.

The determinations of remote sensing satellite data delivery service quality: A positivistic case study in Chinese context

NASA Astrophysics Data System (ADS)

Jin, Jiahua; Yan, Xiangbin; Tan, Qiaoqiao; Li, Yijun

2014-03-01

With the development of remote sensing technology, remote-sensing satellite has been widely used in many aspects of national construction. Big data with different standards and massive users with different needs, make the satellite data delivery service to be a complex giant system. How to deliver remote-sensing satellite data efficiently and effectively is a big challenge. Based on customer service theory, this paper proposes a hierarchy conceptual model for examining the determinations of remote-sensing satellite data delivery service quality in the Chinese context. Three main dimensions: service expectation, service perception and service environment, and 8 sub-dimensions are included in the model. Large amount of first-hand data on the remote-sensing satellite data delivery service have been obtained through field research, semi-structured questionnaire and focused interview. A positivist case study is conducted to validate and develop the proposed model, as well as to investigate the service status and related influence mechanisms. Findings from the analysis demonstrate the explanatory validity of the model, and provide potentially helpful insights for future practice.

Factors associated with Institutional delivery service utilization among mothers in Bahir Dar City administration, Amhara region: a community based cross sectional study

PubMed Central

2014-01-01

Background High maternal mortality is a continued challenge for the achievement of the fifth millennium development goal in Sub-Saharan African countries including Ethiopia. Although institutional delivery service utilization ensures safe birth and a key to reduce maternal mortality, interventions at the community and/or institutions were unsatisfactorily reduced maternal mortality. Institutional delivery service utilization is affected by the interaction of personal, socio-cultural, behavioral and institutional factors. Therefore this study was designed to assess factors associated with institutional delivery service use among mothers in Bahir Dar city administration. Methods A community based cross sectional study was conducted in Bahir Dar City administration Northwest of Addis Ababa, Ethiopia. Four hundred eighty four mothers were included in the study. Data were collected by trained female data collectors. Descriptive statistics, binary and multivariable logistic regression analyses were computed. Statistical significance was considered at p < 0.05 and the strength of statistical association was assessed by odds ratios (OR) with 95% confidence intervals. Result In this study, 78.8% of women gave birth to their current child at health institution. The multivariable logistic regression showed that, attending primary education (AOR = 4.7[95% CI:1.3-16.7], secondary education (AOR = 3.5[95% CI:1.1-10.7]), age at first marriage; first time marriage at 15–19 years (AOR = 5.4[95% CI:2.0-15.0]) and first time marriage at 20–24 years (AOR = 5.0[95% CI:1.5-16.8] and gestational age at first ANC visit (first trimester) (AOR = 5.3[1.3-22.2]) and second trimester (AOR = 2.8[95% CI:0.7-11.]) were independent factors affecting institutional delivery service utilization. Conclusion In this study, institutional delivery service utilization is optimal, urban mothers were more likely to practice institutional delivery. This study indicated that age at first marriage, educational status of the women and gestational age at first ANC visit are independent predictors of delivery service utilization. Hence, intensifying education for women and behavior change communication (BCC) interventions to increase early initiation and up-take of ANC service use in the first trimester and delaying marriage are recommended to promote institutional delivery service utilization. PMID:24629278

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

PubMed Central

2013-01-01

Background 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. Methods 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. Results 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. Conclusion 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 men, exploring promotion of joint HIV testing and counselling, staff training, and design of couple friendly antenatal and delivery units. PMID:23800139

Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter?

PubMed Central

2013-01-01

Background As health systems evolve, it is essential to evaluate their impact on the delivery of health services to socially disadvantaged populations. We evaluated the delivery of primary health services for different socio-economic groups and assessed the performance of different organizational models in terms of equality of health care delivery in Ontario, Canada. Methods Cross sectional study of 5,361 patients receiving care from primary care practices using Capitation, Salaried or Fee-For-Service remuneration models. We assessed self-reported health status of patients, visit duration, number of visits per year, quality of health service delivery, and quality of health promotion. We used multi-level regressions to study service delivery across socio-economic groups and within each delivery model. Identified disparities were further analysed using a t-test to determine the impact of service delivery model on equity. Results Low income individuals were more likely to be women, unemployed, recent immigrants, and in poorer health. These individuals were overrepresented in the Salaried model, reported more visits/year across all models, and tended to report longer visits in the Salaried model. Measures of primary care services generally did not differ significantly between low and higher income/education individuals; when they did, the difference favoured better service delivery for at-risk groups. At-risk patients in the Salaried model were somewhat more likely to report health promotion activities than patients from Capitation and Fee-For-Service models. At-risk patients from Capitation models reported a smaller increase in the number of additional clinic visits/year than Fee-For-Service and Salaried models. At-risk patients reported better first contact accessibility than their non-at-risk counterparts in the Fee-For-Service model only. Conclusions Primary care service measures did not differ significantly across socio-economic status or primary care delivery models. In Ontario, capitation-based remuneration is age and sex adjusted only. Patients of low socio-economic status had fewer additional visits compared to those with high socio-economic status under the Capitation model. This raises the concern that Capitation may not support the provision of additional care for more vulnerable groups. Regions undertaking primary care model reforms need to consider the potential impact of the changes on the more vulnerable populations. PMID:24341530

Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter?

PubMed

Dahrouge, Simone; Hogg, William; Ward, Natalie; Tuna, Meltem; Devlin, Rose Anne; Kristjansson, Elizabeth; Tugwell, Peter; Pottie, Kevin

2013-12-17

As health systems evolve, it is essential to evaluate their impact on the delivery of health services to socially disadvantaged populations. We evaluated the delivery of primary health services for different socio-economic groups and assessed the performance of different organizational models in terms of equality of health care delivery in Ontario, Canada. Cross sectional study of 5,361 patients receiving care from primary care practices using Capitation, Salaried or Fee-For-Service remuneration models. We assessed self-reported health status of patients, visit duration, number of visits per year, quality of health service delivery, and quality of health promotion. We used multi-level regressions to study service delivery across socio-economic groups and within each delivery model. Identified disparities were further analysed using a t-test to determine the impact of service delivery model on equity. Low income individuals were more likely to be women, unemployed, recent immigrants, and in poorer health. These individuals were overrepresented in the Salaried model, reported more visits/year across all models, and tended to report longer visits in the Salaried model. Measures of primary care services generally did not differ significantly between low and higher income/education individuals; when they did, the difference favoured better service delivery for at-risk groups. At-risk patients in the Salaried model were somewhat more likely to report health promotion activities than patients from Capitation and Fee-For-Service models. At-risk patients from Capitation models reported a smaller increase in the number of additional clinic visits/year than Fee-For-Service and Salaried models. At-risk patients reported better first contact accessibility than their non-at-risk counterparts in the Fee-For-Service model only. Primary care service measures did not differ significantly across socio-economic status or primary care delivery models. In Ontario, capitation-based remuneration is age and sex adjusted only. Patients of low socio-economic status had fewer additional visits compared to those with high socio-economic status under the Capitation model. This raises the concern that Capitation may not support the provision of additional care for more vulnerable groups. Regions undertaking primary care model reforms need to consider the potential impact of the changes on the more vulnerable populations.

Exploration of the administrative aspects of the delivery of home health care services: a qualitative study.

PubMed

Shahsavari, Hooman; Nasrabadi, Alireza Nikbakht; Almasian, Mohammad; Heydari, Heshmatolah; Hazini, Abdolrahim

2018-01-01

Because of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task. The purpose of this study was to explore the administrative aspects of the delivery of home health care services. This qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method. 23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories. Health policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.

Web-based data delivery services in support of disaster-relief applications

USGS Publications Warehouse

Jones, Brenda K.; Risty, Ron R.; Buswell, M.

2003-01-01

The U.S. Geological Survey Earth Resources Observation Systems Data Center responds to emergencies in support of various government agencies for human-induced and natural disasters. This response consists of satellite tasking and acquisitions, satellite image registrations, disaster-extent maps analysis and creation, base image provision and support, Web-based mapping services for product delivery, and predisaster and postdisaster data archiving. The emergency response staff are on call 24 hours a day, 7 days a week, and have access to many commercial and government satellite and aerial photography tasking authorities. They have access to value-added data processing and photographic laboratory services for off-hour emergency requests. They work with various Federal agencies for preparedness planning, which includes providing base imagery. These data may include digital elevation models, hydrographic models, base satellite images, vector data layers such as roads, aerial photographs, and other predisaster data. These layers are incorporated into a Web-based browser and data delivery service that is accessible either to the general public or to select customers. As usage declines, the data are moved to a postdisaster nearline archive that is still accessible, but not in real time.

Degree of Fit: University Students in Paid Employment, Service Delivery and Technology

ERIC Educational Resources Information Center

Anderson, Marilyn J.

2006-01-01

This study examines the ease of, and proficiency in, accessing web based technology, and the convenience (or otherwise) of service delivery in the facilitation of combining study with paid work for undergraduate students of James Cook University (JCU), Cairns Campus, Far North Queensland. Considering that the typical new millennium student is…

Delivery cost of human papillomavirus vaccination of young adolescent girls in Peru, Uganda and Viet Nam.

PubMed

Levin, Carol E; Van Minh, Hoang; Odaga, John; Rout, Swampa Sarit; Ngoc, Diep Nguyen Thi; Menezes, Lysander; Araujo, Maria Ana Mendoza; LaMontagne, D Scott

2013-08-01

To estimate the incremental delivery cost of human papillomavirus (HPV) vaccination of young adolescent girls in Peru, Uganda and Viet Nam. Data were collected from a sample of facilities that participated in five demonstration projects for hpv vaccine delivery: school-based delivery was used in Peru, Uganda and Viet Nam; health-centre-based delivery was also used in Viet Nam; and integrated delivery, which involved existing health services, was also used in Uganda. Microcosting methods were used to guide data collection on the use of resources (i.e. staff, supplies and equipment) and data were obtained from government, demonstration project and health centre administrative records. Delivery costs were expressed in 2009 United States dollars (US$). Exclusively project-related expenses and the cost of the vaccine were excluded. The economic delivery cost per vaccine dose ranged from US$ 1.44 for integrated outreach in Uganda to US$ 3.88 for school-based delivery in Peru. In Viet Nam, the lowest cost per dose was US$ 1.92 for health-centre-based delivery. Cost profiles revealed that, in general, the largest contributing factors were project start-up costs and recurrent personnel costs. The delivery cost of HPV vaccine was higher than published costs for traditional vaccines recommended by the Expanded Programme on Immunization (EPI). The cost of delivering HPV vaccine to young adolescent girls in Peru, Uganda and Viet Nam was higher than that for vaccines currently in the EPI schedule. The cost per vaccine dose was lower when delivery was integrated into existing health services.

Policies and Practices in the Delivery of HIV Services in Correctional Agencies and Facilities: Results from a Multi-Site Survey

PubMed Central

Belenko, Steven; Hiller, Matthew; Visher, Christy; Copenhaver, Michael; O’Connell, Daniel; Burdon, William; Pankow, Jennifer; Clarke, Jennifer; Oser, Carrie

2013-01-01

HIV risk is disproportionately high among incarcerated individuals. Corrections agencies have been slow to implement evidence-based guidelines and interventions for HIV prevention, testing, and treatment. The emerging field of implementation science focuses on organizational interventions to facilitate adoption and implementation of evidence-based practices. A survey of among CJ-DATS correctional agency partners revealed that HIV policies and practices in prevention, detection and medical care varied widely, with some corrections agencies and facilities closely matching national guidelines and/or implementing evidence-based interventions. Others, principally attributed to limited resources, had numerous gaps in delivery of best HIV service practices. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery gaps in corrections. PMID:24078624

Skilled delivery service utilization and its association with the establishment of Women's Health Development Army in Yeky district, South West Ethiopia: a multilevel analysis.

PubMed

Negero, Melese Girmaye; Mitike, Yifru Berhan; Worku, Abebaw Gebeyehu; Abota, Tafesse Lamaro

2018-01-30

Because of the unacceptably high maternal and perinatal morbidity and mortality, the government of Ethiopia has established health extension program with a community-based network involving health extension workers (HEWs) and a community level women organization which is known as "Women's Health Development Army" (WHDA). Currently, the HEWs and WHDA network is the approach preferred by the government to register pregnant women and encourage them to link in the healthcare system. However, its association with skilled delivery service utilization is not well known. A community-based cross-sectional study was conducted from January to February 2015. Within 380 clusters of WHDA, a total of 748 reproductive-age women who gave birth in 1 year preceding the study, were included using multistage sampling technique. The data were entered into EPI info version 7 statistical software and exported to STATA version 11 for analysis. Multilevel analysis technique was applied to check for an association of selected variables with a utilization of skilled delivery service. About 45% of women have received skilled delivery care. A significant heterogeneity was observed between "Women's Health Development Teams (clusters)" for skilled delivery care service utilization which explains about 62% of the total variation. Individual-level predictors including urban residence [AOR (95% CI) 35.10 (4.62, 266.52)], previous exposure of complications [AOR (95% CI) 3.81 (1.60, 9.08)], at least four ANC visits [AOR (95% CI) 7.44 (1.48, 37.42)] and preference of skilled personnel [AOR (95% CI) 8.11 (2.61, 25.15)] were significantly associated with skilled delivery service use. Among cluster level variables, the distance of clusters within 2 km radius from the nearest health facility was significantly associated [AOR (95% CI) 6.03 (1.92, 18.93)] with skilled delivery service utilization. In this study, significant variation among clusters of WHDA was observed. Both individual and cluster level variables were identified to predict skilled delivery service utilization. Encouraging women to have frequent ANC visits (- 4 and above), enhancing awareness creation towards the delivery care attendance, constructing more health facilities and roads in hard to reach areas and establishing telemedicine services are recommended.

Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study

PubMed Central

Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele

2016-01-01

Introduction The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones. Methods A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 –April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively. Result Only 38% of study participants delivered the index child at health facility. Husband’s educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery. Conclusion The use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization. PMID:26986563

Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study.

PubMed

Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele

2016-01-01

The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones. A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 -April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively. Only 38% of study participants delivered the index child at health facility. Husband's educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery. The use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization.

Trends in inequalities in utilization of reproductive health services from 2000 to 2011 in Vietnam.

PubMed

Duc, Nguyen Huu Chau; Nakamura, Keiko; Kizuki, Masashi; Seino, Kaoruko; Rahman, Mosiur

2015-01-01

This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household's ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. Significant increase in overall utilization was observed in all indicators (all p < 0.001). The concentration indices were 0.19 in 2000 and 0.06 in 2011 for antenatal care, 0.10 in 2000 and 0.06 in 2011 for tetanus vaccination, 0.23 in 2000 and 0.08 in 2011 for skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery had been reduced.

Mapping the ecosystem service delivery chain: Capacity, flow, and demand pertaining to aesthetic experiences in mountain landscapes.

PubMed

Egarter Vigl, Lukas; Depellegrin, Daniel; Pereira, Paulo; de Groot, Rudolf; Tappeiner, Ulrike

2017-01-01

Accounting for the spatial connectivity between the provision of ecosystem services (ES) and their beneficiaries (supply-benefit chain) is fundamental to understanding ecosystem functioning and its management. However, the interrelationships of the specific chain links within ecosystems and the actual benefits that flow from natural landscapes to surrounding land have rarely been analyzed. We present a spatially explicit model for the analysis of one cultural ecosystem service (aesthetic experience), which integrates the complete ecosystem service delivery chain for Puez-Geisler Nature Park (Italy): (1) The potential service stock (ES capacity) relies on an expert-based land use ranking matrix, (2) the actual supply (ES flow) is based on visibility properties of observation points along recreational routes, (3) the beneficiaries of the service (ES demand) are derived from socioeconomic data as a measure of the visitation rate to the recreation location, and (4) the supply-demand relationship (ES budget) addresses the spatially explicit oversupply and undersupply of ES. The results indicate that potential ES stocks are substantially higher in core and buffer zones of protected areas than in surrounding land owing to the specific landscape composition. ES flow maps reveal service delivery to 80% of the total area studied, with the highest actual service supply to locations with long and open vistas. ES beneficiary analyses show the highest demand for aesthetic experiences in all-season tourist destinations like Val Badia and Val Gardena, where both recreational amenity and overnight stays are equally high. ES budget maps identify ES hot and cold spots in terms of ES delivery, and they highlight ES undersupply in nature protection buffer zones although they are characterized by highest ES capacity. We show how decision/policy makers can use the presented methodology to plan landscape protection measures and develop specific regulation strategies for visitors based on the ES delivery chain concept. Copyright © 2016 Elsevier B.V. All rights reserved.

Vision and Reality for Technology-Based Delivery Systems in Postsecondary Education.

ERIC Educational Resources Information Center

Mingle, James R.

This paper explores the implications of technological advancement and telecommunications services on postsecondary education, especially in relation to educational effectiveness, costs, increasing deregulation, and financing. Four scenarios illustrate different educational delivery modes. Common elements of educational delivery systems of the…

Impact of free delivery policy on utilization of maternal health services in county referral hospitals in Kenya.

PubMed

Njuguna, John; Kamau, Njoroge; Muruka, Charles

2017-06-21

Kenya has a high maternal mortality rate. Provision of skilled delivery plays a major role in reducing maternal mortality. Cost is a hindrance to the utilization of skilled delivery. The Government of Kenya introduced a policy of free delivery services in government facilities beginning June 2013. We sought to determine the impact of this intervention on facility based deliveries in Kenya. We compared deliveries and antenatal attendance in 47 county referral hospitals and 30 low cost private hospitals not participating in the free delivery policy for 2013 and 2014 respectively. The data was extracted from the Kenya Health Information System. Multiple regression was done to assess factors influencing increase in number of deliveries among the county referral hospitals. The number of deliveries and antenatal attendance increased by 26.8% and 16.2% in county referral hospitals and decreased by 11.9% and 5.4% respectively in low cost private hospitals. Increase in deliveries among county referral hospitals was influenced by population size of county and type of county referral hospital. Counties with level 5 hospitals recorded more deliveries compared to those with level 4 hospitals. This intervention increased the number of facility based deliveries. Policy makers may consider incorporating low cost private hospitals so as to increase the coverage of this intervention.

Expansion in the private sector provision of institutional delivery services and horizontal equity: evidence from Nepal and Bangladesh

PubMed Central

Hotchkiss, David R; Godha, Deepali; Do, Mai

2014-01-01

Wealth-related inequity in the use of maternal healthcare services continues to be a substantial problem in most low- and middle-income countries. One strategic approach to increase the use of appropriate maternal healthcare services is to encourage the expansion of the role of the private sector. However, critics of such an approach argue that increasing the role of the private sector will lead to increased inequity in the use of maternal healthcare services. This article explores this issue in two South Asian countries that have traditionally had high rates of maternal mortality—Nepal and Bangladesh. The study is based on multiple rounds of nationally representative household survey data collected in Nepal and Bangladesh from 1996 to 2011. The methodology involves estimating a concentration index for each survey to assess changes in wealth-related inequity in the use of institutional delivery assistance over time. The results of the study suggest that the expansion of private sector supply of institutional-based delivery services in Nepal and Bangladesh has not led to increased horizontal inequity. In fact, in both countries, inequity was shown to have decreased over the study period. The study findings also suggest that the provision of government delivery services to the poor protects against increased wealth-related inequity in service use. PMID:25012794

Variations in the implementation and characteristics of chiropractic services in VA.

PubMed

Lisi, Anthony J; Khorsan, Raheleh; Smith, Monica M; Mittman, Brian S

2014-12-01

In 2004, the US Department of Veterans Affairs expanded its delivery of chiropractic care by establishing onsite chiropractic clinics at select facilities across the country. Systematic information regarding the planning and implementation of these clinics and describing their features and performance is lacking. To document the planning, implementation, key features and performance of VA chiropractic clinics, and to identify variations and their underlying causes and key consequences as well as their implications for policy, practice, and research on the introduction of new clinical services into integrated health care delivery systems. Comparative case study of 7 clinics involving site visit-based and telephone-based interviews with 118 key stakeholders, including VA clinicians, clinical leaders and administrative staff, and selected external stakeholders, as well as reviews of key documents and administrative data on clinic performance and service delivery. Interviews were recorded, transcribed, and analyzed using a mixed inductive (exploratory) and deductive approach. Interview data revealed considerable variations in clinic planning and implementation processes and clinic features, as well as perceptions of clinic performance and quality. Administrative data showed high variation in patterns of clinic patient care volume over time. A facility's initial willingness to establish a chiropractic clinic, along with a higher degree of perceived evidence-based and collegial attributes of the facility chiropractor, emerged as key factors associated with higher and more consistent delivery of chiropractic services and higher perceived quality of those services.

Is there any role for community involvement in the community-based health planning and services skilled delivery program in rural Ghana?

PubMed

Sakeah, Evelyn; McCloskey, Lois; Bernstein, Judith; Yeboah-Antwi, Kojo; Mills, Samuel; Doctor, Henry V

2014-08-11

In Ghana, between 1,400 and 3,900 women and girls die annually due to pregnancy related complications and an estimated two-thirds of these deaths occur in late pregnancy through to 48 hours after delivery. The Ghana Health Service piloted a strategy that involved training Community Health Officers (CHOs) as midwives to address the gap in skilled attendance in rural Upper East Region (UER). CHO-midwives collaborated with community members to provide skilled delivery services in rural areas. This paper presents findings from a study designed to assess the extent to which community residents and leaders participated in the skilled delivery program and the specific roles they played in its implementation and effectiveness. We employed an intrinsic case study design with a qualitative methodology. We conducted 29 in-depth interviews with health professionals and community stakeholders. We used a random sampling technique to select the CHO-midwives in three Community-based Health Planning and Services (CHPS) zones for the interviews and a purposive sampling technique to identify and interview District Directors of Health Services from the three districts, the Regional Coordinator of the CHPS program and community stakeholders. Community members play a significant role in promoting skilled delivery care in CHPS zones in Ghana. We found that community health volunteers and traditional birth attendants (TBAs) helped to provide health education on skilled delivery care, and they also referred or accompanied their clients for skilled attendants at birth. The political authorities, traditional leaders, and community members provide resources to promote the skilled delivery program. Both volunteers and TBAs are given financial and non-financial incentives for referring their clients for skilled delivery. However, inadequate transportation, infrequent supply of drugs, attitude of nurses remains as challenges, hindering women accessing maternity services in rural areas. Mutual collaboration and engagement is possible between health professionals and community members for the skilled delivery program. Community leaders, traditional and political leaders, volunteers, and TBAs have all been instrumental to the success of the CHPS program in the UER, each in their unique way. However, there are problems confronting the program and we have provided recommendations to address these challenges.

Utilisation of health services and the poor: deconstructing wealth-based differences in facility-based delivery in the Philippines.

PubMed

Hodge, Andrew; Firth, Sonja; Bermejo, Raoul; Zeck, Willibald; Jimenez-Soto, Eliana

2016-07-06

Despite achieving some success, wealth-related disparities in the utilisation of maternal and child health services persist in the Philippines. The aim of this study is to decompose the principal factors driving the wealth-based utilisation gap. Using national representative data from the 2013 Philippines Demographic and Health Survey, we examine the extent overall differences in the utilisation of maternal health services can be explained by observable factors. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect of differences in measurable characteristics on the wealth-based coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was respectively 41.1 % and 74.6 % for poor and non-poor households. Between 67 and 69 % of the wealth-based coverage gap was explained by differences in observed characteristics. After controlling for factors characterising the socioeconomic status of the household (i.e. the mothers' and her partners' education and occupation), the birth order of the child was the major factor contributing to the disparity. Mothers' religion and the subjective distance to the health facility were also noteworthy. This study has found moderate wealth-based disparities in the utilisation of institutional delivery in the Philippines. The results confirm the importance of recent efforts made by the Philippine government to implement equitable, pro-poor focused health programs in the most deprived geographic areas of the country. The importance of addressing the social determinants of health, particularly education, as well as developing and implementing effective strategies to encourage institutional delivery for higher order births, should be prioritised.

Toward Effective Science Delivery among Recreation Personnel

ERIC Educational Resources Information Center

Courtney, Arielle; Schneider, Ingrid E.

2016-01-01

Effective science delivery to practitioners can improve recreation experiences and environmental educational outcomes. This project explored U.S. Department of Agriculture-Forest Service recreation personnel's research-based information sources, constraints to access and use of research, and opinions about how to improve science delivery to…

Identifying Continuous Quality Improvement Priorities in Maternal, Infant, and Early Childhood Home Visiting.

PubMed

Preskitt, Julie; Fifolt, Matthew; Ginter, Peter M; Rucks, Andrew; Wingate, Martha S

2016-01-01

The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, were the highest ranked. The Q-sort exercise allowed home visitors an opportunity to examine priorities within their service delivery model as well as for the overall First Teacher HV system. Participants engaged in meaningful discussions regarding how and why they selected specific quality measures and developed a greater awareness and understanding of a systems approach to HV within the state. The Q-sort methodology presented in this article can easily be replicated by other states to identify CQI priorities at the local and state levels and can be used effectively in states that use a single HV service delivery model or those that implement multiple evidence-based models for HV service delivery.

Outcome Measures for Early Childhood Intervention Services.

ERIC Educational Resources Information Center

Accreditation Council on Services for People with Disabilities, Landover, MD.

This collection of 21 suggested outcome measures for early childhood intervention services is intended to apply to all types of service and support program models for children (birth to age 5) with various developmental delays and/or disabilities. The measures are appropriate for either home-based or center-based service delivery models. Section 1…

Delivery cost of human papillomavirus vaccination of young adolescent girls in Peru, Uganda and Viet Nam

PubMed Central

Van Minh, Hoang; Odaga, John; Rout, Swampa Sarit; Ngoc, Diep Nguyen Thi; Menezes, Lysander; Araujo, Maria Ana Mendoza; LaMontagne, D Scott

2013-01-01

Abstract Objective To estimate the incremental delivery cost of human papillomavirus (HPV) vaccination of young adolescent girls in Peru, Uganda and Viet Nam. Methods Data were collected from a sample of facilities that participated in five demonstration projects for HPV vaccine delivery: school-based delivery was used in Peru, Uganda and Viet Nam; health-centre-based delivery was also used in Viet Nam; and integrated delivery, which involved existing health services, was also used in Uganda. Microcosting methods were used to guide data collection on the use of resources (i.e. staff, supplies and equipment) and data were obtained from government, demonstration project and health centre administrative records. Delivery costs were expressed in 2009 United States dollars (US$). Exclusively project-related expenses and the cost of the vaccine were excluded. Findings The economic delivery cost per vaccine dose ranged from US$ 1.44 for integrated outreach in Uganda to US$ 3.88 for school-based delivery in Peru. In Viet Nam, the lowest cost per dose was US$ 1.92 for health-centre-based delivery. Cost profiles revealed that, in general, the largest contributing factors were project start-up costs and recurrent personnel costs. The delivery cost of HPV vaccine was higher than published costs for traditional vaccines recommended by the Expanded Programme on Immunization (EPI). Conclusion The cost of delivering HPV vaccine to young adolescent girls in Peru, Uganda and Viet Nam was higher than that for vaccines currently in the EPI schedule. The cost per vaccine dose was lower when delivery was integrated into existing health services. PMID:23940406

Web-Based Course Delivery and Administration Using Scheme.

ERIC Educational Resources Information Center

Salustri, Filippo A.

This paper discusses the use at the University of Windsor (Ontario) of a small World Wide Web-based tool for course delivery and administration called HAL (HTML-based Administrative Lackey), written in the Scheme programming language. This tool was developed by the author to provide Web-based services for a large first-year undergraduate course in…

Institutional delivery service utilization in Munisa Woreda, South East Ethiopia: a community based cross-sectional study.

PubMed

Amano, Abdella; Gebeyehu, Abebaw; Birhanu, Zelalem

2012-10-08

Reducing maternal morbidity and mortality is a global priority which is particularly relevant to developing countries like Ethiopia. One of the key strategies for reducing maternal morbidity and mortality is increasing institutional delivery service utilization of mothers under the care of skilled birth attendants. The aim of this study was to determine the level of institutional delivery service utilization and associated factors. A community-based cross-sectional survey was conducted from April 1-20, 2011, among mothers who gave birth 12 months before the study began in Munesa Woreda, Arsi Zone, Oromia Region, Southeast Ethiopia. A stratified cluster sampling was used to select a sample of 855 participants. Out of all deliveries, only 12.3% took place at health facilities. Women who were urban residents (AOR = 2.27, 95%CI: 1.17, 4.40), women of age at interview less than 20 years (AOR = 6.06, 95%CI: 1.54, 23.78), women with first pregnancy (AOR = 2.41, 95%CI: 1.17, 4.97) and, women who had ANC visit during the last pregnancy (AOR = 4.18, 95%CI: 2.54, 6.89) were more likely to deliver at health institutions. Secondary and above level of mother`s and husband`s education had also a significant effect on health institution delivery with AOR = 4.31 (95%CI: 1.62, 11.46) and AOR = 2.77 (95%CI: 1.07, 7.19) respectively. Institutional delivery service utilization was found to be low in the study area. Secondary and above level of mother`s and husband`s education, urban residence and ANC visit were amongst the main factors that had an influence on health institution delivery. Increasing the awareness of mothers and their partners about the benefits of institutional delivery services are recommended.

Institutional delivery service utilization in Munisa Woreda, South East Ethiopia: a community based cross-sectional study

PubMed Central

2012-01-01

Background Reducing maternal morbidity and mortality is a global priority which is particularly relevant to developing countries like Ethiopia. One of the key strategies for reducing maternal morbidity and mortality is increasing institutional delivery service utilization of mothers under the care of skilled birth attendants. The aim of this study was to determine the level of institutional delivery service utilization and associated factors. Methods A community-based cross-sectional survey was conducted from April 1–20, 2011, among mothers who gave birth 12 months before the study began in Munesa Woreda, Arsi Zone, Oromia Region, Southeast Ethiopia. A stratified cluster sampling was used to select a sample of 855 participants. Results Out of all deliveries, only 12.3% took place at health facilities. Women who were urban residents (AOR = 2.27, 95%CI: 1.17, 4.40), women of age at interview less than 20 years (AOR = 6.06, 95%CI: 1.54, 23.78), women with first pregnancy (AOR = 2.41, 95%CI: 1.17, 4.97) and, women who had ANC visit during the last pregnancy (AOR = 4.18, 95%CI: 2.54, 6.89) were more likely to deliver at health institutions. Secondary and above level of mother`s and husband`s education had also a significant effect on health institution delivery with AOR = 4.31 (95%CI: 1.62, 11.46) and AOR = 2.77 (95%CI: 1.07, 7.19) respectively. Conclusion Institutional delivery service utilization was found to be low in the study area. Secondary and above level of mother`s and husband`s education, urban residence and ANC visit were amongst the main factors that had an influence on health institution delivery. Increasing the awareness of mothers and their partners about the benefits of institutional delivery services are recommended. PMID:23043258

Predisposing, enabling, and need factors associated with utilization of institutional delivery services: A community-based cross-sectional study in far-western Nepal.

PubMed

Freidoony, Leila; Ranabhat, Chhabi Lal; Kim, Chun-Bae; Kim, Chang-Soo; Ahn, Dong-Won; Doh, Young Ah

2018-01-01

Use of institutional delivery services can be effective in reducing maternal and infant mortality. In Nepal, however, the majority of women deliver at home. Using Andersen's behavioral model of use of health care services, this cross-sectional study aimed to identify factors associated with use of institutional delivery services in four villages and one municipality in Kailali district, Nepal. Mothers (N = 500) who had given birth in the 5 years preceding the survey (conducted between January and February 2015) were randomly selected by cluster sampling and interviewed using a semi-structured questionnaire. Bivariate analyses and multivariate hierarchical logistic regression analyses were performed. Among the women surveyed, 65.6% had used institutional delivery services for their last delivery, a higher proportion than the national average. Primiparity, having a secondary or higher education level, living in the Durgauli village, having husbands with occupations other than agriculture or professional/technical jobs, and having attended four or more antenatal care (ANC) visits had significantly increased use of institutional deliveries. Also, belonging to the richest 20% of the community and having experienced pregnancy complications were marginally significantly associated. These findings demonstrate the need for improving mother's education, encouraging them to attend ANC visits and addressing disparities between different regions.

Initiation of highly active antiretroviral therapy among pregnant women in Cape Town, South Africa.

PubMed

Stinson, Kathryn; Boulle, Andrew; Coetzee, David; Abrams, Elaine J; Myer, Landon

2010-07-01

To investigate highly active antiretroviral therapy (HAART) initiation among pregnant women and the optimum model of service delivery for integrating HAART services into antenatal care. We analysed clinic records to reconstruct a cohort of all HIV-infected pregnant women eligible for HAART at four antenatal clinics representing three service delivery models in Cape Town, South Africa. To assess HAART coverage, records of women determined to be eligible for HAART in pregnancy were reviewed at corresponding HIV treatment services. Of 13,208 pregnant women tested for HIV, 26% were HIV-infected and 15% were HAART-eligible based on a CD4 cell count of

Faith-Based Human Services Initiatives: Considerations for Social Work Practice and Theory

ERIC Educational Resources Information Center

Tangenberg, Kathleen M.

2005-01-01

Faith-based human services initiatives present numerous challenges to professional social work. This article explores ways a theoretical integration of ecosystems and structuration perspectives may help social workers navigate complex ideological and practical implications of changing service delivery policies. The article highlights diversity…

Staffing Systems of Care for Children and Families: A Report of the Southern Human Resource Development Consortium for Mental Health on Workforce Issues Related to Community-Based Service Delivery for Children and Adolescents with Serious Emotional Disturbance/Mental Illness and Their Families.

ERIC Educational Resources Information Center

Pires, Sheila A.

This report describes the results of a regional needs assessment of workforce issues related to the delivery of community-based services for children and adolescents with serious emotional disturbance or mental illness and their families in a region comprising 12 southern states. The assessment involved a survey of key stakeholders, principally…

Safe delivery care practices in western Nepal: Does women's autonomy influence the utilization of skilled care at birth?

PubMed

Bhandari, Tulsi Ram; Kutty, V Raman; Sarma, P Sankara; Dangal, Ganesh

2017-01-01

Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives-women's autonomy-plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women's autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women's autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women's education had a strong positive association (odds ratio = 24.11, CI = 9.43-61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women's education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband's education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women's autonomy may be an important mediating factor in this pathway.

Safe delivery care practices in western Nepal: Does women’s autonomy influence the utilization of skilled care at birth?

PubMed Central

Kutty, V. Raman; Sarma, P. Sankara; Dangal, Ganesh

2017-01-01

Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives—women’s autonomy—plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women’s autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women’s autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women’s education had a strong positive association (odds ratio = 24.11, CI = 9.43–61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women’s education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband’s education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women’s autonomy may be an important mediating factor in this pathway. PMID:28771579

Manage Hydrologic Fluxes Instead of Land Cover in Watershed Services Projects

NASA Astrophysics Data System (ADS)

Brauman, K. A.; Ponette-González, A. G.; Marin-Spiotta, E.; Farley, K. A.; Weathers, K. C.; Young, K. R.; Curran, L. M.

2014-12-01

Payments for Watershed Services (PWS), Water Funds, and other payment schemes intended to increase the delivery of hydrologic ecosystem services have great potential for ensuring water resources for downstream beneficiaries while improving livelihoods for upstream residents. However, it is often ambiguous which land-management options should be promoted to enhance watershed service delivery. In many watershed investment programs, specific land covers are promoted as proxies for water service delivery. This approach is based on assumed relationships between land cover and water service outcomes. When land cover does not sufficiently describe ecosystem characteristics that affect water flow, however, desired water services may not be delivered. The use of land cover proxies is especially problematic for watershed investments in the tropics, where many projects are located, because these proxies rely on generalizations about landscape hydrology established for temperate zones. Based on an extensive review of hydrologic fluxes in the high-elevation tropics, we argue that direct management of hydrologic fluxes is a good design for achieving quantifiable results. We use case studies from sites in the Caribbean and Latin American tropics to illustrate how designers of watershed payment projects can manage hydrologic fluxes. To do so, projects must explicitly articulate the water service of interest based on the specific social setting. Projects must also explicitly account for the particulars of the geographic setting. Finally, outcomes must be assessed relative to water services delivered under an alternative land use or land cover scenario.

Expansion in the private sector provision of institutional delivery services and horizontal equity: evidence from Nepal and Bangladesh.

PubMed

Hotchkiss, David R; Godha, Deepali; Do, Mai

2014-07-01

Wealth-related inequity in the use of maternal healthcare services continues to be a substantial problem in most low- and middle-income countries. One strategic approach to increase the use of appropriate maternal healthcare services is to encourage the expansion of the role of the private sector. However, critics of such an approach argue that increasing the role of the private sector will lead to increased inequity in the use of maternal healthcare services. This article explores this issue in two South Asian countries that have traditionally had high rates of maternal mortality-Nepal and Bangladesh. The study is based on multiple rounds of nationally representative household survey data collected in Nepal and Bangladesh from 1996 to 2011. The methodology involves estimating a concentration index for each survey to assess changes in wealth-related inequity in the use of institutional delivery assistance over time. The results of the study suggest that the expansion of private sector supply of institutional-based delivery services in Nepal and Bangladesh has not led to increased horizontal inequity. In fact, in both countries, inequity was shown to have decreased over the study period. The study findings also suggest that the provision of government delivery services to the poor protects against increased wealth-related inequity in service use. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

A new analytical framework of 'continuum of prevention and care' to maximize HIV case detection and retention in care in Vietnam

PubMed Central

2012-01-01

Background The global initiative ‘Treatment 2.0’ calls for expanding the evidence base of optimal HIV service delivery models to maximize HIV case detection and retention in care. However limited systematic assessment has been conducted in countries with concentrated HIV epidemic. We aimed to assess HIV service availability and service connectedness in Vietnam. Methods We developed a new analytical framework of the continuum of prevention and care (COPC). Using the framework, we examined HIV service delivery in Vietnam. Specifically, we analyzed HIV service availability including geographical distribution and decentralization and service connectedness across multiple services and dimensions. We then identified system-related strengths and constraints in improving HIV case detection and retention in care. This was accomplished by reviewing related published and unpublished documents including existing service delivery data. Results Identified strengths included: decentralized HIV outpatient clinics that offer comprehensive care at the district level particularly in high HIV burden provinces; functional chronic care management for antiretroviral treatment (ART) with the involvement of people living with HIV and the links to community- and home-based care; HIV testing and counseling integrated into tuberculosis and antenatal care services in districts supported by donor-funded projects, and extensive peer outreach networks that reduce barriers for the most-at-risk populations to access services. Constraints included: fragmented local coordination mechanisms for HIV-related health services; lack of systems to monitor the expansion of HIV outpatient clinics that offer comprehensive care; underdevelopment of pre-ART care; insufficient linkage from HIV testing and counseling to pre-ART care; inadequate access to HIV-related services in districts not supported by donor-funded projects particularly in middle and low burden provinces and in mountainous remote areas; and no systematic monitoring of referral services. Conclusions Our COPC analytical framework was instrumental in identifying system-related strengths and constraints that contribute to HIV case detection and retention in care. The national HIV program plans to strengthen provincial programming by re-defining various service linkages and accelerate the transition from project-based approach to integrated service delivery in line with the ‘Treatment 2.0’ initiative. PMID:23272730

A new analytical framework of 'continuum of prevention and care' to maximize HIV case detection and retention in care in Vietnam.

PubMed

Fujita, Masami; Poudel, Krishna C; Do, Thi Nhan; Bui, Duc Duong; Nguyen, Van Kinh; Green, Kimberly; Nguyen, Thi Minh Thu; Kato, Masaya; Jacka, David; Cao, Thi Thanh Thuy; Nguyen, Thanh Long; Jimba, Masamine

2012-12-29

The global initiative 'Treatment 2.0' calls for expanding the evidence base of optimal HIV service delivery models to maximize HIV case detection and retention in care. However limited systematic assessment has been conducted in countries with concentrated HIV epidemic. We aimed to assess HIV service availability and service connectedness in Vietnam. We developed a new analytical framework of the continuum of prevention and care (COPC). Using the framework, we examined HIV service delivery in Vietnam. Specifically, we analyzed HIV service availability including geographical distribution and decentralization and service connectedness across multiple services and dimensions. We then identified system-related strengths and constraints in improving HIV case detection and retention in care. This was accomplished by reviewing related published and unpublished documents including existing service delivery data. Identified strengths included: decentralized HIV outpatient clinics that offer comprehensive care at the district level particularly in high HIV burden provinces; functional chronic care management for antiretroviral treatment (ART) with the involvement of people living with HIV and the links to community- and home-based care; HIV testing and counseling integrated into tuberculosis and antenatal care services in districts supported by donor-funded projects, and extensive peer outreach networks that reduce barriers for the most-at-risk populations to access services. Constraints included: fragmented local coordination mechanisms for HIV-related health services; lack of systems to monitor the expansion of HIV outpatient clinics that offer comprehensive care; underdevelopment of pre-ART care; insufficient linkage from HIV testing and counseling to pre-ART care; inadequate access to HIV-related services in districts not supported by donor-funded projects particularly in middle and low burden provinces and in mountainous remote areas; and no systematic monitoring of referral services. Our COPC analytical framework was instrumental in identifying system-related strengths and constraints that contribute to HIV case detection and retention in care. The national HIV program plans to strengthen provincial programming by re-defining various service linkages and accelerate the transition from project-based approach to integrated service delivery in line with the 'Treatment 2.0' initiative.

The quality of free antenatal and delivery services in Northern Sierra Leone.

PubMed

Koroma, Manso M; Kamara, Samuel S; Bangura, Evelyn A; Kamara, Mohamed A; Lokossou, Virgil; Keita, Namoudou

2017-07-12

The number of maternal deaths in sub-Saharan Africa continues to be overwhelmingly high. In West Africa, Sierra Leone leads the list, with the highest maternal mortality ratio. In 2010, financial barriers were removed as an incentive for more women to use available antenatal, delivery and postnatal services. Few published studies have examined the quality of free antenatal services and access to emergency obstetric care in Sierra Leone. A cross-sectional survey was conducted in 2014 in all 97 peripheral health facilities and three hospitals in Bombali District, Northern Region. One hundred antenatal care providers were interviewed, 276 observations were made and 486 pregnant women were interviewed. We assessed the adequacy of antenatal and delivery services provided using national standards. The distance was calculated between each facility providing delivery services and the nearest comprehensive emergency obstetric care (CEOC) facility, and the proportion of facilities in a chiefdom within 15 km of each CEOC facility was also calculated. A thematic map was developed to show inequities. The quality of services was poor. Based on national standards, only 27% of women were examined, 2% were screened on their first antenatal visit and 47% received interventions as recommended. Although 94% of facilities provided delivery services, a minority had delivery rooms (40%), delivery kits (42%) or portable water (46%). Skilled attendants supervised 35% of deliveries, and in only 35% of these were processes adequately documented. None of the five basic emergency obstetric care facilities were fully compliant with national standards, and the central and northernmost parts of the district had the least access to comprehensive emergency obstetric care. The health sector needs to monitor the quality of antenatal interventions in addition to measuring coverage. The quality of delivery services is compromised by poor infrastructure, inadequate skilled staff, stock-outs of consumables, non-functional basic emergency obstetric care facilities, and geographic inequities in access to CEOC facilities. These findings suggest that the health sector needs to urgently investigate continuing inequities adversely influencing the uptake of these services, and explore more sustainable funding mechanisms. Without this, the country is unlikely to achieve its goal of reducing maternal deaths.

Efficiency of HIV/AIDS Health Centers and Effect of Community-Based Health Insurance and Performance-Based Financing on HIV/AIDS Service Delivery in Rwanda

PubMed Central

Zeng, Wu; Rwiyereka, Angelique K.; Amico, Peter R.; Ávila-Figueroa, Carlos; Shepard, Donald S.

2014-01-01

This study evaluates the efficiency of rural health centers in Rwanda in delivering the three key human immunodeficiency virus/acquired immunodeficiency syndrome services: antiretroviral treatment, prevention of mother-to-child transmission, and voluntary counseling and testing using data envelopment analysis, and assesses the impact of community-based health insurance (CBHI) and performance-based financing on improving the delivery of the three services. Results show that health centers average efficiency of 78%, and despite the observed variation, the performance increased by 15.6% from 2006 through 2007. When the services are examined separately, each 1% growth of CBHI use was associated with 3.7% more prevention of mother-to-child transmission and 2.5% more voluntary counseling and testing services. Although more health centers would have been needed to evaluate performance-based financing, we found that high use of CBHI in Rwanda was an important contributor to improving human immunodeficiency virus/acquired immunodeficiency syndrome services in rural health centers in Rwanda. PMID:24515939

Efficiency of HIV/AIDS health centers and effect of community-based health insurance and performance-based financing on HIV/AIDS service delivery in Rwanda.

PubMed

Zeng, Wu; Rwiyereka, Angelique K; Amico, Peter R; Avila-Figueroa, Carlos; Shepard, Donald S

2014-04-01

This study evaluates the efficiency of rural health centers in Rwanda in delivering the three key human immunodeficiency virus/acquired immunodeficiency syndrome services: antiretroviral treatment, prevention of mother-to-child transmission, and voluntary counseling and testing using data envelopment analysis, and assesses the impact of community-based health insurance (CBHI) and performance-based financing on improving the delivery of the three services. Results show that health centers average efficiency of 78%, and despite the observed variation, the performance increased by 15.6% from 2006 through 2007. When the services are examined separately, each 1% growth of CBHI use was associated with 3.7% more prevention of mother-to-child transmission and 2.5% more voluntary counseling and testing services. Although more health centers would have been needed to evaluate performance-based financing, we found that high use of CBHI in Rwanda was an important contributor to improving human immunodeficiency virus/acquired immunodeficiency syndrome services in rural health centers in Rwanda.

Frail elderly patients. New model for integrated service delivery.

PubMed Central

Hébert, Rejean; Durand, Pierre J.; Dubuc, Nicole; Tourigny, André

2003-01-01

PROBLEM BEING ADDRESSED: Given the complex needs of frail older people and the multiplicity of care providers and services, care for this clientele lacks continuity. OBJECTIVE OF PROGRAM: Integrated service delivery (ISD) systems have been developed to improve continuity and increase the efficacy and efficiency of services. PROGRAM DESCRIPTION: The Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is an innovative ISD model based on coordination. It includes coordination between decision makers and managers of different organizations and services; a single entry point; a case-management process; individualized service plans; a single assessment instrument based on clients' functional autonomy, coupled with a case-mix classification system; and a computerized clinical chart for communicating between institutions and professionals for client monitoring. CONCLUSION: Preliminary results on the efficacy of this model showed a decreased incidence of functional decline, a decreased burden for caregivers, and a smaller proportion of older people wishing to enter institutions. PMID:12943358

Who benefits from removing user fees for facility-based delivery services? Evidence on socioeconomic differences from Ghana, Senegal and Sierra Leone.

PubMed

McKinnon, Britt; Harper, Sam; Kaufman, Jay S

2015-06-01

Coverage of skilled delivery care has been increasing across most low-income countries; however, it remains far from universal and is very unequally distributed according to socioeconomic position. In an effort to increase coverage of skilled delivery care and reduce socioeconomic inequalities, governments of several countries in sub-Saharan Africa have recently adopted policies that remove user fees for facility-based delivery services. There is little rigorous evidence of the impact of these policies and few studies have examined effects on socioeconomic inequalities. This study investigates the impact of recent delivery fee exemption policies in Ghana, Senegal, and Sierra Leone on socioeconomic differences in the use of facility-based delivery services. Using Demographic and Health Survey data from nine sub-Saharan African countries, we evaluated the user fee policy changes using a difference-in-differences approach that accounts for underlying common secular trends and time invariant differences among countries, and allows for differential effects of the policy by socioeconomic position. Removing user fees was consistent with meaningful increases in facility deliveries across all categories of household wealth and maternal education. We found little evidence of differential effects of removing user fees across quartiles of household wealth, with increases of 5.4 facility deliveries per hundred live births (95% CI: 2.1, 8.8) among women in the poorest quartile and 6.8 per hundred live births (95% CI: 4.0, 9.7) for women in the richest quartile. However, our results suggest that educated women benefited more from removing user fees compared to women with no education. For women with at least some secondary education, the estimated effect was 8.6 facility deliveries per hundred live births (95% CI: 5.4, 11.9), but only 4.6 per hundred live births (95% CI: 2.2, 7.0) for women with no education (heterogeneity p-value = 0.04). Thus, while removing fees at the point of service increased facility deliveries across the socioeconomic gradient, it did not reduce inequalities defined by household wealth and may have contributed to a widening of educational inequalities. These findings emphasize the need for concerted efforts to address financial and other barriers that contribute to large and persistent socioeconomic inequalities in delivery care. Copyright © 2015 Elsevier Ltd. All rights reserved.

16 CFR 4.4 - Service.

Code of Federal Regulations, 2011 CFR

2011-01-01

...). Service under this provision is complete upon delivery by the Post Office or upon personal delivery. (3... counsel, service shall be by personal delivery (including delivery by courier) or delivery by first-class... association, to an officer or agent authorized to accept service of process therefor. Personal service...

16 CFR 4.4 - Service.

Code of Federal Regulations, 2012 CFR

2012-01-01

...). Service under this provision is complete upon delivery by the Post Office or upon personal delivery. (3... counsel, service shall be by personal delivery (including delivery by courier) or delivery by first-class... association, to an officer or agent authorized to accept service of process therefor. Personal service...

16 CFR 4.4 - Service.

Code of Federal Regulations, 2010 CFR

2010-01-01

...). Service under this provision is complete upon delivery by the Post Office or upon personal delivery. (3... counsel, service shall be by personal delivery (including delivery by courier) or delivery by first-class... association, to an officer or agent authorized to accept service of process therefor. Personal service...

16 CFR 4.4 - Service.

Code of Federal Regulations, 2013 CFR

2013-01-01

...). Service under this provision is complete upon delivery by the Post Office or upon personal delivery. (3... counsel, service shall be by personal delivery (including delivery by courier) or delivery by first-class... association, to an officer or agent authorized to accept service of process therefor. Personal service...

16 CFR 4.4 - Service.

Code of Federal Regulations, 2014 CFR

2014-01-01

...). Service under this provision is complete upon delivery by the Post Office or upon personal delivery. (3... counsel, service shall be by personal delivery (including delivery by courier) or delivery by first-class... association, to an officer or agent authorized to accept service of process therefor. Personal service...

Linking Terrigenous Sediment Delivery to Declines in Coral ...

EPA Pesticide Factsheets

Worldwide coral reef conditions continue to decline despite the valuable socioeconomic benefits of these ecosystems. There is growing recognition that quantifying reefs in terms reflecting what stakeholders value is vital for comparing inherent tradeoffs among coastal management decisions. Terrestrial sediment runoff ranks high as a stressor to coral reefs and is a key concern in Puerto Rico where reefs are among the most threatened in the Caribbean. This research aimed to identify the degree to which sediment runoff impacts production of coral reef ecosystem services and the potential for watershed management actions to improve these services. Ecosystem service production functions were applied to map and translate metrics of ecological reef condition into ecosystem service production under a gradient of increasing sediment delivery. We found that higher sediment delivery decreased provisioning of most ecosystem services, including ecosystem integrity, bioprospecting discovery, and reef-based recreational opportunities and fisheries production. However, shoreline protection and services with a strong contribution from non-reef habitats (e.g., mangroves, seagrasses) were higher in locations with high sediment delivery, although there was a strong inshore effect suggesting the influence of distance to shore, depth, and inshore habitats. Differences among services may indicate potential tradeoffs and the need to consider habitat connectivity, nursery habitat, acce

Delivered! A Mid-Sized Academic Library's Experience with Distance Education

ERIC Educational Resources Information Center

Bartnik, Linda

2010-01-01

Murray State University (Kentucky) has been experimenting with various means of document delivery and research instruction for its online only and satellite campuses. These include ILLiad-based document delivery, Camtasia-to-UTube tutorials, a discipline-based service called Library on Blackboard, Eluminate and other virtual instructional methods.…

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.

Informing resource-poor populations and the delivery of entitled health and social services in rural India: a cluster randomized controlled trial.

PubMed

Pandey, Priyanka; Sehgal, Ashwini R; Riboud, Michelle; Levine, David; Goyal, Madhav

2007-10-24

A lack of awareness about entitled health and social services may contribute to poor delivery of such services in developing countries, especially among individuals of low socioeconomic status. To determine the impact of informing resource-poor rural populations about entitled services. Community-based, cluster randomized controlled trial conducted from May 2004 to May 2005 in 105 randomly selected village clusters in Uttar Pradesh state in India. Households (548 intervention and 497 control) were selected by a systematic sampling design, including both low-caste and mid- to high-caste households. Four to 6 public meetings were held in each intervention village cluster to disseminate information on entitled health services, entitled education services, and village governance requirements. No intervention took place in control village clusters. Visits by nurse midwife; prenatal examinations, tetanus vaccinations, and prenatal supplements received by pregnant women; vaccinations received by infants; excess school fees charged; occurrence of village council meetings; and development work in villages. At baseline, there were no significant differences in self-reported delivery of health and social services. After 1 year, intervention villagers reported better delivery of several services compared with control villagers: in a multivariate analysis, 30% more prenatal examinations (95% confidence interval [CI], 17%-43%; P < .001), 27% more tetanus vaccinations (95% CI, 12%-41%; P < .001), 24% more prenatal supplements (95% CI, 8%-39%; P = .003), 25% more infant vaccinations (95% CI, 8%-42%; P = .004), and decreased excess school fees of 8 rupees (95% CI, 4-13 rupees; P < .001). In a difference-in-differences analysis, 21% more village council meetings were reported (95% CI, 5%-36%; P = .01). There were no improvements in visits by a nurse midwife or in development work in the villages. Both low-caste and mid- to high-caste intervention households reported significant improvements in service delivery. Informing resource-poor rural populations in India about entitled services enhanced the delivery of health and social services among both low- and mid- to high-caste households. Interventions that emphasize educating resource-poor populations about entitled services may improve the delivery of such services. clinicaltrials.gov Identifier: NCT00421291.

The effects of MCH insurance cards on improving equity in access and use of maternal and child health care services in Tanzania: a mixed methods analysis.

PubMed

Kuwawenaruwa, August; Mtei, Gemini; Baraka, Jitihada; Tani, Kassimu

2016-11-18

Inequity in access and use of child and maternal health services is impeding progress towards reduction of maternal mortality in low-income countries. To address low usage of maternal and newborn health care services as well as financial protection of families, some countries have adopted demand-side financing. In 2010, Tanzania introduced free health insurance cards to pregnant women and their families to influence access, use, and provision of health services. However, little is known about whether the use of the maternal and child health cards improved equity in access and use of maternal and child health care services. A mixed methods approach was used in Rungwe district where maternal and child health insurance cards had been implemented. To assess equity, three categories of beneficiaries' education levels were used and were compared to that of women of reproductive age in the region from previous surveys. To explore factors influencing women's decisions on delivery site and use of the maternal and child health insurance card and attitudes towards the birth experience itself, a qualitative assessment was conducted at representative facilities at the district, ward, facility, and community level. A total of 31 in-depth interviews were conducted on women who delivered during the previous year and other key informants. Women with low educational attainment were under-represented amongst those who reported having received the maternal and child health insurance card and used it for facility delivery. Qualitative findings revealed that problems during the current pregnancy served as both a motivator and a barrier for choosing a facility-based delivery. Decision about delivery site was also influenced by having experienced or witnessed problems during previous birth delivery and by other individual, financial, and health system factors, including fines levied on women who delivered at home. To improve equity in access to facility-based delivery care using strategies such as maternal and child health insurance cards is necessary to ensure beneficiaries and other stakeholders are well informed of the programme, as giving women insurance cards only does not guarantee facility-based delivery.

Trends in inequalities in utilization of reproductive health services from 2000 to 2011 in Vietnam

PubMed Central

Duc, Nguyen Huu Chau; Nakamura, Keiko; Kizuki, Masashi; Seino, Kaoruko; Rahman, Mosiur

2015-01-01

Objective: This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. Methods: Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household’s ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. Results: Significant increase in overall utilization was observed in all indicators (all p < 0.001). The concentration indices were 0.19 in 2000 and 0.06 in 2011 for antenatal care, 0.10 in 2000 and 0.06 in 2011 for tetanus vaccination, 0.23 in 2000 and 0.08 in 2011 for skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. Conclusions: More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery had been reduced. PMID:26705431

Effects of Alternate Format In-Service Delivery on Teacher Knowledge Base and Problem-Solving Related to Autism & Adaptations: What Teachers Need to Know

ERIC Educational Resources Information Center

Bruening, Marie Diane

2010-01-01

This study's purpose was to explore effectiveness of alternate format in-service delivery for what teachers needed to know to effectively teach their students with Autism Spectrum Disorder/High Functioning Autism/Asperger Syndrome (ASD/HFA/AS) in the general education setting. The study's research questions included: Did participants learn…

Translating knowledge into practice: An exploratory study of dementia-specific training for community-based service providers.

PubMed

O'Sullivan, Grace; Hocking, Clare; McPherson, Kathryn

2017-08-01

Objective To develop, deliver, and evaluate dementia-specific training designed to inform service delivery by enhancing the knowledge of community-based service providers. Methods This exploratory qualitative study used an interdisciplinary, interuniversity team approach to develop and deliver dementia-specific training. Participants included management, care staff, and clients from three organizations funded to provide services in the community. Data on the acceptability, applicability, and perceived outcomes of the training were gathered through focus group discussions and individual interviews. Transcripts were analyzed to generate open codes which were clustered into themes and sub-themes addressing the content, delivery, and value of the training. Findings Staff valued up-to-date knowledge and "real stories" grounded in practice. Clients welcomed the strengths-based approach. Contractual obligations impact on the application of knowledge in practice. Implications The capacity to implement new knowledge may be limited by the legislative policies which frame service provision, to the detriment of service users.

The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients—innovation in the commissioning of primary dental care service delivery and organisation in the UK

PubMed Central

Pavitt, Sue H; Baxter, Paul D; Brunton, Paul A; Douglas, Gail; Edlin, Richard; Gibson, Barry J; Godson, Jenny; Hall, Melanie; Porritt, Jenny; Robinson, Peter G; Vinall, Karen; Hulme, Claire

2014-01-01

Introduction In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards ‘blended contracts’ that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. Methods and analysis The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. Ethics and dissemination The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national and international conferences and in international journals. PMID:25231492

Female Health Workers at the Doorstep: A Pilot of Community-Based Maternal, Newborn, and Child Health Service Delivery in Northern Nigeria

PubMed Central

Uzondu, Charles A; Doctor, Henry V; Findley, Sally E; Afenyadu, Godwin Y; Ager, Alastair

2015-01-01

ABSTRACT Introduction: Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services. Methods: Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008–2010 (before introduction of the pilot) with data from 2011–2013 (during and after the pilot) to gauge sustainability of the model. Results: Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years. Conclusion: Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas. PMID:25745123

Implementation of Age-Specific Services for Transition-Age Youths in California.

PubMed

Ojeda, Victoria D; Hiller, Sarah P; Hurst, Samantha; Jones, Nev; McMenamin, Sara; Burgdorf, James; Gilmer, Todd P

2016-09-01

This study examined the implementation of age-specific services for transition-age youths in California under the Mental Health Services Act (MHSA). This study employed a sequential, exploratory mixed-methods design. Qualitative interviews with 39 mental health service area administrators in California were analyzed to develop an understanding of how the MHSA has facilitated the development of youth-specific programs or services. A quantitative survey of 180 youth-focused programs was also used to describe the range of services that were implemented, the use of evidence-based and promising practices, and the role of youths in the design, planning, delivery, and evaluation of services. Administrators described the MHSA as providing a programmatic focus and financial support for youth-specific services, outlining a stakeholder process to create buy-in and develop a vision for services, and emphasizing the role of youths in service delivery and planning. Youth-specific programs implemented a diverse array of services, including general medical care; employment and education support; housing placement and support; and family, mentoring, and social support. Programs described implementing evidence-based and promising practices and involving youths in service planning, implementation, or quality improvement activities. The MHSA has had a substantial impact on the landscape of youth-specific services in California by expanding both the number of programs and the diversity in types of services and by promoting the engagement of youths in the planning and delivery of services. Additional efforts are necessary to determine the extent to which youth-specific services yield greater improvements in youths' outcomes compared with services designed for adults.

Planning and Implementing Augmentative Communication Service Delivery, 2: Proceedings of the National Planners Conference on Assistive Device Service Delivery.

ERIC Educational Resources Information Center

Coston, Caroline A., Ed.

The document consists of 30 author contributed chapters concerned with augmentative communication service delivery. Chapter titles and authors are: "Communication Options for Persons Who Cannot Speak: Planning for Service Delivery" (David Beukelman); "Planning Service Delivery Systems" (Roland Hahn II); "Planning Ohio's…

The economic rationale of public and private sector roles in the provision of animal health services.

PubMed

Ahuja, V

2004-04-01

In the changing market environment of livestock products, the delivery of animal health services is emerging as an important priority area for enhancing the competitiveness of poor livestock producers. At the same time, governments are continuing to face serious budgetary difficulties and are finding it difficult to expand the reach of these services or improve service quality. In this context of a changing environment and dwindling public resources, this paper revisits the economic framework that has thus far guided thinking about public and private sector roles in the provision of animal health services and examines the ongoing debate on livestock service delivery for the poor. The paper highlights the importance of strong institutions and appropriate legislation for regulating behaviour and enforcing contracts and re-emphasises the idea, which is supported by economic theory, that there is a need for task sharing between the public and private sectors. The paper further emphasizes the need for: a) integrating the debate on livestock service delivery with the larger debate on political economy and institutional development, and b) ensuring service access in poor marginal areas by working through membership organisations, self-help groups and civil society organisations, and by promoting the use of para-professionals and community-based animal health delivery systems.

Recent changes in Medicaid policy and their possible effects on mental health services.

PubMed

Buck, Jeffrey A

2009-11-01

As Medicaid has emerged as the primary funder of public mental health services, its character has affected the organization and delivery of such services. Recent changes to the program, however, promise to further affect the direction of changes in states' mental health service systems. One group of changes will further limit the flexibility of Medicaid mental health funding, while increasing provider accountability and the authority of state Medicaid agencies. Others will increase incentives for deinstitutionalization and community-based care and promote person-centered treatment principles. These changes will likely affect state mental health systems, mental health providers, and the nature of service delivery.

Mental Health Services in School-Based Health Centers: Systematic Review

ERIC Educational Resources Information Center

Bains, Ranbir Mangat; Diallo, Ana F.

2016-01-01

Mental health issues affect 20-25% of children and adolescents, of which few receive services. School-based health centers (SBHCs) provide access to mental health services to children and adolescents within their schools. A systematic review of literature was undertaken to review evidence on the effectiveness of delivery of mental health services…

Research on Clinical Preventive Services for Adolescents and Young Adults: Where Are We and Where Do We Need to Go?

PubMed Central

Harris, Sion K.; Aalsma, Matthew C.; Weitzman, Elissa R.; Garcia-Huidobro, Diego; Wong, Charlene; Hadland, Scott E.; Santelli, John; Park, M. Jane; Ozer, Elizabeth M.

2017-01-01

We reviewed research regarding system- and visit-level strategies to enhance clinical preventive service delivery and quality for adolescents and young adults. Despite professional consensus on recommended services for adolescents, a strong evidence base for services for young adults, and improved financial access to services with the Affordable Care Act’s provisions, receipt of preventive services remains suboptimal. Further research that builds off successful models of linking traditional and community clinics is needed to improve access to care for all youth. To optimize the clinical encounter, promising clinician-focused strategies to improve delivery of preventive services include screening and decision support tools, particularly when integrated into electronic medical record systems and supported by training and feedback. Although results have been mixed, interventions have moved beyond increasing service delivery to demonstrating behavior change. Research on emerging technology—such as gaming platforms, mobile phone applications, and wearable devices—suggests opportunities to expand clinicians’ reach; however, existing research is based on limited clinical settings and populations. Improved monitoring systems and further research are needed to examine preventive services facilitators and ensure that interventions are effective across the range of clinical settings where youth receive preventive care, across multiple populations, including young adults, and for more vulnerable populations with less access to quality care. PMID:28011064

Research on Clinical Preventive Services for Adolescents and Young Adults: Where Are We and Where Do We Need to Go?

PubMed

Harris, Sion K; Aalsma, Matthew C; Weitzman, Elissa R; Garcia-Huidobro, Diego; Wong, Charlene; Hadland, Scott E; Santelli, John; Park, M Jane; Ozer, Elizabeth M

2017-03-01

We reviewed research regarding system- and visit-level strategies to enhance clinical preventive service delivery and quality for adolescents and young adults. Despite professional consensus on recommended services for adolescents, a strong evidence base for services for young adults, and improved financial access to services with the Affordable Care Act's provisions, receipt of preventive services remains suboptimal. Further research that builds off successful models of linking traditional and community clinics is needed to improve access to care for all youth. To optimize the clinical encounter, promising clinician-focused strategies to improve delivery of preventive services include screening and decision support tools, particularly when integrated into electronic medical record systems and supported by training and feedback. Although results have been mixed, interventions have moved beyond increasing service delivery to demonstrating behavior change. Research on emerging technology-such as gaming platforms, mobile phone applications, and wearable devices-suggests opportunities to expand clinicians' reach; however, existing research is based on limited clinical settings and populations. Improved monitoring systems and further research are needed to examine preventive services facilitators and ensure that interventions are effective across the range of clinical settings where youth receive preventive care, across multiple populations, including young adults, and for more vulnerable populations with less access to quality care. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Continuum of Care Services for Maternal and Child Health using mobile technology - a health system strengthening strategy in low and middle income countries.

PubMed

Balakrishnan, Ramkrishnan; Gopichandran, Vijayaprasad; Chaturvedi, Sharadprakash; Chatterjee, Rahul; Mahapatra, Tanmay; Chaudhuri, Indrajit

2016-07-07

Mobile phone technology is utilized for better delivery of health services worldwide. In low-and-middle income countries mobile phones are now ubiquitous. Thus leveraging mHealth applications in health sector is becoming popular rapidly in these countries. To assess the effectiveness of the Continuum of Care Services (CCS) mHealth platform in terms of strengthening the delivery of maternal and child health (MCH) services in a district in Bihar, a resource-poor state in India. The CommCare mHealth platform was customized to CCS as one of the innovations under a project funded by the Bill and Melinda Gates Foundation to improve the maternal and newborn health services in Bihar. The intervention was rolled out in one project district in Bihar, during July 2012. More than 550 frontline workers out of a total of 3000 including Accredited Social Health Activists, Anganwadi Workers, Auxilliary Nurse Midwives and Lady Health Supervisors were trained to use the mHealth platform. The service delivery components namely early registration of pregnant women, three antenatal visits, tetanus toxoid immunization of the mother, iron and folic acid tablet supply, institutional delivery, postnatal home visits and early initiation of breastfeeding were used as indicators for good quality services. The resultant coverage of these services in the implementation area was compared with rest of Bihar and previous year statistics of the same area. The time lag between delivery of a service and its record capture in the maternal and child tracking system (MCTS) database was computed in a random sample of 16,000 beneficiaries. The coverage of services among marginalized and non-marginalized castes was compared to indicate equity of service delivery. Health system strengthening was viewed from the angle of coverage, quality, equity and efficiency of services. The implementation blocks had higher coverage of all the eight indicator services compared to rest of Bihar and the previous year. There was equity of services across castes for all the indicators. Timely capture of data was also ensured compared to paper-based reporting. By virtue of its impact on quality, efficiency and equity of service delivery, health care manpower efficiency and governance, the mHealth inclusion at service provision level can be one of the potential strategy to strengthen the health system.

The role of mHealth intervention on maternal and child health service delivery: findings from a randomized controlled field trial in rural Ethiopia

PubMed Central

Otto, Kate; Herbst, Christopher H.

2017-01-01

Background The provision of consistent and quality maternal and child health (MCH) services is a challenge for Ethiopia where most of the population lives in the rural setup. Health service delivery is constrained mainly by shortage of health professionals, meager resources, limited awareness among the society and bureaucratic procedures. Low health service utilization of antenatal care (ANC), delivery services, and postnatal care (PNC) are believed to contribute for high maternal and child mortality rates. Innovative approach like mHealth based technological intervention believed to alleviate such challenges in countries like ours. However, currently, there are few evidences that demonstrate the impact of mHealth technology applications on the level of service utilization. Therefore, the objective our study is to assess the role of mobile phone equipped with short message service (SMS) based data-exchange software linking community health workers to Health Centers in rural Ethiopia affect selected MCH outcomes. Methods A community-based randomized control trial (RCT) was conducted in three woredas of Guraghe zone (Ezha, partial &Abeshge full intervention, Sodo Control). Mobile phones equipped with FrontlineSMS based, locally developed application was distributed to all health extension workers (HEWs) to both intervention woredas who filled maternal, child and stock related forms and submitted to the central server which in turn sends reminder about the scheduled date of ANC visit, expected date of delivery, PNC, immunization schedule and vaccine and contraceptive stock status. Moreover, in Abeshge, the voluntary health workers (vCHW) and HEW supervisors in both intervention woreda were given a phone to facilitate communication with the HEW. No mobile was offered to the control woreda.Pre [2012] and post [2013] intervention community based survey on mothers who have under 5 and under 1 year old child was done to assess the effect of the mobile intervention on selected MCH process indicators. Structured and pretested questionnaire was used to collect data and SPSS v16 statistical software was used for analysis. Results Three thousand two hundred and forty mothers, 1,080 from each, were surveyed in the three woredas. The study revealed that the proportion of mothers receiving more than four ANC visits increased significantly in both intervention woredas. Besides, the rate of ANC delivered by HEWs improved in Ezha woreda (T1) (19.01% to 28.27%), proportions of deliveries attended by skilled health workers increased and home delivery decreased in all woredas; most pronounced increases in referrals from health post to health center by HEWs, reported in Ezha and Abeshge. The intervention also led to a significant reduction in stock-outs of preferred contraceptive products in Ezha (T1) from 16.96% to 8.24% but no change was observed in both contraceptive prevalence and immunization rates in the control and the other intervention woreda. Conclusions The study confirmed the positive contribution of SMS based mobile phone intervention in most of the selected MCH service indicators, like improvement in the percent of recommended number of ANC visit, percentage of delivery attended by health workers and facilitating the work processes of the health workers in rural Ethiopia. PMID:29184891

The role of mHealth intervention on maternal and child health service delivery: findings from a randomized controlled field trial in rural Ethiopia.

PubMed

Atnafu, Asfaw; Otto, Kate; Herbst, Christopher H

2017-01-01

The provision of consistent and quality maternal and child health (MCH) services is a challenge for Ethiopia where most of the population lives in the rural setup. Health service delivery is constrained mainly by shortage of health professionals, meager resources, limited awareness among the society and bureaucratic procedures. Low health service utilization of antenatal care (ANC), delivery services, and postnatal care (PNC) are believed to contribute for high maternal and child mortality rates. Innovative approach like mHealth based technological intervention believed to alleviate such challenges in countries like ours. However, currently, there are few evidences that demonstrate the impact of mHealth technology applications on the level of service utilization. Therefore, the objective our study is to assess the role of mobile phone equipped with short message service (SMS) based data-exchange software linking community health workers to Health Centers in rural Ethiopia affect selected MCH outcomes. A community-based randomized control trial (RCT) was conducted in three woredas of Guraghe zone (Ezha, partial &Abeshge full intervention, Sodo Control). Mobile phones equipped with FrontlineSMS based, locally developed application was distributed to all health extension workers (HEWs) to both intervention woredas who filled maternal, child and stock related forms and submitted to the central server which in turn sends reminder about the scheduled date of ANC visit, expected date of delivery, PNC, immunization schedule and vaccine and contraceptive stock status. Moreover, in Abeshge, the voluntary health workers (vCHW) and HEW supervisors in both intervention woreda were given a phone to facilitate communication with the HEW. No mobile was offered to the control woreda.Pre [2012] and post [2013] intervention community based survey on mothers who have under 5 and under 1 year old child was done to assess the effect of the mobile intervention on selected MCH process indicators. Structured and pretested questionnaire was used to collect data and SPSS v16 statistical software was used for analysis. Three thousand two hundred and forty mothers, 1,080 from each, were surveyed in the three woredas. The study revealed that the proportion of mothers receiving more than four ANC visits increased significantly in both intervention woredas. Besides, the rate of ANC delivered by HEWs improved in Ezha woreda (T1) (19.01% to 28.27%), proportions of deliveries attended by skilled health workers increased and home delivery decreased in all woredas; most pronounced increases in referrals from health post to health center by HEWs, reported in Ezha and Abeshge. The intervention also led to a significant reduction in stock-outs of preferred contraceptive products in Ezha (T1) from 16.96% to 8.24% but no change was observed in both contraceptive prevalence and immunization rates in the control and the other intervention woreda. The study confirmed the positive contribution of SMS based mobile phone intervention in most of the selected MCH service indicators, like improvement in the percent of recommended number of ANC visit, percentage of delivery attended by health workers and facilitating the work processes of the health workers in rural Ethiopia.

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.

"It's not everyday that parents get a chance to talk like this": Exploring parents' perceptions and expectations of speech-language pathology services for children with intellectual disability.

PubMed

Carroll, Clare

2010-08-01

Tailoring the delivery of disability services to the preferences and requirements of service users allows for more effective partnerships. The aim of this research was to explore parents' perceptions and the expectations of their child's speech-language pathology (SLP) within an intellectual disability service. Parents of school-aged children with intellectual disability who received a SLP service in Ireland participated in the research: 17 parents participated in focus groups and 103 parents answered questionnaires. The core themes from the focus groups, which subsequently informed the questionnaire design, were: experience of the SLP service, communication difficulties, expectations of the SLP service, and future developments. The key questionnaire results indicated that parents viewed their SLP as the "expert" and viewed school-based and clinic-based services differently. Parents were more likely to believe that their child would always need therapy if they received a school-based service. Whereas, parents were more likely to think that their child's speech was improving as they got older and were more likely to be aware of therapy activities if therapy was clinic-based. The findings have implications for the delivery of SLP services suggesting that clarification of parents' roles and expectations are required.

SOA-based model for value-added ITS services delivery.

PubMed

Herrera-Quintero, Luis Felipe; Maciá-Pérez, Francisco; Marcos-Jorquera, Diego; Gilart-Iglesias, Virgilio

2014-01-01

Integration is currently a key factor in intelligent transportation systems (ITS), especially because of the ever increasing service demands originating from the ITS industry and ITS users. The current ITS landscape is made up of multiple technologies that are tightly coupled, and its interoperability is extremely low, which limits ITS services generation. Given this fact, novel information technologies (IT) based on the service-oriented architecture (SOA) paradigm have begun to introduce new ways to address this problem. The SOA paradigm allows the construction of loosely coupled distributed systems that can help to integrate the heterogeneous systems that are part of ITS. In this paper, we focus on developing an SOA-based model for integrating information technologies (IT) into ITS to achieve ITS service delivery. To develop our model, the ITS technologies and services involved were identified, catalogued, and decoupled. In doing so, we applied our SOA-based model to integrate all of the ITS technologies and services, ranging from the lowest-level technical components, such as roadside unit as a service (RSUAAS), to the most abstract ITS services that will be offered to ITS users (value-added services). To validate our model, a functionality case study that included all of the components of our model was designed.

Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa

PubMed Central

2014-01-01

Background Several biological, behavioural, and structural risk factors place female sex workers (FSWs) at heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes. FSW projects in many settings have demonstrated effective ways of altering this risk, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa. Methods On 22 November 2012, we searched Web of Science and MEDLINE, without date restrictions, for studies describing clinical and non-clinical facility-based SRH prevention and care services for FSWs in low- and middle-income countries in Africa. We also identified articles in key non-indexed journals and on websites of international organizations. A single reviewer screened titles and abstracts, and extracted data from articles using standardised tools. Results We located 149 articles, which described 54 projects. Most were localised and small-scale; focused on research activities (rather than on large-scale service delivery); operated with little coordination, either nationally or regionally; and had scanty government support (instead a range of international donors generally funded services). Almost all sites only addressed HIV prevention and STIs. Most services distributed male condoms, but only 10% provided female condoms. HIV services mainly encompassed HIV counselling and testing; few offered HIV care and treatment such as CD4 testing or antiretroviral therapy (ART). While STI services were more comprehensive, periodic presumptive treatment was only provided in 11 instances. Services often ignored broader SRH needs such as family planning, cervical cancer screening, and gender-based violence services. Conclusions Sex work programmes in Africa have limited coverage and a narrow scope of services and are poorly coordinated with broader HIV and SRH services. To improve FSWs’ health and reduce onward HIV transmission, access to ART needs to be addressed urgently. Nevertheless, HIV prevention should remain the mainstay of services. Service delivery models that integrate broader SRH services and address structural risk factors are much needed. Government-led FSW services of high quality and scale would markedly reduce SRH vulnerabilities of FSWs in Africa. PMID:24916010

Home and community care sector accountability.

PubMed

Steele Gray, Carolyn; Berta, Whitney; Deber, Raisa B; Lum, Janet

2014-09-01

This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support the delivery of high-quality care. Copyright © 2014 Longwoods Publishing.

Home and Community Care Sector Accountability

PubMed Central

Gray, Carolyn Steele; Berta, Whitney; Deber, Raisa B.; Lum, Janet

2014-01-01

This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support the delivery of high-quality care. PMID:25305389

Better delivery/pick up routes in the presence of uncertainty.

DOT National Transportation Integrated Search

2007-08-01

We consider the Courier Delivery Problem, a variant of the Vehicle Routing Problem with : time windows in which customers appear probabilistically and their service times are uncertain. : We use scenario-based stochastic optimization with recourse fo...

Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study.

PubMed

Limenih, Miteku Andualem; Endale, Zerfu Mulaw; Dachew, Berihun Assefa

2016-01-01

Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34)), place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79)), outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19)), delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54)), and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28)) were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.

Definition of technology development missions for early space stations orbit transfer vehicle serving. Phase 2, task 1: Space station support of operational OTV servicing

NASA Technical Reports Server (NTRS)

1983-01-01

Representative space based orbital transfer vehicles (OTV), ground based vehicle turnaround assessment, functional operational requirements and facilities, mission turnaround operations, a comparison of ground based versus space based tasks, activation of servicing facilities prior to IOC, fleet operations requirements, maintenance facilities, OTV servicing facilities, space station support requirements, and packaging for delivery are discussed.

Assessing the elimination of user fees for delivery services in Laos.

PubMed

Boudreaux, Chantelle; Chanthala, Phetdara; Lindelow, Magnus

2014-01-01

A pilot eliminating user fees associated with delivery at the point of services was introduced in two districts of Laos in March 2009. Following two years of implementation, an evaluation was conducted to assess the pilot impact, as well as to document the pilot design and implementation challenges. Study results show that, even in the presence of the substantial access and cultural barriers, user fees associated with delivery at health facilities act as a serious deterrent to care seeking behavior. We find a tripling of facility-based delivery rates in the intervention areas, compared to a 40% increase in the control areas. While findings from the control region suggest that facility-based delivery rates may be on the rise across the country, the substantially higher increase in the pilot areas highlight the impact of financial burden associated with facility-based delivery fees. These fees can play an important role in rapidly increasing the uptake of facility delivery to reach the national targets and, ultimately, to improve maternal and child health outcomes. The pilot achieved important gains while relying heavily on capacity and systems already in place. However, the high cost associated with monitoring and evaluation suggest broad-scale expansion of the pilot activities is likely to necessitate targeted capacity building initiatives, especially in areas with limited district level capacity to manage funds and deliver detailed and timely reports.

Multiple Stakeholder Perspectives on Teletherapy Delivery of Speech Pathology Services in Rural Schools: A Preliminary, Qualitative Investigation

PubMed Central

LINCOLN, MICHELLE; HINES, MONIQUE; FAIRWEATHER, CRAIG; RAMSDEN, ROBYN; MARTINOVICH, JULIA

2015-01-01

The objective of this study was to investigate stakeholders’ views on the feasibility and acceptability of a pilot speech pathology teletherapy program for children attending schools in rural New South Wales, Australia. Nine children received speech pathology sessions delivered via Adobe Connect® web-conferencing software. During semi-structured interviews, school principals (n = 3), therapy facilitators (n = 7), and parents (n = 6) described factors that promoted or threatened the program’s feasibility and acceptability. Themes were categorized according to whether they related to (a) the use of technology; (b) the school-based nature of the program; or (c) the combination of using technology with a school-based program. Despite frequent reports of difficulties with technology, teletherapy delivery of speech pathology services in schools was highly acceptable to stakeholders. However, the use of technology within a school environment increased the complexities of service delivery. Service providers should pay careful attention to planning processes and lines of communication in order to promote efficiency and acceptability of teletherapy programs. PMID:25945230

Leveraging the real value of laboratory medicine with the value proposition.

PubMed

Price, Christopher P; John, Andrew St; Christenson, Robert; Scharnhorst, Volker; Oellerich, Michael; Jones, Patricia; Morris, Howard A

2016-11-01

Improving quality and patient safety, containing costs and delivering value-for-money are the key drivers of change in the delivery of healthcare and have stimulated a shift from an activity-based service to a service based on patient-outcomes. The delivery of an outcomes-based healthcare agenda requires that the real value of laboratory medicine to all stakeholders be understood, effectively defined and communicated. The value proposition of any product or service is the link between the provider and the needs of the customer describing the utility of the product or service in terms of benefit to the customer. The framework of a value proposition for laboratory medicine provides the core business case that drives key activities in the evolution and maintenance of high quality healthcare from research through to adoption and quality improvement in an established service. The framework of a value proposition for laboratory medicine is described. The content is endorsed by IFCC and WASPaLM. Copyright © 2016 Elsevier B.V. All rights reserved.

Challenges and Realities: Evaluating a School-Based Service Project.

ERIC Educational Resources Information Center

Keir, Scott S.; Millea, Susan

The Hogg Foundation for Mental Health created the School of the Future (SoF) project to enable selected Texas schools to coordinate and implement school-based social and health services on their campuses and to demonstrate the effectiveness of this method of service delivery by evaluating the project to show the process used and the outcomes that…

Geographic information systems (GIS): an emerging method to assess demand and provision for rehabilitation services.

PubMed

Passalent, Laura; Borsy, Emily; Landry, Michel D; Cott, Cheryl

2013-09-01

To illustrate the application of geographic information systems (GIS) as a tool to assess rehabilitation service delivery by presenting results from research recently conducted to assess demand and provision for community rehabilitation service delivery in Ontario, Canada. Secondary analysis of data obtained from existing sources was used to establish demand and provision profiles for community rehabilitation services. These data were integrated using GIS software. A number of descriptive maps were produced that show the geographical distribution of service provision variables (location of individual rehabilitation health care providers and location of private and publicly funded community rehabilitation clinics) in relation to the distribution of demand variables (location of the general population; location of specific populations (i.e., residents age 65 and older) and distribution of household income). GIS provides a set of tools for describing and understanding the spatial organization of the health of populations and the distribution of health services that can aid the development of health policy and answer key research questions with respect to rehabilitation health services delivery. Implications for Rehabilitation It is important to seek out alternative and innovative methods to examine rehabilitation service delivery. GIS is a computer-based program that takes any data linked to a geographically referenced location and processes it through a software system that manages, analyses and displays the data in the form of a map, allowing for an alternative level of analysis. GIS provides a set of tools for describing and understanding the spatial organization of population health and health services that can aid the development of health policy and answer key research questions with respect to rehabilitation health services delivery.

An assessment of the effect of user fee policy reform on facility-based deliveries in rural Zambia.

PubMed

Chama-Chiliba, Chitalu Miriam; Koch, Steven Fredric

2016-12-07

Improving maternal health outcomes by reducing barriers to accessing maternal health services is a key goal for most developing countries. This paper analyses the effect of user fee removal, which was announced for rural areas of Zambia in April 2006, on the use of public health facilities for childbirth. Data from the 2007 Zambia Demographic and Health Survey, including birth histories for the five years preceding the survey, is linked to administrative data and geo-referenced health facility census data. We exploit a difference-in-differences design, due to a differential change in user fees at the district level; fees were removed in 54 rural districts, but not in the 18 remaining urban districts. We use multilevel modelling to estimate the effect of this policy change, based on 4018 births from May 2002 to September 2007, covering a period before and after the policy announcement in April 2006. The difference-in-difference estimates point to statistically insignificant changes in the proportion of women giving birth at home and in public facilities, but significant changes are found for deliveries in private (faith-based) facilities. Thus, the abolition of delivery fees is found to have some effect on where Zambian mothers choose to have their children born. The removal of user fees has not overcome barriers to the utilisation of delivery services at public facilities. User fee removal may also yield unintended consequences deterring the utilisation of delivery services. Therefore, abolishing user fees, alone, may not be sufficient to affect changes in utilisation; instead, other efforts, such as improving service quality, may have a greater impact.

Use-Inspired Data Information Services for NOAA's National Centers for Environmental Information

NASA Astrophysics Data System (ADS)

Owen, T.

2015-12-01

Leveraging environmental data and information to make specific, informed decisions is critical to the Nation's economy, environment, and public safety. The ability to successfully transform past and recent data into environmental intelligence is predicated on the articulation of use-inspired, actionable requirements for product and service development. With the formation of the National Centers for Environmental Information (NCEI), there is a unique opportunity to revolutionize the delivery of information services in support of customer requirements. Such delivery cuts across the disciplines of meteorology, geophysics, and oceanography, as well as regions and sectors for the United States. At NCEI, information services are based on a two-way dialogue that (i) raises awareness of environmental data products and services and (ii) captures user needs for product and services sustainment and development. To this end, NCEI information services has developed a formal process for collecting user needs and translating them into requirements. This process reflects economically-prevalent and regionally-focused sectors based on Census Bureau classifications.

Internet-based mental health services in Norway and Sweden: characteristics and consequences.

PubMed

Andersen, Anders Johan W; Svensson, Tommy

2013-03-01

Internet-based mental health services increase rapidly. However, national surveys are incomplete and the consequences for such services are poorly discussed. This study describes characteristics of 60 Internet-based mental health services in Norway and Sweden and discusses their social consequences. More than half of the services were offered by voluntary organisations and targeted towards young people. Professionals answered service users' questions in 60% of the services. Eight major themes were identified. These characteristics may indicate a shift in the delivery of mental health services in both countries, and imply changes in the understanding of mental health.

Intervention research to enhance community pharmacists' cognitive services: a systematic review.

PubMed

Patwardhan, Pallavi D; Amin, Mohamed E; Chewning, Betty A

2014-01-01

Positive impact of community pharmacists' cognitive pharmaceutical services (CPS) is well documented. However, community pharmacists have been slow to expand CPS roles. This systematic review explores how community pharmacy intervention research can help inform efforts to expand cognitive pharmaceutical service delivery. To: 1) identify community pharmacy CPS intervention studies that report data on pharmacist behaviors, either as a final study outcome itself or as a fidelity measure in patient outcome studies, and 2) describe the state of this research to help frame future research agendas. Empirical articles examining improvement or expansion of community pharmacist cognitive services published through December 2010 were searched using various search engines, bibliography searches and authors' libraries. Studies were included if they: 1) reported findings on pharmacist behaviors during cognitive service delivery, 2) employed a minimum of pre-post design or two study arms for pharmacists/pharmacies, and 3) were in community-based pharmacies. A total of 50 studies evaluated impact of community pharmacy based CPS delivery; however, only 21 included a pharmacist behavior outcome measure as a final outcome or as a fidelity measure. The majority (14 out of 21) of studies used a randomized controlled trial design. Nearly half (10 of 21) addressed asthma or tobacco cessation. Limited details were provided about interventions to prepare pharmacists for CPS delivery. The most frequent measures of pharmacist behavior were patient surveys and observation of pharmacists' behavior by secret shoppers; electronic data sets were rarely used. There is a need for well-designed intervention research that evaluates how interventions impact on pharmacist cognitive service behavior. Positive findings from this review reinforce that planned interventions have the potential to improve and expand pharmacist cognitive service delivery; however, more detail is needed in study publications for this potential to be fully realized. Copyright © 2014 Elsevier Inc. All rights reserved.

What Health Service Provider Factors Are Associated with Low Delivery of HIV Testing to Children with Acute Malnutrition in Dowa District of Malawi?

PubMed

Chitete, Lusungu; Puoane, Thandi

2015-01-01

The Community-based Management of Acute Malnutrition is the national program for treating acute malnutrition in Malawi. Under this program's guidelines all children enrolled should undergo an HIV test, so that those infected can receive appropriate treatment and care. However, the national data of 2012 shows a low delivery of testing. Prior studies have investigated client-related factors affecting uptake of HIV testing in Community-based Management of Acute Malnutrition program. Lacking is the information on the service provider factors that are associated with the delivery of testing. This study investigated service provider factors that affect delivery of HIV testing among children enrolled in the program and explored ways in which this could be improved. A descriptive study that used qualitative methods of data collection. Client registers were reviewed to obtain the number of children enrolled in Community-based Management of Acute Malnutrition and the number of children who were tested for HIV over a 12-month period. In-depth interviews were conducted with Community-based Management of Acute Malnutrition and HIV Testing and Counselling focal persons to investigate factors affecting HIV test delivery. Descriptive statistics were used to analyze data from client registers. Information from interviews was analyzed using a thematic approach. Quantitative data revealed that 1738 (58%) of 2981 children enrolled in Community-based Management of Acute Malnutrition were tested for HIV. From in-depth interviews four themes emerged, that is, lack of resources for HIV tests; shortage of staff skilled in HIV testing and counseling; lack of commitment among staff in referring children for HIV testing; and inadequately trained staff. There is a need for a functioning health system to help reduce child mortality resulting from HIV related conditions.

Legal considerations for document delivery services.

PubMed

Bunting, A

1994-04-01

Health sciences libraries that provide fee-based information services must consider and develop policies and procedures for complying with legal requirements. This paper reviews the provisions of copyright law that pertain to document delivery, including two court decisions concerning copyright. Also discussed are recent actions by publishers to reinforce their view of libraries' responsibilities for royalty fees for articles copied and their use of licenses to impose additional restrictions on the use of and reproduction of materials.

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…

Effectiveness of community based Safe Motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania.

PubMed

Mushi, Declare; Mpembeni, Rose; Jahn, Albrecht

2010-04-01

In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. Despite a high coverage of antenatal care (96%), only 44% of deliveries take place within the formal health services. Still, "Ensure skilled attendant at birth" is acknowledged as one of the most effective interventions to reduce maternal deaths. Exploring the potential of community-based interventions in increasing the utilization of obstetric care, the study aimed at developing, testing and assessing a community-based safe motherhood intervention in Mtwara rural District of Tanzania. This community-based intervention was designed as a pre-post comparison study, covering 4 villages with a total population of 8300. Intervention activities were implemented by 50 trained safe motherhood promoters (SMPs). Their tasks focused on promoting early and complete antenatal care visits and delivery with a skilled attendant. Data on all 512 deliveries taking place from October 2004 to November 2006 were collected by the SMPs and cross-checked with health service records. In addition 242 respondents were interviewed with respect to knowledge on safe motherhood issues and their perception of the SMP's performance. Skilled delivery attendance was our primary outcome; secondary outcomes included antenatal care attendance and knowledge on Safe Motherhood issues. Deliveries with skilled attendant significantly increased from 34.1% to 51.4% (rho < 0.05). Early ANC booking (4 to 16 weeks) rose significantly from 18.7% at baseline to 37.7% in 2005 and 56.9% (rho < 0.001) at final assessment. After two years 44 (88%) of the SMPs were still active, 79% of pregnant women were visited. Further benefits included the enhancement of male involvement in safe motherhood issues. The study has demonstrated the effectiveness of community-based safe motherhood intervention in promoting the utilization of obstetric care and a skilled attendant at delivery. This improvement is attributed to the SMPs' home visits and the close collaboration with existing community structures as well as health services.

The Computerization of Career Services: Critical Issues To Consider.

ERIC Educational Resources Information Center

Davidson, M. Meghan

2001-01-01

Looks at the technological changes in the delivery of career services in colleges and universities and examines seven critical issues: appropriate web-based services, student diversity, ethical responsibilities, high-tech and high-touch, holistic approach, staffing and financial considerations, and outcomes. (JOW)

Project SCS (Special Communication Services).

ERIC Educational Resources Information Center

Curtis, John A.

This extensive report describes and provides documentation on Special Communications Services for the Sensory Impaired (SCS), a Virginia-based telecommunications delivery system developed by the Center for Excellence, Inc. (CenTex), to provide information and entertainment broadcasting services to the visually handicapped, the hearing impaired,…

Improving quality through performance-based financing in district hospitals in Rwanda between 2006 and 2010: a 5-year experience.

PubMed

Janssen, Willy; Ngirabega, Jean de Dieu; Matungwa, Michel; Van Bastelaere, Stefaan

2015-01-01

Since 2000 performance-based financing (PBF) made its way to sub-Saharan health systems in an attempt to improve service delivery. In Rwanda initial experiences in 2001 and 2002 led to a scaling up of the initiative to all health centres (HC) and district hospitals (DH). In 2008 PBF became national strategy. PBF was introduced in Rwanda in 2006 at the DH level. Evaluation on their service delivery was carried out quarterly in the following areas: hospital management, support to the health centres and clinical activities. We studied four DHs. After 5 years, an improvement in the quantity of clinical activities was observed, as well as quality in hospital management, in HC support and in clinical activities. PBF proves to be a promising approach in strengthening and maintaining quality service delivery in the sub-Saharan district hospitals. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Exploring weight loss services in primary care and staff views on using a web-based programme.

PubMed

Ware, Lisa J; Williams, Sarah; Bradbury, Katherine; Brant, Catherine; Little, Paul; Hobbs, F D Richard; Yardley, Lucy

2012-01-01

Demand is increasing for primary care to deliver effective weight management services to patients, but research suggests that staff feel inadequately resourced for such a role. Supporting service delivery with a free and effective web-based weight management programme could maximise primary care resource and provide cost-effective support for patients. However, integration of e-health into primary care may face challenges. To explore primary care staff experiences of delivering weight management services and their perceptions of a web-based weight management programme to aid service delivery. Focus groups were conducted with primary care physicians, nurses and healthcare assistants (n = 36) involved in delivering weight loss services. Data were analysed using inductive thematic analysis. Participants thought that primary care should be involved in delivering weight management, especially when weight was aggravating health problems. However, they felt under-resourced to deliver these services and unsure as to the effectiveness of their input, as routine services were not evaluated. Beliefs that current services were ineffective resulted in staff reluctance to allocate more resources. Participants were hopeful that supplementing practice with a web-based weight management programme would enhance patient services and promote service evaluation. Although primary care staff felt they should deliver weight loss services, low levels of faith in the efficacy of current treatments resulted in provision of under-resourced and 'ad hoc' services. Integration of a web-based weight loss programme that promotes service evaluation and provides a cost-effective option for supporting patients may encourage practices to invest more in weight management services.

Models of service delivery for cancer genetic risk assessment and counseling.

PubMed

Trepanier, Angela M; Allain, Dawn C

2014-04-01

Increasing awareness of and the potentially concomitant increasing demand for cancer genetic services is driving the need to explore more efficient models of service delivery. The aims of this study were to determine which service delivery models are most commonly used by genetic counselors, assess how often they are used, compare the efficiency of each model as well as impact on access to services, and investigate the perceived benefits and barriers of each. Full members of the NSGC Familial Cancer Special Interest Group who subscribe to its listserv were invited to participate in a web-based survey. Eligible respondents were asked which of ten defined service delivery models they use and specific questions related to aspects of model use. One-hundred ninety-two of the approximately 450 members of the listserv responded (42.7%); 177 (92.2%) had provided clinical service in the last year and were eligible to complete all sections of the survey. The four direct care models most commonly used were the (traditional) face-to-face pre- and post-test model (92.2%), the face-to-face pretest without face-to-face post-test model (86.5%), the post-test counseling only for complex results model (36.2%), and the post test counseling for all results model (18.3%). Those using the face-to-face pretest only, post-test all, and post-test complex models reported seeing more new patients than when they used the traditional model and these differences were statistically significantly. There were no significant differences in appointment wait times or distances traveled by patients when comparing use of the traditional model to the other three models. Respondents recognize that a benefit of using alternative service delivery models is increased access to services; however, some are concerned that this may affect quality of care.

Enabling Healthcare IT Governance: Human Task Management Service for Administering Emergency Department's Resources for Efficient Patient Flow.

PubMed

Rodriguez, Salvador; Aziz, Ayesha; Chatwin, Chris

2014-01-01

The use of Health Information Technology (HIT) to improve healthcare service delivery is constantly increasing due to research advances in medical science and information systems. Having a fully automated process solution for a Healthcare Organization (HCO) requires a combination of organizational strategies along with a selection of technologies that facilitate the goal of improving clinical outcomes. HCOs, requires dynamic management of care capability to realize the full potential of HIT. Business Process Management (BPM) is being increasingly adopted to streamline the healthcare service delivery and management processes. Emergency Departments (EDs) provide a case in point, which require multidisciplinary resources and services to deliver effective clinical outcomes. Managed care involves the coordination of a range of services in an ED. Although fully automated processes in emergency care provide a cutting edge example of service delivery, there are many situations that require human interactions with the computerized systems; e.g. Medication Approvals, care transfer, acute patient care. This requires a coordination mechanism for all the resources, computer and human, to work side by side to provide the best care. To ensure evidence-based medical practice in ED, we have designed a Human Task Management service to model the process of coordination of ED resources based on the UK's NICE Clinical guideline for managing the care of acutely ill patients. This functionality is implemented using Java Business process Management (jBPM).

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…

Pan-London tuberculosis services: a service evaluation

PubMed Central

2012-01-01

Background London has the largest proportion of tuberculosis (TB) cases of any western European capital, with almost half of new cases drug-resistant. Prevalence varies considerably between and within boroughs with research suggesting inadequate control of TB transmission in London. Economic pressures may exacerbate the already considerable challenges for service organisation and delivery within this context. This paper presents selected findings from an evaluation of London’s TB services’ organisation, delivery, professional workforce and skill mix, intended to support development of a strategic framework for a pan-London TB service. These may also interest health service professionals and managers in TB services in the UK, other European cities and countries and in services currently delivered by multiple providers operating independently. Methods Objectives were: 1) To establish how London’s TB services are structured and delivered in relation to leadership, management, organisation and delivery, coordination, staffing and support; 2) To identify tools/models for calculating skill mix as a basis for identifying skill mix requirements in delivering TB services across London; 3) To inform a strategic framework for the delivery of a pan-London TB service, which may be applicable to other European cities. The multi-method service audit evaluation comprised documentary analysis, semi-structured interviews with TB service users (n = 10), lead TB health professionals and managers (n = 13) representing London’s five sectors and focus groups with TB nurses (n = 8) and non-London network professionals (n = 2). Results Findings showed TB services to be mainly hospital-based, with fewer community-based services. Documentary analysis and professionals’ interviews suggested difficulties with early access to services, low suspicion index amongst some GPs and restricted referral routes. Interviews indicated lack of managed accommodation for difficult to treat patients, professional workforce shortages, a need for strategic leadership, nurse-led clinics and structured career paths for TB nurses and few social care/outreach workers to support patients with complex needs. Conclusions This paper has identified key issues relating to London’s TB services’ organisation, delivery, professional workforce and skill mix. The majority of these present challenges which need to be addressed as part of the future development of a strategic framework for a pan-London TB service. More consistent strategic planning/co-ordination and sharing of best practice is needed, together with a review of pan-London TB workforce development strategy, encompassing changing professional roles, skills development needs and patient pathways. These findings may be relevant with the development of TB services in other European cities. PMID:22805234

An Academic Library's Experience with Fee-Based Services.

ERIC Educational Resources Information Center

Hornbeck, Julia W.

1983-01-01

Profile of fee-based information services offered by the Information Exchange Center of Georgia Institute of Technology notes history and background, document delivery to commercial clients and on-campus faculty, online and manual literature searching, staff, cost analysis, fee schedule, operating methods, client relations, marketing, and current…

Family-centred care delivery

PubMed Central

Mayo-Bruinsma, Liesha; Hogg, William; Taljaard, Monica; Dahrouge, Simone

2013-01-01

Abstract Objective To determine whether models of primary care service delivery differ in their provision of family-centred care (FCC) and to identify practice characteristics associated with FCC. Design Cross-sectional study. Setting Primary care practices in Ontario (ie, 35 salaried community health centres, 35 fee-for-service practices, 32 capitation-based health service organizations, and 35 blended remuneration family health networks) that belong to 4 models of primary care service delivery. Participants A total of 137 practices, 363 providers, and 5144 patients. Main outcome measures Measures of FCC in patient and provider surveys were based on the Primary Care Assessment Tool. Statistical analyses were conducted using linear mixed regression models and generalized estimating equations. Results Patient-reported FCC scores were high and did not vary significantly by primary care model. Larger panel size in a practice was associated with lower odds of patients reporting FCC. Provider-reported FCC scores were significantly higher in community health centres than in family health networks (P = .035). A larger number of nurse practitioners and clinical services on-site were both associated with higher FCC scores, while scores decreased as the number of family physicians in a practice increased and if practices were more rural. Conclusion Based on provider and patient reports, primary care reform strategies that encourage larger practices and more patients per family physician might compromise the provision of FCC, while strategies that encourage multidisciplinary practices and a range of services might increase FCC. PMID:24235195

Extending access to essential services against constraints: the three-tier health service delivery system in rural China (1949-1980).

PubMed

Feng, Xing Lin; Martinez-Alvarez, Melisa; Zhong, Jun; Xu, Jin; Yuan, Beibei; Meng, Qingyue; Balabanova, Dina

2017-05-23

China has made remarkable progress in scaling up essential services during the last six decades, making health care increasingly available in rural areas. This was partly achieved through the building of a three-tier health system in the 1950s, established as a linked network with health service facilities at county, township and village level, to extend services to the whole population. We developed a Theory of Change to chart the policy context, contents and mechanisms that may have facilitated the establishment of the three-tier health service delivery system in rural China. We systematically synthesized the best available evidence on how China achieved universal access to essential services in resource-scarce rural settings, with a particular emphasis on the experiences learned before the 1980s, when the country suffered a particularly acute lack of resources. The search identified only three peered-reviewed articles that fit our criteria for scientific rigor. We therefore drew extensively on government policy documents, and triangulated them with other publications and key informant interviews. We found that China's three-tier health service delivery system was established in response to acute health challenges, including high fertility and mortality rates. Health system resources were extremely low in view of the needs and insufficient to extend access to even basic care. With strong political commitment to rural health and a "health-for-all" policy vision underlying implementation, a three-tier health service delivery model connecting villages, townships and counties was quickly established. We identified several factors that contributed to the success of the three-tier system in China: a realistic health human resource development strategy, use of mass campaigns as a vehicle to increase demand, an innovative financing mechanisms, public-private partnership models in the early stages of scale up, and an integrated approach to service delivery. An implementation process involving gradual adaptation and incorporation of the lessons learnt was also essential. China's 60 year experience in establishing a de-professionalized, community-based, health service delivery model that is economically feasible, institutionally and culturally appropriate mechanism can be useful to other low- and middle-income countries (LMICs) seeking to extend essential services. Lessons can be drawn from both reform content and from its implementation pathway, identifying the political, institutional and contextual factors shaping the three-tier delivery model over time.

Changes in the proportion of facility-based deliveries and related maternal health services among the poor in rural Jhang, Pakistan: results from a demand-side financing intervention.

PubMed

Agha, Sohail

2011-11-30

Demand-side financing projects are now being implemented in many developing countries, yet evidence showing that they reach the poor is scanty. A maternal health voucher scheme provided voucher-paid services in Jhang, a predominantly rural district of Pakistan, during 2010. A pre-test/post-test quasi-experimental design was used to assess the changes in the proportion of facility-based deliveries and related maternal health services among the poor. Household interviews were conducted with randomly selected women in the intervention and control union councils, before and after the intervention.A strong outreach model was used. Voucher promoters were given basic training in identification of poor women using the Poverty Scorecard for Pakistan, in the types of problems women could face during delivery, and in the promotion of antenatal care (ANC), institutional delivery and postnatal care (PNC). Voucher booklets valued at Rs. 4,000 ($48), including three ANC visits, a PNC visit, an institutional delivery, and a postnatal family planning visit, were sold for Rs. 100 ($1.2) to low-income women targeted by project outreach workers. Women suffering from complications were referred to emergency obstetric care services.Analysis was conducted at the bivariate and the multivariate levels. At the multivariate level, logistic regression analysis was conducted to determine whether the increase in institutional delivery was greater among poor women (defined for this study as women in the fourth or fifth quintiles) relative to non-poor women (defined for this study as women in the first quintile) in the intervention union councils compared to the control union councils. Bivariate analysis showed significant increases in the institutional delivery rate among women in the fourth or fifth wealth quintiles in the intervention union councils but no significant changes in this indicator among women in the same wealth quintiles in the control union councils. Multivariate analysis showed that the increase in institutional delivery among poor women relative to non-poor women was significantly greater in the intervention compared to the control union councils. Demand-side financing projects using vouchers can be an effective way of reducing inequities in institutional delivery.

A Blueprint for School-Based Services. School of the Future: Dallas.

ERIC Educational Resources Information Center

Iscoe, Louise

The Hogg Foundation for Mental Health created the School of the Future (SoF) project to enable selected Texas schools to coordinate and implement school-based social and health services on their campuses and to demonstrate the effectiveness of this method of service delivery by evaluating the project. At each of four urban sites consisting of a…

Revisiting the School of the Future: The Evolution of a School-Based Services Project.

ERIC Educational Resources Information Center

Iscoe, Louise K.; Keir, Scott S.

The Hogg Foundation for Mental Health created the School of the Future (SoF) project to enable selected Texas schools to coordinate and implement school-based social and health services on their campuses and to demonstrate the effectiveness of this method of service delivery by evaluating the project. This report documents the evolution of the SoF…

Beyond the Classroom: Experiences of a School-Based Services Project.

ERIC Educational Resources Information Center

Iscoe, Louise K.

The Hogg Foundation for Mental Health created the School of the Future (SoF) project to enable selected Texas schools to coordinate and implement school-based social and health services on their campuses and to demonstrate the effectiveness of this method of service delivery by evaluating the project. The SoF operated in four sites, each with a…

Prison-Based Relationship Counselling: Service User Perceptions and Implications for Resettlement

ERIC Educational Resources Information Center

Meek, Rosie

2011-01-01

This article is based on a brief evaluation carried out on behalf of the relationship counselling service, Relate, regarding the delivery of a pilot specialist counselling service for adult male prisoners at HMP Ford, a low security "category D" prison in the South East of England. At the heart of the research lies a focus on the…

Older Adults and Emerging Digital Service Delivery: A Mixed Methods Study on Information and Communications Technology Use, Skills, and Attitudes.

PubMed

Siren, Anu; Knudsen, Sine Grønborg

2017-01-01

Based on data from a survey (n = 3291) and 14 qualitative interviews among Danish older adults, this study investigated the use of, and attitudes toward, information communications technology (ICT) and the digital delivery of public services. While age, gender, and socioeconomic status were associated with use of ICT, these determinants lost their explanatory power when we controlled for attitudes and experiences. We identified three segments that differed in their use of ICT and attitudes toward digital service delivery. As nonuse of ICT often results from the lack of willingness to use it rather than from material or cognitive deficiencies, policy measures for bridging the digital divide should focus on skills and confidence rather than on access or ability.

How to achieve optimal organization of primary care service delivery at system level: lessons from Europe.

PubMed

Pelone, Ferruccio; Kringos, Dionne S; Spreeuwenberg, Peter; De Belvis, Antonio G; Groenewegen, Peter P

2013-09-01

To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes. Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data Envelopment models were run to compare the relative technical efficiency. A sensitivity analysis of the resulting efficiency scores was performed. PC systems in 22 European countries in 2009/2010. Model 1 included data on PC governance, workforce development and economic conditions as inputs and access, coordination, continuity and comprehensiveness of care as outputs. Model 2 included the previous process dimensions as inputs and quality indicators as outputs. There is relatively reasonable efficiency in all countries at delivering as many as possible PC processes at a given level of PC structure. It is particularly important to invest in economic conditions to achieve an efficient structure-process balance. Only five countries have fully efficient PC systems in turning their services delivery into high quality outcomes, using a similar combination of access, continuity and comprehensiveness, although they differ on the adoption of coordination of services. There is a large variation in efficiency levels obtained by countries with inefficient PC in turning their services delivery into quality outcomes. Maximizing the individual functions of PC without taking into account the coherence within the health-care system is not sufficient from a policymaker's point of view when aiming to achieve efficiency.

Phased implementation of spaced clinic visits for stable HIV-positive patients in Rwanda to support Treat All.

PubMed

Nsanzimana, Sabin; Remera, Eric; Ribakare, Muhayimpundu; Burns, Tracy; Dludlu, Sibongile; Mills, Edward J; Condo, Jeanine; Bucher, Heiner C; Ford, Nathan

2017-07-21

In 2016, Rwanda implemented "Treat All," requiring the national HIV programme to increase antiretroviral (ART) treatment coverage to all people living with HIV. Approximately half of the 164,262 patients on ART have been on treatment for more than five years, and long-term retention of patients in care is an increasing concern. To address these challenges, the Ministry of Health has introduced a differentiated service delivery approach to reduce the frequency of clinical visits and medication dispensing for eligible patients. This article draws on key policy documents and the views of technical experts involved in policy development to describe the process of implementation of differentiated service delivery in Rwanda. Implementation of differentiated service delivery followed a phased approach to ensure that all steps are clearly defined and agreed by all partners. Key steps included: definition of scope, including defining which patients were eligible for transition to the new model; definition of the key model components; preparation for patient enrolment; considerations for special patient groups; engagement of implementing partners; securing political and financial support; forecasting drug supply; revision, dissemination and implementation of ART guidelines; and monitoring and evaluation. Based on the outcomes of the evaluation of the new service delivery model, the Ministry of Health will review and strategically reduce costs to the national HIV program and to the patient by exploring and implementing adjustments to the service delivery model.

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.

Building community resilience through mental health infrastructure and training in post-Katrina New Orleans.

PubMed

Springgate, Benjamin F; Wennerstrom, Ashley; Meyers, Diana; Allen, Charles E; Vannoy, Steven D; Bentham, Wayne; Wells, Kenneth B

2011-01-01

To describe a disaster recovery model focused on developing mental health services and capacity-building within a disparities-focused, community-academic participatory partnership framework. Community-based participatory, partnered training and services delivery intervention in a post-disaster setting. Post-Katrina Greater New Orleans community. More than 400 community providers from more than 70 health and social services agencies participated in the trainings. Partnered development of a training and services delivery program involving physicians, therapists, community health workers, and other clinical and non-clinical personnel to improve access and quality of care for mental health services in a post-disaster setting. Services delivery (outreach, education, screening, referral, direct treatment); training delivery; satisfaction and feedback related to training; partnered development of training products. Clinical services in the form of outreach, education, screening, referral and treatment were provided in excess of 110,000 service units. More than 400 trainees participated in training, and provided feedback that led to evolution of training curricula and training products, to meet evolving community needs over time. Participant satisfaction with training generally scored very highly. This paper describes a participatory, health-focused model of community recovery that began with addressing emerging, unmet mental health needs using a disparities-conscious partnership framework as one of the principle mechanisms for intervention. Population mental health needs were addressed by investment in infrastructure and services capacity among small and medium sized non-profit organizations working in disaster-impacted, low resource settings.

Legal considerations for document delivery services.

PubMed Central

Bunting, A

1994-01-01

Health sciences libraries that provide fee-based information services must consider and develop policies and procedures for complying with legal requirements. This paper reviews the provisions of copyright law that pertain to document delivery, including two court decisions concerning copyright. Also discussed are recent actions by publishers to reinforce their view of libraries' responsibilities for royalty fees for articles copied and their use of licenses to impose additional restrictions on the use of and reproduction of materials. PMID:8004023

The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients-innovation in the commissioning of primary dental care service delivery and organisation in the UK.

PubMed

Pavitt, Sue H; Baxter, Paul D; Brunton, Paul A; Douglas, Gail; Edlin, Richard; Gibson, Barry J; Godson, Jenny; Hall, Melanie; Porritt, Jenny; Robinson, Peter G; Vinall, Karen; Hulme, Claire

2014-09-17

In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards 'blended contracts' that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national and international conferences and in international journals. 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.

Provider cost analysis supports results-based contracting out of maternal and newborn health services: an evidence-based policy perspective.

PubMed

Hatcher, Peter; Shaikh, Shiraz; Fazli, Hassan; Zaidi, Shehla; Riaz, Atif

2014-11-13

There is dearth of evidence on provider cost of contracted out services particularly for Maternal and Newborn Health (MNH). The evidence base is weak for policy makers to estimate resources required for scaling up contracting. This paper ascertains provider unit costs and expenditure distribution at contracted out government primary health centers to inform the development of optimal resource envelopes for contracting out MNH services. This is a case study of provider costs of MNH services at two government Rural Health Centers (RHCs) contracted out to a non-governmental organization in Pakistan. It reports on four selected Basic Emergency Obstetrical and Newborn Care (BEmONC) services provided in one RHC and six Comprehensive Emergency Obstetrical and Newborn Care (CEmONC) services in the other. Data were collected using staff interviews and record review to compile resource inputs and service volumes, and analyzed using the CORE Plus tool. Unit costs are based on actual costs of MNH services and are calculated for actual volumes in 2011 and for volumes projected to meet need with optimal resource inputs. The unit costs per service for actual 2011 volumes at the BEmONC RHC were antenatal care (ANC) visit USD$ 18.78, normal delivery US$ 84.61, newborn care US$ 16.86 and a postnatal care (PNC) visit US$ 13.86; and at the CEmONC RHC were ANC visit US$ 45.50, Normal Delivery US$ 148.43, assisted delivery US$ 167.43, C-section US$ 183.34, Newborn Care US$ 41.07, and PNC visit US$ 27.34. The unit costs for the projected volumes needed were lower due to optimal utilization of resources. The percentage distribution of expenditures at both RHCs was largest for salaries of technical staff, followed by salaries of administrative staff, and then operating costs, medicines, medical and diagnostic supplies. The unit costs of MNH services at the two contracted out government rural facilities remain higher than is optimal, primarily due to underutilization. Provider cost analysis using standard treatment guideline (STG) based service costing frameworks should be applied across a number of health facilities to calculate the cost of services and guide development of evidence based resource envelopes and performance based contracting.

Audit Culture: Unintended Consequences of Accountability Practices in Evidence-Based Programs

ERIC Educational Resources Information Center

Owczarzak, Jill; Broaddus, Michelle; Pinkerton, Steven

2016-01-01

Evaluation has become expected within the nonprofit sector, including HIV prevention service delivery through community-based organizations (CBOs). While staff and directors at CBOs may acknowledge the potential contribution of evaluation data to the improvement of agency services, the results of evaluation are often used to demonstrate fiscal…

Alabama 622 Project Services to Deaf-Blind Children. Final Report.

ERIC Educational Resources Information Center

Graham, Terry; Bosarge, Zackie

This report describes activities and accomplishments of a 3-year federally supported project to improve services to children (ages 0-21) with deaf-blindness in Alabama. The project utilized a service delivery model based on provision of state, regional, local, and individual technical assistance to service providers and families through three…

The Relationship of School-Based Services to Mental Health Networks.

ERIC Educational Resources Information Center

Polgar, Michael; Johnsen, Matthew; Calloway, Michael; Morrissey, Joseph P.

This paper uses data from a project in South Carolina that provides services to children with severe emotional disturbance (SED) to examine the role of schools in integrated service delivery. This study examined organizations participating in a demonstration project sponsored by the federal Center for Mental Health Services and administered by a…

Links among Social Status, Service Delivery Mode, and Service Delivery Preference in LD, Low-Achieving, and Normally Achieving Elementary-Aged Children.

ERIC Educational Resources Information Center

Le Mare, Lucy; de la Ronde, Marie

2000-01-01

Relations among social status, current service delivery, and service delivery preferences were examined in 42 students with learning disabilities (LD), 40 low-achieving, and 42 average/high-achieving students in grades 2-4 and 6-7. Most students preferred pullout service to in-class service. Only among LD students were self- and peer-rated social…

Online access to journal abstracts and articles.

PubMed

Giedd, J N; Smith, K G

1997-01-01

Advances in information technology now offer several options for child and adolescent psychopharmacologists to navigate the increasingly complex terrain of scientific literature and keep abreast of the rapidly changing advances in our field. MEDLINE, the world's largest database of medical literature, can be accessed and searched by a variety of free or fee-based services. In addition to efficient retrieval of citations and abstracts based on subject, author, or title, many of these services now provide, for a fee, the entire text and graphics of articles (displayed on computer screen, faxed, or mailed). There are also current awareness services to alert the user when new requested literature become available as well as services to send via e-mail the tables of contents of requested journals (sometimes prior to paper publication). For online citation and abstract retrieval, we found that free services, such as PubMed, performed as good or better than fee-based services. Physicians' Online, sponsored by the pharmaceutical industry, offered the lowest price for full-text manuscript delivery. In this article, we review literature search, delivery, and update services and offer some tips on how to most effectively use these resources.

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.

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.

Building Service Delivery Networks: Partnership Evolution Among Children’s Behavioral Health Agencies in Response to New Funding

PubMed Central

Bunger, Alicia C.; Doogan, Nathan J.; Cao, Yiwen

2014-01-01

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. PMID:25574359

Using In-Service and Coaching to Increase Teachers' Accurate Use of Research-Based Strategies

ERIC Educational Resources Information Center

Kretlow, Allison G.; Cooke, Nancy L.; Wood, Charles L.

2012-01-01

Increasing the accurate use of research-based practices in classrooms is a critical issue. Professional development is one of the most practical ways to provide practicing teachers with training related to research-based practices. This study examined the effects of in-service plus follow-up coaching on first grade teachers' accurate delivery of…

Using the community-based health planning and services program to promote skilled delivery in rural Ghana: socio-demographic factors that influence women utilization of skilled attendants at birth in Northern Ghana

PubMed Central

2014-01-01

Background The burden of maternal mortality in sub-Saharan Africa is enormous. In Ghana the maternal mortality ratio was 350 per 100,000 live births in 2010. Skilled birth attendance has been shown to reduce maternal deaths and disabilities, yet in 2010 only 68% of mothers in Ghana gave birth with skilled birth attendants. In 2005, the Ghana Health Service piloted an enhancement of its Community-Based Health Planning and Services (CHPS) program, training Community Health Officers (CHOs) as midwives, to address the gap in skilled attendance in rural Upper East Region (UER). The study determined the extent to which CHO-midwives skilled delivery program achieved its desired outcomes in UER among birthing women. Methods We conducted a cross-sectional household survey with women who had ever given birth in the three years prior to the survey. We employed a two stage sampling techniques: In the first stage we proportionally selected enumeration areas, and the second stage involved random selection of households. In each household, where there is more than one woman with a child within the age limit, we interviewed the woman with the youngest child. We collected data on awareness of the program, use of the services and factors that are associated with skilled attendants at birth. Results A total of 407 households/women were interviewed. Eighty three percent of respondents knew that CHO-midwives provided delivery services in CHPS zones. Seventy nine percent of the deliveries were with skilled attendants; and over half of these skilled births (42% of total) were by CHO-midwives. Multivariate analyses showed that women of the Nankana ethnic group and those with uneducated husbands were less likely to access skilled attendants at birth in rural settings. Conclusions The implementation of the CHO-midwife program in UER appeared to have contributed to expanded skilled delivery care access and utilization for rural women. However, women of the Nankana ethnic group and uneducated men must be targeted with health education to improve women utilizing skilled delivery services in rural communities of the region. PMID:24721385

Using the community-based health planning and services program to promote skilled delivery in rural Ghana: socio-demographic factors that influence women utilization of skilled attendants at birth in northern Ghana.

PubMed

Sakeah, Evelyn; Doctor, Henry V; McCloskey, Lois; Bernstein, Judith; Yeboah-Antwi, Kojo; Mills, Samuel

2014-04-10

The burden of maternal mortality in sub-Saharan Africa is enormous. In Ghana the maternal mortality ratio was 350 per 100,000 live births in 2010. Skilled birth attendance has been shown to reduce maternal deaths and disabilities, yet in 2010 only 68% of mothers in Ghana gave birth with skilled birth attendants. In 2005, the Ghana Health Service piloted an enhancement of its Community-Based Health Planning and Services (CHPS) program, training Community Health Officers (CHOs) as midwives, to address the gap in skilled attendance in rural Upper East Region (UER). The study determined the extent to which CHO-midwives skilled delivery program achieved its desired outcomes in UER among birthing women. We conducted a cross-sectional household survey with women who had ever given birth in the three years prior to the survey. We employed a two stage sampling techniques: In the first stage we proportionally selected enumeration areas, and the second stage involved random selection of households. In each household, where there is more than one woman with a child within the age limit, we interviewed the woman with the youngest child. We collected data on awareness of the program, use of the services and factors that are associated with skilled attendants at birth. A total of 407 households/women were interviewed. Eighty three percent of respondents knew that CHO-midwives provided delivery services in CHPS zones. Seventy nine percent of the deliveries were with skilled attendants; and over half of these skilled births (42% of total) were by CHO-midwives. Multivariate analyses showed that women of the Nankana ethnic group and those with uneducated husbands were less likely to access skilled attendants at birth in rural settings. The implementation of the CHO-midwife program in UER appeared to have contributed to expanded skilled delivery care access and utilization for rural women. However, women of the Nankana ethnic group and uneducated men must be targeted with health education to improve women utilizing skilled delivery services in rural communities of the region.

The role of nurse specialists in the delivery of integrated diabetes care: a cross-sectional survey of diabetes nurse specialist services

PubMed Central

Riordan, Fiona; McHugh, Sheena M; Murphy, Katie; Barrett, Julie; Kearney, Patricia M

2017-01-01

Objectives International evidence suggests the diabetes nurse specialist (DNS) has a key role in supporting integrated management of diabetes. We examine whether hospital and community DNS currently support the integration of care, examine regional variation in aspects of the service relevant to the delivery of integrated care and identify barriers to service delivery and areas for improvement. Design A cross-sectional survey of hospital and community-based DNS in Ireland. Methods Between September 2015 and April 2016, a 67-item online survey, comprising closed and open questions on their clinical role, diabetes clinics, multidisciplinary working, and barriers and facilitators to service delivery, was administered to all eligible DNS (n=152) in Ireland. DNS were excluded if they were retired or on maternity leave or extended leave. Results The response rate was 66.4% (n=101): 60.6% (n=74) and 89.3% (n=25) among hospital and community DNS, respectively. Most DNS had patients with stable (81.8%) and complicated type 2 diabetes mellitus (89.9%) attending their service. The majority were delivering nurse-led clinics (81.1%). Almost all DNS had a role liaising with (91%), and providing support and education to (95%), other professionals. However, only a third reported that there was local agreement on how their service should operate between the hospital and primary care. Barriers to service delivery that were experienced by DNS included deficits in the availability of specialist staff (allied health professionals, endocrinologists and DNS), insufficient space for clinics, structured education and issues with integration. Conclusions Delivering integrated diabetes care through a nurse specialist-led approach requires that wider service issues, including regional disparities in access to specialist resources and formalising agreements and protocols on multidisciplinary working between settings, be explicitly addressed. PMID:28801394

Skilled delivery care service utilization in Ethiopia: analysis of rural-urban differentials based on national demographic and health survey (DHS) data.

PubMed

Fekadu, Melaku; Regassa, Nigatu

2014-12-01

Despite the slight progress made on Antenatal Care (ANC) utilization, skilled delivery care service utilization in Ethiopia is still far-below any acceptable standards. Only 10% of women receive assistance from skilled birth attendants either at home or at health institutions, and as a result the country is recording a high maternal mortality ratio (MMR) of 676 per 100,000 live births (EDHS, 2011). Hence, this study aimed at identifying the rural-urban differentials in the predictors of skilled delivery care service utilization in Ethiopia. The study used the recent Ethiopian Demographic and Health Survey (EDHS 2011) data. Women who had at least one birth in the five years preceding the survey were included in this study. The data were analyzed using univariate (percentage), bivariate (chi-square) and multivariate (Bayesian logistic regression). The results showed that of the total 6,641 women, only 15.6% received skilled delivery care services either at home or at health institution. Rural women were at greater disadvantage to receive the service. Only 4.5% women in rural areas received assistance from skilled birth attendants (SBAs) compared to 64.1 % of their urban counter parts. Through Bayesian logistic regression analysis, place of residence, ANC utilization, women's education, age and birth order were identified as key predictors of service utilization. The findings highlight the need for coordinated effort from government and stakeholders to improve women's education, as well as strengthen community participation. Furthermore, the study recommended the need to scale up the quality of ANC and family planning services backed by improved and equitable access, availability and quality of skilled delivery care services.

Factors influencing the demand of the service of community based animal health care in Zimbabwe.

PubMed

Mutambara, J; Dube, I; Matangi, E; Majeke, F

2013-11-01

This study was done to find out about animal health service providers and factors that determined demand for community based veterinary service delivery in smallholder sector of Zimbabwe. Focus group discussions and a questionnaire was used to collect data on veterinary services providers and socio-economic factors related to animal health from a sample (N=333) smallholder livestock farmers from Gutu district of Masvingo province in Zimbabwe. Analytical techniques used were descriptive statistics, K-mean cluster analysis and Tobit regression model. Results showed that the majority of farmers (45%) obtained services from both Community Based Animal Health Workers (CBAHWs) and Department of Veterinary Service (DVS), 25% DVS only, 20% used CBAHWs while 10% did not seek any services. Further analysis showed that distance to CBAHW, distance to AHMC and employment status were significantly related to demand for CBAHWs with coefficients of -1.5, 0.7 and -10.3, respectively. The study thus concluded that CBAHW is an alternative animal health service delivery approach already practiced in smallholder farming sectors of Zimbabwe. Socio-economic factors significantly influenced the demand for CBAHW services. Given limited resources by state sponsored veterinary services, it is recommended that the CBAHWs approach should be encouraged as supplementary service provider especially in areas further DVS. These community organizations can be empowered by the state to deliver more improved services based on hygiene and modern science at a relatively low cost to farmers. Copyright © 2013 Elsevier B.V. All rights reserved.

A qualitative analysis of health professionals' job descriptions for surgical service delivery in Uganda.

PubMed

Buwembo, William; Munabi, Ian G; Galukande, Moses; Kituuka, Olivia; Luboga, Samuel A

2014-01-01

The ever increasing demand for surgical services in sub-Saharan Africa is creating a need to increase the number of health workers able to provide surgical care. This calls for the optimisation of all available human resources to provide universal access to essential and emergency surgical services. One way of optimising already scarce human resources for health is by clarifying job descriptions to guide the scope of practice, measuring rewards/benefits for the health workers providing surgical care, and informing education and training for health professionals. This study set out to determine the scope of the mandate to perform surgical procedures in current job descriptions of surgical care health professionals in Uganda. A document review was conducted of job descriptions for the health professionals responsible for surgical service delivery in the Ugandan Health care system. The job descriptions were extracted and subjected to a qualitative content data analysis approach using a text based RQDA package of the open source R statistical computing software. It was observed that there was no explicit mention of assignment of delivery of surgical services to a particular cadre. Instead the bulk of direct patient related care, including surgical attention, was assigned to the lower cadres, in particular the medical officer. Senior cadres were assigned to perform predominantly advisory and managerial roles in the health care system. In addition, a no cost opportunity to task shift surgical service delivery to the senior clinical officers was identified. There is a need to specifically assign the mandate to provide surgical care tasks, according to degree of complexity, to adequately trained cadres of health workers. Health professionals' current job descriptions are not explicit, and therefore do not adequately support proper training, deployment, defined scope of practice, and remuneration for equitable surgical service delivery in Uganda. Such deliberate assignment of mandates will provide a means of increasing surgical service delivery through further optimisation of the available human resources for health.

Occupational lead poisoning: who should conduct surveillance and training?

PubMed

Keogh, J P; Gordon, J

1994-11-01

This commentary challenges the current employer-controlled model for delivering occupational health services. Problems emanating from traditional employer-based medical surveillance and worker education programs for occupational lead poisoning are identified. A new public health model for delivering these services is proposed. This model utilizes a case-based and hazard-based method for bringing workplaces and employers into the program and features direct delivery of surveillance and training services by public health agencies.

Episode-Based Payment and Direct Employer Purchasing of Healthcare Services: Recent Bundled Payment Innovations and the Geisinger Health System Experience.

PubMed

Slotkin, Jonathan R; Ross, Olivia A; Newman, Eric D; Comrey, Janet L; Watson, Victoria; Lee, Rachel V; Brosious, Megan M; Gerrity, Gloria; Davis, Scott M; Paul, Jacquelyn; Miller, E Lynn; Feinberg, David T; Toms, Steven A

2017-04-01

One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms. The Patient Protection and Affordable Care Act has allowed many care delivery systems to partner with Medicare in episode-based payment programs such as the Bundled Payments for Care Improvement (BPCI) initiative, and in patient-based models such as the Medicare Shared Savings Program. Several employer purchasers of healthcare services are experimenting with innovative payment models to include episode-based bundled rate destination centers of excellence programs and the direct purchasing of accountable care organization services. The Geisinger Health System has over 10 years of experience with episode-based payment bundling coupled with the care delivery reengineering which is integral to its ProvenCare® program. Recent experiences at Geisinger have included participation in BPCI and also partnership with employer-purchasers of healthcare through the Pacific Business Group on Health (representing Walmart, Lowe's, and JetBlue Airways). As the shift towards value-focused care delivery and patient experience progresses forward, bundled payment arrangements and direct purchasing of healthcare will be critical financial drivers in effecting change. Copyright © 2017 by the Congress of Neurological Surgeons.

Intimate partner violence and the utilization of maternal health care services in Nigeria.

PubMed

Ononokpono, Dorothy Ngozi; Azfredrick, Ezinwanne Christiana

2014-01-01

Our aim in this study is to examine the association between women's lifetime experiences of physical, sexual, and emotional intimate partner violence (IPV) and the use of maternal health care services. We used data from the 2008 Nigeria Demographic and Health Survey. Analysis was based on responses from 17,476 women (for antenatal care [ANC]) and 17,412 (for delivery assisted by a skilled health provider) who had had deliveries in the 5 years preceding the survey. We found an overall IPV prevalence rate of 33.4%. Physical IPV was associated with low use of ANC. Emotionally abused women were less likely to use delivery assistance from skilled health care providers. Based on our findings, we suggest the importance of designing interventions to address the health care needs of women who have experienced violence from their partners.

Channeling a Community's Aging Resources.

ERIC Educational Resources Information Center

Smith, Daniel J.

This report addresses the issue of community utilization of resources for the elderly population. A strategy for channeling resources is presented, including: (1) design of a comprehensive aging services administration and delivery plan based on needs assessment data and a service resource inventory; (2) development of a service agencies network…

Converting Student Support Services to Online Delivery.

ERIC Educational Resources Information Center

Brigham, David E.

2001-01-01

Uses a systems framework to analyze the creation of student support services for distance education at Regents College: electronic advising, electronic peer network, online course database, online bookstore, virtual library, and alumni services website. Addresses the issues involved in converting distance education programs from print-based and…

Five types of home-visit nursing agencies in Japan based on characteristics of service delivery: cluster analysis of three nationwide surveys.

PubMed

Fukui, Sakiko; Yamamoto-Mitani, Noriko; Fujita, Junko

2014-12-20

The number of home-visit nursing agencies in Japan has greatly increased over the past 20 years since the Japanese government first introduced it in 1992 to meet the increased needs of home-bound elderly. Since then, home-visit nursing has come to serve for a variety of populations such as those with terminal-stage cancer, neurological diseases, psychiatric conditions, or children with chronic conditions; currently the number of agencies has reached 6,801 (as of April 2013). Yet little has been known about the details of their characteristics in terms of patient types or differences/similarities across regions. In this study, we developed a method to categorize home-visit nursing agencies throughout Japan based on their actual service delivery, in order to help improve healthcare policies allowing better services by those agencies. We performed a cluster analysis on data from two national databases (Survey of Institutions and Establishments for Long-term Care which is annually administered by the Ministry of Health, Labour and Welfare [dataset 1; n = 5,161] and Information Publication System for Long-term Care which is annually reported by home-visit nursing agencies to their respective prefectural governments [dataset 2; n = 4,400, matching rate to data set 1: 84.4%]), in addition to the results from our original nationwide Fax survey of the service delivery system of home-visit nursing agencies (dataset 3; n = 2,049 matching rate to data set 1: 39.3%). The cluster analysis suggested five categories for home-visit nursing agencies based on the type of service delivery system. For deciding of these categories, we held 13 panel discussions with specialists to confirm that the categorization of the home-visit nursing agencies appropriately reflected their actual delivery systems. The five categories were: nurse-centered (560, 10.9%), rehabilitation-centered (211, 4.1%), psychiatric-centered (360, 7.0%), urban-centered (1,784, 34.5%), and rural-centered (2246, 43.5%). This five categorization system of home-visit nursing agencies could ensure appropriate healthcare policies that will allow agencies to provide better home-visit nursing services based on their patient and staff characteristics and regional needs. The findings would be valuable both in Japan as well as in other countries with rapidly growing aging populations.

Effect of an innovative community based health program on maternal health service utilization in north and south central Ethiopia: a community based cross sectional study.

PubMed

Afework, Mesganaw Fantahun; Admassu, Kesteberhan; Mekonnen, Alemayehu; Hagos, Seifu; Asegid, Meselech; Ahmed, Saifuddin

2014-04-04

Among Millennium Development Goals, achieving the fifth goal (MDG-5) of reducing maternal mortality poses the greatest challenge in Sub-Saharan Africa. Ethiopia has one of the highest maternal mortality ratios in the world with unacceptably low maternal health service utilization. The Government of Ethiopia introduced an innovative community-based intervention as a national strategy under the Health Sector Development Program. This new approach, known as the Health Extension Program, aims to improve access to and equity in essential health services through community based Health Extension Workers. The objective of the study is to assess the role of Health Extension Workers in improving women's utilization of antenatal care, delivery at health facility and postnatal care services. A cross sectional household survey was conducted in early 2012 in two districts of northern and south central parts of Ethiopia. Data were collected from 4949 women who had delivered in the two years preceding the survey. Logistic regression analysis was performed to determine the association between visit by Health Extension Workers during pregnancy and use of maternal health services, controlling for the effect of other confounding factors. The non-adjusted analysis showed that antenatal care attendance at least four times during pregnancy was significantly associated with visit by Health Extension Workers [Odds Ratio 3.46(95% CI 3.07,3.91)], whereas health facility delivery (skilled attendance at birth) was not significantly associated with visit by Health Extension Workers during pregnancy [Odds Ratio 0.87(95% CI 0.25,2.96)]. When adjusted for other factors the association of HEWs visit during pregnancy was weaker for antenatal care attendance [Adjusted Odds Ratio: 1.35(95% CI: 1.05, 1.72)] but positively and significantly associated with health facility delivery [Adjusted Odds Ratio 1.96(1.25,3.06)]. In general HEWs visit during pregnancy improved utilization of maternal health services. Health facility delivery is heavily affected by other factors. Meaningful improvement in skilled attendance at birth (health facility delivery) should include addressing other factors on top of visits by HEWs during pregnancy and specific target oriented interventions during visits by HEWs to support skilled attendance at birth.

Human service delivery in a multi-tier system: the subtleties of collaboration among partners.

PubMed

Mayhew, Fred

2012-01-01

This article examines the nature of interorganizational relationships that are formed within a multi-tier human service delivery system. Taking into account the hierarchical structure of a statewide initiative to support early childhood education, the study investigates the differences in the relationships between organizations at the service and administrative levels of the system. Forty-nine administrative level and 146 service delivery level relationships are evaluated. Findings indicate that organizations involved in direct service delivery form more collaborative relationships. Thus, when government provides funding for human services, policymakers must seek to balance public accountability with the advantages believed to be inherent in devolved service delivery. Furthermore, practitioners who appreciate the importance and nuances of interorganizational relationships will be in a position to better manage their organizations in an environment of increased collaborative activity and joint delivery of services. Going forward, human service systems will continue to involve organizations from the public, nonprofit, and private sector. A better understanding of how these organizations work together is crucial to the effective delivery of these essential services.

Analyzing the costs to deliver medication therapy management services.

PubMed

Rupp, Michael T

2011-01-01

To provide pharmacy managers and consultant pharmacists with a step-by-step approach for analyzing of the costs of delivering medication therapy management (MTM) services and to describe use of a free online software application for determining costs of delivering MTM. The process described is applicable to community pharmacies and consultant pharmacists who provide MTM services from nonpharmacy settings. The PharmAccount Service Cost Calculator is an Internet- based software application that uses a guided online interview to collect information needed to conduct a comprehensive cost analysis of any specialized pharmacy service. In addition to direct variable and fixed costs, the software automatically allocates indirect and overhead costs to the service and generates an itemized report that details the components of service delivery costs. The service cost calculator is sufficiently flexible to support the analysis of virtually any specialized pharmacy service, irrespective of whether the service is being delivered from a physical pharmacy. The software application allows users to perform sensitivity analysis to quickly determine the potential impact that alternate scenarios would have on service delivery cost. It is therefore particularly well suited to assist in the design and planning of a new pharmacy service. Good management requires that the cost implications of service delivery decisions are known and considered. Analyzing the cost of an MTM service is an important step in developing a sustainable business model.

Measuring the degree of integrated tuberculosis and HIV service delivery in Cape Town, South Africa.

PubMed

Uyei, Jennifer; Coetzee, David; Macinko, James; Weinberg, Sharon L; Guttmacher, Sally

2014-01-01

To address the considerable tuberculosis (TB)/HIV co-infected population in Cape Town, a number of clinics have made an effort of varying degrees to integrate TB and HIV services. This article describes the development of a theory-based survey instrument designed to quantify the extent to which services were integrated in 33 clinics and presents the results of the survey. Using principal factor analysis, eight factors were extracted and used to make comparisons across three types of clinics: co-located TB and antiretroviral therapy (ART) services, clinics with TB services only and clinics with ART only. Clinics with co-located services scored highest on measures related to integrated TB/ART service delivery compared to clinics with single services, but within group variability was high indicating that co-location of TB and ART services is a necessary but insufficient condition for integrated service delivery. In addition, we found almost all clinics with only TB services in our sample had highly integrated pre-ART services, suggesting that integration of these services across a large number of clinics is feasible and acceptable to clinic staff. TB clinics with highly integrated pre-ART services appear to be efficient sites for introducing ART given that co-infected patients are already engaged in care, and may potentially facilitate earlier access to treatment and minimize loss to follow-up.

Pregnant women's preference and factors associated with institutional delivery service utilization in Debra Markos Town, North West Ethiopia: a community based follow up study.

PubMed

Bayu, Hinsermu; Adefris, Mulatu; Amano, Abdella; Abuhay, Mulunesh

2015-02-05

Majority of deaths from obstetric complications are preventable. But every pregnant woman face risks which may not always be detected through the risk assessment approach during antenatal care (ANC). Therefore, the presence of a skilled birth attendant in every delivery is the most critical intervention in reducing maternal mortality and morbidity. In Ethiopia the proportion of births attended by skilled personnel, is very low, even for women who have access to the services. A community-based follow up study was conducted from January 17, 2012 to July 30, 2012, among 2(nd) and 3(rd) trimester's pregnant women in Debre-Markos town, east Gojam Zone, Amhara Region, North West Ethiopia. Simple random sampling technique was used to get a total sample size of 422 participants. A total of 393 pregnant women were included in the study. The study revealed that 292(74.3%) of the pregnant women planned to deliver in a health institution. Of these 292 pregnant women 234 (80.14%) actually delivered in a health facility. Age range from 15-19 year (AOR = 4.83, 95% CI = 1.562-12.641), college and above education of the pregnant women (AOR = 12.508, 95% CI = 1.082-14.557), ANC visit during the current pregnancy (AOR = 1.975, 95% CI = 1.021-3.392),perceived susceptibility and severity of pregnancy and delivery complication (AOR = 3.208, 95% CI = 1.262-8.155) and intention (preference) of pregnant women for place of delivery (AOR = 7.032, 95% CI = 3.045-10.234) are predictors of institutional delivery service utilization. Preference for institutional delivery is low in the study area. Sociodemographic factors, perception about delivery complication, ANC follow up and their intentions for institutional delivery are among important predictors of institutional delivery.

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

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-81,827] Verizon Business Networks... Verizon Business Network Services, Inc., Senior Analyst-Service Program Delivery, Hilliard, Ohio (subject.... Specifically, the worker group supplies service program delivery services. At the request of the State of Ohio...

Population-centered Risk- and Evidence-based Dental Interprofessional Care Team (PREDICT): study protocol for a randomized controlled trial.

PubMed

Cunha-Cruz, Joana; Milgrom, Peter; Shirtcliff, R Michael; Bailit, Howard L; Huebner, Colleen E; Conrad, Douglas; Ludwig, Sharity; Mitchell, Melissa; Dysert, Jeanne; Allen, Gary; Scott, JoAnna; Mancl, Lloyd

2015-06-20

To improve the oral health of low-income children, innovations in dental delivery systems are needed, including community-based care, the use of expanded duty auxiliary dental personnel, capitation payments, and global budgets. This paper describes the protocol for PREDICT (Population-centered Risk- and Evidence-based Dental Interprofessional Care Team), an evaluation project to test the effectiveness of new delivery and payment systems for improving dental care and oral health. This is a parallel-group cluster randomized controlled trial. Fourteen rural Oregon counties with a publicly insured (Medicaid) population of 82,000 children (0 to 21 years old) and pregnant women served by a managed dental care organization are randomized into test and control counties. In the test intervention (PREDICT), allied dental personnel provide screening and preventive services in community settings and case managers serve as patient navigators to arrange referrals of children who need dentist services. The delivery system intervention is paired with a compensation system for high performance (pay-for-performance) with efficient performance monitoring. PREDICT focuses on the following: 1) identifying eligible children and gaining caregiver consent for services in community settings (for example, schools); 2) providing risk-based preventive and caries stabilization services efficiently at these settings; 3) providing curative care in dental clinics; and 4) incentivizing local delivery teams to meet performance benchmarks. In the control intervention, care is delivered in dental offices without performance incentives. The primary outcome is the prevalence of untreated dental caries. Other outcomes are related to process, structure and cost. Data are collected through patient and staff surveys, clinical examinations, and the review of health and administrative records. If effective, PREDICT is expected to substantially reduce disparities in dental care and oral health. PREDICT can be disseminated to other care organizations as publicly insured clients are increasingly served by large practice organizations. ClinicalTrials.gov NCT02312921 6 December 2014. The Robert Wood Johnson Foundation and Advantage Dental Services, LLC, are supporting the evaluation.

Operational Space-Assisted Irrigation Advisory Services: Overview Of And Lessons Learned From The Project DEMETER

NASA Astrophysics Data System (ADS)

Osann Jochum, M. A.; Demeter Partners

2006-08-01

The project DEMETER (DEMonstration of Earth observation TEchnologies in Routine irrigation advisory services) was dedicated to assessing and demonstrating improvements introduced by Earth observation (EO) and Information and Communication Technologies (ICT) in farm and Irrigation Advisory Service (IAS) day-to-day operations. The DEMETER concept of near-real-time delivery of EO-based irrigation scheduling information to IAS and farmers has proven to be valid. The operationality of the space segment was demonstrated for Landsat 5-TM in the Barrax pilot zone during the 2004 and 2005 irrigation campaigns. Extra-fast image delivery and quality controlled operational processing make the EO-based crop coefficient maps available at the same speed and quality as ground-based data (point samples), while significantly extending the spatial coverage and reducing service cost. Leading-edge online analysis and visualization tools provide easy, intuitive access to the information and personalized service to users. First feedback of users at IAS and farmer level is encouraging. The paper gives an overview of the project and its main achievements.

Retail and Real Estate: The Changing Landscape of Care Delivery.

PubMed

Mason, Scott A

2015-01-01

By its nature, retail medicine is founded in real estate. That retail medicine has expanded so dramatically in a relatively short period of time has taken people by surprise. This rapid growth of integrating healthcare services into retail real estate begs the question of whether real estate will eventually take on the importance in healthcare delivery that it has in retail. This article advances the view that it will. In the end, what retail and healthcare have in common is that they both reflect the attributes of demanding consumers as part of an experience-based economy, where products and services are sought based on how they fit with their lifestyles and how they make them feel (Pine and Gilmore 1998). Changing the selection process for healthcare services to be more like retail is already expanding how and where healthcare services are delivered.

Facilitating earlier transfer of care from acute stroke services into the community.

PubMed

Robinson, Jennifer

This article outlines an initiative to reduce length of stay for stroke patients within an acute hospital and to facilitate earlier transfer of care. Existing care provision was remodelled and expanded to deliver stroke care to patients within a community bed-based intermediate care facility or intermediate care at home. This new model of care has improved the delivery of rehabilitation through alternative and innovative ways of addressing service delivery that meet the needs of the patients.

Consensus guidelines: improving the delivery of clinical preventive services.

PubMed

Ayres, Cynthia G; Griffith, Hurdis M

2008-01-01

Medical directors from the largest competing health plans in the state came together in a noncompetitive way to collaborate on improving the delivery of clinical preventive service (CPS) among their provider base. They identified one consistent set of CPS guidelines based on U.S. Preventive Services Task Force recommendations, the health plan consensus guidelines (HPCG), that they could endorse as priority for guideline implementation. The purposes of this study were to assess clinicians' knowledge and use of CPS recommendations as a guide to delivering preventive care services to their patients and, most importantly, to test the effectiveness of providing the HPCG to clinicians in an effort to increase knowledge and use of CPS guidelines. Within-subjects repeated-measures design was used. We hypothesized an increase in clinician's knowledge and use of CPS after the provision of the HPCG. Survey methodology, including two surveys that assessed clinicians' knowledge and use of CPS in practice, was used. Health plan clinician databases were obtained from the health plans that participated in the development of the HPCG. Health plan clinicians directly involved in delivering preventive services were invited to participate in the study. Final sample included 163 clinicians. Spearman's rho correlation coefficients were determined to examine the relationships between clinician's knowledge and clinician's use of CPS guidelines. Differences between knowledge and use of CPS before and after HPCG were examined by t tests. No difference was found in the familiarity with U.S. Preventive Services Task Force guidelines before and after receipt of HPCG. However, clinician's use increased significantly. A consistent set of CPS guidelines provided by competing health plans can improve the delivery of CPS among contracted health plan clinicians. This approach provides a template for competing health plans nationwide to come to consensus on guidelines that support clinicians in the delivery of CPS ().

Predictors of safe delivery service utilization in arsi zone, South-East ethiopia.

PubMed

Abera, Mulumebet; Gebremariam, Abebe; Belachew, Tefera

2011-08-01

Evidence show that lack of access to and use of, essential obstetric care services to be a crucial factor that contributes to the high maternal morbidity and mortality. Skilled attendance during labor, delivery and early post-partum period could reduce deaths due to obstructed labor, hemorrhage, sepsis and eclampsia. There is limited information on the mothers' use of skilled delivery services in the study area. This study assessed the predictors of safe delivery service utilization in Arsi Zone, Southeast Ethiopia. A cross- sectional community based study using quantitative and qualitative methods was conducted from February 15(th) to March 15(th) 2006. A total of 1089 women who had at least one birth one year prior to the study were involved in the study from nine rural and four urban kebeles in three Woredas (Districts) selected using a systematic sampling method from all households in the study area. A pre-tested structured interviewer administered questionnaire was used to collect data. Information on the utilization of safe delivery service and socio-demographic, individual and institutional factors and past obstetric history were collected. Focus Group Discussion guide was used for qualitative data collection. The data were edited, cleaned, and entered into a computer and analyzed using SPSS for windows version 12.0. One thousand seventy four women who had at least one birth were interviewed making a response rate 98.6%. Two hundred seventy one (75.0%) of urban and 373(52.0%) rural women received antenatal care from skilled health professional at least once during their last pregnancy. Thirty-one (4.3%) of rural and 145 (40.4%) of urban women delivered in health institution. In multivariate analysis showed that residential area OR= 8.5, 95%CI; (5.1,13.9), parity OR=0.18, 95%CI; (0.08, 0.42), and ANC service use OR= 4.5, 95%CI; (2.2,8.9), and maternal education OR=4.6, 95%CI; (1.7,12.8), were most significant predictors of safe delivery service use by mothers (P< 0.01). Birth attended by skilled personnel was low in the study area. Maternal education, her birth experience and her use of prenatal services are important predictors. Promoting information, education and communication on safe delivery service utilization, expansion of health service and empowerment of women are needed.

An evolutionary approach to the architecture of effective healthcare delivery systems.

PubMed

Towill, D R; Christopher, M

2005-01-01

Aims to show that material flow concepts developed and successfully applied to commercial products and services can form equally well the architectural infrastructure of effective healthcare delivery systems. The methodology is based on the "power of analogy" which demonstrates that healthcare pipelines may be classified via the Time-Space Matrix. A small number (circa 4) of substantially different healthcare delivery pipelines will cover the vast majority of patient needs and simultaneously create adequate added value from their perspective. The emphasis is firmly placed on total process mapping and analysis via established identification techniques. Healthcare delivery pipelines must be properly engineered and matched to life cycle phase if the service is to be effective. This small family of healthcare delivery pipelines needs to be designed via adherence to very specific-to-purpose principles. These vary from "lean production" through to "agile delivery". The proposition for a strategic approach to healthcare delivery pipeline design is novel and positions much currently isolated research into a comprehensive organisational framework. It therefore provides a synthesis of the needs of global healthcare.

Contributions of Ecological School Mental Health Services to Students' Academic Success

ERIC Educational Resources Information Center

Doll, Beth; Spies, Rob; Champion, Allison

2012-01-01

This article describes an ecological framework for school mental health services that differs in important ways from existing service delivery models. The model is based on research describing ecological frameworks underlying students' school success. Ecological characteristics of schools and classrooms that promote academic success are described…

48 CFR 252.237-7013 - Instruction to offerors (bulk weight).

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Offers shall be submitted on a unit price per pound of serviced laundry. Unit prices shall include all costs to the Government of providing the service, including pickup and delivery charges. (b) The Contracting Officer will evaluate bids based on the estimated pounds of serviced laundry stated in the...

Social workers and delivery of evidence-based psychosocial treatments for substance use disorders.

PubMed

Wells, Elizabeth A; Kristman-Valente, Allison N; Peavy, K Michelle; Jackson, T Ron

2013-01-01

Social workers encounter individuals with substance use disorders (SUDs) in a variety of settings. With changes in health care policy and a movement toward integration of health and behavioral health services, social workers will play an increased role vis-á-vis SUD. As direct service providers, administrators, care managers, and policy makers, they will select, deliver, or advocate for delivery of evidence-based SUD treatment practices. This article provides an overview of effective psychosocial SUD treatment approaches. In addition to describing the treatments, the article discusses empirical support, populations for whom the treatments are known to be efficacious, and implementation issues.

Operationalising emergency care delivery in sub-Saharan Africa: consensus-based recommendations for healthcare facilities.

PubMed

Calvello, Emilie J B; Tenner, Andrea G; Broccoli, Morgan C; Skog, Alexander P; Muck, Andrew E; Tupesis, Janis P; Brysiewicz, Petra; Teklu, Sisay; Wallis, Lee; Reynolds, Teri

2016-08-01

A major barrier to successful integration of acute care into health systems is the lack of consensus on the essential components of emergency care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of emergency care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on emergency care delivery at health facilities. Using the well-established approach developed in the WHO's Monitoring Emergency Obstetric Care, the workgroup identified the essential services delivered-signal functions-associated with each emergency care sentinel condition. Levels of emergency care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

43 CFR 4.909 - How do I request an extension of time?

Code of Federal Regulations, 2010 CFR

2010-10-01

... purpose, you may obtain an extension of time under this section. (b) You must submit a written request for... Service, a private delivery or courier service, hand delivery or telefax to (703) 235-8349; (2) If you.... Postal Service, a private delivery or courier service or hand delivery so that it is received within 5...

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...

Developing a Curriculum for Human Service Workers. Career Education for Mental Health Workers. Occasional Paper Series, No. 6.

ERIC Educational Resources Information Center

Slater, Arthur L.; Gordon, Katherine K.

Based on an educational needs assessment, a project designed a community college curriculum to develop the competencies of human service workers for the changing mental health service delivery system. The curriculum prepares workers to meet future service needs such as pre-discharge preparation of patients, outreach, aftercare, community…

Automating Document Delivery: A Conference Report.

ERIC Educational Resources Information Center

Ensor, Pat

1992-01-01

Describes presentations made at a forum on automation, interlibrary loan (ILL), and document delivery sponsored by the Houston Area Library Consortium. Highlights include access versus ownership; software for ILL; fee-based services; automated management systems for ILL; and electronic mail and online systems for end-user-generated ILL requests.…

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.

Performance and measurement of a community-based distribution model of family planning services in Pakistan.

PubMed

Azmat, Syed Khurram; Ahmed, Shirin; Hameed, Waqas; Bilgrami, Mohsina; Khan, Ayesha; Khan, Adnan Ahmad; Mustafa, Ghulam

2013-04-01

Community-based distribution (CBD) has been successfully applied to family planning (FP) services worldwide. It forms the basis for the large lady health worker (LHW) programme in Pakistan which serves a limited number of women with contraception services. Thus, the concept has seen limited application in Pakistan. We present the outcomes of a CBD model that was implemented in 49 districts across Pakistan by a non-government organization (NGO). The Marie Stopes Society (MSS) developed a CBD model around its fixed centres and reached around half a million married women of reproductive age (MWRA) with services. The services provided included outreach, counselling, condoms, pills, injections, and referrals for intrauterine contraceptive devices (IUCDs) and other reproductive health services. Services were provided in peri-urban locations for a subsidized fee using a businesslike target setting approach. The results of the programme were assessed by triangulating inception records against a cross-sectional end-of-project survey and service delivery records. The contraceptive prevalence rate (CPR) had increased from 38% to 51% by project-end with modern method use increasing by 50-200% and traditional method use remaining unchanged. Unmet need and self-reported pregnancy rates fell correspondingly. Approximately 73,500 new users were added to the initial user registered numbers to a total of 132,300; MSS accounted for 53,000 per year at the end of the project, which matched the commodities supplied by the NGO. The MSS CBD model presents a viable option for scaling effective FP services that may be replicated and scaled up with either donor support or by contracting out by the government. Triangulation of multiple data sources can provide more in-depth assessment of service delivery programmes and provide inferences that can inform service delivery.

Community Rehabilitation: "Home versus Centre" Guidelines for Choosing the Optimal Treatment Location

ERIC Educational Resources Information Center

Barker, Lauren N.; Ziino, Carlo

2010-01-01

This study aimed to produce indicators and guidelines for clinician use in determining whether individual therapy sessions for community rehabilitation services should be delivered in a home/community-based setting or centre-based setting within a flexible service delivery model. Concept mapping techniques as described by Tochrim and Kane (2005)…

Understanding the organization of public health delivery systems: an empirical typology.

PubMed

Mays, Glen P; Scutchfield, F Douglas; Bhandari, Michelyn W; Smith, Sharla A

2010-03-01

Policy discussions about improving the U.S. health care system increasingly recognize the need to strengthen its capacities for delivering public health services. A better understanding of how public health delivery systems are organized across the United States is critical to improvement. To facilitate the development of such evidence, this article presents an empirical method of classifying and comparing public health delivery systems based on key elements of their organizational structure. This analysis uses data collected through a national longitudinal survey of local public health agencies serving communities with at least 100,000 residents. The survey measured the availability of twenty core public health activities in local communities and the types of organizations contributing to each activity. Cluster analysis differentiated local delivery systems based on the scope of activities delivered, the range of organizations contributing, and the distribution of effort within the system. Public health delivery systems varied widely in organizational structure, but the observed patterns of variation suggested that systems adhere to one of seven distinct configurations. Systems frequently migrated from one configuration to another over time, with an overall trend toward offering a broader scope of services and engaging a wider range of organizations. Public health delivery systems exhibit important structural differences that may influence their operations and outcomes. The typology developed through this analysis can facilitate comparative studies to identify which delivery system configurations perform best in which contexts.

Operational Experience of an Open-Access, Subscription-Based Mass Spectrometry and Proteomics Facility.

PubMed

Williamson, Nicholas A

2018-03-01

This paper discusses the successful adoption of a subscription-based, open-access model of service delivery for a mass spectrometry and proteomics facility. In 2009, the Mass Spectrometry and Proteomics Facility at the University of Melbourne (Australia) moved away from the standard fee for service model of service provision. Instead, the facility adopted a subscription- or membership-based, open-access model of service delivery. For a low fixed yearly cost, users could directly operate the instrumentation but, more importantly, there were no limits on usage other than the necessity to share available instrument time with all other users. All necessary training from platform staff and many of the base reagents were also provided as part of the membership cost. These changes proved to be very successful in terms of financial outcomes for the facility, instrument access and usage, and overall research output. This article describes the systems put in place as well as the overall successes and challenges associated with the operation of a mass spectrometry/proteomics core in this manner. Graphical abstract ᅟ.

Operational Experience of an Open-Access, Subscription-Based Mass Spectrometry and Proteomics Facility

NASA Astrophysics Data System (ADS)

Williamson, Nicholas A.

2018-03-01

This paper discusses the successful adoption of a subscription-based, open-access model of service delivery for a mass spectrometry and proteomics facility. In 2009, the Mass Spectrometry and Proteomics Facility at the University of Melbourne (Australia) moved away from the standard fee for service model of service provision. Instead, the facility adopted a subscription- or membership-based, open-access model of service delivery. For a low fixed yearly cost, users could directly operate the instrumentation but, more importantly, there were no limits on usage other than the necessity to share available instrument time with all other users. All necessary training from platform staff and many of the base reagents were also provided as part of the membership cost. These changes proved to be very successful in terms of financial outcomes for the facility, instrument access and usage, and overall research output. This article describes the systems put in place as well as the overall successes and challenges associated with the operation of a mass spectrometry/proteomics core in this manner. [Figure not available: see fulltext.

Targeting community-dwelling urinary incontinence sufferers: a multi-disciplinary community based model for conservative continence services.

PubMed

St John, Winsome; Wallis, Marianne; James, Heather; McKenzie, Shona; Guyatt, Sheridan

2004-10-01

This paper presents an argument that there is a need to provide services that target community-dwelling incontinence sufferers, and presents a demonstration case study of a multi-disciplinary, community-based conservative model of service delivery: The Waterworx Model. Rationale for approaches taken, implementation of the model, evaluation and lessons learned are discussed. In this paper community-dwelling sufferers of urinary incontinence are identified as an underserved group, and useful information is provided for those wishing to establish services for them. The Waterworx Model of continence service delivery incorporates three interrelated approaches. Firstly, client access is achieved by using community-based services via clinic and home visits, creating referral pathways and active promotion of services. Secondly, multi-disciplinary client care is provided by targeting a specific client group, multi-disciplinary assessment, promoting client self-management and developing client knowledge and health literacy. Finally, interdisciplinary collaboration and linkages is facilitated by developing multidisciplinary assessment tools, using interdisciplinary referrals, staff development, multi-disciplinary management and providing professional education. Implementation of the model achieved greater client access, improvement in urinary incontinence and client satisfaction. Our experiences suggest that those suffering urinary incontinence and living in the community are an underserved group and that continence services should be community focussed, multi-disciplinary, generalist in nature.

Utilisation of health services and geography: deconstructing regional differences in barriers to facility-based delivery in Nepal.

PubMed

Hodge, Andrew; Byrne, Abbey; Morgan, Alison; Jimenez-Soto, Eliana

2015-03-01

While established that geographical inaccessibility is a key barrier to the utilisation of health services, it remains unknown whether disparities are driven only by limited access to these services, or are also attributable to health behaviour. Significant disparities exist in health outcomes and the coverage of many critical health services between the mountains region of Nepal and the rest of the country, yet the principal factors driving these regional disparities are not well understood. Using national representative data from the 2011 Nepal Demographic and Health Survey, we examine the extent to which observable factors explain the overall differences in the utilisation of maternal health services. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect that differences in measurable characteristics have on the regional coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was 18.6 and 36.3 % in the mountains region and the rest of Nepal, respectively. Between 54.8 and 74.1 % of the regional coverage gap was explained by differences in observed characteristics. Factors influencing health behaviours (proxied by mothers' education, TV viewership and tobacco use, and household wealth) and subjective distance to the health facility were the major factors, contributing between 52.9 and 62.5 % of the disparity. Mothers' birth history was also noteworthy. Policies simultaneously addressing access and health behaviours appear necessary to achieve greater coverage and better health outcomes for women and children in isolated areas.

The Association Between Gender Inequalities and Women's Utilization of Maternal Health Services: A Cross-Sectional Survey in Eight South Central Coast Provinces, Vietnam.

PubMed

Bui, Ha Thi Thu; Le, Thi Minh; Van Pham, Tac; Doan, Duong Thi Thuy; Nguyen, Duy Anh; Nguyen, Canh Chuong; Duong, Duc Minh

Gender inequalities influence the utilization of maternal health services in Vietnam, but little research has been published. This study, therefore, aimed to explore the association between gender inequalities and women's utilization of maternal health services in Vietnam. The study was conducted in 8 provinces in the South Central Coast region of Vietnam during August 2013 to May 2014. A total of 907 women who delivered a year prior to the date of interview participated in the study. A multiple logistic regression model was used to examine the association between gender inequalities (including sociodemographic determinants of health) and utilization of 4 or more antenatal care (ANC4+) services, institutional delivery, and ever used contraceptive methods. The utilization rate of maternal health services was varied, from 53.9% for ANC4+ to 87.7% for ever used a contraceptive method and 97% for institutional delivery. Ethnicity was identified as the most influential variable out of all sociodemographic determinants of health. Regarding gender inequalities, couple communication was the only variable having significant association with women's utilization of maternal health services. Women's equal role within context of their daily life and relations with their husbands (discussing maternal care with husband and having equal income to husband) supported their use of maternal health services. Therefore, there should be concerted efforts from all relevant stakeholders including the health system to focus on disadvantaged women in planning and delivery of maternal health services, especially to ethnic minority women. Male involvement strategy should be implemented to promote maternal health care, especially during the prenatal and postpartum period. To provide more culturally sensitive and right-based approaches in delivery of maternal health services to disadvantaged women in Vietnam, interventions are recommended that promote male involvement, that is, to engage men in service delivery to adapt and ensure the most appropriate and effective maternal health care.

Factors associated with safe delivery service utilization among women in Sheka zone, southwest Ethiopia.

PubMed

Asres, Abyot; Davey, Gail

2015-04-01

Attempts to predict pregnancy and childbirth complications before they occur have not been successful. Provision of safe delivery service for all births is considered to be a critical intervention for ensuring safe motherhood. Hence the aim of the study was to assess factors associated with safe delivery service utilization among women in Sheka Zone South West Ethiopia. A community based comparative cross sectional survey was conducted among 554 women in Sheka Zone from February to March 2008. Data were collected through structured pre-tested questionnaire and entered into Epinfo version 3.3. Analyses were done with SPSS version 13 computer software with which bivariate and multiple logistic regressions were carried out. Mothers who completed at least secondary school were more likely to give birth at health facility than those uneducated (AOR = 3.26, 95 % CI 1.51-7.06). Women with birth order above four were less likely to give birth in a health facility than those with first order births (AOR = 0.21, 95 %CI 0.10-0.43). Women who had encountered problems in their immediate birth and received prenatal care were more likely to give birth at health facilities AOR = 33.78 95 % CI 16.44-69.39) and (AOR = 2.55, 95 % CI 1.05-6.21) respectively. Factors associated with safe delivery service utilization are related to the women's socioeconomic status and obstetric experiences. Consequently promotion of maternal education, prenatal care utilization, information education and communication on obstetric risks and general health service expansion are needed to ensure safe delivery service.

Receipt of Preventive Health Services in Young Adults

PubMed Central

Lau, Josephine S.; Adams, Sally H.; Irwin, Charles E.; Ozer, Elizabeth M.

2013-01-01

Objective To examine self-reported rates and disparities in delivery of preventive services to young adults. Design Population-based cross-sectional analysis. Multivariate logistic regression was used to examine how age, gender, race/ethnicity, income, insurance, and usual source of care influence the receipt of preventive services. Setting 2005 and 2007 California Health Interview Surveys (CHIS). Participants 3670 and 3621 young adults aged 18-26 years who responded to CHIS 2005 and 2007, respectively. Main Outcome Measures Self-reported receipt of flu vaccination, STD screening, cholesterol screening, diet counseling, exercise counseling and emotional health screening. Results Delivery rates ranged from 16.7% (flu vaccine) to 50.6% (cholesterol screening). Being female and having a usual source of care significantly increased receipt of services, with females more likely to receive STD screening (p<.001), cholesterol screening (p<.01), emotional health screening (p<.001), diet counseling (p<.01) and exercise counseling (p<.05) than males after controlling for age, race/ethnicity, income, insurance and usual source of care. Young adults with a usual source of care were more likely to receive a flu vaccine (p<.05), STD screening (p<.01), cholesterol screening (p<.001), diet counseling (p<.05) and exercise counseling (p<.05) than those without a usual source of care after adjusting for age, race/ethnicity, income, and insurance. Conclusions Rates of preventive service delivery are generally low. Greater efforts are needed to develop guidelines for young adults to increase the delivery of preventive care to this age group, and to address the gender and ethnic/racial disparities in preventive services delivery. PMID:23260833

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.

"The family is the clinic, the community is the hospital": community mental health in Timor-Leste.

PubMed

Hawkins, Zoe; Tilman, Teofilo

2011-07-01

This paper describes the history and recent development of mental health services in Timor-Leste, a small developing country recovering from conflict. Challenges to effective service delivery are discussed as well as plans for future development. Timor-Leste's mental health service began just over a decade ago. Unlike many other low and middle income countries where hospital-based services predominate, the mental health model in Timor-Leste is entirely community based. However, challenges to effective mental health care delivery are similar to most developing countries and include a lack of sufficient financial resources, human resources, and mental health infrastructure. Addressing these issues successfully requires political will, a greater prioritization of mental health services, close coordination between stakeholders, as well as developments in the area of education, training and infrastructure. Greater understanding and education about the links between mental and physical health would benefit the overall health of the population, and integration of these respective policies may prove a successful method of more equitably redistributing finances and resources.

Asymptotically reliable transport of multimedia/graphics over wireless channels

NASA Astrophysics Data System (ADS)

Han, Richard Y.; Messerschmitt, David G.

1996-03-01

We propose a multiple-delivery transport service tailored for graphics and video transported over connections with wireless access. This service operates at the interface between the transport and application layers, balancing the subjective delay and image quality objectives of the application with the low reliability and limited bandwidth of the wireless link. While techniques like forward-error correction, interleaving and retransmission improve reliability over wireless links, they also increase latency substantially when bandwidth is limited. Certain forms of interactive multimedia datatypes can benefit from an initial delivery of a corrupt packet to lower the perceptual latency, as long as reliable delivery occurs eventually. Multiple delivery of successively refined versions of the received packet, terminating when a sufficiently reliable version arrives, exploits the redundancy inherently required to improve reliability without a traffic penalty. Modifications to acknowledgment-repeat-request (ARQ) methods to implement this transport service are proposed, which we term `leaky ARQ'. For the specific case of pixel-coded window-based text/graphics, we describe additional functions needed to more effectively support urgent delivery and asymptotic reliability. X server emulation suggests that users will accept a multi-second delay between a (possibly corrupt) packet and the ultimate reliably-delivered version. The relaxed delay for reliable delivery can be exploited for traffic capacity improvement using scheduling of retransmissions.

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... CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE SUPPORT ACTIVITIES TECHNICAL SERVICE PROVIDER ASSISTANCE General Provisions § 652.6 Department delivery of technical services. (a) The Department may enter into a...

Reconciling IWRM and water delivery in Ghana - The potential and the challenges

NASA Astrophysics Data System (ADS)

Anokye, Nana Amma; Gupta, Joyeeta

The key elements of integrated water resources management include a holistic integrated approach and the main principles of public participation, the role of gender and the notion of recognising the economic value of water. This paper investigates how these notions play out in the context of providing water to the rural communities in the Densu basin in Ghana. This investigation is based on a content analysis of the relevant policy documents and interviews with state agencies and local stakeholders. The paper concludes that there is a conflict between the IWRM goal of integrating all water uses and sectors in the management of water resources and focusing on the prioritisation of water delivery services. However, three of the IWRM principles can be used in implementing water delivery. While Ghana has adopted IWRM, it clearly prioritises water delivery. At basin level, the IWRM planning process does not take water delivery into account and water delivery is conducted independent of the IWRM process. Although the participatory and gender approaches are being implemented relatively successfully, if slowly, the ‘water as an economic good’ principle is given less priority than the notion of the human right to water as local communities pay only 5% of the capital costs of water delivery services. The impact of the rural water delivery services has been positive in the Densu basin in seven different ways; and if this helps the rural community out of the poverty trap, it may lead to economically viable water facilities in the long-term.

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

PubMed

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

2018-01-25

Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models. Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified - accessible health services, community participation, continuous quality improvement, culturally appropriate and skilled workforce, flexible approach to care, holistic health care, and self-determination and empowerment. While the eight characteristics were clearly distinguishable within the review, the interdependence between each characteristic was also evident. These findings were used to develop a new Indigenous PHC Service Delivery Model, which clearly demonstrates some of the unique characteristics of Indigenous specific models.

The work of local healthcare innovation: a qualitative study of GP-led integrated diabetes care in primary health care.

PubMed

Foster, Michele; Burridge, Letitia; Donald, Maria; Zhang, Jianzhen; Jackson, Claire

2016-01-14

Service delivery innovation is at the heart of efforts to combat the growing burden of chronic disease and escalating healthcare expenditure. Small-scale, locally-led service delivery innovation is a valuable source of learning about the complexities of change and the actions of local change agents. This exploratory qualitative study captures the perspectives of clinicians and managers involved in a general practitioner-led integrated diabetes care innovation. Data on these change agents' perspectives on the local innovation and how it works in the local context were collected through focus groups and semi-structured interviews at two primary health care sites. Transcribed data were analysed thematically. Normalization Process Theory provided a framework to explore perspectives on the individual and collective work involved in putting the innovation into practice in local service delivery contexts. Twelve primary health care clinicians, hospital-based medical specialists and practice managers participated in the study, which represented the majority involved in the innovation at the two sites. The thematic analysis highlighted three main themes of local innovation work: 1) trusting and embedding new professional relationships; 2) synchronizing services and resources; and 3) reconciling realities of innovation work. As a whole, the findings show that while locally-led service delivery innovation is designed to respond to local problems, convincing others to trust change and managing the boundary tensions is core to local work, particularly when it challenges taken-for-granted practices and relationships. Despite this, the findings also show that local innovators can and do act in both discretionary and creative ways to progress the innovation. The use of Normalization Process Theory uncovered some critical professional, organizational and structural factors early in the progression of the innovation. The key to local service delivery innovation lies in building coalitions of trust at the point of service delivery and persuading organizational and institutional mindsets to consider the opportunities of locally-led innovation.

Dumbing Down the Net

NASA Astrophysics Data System (ADS)

Jamison, Mark A.; Hauge, Janice A.

It is commonplace for sellers of goods and services to enhance the value of their products by paying extra for premium delivery service. For example, package delivery services such as Federal Express and the US Postal Service offer shippers a variety of delivery speeds and insurance programs. Web content providers such as Yahoo! and MSN Live Earth can purchase web-enhancing services from companies such as Akamai to speed the delivery of their web content to customers.1

Prototype system of secure VOD

NASA Astrophysics Data System (ADS)

Minemura, Harumi; Yamaguchi, Tomohisa

1997-12-01

Secure digital contents delivery systems are to realize copyright protection and charging mechanism, and aim at secure delivery service of digital contents. Encrypted contents delivery and history (log) management are means to accomplish this purpose. Our final target is to realize a video-on-demand (VOD) system that can prevent illegal usage of video data and manage user history data to achieve a secure video delivery system on the Internet or Intranet. By now, mainly targeting client-server systems connected with enterprise LAN, we have implemented and evaluated a prototype system based on the investigation into the delivery method of encrypted video contents.

The Ethical Imperative to Move to a Seven-Day Care Model.

PubMed

Bell, Anthony; McDonald, Fiona; Hobson, Tania

2016-06-01

Whilst the nature of human illness is not determined by time of day or day of week, we currently structure health service delivery around a five-day delivery model. At least one country is endeavouring to develop a systems-based approach to planning a transition from five- to seven-day healthcare delivery models, and some services are independently instituting program reorganization to achieve these ends as research, amongst other things, highlights increased mortality and morbidity for weekend and after-hours admissions to hospitals. In this article, we argue that this issue does not merely raise instrumental concerns but also opens up a normative ethical dimension, recognizing that clinical ethical dilemmas are impacted on and created by systems of care. Using health policy ethics, we critically examine whether our health services, as currently structured, are at odds with ethical obligations for patient care and broader collective goals associated with the provision of publicly funded health services. We conclude by arguing that a critical health policy ethics perspective applying relevant ethical values and principles needs to be included when considering whether and how to transition from five-day to seven-day models for health delivery.

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…

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…

An Exploration of Service Delivery in India.

ERIC Educational Resources Information Center

McClam, Tricia; Woodside, Marianne

2000-01-01

Discusses visits to five social service agencies in Mumbai, India and interviews with human service providers and clients to better understand Indian human service delivery and its societal context. Identifies three Indian service delivery strategies to enrich teaching and add a global component to the curriculum: advocacy, the use of…

[Fundamental strategies to address the problem of public health service delivery insufficiency of disease prevention and control system of China].

PubMed

Shao, Jing-jing; Yu, Jing-jin; Yu, Ming-zhu; Duan, Yong; Gong, Xiangguang; Chen, Zheng; Wang, Hua; Shi, Peiwu; Liang, Zhankai; Yang, Feng; Wang, Dunzhi; Yue, Jianning; Luo, Shi; Luo, Li; Wang, Weicheng; Wang, Ying; Sun, Mei; Su, Zhongxin; Ma, Ning; Xie, Hongbin; Hao, Mo

2005-03-01

To develop and demonstrate the strategies to solve the problem of public health service delivery insufficiency of disease prevention and control system of China. 205 literatures in 8 national academic journals concerning health service management have been reviewed. The method of boundary analysis has been employed to conclude the various reform strategies. Based on the causes and mechanism of public health service delivery insufficiency of disease prevention and control system, the logic analysis has been employed to develop fundamental strategies, which has been demonstrated by 154 CDC using intention questionnaires. There are fundamental strategies to which the agreeing rate for sampling CDC was over 95%: to make sure government should afford the financing function of disease prevention and control and secure the feasible investment for centers of disease prevention and control. Meanwhile, the working efficiency of CDC should be improved through strengthening management and reforming government investing manner.

Economic incentives to promote innovation in healthcare delivery.

PubMed

Luft, Harold S

2009-10-01

Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works well in highly integrated practices but not for independent practitioners. The failures of utilization management in the 1990s demonstrated the need for a third alternative to better align incentives, such as bundling payment for an episode of care. Building on Medicare's approach to hospital payment, one can define expanded diagnosis-related groups that include all hospital, physician, and other costs during the stay and appropriate preadmission and postdischarge periods. Physicians and hospitals voluntarily forming a new entity (a care delivery team) would receive such bundled payments along with complete flexibility in allocating the funds. Modifications to gainsharing and antikickback rules, as well as reforms to malpractice liability laws, will facilitate the functioning of the care delivery teams. The implicit financial incentives encourage efficient care for the patient; the episode focus will facilitate measuring patient outcomes. Payment can be based on the resources used by those care delivery teams achieving superior outcomes, thereby fostering innovation improving outcomes and reducing waste.

The power of collaboration: using internet-based tools to facilitate networking and benchmarking within a consortium of academic health centers.

PubMed

Korner, Eli J; Oinonen, Michael J; Browne, Robert C

2003-02-01

The University HealthSystem Consortium (UHC) represents a strategic alliance of 169 academic health centers and associated institutions engaged in knowledge sharing and idea-generation. The use of the Internet as a tool in the delivery of UHC's products and services has increased dramatically over the past year and will continue to increase during the foreseeable future. This paper examines the current state of UHC-member institution driven tools and services that utilize the Web as a fundamental component in their delivery. The evolution of knowledge management at UHC, its management information and reporting tools, and expansion of e-commerce provide real world examples of Internet use in health care delivery and management. Health care workers are using these Web-based tools to help manage rising costs and optimize patient outcomes. Policy, technical, and organizational issues must be resolved to facilitate rapid adoption of Internet applications.

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 evidence base to show that providing an attachment-informed service improves patient outcomes. © 2014 The British Psychological Society.

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 after controlling for socio-demographic factors. Improving uptake of delivery care would require greater attention to rural-urban inequities and health facility management practices, and to increasing the number of health facilities with fundamental elements for delivery of basic emergency obstetric and neonatal care.

Determination of Appropriate Service Delivery Level for Quantitative Attributes of Household Toilets in Rural Settlements of India from Users' Perspective

NASA Astrophysics Data System (ADS)

Rashid, Mohammad; Pandit, Debapratim

2018-04-01

Improvement of quality of sanitation services in rural settlements is an important development goal in developing countries including India and accordingly several strategies are adopted which promote the demand and use of household toilets through creating awareness and providing subsidies to poor people for construction of household toilets with service-level standards specified from experts' perspective. In many cases, users are unsatisfied with the quality of toilets constructed using subsidies and the same remain unused. Users' satisfaction depends on their perceptions of service quality of individual attributes and overall service quality of the household toilets, which is an important determinant of sustainability and sustained use of toilets. This study aims to assess and benchmark the appropriate service delivery level for quantitative attributes of rural household toilets based on user perception. The service quality is determined with the help of level of service (LOS) scales developed using successive interval scaling technique, the zone of tolerance (ZOT), and users satisfaction level (USL) which relates service delivery levels with user satisfaction directly. The study finds that the service quality of most of the attributes of household toilets constructed using subsidies is perceived as poor. The results also suggest that most of the users expect to have a toilet with the service level of attributes ranging between LOS A and LOS B.

Determination of Appropriate Service Delivery Level for Quantitative Attributes of Household Toilets in Rural Settlements of India from Users' Perspective.

PubMed

Rashid, Mohammad; Pandit, Debapratim

2018-04-01

Improvement of quality of sanitation services in rural settlements is an important development goal in developing countries including India and accordingly several strategies are adopted which promote the demand and use of household toilets through creating awareness and providing subsidies to poor people for construction of household toilets with service-level standards specified from experts' perspective. In many cases, users are unsatisfied with the quality of toilets constructed using subsidies and the same remain unused. Users' satisfaction depends on their perceptions of service quality of individual attributes and overall service quality of the household toilets, which is an important determinant of sustainability and sustained use of toilets. This study aims to assess and benchmark the appropriate service delivery level for quantitative attributes of rural household toilets based on user perception. The service quality is determined with the help of level of service (LOS) scales developed using successive interval scaling technique, the zone of tolerance (ZOT), and users satisfaction level (USL) which relates service delivery levels with user satisfaction directly. The study finds that the service quality of most of the attributes of household toilets constructed using subsidies is perceived as poor. The results also suggest that most of the users expect to have a toilet with the service level of attributes ranging between LOS A and LOS B.

Using Technology to Deliver Mental Health Services to Children and Youth: A Scoping Review

PubMed Central

Boydell, Katherine M.; Hodgins, Michael; Pignatiello, Antonio; Teshima, John; Edwards, Helen; Willis, David

2014-01-01

Objective: To conduct a scoping review on the use of technology to deliver mental health services to children and youth in order to identify the breadth of peer-reviewed literature, summarize findings and identify gaps. Method: A literature database search identified 126 original studies meeting criteria for review. Descriptive numerical summary and thematic analyses were conducted. Two reviewers independently extracted data. Results: Studies were characterized by diverse technologies including videoconferencing, telephone and mobile phone applications and Internet-based applications such as email, web sites and CD-ROMs. Conclusion: The use of technologies plays a major role in the delivery of mental health services and supports to children and youth in providing prevention, assessment, diagnosis, counseling and treatment programs. Strategies are growing exponentially on a global basis, thus it is critical to study the impact of these technologies on child and youth mental health service delivery. An in-depth review and synthesis of the quality of findings of studies on effectiveness of the use of technologies in service delivery are also warranted. A full systematic review would provide that opportunity. PMID:24872824

Using technology to deliver mental health services to children and youth: a scoping review.

PubMed

Boydell, Katherine M; Hodgins, Michael; Pignatiello, Antonio; Teshima, John; Edwards, Helen; Willis, David

2014-05-01

To conduct a scoping review on the use of technology to deliver mental health services to children and youth in order to identify the breadth of peer-reviewed literature, summarize findings and identify gaps. A literature database search identified 126 original studies meeting criteria for review. Descriptive numerical summary and thematic analyses were conducted. Two reviewers independently extracted data. Studies were characterized by diverse technologies including videoconferencing, telephone and mobile phone applications and Internet-based applications such as email, web sites and CD-ROMs. The use of technologies plays a major role in the delivery of mental health services and supports to children and youth in providing prevention, assessment, diagnosis, counseling and treatment programs. Strategies are growing exponentially on a global basis, thus it is critical to study the impact of these technologies on child and youth mental health service delivery. An in-depth review and synthesis of the quality of findings of studies on effectiveness of the use of technologies in service delivery are also warranted. A full systematic review would provide that opportunity.

Activities of Intellectual Disability Clinical Nurse Specialists in Ireland.

PubMed

Doody, Owen; Slevin, Eamonn; Taggart, Laurence

The aim of this study was to identify the contribution of Irish intellectual disability clinical nurse specialists (ID CNSs) to service delivery. A nonexperimental descriptive design was selected to survey ID CNSs presently working in Ireland. The questionnaire was developed based on focus group interviews, available literature, and expert panel views. Ethical approval and access were granted to all ID CNSs in Ireland. Thirty-two responded (33.68% response rate) from all work areas (voluntary organizations or health service executive) practicing within residential, community, or school services. Respondents were surveyed across a range of areas (demographic details and support to client, staff, family, organization, community, other agencies, and professional development). Findings identify that ID CNSs are active in all aspects of their roles as clinical specialist, educator, communicator, researcher, change agent, and leader, thus supporting person-centered care and improving service delivery. To meet changing healthcare demands, promote person-centered care, and improve service delivery, the CNS role in ID should be developed and supported. The findings merit a further study on ID CNS role activity, possible variables influencing role activity, and team members' views.

FACTORS ASSOCIATED WITH UPTAKE OF SKILLED ATTENDANTS' SERVICES DURING CHILD DELIVERY IN GARISSA TOWN, KENYA.

PubMed

Abikar, R A; Karama, M; Ng'ang'a, Z W

2013-11-01

To identify the factors that are associated with uptake of skilled delivery services during child delivery among women of reproductive age in Garissa town. Cross sectional study. Garissa town. Three hundred and thirty four women aged 15-49 years who had had at least one delivery in their lifetime were asked about the type of delivery services they had during their last child delivery. The study found that 47% of the last deliveries women were attended by skilled persons and the rest of the deliveries were provided by TBAs. The predictors of skilled delivery uptake in this study were found to be; having knowledge on skilled delivery service providers (AOR = 17.2; 95% CI: 1.05-281.12; p = 0.046), child deliveries numbering one to three (AOR = 116.95; 95% CI: 26.68-512.64; p = 0.001) and four to six (AOR = 16.75; 95% CI: 4.44-62.87; p = 0.001), presence of previous delivery complication (AOR = 11.71; 95% CI: 3.96-34.60; p = 0.001), disapproval of TBA services (AOR = 27.19; 95% CI: 6.67-110.76; p = 0.001), lack of preference for gender of skilled delivery service provider (AOR = 6.51; 95% CI: 1.08-39.37; p = 0.041), and positive view on service related factors such as time to nearest facility (AOR = 3.91; 95% CI: 1.24-12.34; p = 0.020), hygiene (AOR = 5.03; 95% CI: 1.49-17.05; p = 0.009) and operation time of health facility (AOR = 4.67; 95% CI: 1.59-13.76; p = 0.005). The findings show that cultural and maternal factors as well as quality of services at facility level play major role in determining uptake of skilled services among women in Garissa as compared to social demographic and economic factors.

Antenatal care service quality increases the odds of utilizing institutional delivery in Bahir Dar city administration, North Western Ethiopia: A prospective follow up study.

PubMed

Ejigu Tafere, Tadese; Afework, Mesganaw Fanthahun; Yalew, Alemayehu Worku

2018-01-01

In Ethiopia, more than 62% of pregnant women attend antenatal care at least once, yet only about one in four women give birth at health facility. This gap has fueled the need to investigate on the quality of ANC services at public health facilities and its link with the use of institutional delivery. To assess the linkage between ANC quality and the use of institutional delivery among pregnant women attending ANC at public health facilities of BDR City Administration. A facility based prospective follow up study was conducted. and nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit were enrolled.Women were followed from their first ANC visit until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation (GEE) was carried out to control cluster effect among women who received ANC in the same facility. Among 823 pregnant women who completed follow up, only about one third (27.6%) received acceptable quality of ANC services. In one health facility syphilis test was not done at all for the last two years. The odds of giving birth at health institution among pregnant women who received acceptable ANC quality service was about 3.38 times higher than among pregnant women who received unacceptable ANC quality service (AOR = 3.38, 95% CI: 1.67, 6.83). In this study the quality of ANC service provision in public health facilities was compromised/low. Provision of quality ANC service had a great role in promoting institutional delivery. Therefore the local authorities at each level of health sector or the nongovernmental organizations working to improve maternal health need to provide training on focused antenatal care protocol for ANC providers.

Antenatal care service quality increases the odds of utilizing institutional delivery in Bahir Dar city administration, North Western Ethiopia: A prospective follow up study

PubMed Central

Afework, Mesganaw Fanthahun; Yalew, Alemayehu Worku

2018-01-01

Background In Ethiopia, more than 62% of pregnant women attend antenatal care at least once, yet only about one in four women give birth at health facility. This gap has fueled the need to investigate on the quality of ANC services at public health facilities and its link with the use of institutional delivery. Objective To assess the linkage between ANC quality and the use of institutional delivery among pregnant women attending ANC at public health facilities of BDR City Administration Methods A facility based prospective follow up study was conducted. and nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit were enrolled.Women were followed from their first ANC visit until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation (GEE) was carried out to control cluster effect among women who received ANC in the same facility. Results Among 823 pregnant women who completed follow up, only about one third (27.6%) received acceptable quality of ANC services. In one health facility syphilis test was not done at all for the last two years. The odds of giving birth at health institution among pregnant women who received acceptable ANC quality service was about 3.38 times higher than among pregnant women who received unacceptable ANC quality service (AOR = 3.38, 95% CI: 1.67, 6.83). Conclusion and recommendation In this study the quality of ANC service provision in public health facilities was compromised/low. Provision of quality ANC service had a great role in promoting institutional delivery. Therefore the local authorities at each level of health sector or the nongovernmental organizations working to improve maternal health need to provide training on focused antenatal care protocol for ANC providers. PMID:29420598

A Success-Oriented Framework to Enable Co-Created e-Services

ERIC Educational Resources Information Center

McCormick, Thomas J.

2010-01-01

This dissertation establishes a novel framework and the implementation steps necessary to guide the acceleration of economic growth through the transformation from a product-based orientation to co-created e-Services. Co-creation promotes the sharing of innovation in the development and delivery of services in a close partnership between end users…

Multi-Cultural Issues In Mental Health Services: Strategies Towards Equity.

ERIC Educational Resources Information Center

California State Dept. of Health, Sacramento.

While California has evolved the elements of a strong and responsive mental health service delivery system based on a statutory partnership among the executive office, local jurisdictions, and citizens, many groups of persons in need of mental health services remain underserved. Such is the plight of the racial/ethnic minority people, whose…

76 FR 77483 - Nationwide Change in Postal Delivery Service Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-13

... whether certain changes in the nature of postal services conform to the applicable polices of title 39.\\1... D. Bradley on behalf of the United States Postal Service (USPS-T-10). Based upon quantitative and qualitative market research provided in Direct Testimony of Rebecca Elmore-Yalch on bhalf of the United States...

The Medicaid School Program: An Effective Public School and Private Sector Partnership

ERIC Educational Resources Information Center

Mallett, Christopher A.

2013-01-01

Privatized service delivery within Medicaid has greatly increased over the past two decades. This public program-private sector collaboration is quite common today, with a majority of Medicaid recipients receiving services in this fashion; yet controversy remains. This article focuses on just one program within Medicaid, school-based services for…

Ecological Psychology: Replacing the Medical Model Paradigm for School-Based Psychological and Psychoeducational Services

ERIC Educational Resources Information Center

Gutkin, Terry B.

2012-01-01

Traditional medical model service delivery systems have facilitated the creation of nationwide mental health and education pandemics for children and youth. The characteristics and shortcomings of medical model approaches leading to these problems are explicated, including the focus of services on individuals rather than populations, relying…

Insurers' policies on coverage for behavior management services and the impact of the Affordable Care Act.

PubMed

Edelstein, Burton L

2014-01-01

The impact of the Affordable Care Act (ACA) on dental insurance coverage for behavior management services depends upon the child's source of insurance (Medicaid, CHIP, private commercial) and the policies that govern each such source. This contribution describes historical and projected sources of pediatric dental coverage, catalogues the seven behavior codes used by dentists, compares how often they are billed by pediatric and general dentists, assesses payment policies and practices for behavioral services across coverage sources, and describes how ACA coverage policies may impact each source. Differences between Congressional intent to ensure comprehensive oral health services with meaningful consumer protections for all legal-resident children and regulatory action by the Departments of Treasury and Health and Human Services are explored to explain how regulations fail to meet Congressional intent as of 2014. The ACA may additionally impact pediatric dentistry practice, including dentists' behavior management services, by expanding pediatric dental training and safety net delivery sites and by stimulating the evolution of novel payment and delivery systems designed to move provider incentives away from procedure-based payments and toward health outcome-based payments.

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.

Use of previous maternal health services has a limited role in reattendance for skilled institutional delivery: cross-sectional survey in Northwest Ethiopia

PubMed Central

Kebede, Bekana; Gebeyehu, Abebaw; Andargie, Gashaw

2013-01-01

Background Maternal mortality rates are unacceptably high in Ethiopia. Institutional delivery with skilled care of the mother is one of the interventions proven to reduce the risk of complications that can cause maternal and neonatal mortality. Quality of service given during antenatal visits and childbirth are important measures. The purpose of this study was to investigate the use of skilled institutional delivery and its repeat use during a subsequent pregnancy and to identify any reasons why women avoid institutional delivery. Methods A community-based cross-sectional study was conducted from March to June 2012 in Chilga Woreda, Northwest Ethiopia. Data were collected from women who gave birth during the year preceding the survey. Information was entered and cleaned using the Statistical Package for Social Sciences. Multivariate and binary logistic regression was used to identify the relative effect of each explanatory variable on the outcome. Results A total of 402 (84.2%) women gave birth at home. Previous experience of skilled institutional delivery had a limited role in subsequent acceptance or use of institutional delivery. Most mothers who had previously had institutional delivery gave birth at home. Although 111 (40.8%) women visited the health facility during their pregnancy only because of illness, 184 (38.8%) did not know when to visit for antenatal care. In multivariate analysis, lower maternal education, being a rural resident, previous use of institutional delivery, remoteness of the health facility, and multiparity were factors significantly associated with less likelihood of institutional delivery. Number of months pregnant at the time of the first antenatal visit had no role in increasing the likelihood of institutional delivery. Conclusion The quality of the obstetric services presently available for women living in Ethiopia needs review. PMID:23459063

Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children's Mental Health Services.

PubMed

Brookman-Frazee, Lauren; Zhan, Chanel; Stadnick, Nicole; Sommerfeld, David; Roesch, Scott; Aarons, Gregory A; Innes-Gomberg, Debbie; Bando, Lillian; Lau, Anna S

2018-01-01

Evidence-based practice (EBP) implementation requires substantial resources in workforce training; yet, failure to achieve long-term sustainment can result in poor return on investment. There is limited research on EBP sustainment in mental health services long after implementation. This study examined therapists' continued vs. discontinued practice delivery based on administrative claims for reimbursement for six EBPs [Cognitive Behavioral Interventions for Trauma in Schools (CBITS), Child-Parent Psychotherapy, Managing and Adapting Practices (MAP), Seeking Safety (SS), Trauma-Focused Cognitive Behavior Therapy (TF-CBT), and Positive Parenting Program] adopted in a system-driven implementation effort in public mental health services for children. Our goal was to identify agency and therapist factors associated with a sustained EBP delivery. Survival analysis (i.e., Kaplan-Meier survival functions, log-rank tests, and Cox regressions) was used to analyze 19 fiscal quarters (i.e., approximately 57 months) of claims data from the Prevention and Early Intervention Transformation within the Los Angeles County Department of Mental Health. These data comprised 2,322,389 claims made by 6,873 therapists across 88 agencies. Survival time was represented by the time elapsed from therapists' first to final claims for each practice and for any of the six EBPs. Results indicate that therapists continued to deliver at least one EBP for a mean survival time of 21.73 months (median = 18.70). When compared to a survival curve of the five other EBPs, CBITS, SS, and TP demonstrated a higher risk of delivery discontinuation, whereas MAP and TF-CBT demonstrated a lower risk of delivery discontinuation. A multivariate Cox regression model revealed that agency (centralization and service setting) and therapist (demographics, discipline, and case-mix characteristics) characteristics were significantly associated with risk of delivery discontinuation for any of the six EBPs. This study illustrates a novel application of survival analysis to administrative claims data in system-driven implementation of multiple EBPs. Findings reveal variability in the long-term continuation of therapist-level delivery of EBPs and highlight the importance of both agency and workforce characteristics in the sustained delivery of EBPs. Findings direct the field to potential targets of sustainment interventions (e.g., strategic assignment of therapists to EBP training and strategic selection of EBPs by agencies).

Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases.

PubMed

Schwartz, Jeremy I; Dunkle, Ashley; Akiteng, Ann R; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K; Mutungi, Gerald; Rabin, Tracy L; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

2015-01-01

The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda.

Maternal occupation and risk for low birth weight delivery: assessment using state birth registry data.

PubMed

Meyer, John D; Nichols, Ginger H; Warren, Nicholas; Reisine, Susan

2008-03-01

To determine the effects of employment on low birth weight (LBW) in a service-based economy, we evaluated the association of LBW delivery with occupational data collected in a state birth registry. Occupational data in the 2000 Connecticut birth registry were coded for 41,009 singleton births. Associations between employment and LBW delivery were analyzed using logistic regression controlling for covariates in the registry data set. Evidence for improved LBW outcomes in working mothers did not persist when adjusted for maternal covariates. Among working mothers, elevated risk of LBW was seen in textile, food service, personal appearance, material dispatching or distributing, and retail sales workers. Improved overall birth outcomes seen in working mothers may arise from favorable demographic and health attributes. Higher LBW risk was seen in several types of service sector jobs and in textile work.

Delivery arrangements for health systems in low-income countries: an overview of systematic reviews

PubMed Central

Ciapponi, Agustín; Lewin, Simon; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Paulsen, Elizabeth; Rada, Gabriel; Wiysonge, Charles S; Bastías, Gabriel; Dudley, Lilian; Flottorp, Signe; Gagnon, Marie-Pierre; Garcia Marti, Sebastian; Glenton, Claire; Okwundu, Charles I; Peñaloza, Blanca; Suleman, Fatima; Oxman, Andrew D

2017-01-01

Background Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services. Objectives To provide an overview of the available evidence from up-to-date systematic reviews about the effects of delivery arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on delivery arrangements and informing refinements of the framework for delivery arrangements outlined in the review. Methods We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of delivery arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty or employment) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries. Main results We identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Who receives care and when: queuing strategies and antenatal care to groups of mothers. Who provides care: lay health workers for caring for people with hypertension, lay health workers to deliver care for mothers and children or infectious diseases, lay health workers to deliver community-based neonatal care packages, midlevel health professionals for abortion care, social support to pregnant women at risk, midwife-led care for childbearing women, non-specialist providers in mental health and neurology, and physician-nurse substitution. Coordination of care: hospital clinical pathways, case management for people living with HIV and AIDS, interactive communication between primary care doctors and specialists, hospital discharge planning, adding a service to an existing service and integrating delivery models, referral from primary to secondary care, physician-led versus nurse-led triage in emergency departments, and team midwifery. Where care is provided: high-volume institutions, home-based care (with or without multidisciplinary team) for people living with HIV and AIDS, home-based management of malaria, home care for children with acute physical conditions, community-based interventions for childhood diarrhoea and pneumonia, out-of-facility HIV and reproductive health services for youth, and decentralised HIV care. Information and communication technology: mobile phone messaging for patients with long-term illnesses, mobile phone messaging reminders for attendance at healthcare appointments, mobile phone messaging to promote adherence to antiretroviral therapy, women carrying their own case notes in pregnancy, interventions to improve childhood vaccination. Quality and safety systems: decision support with clinical information systems for people living with HIV/AIDS. Complex interventions (cutting across delivery categories and other health system arrangements): emergency obstetric referral interventions. Authors' conclusions A wide range of strategies have been evaluated for improving delivery arrangements in low-income countries, using sound systematic review methods in both Cochrane and non-Cochrane reviews. These reviews have assessed a range of outcomes. Most of the available evidence focuses on who provides care, where care is provided and coordination of care. For all the main categories of delivery arrangements, we identified gaps in primary research related to uncertainty about the applicability of the evidence to low-income countries, low- or very low-certainty evidence or a lack of studies. Effects of delivery arrangements for health systems in low-income countries What is the aim of this overview? The aim of this Cochrane Overview is to provide a broad summary of what is known about the effects of delivery arrangements for health systems in low-income countries. This overview is based on 51 systematic reviews. These systematic reviews searched for studies that evaluated different types of delivery arrangements. The reviews included a total of 850 studies. This overview is one of a series of four Cochrane Overviews that evaluate health system arrangements. What was studied in the overview? Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different health care providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This overview can help policymakers and other stakeholders to identify evidence-informed strategies to improve the delivery of services. What are the main results of the overview? When focusing only on evidence assessed as high to moderate certainty, the overview points to a number of delivery arrangements that had at least one desirable outcome and no evidence of any undesirable outcomes. These include the following: Who receives care and when - Queuing strategies - Group antenatal care Who provides care – role expansion or task shifting - Lay or community health workers supporting the care of people with hypertension - Community-based neonatal packages that include additional training of outreach workers - Lay health workers to deliver care for mothers and children or for infectious diseases - Mid-level, non-physician providers for abortion care - Health workers providing social support during at-risk pregnancies - Midwife-led care for childbearing women and their infants - Non-specialist health workers or other professionals with health roles to help people with mental, neurological and substance-abuse disorders - Nurses substituting for physicians in providing care Coordination of care - Structured multidisciplinary care plans (care pathways) used by health care providers in hospitals to detail essential steps in the care of people with a specific clinical problem - Interactive communication between collaborating primary care physicians and specialist physicians in outpatient care - Planning to facilitate patients’ discharge from hospital to home - Adding a new health service to an existing service and integrating services in health care delivery - Integrating vaccination with other healthcare services - Using physicians rather than nurses to lead triage in emergency departments - Groups or teams of midwives providing care for a group of women during pregnancy and childbirth and after childbirth Where care is provided – site of service delivery - Clinics or hospitals that manage a high volume of people living with HIV and AIDS rather than smaller volumes - Intensive home-based care for people living with HIV and AIDS - Home-based management of malaria in children - Providing care closer to home for children with long-term health conditions - Community-based interventions using lay health workers for childhood diarrhoea and pneumonia - Youth HIV and reproductive health services provided outside of health facilities - Decentralising care for initiation and maintenance of HIV and AIDS medicine treatment to peripheral health centres or lower levels of healthcare Information and communication technology - Mobile phone messaging for people with long-term illnesses - Mobile phone messaging reminders for attendance at healthcare appointments - Mobile phone messaging to promote adherence to antiretroviral therapy - Women carrying their own case notes in pregnancy - Information and communication interventions to improve childhood vaccination coverage Quality and safety systems - Establishing clinical information systems to organize patient data for people living with HIV and AIDS Packages that include multiple interventions - Interventions to improve referral for emergency care during pregnancy and childbirth How up to date is this overview? The overview authors searched for systematic reviews that had been published up to 17 December 2016. PMID:28901005

Use of Community and School Mental Health Services by Custodial Grandchildren

ERIC Educational Resources Information Center

Montoro-Rodriguez, Julian; Smith, Gregory C.; Palmieri, Patrick A.

2012-01-01

We examined patterns and predictors of perceived need, use, and unmet need for mental health services by custodial grandchildren within the school-based and community-based delivery sectors. Data were from a national sample of 610 grandmothers caring for grandchildren ages 6 to 17 in the absence of biological parents. Overlapping use of services…

Innovative Interdisciplinary Training in and Delivery of Evidence-Based Geriatric Services: Creating a Bridge with Social Work and Physical Therapy

ERIC Educational Resources Information Center

Rowan, Noell L.; Gillette, Patricia D.; Faul, Anna C.; Yankeelov, Pamela A.; Borders, Kevin W.; Deck, Stacy; Nicholas, Lori D.; Wiegand, Mark

2009-01-01

With focus on interdisciplinary education models, social work and physical therapy faculty from two proximate universities partnered to create an evidence-based geriatric assessment and brief intervention research, training, and service project for community-dwelling older adults. Assessment tools and interventions were selected from the…

Characterizing the Use of Research-Community Partnerships in Studies of Evidence-Based Interventions in Children's Community Services

ERIC Educational Resources Information Center

Frazee-Brookman, Lauren; Stahmer, Aubyn; Stadnick, Nicole; Chlebowski, Colby; Herschel, Amy; Garland, Ann F.

2015-01-01

This study characterized the use of research community partnerships (RCPs) to tailor evidence-based intervention, training, and implementation models for delivery across different childhood problems and service contexts using a survey completed by project principal investigators and community partners. To build on previous RCP research and to…

TOC/DOC: "It Has Changed the Way I Do Science".

ERIC Educational Resources Information Center

Douglas, Kimberly; Roth, Dana L.

1997-01-01

Describes a user-based automated service developed at the California Institute of Technology that combines access to journal article databases with an in-house document delivery system. TOC/DOC (Tables of Contents/Document Delivery) has undergone a conceptual change from a catalog of locally-held journal articles to a broader, more retrospective…

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

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

... Delivery Services (IDS)/Corporate & Financial Reporting group, Hartford, Connecticut (The Hartford-IDS... technology applications for corporate, regulatory, and financial reporting. Pursuant to 29 CFR 90.18(c...., Commercial/Actuarial/Information Delivery Services (IDS)/ Corporate & Financial Reporting group, Hartford...

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 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT RULES ON SOURCE, ORIGIN AND NATIONALITY FOR COMMODITIES AND SERVICES FINANCED BY USAID Waivers § 228.55 Delivery services. (a) Ocean transportation. A...

Women's preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery.

PubMed

Kruk, M E; Paczkowski, M M; Tegegn, A; Tessema, F; Hadley, C; Asefa, M; Galea, S

2010-11-01

Delivery attended by skilled professionals is essential to reducing maternal mortality. Although the facility delivery rate in Ethiopia's rural areas is extremely low, little is known about which health system characteristics most influence women's preferences for delivery services. In this study, women's preferences for attributes of health facilities for delivery in rural Ethiopia were investigated. A population-based discrete choice experiment (DCE) was fielded in Gilgel Gibe, in southwest Ethiopia, among women with a delivery in the past 5 years. Women were asked to select a hypothetical health facility for future delivery from two facilities on a picture card. A hierarchical Bayesian procedure was used to estimate utilities associated with facility attributes: distance, type of provider, provider attitude, drugs and medical equipment, transport and cost. 1006 women completed 8045 DCE choice tasks. Among them, 93.8% had delivered their last child at home. The attributes with the greatest influence on the overall utility of a health facility for delivery were availability of drugs and equipment (mean β=3.9, p<0.01), seeing a doctor versus a health extension worker (mean β=2.1, p<0.01) and a receptive provider attitude (mean β=1.4, p<0.01). Women in rural southwest Ethiopia who have limited personal experience with facility delivery nonetheless value health facility attributes that indicate high technical quality: availability of drugs and equipment and physician providers. Well-designed policy experiments that measure the contribution of quality improvements to facility delivery rates in Ethiopia and other countries with low health service utilisation and high maternal mortality may inform national efforts to reduce maternal mortality.

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

Client perspective assessment of women's satisfaction towards labour and delivery care service in public health facilities at Arba Minch town and the surrounding district, Gamo Gofa zone, south Ethiopia.

PubMed

Dewana, Zeritu; Fikadu, Teshale; G/Mariam, Abebe; Abdulahi, Misra

2016-02-11

A woman's satisfaction with labour and delivery care service has a good effect on her health and subsequent utilization of the services. Thus knowledge about women's satisfaction on labour and delivery care used to enhances the services utilization. The objective of this study was to assess the satisfaction of women's towards labour and delivery care service and identify factors associated it at public health facilities in Arba Minch town and the surrounding district, Gamo Gofa zone, southern Ethiopia. Facility based cross sectional study was conducted among women who gave birth at public health facility. A total 256 women who gave birth during the study period were included in the study. Data was collected using a structured questionnaire. Satisfaction level was measured using a 5 point-Likert scale questions. Data were entered using Epi data version 3.5.1 and analyzed using SPSS 20.0 statistical software. Factor analysis was employed for Likert scale questions to extract factor represented each of the scale which facilitate treatment of variable as continuous for further analysis. Bi-variate and multivariable logistic regression analysis was employed to identify association between women's satisfaction and predicator variables. Statistical significance was declared at P value <0.05 on final model. The strength of association was interpreted using the adjusted odds ratio and 95% CI. This study revealed that 90.2% of women who gave birth in public health facilities were satisfied with labour and delivery care. Factors associated with women's satisfaction with labour and delivery care services include: not attending formal education [AOR = 8.00, 95% CI = (1.52, 12.27)] attending antenatal care four times and more [AOR = 5.00, 95% CI = (1.76, 14.20)] waiting below 15 minutes to be seen by health professional [AOR = 3.37, 95% CI = (1.14, 9.97)] and not paying for drugs and supplies [AOR = 6.19, 95% CI = (1.34, 18.59)]. Although majority of women were satisfied with the labour and delivery service they got, their level of satisfaction was influenced by educational status, number of ANC visits, waiting time, and payment for drug and supplies. Thus, public health intervention working on improving delivery care should consider these factors.

Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary guidance from CDC and the U.S. Department of Health and Human Services.

PubMed

2012-11-09

This report summarizes current (as of 2011) guidelines or recommendations published by multiple agencies of the U.S. Department of Health and Human Services (DHHS) for prevention and control of human immunodeficiency virus (HIV) infection, viral hepatitis, sexually transmitted diseases (STDs), and tuberculosis (TB) for persons who use drugs illicitly. It also summarizes existing evidence of effectiveness for practices to support delivery of integrated prevention services. Implementing integrated services for prevention of HIV infection, viral hepatitis, STDs, and TB is intended to provide persons who use drugs illicitly with increased access to services, to improve timeliness of service delivery, and to increase effectiveness of efforts to prevent infectious diseases that share common risk factors, behaviors, and social determinants. This guidance is intended for use by decision makers (e.g., local and federal agencies and leaders and managers of prevention and treatment services), health-care providers, social service providers, and prevention and treatment support groups. Consolidated guidance can strengthen efforts of health-care providers and public health providers to prevent and treat infectious diseases and substance use and mental disorders, use resources efficiently, and improve health-care services and outcomes in persons who use drugs illicitly. An integrated approach to service delivery for persons who use drugs incorporates recommended science-based public health strategies, including 1) prevention and treatment of substance use and mental disorders; 2) outreach programs; 3) risk assessment for illicit use of drugs; 4) risk assessment for infectious diseases; 5) screening, diagnosis, and counseling for infectious diseases; 6) vaccination; 7) prevention of mother-to-child transmission of infectious diseases; 8) interventions for reduction of risk behaviors; 9) partner services and contact follow-up; 10) referrals and linkage to care; 11) medical treatment for infectious diseases; and 12) delivery of integrated prevention services. These strategies are science-based, public health strategies to prevent and treat infectious diseases, substance use disorders, and mental disorders. Treatment of infectious diseases and treatment of substance use and mental disorders contribute to prevention of transmission of infectious diseases. Integrating prevention services can increase access to and timeliness of prevention and treatment.

Using Quality Improvement Methods and Time-Driven Activity-Based Costing to Improve Value-Based Cancer Care Delivery at a Cancer Genetics Clinic.

PubMed

Tan, Ryan Y C; Met-Domestici, Marie; Zhou, Ke; Guzman, Alexis B; Lim, Soon Thye; Soo, Khee Chee; Feeley, Thomas W; Ngeow, Joanne

2016-03-01

To meet increasing demand for cancer genetic testing and improve value-based cancer care delivery, National Cancer Centre Singapore restructured the Cancer Genetics Service in 2014. Care delivery processes were redesigned. We sought to improve access by increasing the clinic capacity of the Cancer Genetics Service by 100% within 1 year without increasing direct personnel costs. Process mapping and plan-do-study-act (PDSA) cycles were used in a quality improvement project for the Cancer Genetics Service clinic. The impact of interventions was evaluated by tracking the weekly number of patient consultations and access times for appointments between April 2014 and May 2015. The cost impact of implemented process changes was calculated using the time-driven activity-based costing method. Our study completed two PDSA cycles. An important outcome was achieved after the first cycle: The inclusion of a genetic counselor increased clinic capacity by 350%. The number of patients seen per week increased from two in April 2014 (range, zero to four patients) to seven in November 2014 (range, four to 10 patients). Our second PDSA cycle showed that manual preappointment reminder calls reduced the variation in the nonattendance rate and contributed to a further increase in patients seen per week to 10 in May 2015 (range, seven to 13 patients). There was a concomitant decrease in costs of the patient care cycle by 18% after both PDSA cycles. This study shows how quality improvement methods can be combined with time-driven activity-based costing to increase value. In this paper, we demonstrate how we improved access while reducing costs of care delivery. Copyright © 2016 by American Society of Clinical Oncology.

Care closer to home for children and young people who are ill: developing and testing a model of service delivery and organization.

PubMed

Parker, Gillian; Spiers, Gemma; Cusworth, Linda; Birks, Yvonne; Gridley, Kate; Mukherjee, Suzanne

2012-09-01

To report findings of a national survey of care closer to home services for children and young people and a typology based on these findings. Providing care closer to home for children is a policy and practice aspiration internationally. While the main model of such services is children's community nursing, other models have also developed. Past research has proposed a relatively static typology of services, determined by where they are based, whether they are generic or specialist and whether they provide short- or longer-term input. As services develop, however, this typology needs further elaboration. A two-stage national survey of all primary care and hospital trusts in England, in mid-2008. In all, 67% of trusts responded to the screening questionnaire and 75% of relevant services to the main stage questionnaire. Thirteen distinct types of services were identified initially. Cluster analysis of delivery and organization characteristics then identified a three-model typology: hospital-based, condition-specific services (36%); children's community nurses and other community services (45%) and other (mainly therapy-based) services (19%). The models differed in staffing, costs, functions, type of care provided and geographical coverage. Only a third of nurses in teams were paediatric-trained. Care closer to home services are an established part of care for children and young people who are ill. They deal with complex and technical care and can prevent or reduce the length of acute hospital admission. Lack of readily available information about caseloads, case mix and costs may hamper their further development. © 2011 Blackwell Publishing Ltd.

Older individuals' experiences during the assistive technology device service delivery process.

PubMed

Gramstad, Astrid; Storli, Sissel Lisa; Hamran, Torunn

2014-07-01

Providing assistive technology devices to older individuals living in their ordinary homes is an important intervention to increase and sustain independence and to enable ageing at home. However, little is known about older individuals' experiences and needs in the assistive technology device (ATD) service delivery process. The purpose of this study was to investigate older individuals' experiences during the service delivery process of ATDs. Nine older individuals were interviewed three times each throughout the ATD service delivery process. The interviews were analysed within a hermeneutical phenomenological perspective. The results show that the service delivery process could be interpreted as an enigmatic journey and described using four themes: "hope and optimistic expectations", "managing after delivery or needing additional help", "having available help versus being abandoned", and "taking charge or putting up". The results emphasize the need for occupational therapists to maintain an individualized approach towards older clients throughout the service delivery process. The experiences of older individuals were diverse and related to expectations that were not necessarily articulated to the occupational therapist. The situation when the ATD is delivered to the client was highlighted by the clients as an important event with the potential to facilitate a successful service delivery process.

Unintended Consequences of Evidence-Based Treatment Policy Reform: Is Implementation the Goal or the Strategy for Higher Quality Care?

PubMed

Park, Alayna L; Tsai, Katherine H; Guan, Karen; Chorpita, Bruce F

2018-02-14

This study examined patterns of evidence-based treatment (EBT) delivery following a county-wide EBT reform initiative. Data were gathered from 60 youth and their 21 providers, who were instructed to deliver therapy as they normally would under the EBT initiative. Results showed limited applicability of county-supported EBTs to this service sample, and that most youth did not receive traditional delivery of EBTs. Findings suggest that it may be unrealistic to expect providers to deliver EBTs with fidelity with all clients, and that EBT implementation may be best thought of as a strategy for improving mental health services rather than a goal.

Bridging existing governance gaps: five evidence-based actions that boards can take to pursue high quality care.

PubMed

Leggat, Sandra G; Balding, Cathy

2017-11-13

Objective To explore the impact of the organisational quality systems on quality of care in Victorian health services. Methods During 2015 a total of 55 focus groups were conducted with more than 350 managers, clinical staff and board members in eight Victorian health services to explore the effectiveness of health service quality systems. A review of the quality and safety goals and strategies outlined in the strategic and operating plans of the participating health services was also undertaken. Results This paper focuses on the data related to the leadership role of health service boards in ensuring safe, high-quality care. The findings suggest that health service boards are not fully meeting their governance accountability to ensure consistently high-quality care. The data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety and the implementation of these expectations at point of care. These gaps were further compounded by quality system confusion, over-reliance on compliance, and inadequate staff engagement. Conclusion Based on the existing evidence we propose five specific actions boards can take to close the gaps, thereby supporting improved care for all consumers. What is known about this topic? Effective governance is essential for high-quality healthcare delivery. Boards are required to play an active role in their organisation's pursuit of high quality care. What does this paper add? Recent government reports suggest that Australian health service boards are not fully meeting their governance requirements for high quality, safe care delivery, and our research pinpoints key governance gaps. What are the implications for practitioners? Based on our research findings we outline five evidence-based actions for boards to improve their governance of quality care delivery. These actions focus on an organisational strategy for high-quality care, with the chief executive officer held accountable for successful implementation, which is actively guided and monitored by the board.

[Research progress of ecosystem service flow.

PubMed

Liu, Hui Min; Fan, Yu Long; Ding, Sheng Yan

2016-07-01

With the development of social economy, human disturbance has resulted in a variety of ecosystem service degradation or disappearance. Ecosystem services flow plays an important role in delivery, transformation and maintenance of ecosystem services, and becomes one of the new research directions. In this paper, based on the classification of ecosystem services flow, we analyzed ecosystem service delivery carrier, and investigated the mechanism of ecosystem service flow, including the information, property, scale features, quantification and cartography. Moreover, a tentative analysis on cost-effective of ecosystem services flow (such as transportation costs, conversion costs, usage costs and cost of relativity) was made to analyze the consumption cost in ecosystem services flow process. It aimed to analyze dissipation cost in ecosystem services flow process. To a certain extent, the study of ecosystem service flow solved the problem of "double counting" in ecosystem services valuation, which could make a contribution for the sake of recognizing hot supply and consumption spots of ecosystem services. In addition, it would be conducive to maximizing the ecosystem service benefits in the transmission process and putting forward scientific and reasonable ecological compensation.

Service quality framework for clinical laboratories.

PubMed

Ramessur, Vinaysing; Hurreeram, Dinesh Kumar; Maistry, Kaylasson

2015-01-01

The purpose of this paper is to illustrate a service quality framework that enhances service delivery in clinical laboratories by gauging medical practitioner satisfaction and by providing avenues for continuous improvement. The case study method has been used for conducting the exploratory study, with focus on the Mauritian public clinical laboratory. A structured questionnaire based on the SERVQUAL service quality model was used for data collection, analysis and for the development of the service quality framework. The study confirms the pertinence of the following service quality dimensions within the context of clinical laboratories: tangibility, reliability, responsiveness, turnaround time, technology, test reports, communication and laboratory staff attitude and behaviour. The service quality framework developed, termed LabSERV, is vital for clinical laboratories in the search for improving service delivery to medical practitioners. This is a pioneering work carried out in the clinical laboratory sector in Mauritius. Medical practitioner expectations and perceptions have been simultaneously considered to generate a novel service quality framework for clinical laboratories.

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 quality of services and service availability in the area are likely to significantly increase institutional delivery. PMID:24886375

Ecosystem Services Linking People to Coastal Habitats

EPA Science Inventory

Background/Question/Methods: There is a growing need to incorporate and prioritize ecosystem services/condition information into land-use decision making. While there are a number of place-based studies looking at how land-use decisions affect the availability and delivery of coa...

Partners in Collaboration: The Homan Square Project.

ERIC Educational Resources Information Center

Hollinger-Smith, Linda

1998-01-01

Collaboration between a community coalition and a nursing school in Chicago resulted in a primary health care clinic, school-based health centers, family education and counseling programs, and screening services. It provides a unique opportunity to combine service delivery and academic education. (SK)

Interventions That Target Criminogenic Needs for Justice-Involved Persons With Serious Mental Illnesses: A Targeted Service Delivery Approach.

PubMed

Wilson, Amy Blank; Farkas, Kathleen; Bonfine, Natalie; Duda-Banwar, Janelle

2018-05-01

This research describes the development of a targeted service delivery approach that tailors the delivery of interventions that target criminogenic needs to the specific learning and treatment needs of justice-involved people with serious mental illnesses (SMIs). This targeted service delivery approach includes five service delivery strategies: repetition and summarizing, amplification, active coaching, low-demand practice, and maximizing participation. Examples of how to apply each strategy in session are provided, as well as recommendations on when to use each strategy during the delivery of interventions that target criminogenic needs. This targeted service delivery approach makes an important contribution to the development of interventions for justice-involved people with SMI by increasing the chances that people with SMI can participate fully in and benefit from these interventions that target criminogenic needs. These developments come at a critical time in the field as the next generation of services for justice-involved people with SMI are being developed.

Proposing a health promotion framework to address gambling problems in Australian Indigenous communities.

PubMed

Fogarty, Marisa; Coalter, Nicola; Gordon, Ashley; Breen, Helen

2018-02-01

Gambling impacts affect Australian Indigenous families and communities in diverse and complex ways. Indigenous people throughout Australia engage in a broad range of regulated and unregulated gambling activities. Challenges in this area include the complexities that come with delivering services and programmes between the most remote regions, to highly populated towns and cities of Australia. There is little knowledge transfer between states and territories in Australia and no conceptual understanding or analysis of what constitutes 'best practice' in gambling service delivery for Indigenous people, families and communities. This article reviews health promotion approaches used in Australia, with a particular focus on Indigenous and gambling-based initiatives. Contributing to this review is an examination of health promotion strategies used in Indigenous gambling service delivery in the Northern Territory, New South Wales and Western Australia, demonstrating diversity and innovation in approaches. The article concludes by emphasizing the potential value of adopting health promotion strategies to underpin programme and service delivery for addressing gambling problems in Australian Indigenous communities. However, success is contingent on robust, evidence-based programme design, implementation and evaluation that adhere to health promotion principles. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Parallel NGO networks for HIV control: risks and opportunities for NGO contracting.

PubMed

Zaidi, Shehla; Gul, Xaher; Nishtar, Noureen Aleem

2012-12-27

Policy measures for preventive and promotive services are increasingly reliant on contracting of NGOs. Contracting is a neo-liberal response relying on open market competition for service delivery tenders. In contracting of health services a common assumption is a monolithic NGO market. A case study of HIV control in Pakistan shows that in reality the NGO market comprises of parallel NGO networks having widely different service packages, approaches and agendas. These parallel networks had evolved over time due to vertical policy agendas. Contracting of NGOs for provision of HIV services was faced with uneven capacities and turf rivalries across both NGO networks. At the same time contracting helped NGO providers belonging to different clusters to move towards standardized service delivery for HIV prevention. Market based measures such as contracting need to be accompanied with wider policy measures that facilitate in bringing NGOs groups to a shared understanding of health issues and responses.

Consensus–based approach to develop a measurement framework and identify a core set of indicators to track implementation and progress towards effective coverage of facility–based Kangaroo Mother Care

PubMed Central

Guenther, Tanya; Moxon, Sarah; Valsangkar, Bina; Wetzel, Greta; Ruiz, Juan; Kerber, Kate; Blencowe, Hannah; Dube, Queen; Vani, Shashi N; Vivio, Donna; Magge, Hema; De Leon–Mendoza, Socorro; Patterson, Janna; Mazia, Goldy

2017-01-01

Background As efforts to scale up the delivery of Kangaroo Mother Care (KMC) in facilities are increasing, a standardized approach to measure implementation and progress towards effective coverage is needed. Here, we describe a consensus–based approach to develop a measurement framework and identify a core set of indicators for monitoring facility–based KMC that would be feasible to measure within existing systems. Methods The KMC measurement framework and core list of indicators were developed through: 1) scoping exercise to identify potential indicators through literature review and requests from researchers and program implementers; and 2) face–to–face consultations with KMC and measurement experts working at country and global levels to review candidate indicators and finalize selection and definitions. Results The KMC measurement framework includes two main components: 1) service readiness, based on the WHO building blocks framework; and 2) service delivery action sequence covering identification, service initiation, continuation to discharge, and follow–up to graduation. Consensus was reached on 10 core indicators for KMC, which were organized according to the measurement framework. We identified 4 service readiness indicators, capturing national level policy for KMC, availability of KMC indicators in HMIS, costed operational plans for KMC and availability of KMC services at health facilities with inpatient maternity services. Six indicators were defined for service delivery, including weighing of babies at birth, identification of those ≤2000 g, initiation of facility–based KMC, monitoring the quality of KMC, status of babies at discharge from the facility and levels of follow–up (according to country–specific protocol). Conclusions These core KMC indicators, identified with input from a wide range of global and country–level KMC and measurement experts, can aid efforts to strengthen monitoring systems and facilitate global tracking of KMC implementation. As data collection systems advance, we encourage program managers and evaluators to document their experiences using this framework to measure progress and allow indicator refinement, with the overall aim of working towards sustainable, country–led data systems. PMID:29057074

Consensus-based approach to develop a measurement framework and identify a core set of indicators to track implementation and progress towards effective coverage of facility-based Kangaroo Mother Care.

PubMed

Guenther, Tanya; Moxon, Sarah; Valsangkar, Bina; Wetzel, Greta; Ruiz, Juan; Kerber, Kate; Blencowe, Hannah; Dube, Queen; Vani, Shashi N; Vivio, Donna; Magge, Hema; De Leon-Mendoza, Socorro; Patterson, Janna; Mazia, Goldy

2017-12-01

As efforts to scale up the delivery of Kangaroo Mother Care (KMC) in facilities are increasing, a standardized approach to measure implementation and progress towards effective coverage is needed. Here, we describe a consensus-based approach to develop a measurement framework and identify a core set of indicators for monitoring facility-based KMC that would be feasible to measure within existing systems. The KMC measurement framework and core list of indicators were developed through: 1) scoping exercise to identify potential indicators through literature review and requests from researchers and program implementers; and 2) face-to-face consultations with KMC and measurement experts working at country and global levels to review candidate indicators and finalize selection and definitions. The KMC measurement framework includes two main components: 1) service readiness, based on the WHO building blocks framework; and 2) service delivery action sequence covering identification, service initiation, continuation to discharge, and follow-up to graduation. Consensus was reached on 10 core indicators for KMC, which were organized according to the measurement framework. We identified 4 service readiness indicators, capturing national level policy for KMC, availability of KMC indicators in HMIS, costed operational plans for KMC and availability of KMC services at health facilities with inpatient maternity services. Six indicators were defined for service delivery, including weighing of babies at birth, identification of those ≤2000 g, initiation of facility-based KMC, monitoring the quality of KMC, status of babies at discharge from the facility and levels of follow-up (according to country-specific protocol). These core KMC indicators, identified with input from a wide range of global and country-level KMC and measurement experts, can aid efforts to strengthen monitoring systems and facilitate global tracking of KMC implementation. As data collection systems advance, we encourage program managers and evaluators to document their experiences using this framework to measure progress and allow indicator refinement, with the overall aim of working towards sustainable, country-led data systems.

Opening the Black Box: Exploring the Effect of Transformation on Online Service Delivery in Local Governments

NASA Astrophysics Data System (ADS)

van Veenstra, Anne Fleur; Zuurmond, Arre

To enhance the quality of their online service delivery, many government organizations seek to transform their organization beyond merely setting up a front office. This transformation includes elements such as the formation of service delivery chains, the adoption of a management strategy supporting process orientation and the implementation of enterprise architecture. This paper explores whether undertaking this transformation has a positive effect on the quality of online service delivery, using data gathered from seventy local governments. We found that having an externally oriented management strategy in place, adopting enterprise architecture, aligning information systems to business and sharing activities between processes and departments are positively related to the quality of online service delivery. We recommend that further research should be carried out to find out whether dimensions of organizational development too have an effect on online service delivery in the long term.

Early childhood education: Status trends, and issues related to electronic delivery

NASA Technical Reports Server (NTRS)

Rothenberg, D.

1973-01-01

The status of, and trends and issues within, early childhood education which are related to the possibilities of electronic delivery of educational service are considered in a broader investigation of the role of large scale, satellite based educational telecommunications systems. Data are analyzed and trends and issues discussed to provide information useful to the system designer who wishes to identify and assess the opportunities for large scale electronic delivery in early childhood education.

Research Area 14.3 Microbiology and Biodegradation: Development of RNA-based Vectors for in vivo Delivery of siRNAs

DTIC Science & Technology

2014-09-08

P.O. Box 12211 Research Triangle Park, NC 27709-2211 Vector, RNAi, delivery REPORT DOCUMENTATION PAGE 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 10...suggesstions for reducing this burden, to Washington Headquarters Services , Directorate for Information Operations and Reports, 1215 Jefferson Davis...Shapiro, Alissa M Pham, Benjamin R tenOever. In Vivo Delivery of Cytoplasmic RNA Virus-derived miRNAs, Molecular Therapy, (11 2011): 0. doi

The role of nurse specialists in the delivery of integrated diabetes care: a cross-sectional survey of diabetes nurse specialist services.

PubMed

Riordan, Fiona; McHugh, Sheena M; Murphy, Katie; Barrett, Julie; Kearney, Patricia M

2017-08-11

International evidence suggests the diabetes nurse specialist (DNS) has a key role in supporting integrated management of diabetes. We examine whether hospital and community DNS currently support the integration of care, examine regional variation in aspects of the service relevant to the delivery of integrated care and identify barriers to service delivery and areas for improvement. A cross-sectional survey of hospital and community-based DNS in Ireland. Between September 2015 and April 2016, a 67-item online survey, comprising closed and open questions on their clinical role, diabetes clinics, multidisciplinary working, and barriers and facilitators to service delivery, was administered to all eligible DNS (n=152) in Ireland. DNS were excluded if they were retired or on maternity leave or extended leave. The response rate was 66.4% (n=101): 60.6% (n=74) and 89.3% (n=25) among hospital and community DNS, respectively. Most DNS had patients with stable (81.8%) and complicated type 2 diabetes mellitus (89.9%) attending their service. The majority were delivering nurse-led clinics (81.1%). Almost all DNS had a role liaising with (91%), and providing support and education to (95%), other professionals. However, only a third reported that there was local agreement on how their service should operate between the hospital and primary care. Barriers to service delivery that were experienced by DNS included deficits in the availability of specialist staff (allied health professionals, endocrinologists and DNS), insufficient space for clinics, structured education and issues with integration. Delivering integrated diabetes care through a nurse specialist-led approach requires that wider service issues, including regional disparities in access to specialist resources and formalising agreements and protocols on multidisciplinary working between settings, be explicitly addressed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Place, Time and Experience: Barriers to Universalization Of Institutional Child Delivery in Rural Mozambique

PubMed Central

Agadjanian, Victor; Yao, Jing; Hayford, Sarah R.

2017-01-01

CONTEXT Although institutional coverage of childbirth is increasing in the developing world, a substantial minority of births in rural Mozambique still occur outside of health facilities. Identifying the remaining barriers to safe professional delivery services can aid in achieving universal coverage. METHODS Survey data collected in 2009 from 1,373 women in Gaza, Mozambique, were used in combination with spatial, meteorological and health facility data to examine patterns in place of delivery. Geographic information system–based visualization and mapping and exploratory spatial data analysis were used to outline the spatial distribution of home deliveries. Multilevel logistic regression models were constructed to identify associations between individual, spatial and other characteristics and whether women’s most recent delivery took place at home. RESULTS Spatial analysis revealed high- and low-prevalence clusters of home births. In multivariate analyses, women with a higher number of clinics within 10 kilometers of their home had a reduced likelihood of home delivery, but those living closer to urban centers had an increased likelihood. Giving birth during the rainy, high agricultural season was positively associated with home delivery, while household wealth was negatively associated with home birth. No associations were evident for measures of exposure to and experience with health institutions. CONCLUSIONS The results suggest the need for a comprehensive approach to expansion of professional delivery services. Such an approach should complement measures facilitating physical access to health institutions for residents of harder-to-reach areas with community-based interventions aimed at improving rural women’s living conditions and opportunities, while also taking into account seasonal and other variables. PMID:28770025

Integration of Technology-based Behavioral Health Interventions in Substance Abuse and Addiction Services.

PubMed

Ramsey, Alex

2015-08-01

The past decade has witnessed revolutionary changes to the delivery of health services, ushered in to a great extent by the introduction of electronic health record systems. More recently, a new class of technological advancements-technology-based behavioral health interventions, which involve the delivery of evidence-informed practices via computers, web-based applications, mobile phones, wearable sensors, or other technological platforms-has emerged and is primed to once again radically shift current models for behavioral healthcare. Despite the promise and potential of these new therapeutic approaches, a greater understanding of the impact of technology-based interventions on cornerstone issues of mental health and addiction services-namely access, quality, and cost -is needed. The current review highlights 1) relevant conceptual frameworks that guide this area of research, 2) key studies that inform the relevance of technology-based interventions for behavioral healthcare access, quality, and cost, 3) pressing methodological issues that require attention, 4) unresolved questions that warrant further investigation, and 5) practical implications that underscore important new directions for this emerging area of research.

Differentiated protection method in passive optical networks based on OPEX

NASA Astrophysics Data System (ADS)

Zhang, Zhicheng; Guo, Wei; Jin, Yaohui; Sun, Weiqiang; Hu, Weisheng

2011-12-01

Reliable service delivery becomes more significant due to increased dependency on electronic services all over society and the growing importance of reliable service delivery. As the capability of PON increasing, both residential and business customers may be included in a PON. Meanwhile, OPEX have been proven to be a very important factor of the total cost for a telecommunication operator. Thus, in this paper, we present the partial protection PON architecture and compare the operational expenditures (OPEX) of fully duplicated protection and partly duplicated protection for ONUs with different distributed fiber length, reliability requirement and penalty cost per hour. At last, we propose a differentiated protection method to minimize OPEX.

The Resource Team: an innovative service delivery support model for mental health services.

PubMed

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

2009-04-01

This paper outlines the development of the Resource Team, an innovative service delivery model supporting clinical services at the Inner North Brisbane Mental Health Service, Royal Brisbane and Women's Hospital Health Service District. The team aims to provide a base for specialist mental health support staff, improve knowledge management and support the development of meaningful community partnerships. Development of the team included a literature review and consultation with internal and external stakeholders. From this, the objectives, roles and functions of the team were clarified and disseminated to stakeholders. The team currently encompasses 12 positions and has initiated a number of programs and service developments. These include improved IT management of clinical resources and the development of partnerships with the community and non-government sectors. The Resource Team effectively coordinates specialist clinical support positions, addresses knowledge management issues and facilitates meaningful engagement with the community and non-government sectors. The model could easily be applied in other mental health and general health services.

The primary health care service experiences and needs of homeless youth: a narrative synthesis of current evidence.

PubMed

Dawson, Angela; Jackson, Debra

2013-04-01

Homeless youth are a growing, vulnerable population with specific primary health care (PHC) requirements. There are no systematic reviews of evidence to guide the delivery of PHC interventions to best address the needs of homeless youth in Australia. We present a narrative synthesis of peer reviewed research designed to determine: (1) the PHC services homeless youth access; (2) experiences of services, reported outcomes and barriers to use; and, (3) the PHC service needs of homeless youth. Findings show that homeless youth access a variety of services and delivery approaches. Increased PHC use is associated with youth who recognise they need help. Street-based clinic linked services and therapy and case management alongside improved housing can positively impact upon mental health and substance use outcomes. Barriers to service use include knowledge; provider attitudes, financial constraints and inappropriate environments. Findings support targetted, co-ordinated networks of PHC and housing services with nurses working alongside community workers.

Issues in bidding for contracts for occupational therapy services.

PubMed

Harms, S; Law, M

2001-06-01

There is an increasing number of occupational therapists in Canada who are involved in bidding for contracts to deliver occupational therapy services. Occupational therapists working in an institutional or community-based setting may not have had the responsibility of developing a proposal or a marketing plan for bidding purposes. However, the responsibility of developing a bid to compete for a service delivery contract often rests on occupational therapists who are sole practitioners in a private practice setting. The purpose of this paper is to highlight issues in the literature such as service delivery plans, marketing strategies and costing of services that can assist the occupational therapist in the development of a contractual bid. A specific clinical example, school therapy services, has been used to illustrate how these strategies can be applied to practice. Success in contractual bids appears to be primarily influenced by cost of the service, the expertise of the service provider, ability to provide coordinated care, ease of access for clients, and inclusion of methods to measure client outcome.

Young People’s Preferences for Family Planning Service Providers in Rural Malawi: A Discrete Choice Experiment

PubMed Central

Michaels-Igbokwe, Christine; Terris-Prestholt, Fern; Lagarde, Mylene; Chipeta, Effie; Cairns, John

2015-01-01

Objective To quantify the impact of service provider characteristics on young people’s choice of family planning (FP) service provider in rural Malawi in order to identify strategies for increasing access and uptake of FP among youth. Methods and Findings A discrete choice experiment was developed to assess the relative impact of service characteristics on preferences for FP service providers among young people (aged 15–24). Four alternative providers were included (government facility, private facility, outreach and community based distribution of FP) and described by six attributes (the distance between participants’ home and the service delivery point, frequency of service delivery, waiting time at the facility, service providers’ attitude, availability of FP commodities and price). A random parameters logit model was used to estimate preferences for service providers and the likely uptake of services following the expansion of outreach and community based distribution (CBDA) services. In the choice experiment young people were twice as likely to choose a friendly provider (government service odds ratio [OR] = 2.45, p<0.01; private service OR = 1.99, p<0.01; CBDA OR = 1.88, p<0.01) and more than two to three times more likely to choose a provider with an adequate supply of FP commodities (government service OR = 2.48, p<0.01; private service OR = 2.33, p<0.01; CBDA = 3.85, p<0.01). Uptake of community based services was greater than facility based services across a variety of simulated service scenarios indicating that such services may be an effective means of expanding access for youth in rural areas and an important tool for increasing service uptake among youth. Conclusions Ensuring that services are acceptable to young people may require additional training for service providers in order to ensure that all providers are friendly and non-judgemental when dealing with younger clients and to ensure that supplies are consistently available. PMID:26630492

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.

On-Line Databases in Mexico.

ERIC Educational Resources Information Center

Molina, Enzo

1986-01-01

Use of online bibliographic databases in Mexico is provided through Servicio de Consulta a Bancos de Informacion, a public service that provides information retrieval, document delivery, translation, technical support, and training services. Technical infrastructure is based on a public packet-switching network and institutional users may receive…

Maternal and neonatal health impact of obstetrical risk insurance scheme in Mauritania: a quasi experimental before-and-after study.

PubMed

Philibert, Aline; Ravit, Marion; Ridde, Valéry; Dossa, Inès; Bonnet, Emmanuel; Bedecarrats, Florent; Dumont, Alexandre

2017-04-01

A variety of health financing schemes shaped on pre-payment scheme have been implemented across Sub-Saharan Africa (SSA) to address the Millennium Development Goals (MDGs). In Mauritania, the Obstetric Risk Insurance package (ORI) focusing on maternal and perinatal health has been progressively implemented at the health district level since 2002. Here, our main objective was to assess the effectiveness of the ORI in increasing facility-based delivery rates, as well as increases in family planning, antenatal and postnatal care, caesarean delivery and neonatal health, from demographic and health survey data between 2002 and 2011. We also examined whether the effects of the ORI varied between strata of the population. The study was based on a quasi-experimental before-and-after design to assess the causal link between availability of ORI and increase in use of maternal health services and neonatal mortality. In combination with geographical information system, difference-in-differences and odd ratio approaches were used to address our objectives. Indicators of access to care for pregnant women and neonatal health and improved in both non-intervention and intervention groups during the study period. There was no global effect of the availability of ORI on facility-based delivery rates, nor on the use of antenatal and postnatal care services, except for qualified antenatal services. However, delivery rates in local health centres with ORI increased more rapidly than in those with no ORI, the contrary was shown for hospitals. Caesarean delivery and family planning decreased with ORI. Although late neonatal mortality rates remained low in the country, a significant decrease was seen in districts without ORI. Except for some strata of the population, ORI has not really met its objective of attracting more pregnant women towards facility-based health care. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Optimising Service Delivery of AAC AT Devices and Compensating AT for Dyslexia.

PubMed

Roentgen, Uta R; Hagedoren, Edith A V; Horions, Katrien D L; Dalemans, Ruth J P

2017-01-01

To promote successful use of Assistive Technology (AT) supporting Augmentative and Alternative Communication (AAC) and compensating for dyslexia, the last steps of their provision, delivery and instruction, use, maintenance and evaluation, were optimised. In co-creation with all stakeholders based on a list of requirements an integral method and tools were developed.

Prison mental health in-reach teams, serious mental illness and the Care Programme Approach in England.

PubMed

Brooker, Charlie; Webster, Russell

2017-08-01

The delivery of prison mental health services in England is examined over the last 12 years. Resources for services have grown significantly during this period and improved organisational models for the delivery of services are now in place. During this period however the challenges of working in the prison environment have increased. The paper argues that a history of sexual abuse or violence are common amongst prisoners and the Care Programme Approach (CPA) provides the vehicle to assess these histories through the use of routine enquiry. Commissioners of prison mental health services now need to ensure that teams are delivering cogent trauma-based interventions where relevant and the outcomes are measured. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

The Role of Distance and Quality on Facility Selection for Maternal and Child Health Services in Urban Kenya.

PubMed

Escamilla, Veronica; Calhoun, Lisa; Winston, Jennifer; Speizer, Ilene S

2018-02-01

Universal access to health care requires service availability and accessibility for those most in need of maternal and child health services. Women often bypass facilities closest to home due to poor quality. Few studies have directly linked individuals to facilities where they sought maternal and child health services and examined the role of distance and quality on this facility choice. Using endline data from a longitudinal survey from a sample of women in five cities in Kenya, we examine the role of distance and quality on facility selection for women using delivery, facility-based contraceptives, and child health services. A survey of public and private facilities offering reproductive health services was also conducted. Distances were measured between household cluster location and both the nearest facility and facility where women sought care. A quality index score representing facility infrastructure, staff, and supply characteristics was assigned to each facility. We use descriptive statistics to compare distance and quality between the nearest available facility and visited facility among women who bypassed the nearest facility. Facility distance and quality comparisons were also stratified by poverty status. Logistic regression models were used to measure associations between the quality and distance to the nearest facility and bypassing for each outcome. The majority of women bypassed the nearest facility regardless of service sought. Women bypassing for delivery traveled the furthest and had the fewest facility options near their residential cluster. Poor women bypassing for delivery traveled 4.5 km further than non-poor women. Among women who bypassed, two thirds seeking delivery and approximately 46% seeking facility-based contraception or child health services bypassed to a public hospital. Both poor and non-poor women bypassed to higher quality facilities. Our findings suggest that women in five cities in Kenya prefer public hospitals and are willing to travel further to obtain services at public hospitals, possibly related to free service availability. Over time, it will be important to examine service quality and availability in public sector facilities with reduced or eliminated user fees, and whether it lends itself to a continuum of care where women can visit one facility for multiple services reducing travel burden.

Effects of climate change on the delivery of soil-mediated ecosystem services within the primary sector in temperate ecosystems: a review and New Zealand case study.

PubMed

Orwin, Kate H; Stevenson, Bryan A; Smaill, Simeon J; Kirschbaum, Miko U F; Dickie, Ian A; Clothier, Brent E; Garrett, Loretta G; van der Weerden, Tony J; Beare, Michael H; Curtin, Denis; de Klein, Cecile A M; Dodd, Michael B; Gentile, Roberta; Hedley, Carolyn; Mullan, Brett; Shepherd, Mark; Wakelin, Steven A; Bell, Nigel; Bowatte, Saman; Davis, Murray R; Dominati, Estelle; O'Callaghan, Maureen; Parfitt, Roger L; Thomas, Steve M

2015-08-01

Future human well-being under climate change depends on the ongoing delivery of food, fibre and wood from the land-based primary sector. The ability to deliver these provisioning services depends on soil-based ecosystem services (e.g. carbon, nutrient and water cycling and storage), yet we lack an in-depth understanding of the likely response of soil-based ecosystem services to climate change. We review the current knowledge on this topic for temperate ecosystems, focusing on mechanisms that are likely to underpin differences in climate change responses between four primary sector systems: cropping, intensive grazing, extensive grazing and plantation forestry. We then illustrate how our findings can be applied to assess service delivery under climate change in a specific region, using New Zealand as an example system. Differences in the climate change responses of carbon and nutrient-related services between systems will largely be driven by whether they are reliant on externally added or internally cycled nutrients, the extent to which plant communities could influence responses, and variation in vulnerability to erosion. The ability of soils to regulate water under climate change will mostly be driven by changes in rainfall, but can be influenced by different primary sector systems' vulnerability to soil water repellency and differences in evapotranspiration rates. These changes in regulating services resulted in different potentials for increased biomass production across systems, with intensively managed systems being the most likely to benefit from climate change. Quantitative prediction of net effects of climate change on soil ecosystem services remains a challenge, in part due to knowledge gaps, but also due to the complex interactions between different aspects of climate change. Despite this challenge, it is critical to gain the information required to make such predictions as robust as possible given the fundamental role of soils in supporting human well-being. © 2015 John Wiley & Sons Ltd.

Multi-Sided Markets for Transforming Healthcare Service Delivery.

PubMed

Kuziemsky, Craig; Vimarlund, Vivian

2018-01-01

Changes in healthcare delivery needs have necessitated the design of new models for connecting providers and consumers of services. While healthcare delivery has traditionally been a push market, multi-sided markets offer the potential for transitioning to a pull market for service delivery. However, there is a need to better understand the business model for multi-sided markets as a first step to using them in healthcare. This paper addressed that need and describes a multi-sided market evaluation framework. Our framework identifies patient, governance and service delivery as three levels of brokerage consideration for evaluating multi-sided markets in healthcare.

Advances in mobile mental health: opportunities and implications for the spectrum of e-mental health services

PubMed Central

Chan, Steven; Hwang, Tiffany; Wong, Alice; Bauer, Amy M.

2017-01-01

Mobile health (mHealth), telemedicine and other technology-based services facilitate mental health service delivery and may be considered part of an e-mental health (eMH) spectrum of care. Web- and Internet-based resources provide a great opportunity for the public, patients, healthcare providers and others to improve wellness, practice prevention and reduce suffering from illnesses. Mobile apps offer portability for access anytime/anywhere, are inexpensive versus traditional desktop computers, and have additional features (e.g., context-aware interventions and sensors with real-time feedback. This paper discusses mobile mental health (mMH) options, as part of a broader framework of eMH options. The evidence-based literature shows that many people have an openness to technology as a way to help themselves, change behaviors and engage additional clinical services. Studies show that traditional video-based synchronous telepsychiatry (TP) is as good as in-person service, but mHealth outcomes have been rarely, directly compared to in-person and other eMH care options. Similarly, technology options added to in-person care or combined with others have not been evaluated nor linked with specific goals and desired outcomes. Skills and competencies for clinicians are needed for mHealth, social media and other new technologies in the eMH spectrum, in addition to research by randomized trials and study of health service delivery models with an emphasis on effectiveness. PMID:28894744

Determinants of use of health facility for childbirth in rural Hadiya zone, Southern Ethiopia.

PubMed

Asseffa, Netsanet Abera; Bukola, Fawole; Ayodele, Arowojolu

2016-11-16

Maternal mortality remains a major global public health concern despite many international efforts. Facility-based childbirth increases access to appropriate skilled attendance and emergency obstetric care services as the vast majority of obstetric complications occur during delivery. The purpose of the study was to determine the proportion of facility delivery and assess factors influencing utilization of health facility for childbirth. A cross-sectional study was conducted in two rural districts of Hadiya zone, southern Ethiopia. Participants who delivered within three years of the survey were selected by stratified random sampling. Trained interviewers administered a pre-tested semi-structured questionnaire. We employed bivariate analysis and logistic regression to identify determinants of facility-based delivery. Data from 751 participants showed that 26.9% of deliveries were attended in health facilities. In bivariate analysis, maternal age, education, husband's level of education, possession of radio, antenatal care, place of recent ANC attended, planned pregnancy, wealth quintile, parity, birth preparedness and complication readiness, being a model family and distance from the nearest health facility were associated with facility delivery. On multiple logistic regression, age, educational status, antenatal care, distance from the nearest health facility, wealth quintile, being a model family, planned pregnancy and place of recent ANC attended were the determinants of facility-based childbirth. Efforts to improve institutional deliveries in the region must strengthen initiatives that promote female education, opportunities for wealth creation, female empowerment and increased uptake of family planning among others. Service related barriers and cultural influences on the use of health facility for childbirth require further evaluation.

Implementation of Fee-Free Maternal Health-Care Policy in Ghana: Perspectives of Users of Antenatal and Delivery Care Services From Public Health-Care Facilities in Accra.

PubMed

Anafi, Patricia; Mprah, Wisdom K; Jackson, Allen M; Jacobson, Janelle J; Torres, Christopher M; Crow, Brent M; O'Rourke, Kathleen M

2018-01-01

In 2008, the government of Ghana implemented a national user fee maternal care exemption policy through the National Health Insurance Scheme to improve financial access to maternal health services and reduce maternal as well as perinatal deaths. Although evidence shows that there has been some success with this initiative, there are still issues relating to cost of care to beneficiaries of the initiative. A qualitative study, comprising 12 focus group discussions and 6 interviews, was conducted with 90 women in six selected urban neighborhoods in Accra, Ghana, to examine users' perspectives regarding the implementation of this policy initiative. Findings showed that direct cost of delivery care services was entirely free, but costs related to antenatal care services and indirect costs related to delivery care still limit the use of hospital-based midwifery and obstetric care. There was also misunderstanding about the initiative due to misinformation created by the government through the media.We recommend that issues related to both direct and indirect costs of antenatal and delivery care provided in public health-care facilities must be addressed to eliminate some of the lingering barriers relating to cost hindering the smooth operation and sustainability of the maternal care fee exemption policy.

Shade Trading: An Emerging Riparian Forest-Based Payment for Ecosystem Services Market in Oregon, USA

NASA Astrophysics Data System (ADS)

Guillozet, Kathleen

2015-10-01

This paper describes the regulatory and compliance context for Oregon's emerging ecosystem services (ES) market in riparian shade to meet water quality obligations. In Oregon's market as with many other ES programs, contracts and other regulatory documents not only delimit the obligations and liabilities of different parties, but also constitute a primary mechanism through which ES service delivery is measured. Through a review of compliance criteria I find that under Oregon's shade trades, permittees are held to a number of input-based criteria, which essentially affirm that parties comply with predetermined practices and procedures, and one `pseudo output based' criterion, in which ES delivery is estimated through a model. The case presented in the paper critically engages with the challenges of measuring ES and in assessing the outcomes of ES projects. It places these challenges as interrelated and proposes that market designers, policymakers, and other stakeholders should consider explicit efficacy, efficiency, and equity targets.

Shade Trading: An Emerging Riparian Forest-Based Payment for Ecosystem Services Market in Oregon, USA.

PubMed

Guillozet, Kathleen

2015-10-01

This paper describes the regulatory and compliance context for Oregon's emerging ecosystem services (ES) market in riparian shade to meet water quality obligations. In Oregon's market as with many other ES programs, contracts and other regulatory documents not only delimit the obligations and liabilities of different parties, but also constitute a primary mechanism through which ES service delivery is measured. Through a review of compliance criteria I find that under Oregon's shade trades, permittees are held to a number of input-based criteria, which essentially affirm that parties comply with predetermined practices and procedures, and one 'pseudo output based' criterion, in which ES delivery is estimated through a model. The case presented in the paper critically engages with the challenges of measuring ES and in assessing the outcomes of ES projects. It places these challenges as interrelated and proposes that market designers, policymakers, and other stakeholders should consider explicit efficacy, efficiency, and equity targets.

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

Code of Federal Regulations, 2011 CFR

2011-07-01

... for the type of delivery you use (such as two-day delivery or overnight delivery). If you deposit it... will arrive at the proper address by 5 p.m. on the second business day after the next scheduled... designated delivery services. You should make sure that both the provider and the particular type of delivery...

75 FR 27327 - National Institute on Disability and Rehabilitation Research (NIDRR)-Disability and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-14

... Centers (RRTCs)-- Effective Vocational Rehabilitation (VR) Service Delivery Practices Catalog of Federal... priority for an RRTC on Effective Vocational Rehabilitation (VR) Service Delivery Practices. The Assistant... priority. Effective Vocational Rehabilitation (VR) Service Delivery Practices Background: The...

77 FR 47045 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-07

... the Collection of Qualitative Feedback on the Service Delivery of the Consumer Financial Protection... of Qualitative Feedback on the Service Delivery of the Consumer Financial Protection Bureau... Qualitative Feedback on the Service Delivery of the Consumer Financial Protection Bureau. OMB Control Number...

Supporting good practice in the provision of services to people with comorbid mental health and alcohol and other drug problems in Australia: describing key elements of good service models.

PubMed

Merkes, Monika; Lewis, Virginia; Canaway, Rachel

2010-12-03

The co-occurrence of mental illness and substance use problems (referred to as "comorbidity" in this paper) is common, and is often reported by service providers as the expectation rather than the exception. Despite this, many different treatment service models are being used in the alcohol and other drugs (AOD) and mental health (MH) sectors to treat this complex client group. While there is abundant literature in the area of comorbidity treatment, no agreed overarching framework to describe the range of service delivery models is apparent internationally or at the national level. The aims of the current research were to identify and describe elements of good practice in current service models of treatment of comorbidity in Australia. The focus of the research was on models of service delivery. The research did not aim to measure the client outcomes achieved by individual treatment services, but sought to identify elements of good practice in services. Australian treatment services were identified to take part in the study through a process of expert consultation. The intent was to look for similarities in the delivery models being implemented across a diverse set of services that were perceived to be providing good quality treatment for people with comorbidity problems. A survey was designed based on a concept map of service delivery devised from a literature review. Seventeen Australian treatment services participated in the survey, which explored the context in which services operate, inputs such as organisational philosophy and service structure, policies and procedures that guide the way in which treatment is delivered by the service, practices that reflect the way treatment is provided to clients, and client impacts. The treatment of people with comorbidity of mental health and substance use disorders presents complex problems that require strong but flexible service models. While the treatment services included in this study reflected the diversity of settings and approaches described in the literature, the research found that they shared a range of common characteristics. These referred to: service linkages; workforce; policies, procedures and practices; and treatment.

Delivering a lifelong integrated electronic health record based on a service oriented architecture.

PubMed

Katehakis, Dimitrios G; Sfakianakis, Stelios G; Kavlentakis, Georgios; Anthoulakis, Dimitrios N; Tsiknakis, Manolis

2007-11-01

Efficient access to a citizen's Integrated Electronic Health Record (I-EHR) is considered to be the cornerstone for the support of continuity of care, the reduction of avoidable mistakes, and the provision of tools and methods to support evidence-based medicine. For the past several years, a number of applications and services (including a lifelong I-EHR) have been installed, and enterprise and regional infrastructure has been developed, in HYGEIAnet, the Regional Health Information Network (RHIN) of the island of Crete, Greece. Through this paper, the technological effort toward the delivery of a lifelong I-EHR by means of World Wide Web Consortium (W3C) technologies, on top of a service-oriented architecture that reuses already existing middleware components is presented and critical issues are discussed. Certain design and development decisions are exposed and explained, laying this way the ground for coordinated, dynamic navigation to personalized healthcare delivery.

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.

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

Tang, Liyang

2012-09-14

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. 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. 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. 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's trust in doctor, and the promotion of patient's trust in recommended medical examination could all help promote patient's life satisfaction. But their promotion effects were different among low level public hospital, high level public hospital, and private hospital.

A cross-sectional survey of the prevalence of environmental tobacco smoke preventive care provision by child health services in Australia

PubMed Central

2011-01-01

Background Despite the need for a reduction in levels of childhood exposure to environmental tobacco smoke (ETS) being a recognised public health goal, the delivery of ETS preventive care in child health service settings remains a largely unstudied area. The purpose of this study was to determine the prevalence of ETS preventive care in child health services; differences in the provision of care by type of service; the prevalence of strategies to support such care; and the association between care support strategies and care provision. Method One-hundred and fifty-one (83%) child health service managers within New South Wales, Australia completed a questionnaire in 2002 regarding the: assessment of parental smoking and child ETS exposure; the provision of parental smoking cessation and ETS-exposure reduction advice; and strategies used to support the provision of such care. Child health services were categorised based on their size and case-mix, and a chi-square analysis was performed to compare the prevalence of ETS risk assessment and ETS prevention advice between service types. Logistic regression analysis was used to examine associations between the existence of care support strategies and the provision of ETS risk assessment and ETS exposure prevention advice. Results A significant proportion of services reported that they did not assess parental smoking status (26%), and reported that they did not assess the ETS exposure (78%) of any child. Forty four percent of services reported that they did not provide smoking cessation advice and 20% reported they did not provide ETS exposure prevention advice. Community based child and family health services reported a greater prevalence of ETS preventive care compared to other hospital based units. Less than half of the services reported having strategies to support the provision of ETS preventive care. The existence of such support strategies was associated with greater odds of care provision. Conclusions The existence of major gaps in recommended ETS preventive care provision suggests a need for additional initiatives to increase such care delivery. The low prevalence of strategies that support such care delivery suggests a potential avenue to achieve this outcome. PMID:21575273

Outcome of Sentinel Hospital-based and CDC-based ART Service Delivery: A Prospective Open Cohort of People Living with HIV in China.

PubMed

Ning, Chuanyi; Smith, Kumi M; McCann, Chase D; Hu, Fengyu; Lan, Yun; Zhang, Fuchun; Liang, Hao; Zhao, Jinmin; Tucker, Joseph D; Cai, Weiping

2017-02-14

The primary objective of this study was to obtain insights into the outcomes of people living with HIV who accessed services through HIV/AIDS sentinel hospital-based and ART service delivery in China. Post-hoc analyses of an open cohort from an observational database of 22 qualified HIV/AIDS sentinel hospital-based and two CDC-based drug delivery facilities (DDFs) in Guangdong Province was completed. Linkage to care, mortality and survival rates were calculated according to WHO criteria. 12,966 individuals received ART from HIV/AIDS sentinel hospitals and 1,919 from DDFs, with linkage to care rates of 80.7% and 79.9%, respectively (P > 0.05). Retention rates were 94.1% and 84.0% in sentinel hospitals and DDFs, respectively (P < 0.01). Excess mortality was 1.4 deaths/100 person-years (95% CI: 1.1, 1.8) in DDFs compared to 0.4 deaths/100 person-years (95% CI: 0.3, 0.5) in hospitals (P < 0.01). A Cox-regression analysis revealed that mortality was much higher in patients receiving ART from the DDFs than sentinel hospitals, with an adjusted HR of 3.3 (95% CI: 2.3, 4.6). A crude HR of treatment termination in DDFs was 7.5 fold higher (95% CI: 6.3, 9.0) compared to sentinel hospitals. HIV/AIDS sentinel hospital had better retention, and substantially lower mortality compared to DDFs.

Impact of school health management committees on health services delivery in Ghana: A national level assessment.

PubMed

Bowman, Angela S; Owusu, Andrew; Trueblood, Amber B; Bosumtwi-Sam, Cynthia

2018-05-07

To examine the prevalence, determinants, and impact of local school health management committees on implementation of minimum-recommended school health services delivery among basic and secondary schools in Ghana. National level cross-sectional data from the first-ever assessment of Ghana Global-School Health Policies and Practices Survey was utilized. Complex sample analyses were used to quantify school-level implementation of recommended minimum package for health services delivery. Of 307 schools, 98% were basic and government run, and 33% offered at least half of the recommended health service delivery areas measured. Schools with a school health management committee (53%) were 4.8 (95% CI = 3.23-5.18) times as likely to offer at least 50% of the minimum health services package than schools that did not. There is significant deficit concerning delivery of school health services in schools across Ghana. However, school health management committees positively impact implementation of health service delivery. School health management committees provide a significant impact on delivery of school health services; thus, it is recommended that policy makers and programmers place greater emphasis on the value and need for these advisory boards in all Ghanaian schools. Copyright © 2018 John Wiley & Sons, Ltd.

Developing a higher specialist training programme in renal medicine in the era of competence-based training.

PubMed

Kamesh, Lavanya; Clapham, Mike; Foggensteiner, Lukas

2012-08-01

Renal specialty medical training in the UK was reformed in August 2007, with an emphasis placed on competency-based training and the publication of a new curriculum and assessment blueprint. This model of training places additional time demands on both trainees and trainers, with implications for job planning and service delivery. We evaluated the resource requirements and impact on service delivery of implementing a high-quality training programme in renal medicine. Each trainee maintained a portfolio containing details of workplace-based assessments. The change in educational environment led to improved trainee satisfaction. The mean total consultant time involved in implementing the training programme was 0.7 programmed activities (PAs) per trainee per week in the first year, which decreased to 0.5 PAs per trainee per week in the second year. This pilot study indicates that it is possible to integrate successful and high-quality specialty training in a busy clinical environment. The model outlined could form a template for postgraduate specialist training delivery in a variety of medical specialties.

Commentary: Cultural Adaptation, Collaboration, and Exchange

ERIC Educational Resources Information Center

Palinkas, Lawrence Albert

2010-01-01

This commentary reviews three articles linked together by two themes (a) the use of cultural adaptation of evidence-based practices to reduce disparities in health and services delivery and (b) the importance of collaboration involving intervention developers, practitioners, and consumers when delivering services. Both themes illustrate a process…

Native and agricultural forests at risk to a changing climate in the Northern Plains

USDA-ARS?s Scientific Manuscript database

Native and agricultural forests in the Northern Plains provide ecosystem services that benefit human society—diversified agricultural systems, forest-based products, and rural vitality. The impacts of recent trends in temperature and disturbances are impairing the delivery of these services. Climate...

Partners in Self-Sufficiency Guidebook.

ERIC Educational Resources Information Center

Department of Housing and Urban Development, Washington, DC. Office of Policy Development and Research.

This guidebook is for community leaders who are implementing the Federal Partners in Self-Sufficiency (PS-S) program, a community-based approach to service delivery that helps families get off welfare. The program offers a comprehensive package of services including housing, education, child care, transportation, counseling, and job training and…

Factors associated with quality of life and caregiver strain amongst frail older adults referred to a community rehabilitation service: implications for service delivery.

PubMed

Comans, Tracy A; Currin, Michelle L; Brauer, Sandra G; Haines, Terry P

2011-01-01

To identify factors contributing to reduced quality of life and increased caregiver strain in an older population referred to a community rehabilitation team and to recommend service delivery models. Analytical cross-sectional study arising from baseline assessments from 107 subjects drawn from a randomised controlled trial of community rehabilitation service delivery models. A community rehabilitation team based in Brisbane, Queensland, Australia. Primary outcome variables include quality of life (EQ-5D & VAS) and Carer Strain Index. Predictor variables include participation in functional activities, history of falls, number of medications, number of co-morbidities, depression, environmental hazards, physical function and nutrition. Association between variables assessed using linear regression. Major factors contributing to reduced quality of life were having reduced participation in daily activities, depression, and having poor vision. Having poor nutrition and no longer driving also contributed to poor quality of life. The major factor contributing to increased caregiver strain was reduced participation in daily activities by the older person. Community rehabilitation services working with older populations must adopt models of care that screen for and address a wide range of factors that contribute to poor quality of life and caregiver strain.

Mental health services for Nunavut children and youth: evaluating a telepsychiatry pilot project.

PubMed

Volpe, T; Boydell, K M; Pignatiello, A

2014-01-01

This study examines the delivery of psychiatric consultation services using videoconferencing technology to health and mental health workers in the Nunavut territory of Canada. The research provides insights into the TeleLink Mental Health Program and the delivery of professional-to-professional program consultations and continuing education seminars. Participant observation of 12 program consultations and four continuing education sessions was conducted. Individual interviews were conducted with the consulting psychiatrist and the lead program coordinator in Nunavut. As well, a focus group was held with Nunavut workers who participated in the televideo sessions. The study found a number of factors that facilitated or hindered the process and content of a consultation-based telepsychiatry program and its effect on building capacity among frontline staff. Four main themes emerged related to the delivery of psychiatric services via televideo: gaining access, ensuring culturally appropriate services, providing relevant continuing education, and offering stable and confidential technology. Live interactive videoconferencing technology is an innovative and effective way of delivering specialized mental health services to professionals working in remote areas of Nunavut. Study results provide important strategies for expanding this approach to other jurisdictions in Nunavut and other Inuit regions.

Personalized Location-Based Recommendation Services for Tour Planning in Mobile Tourism Applications

NASA Astrophysics Data System (ADS)

Yu, Chien-Chih; Chang, Hsiao-Ping

Travel and tour planning is a process of searching, selecting, grouping and sequencing destination related products and services including attractions, accommodations, restaurants, and activities. Personalized recommendation services aim at suggesting products and services to meet users’ preferences and needs, while location-based services focus on providing information based on users’ current positions. Due to the fast growing of user needs in the mobile tourism domain, how to provide personalized location-based tour recommendation services becomes a critical research and practical issue. The objective of this paper is to propose a system architecture and design methods for facilitating the delivery of location-based recommendation services to support personalized tour planning. Based on tourists’ current location and time, as well as personal preferences and needs, various recommendations regarding sightseeing spots, hotels, restaurants, and packaged tour plans can be generated efficiently. An application prototype is also implemented to illustrate and test the system feasibility and effectiveness.

Exploring service delivery in occupational therapy: The use of convergent interviewing.

PubMed

van Biljon, Hester; du Toit, Sanetta H J; Masango, July; Casteleijn, Daleen

2017-01-01

Occupational therapy clinicians working in South Africa's public healthcare had views on what patients thought about their vocational rehabilitation services that were based on anecdotal evidence. However evidence-based practice requires more than that. Reliable information is important in patient-centred practice and in the assessment of service quality. Clinical occupational therapists used the convergent interviewing technique to explore patients' views of the vocational rehabilitation services on offer in public hospitals. An Action Learning Action Research (ALAR) approach was used to explore the vocational rehabilitation services occupational therapy clinicians provided over a two week period in three settings. The majority (96%) of patients interviewed were not aware that occupational therapists offered vocational rehabilitation services. The convergent interview technique allowed continued unrestricted discussion of their vocational rehabilitation concerns and provided evidence that patients had significant concerns about work. Critical reflection on the interview experience and technique indicated that therapists were in favour of using convergent interviewing to obtain their patients views about the services offered. Therapists found the convergent interview technique easy to apply in clinical practice. Establishing patients' views of a clinical service have multiple values. However it is meaningless unless clinicians use the knowledge to improve service delivery to the patients who provided the views. Convergent interviewing was a valuable technique for occupational therapy clinicians to incorporate patients' views of their services into service development.

Private sector approaches to workforce enhancement.

PubMed

Wendling, Wayne R

2010-06-01

This paper addresses the private practice model of dental care delivery in the US. The great majority of dental care services are delivered through this model and thus changes in the model represent a means to substantially change the supply and availability of dental services. The two main forces that change how private practices function are broad economic factors, which alter the demand for dental care and innovations in practice structure and function which alter the supply and cost of services. Economics has long recognized that although there are private market solutions for many issues, not all problems can be addressed through this model. The private practice of dentistry is a private market solution that works for a substantial share of the market. However, the private market may not work to resolve all issues associated with access and utilization. Solutions for some problems call for creative private - public arrangements - another form of innovation; and market-based solutions may not be feasible for each and every problem. This paper discusses these economic factors and innovation as they relate to the private practice of dentistry, with special emphasis on those elements that have increased the capacity of the dental practice to offer services to those with limited means to access fee-based care. Innovations are frequently described as new care delivery models or new workforce models. However, innovation can occur on an ongoing and regular basis as dental practices examine new ways to combine capital and human resources and to leverage the education and skill of the dentists to a greater number of patients. Innovation occurs within a market context as the current and projected economic returns reward the innovation. Innovation can also occur through private-public arrangements. There are indications of available capacity within the existing delivery system to expand service delivery. The Michigan Medicaid Healthy Kids Dental program is discussed as one example of how dental services to Medicaid insured children were effectively expanded using the private practice model.

Wealth inequality and utilization of reproductive health services in the Republic of Vanuatu: insights from the multiple indicator cluster survey, 2007

PubMed Central

2011-01-01

Background Although the Republic of Vanuatu has improved maternal indicators, more needs to be done to improve equity among the poorest in the use of reproductive health services to expedite the progress towards the Millennium Development Goal 5(MDG 5) target. While large developing country studies provide evidence of a rich-poor gap in reproductive health services utilization, not much is written in terms of Pacific Islands. Thus, this study aims to examine the degree of inequality in utilization of reproductive health services in a nationally representative sample of Vanuatu households. Methods This paper used data from the 2007 Vanuatu Multiple Indicator Cluster Survey (MICS). The analyses were based on responses from 615 ever married women, living with at least one child below two years of age. Outcomes included antenatal care (ANC) and use of birth attendants at delivery, place of delivery, and counseling and testing for HIV/AIDS. Descriptive statistics and multivariate logistic regression methods were employed in the analysis. Results Findings revealed that the economic well-being status of the household to which women belong, played a crucial role in explaining the variation in service utilization. Inequality in utilization was found to be more pronounced between the poorest and richest groups within the wealth quintiles. In adjusted models, mothers in the richest bands of wealth were 5.50 (95% confidence interval [CI]: 1.34-22.47), 2.12 (95% CI: 1.02-3.42), 4.0 (95% CI 1.58-10.10), and 2.0 (95% CI 1.02-5.88) times more likely to have assisted delivery from medically trained personnel, have institutional deliveries, and have counseling and testing for HIV/AIDS. Conclusions Association between household wealth inequality and utilization of ANC and delivery assistance from medically trained personnel, institutional delivery, and counseling and testing for HIV/AIDS suggest that higher utilization of reproductive health care services in Vanuatu poor-rich inequalities need to be addressed. Reducing poverty and making services more available and accessible to the poor may be essential for improving overall reproductive health care utilization rate in Vanuatu. PMID:22132828

Mental health service delivery following health system reform in Colombia.

PubMed

Romero-González, Mauricio; González, Gerardo; Rosenheck, Robert A

2003-12-01

In 1993, Colombia underwent an ambitious and comprehensive process of health system reform based on managed competition and structured pluralism, but did not include coverage for mental health services. In this study, we sought to evaluate the impact of the reform on access to mental health services and whether there were changes in the pattern of mental health service delivery during the period after the reform. Changes in national economic indicators and in measures of mental health and non-mental health service delivery for the years 1987 and 1997 were compared. Data were obtained from the National Administrative Department of Statistics of Colombia (DANE), the Department of National Planning and Ministry of the Treasury of Colombia, and from national official reports of mental health and non-mental health service delivery from the Ministry of Health of Colombia for the same years. While population-adjusted access to mental health outpatient services declined by -2.7% (-11.2% among women and +5.8% among men), access to general medical outpatient services increased dramatically by 46%. In-patient admissions showed smaller differences, with a 7% increase in mental health admissions, as compared to 22.5% increase in general medical admissions. The health reform in Colombia imposed competition across all health institutions with the intention of encouraging efficiency and financial autonomy. However, the challenge of institutional survival appears to have fallen heavily on mental health care institutions that were also expected to participate in managed competition, but that were at a serious disadvantage because their services were excluded from the compulsory standardized package of health benefits. While the Colombian health care reform intended to close the gap between those who had and those who did not have access to health services, it appears to have failed to address access to specialized mental health services, although it does seem to have promoted a change in the pattern of mental health service delivery from a reliance on costly inpatient care to more efficient outpatient services. Health reform in Colombia improved access to health services for the general medical services, but not for specialized mental health services. Although the primary goal of the health reform was to provide universal medical coverage, by not including mental health services in the standardized benefits package, inequities in the delivery of mental health services appear to have been perpetuated or even exacerbated. IMPLICATIONS FOR HEALTH CARE AND POLICY FORMULATION: If health reform in Colombia and elsewhere is to provide universal coverage and adequate access to comprehensive health care, mental health services must be added to the standardized package of health benefits and efforts to develop accessible and effective mental health treatment at the primary care level should continue. Mental health services research in Colombia should focus future studies on the differential impact of health reform on access to mental health services across regions, and between urban and rural areas.

A State of the Field Study of Child Welfare Services for Migrant Children and Their Families Who are In-Stream, Home-Based, or Settled-Out. Literature Review.

ERIC Educational Resources Information Center

Porteous, Sandra McClure

Part of a study of migrant child welfare services, this review synthesizes all available materials on the issues affecting migrant child welfare. Each chapter discusses the importance of a particular service area, assesses the migrant child's needs in that area, describes existing barriers to service delivery, and presents a history and the…

Profile, knowledge, and work patterns of a cadre of maternal, newborn, and child health CHWs focusing on preventive and promotive services in Morogoro Region, Tanzania.

PubMed

LeFevre, Amnesty E; Mpembeni, Rose; Chitama, Dereck; George, Asha S; Mohan, Diwakar; Urassa, David P; Gupta, Shivam; Feldhaus, Isabelle; Pereira, Audrey; Kilewo, Charles; Chebet, Joy J; Cooper, Chelsea M; Besana, Giulia; Lutale, Harriet; Bishanga, Dunstan; Mtete, Emmanuel; Semu, Helen; Baqui, Abdullah H; Killewo, Japhet; Winch, Peter J

2015-12-24

Despite impressive decreases in under-five mortality, progress in reducing maternal and neonatal mortality in Tanzania has been slow. We present an evaluation of a cadre of maternal, newborn, and child health community health worker (MNCH CHW) focused on preventive and promotive services during the antenatal and postpartum periods in Morogoro Region, Tanzania. Study findings review the effect of several critical design elements on knowledge, time allocation, service delivery, satisfaction, and motivation. A quantitative survey on service delivery and knowledge was administered to 228 (of 238 trained) MNCH CHWs. Results are compared against surveys administered to (1) providers in nine health centers (n = 88) and (2) CHWs (n = 53) identified in the same districts prior to the program's start. Service delivery outputs were measured by register data and through a time motion study conducted among a sub-sample of 33 randomly selected MNCH CHWs. Ninety-seven percent of MNCH CHWs (n = 228) were interviewed: 55% male, 58% married, and 52% with secondary school education or higher. MNCH CHWs when compared to earlier CHWs were more likely to be unmarried, younger, and more educated. Mean MNCH CHW knowledge scores were <50% for 8 of 10 MNCH domains assessed and comparable to those observed for health center providers but lower than those for earlier CHWs. MNCH CHWs reported covering a mean of 186 households and were observed to provide MNCH services for 5 h weekly. Attendance of monthly facility-based supervision meetings was nearly universal and focused largely on registers, yet data quality assessments highlighted inconsistencies. Despite program plans to provide financial incentives and bicycles for transport, only 56% of CHWs had received financial incentives and none received bicycles. Initial rollout of MNCH CHWs yields important insights into addressing program challenges. The social profile of CHWs was not significantly associated with knowledge or service delivery, suggesting a broader range of community members could be recruited as CHWs. MNCH CHW time spent on service delivery was limited but comparable to the financial incentives received. Service delivery registers need to be simplified to reduce inconsistencies and yet expanded to include indicators on the timing of antenatal and postpartum visits.

Delivery of crop pollination services is an insufficient argument for wild pollinator conservation.

PubMed

Kleijn, David; Winfree, Rachael; Bartomeus, Ignasi; Carvalheiro, Luísa G; Henry, Mickaël; Isaacs, Rufus; Klein, Alexandra-Maria; Kremen, Claire; M'Gonigle, Leithen K; Rader, Romina; Ricketts, Taylor H; Williams, Neal M; Lee Adamson, Nancy; Ascher, John S; Báldi, András; Batáry, Péter; Benjamin, Faye; Biesmeijer, Jacobus C; Blitzer, Eleanor J; Bommarco, Riccardo; Brand, Mariëtte R; Bretagnolle, Vincent; Button, Lindsey; Cariveau, Daniel P; Chifflet, Rémy; Colville, Jonathan F; Danforth, Bryan N; Elle, Elizabeth; Garratt, Michael P D; Herzog, Felix; Holzschuh, Andrea; Howlett, Brad G; Jauker, Frank; Jha, Shalene; Knop, Eva; Krewenka, Kristin M; Le Féon, Violette; Mandelik, Yael; May, Emily A; Park, Mia G; Pisanty, Gideon; Reemer, Menno; Riedinger, Verena; Rollin, Orianne; Rundlöf, Maj; Sardiñas, Hillary S; Scheper, Jeroen; Sciligo, Amber R; Smith, Henrik G; Steffan-Dewenter, Ingolf; Thorp, Robbin; Tscharntke, Teja; Verhulst, Jort; Viana, Blandina F; Vaissière, Bernard E; Veldtman, Ruan; Ward, Kimiora L; Westphal, Catrin; Potts, Simon G

2015-06-16

There is compelling evidence that more diverse ecosystems deliver greater benefits to people, and these ecosystem services have become a key argument for biodiversity conservation. However, it is unclear how much biodiversity is needed to deliver ecosystem services in a cost-effective way. Here we show that, while the contribution of wild bees to crop production is significant, service delivery is restricted to a limited subset of all known bee species. Across crops, years and biogeographical regions, crop-visiting wild bee communities are dominated by a small number of common species, and threatened species are rarely observed on crops. Dominant crop pollinators persist under agricultural expansion and many are easily enhanced by simple conservation measures, suggesting that cost-effective management strategies to promote crop pollination should target a different set of species than management strategies to promote threatened bees. Conserving the biological diversity of bees therefore requires more than just ecosystem-service-based arguments.

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.

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.…

Family-Centered Service Delivery.

ERIC Educational Resources Information Center

Higgins, Cindy, Ed.

1997-01-01

This theme issue focuses on family-centered practices and policies for service delivery. The first article, "Family-Centered Service Delivery," reports on a study of 130 published sources in education, social work, nursing, psychology, occupational therapy, and related disciplines, which found that the key components of family-centered…

42 CFR 476.1 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... care facility or facility means an organization involved in the delivery of health care services for... the delivery of health care services that is typical for a specified group. Norms means numerical or statistical measures of average observed performance in the delivery of health care services. Outliers means...

SKI*HI Home-Based Programming for Children with Hearing Impairments: Demographics, Child Identification, and Program Effectiveness, 1979-1991.

ERIC Educational Resources Information Center

Strong, Carol J.; And Others

SKI*HI is a program designed to identify children with hearing impairments as early as possible and to provide them and their families with complete home programming that will facilitate development. The delivery model includes identification/screening services, home visit services, support services, and program management. A parent advisor makes…

Damage Control Surgery and the Joint Solution

DTIC Science & Technology

2017-06-01

IV. THE SERVICES ’ OPERATE, TRAIN AND EQUIP FOR DEPLOYMENT OF DCS 13 V. COURSES OF ACTION 20 VI. CONCLUSION...Figure 14: Notional Service Enlisted Specialty Training Timeline 25 Figure 15: Timeline of Events for Base Hospital #28...implications for casualty care. Lastly, a short excerpt on how each Service organizes, trains and equips their personnel for the delivery of damage control

The Psychology of Delivering a Psychological Service: Self-Organised Learning as a Model for Consultation

ERIC Educational Resources Information Center

Clarke, Steve; Jenner, Simon

2006-01-01

The article describes how one Educational Psychology Service in the UK developed a service delivery based on self-organised learning (SOL). This model is linked to the paradigms and discourses within which educational psychology and special educational needs work. The work described here is dedicated to the memory of Brian Roberts, academic, close…

The Development of a Field Services Network for a Satellite-Based Educational Telecommunications Experiment. Satellite Technology Demonstration, Technical Report No. 0333.

ERIC Educational Resources Information Center

Anderson, Frank; And Others

The Satellite Technology Demonstration (STD) of the Federation of Rocky Mountain States (FRMS) employed a technical delivery system to merge effectively hardware and software, products and services. It also needed a nontechnical component to insure product and service acceptance. Accordingly, the STD's Utilization Component was responsible for…

Unmanned Aerial System (UAS) Traffic Management (UTM): Enabling Low-Altitude Airspace and UAS Operations

NASA Technical Reports Server (NTRS)

Kopardekar, Parimal H.

2014-01-01

Many civilian applications of Unmanned Aerial Systems (UAS) have been imagined ranging from remote to congested urban areas, including goods delivery, infrastructure surveillance, agricultural support, and medical services delivery. Further, these UAS will have different equipage and capabilities based on considerations such as affordability, and mission needs applications. Such heterogeneous UAS mix, along with operations such as general aviation, helicopters, gliders must be safely accommodated at lower altitudes. However, key infrastructure to enable and safely manage widespread use of low-altitude airspace and UAS operations therein does not exist. Therefore, NASA is exploring functional design, concept and technology development, and a prototype UAS Traffic Management (UTM) system. UTM will support safe and efficient UAS operations for the delivery of goods and services

Perinatal staff perceptions of safety and quality in their service.

PubMed

Sinni, Suzanne V; Wallace, Euan M; Cross, Wendy M

2014-11-28

Ensuring safe and appropriate service delivery is central to a high quality maternity service. With this in mind, over recent years much attention has been given to the development of evidence-based clinical guidelines, staff education and risk reporting systems. Less attention has been given to assessing staff perceptions of a service's safety and quality and what factors may influence that. In this study we set out to assess staff perceptions of safety and quality of a maternity service and to explore potential influences on service safety. The study was undertaken within a new low risk metropolitan maternity service in Victoria, Australia with a staffing profile comprising midwives (including students), neonatal nurses, specialist obstetricians, junior medical staff and clerical staff. In depth open-ended interviews using a semi-structured questionnaire were conducted with 23 staff involved in the delivery of perinatal care, including doctors, midwives, nurses, nursing and midwifery students, and clerical staff. Data were analyzed using naturalistic interpretive inquiry to identify emergent themes. Staff unanimously reported that there were robust systems and processes in place to maintain safety and quality. Three major themes were apparent: (1) clinical governance, (2) dominance of midwives, (3) inter-professional relationships. Overall, there was a strong sense that, at least in this midwifery-led service, midwives had the greatest opportunity to be an influence, both positively and negatively, on the safe delivery of perinatal care. The importance of understanding team dynamics, particularly mutual respect, trust and staff cohesion, were identified as key issues for potential future service improvement. Senior staff, particularly midwives and neonatal nurses, play central roles in shaping team behaviors and attitudes that may affect the safety and quality of service delivery. We suggest that strategies targeting senior staff to enhance their performance in their roles, particularly in the training and teamwork role-modeling of the transitory junior workforce, are important for the development and maintenance of a high quality and safe maternity service.

Emergence of a rehabilitation medicine model for low vision service delivery, policy, and funding.

PubMed

Stelmack, Joan

2005-05-01

A rehabilitation medicine model for low vision rehabilitation is emerging. There have been many challenges to reaching consensus on the roles of each discipline (optometry, ophthalmology, occupational therapy, and vision rehabilitation professionals) in the service delivery model and finding a place in the reimbursement system for all the providers. The history of low vision, legislation associated with Centers for Medicare and Medicaid Services coverage for vision rehabilitation, and research on the effectiveness of low vision service delivery are reviewed. Vision rehabilitation is now covered by Medicare under Physical Medicine and Rehabilitation codes by some Medicare carriers, yet reimbursement is not available for low vision devices or refraction. Also, the role of vision rehabilitation professionals (rehabilitation teachers, orientation and mobility specialists, and low vision therapists) in the model needs to be determined. In a recent systematic review of the scientific literature on the effectiveness of low vision services contracted by the Agency for Health Care Quality Research, no clinical trials were found. The literature consists primarily of longitudinal case studies, which provide weak support for third-party funding for vision rehabilitative services. Providers need to reach consensus on medical necessity, treatment plans, and protocols. Research on low vision outcomes is needed to develop an evidence base to guide clinical practice, policy, and funding decisions.

78 FR 4917 - Self-Regulatory Organizations; Financial Industry Regulatory Authority, Inc.; Order Approving...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-23

... establish two new optional TRACE data delivery services, TRACE Data Delivery Plus and TRACE Data Delivery... Data Delivery Plus would provide greater access to TRACE trade journal files by allowing an MPID... the free FINRA ADDS service, firms interested in TRACE Data Delivery Plus must subscribe per MPID. To...

Office-Based Tools and Primary Care Visit Communication, Length, and Preventive Service Delivery.

PubMed

Lafata, Jennifer Elston; Shay, L Aubree; Brown, Richard; Street, Richard L

2016-04-01

The use of physician office-based tools such as electronic health records (EHRs), health risk appraisal (HRA) instruments, and written patient reminder lists is encouraged to support efficient, high-quality, patient-centered care. We evaluate the association of exam room use of EHRs, HRA instruments, and self-generated written patient reminder lists with patient-physician communication behaviors, recommended preventive health service delivery, and visit length. Observational study of 485 office visits with 64 primary care physicians practicing in a health system serving the Detroit metropolitan area. Study data were obtained from patient surveys, direct observation, office visit audio-recordings, and automated health system records. Outcome measures included visit length in minutes, patient use of active communication behaviors, physician use of supportive talk and partnership-building communication behaviors, and percentage of delivered guideline-recommended preventive health services for which patients are eligible and due. Simultaneous linear regression models were used to evaluate associations between tool use and outcomes. Adjusted models controlled for patient characteristics, physician characteristics, characteristics of the relationship between the patient and physician, and characteristics of the environment in which the visit took place. Prior to adjusting for other factors, visits in which the EHR was used on average were significantly (p < .05) longer (27.6 vs. 23.8 minutes) and contained fewer preventive services for which patients were eligible and due (56.5 percent vs. 62.7 percent) compared to those without EHR use. Patient written reminder lists were also significantly associated with longer visits (30.0 vs. 26.5 minutes), and less use of physician communication behaviors facilitating patient involvement (2.1 vs. 2.6 occurrences), but more use of active patient communication behaviors (4.4 vs. 2.6). Likewise, HRA use was significantly associated with increased preventive services delivery (62.1 percent vs. 57.0 percent). All relationships remained significant (p > .05) in adjusted models with the exception of that between HRA use and preventive service delivery. Office-based tools intended to facilitate the implementation of desired primary care practice redesign are associated with both positive and negative cost and quality outcomes. Findings highlight the need for monitoring both intended and unintended consequences of office-based tools commonly used in primary care practice redesign. © Health Research and Educational Trust.

Developing Cost Accounting and Decision Support Software for Comprehensive Community-Based Support Systems: An Analysis of Needs, Interest, and Readiness in the Field.

ERIC Educational Resources Information Center

Harrington, Robert; Jenkins, Peter; Marzke, Carolyn; Cohen, Carol

Prominent among the new models of social service delivery are organizations providing comprehensive, community-based supports and services (CCBSS) to children and their families. A needs analysis explored CCBSS sites' interest in and readiness to use a software tool designed to help them make more effective internal resource allocation decisions…

76 FR 24339 - Streamlining Service Delivery and Improving Customer Service

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-02

... Order 13571 of April 27, 2011 Streamlining Service Delivery and Improving Customer Service By the... Customer Service Standards), issued on September 11, 1993, requires agencies that provide significant services directly to the public to identify and survey their customers, establish service standards and...

Simulation of Surface Erosion on a Logging Road in the Jackson Demonstration State Forest

Treesearch

Teresa Ish; David Tomberlin

2007-01-01

In constructing management models for the control of sediment delivery to streams, we have used a simulation model of road surface erosion known as the Watershed Erosion Prediction Project (WEPP) model, developed by the USDA Forest Service. This model predicts discharge, erosion, and sediment delivery at the road segment level, based on a stochastic climate simulator...

High Res at High Speed: Automated Delivery of High-Resolution Images from Digital Library Collections

ERIC Educational Resources Information Center

Westbrook, R. Niccole; Watkins, Sean

2012-01-01

As primary source materials in the library are digitized and made available online, the focus of related library services is shifting to include new and innovative methods of digital delivery via social media, digital storytelling, and community-based and consortial image repositories. Most images on the Web are not of sufficient quality for most…

A Simple Estimation Method for Aggregate Government Outsourcing

ERIC Educational Resources Information Center

Minicucci, Stephen; Donahue, John D.

2004-01-01

The scholarly and popular debate on the delegation to the private sector of governmental tasks rests on an inadequate empirical foundation, as no systematic data are collected on direct versus indirect service delivery. We offer a simple method for approximating levels of service outsourcing, based on relatively straightforward combinations of and…

Impact of the Integration of Water Treatment, Hygiene, Nutrition, and Clean Delivery Interventions on Maternal Health Service Use

PubMed Central

O'Connor, Katherine; Kim, Sunkyung; Kelley, Maureen; Odhiambo, Aloyce; Faith, Sitnah; Otieno, Ronald; Nygren, Benjamin; Kamb, Mary; Quick, Robert

2017-01-01

Reducing 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. PMID:28193744

77 FR 64367 - Removal of International Restricted Delivery From the Competitive Product List

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-19

... POSTAL SERVICE Removal of International Restricted Delivery From the Competitive Product List AGENCY: Postal Service\\TM\\. ACTION: Notice. SUMMARY: The Postal Service hereby provides notice that it has filed a request with the Postal Regulatory Commission to remove International Restricted Delivery...

76 FR 13698 - Agency Information Collection Activities: Proposed Collection; Comment Request; Generic Clearance...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-14

... of Qualitative Feedback on Agency Service Delivery AGENCY: Federal Transit Administration, DOT... Qualitative Feedback on Agency Service Delivery'' to OMB for approval under the Paperwork Reduction Act (PRA... INFORMATION: Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery...

Peer Attitudes toward Students with Disabilities: A Comparison of the In-Class and Pull-Out Models of Service Delivery.

ERIC Educational Resources Information Center

Noland, Emily N.; And Others

1993-01-01

This study compared the differential effects of in-class and pull-out service delivery models on attitudes of students (n=194) in grades four through six toward students with disabilities. Results revealed that students from classrooms where services were being delivered through in-class service delivery models had more positive attitudes.…

Impact of Affirmative Action on Quality of Service Delivery in the Public Service Sector of Kenya: A Comparative Case Study of the Ministry of State in the Office of the President and Ministry of Higher Education

ERIC Educational Resources Information Center

Kilonzo, Evans Mbuthi; Ikamari, Lawrence

2015-01-01

This study was carried out to determine the impact of affirmative action policy on the quality service delivery in the public service sector of Kenya. The study was carried out on the premise that there is a relationship between affirmative Action implementation and the quality of service delivery in the public service sector of Kenya. A lot of…

Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases

PubMed Central

Schwartz, Jeremy I.; Dunkle, Ashley; Akiteng, Ann R.; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K.; Mutungi, Gerald; Rabin, Tracy L.; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

2015-01-01

Background The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Methods Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. Results In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Discussion Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda. PMID:25563451

Male engagement as a strategy to improve utilization and community-based delivery of maternal, newborn and child health services: evidence from an intervention in Odisha, India

PubMed Central

2015-01-01

Background In response to persistently poor levels of maternal, newborn and child health (MNCH) in rural India, the National Rural Health Mission (NRHM) was launched to support the provision of accessible, affordable and quality health care in deprived and underserved communities. The Accredited Social Health Activists (ASHAs), local women, are trained as health promoters to generate demand for, and facilitate access to MNCH care in their communities. While they are also expected to provide husbands of expectant women with information on MNCH care and family planning, their reach to the husbands is limited. The aim of this study is to describe the influence of a male engagement project on the utilization and community-based delivery of MNCH care in a rural district of the country. Methods We used qualitative data from the evaluation of a project which recruited and trained male Community Health Workers (CHWs) known as Male Health Activists (MHAs) to complement the work of ASHAs and target outreach to men. This paper uses data from in-depth interviews (IDIs) with ASHAs (n=11), Anganwadi Workers (AWWs) (n=4) and Auxiliary Nurse Midwives (ANMs) (n=2); with women who had delivered at home, community health center or district hospital in the few months preceding the date of the interview (n=11); and with husbands of these women (n=7). Results Participants’ responses are broadly organized around the facilitation of ASHAs’ work by MHAs, and male engagement activities undertaken by MHAs. More specifically, the narratives reflected gender-based divisions of work and space in three core areas of delivery and use of MNCH services: escorting women to health centers for facility-based deliveries; mobilizing women and children to attend Village Health and Nutrition Days and Immunization Days; and raising awareness among men on MNCH and family planning. Conclusion This study sheds light on male engagement as a strategy to improve the delivery, access and uptake of maternal, newborn and child health in the context of prevailing gender norms and gendered roles in rural India. Ultimately, it unveils the complementarity of male and female CHWs in the community-based delivery of, and increased demand for, MNCH services. PMID:26062910

Neuropsychologists as primary care providers of cognitive health: A novel comprehensive cognitive wellness service delivery model.

PubMed

Pimental, Patricia A; O'Hara, John B; Jandak, Jessica L

2018-01-01

By virtue of their extensive knowledge base and specialized training in brain-behavior relationships, neuropsychologists are especially poised to execute a unique broad-based approach to overall cognitive wellness and should be viewed as primary care providers of cognitive health. This article will describe a novel comprehensive cognitive wellness service delivery model including cognitive health, anti-aging, lifelong wellness, and longevity-oriented practices. These practice areas include brain-based cognitive wellness, emotional and spiritually centric exploration, and related multimodality health interventions. As experts in mind-body connections, neuropsychologists can provide a variety of evidence-based treatment options, empowering patients with a sense of value and purpose. Multiple areas of clinical therapy skill-based learning, tailor-made to fit individual needs, will be discussed including: brain stimulating activities, restorative techniques, automatic negative thoughts and maladaptive thinking reduction, inflammation and pain management techniques, nutrition and culinary focused cognitive wellness, spirituality based practices and mindfulness, movement and exercise, alternative/complimentary therapies, relationship restoration/social engagement, and trauma healing/meaning. Cognitive health rests upon the foundation of counteracting mind-body connection disruptions from multiple etiologies including inflammation, chronic stress, metabolic issues, cardiac conditions, autoimmune disease, neurological disorders, infectious diseases, and allergy spectrum disorders. Superimposed on these issues are lifestyle patterns and negative health behaviors that develop as ill-fated compensatory mechanisms used to cope with life stressors and aging. The brain and body are electrical systems that can "short circuit." The therapy practices inherent in the proposed cognitive wellness service delivery model can provide preventative insulation and circuit breaking against the shock of illness.

[Innovation in the organization of health services delivery within the Metropolitan System of Solidarity in Peru].

PubMed

Arroyo, Juan; Pastor-Goyzueta, Ada

2013-06-01

Based on the results achieved to date by the Metropolitan System of Solidarity (SISOL) in Peru, this study undertook to analyze the extent to which SISOL has contributed to innovation in the organization of health services delivery. SISOL performance indicators were analyzed and compared with those of other health services delivery models in Peru, drawing on data from a survey of 4 570 SISOL users conducted in the last quarter of 2011, National Household Surveys from 2003 through 2011, and statistical data from the Peruvian Ministry of Health and Social Security. SISOL rated high in terms of growth of the demand served in Lima, productivity of human resources in office visits, and levels of user satisfaction. These results are attributed to: (a) the presence of specialists at the first level of care; (b) an innovative public-private structure, as opposed to outsourcing; and (c) a system of incentives based on shared risk management. The findings support the need for primary health care renewal, especially in urban areas to reduce the proliferation of unnecessary levels and sublevels of care. They also point to the possibility of developing synergistic public-private partnerships in which both sectors share risks and act in collaboration within a single service system. And finally, they indicate that primary care needs to be articulated into the segmented models.

Implementation research on community health workers' provision of maternal and child health services in rural Liberia.

PubMed

Luckow, Peter W; Kenny, Avi; White, Emily; Ballard, Madeleine; Dorr, Lorenzo; Erlandson, Kirby; Grant, Benjamin; Johnson, Alice; Lorenzen, Breanna; Mukherjee, Subarna; Ly, E John; McDaniel, Abigail; Nowine, Netus; Sathananthan, Vidiya; Sechler, Gerald A; Kraemer, John D; Siedner, Mark J; Panjabi, Rajesh

2017-02-01

To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme. The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation. Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly. We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes.

Implementation research on community health workers’ provision of maternal and child health services in rural Liberia

PubMed Central

Luckow, Peter W; Kenny, Avi; White, Emily; Ballard, Madeleine; Dorr, Lorenzo; Erlandson, Kirby; Grant, Benjamin; Johnson, Alice; Lorenzen, Breanna; Mukherjee, Subarna; Ly, E John; McDaniel, Abigail; Nowine, Netus; Sathananthan, Vidiya; Sechler, Gerald A; Kraemer, John D; Siedner, Mark J

2017-01-01

Abstract Objective To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme. Methods The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation. Findings Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly. Conclusion We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes. PMID:28250511

National dissemination of supported housing in the VA: model adherence versus model modification.

PubMed

O'Connell, Maria; Kasprow, Wesley; Rosenheck, Robert A

2010-01-01

The continuing development and dissemination of emerging evidence-based practices may be facilitated by the availability of descriptive information on the actual delivery of the service, and its variability, across sites. This paper presents data on the participation of 2,925 homeless veterans in the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program at 36 sites across the country, for up to five years. While most conceptual models emphasize rapid placement, sustained intensive case management, rehabilitation services, and "permanent" housing, no program has yet presented empirical data on the actual delivery of such services over an extended period of time. Using extensive longitudinal data from the VA's national homeless outreach program, the Health Care for Homeless Veterans (HCHV) program, a quantitative portrait presents what happens in supported housing in a large real-world dissemination effort. Program entry to HUD-VASH was generally slow with 108 days (sd = 92 days) on average passing between program entry and housing placement. Total program participation lasted 2.6 years on average (sd = 1.6 years)-just half of the possible 5 years. Service delivery became substantially less intensive over time by several measures, and three-fourths of the veterans terminated within five years, although the vast majority (82%) were housed at the time. Few veterans received rehabilitation services (6%) or employment assistance (17%) and most service delivery focused on obtaining housing. These data suggest that real-world supported housing programs may not adhere to the prevalent model descriptions either because of implementation failure or because veteran needs and preferences differ from those suggested by that model.

Assessing care-givers' satisfaction with child immunisation services in Zambia: Evidence from a national survey.

PubMed

Chama-Chiliba, Chitalu Miriam; Masiye, Felix; Mphuka, Chrispin

2017-10-09

The main aim of this study was to assess care-giver satisfaction with vaccination services in public health facilities in Zambia, and examine its determinants. This study used data from a recent population-based household survey, conducted from May to August 2015. Respondent satisfaction with vaccination services received during the last visit was measured on a five point Likert scale ranging from 1 to 5. We used an ordered logistic regression model to analyse the significance of perceived quality of vaccination services, immunisation delivery mode and a range of individual characteristics in predicting care-giver satisfaction. Findings show that one in five care givers were unsatisfied with the vaccination services that they had received, with rural populations showing a significantly higher level of satisfaction. Poor quality of care, defined by long waiting times, poor quality of communication between health staff and care givers, long distance to vaccination sites, mode of delivery, and personal characteristics were among major factors driving care-giver satisfaction ratings. We also find that receiving a vaccination at outreach mode of delivery was associated with higher odds of greater satisfaction compared to on-facility vaccination services. The odds of satisfaction were lower for respondents living further away from a health facility, which emphasizes the importance of access in seeking vaccination services. These findings suggest that major improvements in quality of vaccination and service organisation will be needed to increase client satisfaction and service utilisation. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Ontario Mother and Infant Study (TOMIS) III: A multi-site cohort study of the impact of delivery method on health, service use, and costs of care in the first postpartum year

PubMed Central

Sword, Wendy; Watt, Susan; Krueger, Paul; Thabane, Lehana; Landy, Christine Kurtz; Farine, Dan; Swinton, Marilyn

2009-01-01

Background The caesarean section rate continues to rise globally. A caesarean section is inarguably the preferred method of delivery when there is good evidence that a vaginal delivery may unduly risk the health of a woman or her infant. Any decisions about delivery method in the absence of clear medical indication should be based on knowledge of outcomes associated with different childbirth methods. However, there is lack of sold evidence of the short-term and long-term risks and benefits of a planned caesarean delivery compared to a planned vaginal delivery. It also is important to consider the economic aspects of caesarean sections, but very little attention has been given to health care system costs that take into account services used by women for themselves and their infants following hospital discharge. Methods and design The Ontario Mother and Infant Study III is a prospective cohort study to examine relationships between method of delivery and maternal and infant health, service utilization, and cost of care at three time points during the year following postpartum hospital discharge. Over 2500 women were recruited from 11 hospitals across the province of Ontario, Canada, with data collection occurring between April 2006 and October 2008. Participants completed a self-report questionnaire in hospital and structured telephone interviews at 6 weeks, 6 months, and 12 months after discharge. Data will be analyzed using generalized estimating equation, a special generalized linear models technique. A qualitative descriptive component supplements the survey approach, with the goal of assisting in interpretation of data and providing explanations for trends in the findings. Discussion The findings can be incorporated into patient counselling and discussions about the advantages and disadvantages of different delivery methods, potentially leading to changes in preferences and practices. In addition, the findings will be useful to hospital- and community-based postpartum care providers, managers, and administrators in guiding risk assessment and early intervention strategies. Finally, the research findings can provide the basis for policy modification and implementation strategies to improve outcomes and reduce costs of care. PMID:19397827

Determinants of antenatal and delivery care utilization in Tigray region, Ethiopia: a cross-sectional study.

PubMed

Tsegay, Yalem; Gebrehiwot, Tesfay; Goicolea, Isabel; Edin, Kerstin; Lemma, Hailemariam; Sebastian, Miguel San

2013-05-14

Despite the international emphasis in the last few years on the need to address the unmet health needs of pregnant women and children, progress in reducing maternal mortality has been slow. This is particularly worrying in sub-Saharan Africa where over 162,000 women still die each year during pregnancy and childbirth, most of them because of the lack of access to skilled delivery attendance and emergency care. With a maternal mortality ratio of 673 per 100,000 live births and 19,000 maternal deaths annually, Ethiopia is a major contributor to the worldwide death toll of mothers. While some studies have looked at different risk factors for antenatal care (ANC) and delivery service utilisation in the country, information coming from community-based studies related to the Health Extension Programme (HEP) in rural areas is limited. This study aims to determine the prevalence of maternal health care utilisation and explore its determinants among rural women aged 15-49 years in Tigray, Ethiopia. The study was a community-based cross-sectional survey using a structured questionnaire. A cluster sampling technique was used to select women who had given birth at least once in the five years prior to the survey period. Univariable and multivariable logistic regression analyses were carried out to elicit the impact of each factor on ANC and institutional delivery service utilisation. The response rate was 99% (n=1113). The mean age of the participants was 30.4 years. The proportion of women who received ANC for their recent births was 54%; only 46 (4.1%) of women gave birth at a health facility. Factors associated with ANC utilisation were marital status, education, proximity of health facility to the village, and husband's occupation, while use of institutional delivery was mainly associated with parity, education, having received ANC advice, a history of difficult/prolonged labour, and husbands' occupation. A relatively acceptable utilisation of ANC services but extremely low institutional delivery was observed. Classical socio-demographic factors were associated with both ANC and institutional delivery attendance. ANC advice can contribute to increase institutional delivery use. Different aspects of HEP need to be strengthened to improve maternal health in Tigray.

An equity analysis of performance-based financing in Rwanda: are services reaching the poorest women?

PubMed

Priedeman Skiles, Martha; Curtis, Siân L; Basinga, Paulin; Angeles, Gustavo

2013-12-01

Maternal health services continue to favour the wealthiest in lower and middle income countries. Debate about the potential of performance-based financing (PBF) to address these disparities continues. As PBF is adopted by countries, it is critical to understand the equity effects for maternal services. The aim of this study is to examine the effects of PBF on equity in maternal health service use when no specific provisions target the poorest in the population. In Rwanda, PBF was designed to increase health service use, which was universally low. Paired districts were randomly assigned to intervention and control for PBF implementation. Using Rwanda's Demographic Health Survey data from 2005 (pre-intervention) and 2007-8 (post-intervention), a cluster-level panel dataset of 7899 women 15-49 years of age from intervention (4477) and control districts (3422) was created. The impact of PBF on reported use of facility deliveries, antenatal care (ANC) and modern contraceptive use was estimated using a difference-in-differences model with community fixed effects. Interaction terms between wealth quintiles and PBF were estimated to identify the differential effect of PBF among poorer women. The probability of a facility delivery increased by 10 percentage points in the intervention when compared with the control districts (P = 0.014), while no significant effects were noted for ANC visits or modern contraceptive use. Service use increased for intervention and control populations and across all wealth quintiles from 2005 to 2007, with no evidence that PBF was a pro-poor or a pro-rich strategy. Insurance remained a positive predictor of service use. This research suggests that if service use is uniformly low then a PBF programme that incentivizes select services, such as facility deliveries, may improve service use overall. However, if the equity gap is extreme, then a PBF programme without equity targets will do little to alleviate disparities.

Integrating community health workers within Patient Protection and Affordable Care Act implementation.

PubMed

Islam, Nadia; Nadkarni, Smiti Kapadia; Zahn, Deborah; Skillman, Megan; Kwon, Simona C; Trinh-Shevrin, Chau

2015-01-01

The Patient Protection and Affordable Care Act's (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers' role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers' unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models.

Integrating Community Health Workers Within Patient Protection and Affordable Care Act Implementation

PubMed Central

Islam, Nadia; Nadkarni, Smiti Kapadia; Zahn, Deborah; Skillman, Megan; Kwon, Simona C.; Trinh-Shevrin, Chau

2015-01-01

Context The Patient Protection and Affordable Care Act’s (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. Objective This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Results Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers’ role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers’ unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Conclusion Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models. PMID:25414955

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…

76 FR 22937 - Agency Information Collection Activities: Proposed Collection; Comment Request; Generic Clearance...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-25

...; Comment Request; Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery... the Collection of Qualitative Feedback on Agency Service Delivery '' to OMB for approval under the... INFORMATION: Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery...

76 FR 10626 - Agency Information Collection Activities: Proposed Collection; Comment Request; Generic Clearance...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-25

... Request; Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery AGENCY... Clearance for the Collection of Qualitative Feedback on Agency Service Delivery'' to OMB for approval under...: Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery. Abstract...

76 FR 81014 - Agency Information Collection Activities: Proposed Collection; Comment Request; Generic Clearance...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-27

... of Qualitative Feedback on Agency Service Delivery AGENCY: Office of Hazardous Materials Safety... Collection of Qualitative Feedback on Agency Service Delivery'' to the Office of Management and Budget (OMB...: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Abstract. The...

78 FR 21338 - Agency Information Collection Activities; Revision and Extension of Approved Collection; Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-10

... the Collection of Qualitative Feedback on Agency Service Delivery April 4, 2013. AGENCY: Animal and... Collection of Qualitative Feedback on Agency Service Delivery'' to OMB for approval under the Paperwork... INFORMATION: Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery...

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 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT RULES ON SOURCE, ORIGIN AND NATIONALITY FOR... for USAID Financing § 228.24 Other delivery services. No source or nationality rules apply to other...

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.…

Development and formative evaluation of an innovative mHealth intervention for improving coverage of community-based maternal, newborn and child health services in rural areas of India

PubMed Central

Modi, Dhiren; Gopalan, Ravi; Shah, Shobha; Venkatraman, Sethuraman; Desai, Gayatri; Desai, Shrey; Shah, Pankaj

2015-01-01

Background A new cadre of village-based frontline health workers, called Accredited Social Health Activists (ASHAs), was created in India. However, coverage of selected community-based maternal, newborn and child health (MNCH) services remains low. Objective This article describes the process of development and formative evaluation of a complex mHealth intervention (ImTeCHO) to increase the coverage of proven MNCH services in rural India by improving the performance of ASHAs. Design The Medical Research Council (MRC) framework for developing complex interventions was used. Gaps were identified in the usual care provided by ASHAs, based on a literature search, and SEWA Rural's1 three decades of grassroots experience. The components of the intervention (mHealth strategies) were designed to overcome the gaps in care. The intervention, in the form of the ImTeCHO mobile phone and web application, along with the delivery model, was developed to incorporate these mHealth strategies. The intervention was piloted through 45 ASHAs among 45 villages in Gujarat (population: 45,000) over 7 months in 2013 to assess the acceptability, feasibility, and usefulness of the intervention and to identify barriers to its delivery. Results Inadequate supervision and support to ASHAs were noted as a gap in usual care, resulting in low coverage of selected MNCH services and care received by complicated cases. Therefore, the ImTeCHO application was developed to integrate mHealth strategies in the form of job aid to ASHAs to assist with scheduling, behavior change communication, diagnosis, and patient management, along with supervision and support of ASHAs. During the pilot, the intervention and its delivery were found to be largely acceptable, feasible, and useful. A few changes were made to the intervention and its delivery, including 1) a new helpline for ASHAs, 2) further simplification of processes within the ImTeCHO incentive management system and 3) additional web-based features for enhancing value and supervision of Primary Health Center (PHC) staff. Conclusions The effectiveness of the improved ImTeCHO intervention will be now tested through a cluster randomized trial. PMID:25697233

Does quality influence utilization of primary health care? Evidence from Haiti.

PubMed

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

Integration of TB-HIV services at an ANC facility in Frances Baard District, Northern Cape, South Africa.

PubMed

Peters, J A; Heunis, C; Kigozi, G; Osoba, T; van der Walt, M

2015-03-21

Integrated tuberculosis-human immunodeficiency virus (TB-HIV) service delivery as part of maternal health services, including antenatal care (ANC), is widely recommended. This study assessed the implementation of collaborative TB-HIV service delivery at a hospital-based ANC service unit. A record review of a random sample of 308 pregnant women attending the ANC service between April 2011 and February 2012 was conducted. Data were extracted from registers and patient case notes. Outcomes included the proportion of women who underwent HIV counselling and testing (HCT), CD4 count testing, antiretroviral treatment (ART), cotrimoxazole preventive treatment (CPT), TB screening and isoniazid preventive treatment (IPT). Analysis measured variations in patient characteristics associated with service delivery. All women underwent HCT; 80% of those who tested HIV-positive were screened for TB. Most (85.9%) of the HIV-positive women received a CD4 count. However, only 12.9% of eligible women received ART prophylaxis onsite, only 35.7% were referred for initiation of ART, only 42.3% commenced IPT and none received CPT or further investigations for TB. HIV-negative women had 2.6 higher odds (95%CI 1.3-5.3) of receiving TB screening than their HIV-positive counterparts. Although the identification of HIV-positive women and TB suspects was adequate, implementation of other TB-HIV collaborative activities was sub-optimal.

Funding gap for immunization across 94 low- and middle-income countries.

PubMed

Ozawa, Sachiko; Grewal, Simrun; Portnoy, Allison; Sinha, Anushua; Arilotta, Richard; Stack, Meghan L; Brenzel, Logan

2016-12-07

Novel vaccine development and production has given rise to a growing number of vaccines that can prevent disease and save lives. In order to realize these health benefits, it is essential to ensure adequate immunization financing to enable equitable access to vaccines for people in all communities. This analysis estimates the full immunization program costs, projected available financing, and resulting funding gap for 94 low- and middle-income countries over five years (2016-2020). Vaccine program financing by country governments, Gavi, and other development partners was forecasted for vaccine, supply chain, and service delivery, based on an analysis of comprehensive multi-year plans together with a series of scenario and sensitivity analyses. Findings indicate that delivery of full vaccination programs across 94 countries would result in a total funding gap of $7.6 billion (95% uncertainty range: $4.6-$11.8 billion) over 2016-2020, with the bulk (98%) of the resources required for routine immunization programs. More than half (65%) of the resources to meet this funding gap are required for service delivery at $5.0 billion ($2.7-$8.4 billion) with an additional $1.1 billion ($0.9-$2.7 billion) needed for vaccines and $1.5 billion ($1.1-$2.0 billion) for supply chain. When viewed as a percentage of total projected costs, the funding gap represents 66% of projected supply chain costs, 30% of service delivery costs, and 9% of vaccine costs. On average, this funding gap corresponds to 0.2% of general government expenditures and 2.3% of government health expenditures. These results suggest greater need for country and donor resource mobilization and funding allocation for immunizations. Both service delivery and supply chain are important areas for further resource mobilization. Further research on the impact of advances in service delivery technology and reductions in vaccine prices beyond this decade would be important for efficient investment decisions for immunization. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

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.

The challenges of reshaping disease specific and care oriented community based services towards comprehensive goals: a situation appraisal in the Western Cape Province, South Africa.

PubMed

Schneider, Helen; Schaay, Nikki; Dudley, Lilian; Goliath, Charlyn; Qukula, Tobeka

2015-09-30

Similar to other countries in the region, South Africa is currently reorienting a loosely structured and highly diverse community care system that evolved around HIV and TB, into a formalized, comprehensive and integrated primary health care outreach programme, based on community health workers (CHWs). While the difficulties of establishing national CHW programmes are well described, the reshaping of disease specific and care oriented community services, based outside the formal health system, poses particular challenges. This paper is an in-depth case study of the challenges of implementing reforms to community based services (CBS) in one province of South Africa. A multi-method situation appraisal of CBS in the Western Cape Province was conducted over eight months in close collaboration with provincial stakeholders. The appraisal mapped the roles and service delivery, human resource, financing and governance arrangements of an extensive non-governmental organisation (NGO) contracted and CHW based service delivery infrastructure that emerged over 15-20 years in this province. It also gathered the perspectives of a wide range of actors - including communities, users, NGOs, PHC providers and managers - on the current state and future visions of CBS. While there was wide support for new approaches to CBS, there are a number of challenges to achieving this. Although largely government funded, the community based delivery platform remains marginal to the formal public primary health care (PHC) and district health systems. CHW roles evolved from a system of home based care and are limited in scope. There is a high turnover of cadres, and support systems (supervision, monitoring, financing, training), coordination between CHWs, NGOs and PHC facilities, and sub-district capacity for planning and management of CBS are all poorly developed. Reorienting community based services that have their origins in care responses to HIV and TB presents an inter-related set of resource mobilisation, system design and governance challenges. These include not only formalising community based teams themselves, but also the forging of new roles, relationships and mind-sets within the primary health care system, and creating greater capacity for contracting and engaging a plural set of actors - government, NGO and community - at district and sub-district level.

Updated Priorities Among Effective Clinical Preventive Services

PubMed Central

Maciosek, Michael V.; LaFrance, Amy B.; Dehmer, Steven P.; McGree, Dana A.; Flottemesch, Thomas J.; Xu, Zack; Solberg, Leif I.

2017-01-01

PURPOSE The Patient Protection and Affordable Care Act’s provisions for first-dollar coverage of evidence-based preventive services have reduced an important barrier to receipt of preventive care. Safety-net providers, however, still serve a substantial uninsured population, and clinician and patient time remain limited in all primary care settings. As a consequence, decision makers continue to set priorities to help focus their efforts. This report updates estimates of relative health impact and cost-effectiveness for evidence-based preventive services. METHODS We assessed the potential impact of 28 evidence-based clinical preventive services in terms of their cost-effectiveness and clinically preventable burden, as measured by quality-adjusted life years (QALYs) saved. Each service received 1 to 5 points on each of the 2 measures—cost-effectiveness and clinically preventable burden—for a total score ranging from 2 to 10. New microsimulation models were used to provide updated estimates of 12 of these services. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally. RESULTS The 3 highest-ranking services, each with a total score of 10, are immunizing children, counseling to prevent tobacco initiation among youth, and tobacco-use screening and brief intervention to encourage cessation among adults. Greatest population health improvement could be obtained from increasing utilization of clinical preventive services that address tobacco use, obesity-related behaviors, and alcohol misuse, as well as colorectal cancer screening and influenza vaccinations. CONCLUSIONS This study identifies high-priority preventive services and should help decision makers select which services to emphasize in quality-improvement initiatives. PMID:28376457

Female health workers at the doorstep: a pilot of community-based maternal, newborn, and child health service delivery in northern Nigeria.

PubMed

Uzondu, Charles A; Doctor, Henry V; Findley, Sally E; Afenyadu, Godwin Y; Ager, Alastair

2015-03-01

Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services. Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008-2010 (before introduction of the pilot) with data from 2011-2013 (during and after the pilot) to gauge sustainability of the model. Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years. Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas. © Uzondu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/. When linking to this article, please use the following permanent link: http://dx.doi.org/10.9745/GHSP-D-14-00117.

Integration of antenatal care services with health programmes in low- and middle-income countries: systematic review.

PubMed

de Jongh, Thyra E; Gurol-Urganci, Ipek; Allen, Elizabeth; Zhu, Nina Jiayue; Atun, Rifat

2016-06-01

Antenatal care (ANC) presents a potentially valuable platform for integrated delivery of additional health services for pregnant women-services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs. Cochrane Library, MEDLINE, Embase, CINAHL Plus, POPLINE and Global Health were searched for studies that compared integrated models for delivery of postnatal and other health services with ANC to non-integrated models. Risk of bias of included studies was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) criteria and the Newcastle-Ottawa Scale, depending on the study design. Due to high heterogeneity no meta-analysis could be conducted. Results are presented narratively. 12 studies were included in the review. Limited evidence, with moderate- to high-risk of bias, suggests that integrated service delivery results in improved uptake of essential health services for women, earlier initiation of treatment, and better health outcomes. Women also reported improved satisfaction with integrated services. The reported evidence is largely based on non-randomised studies with poor generalizability, and therefore offers very limited policy guidance. More rigorously conducted and geographically diverse studies are needed to better ascertain and quantify the health and economic benefits of integrating health services with ANC.

Selling: A Non-traditional Human Service Skill.

ERIC Educational Resources Information Center

McClam, Tricia; Woodside, Marianne

1999-01-01

Interviews with human service professional across the United States identify selling as a helpful and often necessary skill for effective service delivery. Article introduces selling as a human service skill, explores its benefits to service delivery, and discusses its implications for human service education. (Author/GCP)

Parallel NGO Networks for HIV Control: Risks and Opportunities for NGO Contracting

PubMed Central

Zaidi, Shehla; Gul, Xaher; Nishtar, Noureen

2013-01-01

Policy measures for preventive and promotive services are increasingly reliant on contracting of NGOs. Contracting is a neo-liberal response relying on open market competition for service delivery tenders. In contracting of health services a common assumption is a monolithic NGO market. A case study of HIV control in Pakistan shows that in reality the NGO market comprises of parallel NGO networks having widely different service packages, approaches and agendas. These parallel networks had evolved over time due to vertical policy agendas. Contracting of NGOs for provision of HIV services was faced with uneven capacities and turf rivalries across both NGO networks. At the same time contracting helped NGO providers belonging to different clusters to move towards standardized service delivery for HIV prevention. Market based measures such as contracting need to be accompanied with wider policy and system measures that overcome silos in NGO working by facilitating a common construct on the health issue, cohesive priorities and integrated working. PMID:23445705

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’s trust in doctor, and the promotion of patient’s trust in recommended medical examination could all help promote patient’s life satisfaction. But their promotion effects were different among low level public hospital, high level public hospital, and private hospital. PMID:22978432

Differential effects of community health worker visits across social and economic groups in Uttar Pradesh, India: a link between social inequities and health disparities.

PubMed

Seth, Aparna; Tomar, Shweta; Singh, Kultar; Chandurkar, Dharmendra; Chakraverty, Amit; Dey, Arnab; Das, Arup K; Hay, Katherine; Saggurti, Niranjan; Boyce, Sabrina; Raj, Anita; Silverman, Jay G

2017-03-07

Uttar Pradesh (UP) accounts for the largest number of neonatal deaths in India. This study explores potential socio-economic inequities in household-level contacts by community health workers (CHWs) and whether the effects of such household-level contacts on receipt of health services differ across populations in this state. A multistage sampling design identified live births in the last 12 months across the 25 highest-risk districts of UP (N = 4912). Regression models described the relations between household demographics (caste, religion, wealth, literacy) and CHW contact, and interactions of demographics and CHW contact in predicting health service utilization (> = 4 antenatal care (ANC) visits, facility delivery, modern contraceptive use). No differences were found in likelihood of CHW contact based on caste, religion, wealth or literacy. Associations of CHW contact with receipt of ANC and facility delivery were significantly affected by religion, wealth and literacy. CHW contact increased the odds of 4 or more ANC visits only among non-Muslim women, increased the odds of both four or more ANC visits and facility delivery only among lower wealth women, increased the odds of facility delivery to a greater degree among illiterate vs. literate women. CHW visits play a vital role in promoting utilization of critical maternal health services in UP. However, significant social inequities exist in associations of CHW visits with such service utilization. Research to clarify these inequities, as well as training for CHWs to address potential biases in the qualities or quantity of their visits based on household socio-economic characteristics is recommended.

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. Copyright © 2013 Elsevier Ltd. All rights reserved.

Refocusing and Evolving Subseasonal-to-Seasonal Services in NOAA's National Weather Service

NASA Astrophysics Data System (ADS)

Timofeyeva-Livezey, M. M.; Horsfall, F. M. C.; Silva, V.; Mangan, M. R.; Meyers, J. C.; Zdrojewski, J.

2017-12-01

NOAA's National Weather Service (NWS) recently completed a reorganization to better support its goal to build a Weather-Ready Nation. As part of the reorganization, NWS streamlined its 11 national service programs, including climate services, to provide a more structured approach to supporting service delivery needs. As the American public increasingly requests information at sub-seasonal and seasonal time scales for decision making, the NWS Climate Services Program is striving to meet those needs by accelerating transition of research to operations, improving delivery of products and services, and enhancing partnerships to facilitate provision of seamless weather, water, and climate products and services at regional and local scales. Additionally, NWS forecasters are requesting more tools to be able to put severe weather and water events into a climate context to provide more effective impact-based decision support services (IDSS). This paper will describe the activities to more effectively integrate climate services into the NWS suite of environmental information, the roles of the NWS offices supporting or delivering sub-seasonal and seasonal information to the US public, and engaging NWS core and deep-core partners in provision of information on climatological risks and preparedness as a part of IDSS. We will discuss the process by which we collect user requests and/or needs and the NWS process that allows us to move these requests and needs through a formal requirements validation process and thus place the requirement on a path to identify a potential solution for implementation. The validation of a NWS climate-related requirement is also key to identify research, development, and transition mission delivery needs that are supported through the Office of Oceanic and Atmospheric Research (OAR) Climate Program Office (CPO). In addition, we will present the outcomes of key actions of the first ever NWS National Climate Services Meeting (NCSM) that was held in May 2016 with the participation of more than 250 NWS climate services staff and key partners from across the country. The key actions include understanding core and deep-core partners, advancing training for NWS staff focused on IDSS, and better organization of service delivery at regional and local levels.

Shifting from Categories to Services: Comprehensive School-Based Mental Health for Children with Emotional Disturbance and Social Maladjustment

ERIC Educational Resources Information Center

Heathfield, Lora Tuesday; Clark, Elaine

2004-01-01

To meet the present and future educational and mental health needs of our nation's youth, current models of mental health service delivery need to be reformed. Any more time spent arguing the differences between categories such as Emotional Disturbance (ED) and Social Maladjustment (SM) will only delay much needed services and deplete our already…

A Review of the Services Offered by English Sure Start Children's Centres in 2011 and 2012

ERIC Educational Resources Information Center

Hall, James; Eisenstadt, Naomi; Sylva, Kathy; Smith, Teresa; Sammons, Pamela; Smith, George; Evangelou, Maria; Goff, Jenny; Tanner, Emily; Agur, Maya; Hussey, David

2015-01-01

This paper presents a review of the family services that were offered by a sample of 121 English Sure Start Children's Centres in 2011 and 2012. Children's Centres are community based facilities that aim to improve outcomes for at-risk families and children through the delivery of a range of services largely aimed at families with young children.…

The University of Houston Libraries' Chemistry Research Information Service: A Research Support Service Based on End-User Searching and Document Delivery. Final Report.

ERIC Educational Resources Information Center

Bailey, Charles W., Jr.

This report on a funded project that established a chemistry research information service for researchers in the University of Houston's chemistry department provides detailed descriptions of the three objectives of the project, together with an explanation of how each objective was/is to be accomplished. These objectives were/are: (1) to document…

Profile of pregnant women using delivery hut services of the Ballabgarh Health and Demographic Surveillance System in rural north India.

PubMed

Kant, Shashi; Haldar, Partha; Singh, Arvind K; Archana, S; Misra, Puneet; Rai, Sanjay

2016-08-01

To describe women who attended two delivery huts in rural Haryana, India. The present observational study assessed routinely collected service provision data from two delivery huts located at primary health centers in the district of Faridabad. Data on sociodemographic characteristics, prenatal care, use of free transport services, and maternal and neonatal indicators at delivery were assessed for all pregnant women who used the delivery hut services from January 2012 to June 2014. During the study period, 1796 deliveries occurred at the delivery huts. The mean age of the mothers was 23.3 ± 3.3 years (95% confidence interval 23.1-23.5). Of 1648 mothers for whom data were available, 1039 (63.0%) had travelled less than 5 km to the delivery hut. The proportion of mothers who belonged to a lower caste increased from 31.0% (193/622) in 2012 to 41.1% (162/394) in 2014. The proportion of mothers who were illiterate also increased, from 8.1% (53/651) in 2012 to 26.4% (104/394) in 2014. Belonging to a disadvantaged social group (in terms of caste or education) was not an obstacle to use of delivery hut services. The delivery huts might have satisfied some unmet needs of community members in rural India. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Event Driven Messaging with Role-Based Subscriptions

NASA Technical Reports Server (NTRS)

Bui, Tung; Bui, Bach; Malhotra, Shantanu; Chen, Fannie; Kim, rachel; Allen, Christopher; Luong, Ivy; Chang, George; Zendejas, Silvino; Sadaqathulla, Syed

2009-01-01

Event Driven Messaging with Role-Based Subscriptions (EDM-RBS) is a framework integrated into the Service Management Database (SMDB) to allow for role-based and subscription-based delivery of synchronous and asynchronous messages over JMS (Java Messaging Service), SMTP (Simple Mail Transfer Protocol), or SMS (Short Messaging Service). This allows for 24/7 operation with users in all parts of the world. The software classifies messages by triggering data type, application source, owner of data triggering event (mission), classification, sub-classification and various other secondary classifying tags. Messages are routed to applications or users based on subscription rules using a combination of the above message attributes. This program provides a framework for identifying connected users and their applications for targeted delivery of messages over JMS to the client applications the user is logged into. EDMRBS provides the ability to send notifications over e-mail or pager rather than having to rely on a live human to do it. It is implemented as an Oracle application that uses Oracle relational database management system intrinsic functions. It is configurable to use Oracle AQ JMS API or an external JMS provider for messaging. It fully integrates into the event-logging framework of SMDB (Subnet Management Database).

Academic Institutionalization of Community Health Services: Way Ahead in Medical Education Reforms

PubMed Central

Kumar, Raman

2012-01-01

Policy on medical education has a major bearing on the outcome of health care delivery system. Countries plan and execute development of human resource in health, based on the realistic assessments of health system needs. A closer observation of medical education and its impact on the delivery system in India reveals disturbing trends. Primary care forms backbone of any system for health care delivery. One of the major challenges in India has been chronic deficiency of trained human resource eager to work in primary care setting. Attracting talent and employing skilled workforce seems a distant dream. Talking specifically of the medical education, there are large regional variations, urban - rural divide and issues with financing of the infrastructure. The existing design of medical education is not compatible with the health care delivery system of India. Impact is visible at both qualitative as well as quantitative levels. Medical education and the delivery system are working independent of each other, leading outcomes which are inequitable and unjust. Decades of negligence of medical education regulatory mechanism has allowed cropping of multiple monopolies governed by complex set of conflict of interest. Primary care physicians, supposed to be the community based team leaders stand disfranchised academically and professionally. To undo the distorted trajectory, a paradigm shift is required. In this paper, we propose expansion of ownership in medical education with academic institutionalization of community health services. PMID:24478994

Performance-based incentives may be appropriate to address challenges to delivery of prevention of vertical transmission of HIV services in rural Mozambique: a qualitative investigation.

PubMed

Schuster, Roseanne C; de Sousa, Octávio; Rivera, Jacqueline; Olson, Rebecca; Pinault, Delphine; Young, Sera L

2016-10-07

Performance-based incentives (PBIs) have garnered global attention as a promising strategy to improve healthcare delivery to vulnerable populations. However, literature gaps in the context in which an intervention is implemented and how the PBIs were developed exist. Therefore, we (1) characterized the barriers and promoters to prevention of vertical transmission of HIV (PVT) service delivery in rural Mozambique, where the vertical transmission rate is 12 %, and (2) assessed the appropriateness for a PBI's intervention and application to PVT. We conducted 24 semi-structured interviews with nurses, volunteers, community health workers, and traditional birth attendants about the barriers and promoters they experienced delivering PVT services. We then explored emergent themes in subsequent focus group discussions (n = 7, total participants N = 92) and elicited participant perspectives on PBIs. The ecological motivation-opportunity-ability framework guided our iterative data collection and thematic analysis processes. The interviews revealed that while all health worker cadres were motivated intrinsically and by social recognition, they were dissatisfied with low and late remuneration. Facility-based staff were challenged by factors across the rest of the ecological levels, primarily in the opportunity domain, including the following: poor referral and record systems (work mandate), high workload, stock-outs, poor infrastructure (facility environment), and delays in obtaining patient results and donor payment discrepancies (administrative). Community-based cadres' opportunity challenges included lack of supplies, distance (work environment), lack of incorporation into the health system (administration), and ability challenges of incorrect knowledge (health worker). PBIs based on social recognition and that enable action on intrinsic motivation through training, supervision, and collaboration were thought to have the most potential for targeting improvements in record and referral systems and better integrating community-based health workers into the health system. Concerns about the implementation of incentives included neglect of non-incentivized tasks and distorted motivation among colleagues. We found that highly motivated health workers encountered severe opportunity challenges in their PVT mandate. PBIs have the potential to address key barriers that facility- and community-based health workers encounter when delivering PVT services, specifically by building upon existing intrinsic motivation and leveraging highly valued social recognition. We recommend a controlled intervention to monitor incentives' effects on worker motivation and non-incentivized tasks to generate insights about the feasibility of PBIs to improve the delivery of PVT services.

The Role of the Family in Disability Concerned Policies and Services: Challenges for Community Based Rehabilitation in the Asian and Pacific Decade of Disabled Persons, 1993-2002.

ERIC Educational Resources Information Center

Kwok, J.

1995-01-01

This article addresses cultural influences on the family care and community-based rehabilitation of people with disabilities in Asia, especially Hong Kong. Considered are factors influencing the Hong Kong family, the caregiver role, the role of community development, and implications for policy and service delivery in newly industrialized cities…

75 FR 10508 - Duke Energy Carolinas, LLC; Notice of Consideration of Issuance of Amendment to Facility...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-08

... delivery service to the Office of the Secretary, Sixteenth Floor, One White Flint North, 11555 Rockville..., or expedited delivery service upon depositing the document with the provider of the service. A... General Counsel, Washington, DC 20555-0001. The expedited delivery or courier mail address for both...

75 FR 10513 - Duke Energy Carolinas, LLC; Notice of Consideration of Issuance of Amendment to Facility...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-08

... delivery service to the Office of the Secretary, Sixteenth Floor, One White Flint North, 11555 Rockville..., or expedited delivery service upon depositing the document with the provider of the service. A... General Counsel, Washington, DC 20555-0001. The expedited delivery or courier mail address for both...

Ability to pay and impoverishment among women who give birth at a University Hospital in Kathmandu, Nepal.

PubMed

Gartoulla, Pragya; Liabsuetrakul, Tippawan; Chongsuvivatwong, Virasakdi; McNeil, Edward

2012-01-01

Pregnant women giving birth in Nepal need to use out-of-pocket payment for delivery care services due to a lack of insurance policies. The objective of this study was to examine the ability of pregnant Nepalese women to pay for delivery care services and the effects of the current household health expenditure on impoverishment due to hospital-based delivery services, especially normal delivery (ND) and caesarean section (CS). A cross-sectional study was conducted from May to August 2009 at Tribhuvan University Teaching Hospital. Ability to pay was defined as the current health spending being less than 5% of annual household income. Poverty occurred when a household's per capita income fell to less than US$1 per day. Impoverishment was considered as poverty headcount and normalised poverty gap. On average, the percentage of annual household income spent on current delivery care was 5.9% in the ND group and 9.7% in the CS group. The CS group had a stronger impoverishment effect resulting in a high per cent change of payment-induced poverty headcount by 78.1% and poverty gap by 97.3% compared to 7.7 and 24.1% in the ND group, respectively. There is a strong need to develop a well-prepared financial system to prevent the issue of poverty and impoverishment.

The influence of integrated tuberculosis and human immunodeficiency virus service delivery on patient outcomes.

PubMed

Uyei, J; Coetzee, D; Macinko, J; Weinberg, S L; Guttmacher, S

2014-03-01

Public health clinics in Cape Town, South Africa. To examine the influence of integrated tuberculosis (TB) and human immunodeficiency virus (HIV) service delivery on mortality, TB cure and successful treatment completion and loss to follow-up of TB-HIV co-infected patients on concurrent anti-tuberculosis and antiretroviral treatment (ART). A survey instrument was used to measure the degree to which TB and HIV services were jointly delivered, and patient data were collected retrospectively from clinic sites and the Department of Health. Six domains measuring integrated TB and HIV service delivery were modelled to assess their relationship with patient outcomes. Two domains, integrated TB and ART service delivery and the delivery of TB and HIV care by one clinical team, were associated with lowered odds of death. Care by the same clinical team was also associated with reduced loss to follow-up. Overall, these findings show that the organization and delivery of health services are important factors that influence health outcomes. These findings strongly support efforts by local governments to integrate TB and ART services, and may help to alleviate concerns that restructuring of TB programs could have a negative impact on long-standing gains.

Fixing the system? The experience of service users of the quasi-market in disability services in Australia.

PubMed

Spall, Pam; McDonald, Catherine; Zetlin, Di

2005-01-01

A qualitative study involving semi-structured interviews with 31 people with disabilities and 32 carers in the state of Queensland, Australia, found that their experience of supportive service delivery had not improved despite reforms of the service delivery system driven by a version of the quasi-market model. Instead of delivering increased consumer choice and improved efficiency in service delivery, service users experienced inadequate service supply, service cutbacks, and an increased emphasis on cost subsidisation and assessment processes. Additionally, few consumers felt that individualised funding arrangements had personally delivered the benefits which the quasi-market model and associated policy paradigm had indicated that they should receive. For many consumers, the notion of consumer 'choice' around service provision was fictitious and they felt that any efficiency gains were at the agency level, largely at the consumers' cost. It is concluded that there appears to be no particular benefit to service users of quasi-market reforms, particularly in policy contexts where service delivery systems are historically under-funded.

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

Interprofessional education for personalized medicine through technology-based learning.

PubMed

Haga, Susanne B; Mills, Rachel; Aucoin, Julia; Taekman, Jeff

2015-06-01

The delivery of personalized medicine utilizing genetic and genomic technologies is anticipated to involve many medical specialties. Interprofessional education will be key to the delivery of personalized medicine in order to reduce disjointed or uncoordinated clinical care, and optimize effective communication to promote patient understanding and engagement regarding the use of or need for these services. While several health professional organizations have endorsed and/or developed core competencies for genetics and genomics, the lack of interprofessional guidelines and training may hamper the delivery of coordinated personalized medicine. In this perspective, we consider the potential for interprofessional education and training using technology-based approaches, such as virtual simulation and gaming, compared with traditional educational approaches.

Service quality and perceived value of technology-based service encounters: evaluation of clinical staff satisfaction in Taiwan.

PubMed

Hung, Chung-Jye; Chang, Hsin Hsin; Eng, Cheng Joo; Wong, Kit Hong

Previous research has evaluated technology-based service encounters (TBSEs) in the delivery of health care by assessing patient satisfaction. This study examined service quality and perceived value of TBSEs used in health organisations from the perspective of clinical staff, with staff technology readiness as a moderator. A quantitative survey was conducted in Taiwan, across private and public healthcare organisations. Results showed that TBSEs had a direct effect on service quality and perceived value, which in turn had a direct effect on staff satisfaction in using TBSEs. However, service quality had no effect on perceived value when moderated by technology readiness. Theoretical and managerial implications of these findings are discussed.

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.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...

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 To...

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 To...

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...

Recovery-oriented care in a secure mental health setting: "striving for a good life".

PubMed

McKenna, Brian; Furness, Trentham; Dhital, Deepa; Park, Malcolm; Connally, Fiona

2014-01-01

Recovery-oriented care acknowledges the unique journey of the consumer to regain control of his or her life in order to live a good life. Recovery has become a dominant policy-directed model of mental health service delivery. Even services that have traditionally been institutional and custodial have been challenged to embrace a recovery-oriented model. The aim of this qualitative study was to provide a description of service delivery in a secure in-patient mental health service, which has developed a self-professed recovery-oriented model of service delivery. An in-depth case study of the secure in-patient service using an exploratory research design was undertaken to meet the aim of this study. Qualitative data was gathered from interviews with consumers and staff (n = 15) and a focus group with carers (n = 5). Data were analyzed using a content analysis approach. Ethical approval for the study was obtained. The stakeholders readily described the secure service within recovery domains. They described a common vision; ways to promote hope and autonomy; examples of collaborative partnership which enhanced the goal of community integration; a focus on strength-based, holistic care; and the management of risk by taking calculated risks. Discrepancies in the perceptions of stakeholders were determined. This case study research provides a demonstrable example of recovery-in-action in one secure mental health service in Australia. It is intended to assist mental health services and clinicians seeking guidance in developing strategies for building and maintaining partnerships with consumers and carers in order for secure services to become truly recovery-oriented.

Active Implementation Frameworks for Successful Service Delivery: Catawba County Child Wellbeing Project

ERIC Educational Resources Information Center

Metz, Allison; Bartley, Leah; Ball, Heather; Wilson, Dawn; Naoom, Sandra; Redmond, Phil

2015-01-01

Traditional approaches to disseminating research based programs and innovations for children and families, which rely on practitioners and policy makers to make sense of research on their own, have been found insufficient. There is growing interest in strategies that "make it happen" by actively building the capacity of service providers…

Mental Health, United States, 2000.

ERIC Educational Resources Information Center

Manderscheid, Ronald W., Ed.; Henderson, Marilyn J., Ed.

In recent years, the mental health community has made great strides in understanding more about the delivery of mental health services, improving efficiency and quality in services, and also about how to build strengths and resilience in the face of lifes stresses. This volume adds to the knowledge base so that the important task of system change…

27 CFR 28.275 - Receipt by armed services.

Code of Federal Regulations, 2011 CFR

2011-04-01

... to the armed services of the United States are received at the supply base or other designated place... other place of delivery shall enter the quantity of liquors received on both copies of the application... case may be. After signing the form, he shall forward the original with attachments, if any, to the...

27 CFR 28.275 - Receipt by armed services.

Code of Federal Regulations, 2010 CFR

2010-04-01

... to the armed services of the United States are received at the supply base or other designated place... other place of delivery shall enter the quantity of liquors received on both copies of the application... case may be. After signing the form, he shall forward the original with attachments, if any, to the...

General Summary of the National Long-Term Care Channeling Demonstration. Revised.

ERIC Educational Resources Information Center

Office of the Assistant Secretary for Planning and Evaluation (DHHS), Washington, DC.

This paper summarizes the National Long-Term Care Channeling Demonstration Program, a project designed to test the feasibility and cost effectiveness of an alternative community-based long-term care service delivery concept for the frail elderly which integrated health and social services. Program management and early federal planning efforts are…

Youth Risk Assessment in Complex Agency Practice

ERIC Educational Resources Information Center

Groner, Mark R.; Solomon, Jean

2007-01-01

Advancements in the delivery of community-based services and tight utilization management of high-cost treatment options result in youths with serious behavior problems receiving intervention in lower levels of care than was true ten or fifteen years ago. This shift in where services tend to be delivered necessitates enhancement of risk assessment…

The Delivery of Services to Mentally Retarded Persons Living in Rural Areas: Context, Problems and Issues.

ERIC Educational Resources Information Center

Horejsi, Charles R.

Strategies and techniques for developing community-based programs for mentally retarded persons in rural areas must take into consideration local circumstances, resources, and characteristics. Rural norms such as overt racial segregation, social conformity, the importance of church, and the stigma of obtaining human services for personal problems…

A spatial model to quantify the mortality impact of service delivery in Sub-Saharan Africa: an ecological design utilizing data from South Africa

PubMed Central

2013-01-01

Background Sub Saharan Africa is confronted with a wide range of interlinked health and economic problems that include high levels of mortality and poor service delivery. The objective of the paper is to develop a spatial model for Sub-Saharan Africa that can quantify the mortality impact of (poor) service delivery at sub-district level in order to integrate related health and local level policy interventions. In this regard, an expanded composite service delivery index was developed, and the data were analysed using a Bayesian Poisson spatial model. Results The results indicate significant differences in the risk of mortality and poor service delivery at sub-district level. In particular, the results indicate clusters of high mortality and poor service delivery in two of the bigger, poorer provinces with large rural communities. Conversely, two of the wealthier provinces have lower levels of mortality and higher levels of service delivery, but income inequality is more widespread. The bivariate and multivariate models, moreover, reflect significant positive linkages (p < 0.01) between increased mortality and poor service delivery after adjusting for HIV/AIDS, income inequality, population density and the protective influence of metropolitan areas. Finally, the hypothesized provision of a basket of services reduced the mortality rate in South Africa’s 248 sub-districts by an average of 5.3 (0.3-15.4) deaths per 1000. Conclusion The results indicate that the model can accurately plot mortality and service delivery “hotspots’ at sub-district level, as well as explain their associations and causality. A mortality reduction index shows that mortality in the highest risk sub-districts can be reduced by as much as 15.4 deaths per 1000 by providing a range of basic services. The ability to use the model in a wider SSA context and elsewhere is also feasible given the innovative use of available databases. Finally, the paper illustrates the importance of developing policy in SSA that can simultaneously solve both economic and health problems. PMID:23425437

A spatial model to quantify the mortality impact of service delivery in Sub-Saharan Africa: an ecological design utilizing data from South Africa.

PubMed

Sartorius, Kurt; Sartorius, Benn K D

2013-02-20

Sub Saharan Africa is confronted with a wide range of interlinked health and economic problems that include high levels of mortality and poor service delivery. The objective of the paper is to develop a spatial model for Sub-Saharan Africa that can quantify the mortality impact of (poor) service delivery at sub-district level in order to integrate related health and local level policy interventions. In this regard, an expanded composite service delivery index was developed, and the data were analysed using a Bayesian Poisson spatial model. The results indicate significant differences in the risk of mortality and poor service delivery at sub-district level. In particular, the results indicate clusters of high mortality and poor service delivery in two of the bigger, poorer provinces with large rural communities. Conversely, two of the wealthier provinces have lower levels of mortality and higher levels of service delivery, but income inequality is more widespread. The bivariate and multivariate models, moreover, reflect significant positive linkages (p < 0.01) between increased mortality and poor service delivery after adjusting for HIV/AIDS, income inequality, population density and the protective influence of metropolitan areas. Finally, the hypothesized provision of a basket of services reduced the mortality rate in South Africa's 248 sub-districts by an average of 5.3 (0.3-15.4) deaths per 1000. The results indicate that the model can accurately plot mortality and service delivery "hotspots' at sub-district level, as well as explain their associations and causality. A mortality reduction index shows that mortality in the highest risk sub-districts can be reduced by as much as 15.4 deaths per 1000 by providing a range of basic services. The ability to use the model in a wider SSA context and elsewhere is also feasible given the innovative use of available databases. Finally, the paper illustrates the importance of developing policy in SSA that can simultaneously solve both economic and health problems.

A case series study on the effect of Ebola on facility-based deliveries in rural Liberia.

PubMed

Lori, Jody R; Rominski, Sarah Danielson; Perosky, Joseph E; Munro, Michelle L; Williams, Garfee; Bell, Sue Anne; Nyanplu, Aloysius B; Amarah, Patricia N M; Boyd, Carol J

2015-10-12

As communities' fears of Ebola virus disease (EVD) in West Africa exacerbate and their trust in healthcare providers diminishes, EVD has the potential to reverse the recent progress made in promoting facility-based delivery. Using retrospective data from a study focused on maternal and newborn health, this analysis examined the influence of EVD on the use of facility-based maternity care in Bong Country, Liberia, which shares a boarder with Sierra Leone - near the epicenter of the outbreak. Using a case series design, retrospective data from logbooks were collected at 12 study sites in one county. These data were then analyzed to determine women's use of facility-based maternity care between January 2012 and October 2014. The primary outcome was the number of facility-based deliveries over time. The first suspected case of EVD in Bong County was reported on June 30, 2014. Heat maps were generated and the number of deliveries was normalized to the average number of deliveries during the full 12 months before the EVD outbreak (March 2013 - February 2014). Prior to the EVD outbreak, facility-based deliveries steadily increased in Bong County reaching an all-time high of over 500 per month at study sites in the first half of 2014 - indicating Liberia was making inroads in normalizing institutional maternal healthcare. However, as reports of EVD escalated, facility-based deliveries decreased to a low of 113 in August 2014. Ebola virus disease has negatively impacted the use of facility-based maternity services, placing childbearing women at increased risk for morbidity and death.

Performance-based financing and changing the district health system: experience from Rwanda.

PubMed Central

Soeters, Robert; Habineza, Christian; Peerenboom, Peter Bob

2006-01-01

Evidence from low-income Asian countries shows that performance-based financing (as a specific form of contracting) can improve health service delivery more successfully than traditional input financing mechanisms. We report a field experience from Rwanda demonstrating that performance-based financing is a feasible strategy in sub-Saharan Africa too. Performance-based financing requires at least one new actor, an independent well equipped fundholder organization in the district health system separating the purchasing, service delivery as well as regulatory roles of local health authorities from the technical role of contract negotiation and fund disbursement. In Rwanda, local community groups, through patient surveys, verified the performance of health facilities and monitored consumer satisfaction. A precondition for the success of performance-based financing is that authorities must respect the autonomous management of health facilities competing for public subsidies. These changes are an opportunity to redistribute roles within the health district in a more transparent and efficient fashion. PMID:17143462

Adapting chronic care models for diabetes care delivery in low-and-middle-income countries: A review

PubMed Central

Ku, Grace Marie V; Kegels, Guy

2015-01-01

A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes. The Philippines was used as the setting of a low-to-middle-income country. A context-based narrative review of existing models for chronic care was conducted. A situational analysis was done at the grassroots level, involving the leaders and members of the community, the patients, the local health system and the healthcare providers. A second analysis making use of certain organizational theories was done to explore on improving feasibility and acceptability of organizing care for chronic conditions. The analyses indicated that care for chronic conditions may be introduced, considering the needs of people with diabetes in particular and the community in general as recipients of care, and the issues and factors that may affect the healthcare workers and the health system as providers of this care. The context-adapted chronic care model-based service delivery model was constructed accordingly. Key features are: incorporation of chronic care in the health system’s services; assimilation of chronic care delivery with the other responsibilities of the healthcare workers but with redistribution of certain tasks; and ensuring that the recipients of care experience the whole spectrum of basic chronic care that includes education and promotion in the general population, risk identification, screening, counseling including self-care development, and clinical management of the chronic condition and any co-morbidities, regardless of level of control of the condition. This way, low-to-middle income countries can introduce and improve care for chronic conditions without entailing much additional demand on their limited resources. PMID:25987954

Essential basic and emergency obstetric and newborn care: from education and training to service delivery and quality of care.

PubMed

Otolorin, Emmanuel; Gomez, Patricia; Currie, Sheena; Thapa, Kusum; Dao, Blami

2015-06-01

Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego's programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings. Copyright © 2015. Published by Elsevier Ireland Ltd.

A case study detailing key considerations for implementing a telehealth approach to office ergonomics.

PubMed

Ritchie, Catherine L W; Miller, Linda L; Antle, David M

2017-01-01

Telehealth approaches to delivering ergonomics assessment hold great potential to improve service delivery in rural and remote settings. This case study describes a telehealth-based ergonomics service delivery process, and compares in-person and telehealth-based ergonomics approaches at an Alberta-based non-profit advocacy group. This project demonstrates that telehealth approaches to ergonomics do not lead to significantly different scoring outcomes for assessment of ergonomics issues, when compared to in-person assessments. This project also outlines the importance of live real-time video conferencing to improving communication, attaining key assessment information, and demonstrating ergonomic adjustments. However, some key considerations of bandwidth and hardware capabilities need to be taken into account. Key communication strategies are outlined to improve rapport, maintain employee confidentiality, and reduce client anxiety around telehealth ergonomics assessments. This project provides further support for telehealth approaches to office ergonomics, and outlines some key implementation strategies and barriers that should be considered.

Effect of a package of integrated demand- and supply-side interventions on facility delivery rates in rural Bangladesh: Implications for large-scale programs

PubMed Central

Choudhury, Aziz Ahmed; Khanam, Rasheda; Moin, Syed Mamun Ibne; Ahmed, Salahuddin; Begum, Nazma; Shoma, Nurun Naher; Quaiyum, Md Abdul; Baqui, Abdullah H.

2017-01-01

Background According to the Bangladesh Demographic and Health Survey 2014, only approximately 37 percent of women deliver in a health facility. Among the eight administrative divisions of Bangladesh, the facility delivery rate is lowest in the Sylhet division (22.6 percent) where we assessed the effect of integrated supply- and demand-side interventions on the facility-based delivery rate. Methods Population-based cohort data of pregnant women from an ongoing maternal and newborn health improvement study being conducted in a population of ~120,000 in Sylhet district were used. The study required collection and processing of biological samples immediately after delivery. Therefore, the project assembled various strategies to increase institutional delivery rates. The supply-side intervention included capacity expansion of the health facilities through service provider refresher training, 24/7 service coverage, additions of drugs and supplies, and incentives to the providers. The demand-side component involved financial incentives to cover expenses, a provision of emergency transport, and referral support to a tertiary-level hospital. We conducted a before-and-after observational study to assess the impact of the intervention in a total of 1,861 deliveries between December 2014 and November 2016. Results Overall, implementation of the intervention package was associated with 52.6 percentage point increase in the proportions of facility-based deliveries from a baseline rate of 25.0 percent to 77.6 percent in 24 months. We observed lower rates of institutional deliveries when only supply-side interventions were implemented. The proportion rose to 47.1 percent and continued increasing when the project emphasized addressing the financial barriers to accessing obstetric care in a health facility. Conclusions An integrated supply- and demand-side intervention was associated with a substantial increase in institutional delivery. The package can be tailored to identify which combination of interventions may produce the optimum result and be scaled. Rigorous implementation research studies are needed to draw confident conclusions and to provide information about the costs, feasibility for scale-up and sustainability. PMID:29073229

Increase in facility-based deliveries associated with a maternal health voucher programme in informal settlements in Nairobi, Kenya.

PubMed

Bellows, Ben; Kyobutungi, Catherine; Mutua, Martin Kavao; Warren, Charlotte; Ezeh, Alex

2013-03-01

To measure whether there was an association between the introduction of an output-based voucher programme and the odds of a facility-based delivery in two Nairobi informal settlements. Nairobi Urban Health and Demographic Surveillance System (NUHDSS) and two cross-sectional household surveys in Korogocho and Viwandani informal settlements in 2004-05 and 2006-08. Odds of facility-based delivery were estimated before and after introduction of an output-based voucher. Supporting NUHDSS data were used to determine whether any trend in maternal health care was coincident with immunizations, a non-voucher outpatient service. As part of NUHDSS, households in Korogocho and Viwandani reported place of delivery and the presence of a skilled birth attendant (2003-10) and vaccination coverage (2003-09). A detailed maternal and child health (MCH) tool was added to NUHDSS (September 2006-10). Prospective enrolment in NUHDSS-MCH was conditional on having a newborn after September 2006. In addition to recording mother's place of delivery, NUHDSS-MCH recorded the use of the voucher. There were significantly greater odds of a facility-based delivery among respondents during the voucher programme compared with similar respondents prior to voucher launch. Testing whether unrelated outpatient care also increased, a falsification exercise found no significant increase in immunizations for children 12-23 months of age in the same period. Although the proportion completing any antenatal care (ANC) visit remained above 95% of all reported pregnancies and there was a significant increase in facility-based deliveries, the proportion of women completing 4+ ANC visits was significantly lower during the voucher programme. A positive association was observed between vouchers and facility-based deliveries in Nairobi. Although there is a need for higher quality evidence and validation in future studies, this statistically significant and policy relevant finding suggests that increases in facility-based deliveries can be achieved through output-based finance models that target subsidies to underserved populations.

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

The objective of the scoping review is to identify and describe within the existing literature the characteristics (values, principles, components and suggest practical applications) of primary health care models of service delivery for Indigenous people. More specifically, the review question is:What are the characteristics (values, principles, components and suggested practical applications) of primary health care models of service delivery for Indigenous people?Findings from this scoping review will inform two systematic reviews. One of these will explore the acceptability and the other the effectiveness of identified characteristics. The scoping review will follow the JBI Scoping Review methodology as outlined in the 2015 Joanna Briggs Institute Reviewers' Manual. Indigenous populations in colonized countries experience worse health outcomes relative to their non-Indigenous counterparts. In Australia, in the period 2010 to 2012 the estimated gap in life expectancy between Aboriginal and Torres Strait Islander Australians compared to non-Indigenous Australians was 10 years Similar gaps in life expectancy between Indigenous and non-Indigenous have been demonstrated in other countries, such as New Zealand, Canada and the United StatesThe gap in life expectancy and the health disadvantage experienced by Indigenous people is in part the result of mainstream health services not adequately meeting the health needs of Indigenous people and Indigenous people's inability to access mainstream services Part of the solution has been the establishment of primary health care services for and in many cases run by Indigenous people. Indigenous primary health services have been developed to provide culturally appropriate services that meet the needs of local Indigenous communities.In Australia, the first Aboriginal medical service was established in 1971 in Redfern, New South Wales, by "community activists in response to ongoing discrimination against Aboriginal people within mainstream health services to address the poor health and premature deaths of Aboriginal people, and to provide a culturally appropriate system of health care". There are now over 150 Aboriginal Community Controlled Health Services in Australia. Aboriginal Community Controlled Health Services are underpinned by common values such as culture, cultural respect, integrity, inclusion, self-determination, community control, sovereignty and leadership.Similar models of Indigenous health services exist in other countries, such as Māori health providers in New Zealand, First Nations and Inuit Health Authorities in Canada, and the Indian Health Services in the US. In New Zealand, Māori health providers deliver health and disability services to Māori and non-Māori clients. The difference between Māori health providers and mainstream services in New Zealand is that Māori health services are based on kaupapa, a plan or set of principles and ideas that informs behavior and customs, and the delivery framework which is distinctively Māori. First Nations and Inuit Health Authorities in Canada coordinate and integrate health programs and services to achieve better health outcomes for First Nations people. These community-based services largely focus on health promotion and prevention. First Nations and Inuit Health Authorities work under a unique health governance structure that includes local First Nations' leadership, based on the philosophy of self-governance and self-determination, which represent and address the health needs of First Nation communities. The Indian Health Service (IHS) in the US is responsible for providing comprehensive health services to American Indians and Alaska Natives. The IHS aims to raise the physical, mental, social and spiritual health of American Indians and Alaska Natives to the highest level, and its goal is "to ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and 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 services are delivered in this setting.An initial search of literature was conducted to establish whether there are studies with findings available to answer the review question, and whether there is a systematic or scoping review addressing the knowledge gap currently underway or published. There are no systematic or scoping reviews published or underway that address the question proposed by this review.

Documentation of and satisfaction with the service delivery process of electric powered scooters among adult users in different national contexts.

PubMed

Sund, Terje; Iwarsson, Susanne; Andersen, Mette C; Brandt, Åse

2013-03-01

The purpose of this study was to investigate how different service delivery systems for assistive devices were associated with the service delivery process (SDP) and user satisfaction in two national contexts when electric powered scooters were provided. The study had a follow-up design based on a consecutive inclusion of 50 Danish and 86 Norwegian adults as they were about to be provided a scooter. A study-specific structured questionnaire for documentation of the SDP was administered. The Satisfaction with Assistive Technology Services was used for documenting user satisfaction with the SDP. Besides descriptive statistics, regression analysis was used to identify contributors of variance and predictors of user satisfaction. The various steps of the SDP were carried out to a various degree. Significantly more total time was spent in the SDP in the Danish sample (p < 0.001). About 80% of the informants were satisfied/very satisfied with different aspects of the SDP. Time spent in the different steps was not associated with user satisfaction with the SDP. This study supports the assumption that structure of the service impacts on the SDP, but not that the process impacts on outcomes in terms of user satisfaction with the SDP. It may, however, be questioned whether this actually is an outcome.

Disaster planning for vulnerable populations: leveraging Community Human Service Organizations direct service delivery personnel.

PubMed

Levin, Karen L; Berliner, Maegan; Merdjanoff, Alexis

2014-01-01

Given the variability, complexities, and available resources for local vulnerable populations, it is clear that preparing effectively for catastrophic events cannot be accomplished with a single, simple template. Inclusion of Community Human Service Organizations' (CHSO's) direct service delivery personnel ensures that emergency disaster planning efforts for vulnerable populations are effective and responsive to unique needs and constraints. By leveraging existing local resources, it extends the preparedness system's reach to the whole community. CHSO personnel already perform community-based services and directly engage with vulnerable and special needs populations; typically they are on the front lines during an emergency event. Generally, however, the CHSOs, staff, and clients are neither adequately prepared for disasters nor well integrated into emergency systems. To address preparedness gaps identified during Hurricane Sandy, regional CHSO and local health department partners requested that the Columbia Regional Learning Center provide preparedness trainings for their agencies and staff responsible for vulnerable clients. Evaluation of this initiative was begun with a mixed-methods approach consisting of collaborative learning activities, a function-based assessment tool, and a 5 Steps to Preparedness module. Results from a survey were inclusive because of a low response rate but suggested satisfaction with the training format and content; increases in awareness of a client preparedness role; and steps toward improved personal, agency, and client preparedness. Direct service delivery personnel can leverage routine client interactions for preparedness planning and thus can contribute significantly to vulnerable population and community disaster readiness. Trainings that provide preparedness tools can help support this role. CHSO personnel are knowledgeable and have the expertise to assist clients in personal preparedness planning; yet, there are challenges around their ability and willingness to take on additional responsibilities.

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

PubMed Central

2012-01-01

Background 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. Methods 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. Results 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. Conclusion 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. PMID:22863400

Quality management in home care: models for today's practice.

PubMed

Verhey, M P

1996-01-01

In less than a decade, home care providers have been a part of two major transitions in health care delivery. First, because of the advent of managed care and a shift from inpatient to community-based services, home care service delivery systems have experienced tremendous growth. Second, the principles and practices of total quality management and continuous quality improvement have permeated the organization, administration, and practice of home health care. Based on the work of Deming, Juran, and Crosby, the basic tenets of the new quality management philosophy involve a focus on the following five key areas: (1) systems and processes rather than individual performance; (2) involvement, collaboration, and empowerment; (3) internal and external "customers"; (4) data and measurement; and (5) standards, guidelines, and outcomes of care. Home care providers are among those in the forefront who are developing and implementing programs that integrate these foci into the delivery of quality home care services. This article provides a summary of current home care programs that address these five key areas of quality management philosophy and provide models for innovative quality management practice in home care. For further information about each program, readers are referred to the original reports in the home care and quality management journal literature, as cited herein.

Metrics for Radiologists in the Era of Value-based Health Care Delivery.

PubMed

Sarwar, Ammar; Boland, Giles; Monks, Annamarie; Kruskal, Jonathan B

2015-01-01

Accelerated by the Patient Protection and Affordable Care Act of 2010, health care delivery in the United States is poised to move from a model that rewards the volume of services provided to one that rewards the value provided by such services. Radiology department operations are currently managed by an array of metrics that assess various departmental missions, but many of these metrics do not measure value. Regulators and other stakeholders also influence what metrics are used to assess medical imaging. Metrics such as the Physician Quality Reporting System are increasingly being linked to financial penalties. In addition, metrics assessing radiology's contribution to cost or outcomes are currently lacking. In fact, radiology is widely viewed as a contributor to health care costs without an adequate understanding of its contribution to downstream cost savings or improvement in patient outcomes. The new value-based system of health care delivery and reimbursement will measure a provider's contribution to reducing costs and improving patient outcomes with the intention of making reimbursement commensurate with adherence to these metrics. The authors describe existing metrics and their application to the practice of radiology, discuss the so-called value equation, and suggest possible metrics that will be useful for demonstrating the value of radiologists' services to their patients. (©)RSNA, 2015.

Predictors of maternal health services utilization by poor, rural women: a comparative study in Indian States of Gujarat and Tamil Nadu.

PubMed

Vora, Kranti Suresh; Koblinsky, Sally A; Koblinsky, Marge A

2015-07-31

India leads all nations in numbers of maternal deaths, with poor, rural women contributing disproportionately to the high maternal mortality ratio. In 2005, India launched the world's largest conditional cash transfer scheme, Janani Suraksha Yojana (JSY), to increase poor women's access to institutional delivery, anticipating that facility-based birthing would decrease deaths. Indian states have taken different approaches to implementing JSY. Tamil Nadu adopted JSY with a reorganization of its public health system, and Gujarat augmented JSY with the state-funded Chiranjeevi Yojana (CY) scheme, contracting with private physicians for delivery services. Given scarce evidence of the outcomes of these approaches, especially in states with more optimal health indicators, this cross-sectional study examined the role of JSY/CY and other healthcare system and social factors in predicting poor, rural women's use of maternal health services in Gujarat and Tamil Nadu. Using the District Level Household Survey (DLHS)-3, the sample included 1584 Gujarati and 601 Tamil rural women in the lowest two wealth quintiles. Multivariate logistic regression analyses examined associations between JSY/CY and other salient health system, socio-demographic, and obstetric factors with three outcomes: adequate antenatal care, institutional delivery, and Cesarean-section. Tamil women reported greater use of maternal healthcare services than Gujarati women. JSY/CY participation predicted institutional delivery in Gujarat (AOR = 3.9), but JSY assistance failed to predict institutional delivery in Tamil Nadu, where mothers received some cash for home births under another scheme. JSY/CY assistance failed to predict adequate antenatal care, which was not incentivized. All-weather road access predicted institutional delivery in both Tamil Nadu (AOR = 3.4) and Gujarat (AOR = 1.4). Women's education predicted institutional delivery and Cesarean-section in Tamil Nadu, while husbands' education predicted institutional delivery in Gujarat. Overall, assistance from health financing schemes, good road access to health facilities, and socio-demographic and obstetric factors were associated with differential use of maternity health services by poor, rural women in the two states. Policymakers and practitioners should promote financing schemes to increase access, including consideration of incentives for antenatal care, and address health system and social factors in designing state-level interventions to promote safe motherhood.

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

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false How are core services and intensive services... § 652.208 How are core services and intensive services related to the methods of service delivery described in § 652.207(b)(2)? Core services and intensive services may be delivered through any of the...

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

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false How are core services and intensive services... § 652.208 How are core services and intensive services related to the methods of service delivery described in § 652.207(b)(2)? Core services and intensive services may be delivered through any of the...

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

75 FR 71183 - 23rd Meeting: RTCA Special Committee 206: EUROCAE WG 76 Plenary: AIS and MET Data Link Services

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-22

... Services Delivery Architecture Recommendations are included in the TOR deliverables. The Concept of Use for... operating picture for evolving global ATM concepts. The AIS and MET Services Delivery Architecture... provides recommended alternatives for AIS and MET data delivery architectures. The Concept of Use and...

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. Copyright © 2015 John Wiley & Sons, Ltd.

The fee-for-service shift to bundled payments: financial considerations for hospitals.

PubMed

Scamperle, Keely

2013-01-01

Skyrocketing health care costs are forcing payers to demand delivery efficiencies that preserve and promote quality care while reducing costs. Hospitals are challenged to meet the pressure from payers to deliver value and outcome-based health care while preserving sufficient financial margins. The fee-for-service (FFS) model with its perverse incentives to incur high-volume services is no longer, if ever, sufficient to ensure quality, cost-efficient health care. In response, payers have sought to force the issue through accelerated efforts to bundle payments to providers. It is theorized that by tying together providers throughout the continuum or episode of care for a patient, efficiencies in delivery inclusive of cost reductions will be obtained. This article examines the bundled payment models and the financial considerations for hospital facility providers.

AAC Camp as an Alternative School-Based Service Delivery Model: A Retrospective Survey

ERIC Educational Resources Information Center

Dodd, Janet L.; Hagge, Darla K.

2014-01-01

School-based speech-language pathologists are obligated to apply evidence-based practice and document progress of their students' response to intervention in compliance with federal law. The purpose of this preliminary study was to explore the effects of an augmentative and alternative communication (AAC)-based intervention provided in a camp…

Analysis of the Salvation Army World Service Offices Disaster Relief Capabilities

DTIC Science & Technology

2017-03-01

AOR based primarily on their financial revenues, since revenue is a prerequisite enabling mechanism for the delivery of goods and services . The...are from government sources, whereas contributions include cash and dollar value of in-kind services and goods . Investment revenues largely consist of...taking action among those most in need of assistance offers a compelling and admirable example of the good a religious organization can accomplish

Automated Developmental Disabilities Out-Patient Treatment Review System (ADDOPTRS)—Development and Automation of a Microcomputer Based Case Management System

PubMed Central

Fisch, Clifford B.; Fisch, Martin L.

1979-01-01

The Stanley S. Lamm Institute for Developmental Disabilities of The Long Island College Hospital, in conjunction with Micro-Med Systems has developed a low cost micro-computer based information system (ADDOP TRS) which monitors quality of care in outpatient settings rendering services to the developmentally disabled population. The process of conversion from paper record keeping systems to direct key-to-disk data capture at the point of service delivery is described. Data elements of the information system including identifying patient information, coded and English-grammar entry procedures for tracking elements of service as well as their delivery status are described. Project evaluation criteria are defined including improved quality of care, improved productivity for clerical and professional staff and enhanced decision making capability. These criteria are achieved in a cost effective manner as a function of more efficient information flow. Administrative applications including staff/budgeting procedures, submissions for third party reimbursement and case reporting to utilization review committees are considered.

Community perspectives on post-Katrina mental health recovery in New Orleans.

PubMed

Meyers, Diana; Allien, Charles E; Dunn, Donisha; Wennerstrom, Ashley; Springgate, Benjamin F

2011-01-01

Disaster-affected communities may face prolonged challenges to community-wide mental health recovery due to limitations in local resources, infrastructure, and leadership. REACH NOLA, an umbrella non-profit organization comprising academic institutions and community-based agencies, sought to promote community recovery, increase mental health service delivery capacity, and develop local leadership in post-Katrina New Orleans through its Mental Health infrastructure and Training Project (MHIT). The project offered local health service providers training and follow-up support for implementing evidence-based and new approaches to mental health service delivery. This commentary shares the perspectives of three community leaders who co-directed MHIT. They describe the genesis of MHIT, the experience of each agency in adopting leadership roles in addressing post-disaster needs, challenges and growth opportunities, and then overarching lessons learned concerning leadership in a prolonged crisis. These lessons may be relevant to community agencies addressing hurricane recovery in other areas of the Gulf States as well as to inform long-term disaster recovery efforts elsewhere.

The State of Client-Centered Public Service Delivery in the Netherlands

NASA Astrophysics Data System (ADS)

Jansen, Jurjen; de Vries, Sjoerd; van der Geest, Thea; Arendsen, Rex; van Dijk, Jan

Businesses and citizens demand a better and more client-centered way of service delivery from public organizations. As society becomes more complex, dynamic and diverse, public organizations need to adapt to this demand. Conversely, our perception is that public organizations might still treat their target groups as one. However, the need for client-centered public service delivery is growing. This is widely debated in literature. Nonetheless, little empirical evidence is available about the state of client-centeredness of public organizations. The objective of the present study is to identify the state of client-centered public service delivery in the Netherlands. In order to research this topic 400 people from 194 Dutch public organizations were invited to complete an electronic questionnaire. 105 people responded. According to the respondents the state of client-centeredness is acceptable. However, only 25% of the public organizations seem to take differentiation as the point of departure for their service delivery.

Case Management and the Integration of Services: How Service Delivery Systems Shape Case Management.

ERIC Educational Resources Information Center

Moore, Stephen

1992-01-01

Notes that primary role that case management plays in coordination of services is determined by level of service integration and by level of resources in service delivery system. Describes conditions under which case management serves as mechanism for rationing services, marketing function, brokering function, or development role. Discusses…

20 CFR 663.155 - How are core services delivered?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false How are core services delivered? 663.155... Worker Services Through the One-Stop Delivery System § 663.155 How are core services delivered? Core services must be provided through the One-Stop delivery system. Core services may be provided directly by...

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…

20 CFR 663.155 - How are core services delivered?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false How are core services delivered? 663.155... Worker Services Through the One-Stop Delivery System § 663.155 How are core services delivered? Core services must be provided through the One-Stop delivery system. Core services may be provided directly by...

Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria.

PubMed

Yaya, Sanni; Bishwajit, Ghose; Uthman, Olalekan A; Amouzou, Agbessi

2018-01-01

Obstetric complications and maternal deaths can be prevented through safe delivery process. Facility based delivery significantly reduces maternal mortality by increasing women's access to skilled personnel attendance. However, in sub-Saharan Africa, most deliveries take place without skilled attendants and outside health facilities. Utilization of facility-based delivery is affected by socio-cultural norms and several other factors including cost, long distance, accessibility and availability of quality services. This study examined country-level variations of the self-reported causes of not choosing to deliver at a health facility. Cross-sectional data on 37,086 community dwelling women aged between 15-49 years were collected from DHS surveys in Ethiopia (n = 13,053) and Nigeria (n = 24,033). Outcome variables were the self-reported causes of not delivering at health facilities which were regressed against selected sociodemographic and community level determinants. In total eight items complaints were identified for non-use of facility delivery: 1) Cost too much 2) Facility not open, 3) Too far/no transport, 4) don't trust facility/poor service, 5) No female provider, 6) Husband/family didn't allow, 7) Not necessary, 8) Not customary. Multivariable regression methods were used for measuring the associations. In both countries a large proportion of the women mentioned facility delivery as not necessary, 54.9% (52.3-57.9) in Nigeria and 45.4% (42.0-47.5) in Ethiopia. Significant urban-rural variations were observed in the prevalence of the self-reported causes of non-utilisation. Women in the rural areas are more likely to report delivering at health facility as not customary/not necessary and healthy facility too far/no transport. However, urban women were more likely to complain that husband/family did not allow and that the costs were too high. Women in the rural were more likely to regard facility delivery as unnecessary and complain about transportation and financial difficulties. In order to achieving the maternal mortality related targets, addressing regional disparities in accessing maternal healthcare services should be regarded as a priority of health promotion programs in Nigeria and Ethiopia.

Patients' perceptions of service quality dimensions: an empirical examination of health care in New Zealand.

PubMed

Clemes, M D; Ozanne, L K; Laurensen, W L

2001-01-01

The 1984 liberalization of the New Zealand economy has resulted in a health care sector that has become very competitive (Zwier and Clarke, 1999). The private sector is now able to supply health care services and, as a result, a greater value is being placed on patient satisfaction (Zwier and Clarke, 1999). However, despite the increasing focus on customer satisfaction, research into health care patients' perceptions of the dimensions of service quality is scarce. This can be problematic, as quality of care is an essential issue in the strategic marketing of health care services (Turner and Pol, 1995). This study takes a step towards addressing this deficiency by identifying patients' perceptions of the dimensions of service quality in health care. The findings of this study are based on the empirical analysis of a sample of 389 respondents interviewed by telephone. The findings indicate that the service quality dimensions identified in this health care specific study differ in number and dimensional structure from the widely adopted service quality dimensions first identified by Parasuraman, Berry and Zeithaml (1988): reliability, responsiveness, assurance, empathy and tangibles. The service quality dimensions identified in this study were: reliability, tangibles, assurance, empathy, food, access, outcome, admission, discharge and responsiveness. In addition, health care patients perceive the service quality dimensions relating to the core product in health care delivery (for example, outcome and reliability) as more important than the service quality dimensions relating to the peripheral product in health care delivery (for example, food, access and tangibles). Finally, the results of this study suggest that patients with different geographic, demographic, and behavioristic characteristics have different needs and wants during health care delivery and therefore perceive different service quality dimensions as important.

A Developing Educational Psychology Service Work-Allocation Model

ERIC Educational Resources Information Center

Marsh, Alan J.; Higgins, Andrea

2018-01-01

As UK governments continue with the economic policy of deficit reduction from 2010, many Local Authorities' (LAs) Educational Psychology Services (EPSs) have begun to develop "traded" models of service delivery in order to maintain jobs and secure services. Nevertheless, EPSs still provide a core service delivery to schools, settings and…

The use of a new ecosystem services assessment tool, EPA H2O, for identifying, quantifying, and valuing ecosystem services production.

EPA Science Inventory

The task of estimating ecosystem service production and delivery deserves special attention. Assessment tools that incorporate both supply and delivery of ecosystem services are needed to better understand how ecosystem services production becomes realized benefits. Here, we de...

How Fidelity invests in service professionals.

PubMed

McColgan, E A

1997-01-01

If you're in the business of service delivery, investment in the training and development of your staff is one of the keys to your company's success. But what's the best way to design and implement your investment? In 1994, Fidelity Institutional Retirement Services Company (FIRSCo) needed to ensure that its rapidly expanding staff maintained the company's high levels of customer satisfaction. The solution, according to Ellyn McColgan, formerly an executive vice president of FIRSCo and now the president of Fidelity Investments Tax-Exempt Services Company, was to reach out to its service associates with a powerful new model for training and development called Service Delivery University. SDU is a virtual university with a content-based core curriculum and five colleges that focus on business concepts and skills. It is driven by three principles. First, all training must be directly aligned with the company's strategic and financial objectives and focused on customer needs. Second, service delivery is a profession and should be taught as such. And finally, professional development should be the primary responsibility of line managers rather than the human resources department. McColgan explains how FIRSCo overcame resistance to this sweeping change in employee education. (Time was one obstacle: each associate receives 80 hours of training per year.) In addition, the author discusses the fine art of measuring the success of a program like SDU. She finds that the company's investment has paid dividends to the staff, to the organization as a whole, and to FIRSCo's customers.

Delivery of crop pollination services is an insufficient argument for wild pollinator conservation

PubMed Central

Kleijn, David; Winfree, Rachael; Bartomeus, Ignasi; Carvalheiro, Luísa G; Henry, Mickaël; Isaacs, Rufus; Klein, Alexandra-Maria; Kremen, Claire; M'Gonigle, Leithen K; Rader, Romina; Ricketts, Taylor H; Williams, Neal M; Lee Adamson, Nancy; Ascher, John S; Báldi, András; Batáry, Péter; Benjamin, Faye; Biesmeijer, Jacobus C; Blitzer, Eleanor J; Bommarco, Riccardo; Brand, Mariëtte R; Bretagnolle, Vincent; Button, Lindsey; Cariveau, Daniel P; Chifflet, Rémy; Colville, Jonathan F; Danforth, Bryan N; Elle, Elizabeth; Garratt, Michael P.D.; Herzog, Felix; Holzschuh, Andrea; Howlett, Brad G; Jauker, Frank; Jha, Shalene; Knop, Eva; Krewenka, Kristin M; Le Féon, Violette; Mandelik, Yael; May, Emily A; Park, Mia G; Pisanty, Gideon; Reemer, Menno; Riedinger, Verena; Rollin, Orianne; Rundlöf, Maj; Sardiñas, Hillary S; Scheper, Jeroen; Sciligo, Amber R; Smith, Henrik G; Steffan-Dewenter, Ingolf; Thorp, Robbin; Tscharntke, Teja; Verhulst, Jort; Viana, Blandina F; Vaissière, Bernard E; Veldtman, Ruan; Westphal, Catrin; Potts, Simon G

2015-01-01

There is compelling evidence that more diverse ecosystems deliver greater benefits to people, and these ecosystem services have become a key argument for biodiversity conservation. However, it is unclear how much biodiversity is needed to deliver ecosystem services in a cost-effective way. Here we show that, while the contribution of wild bees to crop production is significant, service delivery is restricted to a limited subset of all known bee species. Across crops, years and biogeographical regions, crop-visiting wild bee communities are dominated by a small number of common species, and threatened species are rarely observed on crops. Dominant crop pollinators persist under agricultural expansion and many are easily enhanced by simple conservation measures, suggesting that cost-effective management strategies to promote crop pollination should target a different set of species than management strategies to promote threatened bees. Conserving the biological diversity of bees therefore requires more than just ecosystem-service-based arguments. PMID:26079893

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…

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...

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.

Motherhood: making it safer for Filipino women.

PubMed

Baylon, M C

1996-01-01

In November 1995, in the Philippines, the Department of Health implemented the Women's Health and Safe Motherhood Project. Its target audience is poor women in remote and underserved provinces. It addresses maternal health, reproductive tract infections (RTIs), sexually transmitted diseases (STDs), cervical cancer, domestic violence, and the desire to space births. It aims to improve the quality of women's health services through training of health providers, providing women with information to help them make informed choices, providing regular supplies and drugs, privacy and infection control at service delivery points, providing follow-up care, and improved cost-effective and technically-sound referral systems. The project also aims to ensure accessible service delivery points, well-equipped and maintained facilities, client and community feedback in managing service delivery, and information provision in order to increase acceptability of health services. The major components of the project include service delivery, institutional strengthening (via information, education, and communication; training of health providers; and improvement of the logistics system), community partnership for women's health development, and policy and operations research. The service delivery component will adopt a life-cycle approach to service delivery in Region 8 (urban and rural communities). It will pilot the syndromic approach in the management and detection of RTIs and STDs in 10 provinces. The biggest tasks of the project are upgrading referral networks from provincial and district hospitals to rural health units and barangay health stations and upgrading primary hospitals.

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.

Boosting ART uptake and retention among HIV-infected pregnant and breastfeeding women and their infants: the promise of innovative service delivery models.

PubMed

Srivastava, Meena; Sullivan, David; Phelps, B Ryan; Modi, Surbhi; Broyles, Laura N

2018-01-01

With the rapid scale-up of antiretroviral treatment (ART) in the "Treat All" era, there has been increasing emphasis on using differentiated models of HIV service delivery. The gaps within the clinical cascade for mothers and their infants suggest that current service delivery models are not meeting families' needs and prompt re-consideration of how services are provided. This article will explore considerations for differentiated care and encourage the ongoing increase of ART coverage through innovative strategies while also addressing the unique needs of mothers and infants. Service delivery models should recognize that the timing of the mother's HIV diagnosis is a critical aspect of determining eligibility. Women newly diagnosed with HIV require a more intensive approach so that adequate counselling and monitoring of ART initiation and response can be provided. Women already on ART with evidence of virologic failure are also at high risk of transmitting HIV to their infants and require close follow-up. However, women stable on ART with a suppressed viral load before conception have a very low likelihood of HIV transmission and thus are strong candidates for multi-month ART dispensing, community-based distribution of ART, adherence clubs, community adherence support groups and longer intervals between clinical visits. A number of other factors should be considered when defining eligibility of mothers and infants for differentiated care, including location of services, viral load monitoring and duration on ART. To provide differentiated care that is client-centred and driven while encompassing a family-based approach, it will be critical to engage mothers, families and communities in models that will optimize client satisfaction, retention in care and quality of services. Differentiated care for mothers and infants represents an opportunity to provide client-centred care that reduces the burden on clients and health systems while improving the quality and uptake of services for families. However, with decreasing funding, stable HIV incidence, and aspirations for sustainability, it is critical to consider efficient, customized and cost-effective models of care for these populations as we aspire to eliminate mother-to-child transmission of HIV. Published 2018. This article is a U.S. Government work and is in the public domain in the USA. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.

Providing Alternatives to Nursing Home Care: An Interorganizational Analysis.

ERIC Educational Resources Information Center

Austin, Carol D.

The development of alternatives to institutionally based long-term care requires the creation of greater interdependence among community based agencies and the provision of appropriate interdependence as the foundation for coordinated service delivery. Theoretical models of interorganizational interdependence are examined and assessed for their…

The Project Coordinators: A Key to the School of the Future.

ERIC Educational Resources Information Center

Iscoe, Louise K.

The Hogg Foundation for Mental Health created the School of the Future (SoF) project to enable selected Texas schools to coordinate and implement school-based social and health services on their campuses and to demonstrate the effectiveness of this method of service delivery by evaluating the project. This booklet reports on one aspect of the…

The Health Clinic. School of the Future: Houston.

ERIC Educational Resources Information Center

Iscoe, Louise

The Hogg Foundation for Mental Health created the School of the Future (SoF) project to enable selected Texas schools to coordinate and implement school-based social and health services on their campuses and to demonstrate the effectiveness of this method of service delivery by evaluating the project. SoF operated in four urban sites in Texas,…

Parent Volunteer Program. School of the Future: San Antonio.

ERIC Educational Resources Information Center

Iscoe, Louise

The Hogg Foundation for Mental Health created the School of the Future (SoF) project to enable selected Texas schools to coordinate and implement school-based social and health services on their campuses and to demonstrate the effectiveness of this method of service delivery by evaluating the project. This booklet focuses on the Parent Volunteer…

A Community Catalyst. School of the Future: Austin.

ERIC Educational Resources Information Center

Iscoe, Louise

The Hogg Foundation for Mental Health created the School of the Future (SoF) project to enable selected Texas schools to coordinate and implement school-based social and health services on their campuses and to demonstrate the effectiveness of this method of service delivery by evaluating the project. The projects, each of which involved a middle…

77 FR 47079 - Notice of Availability of Draft Policy Document for Comment

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-07

... Public Health Service Act (PHS Act) to support the delivery of preventive and primary care services to... section 1861(aa)(4) and section 1905(l)(2)(B) of the Social Security Act, FQHC Look-Alikes do not receive... support the fee and discount schedules based on an individual's ability to pay. When finalized, this PIN...

Postpartum family planning: current evidence on successful interventions.

PubMed

Blazer, Cassandra; Prata, Ndola

2016-01-01

We reviewed existing evidence of the efficacy of postpartum family planning interventions targeting women in the 12 months postpartum period in low- and middle-income countries. We searched for studies from January 1, 2004 to September 19, 2015, using the US Preventive Services Task Force recommendations to assess evidence quality. Our search resulted in 26 studies: 11 based in sub-Saharan Africa, six in the Middle East and North Africa, and nine in Asia. Twenty of the included studies assessed health facility-based interventions. Three were focused on community interventions, two had community and facility components, and one was a workplace program. Overall quality of the evidence was moderate, including evidence for counseling interventions. Male partner involvement, integration with other service delivery platforms, such as prevention of mother-to-child transmission of HIV and immunization, and innovative product delivery programs may increase knowledge and use during the postpartum period. Community-based and workplace strategies need a much stronger base of evidence to prompt recommendations.

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

PubMed

English, Mike

2013-03-28

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. 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. 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 providing the necessary understanding, knowledge, and skills for mid-level managers to work effectively with senior managers and frontline staff to improve services. The intervention will include development of an information system, feedback mechanisms, and discussion fora that promote positive change. The vehicle for such an intervention is a collaborative network partnering government and national professional associations. This case is presented to promote discussion on approaches to developing context appropriate interventions particularly in international health.

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 the introduction of clinical mentoring into the Jigawa State health system gave rise to an improved capacity of the mentored health care workers to deliver better quality maternal, newborn and child health services. It is anticipated that with a scale up of clinical mentoring, health outcomes will also significantly improve across northern Nigeria.

The Children's Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes.

PubMed

Vander Stoep, Ann; McCarty, Carolyn A; Zhou, Chuan; Rockhill, Carol M; Schoenfelder, Erin N; Myers, Kathleen

2017-01-01

The Children's Attention-deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) tested the hypotheses that children and caregivers who received guideline-based treatment delivered through a hybrid telehealth service delivery model would experience greater improvements in outcomes than children and caregivers receiving treatment via a comparison delivery model. Here, we present caregiver outcomes. 88 primary care providers (PCPs) in seven geographically underserved communities referred 223 children (ages 5.5 - 12.9 years) to the randomized controlled trial. Over 22 weeks, children randomized to the CATTS service delivery model received six sessions of telepsychiatry and six sessions of caregiver behavior management training provided in person by community therapists who were trained and supervised remotely. Children randomized to the comparison Augmented Primary Care (APC) service model received management in primary care augmented by a single telepsychiatry consultation. Caregiver outcomes included changes in distress, as measured by the Patient Health Questionnaire (PHQ-9), Parenting Stress Index (PSI), Caregiver Strain Questionnaire (CSQ) and Family Empowerment Scale (FES). Caregivers completed five assessments. Multilevel mixed effects regression modeling tested for differences between the two service delivery models in caregiver outcomes from baseline to 25 weeks. Compared to caregivers of children in the APC model, caregivers of children in the CATTS service model showed statistically significantly greater improvements on the PHQ-9 (β = -1.41, 95 % CI = [-2.74, -0.08], p < .05), PSI (β = -4.59, 95 % CI = [-7.87, - 1.31], p < .001), CSQ (β = -5.41, 95 % CI = [- 8.58, -2.24], p < .001) and FES (β = 6.69, 95 % CI = [2.32, 11.06], p < .01). Improvement in child ADHD symptoms mediated improved caregiver scores on the PSI and CSQ. Improvement in child ODD behaviors mediated caregiver CSQ scores. The CATTS trial supports the effectiveness of a hybrid telehealth service delivery model for reducing distress in caregivers of children with ADHD and suggests a mechanism through which the service model affected caregiver distress.

Human resource development for a community-based health extension program: a case study from Ethiopia.

PubMed

Teklehaimanot, Hailay D; Teklehaimanot, Awash

2013-08-20

Ethiopia is one of the sub-Saharan countries most affected by high disease burden, aggravated by a shortage and imbalance of human resources, geographical distance, and socioeconomic factors. In 2004, the government introduced the Health Extension Program (HEP), a primary care delivery strategy, to address the challenges and achieve the World Health Organization Millennium Development Goals (MDGs) within a context of limited resources. The health system was reformed to create a platform for integration and institutionalization of the HEP with appropriate human capacity, infrastructure, and management structures. Human resources were developed through training of female health workers recruited from their prospective villages, designed to limit the high staff turnover and address gender, social and cultural factors in order to provide services acceptable to each community. The service delivery modalities include household, community and health facility care. Thus, the most basic health post infrastructure, designed to rapidly and cost-effectively scale up HEP, was built in each village. In line with the country's decentralized management system, the HEP service delivery is under the jurisdiction of the district authorities. The nationwide implementation of HEP progressed in line with its target goals. In all, 40 training institutions were established, and over 30,000 Health Extension Workers have been trained and deployed to approximately 15,000 villages. The potential health service coverage reached 92.1% in 2011, up from 64% in 2004. While most health indicators have improved, performance in skilled delivery and postnatal care has not been satisfactory. While HEP is considered the most important institutional framework for achieving the health MDGs in Ethiopia, quality of service, utilization rate, access and referral linkage to emergency obstetric care, management, and evaluation of the program are the key challenges that need immediate attention. This article describes the strategies, human resource developments, service delivery modalities, progress in service coverage, and the challenges in the implementation of the HEP. The Ethiopian approach of revitalization of primary care through innovative, locally appropriate and acceptable strategies will provide important lessons to other poorly resourced countries. It is hoped that the approaches and strategies described in this paper will aid in that process.

Including customers in health service design.

PubMed

Perrott, Bruce E

2013-01-01

This article will explore the concept and meaning of codesign as it applies to the delivery of health services. The results of a pilot study in health codesign will be used as a research based case discussion, thus providing a platform to suggest future research that could lead to building more robust knowledge of how the consumers of health services may be more effectively involved in the process of developing and delivering the type of services that are in line with expectations of the various stakeholder groups.

20 CFR 641.210 - What services, in addition to the applicable core services, must SCSEP grantees and sub...

Code of Federal Regulations, 2011 CFR

2011-04-01

... core services, must SCSEP grantees and sub-recipients provide through the One-Stop delivery system? 641... Investment Act § 641.210 What services, in addition to the applicable core services, must SCSEP grantees and sub-recipients provide through the One-Stop delivery system? In addition to providing core services...

20 CFR 641.210 - What services, in addition to the applicable core services, must SCSEP grantees provide through...

Code of Federal Regulations, 2010 CFR

2010-04-01

... core services, must SCSEP grantees provide through the One-Stop Delivery System? 641.210 Section 641... § 641.210 What services, in addition to the applicable core services, must SCSEP grantees provide through the One-Stop Delivery System? In addition to providing core services, SCSEP grantees must make...

Involving a young person in the development of a digital resource in nurse education.

PubMed

Fenton, Gaynor

2014-01-01

Health policies across western societies have embedded the need for service user and carer perspectives in service design and delivery of educational programmes. There is a growing recognition of the need to include the perspectives of children and young people as service users in the design and delivery of child focused educational programmes. Digital storytelling provides a strategy for student nurses to gain insight into the lived experiences of children and young people. Engaging with these stories enables students to develop an understanding of a young persons' experience of healthcare. This paper outlines a project that developed a digital learning object based upon a young person's experience of cancer and student evaluations of the digital learning object as a teaching and learning strategy. Over 80% of students rated the digital learning object as interesting and were motivated to explore its content. In addition, the evaluation highlighted that listening to the young person's experiences of her treatment regimes was informative and assisted understanding of a patients' perspective of care delivery. Copyright © 2013 Elsevier Ltd. All rights reserved.

Models of home care services for persons with dementia: a narrative review.

PubMed

Low, Lee-Fay; Fletcher, Jennifer

2015-10-01

Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care. We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs. Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study. There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.

Barriers and enablers for iron folic acid (IFA) supplementation in pregnant women.

PubMed

Siekmans, Kendra; Roche, Marion; Kung'u, Jacqueline K; Desrochers, Rachelle E; De-Regil, Luz Maria

2017-12-22

In order to inform large scale supplementation programme design, we review and summarize the barriers and enablers for improved coverage and utilization of iron and folic acid (IFA) supplements by pregnant women in 7 countries in Africa and Asia. Mixed methods were used to analyse IFA supplementation programmes in Afghanistan, Bangladesh, Indonesia, Ethiopia, Kenya, Nigeria, and Senegal based on formative research conducted in 2012-2013. Qualitative data from focus-group discussions and interviews with women and service providers were used for content analysis to elicit common themes on barriers and enablers at internal, external, and relational levels. Anaemia symptoms in pregnancy are well known among women and health care providers in all countries, yet many women do not feel personally at risk. Broad awareness and increased coverage of facility-based antenatal care (ANC) make it an efficient delivery channel for IFA; however, first trimester access to IFA is hindered by beliefs about when to first attend ANC and preferences for disclosing pregnancy status. Variable access and poor quality ANC services, including insufficient IFA supplies and inadequate counselling to encourage consumption, are barriers to both coverage and adherence. Community-based delivery of IFA and referral to ANC provides earlier and more frequent access and opportunities for follow-up. Improving ANC access and quality is needed to facilitate IFA supplementation during pregnancy. Community-based delivery and counselling can address problems of timely and continuous access to supplements. Renewed investment in training for service providers and effective behaviour change designs are urgently needed to achieve the desired impact. © 2018 John Wiley & Sons Ltd.

Rethinking the cost of healthcare in low-resource settings: the value of time-driven activity-based costing

PubMed Central

McBain, Ryan K; Jerome, Gregory; Warsh, Jonathan; Browning, Micaela; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Rhatigan, Joseph; Leandre, Fernet; Kaplan, Robert

2016-01-01

Low-income and middle-income countries account for over 80% of the world's infectious disease burden, but <20% of global expenditures on health. In this context, judicious resource allocation can mean the difference between life and death, not just for individual patients, but entire patient populations. Understanding the cost of healthcare delivery is a prerequisite for allocating health resources, such as staff and medicines, in a way that is effective, efficient, just and fair. Nevertheless, health costs are often poorly understood, undermining effectiveness and efficiency of service delivery. We outline shortcomings, and consequences, of common approaches to estimating the cost of healthcare in low-resource settings, as well as advantages of a newly introduced approach in healthcare known as time-driven activity-based costing (TDABC). TDABC is a patient-centred approach to cost analysis, meaning that it begins by studying the flow of individual patients through the health system, and measuring the human, equipment and facility resources used to treat the patients. The benefits of this approach are numerous: fewer assumptions need to be made, heterogeneity in expenditures can be studied, service delivery can be modelled and streamlined and stronger linkages can be established between resource allocation and health outcomes. TDABC has demonstrated significant benefits for improving health service delivery in high-income countries but has yet to be adopted in resource-limited settings. We provide an illustrative case study of its application throughout a network of hospitals in Haiti, as well as a simplified framework for policymakers to apply this approach in low-resource settings around the world. PMID:28588971

Rethinking the cost of healthcare in low-resource settings: the value of time-driven activity-based costing.

PubMed

McBain, Ryan K; Jerome, Gregory; Warsh, Jonathan; Browning, Micaela; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Rhatigan, Joseph; Leandre, Fernet; Kaplan, Robert

2016-01-01

Low-income and middle-income countries account for over 80% of the world's infectious disease burden, but <20% of global expenditures on health. In this context, judicious resource allocation can mean the difference between life and death, not just for individual patients, but entire patient populations. Understanding the cost of healthcare delivery is a prerequisite for allocating health resources, such as staff and medicines, in a way that is effective, efficient, just and fair. Nevertheless, health costs are often poorly understood, undermining effectiveness and efficiency of service delivery. We outline shortcomings, and consequences, of common approaches to estimating the cost of healthcare in low-resource settings, as well as advantages of a newly introduced approach in healthcare known as time-driven activity-based costing (TDABC). TDABC is a patient-centred approach to cost analysis, meaning that it begins by studying the flow of individual patients through the health system, and measuring the human, equipment and facility resources used to treat the patients. The benefits of this approach are numerous: fewer assumptions need to be made, heterogeneity in expenditures can be studied, service delivery can be modelled and streamlined and stronger linkages can be established between resource allocation and health outcomes. TDABC has demonstrated significant benefits for improving health service delivery in high-income countries but has yet to be adopted in resource-limited settings. We provide an illustrative case study of its application throughout a network of hospitals in Haiti, as well as a simplified framework for policymakers to apply this approach in low-resource settings around the world.

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 a local CD4 laboratory. Full ITSDM implementation across 5 service tiers (as opposed to widespread implementation of POC testing to extend service) can facilitate sustainable ‘full service coverage’ across South Africa, and save>than R125 million in HIV/AIDS programmatic costs. ITSDM hierarchical parental-support also assures laboratory/POC management, equipment maintenance, quality control and on-going training between tiers. PMID:25490718