WorldWideScience

Sample records for care coverage indicators

  1. Measuring coverage in MNCH: indicators for global tracking of newborn care.

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    Allisyn C Moran

    Full Text Available Neonatal mortality accounts for 43% of under-five mortality. Consequently, improving newborn survival is a global priority. However, although there is increasing consensus on the packages and specific interventions that need to be scaled up to reduce neonatal mortality, there is a lack of clarity on the indicators needed to measure progress. In 2008, in an effort to improve newborn survival, the Newborn Indicators Technical Working Group (TWG was convened by the Saving Newborn Lives program at Save the Children to provide a forum to develop the indicators and standard measurement tools that are needed to measure coverage of key newborn interventions. The TWG, which included evaluation and measurement experts, researchers, individuals from United Nations agencies and non-governmental organizations, and donors, prioritized improved consistency of measurement of postnatal care for women and newborns and of immediate care behaviors and practices for newborns. In addition, the TWG promoted increased data availability through inclusion of additional questions in nationally representative surveys, such as the United States Agency for International Development-supported Demographic and Health Surveys and the United Nations Children's Fund-supported Multiple Indicator Cluster Surveys. Several studies have been undertaken that have informed revisions of indicators and survey tools, and global postnatal care coverage indicators have been finalized. Consensus has been achieved on three additional indicators for care of the newborn after birth (drying, delayed bathing, and cutting the cord with a clean instrument, and on testing two further indicators (immediate skin-to-skin care and applications to the umbilical cord. Finally, important measurement gaps have been identified regarding coverage data for evidence-based interventions, such as Kangaroo Mother Care and care seeking for newborn infection.

  2. Contraceptive Coverage and the Affordable Care Act.

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    Tschann, Mary; Soon, Reni

    2015-12-01

    A major goal of the Patient Protection and Affordable Care Act is reducing healthcare spending by shifting the focus of healthcare toward preventive care. Preventive services, including all FDA-approved contraception, must be provided to patients without cost-sharing under the ACA. No-cost contraception has been shown to increase uptake of highly effective birth control methods and reduce unintended pregnancy and abortion; however, some institutions and corporations argue that providing contraceptive coverage infringes on their religious beliefs. The contraceptive coverage mandate is evolving due to legal challenges, but it has already demonstrated success in reducing costs and improving access to contraception.

  3. Expanded managed care liability: what impact on employer coverage?

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    Studdert, D M; Sage, W M; Gresenz, C R; Hensler, D R

    1999-01-01

    Policymakers are considering legislative changes that would increase managed care organizations' exposure to civil liability for withholding coverage or failing to deliver needed care. Using a combination of empirical information and theoretical analysis, we assess the likely responses of health plans and Employee Retirement Income Security Act (ERISA) plan sponsors to an expansion of liability, and we evaluate the policy impact of those moves. We conclude that the direct costs of liability are uncertain but that the prospect of litigation may have other important effects on coverage decision making, information exchange, risk contracting, and the extent of employers' involvement in health coverage.

  4. Measuring coverage in MNCH: challenges and opportunities in the selection of coverage indicators for global monitoring.

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    Jennifer Harris Requejo

    Full Text Available Global monitoring of intervention coverage is a cornerstone of international efforts to improve reproductive, maternal, newborn, and child health. In this review, we examine the process and implications of selecting a core set of coverage indicators for global monitoring, using as examples the processes used by the Countdown to 2015 for Maternal, Newborn and Child Survival and the Commission on Accountability for Women's and Children's Health. We describe how the generation of data for global monitoring involves five iterative steps: development of standard indicator definitions and measurement approaches to ensure comparability across countries; collection of high-quality data at the country level; compilation of country data at the global level; organization of global databases; and rounds of data quality checking. Regular and rigorous technical review processes that involve high-level decision makers and experts familiar with indicator measurement are needed to maximize uptake and to ensure that indicators used for global monitoring are selected on the basis of available evidence of intervention effectiveness, feasibility of measurement, and data availability as well as programmatic relevance. Experience from recent initiatives illustrates the challenges of striking this balance as well as strategies for reducing the tensions inherent in the indicator selection process. We conclude that more attention and continued investment need to be directed to global monitoring, to support both the process of global database development and the selection of sets of coverage indicators to promote accountability. The stakes are high, because these indicators can drive policy and program development at the country and global level, and ultimately impact the health of women and children and the communities where they live.

  5. Health Care Coverage among Child Support-Eligible Children.

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    Aron, Laudan Y.

    Using data from the National Survey of America's Families (a nationally representative survey of the economic, social, and health characteristics of children, adults, and their families), this paper discusses health care coverage among child support eligible children. It begins with a detailed profile of child support eligible children living with…

  6. Measuring coverage in MNCH: a validation study linking population survey derived coverage to maternal, newborn, and child health care records in rural China.

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    Li Liu

    Full Text Available BACKGROUND: Accurate data on coverage of key maternal, newborn, and child health (MNCH interventions are crucial for monitoring progress toward the Millennium Development Goals 4 and 5. Coverage estimates are primarily obtained from routine population surveys through self-reporting, the validity of which is not well understood. We aimed to examine the validity of the coverage of selected MNCH interventions in Gongcheng County, China. METHOD AND FINDINGS: We conducted a validation study by comparing women's self-reported coverage of MNCH interventions relating to antenatal and postnatal care, mode of delivery, and child vaccinations in a community survey with their paper- and electronic-based health care records, treating the health care records as the reference standard. Of 936 women recruited, 914 (97.6% completed the survey. Results show that self-reported coverage of these interventions had moderate to high sensitivity (0.57 [95% confidence interval (CI: 0.50-0.63] to 0.99 [95% CI: 0.98-1.00] and low to high specificity (0 to 0.83 [95% CI: 0.80-0.86]. Despite varying overall validity, with the area under the receiver operating characteristic curve (AUC ranging between 0.49 [95% CI: 0.39-0.57] and 0.90 [95% CI: 0.88-0.92], bias in the coverage estimates at the population level was small to moderate, with the test to actual positive (TAP ratio ranging between 0.8 and 1.5 for 24 of the 28 indicators examined. Our ability to accurately estimate validity was affected by several caveats associated with the reference standard. Caution should be exercised when generalizing the results to other settings. CONCLUSIONS: The overall validity of self-reported coverage was moderate across selected MNCH indicators. However, at the population level, self-reported coverage appears to have small to moderate degree of bias. Accuracy of the coverage was particularly high for indicators with high recorded coverage or low recorded coverage but high specificity. The

  7. 75 FR 2562 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Science.gov (United States)

    2010-01-15

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage... Administration, Department of Labor. ACTION: Notice of the Availability of the Model Health Care Continuation... document announces the availability of the model health care continuation coverage notices required by...

  8. 75 FR 26276 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Science.gov (United States)

    2010-05-11

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage... Administration, Department of Labor. ACTION: Notice of the Availability of the Model Health Care Continuation... announces the availability of the model health care continuation coverage notices required by ARRA,...

  9. 75 FR 13595 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Science.gov (United States)

    2010-03-22

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage... Administration, Department of Labor. ACTION: Notice of the availability of the Model Health Care Continuation... document announces the availability of the model health care continuation coverage notices required by...

  10. ESTIMATION OF SEAGRASS COVERAGE BY DEPTH INVARIANT INDICES ON QUICKBIRD IMAGERY

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    Muhammad Anshar Amran

    2010-01-01

    Full Text Available Management of seagrass ecosystem requires availability of information on the actual condition of seagrass coverage. Remote sensing technology for seagrass mapping has been used to detect the presence of seagrass coverage, but so far no information on the condition of seagrass could be obtained. Therefore, a research is required using remote sensing imagery to obtain information on the condition of seagrass coverage.The aim of this research is to formulate mathematical relationship between seagrass coverage and depth invariant indices on Quickbird imagery. Transformation was done on multispectral bands which could detect sea floor objects that are in the region of blue, green and red bands.The study areas covered are the seas around Barranglompo Island and Barrangcaddi Island, westward of Makassar city, Indonesia. Various seagrass coverages were detected within the region under study.Mathematical relationship between seagrass coverage and depth invariant indices was obtained by multiple linear regression method. Percentage of seagrass coverage (C was obtained by transformation of depth invariant indices (Xij on Quickbird imagery, with transformation equation as follows:C = 19.934 – 63.347 X12 + 23.239 X23.A good accuracy of 75% for the seagrass coverage was obtained by transformation of depth invariant indices (Xij on Quickbird imagery.

  11. Beyond UHC: monitoring health and social protection coverage in the context of tuberculosis care and prevention.

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    Lönnroth, Knut; Glaziou, Philippe; Weil, Diana; Floyd, Katherine; Uplekar, Mukund; Raviglione, Mario

    2014-09-01

    Tuberculosis (TB) remains a major global public health problem. In all societies, the disease affects the poorest individuals the worst. A new post-2015 global TB strategy has been developed by WHO, which explicitly highlights the key role of universal health coverage (UHC) and social protection. One of the proposed targets is that "No TB affected families experience catastrophic costs due to TB." High direct and indirect costs of care hamper access, increase the risk of poor TB treatment outcomes, exacerbate poverty, and contribute to sustaining TB transmission. UHC, conventionally defined as access to health care without risk of financial hardship due to out-of-pocket health care expenditures, is essential but not sufficient for effective and equitable TB care and prevention. Social protection interventions that prevent or mitigate other financial risks associated with TB, including income losses and non-medical expenditures such as on transport and food, are also important. We propose a framework for monitoring both health and social protection coverage, and their impact on TB epidemiology. We describe key indicators and review methodological considerations. We show that while monitoring of general health care access will be important to track the health system environment within which TB services are delivered, specific indicators on TB access, quality, and financial risk protection can also serve as equity-sensitive tracers for progress towards and achievement of overall access and social protection.

  12. Beyond UHC: monitoring health and social protection coverage in the context of tuberculosis care and prevention.

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    Knut Lönnroth

    2014-09-01

    Full Text Available Tuberculosis (TB remains a major global public health problem. In all societies, the disease affects the poorest individuals the worst. A new post-2015 global TB strategy has been developed by WHO, which explicitly highlights the key role of universal health coverage (UHC and social protection. One of the proposed targets is that "No TB affected families experience catastrophic costs due to TB." High direct and indirect costs of care hamper access, increase the risk of poor TB treatment outcomes, exacerbate poverty, and contribute to sustaining TB transmission. UHC, conventionally defined as access to health care without risk of financial hardship due to out-of-pocket health care expenditures, is essential but not sufficient for effective and equitable TB care and prevention. Social protection interventions that prevent or mitigate other financial risks associated with TB, including income losses and non-medical expenditures such as on transport and food, are also important. We propose a framework for monitoring both health and social protection coverage, and their impact on TB epidemiology. We describe key indicators and review methodological considerations. We show that while monitoring of general health care access will be important to track the health system environment within which TB services are delivered, specific indicators on TB access, quality, and financial risk protection can also serve as equity-sensitive tracers for progress towards and achievement of overall access and social protection.

  13. Impact of Universal Health Care Coverage on patient demand for health care services in Thailand.

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    Panpiemras, Jirawat; Puttitanun, Thitima; Samphantharak, Krislert; Thampanishvong, Kannika

    2011-12-01

    Fully implemented in Thailand in 2002, the Universal Health Care Coverage (UC) Program aimed to provide cheap access to health care services, for 30 baht (less than 1 U.S. dollar) per visit, to all uninsured Thais. In this paper, we studied the impact of the UC in Thailand on the demand for health care services using hospital level data. We found that the UC program was successful in increasing outpatient demand for health care, particularly the demand from the elderly and the poor. However, outpatient demand for health care dramatically increased during the first year of the program and faded away quickly in subsequent years. In contrast to outpatient demand, the number of inpatient visits and the number of days for which the inpatients were admitted at hospitals declined after the UC program was launched. In this paper, we offer our explanation of these phenomena, highlight problems associated with the UC program, and provide policy recommendations to improve the program.

  14. Improving Health Care Coverage, Equity, And Financial Protection Through A Hybrid System: Malaysia's Experience.

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    Rannan-Eliya, Ravindra P; Anuranga, Chamara; Manual, Adilius; Sararaks, Sondi; Jailani, Anis S; Hamid, Abdul J; Razif, Izzanie M; Tan, Ee H; Darzi, Ara

    2016-05-01

    Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources.

  15. Use of performance metrics for the measurement of universal coverage for maternal care in Mexico.

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    Serván-Mori, Edson; Contreras-Loya, David; Gomez-Dantés, Octavio; Nigenda, Gustavo; Sosa-Rubí, Sandra G; Lozano, Rafael

    2017-01-20

    This study provides evidence for those working in the maternal health metrics and health system performance fields, as well as those interested in achieving universal and effective health care coverage. Based on the perspective of continuity of health care and applying quasi-experimental methods to analyse the cross-sectional 2009 National Demographic Dynamics Survey (n = 14 414 women), we estimated the middle-term effects of Mexico's new public health insurance scheme, Seguro Popular de Salud (SPS) (vs women without health insurance) on seven indicators related to maternal health care (according to official guidelines): (a) access to skilled antenatal care (ANC); (b) timely ANC; (c) frequent ANC; (d) adequate content of ANC; (e) institutional delivery; (f) postnatal consultation and (g) access to standardized comprehensive antenatal and postnatal care (or the intersection of the seven process indicators). Our results show that 94% of all pregnancies were attended by trained health personnel. However, comprehensive access to ANC declines steeply in both groups as we move along the maternal healthcare continuum. The percentage of institutional deliveries providing timely, frequent and adequate content of ANC reached 70% among SPS women (vs 64.7% in the uninsured), and only 57.4% of SPS-affiliated women received standardized comprehensive care (vs 53.7% in the uninsured group). In Mexico, access to comprehensive antenatal and postnatal care as defined by Mexican guidelines (in accordance to WHO recommendations) is far from optimal. Even though a positive influence of SPS on maternal care was documented, important challenges still remain. Our results identified key bottlenecks of the maternal healthcare continuum that should be addressed by policy makers through a combination of supply side interventions and interventions directed to social determinants of access to health care.

  16. Partial-year insurance coverage and the health care utilization of children.

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    Leininger, Lindsey Jeanne

    2009-02-01

    A large literature examines the effects of health insurance on the health care utilization of children; however, most existing studies conceptualize coverage as a point-in-time measure rather than as a dynamic phenomenon. The major contribution of this article is its provision of estimates on the relationship between the duration of coverage over the course of a calendar year and health care utilization among children. Using child-level fixed-effects regression, we find that an incremental uninsured month is associated with a 0.7 percentage point decline in the probability of receiving a visit over the course of a year and a 3% decrease in the number of visits received. Children with intrayear coverage losses are more likely than those with continuous coverage to lose their usual source of care, which serves as a potential mechanism through which short gaps in coverage may lead to longer-term decrements in utilization.

  17. 42 CFR 418.21 - Duration of hospice care coverage-Election periods.

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    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Duration of hospice care coverage-Election periods... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.21 Duration of hospice care coverage—Election periods. (a) Subject to the conditions set forth...

  18. Influenza Vaccination Coverage Among Health Care Personnel - United States, 2015-16 Influenza Season.

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    Black, Carla L; Yue, Xin; Ball, Sarah W; Donahue, Sara M A; Izrael, David; de Perio, Marie A; Laney, A Scott; Williams, Walter W; Lindley, Megan C; Graitcer, Samuel B; Lu, Peng-Jun; DiSogra, Charles; Devlin, Rebecca; Walker, Deborah K; Greby, Stacie M

    2016-09-30

    The Advisory Committee on Immunization Practices recommends annual influenza vaccination for all health care personnel to reduce influenza-related morbidity and mortality among both health care personnel and their patients (1-4). To estimate influenza vaccination coverage among U.S. health care personnel for the 2015-16 influenza season, CDC conducted an opt-in Internet panel survey of 2,258 health care personnel during March 28-April 14, 2016. Overall, 79.0% of survey participants reported receiving an influenza vaccination during the 2015-16 season, similar to the 77.3% coverage reported for the 2014-15 season (5). Coverage in long-term care settings increased by 5.3 percentage points compared with the previous season. Vaccination coverage continued to be higher among health care personnel working in hospitals (91.2%) and lower among health care personnel working in ambulatory (79.8%) and long-term care settings (69.2%). Coverage continued to be highest among physicians (95.6%) and lowest among assistants and aides (64.1%), and highest overall among health care personnel who were required by their employer to be vaccinated (96.5%). Among health care personnel working in settings where vaccination was neither required, promoted, nor offered onsite, vaccination coverage continued to be low (44.9%). An increased percentage of health care personnel reporting a vaccination requirement or onsite vaccination availability compared with earlier influenza seasons might have contributed to the overall increase in vaccination coverage during the past 6 influenza seasons.

  19. Equity in maternal, newborn, and child health care coverage in India

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    Prashant Singh

    2013-09-01

    Full Text Available Background: Addressing inequitable coverage of maternal and child health care services among different socioeconomic strata of population and across states is an important part of India's contemporary health program. This has wide implications for the achievement of the Millennium Development Goal targets. Objective: This paper assesses the inequity in coverage of maternal, newborn, and child health (MNCH care services across household wealth quintiles in India and its states. Design: Utilizing the District Level Household and Facility Survey conducted during 2007–08, this paper has constructed a Composite Coverage Index (CCI in MNCH care. Results: The mean overall coverage of 45% was estimated at the national level, ranging from 31% for the poorest to 60% for the wealthiest quintile. Moreover, a massive state-wise difference across wealth quintiles was observed in the mean overall CCI. Almost half of the Indian states and union territories recorded a =50% coverage in MNCH care services, which demands special attention. Conclusion: India needs focused efforts to address the inequity in coverage of health care services by recognising or defining underserved people and pursuing well-planned time-oriented health programs committed to ameliorate the present state of MNCH care.

  20. Media coverage and children's reactions to disaster with implications for primary care and public health.

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    Pfefferbaum, Betty; Jeon-Slaughter, Hattie; Pfefferbaum, Rose L; Houston, J Brian; Rainwater, Scott M; Regens, James L

    2008-12-01

    To address the potential for media coverage of traumatic events to generate fear reactions in children, we examined exposure and reactions to media coverage of the 1995 Oklahoma City bombing in children attending a middle school 100 miles from the disaster site two and three years after the event. Many of the children studied recalled feeling "afraid," "sad," or "mad" in relation to initial media coverage. Overall exposure and reactions to bomb-related media coverage declined over the three years. However, these reactions persisted for some children and, when they did, the reactions were related to exposure to coverage right after the bombing. Approximately one-fourth of the children recalled that the bombing made them feel "a lot" less safe in their home, school, and/or neighborhood. These perceptions persisted for approximately 10% of the children. Our Findings suggest the importance of primary care and public health interventions to determine and monitor children's reactions.

  1. Assessing coverage, equity and quality gaps in maternal and neonatal care in sub-saharan Africa: an integrated approach.

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    Calistus Wilunda

    Full Text Available Gaps in coverage, equity and quality of health services hinder the achievement of the Millennium Development Goals 4 and 5 in most countries of sub-Saharan Africa as well as in other high-burden countries, yet few studies attempt to assess all these dimensions as part of the situation analysis. We present the base-line data of a project aimed at simultaneously addressing coverage, equity and quality issues in maternal and neonatal health care in five districts belonging to three African countries.Data were collected in cross-sectional studies with three types of tools. Coverage was assessed in three hospitals and 19 health centres (HCs utilising emergency obstetric and newborn care needs assessment tools developed by the Averting Maternal Death and Disability program. Emergency obstetrics care (EmOC indicators were calculated. Equity was assessed in three hospitals and 13 HCs by means of proxy wealth indices and women delivering in health facilities were compared with those in the general population to identify inequities. Quality was assessed in three hospitals using the World Health Organization's maternal and neonatal quality of hospital care assessment tool which evaluates the whole range of aspects of obstetric and neonatal care and produces an average score for each main area of care.All the three hospitals qualified as comprehensive EmOC facilities but none of the HCs qualified for basic EmOC. None of the districts met the minimum requisites for EmOC indicators. In two out of three hospitals, there were major quality gaps which were generally greater in neonatal care, management of emergency and complicated cases and monitoring. Higher access to care was coupled by low quality and good quality by very low access. Stark inequities in utilisation of institutional delivery care were present in all districts and across all health facilities, especially at hospital level.Our findings confirm the existence of serious issues regarding coverage

  2. Achieving universal health care coverage: Current debates in Ghana on covering those outside the formal sector

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    Abiiro Gilbert

    2012-10-01

    Full Text Available Abstract Background Globally, extending financial protection and equitable access to health services to those outside the formal sector employment is a major challenge for achieving universal coverage. While some favour contributory schemes, others have embraced tax-funded health service cover for those outside the formal sector. This paper critically examines the issue of how to cover those outside the formal sector through the lens of stakeholder views on the proposed one-time premium payment (OTPP policy in Ghana. Discussion Ghana in 2004 implemented a National Health Insurance Scheme, based on a contributory model where service benefits are restricted to those who contribute (with some groups exempted from contributing, as the policy direction for moving towards universal coverage. In 2008, the OTPP system was proposed as an alternative way of ensuring coverage for those outside formal sector employment. There are divergent stakeholder views with regard to the meaning of the one-time premium and how it will be financed and sustained. Our stakeholder interviews indicate that the underlying issue being debated is whether the current contributory NHIS model for those outside the formal employment sector should be maintained or whether services for this group should be tax funded. However, the advantages and disadvantages of these alternatives are not being explored in an explicit or systematic way and are obscured by the considerable confusion about the likely design of the OTPP policy. We attempt to contribute to the broader debate about how best to fund coverage for those outside the formal sector by unpacking some of these issues and pointing to the empirical evidence needed to shed even further light on appropriate funding mechanisms for universal health systems. Summary The Ghanaian debate on OTPP is related to one of the most important challenges facing low- and middle-income countries seeking to achieve a universal health care system. It

  3. Surveillance of mother-to-child HIV transmission: socioeconomic and health care coverage indicators Vigilância da transmissão vertical do HIV: indicadores socioeconômicos e de cobertura de atenção à saúde

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    Christovam Barcellos

    2009-12-01

    Full Text Available OBJECTIVE: To identify clustering areas of infants exposed to HIV during pregnancy and their association with indicators of primary care coverage and socioeconomic condition. METHODS: Ecological study where the unit of analysis was primary care coverage areas in the city of Porto Alegre, Southern Brazil, in 2003. Geographical Information System and spatial analysis tools were used to describe indicators of primary care coverage areas and socioeconomic condition, and estimate the prevalence of liveborn infants exposed to HIV during pregnancy and delivery. Data was obtained from Brazilian national databases. The association between different indicators was assessed using Spearman's nonparametric test. RESULTS: There was found an association between HIV infection and high birth rates (r=0.22, pOBJETIVO: Identificar áreas de concentración de niños expuestos al HIV durante la gestación y su asociación con indicadores de cobertura de la atención básica de la salud, y de condiciones socioeconómicas salud. MÉTODOS: Estudio ecológico teniendo como unidad de análisis las áreas que abarcan unidades básicas de salud en Porto Alegre, Sur de Brasil, en 2003. Fueron utilizados Sistema de Informaciones Geográficas y herramientas de análisis espacial para calcular indicadores de cobertura de atención básica de la salud, condiciones socioeconómicas y prevalencia e nacidos vivos expuestos al HIV durante el embarazo y perinatal. Los datos analizados fueron obtenidos en sistemas de información nacionales. La asociación entre los diferentes indicadores fue evaluada por medio de prueba no paramétrica de Spearman. RESULTADOS: Se observó asociación entre infección por el HIV en embarazadas con tasas de natalidad (r=0,22, pOBJETIVO: Identificar áreas de concentração de crianças expostas ao HIV durante a gestação e sua associação com indicadores de cobertura da atenção básica à saúde, e de condições socioeconômicas saúde. M

  4. Health Care as Commons: An Indigenous Approach to Universal Health Coverage

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    Young Soon Wong

    2014-06-01

    Full Text Available Modern health care systems of today are predominantly derived from Western models and are either state owned or under private ownership. Government, through their health policies, generally aim to facilitate access for the majority of the population through the design of their health systems. However, there are communities, such as Indigenous peoples, who do not necessarily fall under the formal protection of state systems. Throughout history, these societies have developed different ways to provide health care to its population. These health care systems are held and managed under different property regimes with their attendant advantages and disadvantages. This article investigates the gaps in health coverage among Indigenous peoples using the Malaysian Indigenous peoples as a case study. It conceptually examines a commons approach to health care systems through a study of the traditional health care system of indigenous peoples and suggests how such an approach can help close this gap in the remaining gaps of universal health coverage.

  5. From Coverage to Care: Strengthening and Facilitating Consumer Connections to the Health System.

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    Martin, Laurie T; Luoto, Jill E

    2015-11-30

    To date, most Affordable Care Act implementation efforts have focused on getting individuals enrolled in health insurance coverage; indeed, millions of Americans, many of whom had never been insured, have since obtained health coverage, either through the health insurance marketplaces or through expanded Medicaid eligibility, if available in their state. Yet reducing the number of uninsured is only part of the law's goal. It also aims to improve population health and lower health care costs. Less attention has been paid to confirming that the newly insured obtain appropriate health care and maintain long-term relationships with their health care providers, which are critical steps to help achieve these latter goals. This article describes lessons learned from conversations with a variety of stakeholders in the health care industry. These conversations covered the gamut of steps consumers must undergo to become fully engaged with their health care, from applying for coverage and selecting a plan to finding a provider, accessing care, and engaging in care over time. In each phase of the process, consumers must take specific actions and overcome new challenges. Stakeholder efforts to help consumers often focus on just one of these phases, at the expense of the bigger picture, and often occur in isolation, with little coordination across stakeholder groups. Thinking more strategically and holistically can help provide the "connective tissue" that can help prevent consumers from becoming disengaged and falling through the system's cracks.

  6. Geographical disparities in core population coverage indicators for roll back malaria in Malawi

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    Appleton Christopher C

    2007-07-01

    Full Text Available Abstract Background Implementation of known effective interventions would necessitate the reduction of malaria burden by half by the year 2010. Identifying geographical disparities of coverage of these interventions at small area level is useful to inform where greatest scaling-up efforts should be concentrated. They also provide baseline data against which future scaling-up of interventions can be compared. However, population data are not always available at local level. This study applied spatial smoothing methods to generate maps at subdistrict level in Malawi to serve such purposes. Methods Data for the following responses from the 2000 Malawi Demographic and Health Survey (DHS were aggregated at subdistrict level: (1 households possessing at least one bednet; (2 children under 5 years who slept under a bednet the night before the survey; (3 bednets retreated with insecticide within past 6–12 months preceding the survey; (4 children under 5 who had fever two weeks before the survey and received treatment within 24 hours from the onset of fever; and (5 women who received intermittent preventive treatment of malaria during their last pregnancy. Each response was geographically smoothed at subdistrict level by applying conditional autoregressive models using Markov Chain Monte Carlo simulation techniques. Results The underlying geographical patterns of coverage of indicators were more clear in the smoothed maps than in the original unsmoothed maps, with relatively high coverage in urban areas than in rural areas for all indicators. The percentage of households possessing at least one bednet was 19% (95% credible interval (CI: 16–21%, with 9% (95% CI: 7–11% of children sleeping under a net, while 18% (95% CI: 16–19% of households had retreated their nets within past 12 months prior to the survey. The northern region and lakeshore areas had high bednet coverage, but low usage and re-treatment rates. Coverage rate of children who received

  7. Is universal health coverage the practical expression of the right to health care?

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    Ooms, Gorik; Latif, Laila A; Waris, Attiya; Brolan, Claire E; Hammonds, Rachel; Friedman, Eric A; Mulumba, Moses; Forman, Lisa

    2014-02-24

    The present Millennium Development Goals are set to expire in 2015 and their next iteration is now being discussed within the international community. With regards to health, the World Health Organization proposes universal health coverage as a 'single overarching health goal' for the next iteration of the Millennium Development Goals.The present Millennium Development Goals have been criticised for being 'duplicative' or even 'competing alternatives' to international human rights law. The question then arises, if universal health coverage would indeed become the single overarching health goal, replacing the present health-related Millennium Development Goals, would that be more consistent with the right to health? The World Health Organization seems to have anticipated the question, as it labels universal health coverage as "by definition, a practical expression of the concern for health equity and the right to health".Rather than waiting for the negotiations to unfold, we thought it would be useful to verify this contention, using a comparative normative analysis. We found that--to be a practical expression of the right to health--at least one element is missing in present authoritative definitions of universal health coverage: a straightforward confirmation that international assistance is essential, not optional.But universal health coverage is a 'work in progress'. A recent proposal by the United Nations Sustainable Development Solutions Network proposed universal health coverage with a set of targets, including a target for international assistance, which would turn universal health coverage into a practical expression of the right to health care.

  8. Malaria indicator survey 2007, Ethiopia: coverage and use of major malaria prevention and control interventions

    Directory of Open Access Journals (Sweden)

    Graves Patricia M

    2010-02-01

    Full Text Available Abstract Background In 2005, a nationwide survey estimated that 6.5% of households in Ethiopia owned an insecticide-treated net (ITN, 17% of households had been sprayed with insecticide, and 4% of children under five years of age with a fever were taking an anti-malarial drug. Similar to other sub-Saharan African countries scaling-up malaria interventions, the Government of Ethiopia set an ambitious national goal in 2005 to (i provide 100% ITN coverage in malarious areas, with a mean of two ITNs per household; (ii to scale-up indoor residual spraying of households with insecticide (IRS to cover 30% of households targeted for IRS; and (iii scale-up the provision of case management with rapid diagnostic tests (RDTs and artemisinin-based combination therapy (ACT, particularly at the peripheral level. Methods A nationally representative malaria indicator survey (MIS was conducted in Ethiopia between September and December 2007 to determine parasite and anaemia prevalence in the population at risk and to assess coverage, use and access to scaled-up malaria prevention and control interventions. The survey used a two-stage random cluster sample of 7,621 households in 319 census enumeration areas. A total of 32,380 people participated in the survey. Data was collected using standardized Roll Back Malaria Monitoring and Evaluation Reference Group MIS household and women's questionnaires, which were adapted to the local context. Results Data presented is for households in malarious areas, which according to the Ethiopian Federal Ministry of Health are defined as being located Plasmodium falciparum and Plasmodium vivax, respectively. Moderate-severe anaemia (haemoglobin Conclusions Since mid-2005, the Ethiopian National Malaria Control Programme has considerably scaled-up its malaria prevention and control interventions, demonstrating the impact of strong political will and a committed partnership. The MIS showed, however, that besides sustaining and

  9. Payments for health care and its effect on catastrophe and impoverishment: experience from the transition to Universal Coverage in Thailand.

    Science.gov (United States)

    Somkotra, Tewarit; Lagrada, Leizel P

    2008-12-01

    Equitable health financing was embodied in the reform strategies of Thailand's health care system when the country moved towards implementing the Universal Coverage (UC) policy in 2001. This study aimed to measure the pattern of household out-of-pocket payments for health care and to examine the financial catastrophe and impoverishment due to such payments during the transitional period (pre- and post-Universal Coverage policy implementation) in Thailand. This study used the nationally representative Socioeconomic Surveys in 2000 (pre-UC), 2002, and 2004 (post-UC), which contained data from 24747, 34758 and 34843 individual households, respectively. The proportion of out-of-pocket payments for health care as a share of household living standards among Thai households shows a decreasing pattern during the observed period. Moreover, the incidence and intensity of catastrophic payments for health care decline from the pre-UC to post-UC period. The distribution of incidence and the intensity of catastrophic payments for health care across quintiles also indicate that the lower quintile group (1st and 2nd quintiles) incurs lower catastrophic health care payments compared to the higher quintile group. The UC policy is also effective in preventing impoverishment due to out-of-pocket payments for health care since both the poverty headcount and poverty gap decline from the pre-UC to post-UC period. This study provides important evidence that the UC policy implementation is a valuable social protection and safety net strategy that contributes to the prevention of financial catastrophe and impoverishment due to out-of-pocket payments for health care. In conclusion, the UC policy in Thailand achieves one of the goals of improving the health system through equitable health care financing by reducing financial catastrophe and impoverishment due to out-of-pocket payments for health care.

  10. Coverage and quality of antenatal care provided at primary health care facilities in the 'Punjab' province of 'Pakistan'.

    Directory of Open Access Journals (Sweden)

    Muhammad Ashraf Majrooh

    Full Text Available BACKGROUND: Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In 'Pakistan' antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to 'Divisions' and 'Districts'. By population 'Punjab' is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in 'Punjab' province of 'Pakistan'. METHODS: Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. RESULTS: The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. CONCLUSION: The coverage and quality of the antenatal care services in 'Punjab' are extremely compromised. Only half of the expected pregnancies are enrolled and

  11. Achieving Effective Universal Health Coverage And Diagonal Approaches To Care For Chronic Illnesses.

    Science.gov (United States)

    Knaul, Felicia Marie; Bhadelia, Afsan; Atun, Rifat; Frenk, Julio

    2015-09-01

    Health systems in low- and middle-income countries were designed to provide episodic care for acute conditions. However, the burden of disease has shifted to be overwhelmingly dominated by chronic conditions and illnesses that require health systems to function in an integrated manner across a spectrum of disease stages from prevention to palliation. Low- and middle-income countries are also aiming to ensure health care access for all through universal health coverage. This article proposes a framework of effective universal health coverage intended to meet the challenge of chronic illnesses. It outlines strategies to strengthen health systems through a "diagonal approach." We argue that the core challenge to health systems is chronicity of illness that requires ongoing and long-term health care. The example of breast cancer within the broader context of health system reform in Mexico is presented to illustrate effective universal health coverage along the chronic disease continuum and across health systems functions. The article concludes with recommendations to strengthen health systems in order to achieve effective universal health coverage.

  12. Coverage of certain preventive services under the Affordable Care Act. Interim final rules.

    Science.gov (United States)

    2014-08-27

    This document contains interim final regulations regarding coverage of certain preventive services under section 2713 of the Public Health Service Act (PHS Act), added by the Patient Protection and Affordable Care Act, as amended, and incorporated into the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code. Section 2713 of the PHS Act requires coverage without cost sharing of certain preventive health services by non-grandfathered group health plans and health insurance coverage. Among these services are women's preventive health services, as specified in guidelines supported by the Health Resources and Services Administration (HRSA). As authorized by the current regulations, and consistent with the HRSA Guidelines, group health plans established or maintained by certain religious employers (and group health insurance coverage provided in connection with such plans) are exempt from the otherwise applicable requirement to cover certain contraceptive services. Additionally, under current regulations, accommodations are available with respect to the contraceptive coverage requirement for group health plans established or maintained by eligible organizations (and group health insurance coverage provided in connection with such plans), and student health insurance coverage arranged by eligible organizations that are institutions of higher education, that effectively exempt them from this requirement. The regulations establish a mechanism for separately furnishing payments for contraceptive services on behalf of participants and beneficiaries of the group health plans of eligible organizations that avail themselves of an accommodation, and enrollees and dependents of student health coverage arranged by eligible organizations that are institutions of higher education that avail themselves of an accommodation. These interim final regulations augment current regulations in light of the Supreme Court's interim order in connection with an

  13. Universal Health Coverage and the Right to Health: From Legal Principle to Post-2015 Indicators.

    Science.gov (United States)

    Sridhar, Devi; McKee, Martin; Ooms, Gorik; Beiersmann, Claudia; Friedman, Eric; Gouda, Hebe; Hill, Peter; Jahn, Albrecht

    2015-01-01

    Universal Health Coverage (UHC) is widely considered one of the key components for the post-2015 health goal. The idea of UHC is rooted in the right to health, set out in the International Covenant on Economic, Social, and Cultural Rights. Based on the Covenant and the General Comment of the Committee on Economic, Social, and Cultural Rights, which is responsible for interpreting and monitoring the Covenant, we identify 6 key legal principles that should underpin UHC based on the right to health: minimum core obligation, progressive realization, cost-effectiveness, shared responsibility, participatory decision making, and prioritizing vulnerable or marginalized groups. Yet, although these principles are widely accepted, they are criticized for not being specific enough to operationalize as post-2015 indicators for reaching the target of UHC. In this article, we propose measurable and achievable indicators for UHC based on the right to health that can be used to inform the ongoing negotiations on Sustainable Development Goals. However, we identify 3 major challenges that face any exercise in setting indicators post-2015: data availability as an essential criterion, the universality of targets, and the adaptation of global goals to local populations.

  14. Public trust in health care : a performance indicator?

    NARCIS (Netherlands)

    Schee, Evelien van der; Groenewegen, Peter P.; Friele, Ronald D.

    2006-01-01

    Purpose – If public trust in health care is to be used as a performance indicator for health care systems, its measurement has to be sensitive to changes in the health care system. For this purpose, this study has monitored public trust in health care in The Netherlands over an eight-year period, fr

  15. The accountable health care act of Massachusetts: mixed results for an experiment in universal health care coverage.

    Science.gov (United States)

    Norbash, Alexander; Hindson, David; Heineke, Janelle

    2012-10-01

    The affordable health care act of Massachusetts, signed into law in 2006, resulted in 98% of Massachusetts residents' having some form of insurance coverage by 2011, the highest coverage rate for residents of any state in the nation. With a strong economy, a low unemployment rate, a robust health care delivery system, an extremely low number of undocumented immigrants, and a low baseline uninsured rate, Massachusetts was well positioned for such an effort. Ingredients included mandates, the creation of separate insurance vehicles directed to both poverty-level and non-poverty-level residents, and the reallocation of the former free care pool. The mandates included consumer mandates and employer mandates; the consumer mandate applies to all Massachusetts residents at the risk of losing personal state tax exemptions, and the employer mandate applies to all Massachusetts businesses with 10 or more employees at the risk of per employee financial penalties. The insurance vehicles were created with premiums allocated on the basis of ability to pay by income classes. Unexpected effects included escalating taxpayer health care costs, with taxpayers shouldering the burden for the newly insured, continuing escalating health care costs at a rate greater than the national average, overburdening primary caregivers as newly insured sought new primary care gatekeepers in a system with primary caregiver shortages, and deprivation of support to the safety-net hospitals as a result of siphoned commonwealth free care pool funds. This exercise demonstrates specific benefits and shortfalls of the Massachusetts health care reform experiment, given the conditions and circumstances found in Massachusetts at the time of implementation.

  16. Continuing Care Retirement Communities: An Analysis of Financial Viability and Health Care Coverage.

    Science.gov (United States)

    Ruchlin, Hirsch S.

    1988-01-01

    Calculated financial ratios for 109 Continuing Care Retirement Communities (CCRCs). Noted problems with regard to asset productivity, profitability, and equity levels. Found that a risk-spreading charge structure for financing health care needs appeared to exist among CCRCs providing a full-care contract. (Author/ABL)

  17. 42 CFR 440.385 - Delivery of benchmark and benchmark-equivalent coverage through managed care entities.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Delivery of benchmark and benchmark-equivalent...: GENERAL PROVISIONS Benchmark Benefit and Benchmark-Equivalent Coverage § 440.385 Delivery of benchmark and benchmark-equivalent coverage through managed care entities. In implementing benchmark or...

  18. Health care financing in Nigeria: Implications for achieving universal health coverage.

    Science.gov (United States)

    Uzochukwu, B S C; Ughasoro, M D; Etiaba, E; Okwuosa, C; Envuladu, E; Onwujekwe, O E

    2015-01-01

    The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms. The difference in the proportionate contribution from these stated sources determine the extent to which such health sector will go in achieving successful health care financing system. Unfortunately, in Nigeria, achieving the correct blend of these sources remains a challenge. This review draws on relevant literature to provide an overview and the state of health care financing in Nigeria, including policies in place to enhance healthcare financing. We searched PubMed, Medline, The Cochrane Library, Popline, Science Direct and WHO Library Database with search terms that included, but were not restricted to health care financing Nigeria, public health financing, financing health and financing policies. Further publications were identified from references cited in relevant articles and reports. We reviewed only papers published in English. No date restrictions were placed on searches. It notes that health care in Nigeria is financed through different sources including but not limited to tax revenue, out-of-pocket payments (OOPs), donor funding, and health insurance (social and community). In the face of achieving UHC, achieving successful health care financing system continues to be a challenge in Nigeria and concludes that to achieve universal coverage using health financing as the strategy, there is a dire need to review the system of financing health and ensure that resources are used more efficiently while at the same time removing financial barriers to access by shifting focus from OOPs to other hidden resources. There is also need to give presidential assent to the national health bill and its prompt implementation when signed into law.

  19. [Potential coverage and real coverage of ambulatory health care services in the state of Mexico. The case of 3 marginal communities in Atenco and Chalco].

    Science.gov (United States)

    Nájera-Aguilar, P; Infante-Castañeda, C

    1990-01-01

    Less than a third of the non-insured population studied through a sample in the State of Mexico was covered by the Institute of Health of the State of México. This low coverage was observed in spite the fact that health services were available within 2 kilometer radius. 33 per cent of the non-insured preferred to utilize other services within their own community, and 24 per cent of them traveled to bigger localities to receive care. These results suggest that to attain adequate coverage, utilization patterns should be investigated so that health services can meet the needs of the target population.

  20. Influenza immunization coverage of residents and employees of long-term care facilities in New York State, 2000-2010.

    Science.gov (United States)

    Person, Cara J; Nadeau, Jessica A; Schaffzin, Joshua K; Pollock, Lynn; Wallace, Barbara J; McNutt, Louise Ann; Blog, Debra

    2013-08-01

    We describe influenza immunization coverage trends from the New York State (NYS) Department of Health long-term care facility (LTCF) reports. Overall median immunization coverage levels for NYS LTCF residents and employees were 84.0% (range: 81.6%-86.0%) and 37.7% (range: 32.7%-50.0%), respectively. LTCF resident immunization coverage levels in NYS have neared the Healthy People 2020 target of 90% but have not achieved high LTCF employee coverage, suggesting a need for more regulatory interventions.

  1. Meningococcal, influenza virus, and hepatitis B virus vaccination coverage level among health care workers in Hajj

    Directory of Open Access Journals (Sweden)

    Ghabrah Tawfik M

    2007-07-01

    Full Text Available Abstract Background The objective of this study was to assess the compliance of health care workers (HCWs employed in Hajj in receiving the meningococcal, influenza, and hepatitis B vaccines. Methods A cross-sectional survey of doctors and nurses working in all Mena and Arafat hospitals and primary health care centers who attended Hajj-medicine training programs immediately before the beginning of Hajj of the lunar Islamic year 1423 (2003 using self-administered structured questionnaire which included demographic data and data on vaccination history. Results A total of 392 HCWs were studied including 215 (54.8% nurses and 177 (45.2% doctors. One hundred and sixty four (41.8% HCWs were from Makkah and the rest were recruited from other regions in Saudi Arabia. Three hundred and twenty three (82.4% HCWs received the quadrivalent (ACYW135 meningococcal meningitis vaccine with 271 (83.9% HCWs receiving it at least 2 weeks before coming to Hajj, whereas the remaining 52 (16.1% HCWs received it within Conclusion The meningococcal and hepatitis B vaccination coverage level among HCWs in Hajj was suboptimal and the influenza vaccination level was notably low. Strategies to improve vaccination coverage among HCWs should be adopted by all health care facilities in Saudi Arabia.

  2. The european primary care monitor: structure, process and outcome indicators

    Directory of Open Access Journals (Sweden)

    Wilson Andrew

    2010-10-01

    Full Text Available Abstract Background Scientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited. There is currently a lack of up to date comprehensive and comparable information on variation in development of primary care, and a lack of knowledge of structures and strategies conducive to strengthening primary care in Europe. The EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU aims to fill this gap by developing a Primary Care Monitoring System (PC Monitor for application in 31 European countries. This article describes the development of the indicators of the PC Monitor, which will make it possible to create an alternative model for holistic analyses of primary care. Methods A systematic review of the primary care literature published between 2003 and July 2008 was carried out. This resulted in an overview of: (1 the dimensions of primary care and their relevance to outcomes at (primary health system level; (2 essential features per dimension; (3 applied indicators to measure the features of primary care dimensions. The indicators were evaluated by the project team against criteria of relevance, precision, flexibility, and discriminating power. The resulting indicator set was evaluated on its suitability for Europe-wide comparison of primary care systems by a panel of primary care experts from various European countries (representing a variety of primary care systems. Results The developed PC Monitor approaches primary care in Europe as a multidimensional concept. It describes the key dimensions of primary care systems at three levels: structure, process, and outcome level. On structure level, it includes indicators for governance, economic conditions, and workforce development. On process level, indicators describe access, comprehensiveness, continuity, and coordination of primary care services. On outcome level, indicators

  3. Impact of state mandatory insurance coverage on the use of diabetes preventive care

    Directory of Open Access Journals (Sweden)

    Barker Lawrence

    2010-05-01

    Full Text Available Abstract Background 46 U.S. states and the District of Columbia have passed laws and regulations mandating that health insurance plans cover diabetes treatment and preventive care. Previous research on state mandates suggested that these policies had little impact, since many health plans already covered the benefits. Here, we analyze the contents of and model the effect of state mandates. We examined how state mandates impacted the likelihood of using three types of diabetes preventive care: annual eye exams, annual foot exams, and performing daily self-monitoring of blood glucose (SMBG. Methods We collected information on diabetes benefits specified in state mandates and time the mandates were enacted. To assess impact, we used data that the Behavioral Risk Factor Surveillance System gathered between 1996 and 2000. 4,797 individuals with self-reported diabetes and covered by private insurance were included; 3,195 of these resided in the 16 states that passed state mandates between 1997 and 1999; 1,602 resided in the 8 states or the District of Columbia without state mandates by 2000. Multivariate logistic regression models (with state fixed effect, controlling for patient demographic characteristics and socio-economic status, state characteristics, and time trend were used to model the association between passing state mandates and the usage of the forms of diabetes preventive care, both individually and collectively. Results All 16 states that passed mandates between 1997 and 1999 required coverage of diabetic monitors and strips, while 15 states required coverage of diabetes self management education. Only 1 state required coverage of periodic eye and foot exams. State mandates were positively associated with a 6.3 (P = 0.04 and a 5.8 (P = 0.03 percentage point increase in the probability of privately insured diabetic patient's performing SMBG and simultaneous receiving all three preventive care, respectively; state mandates were not

  4. Vaccination coverage of health care personnel working in health care facilities in France: results of a national survey, 2009.

    Science.gov (United States)

    Guthmann, Jean-Paul; Fonteneau, Laure; Ciotti, Céline; Bouvet, Elisabeth; Pellissier, Gérard; Lévy-Bruhl, Daniel; Abiteboul, Dominique

    2012-06-29

    We conducted a national cross-sectional survey to investigate vaccination coverage (VC) in health care personnel (HCP) working in clinics and hospitals in France. We used a two-stage stratified random sampling design to select 1127 persons from 35 health care settings. Data were collected by face-to-face interviews and completed using information gathered from the occupational health doctor. A total of 183 physicians, 110 nurses, 58 nurse-assistants and 101 midwives were included. VC for compulsory vaccinations was 91.7% for hepatitis B, 95.5% for the booster dose of diphtheria-tetanus-polio (DTP), 94.9% for BCG. For non-compulsory vaccinations, coverage was 11.4% for the 10 year booster of the DTP pertussis containing vaccine, 49.7% for at least one dose of measles, 29.9% for varicella and 25.6% for influenza. Hepatitis B VC did not differ neither between HCP working in surgery and HCP in other sectors, nor in surgeons and anaesthesiologists compared to physicians working in medicine. Young HCP were better vaccinated for pertussis and measles (pvaccinated for influenza and pertussis (pcompulsory vaccinations, whereas VC for non-compulsory vaccinations is very insufficient. The vaccination policy regarding these latter vaccinations should be reinforced in France.

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

    Directory of Open Access Journals (Sweden)

    Fabian Ling Ngai Tung

    2016-01-01

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

  6. Performance of private sector health care: implications for universal health coverage.

    Science.gov (United States)

    Morgan, Rosemary; Ensor, Tim; Waters, Hugh

    2016-08-06

    Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers-including their size, objectives, and technical competence-the interaction of these factors affects how the sector performs in different contexts. Changing the performance of the private sector will require interventions that target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector seems to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health-care sector requires a regulatory response focused on the health-care sector as a whole.

  7. Assessment of levels of hospice care coverage offered to commercial managed care plan members in California: implications for the California Health Insurance Exchange.

    Science.gov (United States)

    Chung, Kyusuk; Jahng, Joelle; Petrosyan, Syuzanna; Kim, Soo In; Yim, Victoria

    2015-06-01

    The implementation of the Affordable Care Act that provides for the expansion of affordable insurance to uninsured individuals and small businesses, coupled with the provision of mandated hospice coverage, is expected to increase the enrollment of the terminally ill younger population in hospice care. We surveyed health insurance companies that offer managed care plans in the 2014 California health insurance exchange and large hospice agencies that provided hospice care to privately insured patients in 2011. Compared with Medicare and Medicaid hospice benefits, hospice benefits for privately insured patients, particularly those enrolled in managed care plans, varied widely. Mandating hospice care alone may not be sufficient to ensure that individuals enrolled in different managed care plans receive the same level of coverage.

  8. Are Americans finding affordable coverage in the health insurance marketplaces? Results from the Commonwealth Fund Affordable Care Act Tracking Survey.

    Science.gov (United States)

    Rasmussen, Petra W; Collins, Sara R; Doty, Michelle M; Beutel, Sophie

    2014-09-01

    By the end of the first open enrollment period for coverage offered through the Affordable Care Act's marketplaces, increasing numbers of people said they found it easy to find a plan they could afford, according to The Commonwealth Fund's Affordable Care Act Tracking Survey, April-June 2014. Adults with low or moderate incomes were more likely to say it was easy to find an affordable plan than were adults with higher incomes. Adults with low or moderate incomes who purchased a plan through the marketplaces this year have similar premium costs and deductibles as adults in the same income ranges with employer-provided coverage. A majority of adults with marketplace coverage gave high ratings to their insurance and were confident in their ability to afford the care they need when sick.

  9. Indicators of health system coverage and activity in Ireland during the economic crisis 2008-2014 - from 'more with less' to 'less with less'.

    LENUS (Irish Health Repository)

    Burke, Sara

    2014-09-01

    A new Irish government came to power in March 2011 with the most radical proposals for health system reform in the history of the state, including improving access to healthcare, free GP care for all by 2015 and the introduction of Universal Health Insurance after 2016. All this was to be achieved amidst the most severe economic crisis experienced by Ireland since the 1930s. The authors assess how well the system coped with a downsizing of resources by an analysis of coverage and health system activity indicators. These show a health system that managed \\'to do more with less\\' from 2008 to 2012. They also demonstrate a system that was \\'doing more with less\\' by transferring the cost of care onto people and by significant resource cuts. From 2013, the indicators show a system that has no choice but \\'to do less with less\\' with diminishing returns from crude cuts. This is evident in declining numbers with free care, of hospital cases and home care hours, alongside increased wait-times and expensive agency staffing. The results suggest a limited window of benefit from austerity beyond which cuts and rationing prevail which is costly, in both human and financial terms.

  10. Indicators of health system coverage and activity in Ireland during the economic crisis 2008-2014 - from 'more with less' to 'less with less'.

    Science.gov (United States)

    Burke, Sara; Thomas, Steve; Barry, Sarah; Keegan, Conor

    2014-09-01

    A new Irish government came to power in March 2011 with the most radical proposals for health system reform in the history of the state, including improving access to healthcare, free GP care for all by 2015 and the introduction of Universal Health Insurance after 2016. All this was to be achieved amidst the most severe economic crisis experienced by Ireland since the 1930s. The authors assess how well the system coped with a downsizing of resources by an analysis of coverage and health system activity indicators. These show a health system that managed 'to do more with less' from 2008 to 2012. They also demonstrate a system that was 'doing more with less' by transferring the cost of care onto people and by significant resource cuts. From 2013, the indicators show a system that has no choice but 'to do less with less' with diminishing returns from crude cuts. This is evident in declining numbers with free care, of hospital cases and home care hours, alongside increased wait-times and expensive agency staffing. The results suggest a limited window of benefit from austerity beyond which cuts and rationing prevail which is costly, in both human and financial terms.

  11. Quality Indicators for Hospital Care : Reliability and validity

    NARCIS (Netherlands)

    C. Fischer (Claudia)

    2015-01-01

    markdownabstractAbstract Hospital quality indicators are widely implemented for purposes such as accountability, transparency and the overarching aim of quality improvement. However, it is not clear whether currently used hospital quality indicators actually reflect quality of care. The aim of

  12. Prescribing quality indicators of type 2 diabetes mellitus ambulatory care

    NARCIS (Netherlands)

    Martirosyan, L.; Braspenning, J.; Denig, P.; de Grauw, W. J. C.; Bouma, M.; Storms, F.; Haaijer-Ruskamp, F. M.

    2008-01-01

    Background: Existing performance indicators for assessing quality of care in type 2 diabetes mellitus (T2DM) focus mostly on registration of measurements and clinical outcomes, and not on quality of prescribing. Objective: To develop a set of valid prescribing quality indicators (PQI) for internal u

  13. [Application of subjective quality indicators in intensive care].

    Science.gov (United States)

    de Souza, Sônia Regina Oliveira e Silva; da Silva, Cláudia Aparecida; de Mello, Ursula Magliano; Ferreira, Carolina Neris

    2006-01-01

    Our aim is to describe the clients'perception related to to the admission in the Intensive Care. We have developed a descriptive study based on a qualitative approach in the intensive care in a university hospital in RJ, from May, 2003 to May, 2004. Thirty-two clients participated in this study just after hospital discharge. Data collection was possible through a questionaire. We consider that the clients showed some kind of satisfaction related to nursing intensive care, and the problem that really annoys them is the physical and ambiental stressors. The study shows questions that need a continuous discussion considering the stress, once it is a part of the activities and the atmosphere of intensive care and it also detaches the relavence of a work using indicatives of subjective quality in the intensive care.

  14. The impact of Universal Health Coverage on health care consumption and risky behaviours: evidence from Thailand.

    Science.gov (United States)

    Ghislandi, Simone; Manachotphong, Wanwiphang; Perego, Viviana M E

    2015-07-01

    Thailand is among the first non-OECD countries to have introduced a form of Universal Health Coverage (UHC). This policy represents a natural experiment to evaluate the effects of public health insurance on health behaviours. In this paper, we examine the impact of Thailand's UHC programme on preventive activities, unhealthy or risky behaviours and health care consumption using data from the Thai Health and Welfare Survey. We use doubly robust estimators that combine propensity scores and linear regressions to estimate differences-in-differences (DD) and differences-in-DD models. Our results offer important insights. First, UHC increases individuals' likelihood of having an annual check-up, especially among women. Regarding health care consumption, we observe that UHC increases hospital admissions by over 2% and increases outpatient visits by 13%. However, there is no evidence that UHC leads to an increase in unhealthy behaviours or a reduction of preventive efforts. In other words, we find no evidence of ex ante moral hazard. Overall, these findings suggest positive health impacts among the Thai population covered by UHC.

  15. AccessMod 3.0: computing geographic coverage and accessibility to health care services using anisotropic movement of patients

    Directory of Open Access Journals (Sweden)

    Ebener Steeve

    2008-12-01

    Full Text Available Abstract Background Access to health care can be described along four dimensions: geographic accessibility, availability, financial accessibility and acceptability. Geographic accessibility measures how physically accessible resources are for the population, while availability reflects what resources are available and in what amount. Combining these two types of measure into a single index provides a measure of geographic (or spatial coverage, which is an important measure for assessing the degree of accessibility of a health care network. Results This paper describes the latest version of AccessMod, an extension to the Geographical Information System ArcView 3.×, and provides an example of application of this tool. AccessMod 3 allows one to compute geographic coverage to health care using terrain information and population distribution. Four major types of analysis are available in AccessMod: (1 modeling the coverage of catchment areas linked to an existing health facility network based on travel time, to provide a measure of physical accessibility to health care; (2 modeling geographic coverage according to the availability of services; (3 projecting the coverage of a scaling-up of an existing network; (4 providing information for cost effectiveness analysis when little information about the existing network is available. In addition to integrating travelling time, population distribution and the population coverage capacity specific to each health facility in the network, AccessMod can incorporate the influence of landscape components (e.g. topography, river and road networks, vegetation that impact travelling time to and from facilities. Topographical constraints can be taken into account through an anisotropic analysis that considers the direction of movement. We provide an example of the application of AccessMod in the southern part of Malawi that shows the influences of the landscape constraints and of the modes of transportation on

  16. Indicators for quality of hospital care : Beyond the numbers

    NARCIS (Netherlands)

    A.M. van Dishoeck (Anne-Margreet)

    2015-01-01

    markdownabstractAbstract This thesis addresses two major topics in measuring, comparing and improving quality of care. We found considerable influence of random variation and case-mix in comparing hospitals using performance indicators. Although we found a significant relation between outcome

  17. Stability of children's insurance coverage and implications for access to care: evidence from the Survey of Income and Program Participation.

    Science.gov (United States)

    Buchmueller, Thomas; Orzol, Sean M; Shore-Sheppard, Lara

    2014-06-01

    Even as the number of children with health insurance has increased, coverage transitions--movement into and out of coverage and between public and private insurance--have become more common. Using data from 1996 to 2005, we examine whether insurance instability has implications for access to primary care. Because unobserved factors related to parental behavior and child health may affect both the stability of coverage and utilization, we estimate the relationship between insurance and the probability that a child has at least one physician visit per year using a model that includes child fixed effects to account for unobserved heterogeneity. Although we find that unobserved heterogeneity is an important factor influencing cross-sectional correlations, conditioning on child fixed effects we find a statistically and economically significant relationship between insurance coverage stability and access to care. Children who have part-year public or private insurance are more likely to have at least one doctor's visit than children who are uninsured for a full year, but less likely than children with full-year coverage. We find comparable effects for public and private insurance. Although cross-sectional analyses suggest that transitions directly between public and private insurance are associated with lower rates of utilization, the evidence of such an effect is much weaker when we condition on child fixed effects.

  18. [Leadership and vision in the improvement of universal health care coverage in low-income countries].

    Science.gov (United States)

    Meda, Ziemlé Clément; Konate, Lassina; Ouedraogo, Hyacinthe; Sanou, Moussa; Hercot, David; Sombie, Issiaka

    2011-01-01

    implementing a decentralized approach to tuberculosis detection, succeeded in improving access to care and enabled us to quantify the rate of tuberculosis-HIV co-infection in the HD. The fourth intervention improved financial access to emergency obstetric care by providing essential drugs and consumables for emergency obstetric surgery free of charge. The fifth intervention boosted the motivation of health workers by an annual 'competition of excellence', organised for workers and teams in the HD. Finally, our sixth intervention was the introduction of a "culture" of evaluation and transparency, by means of a local health journal, used to interact with stakeholders both at the local level and in the health sector more broadly. We also present our experiences regularly during national health science symposia. Although the DT operates with limited resources, it has over time managed to improve care and services in the HD, through its dynamic management and strategic planning. It has reduced inpatient mortality and improved access to care, particularly for vulnerable groups, in line with the Primary Health Care and Bamako Initiative principles. This case study would have benefited from a stronger methodology. However, it shows that in a context of limited resources it is still possible to strengthen the local health system by improving management practices. To progress towards universal health coverage, all core functions of a DT are worth implementing, including leadership and vision. National and international health strategies should thus include a plan to provide for and train local health system managers who can provide both leadership and strategic vision.

  19. Health care coverage among long-distance truckers in India: an evaluation based on the Tanahashi model

    Directory of Open Access Journals (Sweden)

    Sharma V

    2015-03-01

    Full Text Available Varun Sharma,1 Niranjan Saggurti,2 Shalini Bharat11School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India; 2HIV AIDS Program, Population Council, New Delhi, IndiaAbstract: Long-distance truckers (LDTDs are vulnerable to human immunodeficiency virus infection and other sexually transmitted infections due to the nature of their work, working environment, and frequent mobility. This paper examines and comments on the health care coverage provisioned under “Kavach” Project. Data from the Integrated Behavioural and Biological Survey, National Highway gathered from 2,066 LDTDs in Round 1 and 2,085 LDTDs in Round 2, who traveled in four extreme road corridors travelled by LDTDs in India, were used for analysis. Analysis reveals that service capacity in terms of socially marketed condoms per thousand LDTDs has increased from Round 1 to Round 2 (4,430 to 6,876, respectively. Accessibility coverage in terms of knowledge about the Khushi clinic has significantly decreased between Rounds 1 and 2 (60.9% to 54.6%; P<0.001. Acceptability coverage has increased between the two rounds (13.8% to 50.6%; P<0.001. Contact coverage has also increased between the rounds (12.7% to 22.3%; P<0.001. Effectiveness coverage for preventive and curative care has also increased significantly. This paper comments on the gaps in accessibility and acceptability of health care coverage and emphasizes the need for further studies to assess the contextual factors that influence the effectiveness and efficiency of interventions designed to address access barriers and to identify what combination of interventions may generate the best possible outcome.Keywords: HIV, long-distance truck drivers, mobility, national highways, Tanahashi framework, India

  20. Assessment of nursing care using indicators generated by software

    Directory of Open Access Journals (Sweden)

    Ana Paula Souza Lima

    2015-04-01

    Full Text Available OBJECTIVE: to analyze the efficacy of the Nursing Process in an Intensive Care Unit using indicators generated by software. METHOD: cross-sectional study using data collected for four months. RNs and students daily registered patients, took history (at admission, performed physical assessments, and established nursing diagnoses, nursing plans/prescriptions, and assessed care delivered to 17 patients using software. Indicators concerning the incidence and prevalence of nursing diagnoses, rate of effectiveness, risk diagnoses, and rate of effective prevention of complications were computed. RESULTS: the Risk for imbalanced body temperature was the most frequent diagnosis (23.53%, while the least frequent was Risk for constipation (0%. The Risk for Impaired skin integrity was prevalent in 100% of the patients, while Risk for acute confusion was the least prevalent (11.76%. Risk for constipation and Risk for impaired skin integrity obtained a rate of risk diagnostic effectiveness of 100%. The rate of effective prevention of acute confusion and falls was 100%. CONCLUSION: the efficacy of the Nursing Process using indicators was analyzed because these indicators reveal how nurses have identified patients' risks and conditions, and planned care in a systematized manner.

  1. Impacts of the Affordable Care Act dependent coverage provision on health-related outcomes of young adults.

    Science.gov (United States)

    Barbaresco, Silvia; Courtemanche, Charles J; Qi, Yanling

    2015-03-01

    The first major insurance expansion of the Affordable Care Act - a provision requiring insurers to allow dependents to remain on parents' health insurance until turning 26 - took effect in September 2010. We estimate this mandate's impacts on numerous outcomes related to health care access, preventive care utilization, risky behaviors, and self-assessed health. We estimate difference-in-differences models with 23-25 year olds as the treatment group and 27-29 year olds as the control group. For the full sample, the dependent coverage provision increased the probabilities of having health insurance, a primary care doctor, and excellent self-assessed health, while reducing body mass index. However, the mandate also increased risky drinking and did not lead to any significant increases in preventive care utilization. Subsample analyses reveal particularly large gains for men and college graduates.

  2. Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States.

    Science.gov (United States)

    Courtemanche, Charles; Marton, James; Ukert, Benjamin; Yelowitz, Aaron; Zapata, Daniela

    2017-01-01

    The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, at the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those without a college degree, non-whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.

  3. Americans' Experiences with ACA Marketplace and Medicaid Coverage: Access to Care and Satisfaction: Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February–April 2016.

    Science.gov (United States)

    Collins, Sara R; Gunja, Munira; Doty, Michelle M; Beutel, Sophie

    2016-05-01

    The fourth wave of the Commonwealth Fund Affordable Care Act Tracking Survey, February--April 2016, finds at the close of the third open enrollment period that the working-age adult uninsured rate stands at 12.7 percent, statistically unchanged from 2015 but significantly lower than 2014 and 2013. Uninsured rates in the past three years have fallen most steeply for low-income adults though remain higher compared to wealthier adults. ACA marketplace and Medicaid coverage is helping to end long bouts without insurance, bridge gaps when employer insurance is lost, and improve access to health care. Sixty-one percent of enrollees who had used their insurance to get care said they would not have been able to afford or access it prior to enrolling. Doctor availability and appointment wait times are similar to those reported by insured Americans overall. Majorities with marketplace or Medicaid coverage continue to be satisfied with their insurance.

  4. Impact of free delivery care on health facility delivery and insurance coverage in Ghana's Brong Ahafo Region.

    Directory of Open Access Journals (Sweden)

    Susie Dzakpasu

    Full Text Available BACKGROUND: Many sub-Saharan countries, including Ghana, have introduced policies to provide free medical care to pregnant women. The impact of these policies, particularly on access to health services among the poor, has not been evaluated using rigorous methods, and so the empirical basis for defending these policies is weak. In Ghana, a recent report also cast doubt on the current mechanism of delivering free care--the National Health Insurance Scheme. Longitudinal surveillance data from two randomized controlled trials conducted in the Brong Ahafo Region provided a unique opportunity to assess the impact of Ghana's policies. METHODS: We used time-series methods to assess the impact of Ghana's 2005 policy on free delivery care and its 2008 policy on free national health insurance for pregnant women. We estimated their impacts on facility delivery and insurance coverage, and on socioeconomic differentials in these outcomes after controlling for temporal trends and seasonality. RESULTS: Facility delivery has been increasing significantly over time. The 2005 and 2008 policies were associated with significant jumps in coverage of 2.3% (p = 0.015 and 7.5% (p<0.001, respectively after the policies were introduced. Health insurance coverage also jumped significantly (17.5%, p<0.001 after the 2008 policy. The increases in facility delivery and insurance were greatest among the poorest, leading to a decline in socioeconomic inequality in both outcomes. CONCLUSION: Providing free care, particularly through free health insurance, has been effective in increasing facility delivery overall in the Brong Ahafo Region, and especially among the poor. This finding should be considered when evaluating the impact of the National Health Insurance Scheme and in supporting the continuation and expansion of free delivery care.

  5. Quality indicators for international benchmarking of mental health care

    DEFF Research Database (Denmark)

    Hermann, Richard C; Mattke, Soeren; Somekh, David;

    2006-01-01

    To identify quality measures for international benchmarking of mental health care that assess important processes and outcomes of care, are scientifically sound, and are feasible to construct from preexisting data.......To identify quality measures for international benchmarking of mental health care that assess important processes and outcomes of care, are scientifically sound, and are feasible to construct from preexisting data....

  6. Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries

    Directory of Open Access Journals (Sweden)

    Naoki Ikegami

    2016-05-01

    Full Text Available When the Japanese government adopted Western medicine in the late nineteenth century, it left intact the infrastructure of primary care by giving licenses to the existing practitioners and by initially setting the hurdle for entry into medical school low. Public financing of hospitals was kept minimal so that almost all of their revenue came from patient charges. When social health insurance (SHI was introduced in 1927, benefits were focused on primary care services delivered by physicians in clinics, and not on hospital services. This was reflected in the development and subsequent revisions of the fee schedule. The policy decisions which have helped to retain primary care services might provide lessons for achieving universal health coverage in low- and middle-income countries (LMICs.

  7. 78 FR 39869 - Coverage of Certain Preventive Services Under the Affordable Care Act

    Science.gov (United States)

    2013-07-02

    ... Treasury, at (202) 927-9639. For matters related to the Federally-facilitated Exchange user fee adjustment... contraceptive coverage to plan participants and beneficiaries without cost sharing, premium, fee, or other... sharing, premium, fee, or other charge to plan participants or beneficiaries or to the...

  8. Global quality indicators for primary care Electronic Patient Records.

    Science.gov (United States)

    De Clercq, Etienne; Moreels, Sarah; Van Casteren, Viviane; Bossuyt, Nathalie; Goderis, Geert

    2013-01-01

    Electronic Patient Records can be interfaced with medical decision support systems and quality of care assessment tools. An easy way of measuring the quality of EPR data is therefore essential. This study identified a number of global quality indicators (tracers) that could be easily calculated and validated them by correlating them with the Sensitivity and Positive Predictive Value (PPV) of data extracted from the EPR. Sensitivity and PPV of automatically extracted data were calculated using a gold standard constructed using answers to questions GPs were asked at the end of each contact with a patient. These properties were measured for extracted diagnoses, drug prescriptions, and certain parameters. Tracers were defined as drug-disease pairs (e.g. insulin-diabetes) with the assumption that if the patient is taking the drug, then the patient is suffering from the disease. Four tracers were identified that could be used for the ResoPrim primary care research database, which includes data from 43 practices, 10,307 patients, and 13,372 contacts. Moderately positive correlations were found between the 4 tracers and between the tracers and the sensitivity of automatically extracted diagnoses. For some purposes, these results may support the potential use of tracers for monitoring the quality of information systems such as EPRs.

  9. Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses.

    Science.gov (United States)

    Rapin, Joachim; D'Amour, Danielle; Dubois, Carl-Ardy

    2015-01-01

    The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2013). We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 116 articles, we selected 22. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators. Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research.

  10. Health Care: Information on Coverage Choices for Servicemembers, Former Servicemembers, and Dependents

    Science.gov (United States)

    2014-12-01

    Gehrig’s disease; or a condition resulting from an environmental health hazard.27 Part A coverage is generally automatic for eligible individuals,28...includes income, age, disability, citizenship status, and state residency. Minimum income and other eligibility criteria are established by federal...expanded under PPACA to include individuals who have been exposed to certain environmental hazards and, as a result, developed certain conditions

  11. A new role for primary care teams in the United States after “Obamacare:” Track and improve health insurance coverage rates

    Directory of Open Access Journals (Sweden)

    Jennifer DeVoe

    2016-12-01

    Full Text Available Maintaining continuous health insurance coverage is important. With recent expansions in access to coverage in the United States after “Obamacare,” primary care teams have a new role in helping to track and improve coverage rates and to provide outreach to patients. We describe efforts to longitudinally track health insurance rates using data from the electronic health record (EHR of a primary care network and to use these data to support practice-based insurance outreach and assistance. Although we highlight a few examples from one network, we believe there is great potential for doing this type of work in a broad range of family medicine and community health clinics that provide continuity of care. By partnering with researchers through practice-based research networks and other similar collaboratives, primary care practices can greatly expand the use of EHR data and EHR-based tools targeting improvements in health insurance and quality health care.

  12. 78 FR 13575 - Coverage of Certain Preventive Services Under the Affordable Care Act; Correction

    Science.gov (United States)

    2013-02-28

    ... Affordable Care Act; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Correction to... Health Service Act, as added by the Patient Protection and Affordable Care Act, as amended, and incorporated into the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code....

  13. Quality indicators and performance measures in diabetes care.

    Science.gov (United States)

    Aron, David C

    2014-03-01

    The operations of any portion of the healthcare delivery system, eg, ambulatory care, the consultation and referral process, or hospital care, are critically dependent upon their control systems. The quality of health care produced by the system and its components is also subject to "control." One of the regulatory mechanisms involves performance measures. The development of good measures of quality is a complex and dynamic process. Within endocrinology, most measures have addressed diabetes care and most quality measurement in diabetes has focused on the ambulatory setting and mainly includes measures of process and intermediate outcomes. This review addresses quality and performance measures for diabetes, their development, characteristics, use, misuse, and future prospects.

  14. Big Data, Little Data, and Care Coordination for Medicare Beneficiaries with Medigap Coverage.

    Science.gov (United States)

    Ozminkowski, Ronald J; Wells, Timothy S; Hawkins, Kevin; Bhattarai, Gandhi R; Martel, Charles W; Yeh, Charlotte S

    2015-06-01

    Most healthcare data warehouses include big data such as health plan, medical, and pharmacy claims information for many thousands and sometimes millions of insured individuals. This makes it possible to identify those with multiple chronic conditions who may benefit from participation in care coordination programs meant to improve their health. The objective of this article is to describe how large databases, including individual and claims data, and other, smaller types of data from surveys and personal interviews, are used to support a care coordination program. The program described in this study was implemented for adults who are generally 65 years of age or older and have an AARP(®) Medicare Supplement Insurance Plan (i.e., a Medigap plan) insured by UnitedHealthcare Insurance Company (or, for New York residents, UnitedHealthcare Insurance Company of New York). Individual and claims data were used first to calculate risk scores that were then utilized to identify the majority of individuals who were qualified for program participation. For efficient use of time and resources, propensity to succeed modeling was used to prioritize referrals based upon their predicted probabilities of (1) engaging in the care coordination program, (2) saving money once engaged, and (3) receiving higher quality of care. To date, program evaluations have reported positive returns on investment and improved quality of healthcare among program participants. In conclusion, the use of data sources big and small can help guide program operations and determine if care coordination programs are working to help older adults live healthier lives.

  15. A study on coverage utilization and quality of maternal care services

    Directory of Open Access Journals (Sweden)

    Neeraj Agarwal, Abhiruchi Galhotra, H M Swami

    2011-01-01

    Full Text Available The objectives of the study were yo assess the utilization of various maternal services and to compare the quality of services provided by doctors and health workers in terms of components and advice received by pregnant women during antenatal period. It was a Cross-sectional Study conducted in a village on the border of Chandigarh (U.T. and Mohali (Punjab. All the women who had delivered in the past three years in the village Palsora were included in the study. 92.4% of the pregnancies were registered, 53.2% of which received antenatal care by a Doctor and 46.8% by a health worker. The measuring of blood pressure was significantly higher by the doctor than the health workers who recorded weight more significantly. The advice provided by doctors was significantly higher than health workers regarding diet, danger signs, newborn care, family planning and natal care.

  16. The expansion of Medicaid coverage under the ACA: implications for health care access, use, and spending for vulnerable low-income adults.

    Science.gov (United States)

    Clemans-Cope, Lisa; Long, Sharon K; Coughlin, Teresa A; Yemane, Alshadye; Resnick, Dean

    2013-05-01

    The expansion of Medicaid coverage under the Affordable Care Act offers the potential for significant increases in health care access, use, and spending for vulnerable nonelderly adults who are uninsured. Using pooled data from the Medical Expenditure Panel Survey, this study estimates the potential effects of Medicaid, controlling for individual and local community characteristics. Our findings project significant gains in health care access and use for uninsured adults who enroll in Medicaid coverage and have chronic health conditions and mental health conditions. With that increased use, annual per capita health care spending for those newly insured individuals (excluding out-of-pocket spending) is projected to grow from $2,677 to $6,370 in 2013 dollars, while their out-of-pocket spending would drop by $921. It is expected that these increases in spending would be offset at least in part by reductions in uncompensated care and charity care.

  17. Towards a standardized method of developing quality indicators for palliative care: protocol of the Quality indicators for Palliative Care (Q-PAC) study.

    NARCIS (Netherlands)

    Leemans, K.; Cohen, J.; Francke, A.L.; Stichele, R. Vander; Claessen, S.J.J.; Block, L. van den; Deliens, L.

    2013-01-01

    Background: In recent years, there have been several studies, using a wide variety of methods, aimed at developing quality indicators for palliative care. In this Quality Indicators for Palliative Care study (Q-PAC study) we have applied a scientifically rigorous method to develop a comprehensive an

  18. Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada.

    Directory of Open Access Journals (Sweden)

    M Eugenia Socías

    Full Text Available Access to health care is a crucial determinant of health. Yet, even within settings that purport to provide universal health coverage (UHC, sex workers' experiences reveal systematic, institutionally ingrained barriers to appropriate quality health care. The aim of this study was to assess prevalence and correlates of institutional barriers to care among sex workers in a setting with UHC.Data was drawn from an ongoing community-based, prospective cohort of women sex workers in Vancouver, Canada (An Evaluation of Sex Workers' Health Access. Multivariable logistic regression analyses, using generalized estimating equations (GEE, were employed to longitudinally investigate correlates of institutional barriers to care over a 44-month follow-up period (January 2010-August 2013.In total, 723 sex workers were included, contributing to 2506 observations. Over the study period, 509 (70.4% women reported one or more institutional barriers to care. The most commonly reported institutional barriers to care were long wait times (54.6%, limited hours of operation (36.5%, and perceived disrespect by health care providers (26.1%. In multivariable GEE analyses, recent partner- (adjusted odds ratio [AOR] = 1.46, % 95% Confidence Interval [CI] 1.10-1.94, workplace- (AOR = 1.31, 95% CI 1.05-1.63, and community-level violence (AOR = 1.41, 95% CI 1.04-1.92, as well as other markers of vulnerability, such as self-identification as a gender/sexual minority (AOR = 1.32, 95% CI 1.03-1.69, a mental illness diagnosis (AOR = 1.66, 95% CI 1.34-2.06, and lack of provincial health insurance card (AOR = 3.47, 95% CI 1.59-7.57 emerged as independent correlates of institutional barriers to health services.Despite Canada's UHC, women sex workers in Vancouver face high prevalence of institutional barriers to care, with highest burden among most marginalized women. These findings underscore the need to explore new models of care, alongside broader policy changes to fulfill sex

  19. 78 FR 62506 - TRICARE; Coverage of Care Related to Non-Covered Initial Surgery or Treatment

    Science.gov (United States)

    2013-10-22

    ... a non-covered incident of treatment (such as nonadjunctive dental care or cosmetic surgery) but only... Initial Surgery or Treatment AGENCY: Office of the Secretary, Department of Defense. ACTION: Proposed rule... on a determination that a waiver authorizing the original non-covered surgery or treatment...

  20. Measures of Quality of Care for People with HIV: A Scoping Review of Performance Indicators for Primary Care.

    Science.gov (United States)

    Johnston, Sharon; Kendall, Claire; Hogel, Matthew; McLaren, Meaghan; Liddy, Clare

    2015-01-01

    The healthcare of people with HIV is transitioning from specialty care to the primary healthcare (PHC) system. However, many of the performance indicators used to measure the quality of HIV care pre-date this transition. The goal of this work was to examine how existing HIV care performance indicators measure the comprehensive and longitudinal care offered in a PHC setting. A scoping review consisting of peer-reviewed and grey literature searches was performed. Two reviewers evaluated study eligibility and indicators in documents meeting inclusion criteria were extracted into a database. Indicators were matched to a PHC performance measurement framework to determine their applicability for evaluating quality of care in the PHC setting. The literature search identified 221 publications, of which 47 met inclusion criteria. 1184 indicators were extracted and removal of duplicates left 558 unique indicators. A majority of the 558 indicators fell under the 'secondary prevention' (12%) and 'care of chronic conditions' (33%) domains when indicators were matched to the PHC performance framework. Despite the imbalance, nearly all performance domains in the PHC framework were populated by at least one indicator with significant concentrations in domains such as patient-provider relationship, patient satisfaction, population and community characteristics, and access to care. Existing performance frameworks for the care of people with HIV provide a comprehensive set of indicators that align well with a PHC performance framework. Nonetheless, some important elements of care, such as patient-reported outcomes, are poorly covered by existing indicators. Advancing our understanding of how the experience of care for people with HIV is impacted by changes in health services delivery, specifically more care within the PHC system, will require performance indicators to capture this aspect of HIV care.

  1. Comparing Individual Health Coverage On and Off the Affordable Care Act's Insurance Exchanges.

    Science.gov (United States)

    McCue, Michael J; Hall, Mark A

    2015-08-01

    The new health insurance exchanges are the core of the Affordable Care Act's (ACA) reforms, but how the law improves the nonsubsidized portion of the individual market is also important. This issue brief compares products sold on and off the exchanges to gain insight into how the ACA's market reforms are functioning. Initial concerns that insurers might seek to enroll lower-risk customers outside the exchanges have not been realized. Instead, more-generous benefit plans, which appeal to people with health problems, constitute a greater portion of plans sold off-exchange than those sold on-exchange. Although insur­ers that sell mostly on the exchanges incur an additional fee, they still devote a greater portion of their premium dollars to medical care. Their projected admin­istrative costs and profit margins are lower than are those of insurers selling only off the exchanges.

  2. The European Primary Care Monitor: structure, process and outcome indicators.

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.G.W.; Bourgueil, Y.; Cartier, T.; Hasvold, T.; Hutchinson, A.; Lember, M.; Oleszczyk, M.; Pavlick, D.R.; Svab, I.; Tedeschi, P.; Wilson, A.; Windak, A.

    2010-01-01

    Background:Scientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited. There is currently a lack of up to date comprehensive and comparable information on variation in development of prima

  3. Public trust in health care in the Netherlands: a performance indicator?

    NARCIS (Netherlands)

    Schee, E. van der; Groenewegen, P.P.; Friele, R.D.

    2006-01-01

    If public trust in health care is to be used as a performance indicator for health care systems, its measurement has to be sensitive to changes in the health care system. For this purpose, this study has monitored public trust in health care in The Netherlands over an eight-year period, from 1997 to

  4. Assessing Quality of Care of Elderly Patients Using the ACOVE Quality Indicator Set: A Systematic Review

    NARCIS (Netherlands)

    Askari, M.; Wierenga, P.C.; Eslami, S.; Medlock, S.; de Rooij, S.E.; Abu-Hanna, A.

    2011-01-01

    Background: Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE) quality indicators (QIs) were developed to assess and improve the care of elderly patients. Objectives: The purpose of this review is to summarize studi

  5. Can surveys of women accurately track indicators of maternal and newborn care? A validity and reliability study in Kenya

    Science.gov (United States)

    McCarthy, Katharine J; Blanc, Ann K; Warren, Charlotte E; Kimani, James; Mdawida, Brian; Ndwidga, Charity

    2016-01-01

    Background Tracking progress on maternal and newborn survival requires accurate information on the coverage of essential interventions. Despite widespread use, most indicators measuring maternal and newborn intervention coverage have not been validated. This study assessed the ability of women delivering in two Kenyan hospitals to recall critical elements of care received during the intrapartum and immediate postnatal period at two time points: hospital discharge and 13–15 months following delivery. Methods Women’s reports of received care were compared against observations by trained third party observers. Indicators selected for validation were either currently in use or have the potential to be included in population–based surveys. We used a mixed–methods approach to validate women’s reporting ability. We calculated individual–reporting accuracy using the area under the receiver operating curve (AUC), population–level accuracy using the inflation factor (IF), and compared the accuracy of women’s reporting at baseline and follow–up. We also assessed the consistency of women’s reporting over time. We used in–depth interviews with a sub–set of women (n = 20) to assess their understanding of key survey terms. Results Of 606 women who participated at baseline and agreed to follow–up, 515 were re–interviewed. Thirty–eight indicators had sufficient sample size for validation analysis; ten met criteria for high or moderate reporting accuracy (0.60episiotomy, caesarean section, and low birthweight infant (<2500 g). Conclusion The few indicators that women reported accurately at baseline were consistently recalled with accuracy at 13–15 months follow–up. Although there is deterioration in women’s recall in some indicators over time, the extent of deterioration does not appreciably compromise reporting accuracy for indicators with high baseline validity. Indicators related to initial client assessment and the immediate postnatal

  6. Examining financial performance indicators for acute care hospitals.

    Science.gov (United States)

    Burkhardt, Jeffrey H; Wheeler, John R C

    2013-01-01

    Measuring financial performance in acute care hospitals is a challenge for those who work daily with financial information. Because of the many ways to measure financial performance, financial managers and researchers must decide which measures are most appropriate. The difficulty is compounded for the non-finance person. The purpose of this article is to clarify key financial concepts and describe the most common measures of financial performance so that researchers and managers alike may understand what is being measured by various financial ratios.

  7. Quality of Care Indicators in the AMEDD (Army Medical Department)

    Science.gov (United States)

    1983-09-01

    Evaluation, Indicators 6 7rACT (Ceate - re,,vee sfr ,f d ideif y bio\\onb,) Ihis study looked at the feasibility of thev(MEDD)constructing a list of...affect the final list chosen. 7. The list of indicators should not be limited to " failures " or "errors" in medical practice. 6.p, 8. The list of...PATIENTS TRANSFUSED . TH WEIGHT RECORDED 100 1 PIN RNU3 1ED WITH ELECTROLYTE DETERMINATION 00 1 1 WITH INDICATION FOR TRANSFLS ON 100 I 2 2 WiTH ANEMIA EX

  8. Burnout syndrome indices in Greek intensive care nursing personnel.

    Science.gov (United States)

    Karanikola, Maria N K; Papathanassoglou, Elizabeth D E; Mpouzika, Meropi; Lemonidou, Chrysoula

    2012-01-01

    Burnout symptoms in Greek intensive care unit (ICU) nurses have not been explored adequately. The aim of this descriptive, correlational study was to investigate the prevalence and intensity of burnout symptoms in Greek ICU nursing personnel and any potential associations with professional satisfaction, as well as with demographic, educational, and vocational characteristics. Findings showed that the overall burnout level reported by Greek ICU nursing personnel was at a moderate to high degree. The most pronounced symptom of burnout was depersonalization, whereas emotional exhaustion was found to be a strong predictor of job satisfaction. This is a factor connected with the nurses' intention to quit the job. It appears that work factors have a more powerful influence over the development of burnout in comparison to personality traits.

  9. Will male advertisement be a reliable indicator of paternal care, if offspring survival depends on male care?

    Science.gov (United States)

    Kelly, Natasha B; Alonzo, Suzanne H

    2009-09-07

    Existing theory predicts that male signalling can be an unreliable indicator of paternal care, but assumes that males with high levels of mating success can have high current reproductive success, without providing any parental care. As a result, this theory does not hold for the many species where offspring survival depends on male parental care. We modelled male allocation of resources between advertisement and care for species with male care where males vary in quality, and the effect of care and advertisement on male fitness is multiplicative rather than additive. Our model predicts that males will allocate proportionally more of their resources to whichever trait (advertisement or paternal care) is more fitness limiting. In contrast to previous theory, we find that male advertisement is always a reliable indicator of paternal care and male phenotypic quality (e.g. males with higher levels of advertisement never allocate less to care than males with lower levels of advertisement). Our model shows that the predicted pattern of male allocation and the reliability of male signalling depend very strongly on whether paternal care is assumed to be necessary for offspring survival and how male care affects offspring survival and male fitness.

  10. A STUDY ON INDICATION FOR VITRECTOMY IN TERTIARY CARE HOSPITAL

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    Dhawal H. Agrawal

    2015-06-01

    Full Text Available Introduction: Pars planavitrectomy is the final step in management of many disease. Taking into consideration usefulness and necessity of Pars planavitrectomy in today's world we would like to do this study to evaluate the surgical outcome of 20 gauge pars planavitreoretinal surgery. Materials and methods: A hospital-based prospective interventional study of series of 46 patients was carried out in retina clinic of SMIMER, Surat, Gujarat, From July 2012 to November 2014 who underwent vitreo-retina surgeries were reviewed. Demography, duration of symptoms, risk factors and indications, preoperative and post-operative visual acuity, intra-operative and post-operative complications were analyzed. Results:Of 46 patients, preoperatively, 89 % had visual acuity of 2/60 to perception of light .The main indication for TPPV was nuclear drop, in 50 %.The visual acuity improved to better than 6/60 in 57% patients , whereas, overall, in 86.9 % of the subjects, it improved by 1 lines postoperatively. The commonest intra-operative complications was bleeding intraocularly(4.35%. Conclusion: Useful vision can be restored by pars planavitrectomy in the majority of the patients (p value <0.01. Timing of vitrectomy did not have influence on visual outcome in patients of nuclear drop. Progression of cataract is the commonest complication of TPPV(10.87%. Indications of vitrectomy does not have statistically significant influence on visual outcome after vitrectomy. [Natl J Med Res 2015; 5(2.000: 156-160

  11. Inducing Herd Immunity against Seasonal Influenza in Long-Term Care Facilities through Employee Vaccination Coverage: A Transmission Dynamics Model

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    Aaron M. Wendelboe

    2015-01-01

    Full Text Available Introduction. Vaccinating healthcare workers (HCWs in long-term care facilities (LTCFs may effectively induce herd immunity and protect residents against influenza-related morbidity and mortality. We used influenza surveillance data from all LTCFs in New Mexico to validate a transmission dynamics model developed to investigate herd immunity induction. Material and Methods. We adjusted a previously published transmission dynamics model and used surveillance data from an active system among 76 LTCFs in New Mexico during 2006-2007 for model validation. We used a deterministic compartmental model with a stochastic component for transmission between residents and HCWs in each facility in order to simulate the random variation expected in such populations. Results. When outbreaks were defined as a dichotomous variable, our model predicted that herd immunity could be induced. When defined as an attack rate, the model demonstrated a curvilinear trend, but insufficiently strong to induce herd immunity. The model was sensitive to changes in the contact parameter β but was robust to changes in the visitor contact probability. Conclusions. These results further elucidate previous studies’ findings that herd immunity may not be induced by vaccinating HCWs in LTCFs; however, increased influenza vaccination coverage among HCWs reduces the probability of influenza infection among residents.

  12. Examining the "liberal media" claim: journalists' views on politics, economic and social policy (including health care), and media coverage.

    Science.gov (United States)

    Croteau, D

    1999-01-01

    The conservative critique of the news media rests on two general propositions: journalists hold views that are to the left of the public, and journalists frame news content in a way that accentuates these left perspectives. Previous research has revealed persuasive evidence against the latter claim, but the validity of the former claim has often been taken for granted. This research project examined the supposed left orientation of media personnel by surveying Washington-based journalists who cover national politics and/or economic policy at U.S. outlets. The findings include: (1) On select issues from corporate power and trade to Social Security and Medicare to health care and taxes, journalists are actually more conservative than the general public. (2) Journalists are mostly centrist in their political orientation. (3) The minority of journalists who do not identify with the "center" are more likely to identify with the "right" when it comes to economic issues and to identify with the "left" when it comes to social issues. (4) Journalists report that "business-oriented news outlets" and "major daily newspapers" provide the highest quality coverage of economic policy issues, while "broadcast network TV news" and "cable news services" provide the worst.

  13. Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

    NARCIS (Netherlands)

    D. Stalpers (Dewi); R.A.M.M. Kieft (Renate A. M. M.); D. van der Linden (Dimitri); M.J. Kaljouw (Marian J.); M.J. Schuurmans (Marieke )

    2016-01-01

    textabstractBackground: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-s

  14. Monitoring intervention coverage in the context of universal health coverage.

    Directory of Open Access Journals (Sweden)

    Ties Boerma

    2014-09-01

    Full Text Available Monitoring universal health coverage (UHC focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups-promotion/prevention, and treatment/care-as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the

  15. Monitoring intervention coverage in the context of universal health coverage.

    Science.gov (United States)

    Boerma, Ties; AbouZahr, Carla; Evans, David; Evans, Tim

    2014-09-01

    Monitoring universal health coverage (UHC) focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups-promotion/prevention, and treatment/care-as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the production of

  16. A Purchaser’s Guide to Clinical Preventive Services: A Tool to Improve Health Care Coverage for Prevention

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    Kathryn Phillips Campbell, MPH

    2008-04-01

    Full Text Available IntroductionIn 2005, representatives from the Centers for Disease Control and Prevention partnered with the National Business Group on Health and the Agency for Healthcare Research and Quality to form a work group for developing A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage. This guide, designed as a tool for employers, describes recommended clinical preventive services for 46 conditions. The guide includes the scientific evidence and benefits language that employers need to include comprehensive clinical preventive services in their medical benefit plans.MethodsThe work group determined that the guide would address conditions that 1 affected a large percentage of the working population, 2 were costly to control, and 3 had well-defined and accepted recommendations for preventive services. Subject matter experts from the Centers for Disease Control and Prevention, the National Business Group on Health, and the Agency for Healthcare Research and Quality developed or reviewed statements of scientific evidence for 46 diseases and conditions.ResultsThe Purchaser’s Guide, written for an employer audience, includes descriptions for recommended clinical preventive services and their cost savings, syntheses of supporting evidence, strategies for prioritization, and recommendations to improve the delivery and use of preventive services. Twelve hundred copies were sent to more than 275 members of the National Business Group on Health and other purchasers of health care; training sessions on the Guide were held for 228 business leaders, health benefit consultants, and health plan administrators; and an online version was created through the Web sites of the National Business Group on Health and the Centers for Disease Control and Prevention. The online version has received more than 260,000 hits since its release.ConclusionIn 2007, the National Business Group on Health reported that some Fortune 500 companies will be

  17. [Association between coverage by oral health teams in the family health and the increase in dental care output in Brazilian municipalities, 1999 and 2011].

    Science.gov (United States)

    Corrêa, Gabriel Trevizan; Celeste, Roger Keller

    2015-12-01

    The aim of this study was to analyze the association between population coverage by oral health teams under the Family Health Strategy (FHS) and the difference in 1999 and 2011 in rates of use of public dental services in Brazilian municipalities. The sample included all 5,507 municipalities in both years. Data were used from government information systems to perform logistic regression for modeling the increase in procedure rates. By 2011, 85% of Brazil's municipalities had oral health teams under the FHS and there had been an increase in infrastructure, human and financial resources. Dental care output increased 49.5% from 1999 to 2011. Municipalities that incorporated more than 3 oral health teams per 10,000 inhabitants showed higher odds of increasing their rates of community procedures (OR = 1.61, 95%CI: 1.23-2.11), prophylactic procedures (OR = 2.05, CI95%: 1.56-2.69), restorations (OR = 2.07, 95%CI: 1.58-2.71), and extractions (OR = 1.53, 95%CI: 1.19-1.97) after adjusting for socio-demographic factors and variations in physical, human and financial resources. The incorporation of oral health teams into the FHS appears more effective for increasing indicators of the use of dental services.

  18. Final Rules for Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protections Under the Affordable Care Act. Final rules.

    Science.gov (United States)

    2015-11-18

    This document contains final regulations regarding grandfathered health plans, preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, coverage of dependent children to age 26, internal claims and appeal and external review processes, and patient protections under the Affordable Care Act. It finalizes changes to the proposed and interim final rules based on comments and incorporates subregulatory guidance issued since publication of the proposed and interim final rules.

  19. Quality of care in one Italian nursing home measured by ACOVE process indicators.

    Directory of Open Access Journals (Sweden)

    Claudia Pileggi

    Full Text Available To adapt the Assessing Care of Vulnerable Elders Quality Indicators (ACOVE QIs for use in Italy, to assess the adherence to these indicators as reported in the medical records of residents in a nursing home (NH, to compare this adherence for general medical and geriatric conditions, and eventually, to identify the relationships between patients' characteristics and reported processes of care.Two physicians collected the data by reviewing medical records of all NH residents in the previous 5 years, for a period of one year. Patients aged <65 years were excluded. A total of 245 patients were reviewed during the study period. The ACOVE QIs set, developed for NH processes of care, was used to assess the quality of care. Multivariate analysis was performed to identify and to assess the role of patients' characteristics on quality of processes of care by several domains of care in general medical and geriatric conditions.With the exception of diabetes management, quality of processes of care for general medical conditions approached adequate adherence. Care falls substantially short of acceptable levels for geriatric conditions (pressure ulcers, falls, dementia. On the contrary, the recommended interventions for urinary incontinence were commonly performed. Adherence to indicators varied for the different domains of care and was proven worse for the screening and prevention indicators both for geriatric and general medical conditions. Statistical analysis showed disparities in provision of appropriate processes of care associated with gender, age, co-morbidities, level of function and mobility, length of stay and modality of discharge by NHs.Adherence to recommended processes of care delivered in NH is inadequate. Substantial work lies ahead for the improvement of care. Efforts should focus particularly on management of geriatric conditions and on preventive healthcare.

  20. Self-care behaviors and health indicators in adults with type 2 diabetes.

    Science.gov (United States)

    Compeán Ortiz, Lidia Guadalupe; Gallegos Cabriales, Esther Carlota; González González, José Gerardo; Gómez Meza, Marco Vinicio

    2010-01-01

    This descriptive correlational study aimed to analyze self-care behaviors and their relationship with health indicators represented by glycemic control, lipid profile, Body Mass Index [BMI], waist circumference and body fat percentage in a sample of 98 adults with type 2 diabetes in an area of Nuevo Leon, Mexico (August 2005/May 2006). The results showed a low self-care behaviors index (X = 36.94, SD=15.14). A significant relationship was found between self-care behaviors and glycosilated hemoglobin [HbA1c] (r s=-.379, pdiet was the most predictive for health indicators, moderated by gender and understanding of diabetes contents (p< .05).

  1. Nutritional care; do process and structure indicators influence malnutrition prevalence over time?

    Science.gov (United States)

    Meijers, Judith M M; Tan, Frans; Schols, Jos M G A; Halfens, Ruud J G

    2014-06-01

    To date, no information is available about the effect of structural and process factors of nutritional care on the prevalence of malnutrition over time in the long-term care sector. This study analyzes the trend of malnutrition prevalence rates between 2007 and 2011 in the long-term care sector, and the related effects of(1) process indicators such as nutritional screening and treatment and 2) structural indicators (guideline, protocol or nutritional screening policy). From 2007 to 2011, the Dutch National Prevalence Measurement of Care Problems (LPZ) was performed in Dutch long-term care organizations using a standardized questionnaire involving measurements at institutional, ward and resident level. The data were analyzed by mixed-linear regression for longitudinal data. Presence of malnutrition was assessed by BMI, undesired weight loss and nutritional intake. Seventy-four care homes were included (26,101 residents). The malnutrition prevalence trend significantly decreased (P effects analysis only the interacted process indicators nutritional screening and oral nutritional supplementation (ONS) were significant in influencing malnutrition prevalence rates over time. Structural indicators had no impact on the malnutrition prevalence over time. In conclusion, over time a lower prevalence of malnutrition is associated with a higher degree of nutritional screening. As might be expected, a higher prevalence of malnutrition is associated with higher use of ONS. Structural nutritional screening is an important intervention to tackle the problem of malnutrition in the long term care sector.

  2. [Computerized system for managing nursing care indicators at Hospital São Paulo].

    Science.gov (United States)

    Labbadia, Lilian Lestingi; D'Innocenzo, Maria; Fogliano, Rosana Rodrigues Figueira; Silva, Gabriela Eneida Françolin; de Queiroz, Rita Marina Ribeiro Melo; Carmagnani, Maria Isabel Sampaio; Salvador, Maria Elisabete

    2011-08-01

    Indicators are tools that permit to define parameters that will be used to make comparisons between a result and its expected value, as well as to add a value of judgement in this regard. The purpose of this study is to describe the experience of a group of nurses in the development of a computerized system to manage nursing care indicators at Hospital São Paulo. Four stages were used to implement the indicator management system: developing a nursing care indicator handbook; performing a manually registered pilot test; developing the computerized system; and performing the pilot test of the computerized system in eleven units at the hospital.

  3. Assessing quality of care of elderly patients using the ACOVE quality indicator set: a systematic review.

    Directory of Open Access Journals (Sweden)

    Marjan Askari

    Full Text Available BACKGROUND: Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE quality indicators (QIs were developed to assess and improve the care of elderly patients. OBJECTIVES: The purpose of this review is to summarize studies that assess the quality of care using QIs from or based on ACOVE, in order to evaluate the state of quality of care for the reported conditions. METHODS: We systematically searched MEDLINE, EMBASE and CINAHL for English-language studies indexed by February 2010. Articles were included if they used any ACOVE QIs, or adaptations thereof, for assessing the quality of care. Included studies were analyzed and relevant information was extracted. We summarized the results of these studies, and when possible generated an overall conclusion about the quality of care as measured by ACOVE for each condition, in various settings, and for each QI. RESULTS: Seventeen studies were included with 278 QIs (original, adapted or newly developed. The quality scores showed large variation between and within conditions. Only a few conditions showed a stable pass rate range over multiple studies. Overall, pass rates for dementia (interquartile range (IQR: 11%-35%, depression (IQR: 27%-41%, osteoporosis (IQR: 34%-43% and osteoarthritis (IQR: 29-41% were notably low. Medication management and use (range: 81%-90%, hearing loss (77%-79% and continuity of care (76%-80% scored higher than other conditions. Out of the 278 QIs, 141 (50% had mean pass rates below 50% and 121 QIs (44% had pass rates above 50%. Twenty-three percent of the QIs scored above 75%, and 16% scored below 25%. CONCLUSIONS: Quality of care per condition varies markedly across studies. Although there has been much effort in improving the care for elderly patients in the last years, the reported quality of care according to the ACOVE indicators is still relatively low.

  4. Risk adjustment methods for Home Care Quality Indicators (HCQIs based on the minimum data set for home care

    Directory of Open Access Journals (Sweden)

    Hirdes John P

    2005-01-01

    Full Text Available Abstract Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs based on the Minimum Data Set for Home Care (MDS-HC. Methods A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a client covariates only; b client covariates plus an "Agency Intake Profile" (AIP to adjust for ascertainment and selection bias by the agency; and c client covariates plus the intake Case Mix Index (CMI. Results The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. Conclusions Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did

  5. Americans' Experiences with ACA Marketplace Coverage: Affordability and Provider Network Satisfaction: Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February--April 2016.

    Science.gov (United States)

    Gunja, Munira Z; Collins, Sara R; Doty, Michelle M; Beutel, Sophie

    2016-07-01

    For people with low and moderate incomes, the Affordable Care Act's tax credits have made premium costs roughly comparable to those paid by people with job-based health insurance. For those with higher incomes, the tax credits phase out, meaning that adults in marketplace plans on average have higher premium costs than those in employer plans. The law's cost-sharing reductions are reducing deductibles. Lower-income adults in marketplace plans were less likely than higher-income adults to report having deductibles of $1,000 or more. Majorities of new marketplace enrollees and those who have changed plans since they initially obtained marketplace coverage are satisfied with the doctors participating in their plans. Overall, the majority of marketplace enrollees expressed confidence in their ability to afford care if they were to become seriously ill. This issue brief explores these and other findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February--April 2016.

  6. Risk indicators for hearing loss in infants treated in different Neonatal Intensive Care Units

    NARCIS (Netherlands)

    van Dommelen, P.; Mohangoo, A. D.; Verkerk, P. H.; van der Ploeg, C. P. B.; van Straaten, H. L. M.

    2010-01-01

    Aim: To assess which infants' characteristics and specialized procedures are risk indicators for unilateral or bilateral hearing loss (HL) and to evaluate whether these risk indicators are associated with variation in prevalence of HL between Neonatal Intensive Care Units (NICUs). Methods: For 2002-

  7. Assessing Private Sector Involvement in Health Care and Universal Health Coverage in Light of the Right to Health

    NARCIS (Netherlands)

    Hallo de Wolf, Antenor; Toebes, Brigit

    2016-01-01

    e goal of universal health coverage is to “ensure that all people obtain the health services they need without su ering nancial hardship when paying for them.” There are many connections between this goal and the state’s legal obligation to realize the human right to health. In the context of this g

  8. Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association.

    Science.gov (United States)

    Schiele, Francois; Gale, Chris P; Bonnefoy, Eric; Capuano, Frederic; Claeys, Marc J; Danchin, Nicolas; Fox, Keith Aa; Huber, Kurt; Iakobishvili, Zaza; Lettino, Maddalena; Quinn, Tom; Rubini Gimenez, Maria; Bøtker, Hans E; Swahn, Eva; Timmis, Adam; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zeymer, Uwe; Bueno, Hector

    2017-02-01

    Evaluation of quality of care is an integral part of modern healthcare, and has become an indispensable tool for health authorities, the public, the press and patients. However, measuring quality of care is difficult, because it is a multifactorial and multidimensional concept that cannot be estimated solely on the basis of patients' clinical outcomes. Thus, measuring the process of care through quality indicators (QIs) has become a widely used practice in this context. Other professional societies have published QIs for the evaluation of quality of care in the context of acute myocardial infarction (AMI), but no such indicators exist in Europe. In this context, the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) has reflected on the measurement of quality of care in the context of AMI (ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI)) and created a set of QIs, with a view to developing programmes to improve quality of care for the management of AMI across Europe. We present here the list of QIs defined by the ACCA, with explanations of the methodology used, scientific justification and reasons for the choice for each measure.

  9. Study on performance following Key Performance Indicators for trauma care: Khon Kaen Hospital 2000.

    Science.gov (United States)

    Chadbunchachai, Witaya; Saranrittichai, Surachai; Sriwiwat, Sununta; Chumsri, Jirawadee; Kulleab, Sirikul; Jaikwang, Piyaporn

    2003-01-01

    This study was conducted in 2000-2001 in order to improve the quality of trauma care by establishing the Key Performance Indicators (KPIs) as a guideline in providing trauma care service and to study the personnel's performance following 27 indexes of KPIs for trauma care in Khon Kaen Hospital. After the implementation of the KPIs by the method of participatory action research (PAR), the trauma preventable death rate was decreased to 1.3 per cent which was statistically different from the preventable death rate in 1997 (2.0%).

  10. Indicators of patients with major depressive disorder in need of highly specialized care: A systematic review

    Science.gov (United States)

    Kaddouri, Meriam; Goorden, Maartje; van Balkom, Anton J. L. M.; Bockting, Claudi L. H.; Peeters, Frenk P. M. L.; Hakkaart-van Roijen, Leona

    2017-01-01

    Objectives Early identification of patients with major depressive disorder (MDD) that cannot be managed by secondary mental health services and who require highly specialized mental healthcare could enhance need-based patient stratification. This, in turn, may reduce the number of treatment steps needed to achieve and sustain an adequate treatment response. The development of a valid tool to identify patients with MDD in need of highly specialized care is hampered by the lack of a comprehensive understanding of indicators that distinguish patients with and without a need for highly specialized MDD care. The aim of this study, therefore, was to systematically review studies on indicators of patients with MDD likely in need of highly specialized care. Methods A structured literature search was performed on the PubMed and PsycINFO databases following PRISMA guidelines. Two reviewers independently assessed study eligibility and determined the quality of the identified studies. Three reviewers independently executed data extraction by using a pre-piloted, standardized extraction form. The resulting indicators were grouped by topical similarity, creating a concise summary of the findings. Results The systematic search of all databases yielded a total of 7,360 references, of which sixteen were eligible for inclusion. The sixteen papers yielded a total of 48 unique indicators. Overall, a more pronounced depression severity, a younger age of onset, a history of prior poor treatment response, psychiatric comorbidity, somatic comorbidity, childhood trauma, psychosocial impairment, older age, and a socioeconomically disadvantaged status were found to be associated with proxies of need for highly specialized MDD care. Conclusions Several indicators are associated with the need for highly specialized MDD care. These indicators provide easily measurable factors that may serve as a starting point for the development of a valid tool to identify patients with MDD in need of highly

  11. Developing quality indicators for family support services in community team-based mental health care.

    Science.gov (United States)

    Serene Olin, S; Kutash, Krista; Pollock, Michele; Burns, Barbara J; Kuppinger, Anne; Craig, Nancy; Purdy, Frances; Armusewicz, Kelsey; Wisdom, Jennifer; Hoagwood, Kimberly E

    2014-01-01

    Quality indicators for programs integrating parent-delivered family support services for children's mental health have not been systematically developed. Increasing emphasis on accountability under the Affordable Care Act highlights the importance of quality-benchmarking efforts. Using a modified Delphi approach, quality indicators were developed for both program level and family support specialist level practices. These indicators were pilot tested with 21 community-based mental health programs. Psychometric properties of these indicators are reported; variations in program and family support specialist performance suggest the utility of these indicators as tools to guide policies and practices in organizations that integrate parent-delivered family support service components.

  12. Measures to Improve Financial Indicators in Health Care System of the Federation of Bosnia and Herzegovina

    Directory of Open Access Journals (Sweden)

    Slavko Vukić

    2010-12-01

    Full Text Available The first part of the paper analyses the financial indicators in the health care system of the Federation of Bosnia and Herzegovina. The structure of total expenditure of compulsory health insurance in the period 2003-2008 was analysed by comparing the financial reports stipulated in the health care system of the Federation of Bosnia and Herzegovina with some foreign financial indicators. According to the existing situation, the objectives and measures required for their full implementation in the following medium-term period 2009-2013 have been determined. The movements of financial indicators following the implementation of certain institutional measures have been estimated according to the flow of some indicators from the previous period (time series and in accordance with the global trends of some macroeconomic indicators (employment, GDP, etc..

  13. Development of a set of process and structure indicators for palliative care: the Europall project

    Directory of Open Access Journals (Sweden)

    Woitha Kathrin

    2012-11-01

    Full Text Available Abstract Background By measuring the quality of the organisation of palliative care with process and structure quality indicators (QIs, patients, caregivers and policy makers are able to monitor to what extent recommendations are met, like those of the council of the WHO on palliative care and guidelines. This will support the implementation of public programmes, and will enable comparisons between organisations or countries. Methods As no European set of indicators for the organisation of palliative care existed, such a set of QIs was developed. An update of a previous systematic review was made and extended with more databases and grey literature. In two project meetings with practitioners and experts in palliative care the development process of a QI set was finalised and the QIs were categorized in a framework, covering the recommendations of the Council of Europe. Results The searches resulted in 151 structure and process indicators, which were discussed in steering group meetings. Of those QIs, 110 were eligible for the final framework. Conclusions We developed the first set of QIs for the organisation of palliative care. This article is the first step in a multi step project to identify, validate and pilot QIs.

  14. Toward Advanced Nursing Practice along with People-Centered Care Partnership Model for Sustainable Universal Health Coverage and Universal Access to Health 1

    Science.gov (United States)

    Kamei, Tomoko; Takahashi, Keiko; Omori, Junko; Arimori, Naoko; Hishinuma, Michiko; Asahara, Kiyomi; Shimpuku, Yoko; Ohashi, Kumiko; Tashiro, Junko

    2017-01-01

    ABSTRACT Objective: this study developed a people-centered care (PCC) partnership model for the aging society to address the challenges of social changes affecting people’s health and the new role of advanced practice nurses to sustain universal health coverage. Method: a people-centered care partnership model was developed on the basis of qualitative meta-synthesis of the literature and assessment of 14 related projects. The ongoing projects resulted in individual and social transformation by improving community health literacy and behaviors using people-centered care and enhancing partnership between healthcare providers and community members through advanced practice nurses. Results: people-centered care starts when community members and healthcare providers foreground health and social issues among community members and families. This model tackles these issues, creating new values concerning health and forming a social system that improves quality of life and social support to sustain universal health care through the process of building partnership with communities. Conclusion: a PCC partnership model addresses the challenges of social changes affecting general health and the new role of advanced practice nurses in sustaining UHC. PMID:28146179

  15. Gender-affirming Surgeries in the Era of Insurance Coverage: Developing a Framework for Psychosocial Support and Care Navigation in the Perioperative Period.

    Science.gov (United States)

    Deutsch, Madeline B

    2016-01-01

    Transgender people have a gender identity different from their birth-assigned sex. Transgender people may seek gender-affirming surgeries to align their body with their identified gender. With increasing visibility of transgender identities, and recognition of the importance of gender-affirming care, has come a policy shift toward mandated coverage or provision of blanket exclusions of these procedures by insurance companies and Medicaid. The World Professional Association for Transgender Health provides guidance to mental health professionals evaluating patients for gender-affirming surgeries, including making a diagnosis and assessing for capacity to consent. However the expansion of covered gender-affirming surgeries to safety-net populations has highlighted the need for an expanded presurgical process which includes a psychosocial assessment and care navigation. The proposed framework expands the preoperative assessment to include these components, and can be used to guide both health systems and insurance providers in the development of transgender medicine programs.

  16. Quality indicators for all dimensions of infertility care quality: consensus between professionals and patients

    NARCIS (Netherlands)

    Dancet, E.A.; D'Hooghe, T.M.; Spiessens, C.; Sermeus, W.; Neubourg, D. De; Karel, N.; Kremer, J.A.M.; Nelen, W.L.D.M.

    2013-01-01

    STUDY QUESTION: What is the relative importance of the six dimensions of quality of care according to different stakeholders and can a quality indicator set address all six quality dimensions and incorporate the views from professionals working in different disciplines and from patients? SUMMARY ANS

  17. Quality indicators for physiotherapy care in hip and knee osteoarthritis: development and clinimetric properties

    NARCIS (Netherlands)

    Peter, W.F.; Wees, P.J. van der; Hendriks, E.J.; Bie, R.A. de; Verhoef, J.; Jong, Z. de; Bodegom-Vos, L. van; Hilberdink, W.K.H.A.; Vlieland, T.P.

    2013-01-01

    OBJECTIVE: The aim of the present study was to develop process quality indicators for physiotherapy care based on key recommendations of the Dutch physiotherapy guideline on hip and knee osteoarthritis (OA). METHODS: Guideline recommendations were rated for their relevance by an expert panel, transf

  18. Performance indicators for maternity care in a circumpolar context: a scoping review

    Directory of Open Access Journals (Sweden)

    Rebecca Rich

    2016-12-01

    Full Text Available Background: In circumpolar regions, harsh climates and scattered populations have prompted the centralization of care and reduction of local maternity services. The resulting practice of routine evacuation for birth from smaller towns to larger urban centres points to a potential conflict between the necessity to ensure patient safety and the importance of delivering services that are responsive to the health needs and values of populations served. Objective: To identify recommended performance/quality indicators for use in circumpolar maternity care systems. Methods: We searched Scopus, Ebscohost databases (including Academic Search Complete and CINAHL, the Global Health Database, High North Research Documents, and online grey literature. Articles were included if they focused on maternal health indicators in the population of interest (Indigenous women, women receiving care in circumpolar or remote regions. Articles were excluded if they were not related to pregnancy, birth or the immediate post-partum or neonatal periods. Two reviewers independently reviewed articles for inclusion and extracted relevant data. Results: Twenty-six documents were included. Twelve were government documents, seven were review articles or indicator compilations, four were indicator sets recommended by academics or non-governmental organizations and three were research papers. We extracted and categorized 81 unique health indicators. The majority of indicators reflected health systems processes and outcomes during the antenatal and intra-partum periods. Only two governmental indicator sets explicitly considered the needs of Indigenous peoples. Conclusions: This review demonstrates that, although most circumpolar health systems engage in performance reporting for maternity care, efforts to capture local priorities and values are limited in most regions. Future work in this area should involve northern stakeholders in the process of indicator selection and development.

  19. Immunization coverage and infant mortality rate in developing countries.

    Science.gov (United States)

    Shimouchi, A; Ozasa, K; Hayashi, K

    1994-01-01

    We examined whether immunization coverage (IMC) is one of the predictors of infant mortality rate (IMR), as a single indicator representing the availability of primary health care (PHC) services in developing countries. Multiple regression analysis showed that partial correlation coefficients for IMR with immunization coverage (-0.224), logarithm of per capita GNP (-0.294), total fertility rate (0.269), and adult literacy rate (-0.325) were all statistically significant (p immunization coverage is one of the main predictors of the infant mortality rate. It represents one of the health intervention components which can be used as a proxy indicator of the availability of PHC service in developing countries.

  20. Quality indicators for pharmaceutical care: a comprehensive set with national scores for Dutch community pharmacies.

    Science.gov (United States)

    Teichert, Martina; Schoenmakers, Tim; Kylstra, Nico; Mosk, Berend; Bouvy, Marcel L; van de Vaart, Frans; De Smet, Peter A G M; Wensing, Michel

    2016-08-01

    Background The quality of pharmaceutical care in community pharmacies in the Netherlands has been assessed annually since 2008. The initial set has been further developed with pharmacists and patient organizations, the healthcare inspectorate, the government and health insurance companies. The set over 2012 was the first set of quality indicators for community pharmacies which was validated and supported by all major stakeholders. The aims of this study were to describe the validated set of quality indicators for community pharmacies and to report their scores over 2012. In subanalyses the score development over 5 years was described for those indicators, that have been surveyed before and remained unchanged. Methods Community pharmacists in the Netherlands were invited in 2013 to provide information for the set of 2012. Quality indicators were mapped by categories relevant for pharmaceutical care and defined for structures, processes and dispensing outcomes. Scores for categorically-measured quality indicators were presented as the percentage of pharmacies reporting the presence of a quality aspect. For numerical quality indicators, the mean of all reported scores was expressed. In subanalyses for those indicators that had been questioned previously, scores were collected from earlier measurements for pharmacies providing their scores in 2012. Multilevel analysis was used to assess the consistency of scores within one pharmacy over time by the intra-class correlation coefficient (ICC). Results For the set in 2012, 1739 Dutch community pharmacies (88 % of the total) provided information for 66 quality indicators in 10 categories. Indicator scores on the presence of quality structures showed relatively high quality levels. Scores for processes and dispensing outcomes were lower. Subanalyses showed that overall indicators scores improved within pharmacies, but this development differed between pharmacies. Conclusions A set of validated quality indicators provided

  1. Rational use of medicines: prescribing indicators at different levels of health care

    Directory of Open Access Journals (Sweden)

    Maria Beatriz Cardoso Ferreira

    2013-06-01

    Full Text Available This multicenter study aimed to investigate prescribing patterns of drugs at different levels of health care delivery in university-affiliated outpatient clinics located in eight cities in the South and Midwest of Brazil. All prescriptions collected were analyzed for various items, including WHO prescribing indicators. A total of 2,411 prescriptions were analyzed, and 469 drugs were identified. The number of drugs prescribed per encounter, the frequency of polypharmacy, and the percentage of encounters with at least one injection or antibiotic prescribed were higher in centers providing primary health care services, compared to those where this type of care is not provided. Most drugs (86.1% were prescribed by generic name. In centers with primary health care services, drug availability was higher, drugs included in the National and Municipal Lists of Essential Medicines were more frequently prescribed, and patients were given more instructions. However, warnings and non-pharmacological measures were less frequently recommended. This study reveals trends in drug prescribing at different levels of health care delivery in university-affiliated outpatient clinics and indicates possible areas for improvement in prescribing practices.

  2. Impact of Free Delivery Care on Health Facility Delivery and Insurance Coverage in Ghana's Brong Ahafo Region.

    OpenAIRE

    Dzakpasu, S; Soremekun, S; Manu, A; ten Asbroek, G.; Tawiah, C.; Hurt, L.; Fenty, J; Owusu-Agyei, S; Hill, Z; Campbell, OM; Kirkwood, BR

    2012-01-01

    BACKGROUND: Many sub-Saharan countries, including Ghana, have introduced policies to provide free medical care to pregnant women. The impact of these policies, particularly on access to health services among the poor, has not been evaluated using rigorous methods, and so the empirical basis for defending these policies is weak. In Ghana, a recent report also cast doubt on the current mechanism of delivering free care--the National Health Insurance Scheme. Longitudinal surveillance data from t...

  3. [Antenatal emergency call. Indications. Role of the SAMU (Medical Emergency Care Services)].

    Science.gov (United States)

    Lallemand, E; Drouet, N; Faudemay, C; Lacroute, J M; Menthonnex, P

    1989-01-01

    The increased incidence of antenatal distress calls to the SAMU (emergency medical squad) by pediatric obstetricians in maternity departments (6 times in 5 years) poses the problem of recognizing their indications. Based on case reports of 128 newborns who profited from antenatal assistance, the authors attempt to define the indications. The elimination of student physicians in training for anesthesiology-intensive care, additional participants during SAMU transportation of patients, makes it even more necessary to define these indications accurately so that a single language of communication and procedure may be instituted for all who are involved in this effort.

  4. Composing a core set of performance indicators for public mental health care: a modified Delphi procedure.

    Science.gov (United States)

    Lauriks, Steve; de Wit, Matty A S; Buster, Marcel C A; Arah, Onyebuchi A; Klazinga, Niek S

    2014-09-01

    Public mental health care (PMHC) systems are responsible for the wellbeing of vulnerable groups that cope with complex psychosocial problems. This article describes the development of a set of performance indicators that are feasible, meaningful, and useful to assess the quality of the PMHC system in Amsterdam, the Netherlands. Performance indicators were selected from an international inventory and presented to stakeholders of the PMHC system in a modified Delphi procedure. Characteristics of indicators were judged individually, before consensus on a core set was reached during a plenary discussion. Involving stakeholders at early stages of development increases support for quality assessment.

  5. Evaluating the Effect of Software Quality Characteristics on Health Care Quality Indicators

    Directory of Open Access Journals (Sweden)

    Sakineh Aghazadeh

    2015-07-01

    Full Text Available Introduction: Various types of software are used in health care organizations to manage information and care processes. The quality of software has been an important concern for both health authorities and designers of Health Information Technology. Thus, assessing the effect of software quality on the performance quality of healthcare institutions is essential. Method: The most important health care quality indicators in relation to software quality characteristics are provided via an already performed literature review. ISO 9126 standard model is used for definition and integration of various characteristics of software quality. The effects of software quality characteristics and sub-characteristics on the healthcare indicators are evaluated through expert opinion analyses. A questionnaire comprising of 126 questions of 10-point Likert scale was used to gather opinions of experts in the field of Medical/Health Informatics. The data was analyzed using Structural Equation Modeling. Results: Our findings showed that software Maintainability was rated as the most effective factor on user satisfaction (R2 =0.89 and Functionality as the most important and independent variable affecting patient care quality (R2 =0.98. Efficiency was considered as the most effective factor on workflow (R2 =0.97, and Maintainability as the most important factor that affects healthcare communication (R2 =0.95. Usability and Efficiency were rated as the most effectual factor affecting patient satisfaction (R2 =0.80, 0.81. Reliability, Maintainability, and Efficiency were considered as the main factors affecting care costs (R2 =0.87, 0.74, 0.87. Conclusion: We presented a new model based on ISO standards. The model demonstrates and weighs the relations between software quality characteristics and healthcare quality indicators. The clear relationships between variables and the type of the metrics and measurement methods used in the model make it a reliable method to assess

  6. [Health financing in Lebanon. I. Organization of health care services, coverage system and contribution of the Ministry of Public Health].

    Science.gov (United States)

    Ammar, W; Mechbal A el-H; Awar, M

    1998-01-01

    This paper intends to analyze the health care system in Lebanon from the organizational and financial points of view. It allows for an understanding of the health services' market by tackling it from different angles: supply versus demand, private versus public sectors, curative versus preventive services, hospital versus ambulatory care. This study necessitated a review of all previous surveys made in this field, during the after-war period. It also needed the daily collection and follow-up of pertinent data with all private and public agencies and concerned ministries, over a one-year period. In addition, a critical analysis has been made to the survey Conditions de vie des ménages, en 1997, that was carried out by the Central Administration of Statistics, that came to complete the missing data concerning household expenditures on insurance and health services. Especially that this survey covered the same period (1997), subject of this study. The paper reveals that, although the private sector is the main provider of both hospital and ambulatory care, private hospitals are flourishing on public money, whereas outpatients care is mainly financed by the households. Evidence shows that the Lebanese health care system succeeded in resolving the problem of accessibility to primary, secondary and tertiary health care, responding thus to the value of equity. But, at the price of an ever escalating cost, threatening the sustainability of the system. This is what is attained in this paper, as it shows clearly that expenditures on health have reached an alarming level of the GDP share. Our purpose being providing solid arguments in favor of reforming the health system.

  7. Are diagnosis specific outcome indicators based on administrative data useful in assessing quality of hospital care?

    Science.gov (United States)

    Scott, I; Youlden, D; Coory, M

    2004-01-01

    Background: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic (or special cause) variation (SV) suggesting differences in quality of care. For those that did, we determined whether SV persists within hospital peer groups, whether indicator results correlate at the individual hospital level, and how many adverse outcomes would be avoided if all hospitals achieved indicator values equal to the best performing 20% of hospitals. Methods: All patients admitted during a 12 month period to 180 acute care hospitals in Queensland, Australia with heart failure (n = 5745), acute myocardial infarction (AMI) (n = 3427), or stroke (n = 2955) were entered into the study. Outcomes comprised in-hospital deaths, long hospital stays, and 30 day readmissions. Regression models produced standardised, risk adjusted diagnosis specific outcome event ratios for each hospital. Systematic and random variation in ratio distributions for each indicator were then apportioned using hierarchical statistical models. Results: Only five of 12 (42%) diagnosis-outcome indicators showed significant SV across all hospitals (long stays and same diagnosis readmissions for heart failure; in-hospital deaths and same diagnosis readmissions for AMI; and in-hospital deaths for stroke). Significant SV was only seen for two indicators within hospital peer groups (same diagnosis readmissions for heart failure in tertiary hospitals and inhospital mortality for AMI in community hospitals). Only two pairs of indicators showed significant correlation. If all hospitals emulated the best performers, at least 20% of AMI and stroke deaths, heart failure long stays, and heart failure and AMI readmissions could be avoided

  8. Reliability of indicators of nursing care quality: testing interexaminer agreement and reliability

    Directory of Open Access Journals (Sweden)

    Dagmar Willamowius Vituri

    2014-04-01

    Full Text Available OBJECTIVE: this study sought to test the interexaminer agreement and reliability of 15 indicators of nursing care quality.METHODS: this was a quantitative, methodological, experimental, and applied study conducted at a large, tertiary, public teaching hospital in the state of Paraná. For data analysis, the Kappa (k statistic was applied to the categorical variables - indicators 1 to 11 and 15 - and the interclass correlation coefficient (ICC to the continuous variables - indicators 12, 13, and 14, with the corresponding 95% confidence intervals. The categorical data were analyzed using the Lee software, elaborated by the Laboratory of Epidemiology and Statistics of Dante Pazzanese Institute of Cardiology - Brazil, and the continuous data were assessed using BioEstat 5.0.RESULTS: the k-statistic results indicated excellent agreement, which was statistically significant, and the values of the ICC denoted excellent and statistically significant reproducibility/agreement relative to the investigated indicators.CONCLUSION: the investigated indicators exhibited excellent reliability and reproducibility, thus showing that it is possible to formulate valid and reliable assessment instruments for the management of nursing care.

  9. [Pressure ulcer care quality indicator: analysis of medical records and incident report].

    Science.gov (United States)

    dos Santos, Cássia Teixeira; Oliveira, Magáli Costa; Pereira, Ana Gabriela da Silva; Suzuki, Lyliam Midori; Lucena, Amália de Fátima

    2013-03-01

    Cross-sectional study that aimed to compare the data reported in a system for the indication of pressure ulcer (PU) care quality, with the nursing evolution data available in the patients' medical records, and to describe the clinical profile and nursing diagnosis of those who developed PU grade 2 or higher Sample consisted of 188 patients at risk for PU in clinical and surgical units. Data were collected retrospectively from medical records and a computerized system of care indicators and statistically analyzed. Of the 188 patients, 6 (3%) were reported for pressure ulcers grade 2 or higher; however, only 19 (10%) were recorded in the nursing evolution records, thus revealing the underreporting of data. Most patients were women, older adults and patients with cerebrovascular diseases. The most frequent nursing diagnosis was risk of infection. The use of two or more research methodologies such as incident reporting data and retrospective review of patients' records makes the results trustworthy.

  10. Availability and structure of primary medical care services and population health and health care indicators in England

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    Adams Geoffrey

    2004-06-01

    Full Text Available Abstract Background It has been proposed that greater availability of primary medical care practitioners (GPs contributes to better population health. We evaluated whether measures of the supply and structure of primary medical services are associated with health and health care indicators after adjusting for confounding. Methods Data for the supply and structure of primary medical services and the characteristics of registered patients were analysed for 99 health authorities in England in 1999. Health and health care indicators as dependent variables included standardised mortality ratios (SMR, standardised hospital admission rates, and conceptions under the age of 18 years. Linear regression analyses were adjusted for Townsend score, proportion of ethnic minorities and proportion of social class IV/ V. Results Higher proportions of registered rural patients and patients ≥ 75 years were associated with lower Townsend deprivation scores, with larger partnership sizes and with better health outcomes. A unit increase in partnership size was associated with a 4.2 (95% confidence interval 1.7 to 6.7 unit decrease in SMR for all-cause mortality at 15–64 years (P = 0.001. A 10% increase in single-handed practices was associated with a 1.5 (0.2 to 2.9 unit increase in SMR (P = 0.027. After additional adjustment for percent of rural and elderly patients, partnership size and proportion of single-handed practices, GP supply was not associated with SMR (-2.8, -6.9 to 1.3, P = 0.183. Conclusions After adjusting for confounding with health needs of populations, mortality is weakly associated with the degree of organisation of practices as represented by the partnership size but not with the supply of GPs.

  11. [Comparison of the prevalence of molar incisor hypomineralization among children with different health care coverage in the cities of Buenos Aires (Argentina) and Montevideo (Uruguay)].

    Science.gov (United States)

    López Jordi, María del Carmen; Cortese, Silvina G; Álvarez, Licet; Salveraglio, Inés; Ortolani, Andrea M; Biondi, Ana M

    2014-08-01

    The aim of this study was to compare the prevalence of molar incisor hypomineralization (MIH) among children with different health care coverage in Buenos Aires and Montevideo. An observational, cross-sectional and descriptive study was designed, considering children born from 1993-2003 who were seen in the Chairs of Comprehensive Children's Dentistry (Universidad de Buenos Aires) and of Pediatric Dentistry (Universidad de la República) and at five private dental offices between April and December 2010. Two groups were defined: A (Buenos Aires; n=1,090) and B (Montevideo; n=626). The clinical diagnosis was carried out with calibrated examiners (Kappa: 0.94) using the Mathu-Muju and Wright criteria. The prevalence of MIH was found to be 16.1% in A and 12.3% in B (p=0.03), with statistically significant differences between the public and private care sectors in both groups (A p=0.0008; B p=0.0004) and a positive correlation between MIH and year of birth (A p=0.001; B p=0.005). The results show that MIH is an emerging pathology and that MIH prevalence is related to year of birth and access to health care.

  12. Key performance indicators in intensive care medicine. A retrospective matched cohort study.

    Science.gov (United States)

    Kastrup, M; von Dossow, V; Seeling, M; Ahlborn, R; Tamarkin, A; Conroy, P; Boemke, W; Wernecke, K-D; Spies, Claudia

    2009-01-01

    Expert panel consensus was used to develop evidence-based process indicators that were independent risk factors for the main clinical outcome parameters of length of stay in the intensive care unit (ICU) and mortality. In a retrospective, matched data analysis of patients from five ICUs at a tertiary university hospital, agreed process indicators (sedation monitoring, pain monitoring, mean arterial pressure [MAP] >or= 60 mmHg, tidal volume [TV] or= 80 and or= 60 mmHg and BG >or= 80 mg/dl were relevant for survival. Linear regression of the 634 patients showed that analgesia monitoring, PIP or= 60 mmHg, BG >or= 80 mg/dl and indicating that adherence to evidence-based key process indicators may reduce mortality and length of ICU stay.

  13. Using In-Hospital Mortality as an Indicator of Quality Care and Hospital Performance

    Directory of Open Access Journals (Sweden)

    Badia BISBIS

    2016-06-01

    Full Text Available The in-hospital mortality (MIH is used as a performance indicator and quality healthcare in hospital. However, the majority of deaths resulted from an inevitable disease process (severity of cases and / or co-morbidity, and not medical errors or changes in the quality of care. This work aims to make a distribution of deaths in the Regional Hospital of Eastern, Al Farabi hospital and to highlight that more studies on the MIH are required consistently with detailed clinical data at the admission. The MIH showed its limitation as a health care  indicator. The overall rate of in-hospital deaths within the Al Farabi hospital has averaged 2.4%, with 8.4% in the emergency unit, 28% in intensive care unit, 22% Neonatology unit, 1.6% in pediatric unit. The MIH may depend, firstly, on the condition of patients before hospitalization and secondly, on the conditions of their transfer from one institution to another that supports them as a last resort. Al Farabi hospital supports patients transferred from the provinces of the eastern region. Thus, 6% of patients who died in 2014 come from Berkane, 2% from  Nador, 2% from Bouarfa, 4% from  Taourirt and 2% from Jerrada. One might question about  the procedures and the conditions of such transfers. In conclusion, the overall MIH measured from routine data do not allow proper comparison between hospitals or the assessment of the quality of care and patient safety in the hospital. To do so, we should ideally have detailed clinical data on admission (e.g. type of admission, age of patient, sex, comorbidity, .... The MIH is however an important indicator to consider as a tool to detect potential  problems related to admission procedures and to suspect an area of "non-quality" in healthcare . The MIH is interesting for the patient and for the hospital because it serves the improvement of quality healthcare.

  14. Developing Indicators of Service Quality Provided for Cardiovascular Patients Hospitalized in Cardiac Care Unit

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    Saber Azami-Aghdash

    2013-03-01

    Full Text Available Introduction: Cardiovascular diseases are among the most prevalent chronic diseases leading to high degrees of mortality and morbidity worldwide and in Iran. The aim of the current study was to determine and develop appropriate indicators for evaluating provided service quality for cardiovascular patients admitted to Cardiac Care Units (CCU in Iran. Methods: In order to determine the indicators for evaluating provided service quality, a four-stage process including reviewing systematic review articles in premier bibliographic databases, interview, performing two rounds of Delphi technique, and holding experts panel by attendance of experts in different fields was adopted. Finally, after recognizing relevant indicators in resources, these indicators were finalized during various stages using ideas of 27 experts in different fields. Results: Among 2800 found articles in the text reviewing phase, 21 articles, which had completely mentioned relevant indicators, were studied and 48 related indicators were extracted. After two interviews with a cardiologist and an epidemiologist, 32 items of the indicators were omitted and replaced by 27 indicators coping with the conditions of Iranian hospitals. Finally, 43 indicators were added into the Delphi phase and after 2 rounds of Delphi with 18 specialists, 7 cases were excluded due to their low scores of applicability. In the experts’ panel stage, 6 items were also omitted and 10 new indicators were developed to replace them. Eventually, 40 indicators were finalized. Conclusion: In this study, some proper indicators for evaluating provided service quality for CCU admissions in Iran were determined. Considering the informative richness of these indicators, they can be used by managers, policy makers, health service providers, and also insurance agencies in order to improve the quality of services, decisions, and policies.

  15. Nurse staffing and system integration and change indicators in acute care hospitals: evidence from a balanced scorecard.

    Science.gov (United States)

    McGillis Hall, Linda; Peterson, Jessica; Baker, G Ross; Brown, Adalsteinn D; Pink, George H; McKillop, Ian; Daniel, Imtiaz; Pedersen, Cheryl

    2008-01-01

    This study examined relationships between financial indicators for nurse staffing and organizational system integration and change indicators. These indicators, along with hospital location and type, were examined in relation to the nursing financial indicators. Results showed that different indicators predicted each of the outcome variables. Nursing care hours were predicted by the hospital type, geographic location, and the system. Both nursing and patient care hours were significantly related to dissemination and benchmarking of clinical data.

  16. [Coverage of the basic immunization schedule in the first year of life in State capitals in Northeast Brazil].

    Science.gov (United States)

    Queiroz, Lorena Lauren Chaves; Monteiro, Silvio Gomes; Mochel, Elba Gomide; Veras, Maria Amélia de Sousa Mascena; Sousa, Francisca Georgina Macêdo de; Bezerra, Márcio Lee de Meneses; Chein, Maria Bethânia da Costa

    2013-02-01

    Vaccination coverage in the so-called "developing countries" is still lower than expected. Such coverage is an important indicator of population health and the quality of care provided by the health care system. The current study describes the results of a household survey to estimate coverage of the basic immunization schedule in the first year of life in State capitals in Northeast Brazil, for the 2005 birth cohort. The methodology used was that recommended by the Pan American Health Organization for surveys on vaccination coverage. According to the data, vaccination coverage fell short of the goals set by the National Immunization Program for this age group, at high risk of acquiring vaccine-preventable diseases. The lowest coverage rates were found at the two extremes of socioeconomic strata. Assessment of vaccination coverage indicates whether the infant population is immunized and helps identify weak points in vaccination activities.

  17. Assuring Access to Affordable Coverage

    Data.gov (United States)

    U.S. Department of Health & Human Services — Under the Affordable Care Act, millions of uninsured Americans will gain access to affordable coverage through Affordable Insurance Exchanges and improvements in...

  18. Assessment of the Ability of the Health Care Provider to Detect Manifestations Indicative of TBI Management of care for TBI Through the Utilization of High Fidelity Simulation

    Science.gov (United States)

    2015-09-01

    Ability of the medical health care provider to detect manifestations indicative of TBI and management of care for TBI through the utilization of High ...utilizing high fidelity simulation to identify the efficacy of the medics ability to assess and manage manifestations of TBI  Development of Evaluation...AWARD NUMBER: W81XWH-11-1-0837 TITLE: Assessment of the Ability of the medical health care provider to detect manifestations indicative of TBI and

  19. Systematic quality monitoring for specialized palliative care services: development of a minimal set of wuality indicators for palliative care study (QPAC).

    NARCIS (Netherlands)

    Leemans, K.; Deliens, L.; Block, L. van den; Stichele, R. Vander; Francke, A.L.; Cohen, J.

    2016-01-01

    Background: A feasibility evaluation of a comprehensive quality indicator set for palliative care identified the need for a minimal selection of these indicators to monitor quality of palliative care services with short questionnaires for the patients, caregivers, and family carers. Objectives: To d

  20. Social support versus chosen health status indicators in primary care patients

    Directory of Open Access Journals (Sweden)

    Kurpas, Donata

    2014-10-01

    Full Text Available Aim. The purposes of our study were to determine the level of total social support, informational support, instrumental support, appraisal support and emotional support received by patients of primary care as well as factors related to this level with reference to health status and sociodemographic variables. Method. The sample for current analysis included 516 patients of primary care clinicsin Poland cooperating with medical universities. Questionnaires: STAI (State-Trait Anxiety Inventory, SCL-90 (Symptom Checklist-90, EPQ-R (Eysenck Personality Questionaire–Revised, GHQ (General Health Questionnaireand SSS (Social Support Scalewere used in the study. Results from last two questionnaires are presented in the paper. Results. The highest mean levels were obtained for instrumental support, while the lowest levels were observed for emotional support. The highest means were indicated in the GHQ-28 – social dysfunction, the lowest – GHQ-severe depression. Statistically significant relation was found between the level of social support and gender. Less subjectively evaluated total social support as well as instrumental and appraisal support were obtained by women. The highest Spearman score was found in the case of total GHQ-28 score, somatic symptoms, anxiety and insomnia, severe depression and total support. Taking into account the ANOVA findings, it was observed that an increasing GHQ score was associated with intensively increasing emotional support, informative support, appraisal support and the most – instrumental support. Conclusions. The results display the underestimated role of emotional, informational and appraisal support and the overestimated role of instrumental support in primary care. The consequence may be a more frequent using health care accompanied by low level of patients’ satisfaction, severity of social dysfunction disorders, particularly in patients with chronic diseases, who constitute an increasingly large group

  1. Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa

    Directory of Open Access Journals (Sweden)

    Karl Peltzer

    2014-10-01

    Full Text Available Background and objective: The achievement of universal health coverage (UHC in emerging economies is a high priority within the global community. This timely study uses standardized national population data collected from adults aged 50 and older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. The objective is to describe health care utilization and measure association between inpatient and outpatient service use and patient characteristics in these six low- and middle-income countries. Design: Secondary analysis of data from the World Health Organization's Study on global AGEing and adult health Wave 1 was undertaken. Country samples are compared by socio-demographic characteristics, type of health care, and reasons for use. Logistic regressions describe association between socio-demographic and health factors and inpatient and outpatient service use. Results: In the pooled multi-country sample of over 26,000 adults aged 50-plus, who reported getting health care the last time it was needed, almost 80% of men and women received inpatient or outpatient care, or both. Roughly 30% of men and women in the Russian Federation used inpatient services in the previous 3 years and 90% of men and women in India used outpatient services in the past year. In China, public hospitals were the most frequently used service type for 52% of men and 51% of women. Multivariable regression showed that, compared with men, women were less likely to use inpatient services and more likely to use outpatient services. Respondents with two or more chronic conditions were almost three times as likely to use inpatient services and twice as likely to use outpatient services compared with respondents with no reported chronic conditions. Conclusions: This study provides a basis for further investigation of country-specific responses to UHC.

  2. Adaptation and validation of indicators concerning the sterilization process of supplies in Primary Health Care services

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    Isis Pienta Batista Dias Passos

    2015-02-01

    Full Text Available OBJECTIVES: to adapt and validate, by expert consensus, a set of indicators used to assess the sterilization process of dental, medical and hospital supplies to be used in PHC services.METHOD: qualitative methodological study performed in two stages. The first stage included a focal group composed of experts to adapt the indicators to be used in PHC. In the second stage, the indicators were validated using a 4-point Likert scale, which was completed by judges. A Content Validity Index of ≥ 0.75 was considered to show approval of the indicators.RESULTS: the adaptations implemented by the focal group mainly referred to the physical structure, inclusion of dental care professionals, inclusion of chemical disinfection, and replacement of the hot air and moist heat sterilization methods. The validation stage resulted in an index of 0.96, which ranged from 0.90 to 1.00, for the components of the indicators.CONCLUSION: the judges considered the indicators after adaptation to be validated. Even though there may be differences among items processed around the world, there certainly are common characteristics, especially in countries with economic and cultural environments similar to Brazil. The inclusion of these indicators to assess the safety of healthcare supplies used in PHC services should be considered.

  3. Evaluation of a demonstration primary health care project in rural Guatemala: the influence of predisposing, enabling and need factors on immunization coverage, equitable use of health care services and application of treatment guidelines.

    Science.gov (United States)

    Fort, Meredith P; Grembowski, David; Heagerty, Patrick; Lim, Stephen S; Mercer, Mary Anne

    2012-09-01

    In high- and low-resource settings, care is often provided inequitably, with more and higher-quality services being offered to those who need them less. We evaluated the influence of predisposing, enabling and need characteristics on immunization coverage and use of health services in a population-based primary health care model called the Inclusive Health Model in rural Guatemala. We also analyzed providers' application of treatment guidelines for children with pneumonia. A longitudinal cohort design was used from 2006 to 2009 to analyze data from the model's two demonstration sites. We found a significant positive association between families' health risk level and their use of health care services, with the model providing more services to those with greater need. Services are not provided differentially for those families with a higher or lower wealth level or selected sociodemographic characteristics. Distance from a clinic is significantly associated with lower service use, but this constraint decreases with time. Implementation of treatment guidelines does not vary with different provider characteristics. The Inclusive Health Care model's aim of offering care equitably to families living in its catchment area is reflected in these findings. This study offers an approach and conceptual model for tracking equity in service delivery that may be applicable in other settings.

  4. Functional coverages

    NARCIS (Netherlands)

    Donchyts, G.; Baart, F.; Jagers, H.R.A.; Van Dam, A.

    2011-01-01

    A new Application Programming Interface (API) is presented which simplifies working with geospatial coverages as well as many other data structures of a multi-dimensional nature. The main idea extends the Common Data Model (CDM) developed at the University Corporation for Atmospheric Research (UCAR)

  5. [Evaluation of the quality of performance of general practitioners. What is the problem with primary care quality indicators in Hungary?].

    Science.gov (United States)

    Kolozsvári, László Róbert; Rurik, Imre

    2016-02-28

    The Hungarian primary care quality indicator system has been introduced in 2009, and has been continuously developed since then. The system offers extra financing for family physicians who are achieving the expected levels of indicators. There are currently 16 indicators for adult and mixed practices and 8 indicators are used in paediatric care. Authors analysed the influencing factors of the indicators other than those related to the performance of family physicians. Expectations and compliance of patients, quality of outpatient (ambulatory) care services, insufficient flow of information, inadequate primary care softwares which need to be updated could be considered as the most important factors. The level of financial motivations should also be significantly increased besides changes in the reporting system. It is recommended, that decision makers in health policy and financing have to declare clearly their expectations, and professional bodies should find the proper solution. These indicators could contribute properly to the improvement of the quality of primary care services in Hungary.

  6. Emergency obstetric care availability: a critical assessment of the current indicator.

    Science.gov (United States)

    Gabrysch, Sabine; Zanger, Philipp; Campbell, Oona M R

    2012-01-01

    Monitoring progress in reducing maternal and perinatal mortality requires suitable indicators. The density of emergency obstetric care (EmOC) facilities has been proposed as a potentially useful indicator, but different UN documents make inconsistent recommendations, and its current formulation is not associated with maternal mortality. We compiled recently published indicator benchmarks and distinguished three sources of inconsistency: (i) use of different denominator metrics (per birth and per population), (ii) different assumptions on need for EmOC and for EmOC facilities and (iii) failure to specify facility capacity (birth load). The UN guidelines and handbook require fewer EmOC facilities than the World Health Report 2005 and do not specify capacity for deliveries or staffing levels. We recommend (i) always using births as the denominator for EmOC facility density, (ii) clearly stating assumptions on the proportion of deliveries needing basic and comprehensive emergency obstetric care and the desired proportion of deliveries in EmOC facilities and (iii) specifying facility capacity and staffing and adapting benchmarks for settings with different population density to ensure geographical accessibility.

  7. Program note: applying the UN process indicators for emergency obstetric care to the United States.

    Science.gov (United States)

    Lobis, S; Fry, D; Paxton, A

    2005-02-01

    The United Nations Process Indicators for emergency obstetric care (EmOC) have been used extensively in countries with high maternal mortality ratios (MMR) to assess the availability, utilization and quality of EmOC services. To compare the situation in high MMR countries to that of a low MMR country, data from the United States were used to determine EmOC service availability, utilization and quality. As was expected, the United States was found to have an adequate amount of good-quality EmOC services that are used by the majority of women with life-threatening obstetric complications.

  8. The ethics of attribution: the case of health care outcome indicators.

    Science.gov (United States)

    Russell, E

    1998-11-01

    The ethical basis of clinical outcomes measurement is a desire to improve care in a way which will increase both clinical effectiveness and value for money-beneficence as well as competence. To date in the U.K., any debate about producing comparative indicators of clinical outcomes has been concerned mainly with the unfairness to individual doctors or clinical teams of judging their performance on this basis. There has been less interest in the prime purpose of such production, which is to increase the accountability and effectiveness of the NHS as a publicly funded service. Rather than working to improve clinical effectiveness and outcomes within clinical services, health authorities which wish to improve outcomes for their populations have been encouraged simply to shift the contract to another provider of care. The key issue on which the ethics of either action rests is the extent to which the attribution of outcome to intervention is valid and reliable and, therefore, that judgements about performance are just and thus ethical. The consequence of unjust judgements may be to increase the inequalities that medical care resource allocation should attempt to reduce.

  9. Plumage brightness as an indicator of parental care in northern cardinals

    Science.gov (United States)

    Linville; Breitwisch; Schilling

    1998-01-01

    Good parent and differential allocation models predict relationships between degree of sexual ornamentation and parental care, but relatively few studies have tested these models. The northern cardinal, Cardinalis cardinalis, is a sexually dichromatic species in which both sexes are ornamented. Males have red plumage, and females have tan plumage with limited areas of red feathering. Cardinals were used to address the two models and determine whether plumage brightness signals level of parental care by both sexes. Absolute effort in feeding nestlings by males was not correlated with male breast plumage colour, but effort by females was positively correlated with female underwing plumage colour. Absolute feeding effort by females was also inversely related to brightness of the mate's breast colour. As a consequence, the proportion of a pair's total feedings provided by the male was positively correlated with male breast colour. Proportion of total feedings provided by the female was positively correlated with female wing colour. Feeding efforts (both per nest and per nestling) were correlated between mates, but birds did not mate assortatively in relation to colour. These results support the good parent hypothesis, suggesting colour brightness is a signal of parental care. The results also indicate that ornamentation of both members of the pair may be important determinants of relative efforts in provisioning nestlings by parent birds. Copyright 1998 The Association for the Study of Animal Behaviour.

  10. Indications and outcome for obstetric patients' admission to intensive care unit: a 7-year review.

    Science.gov (United States)

    Lataifeh, I; Amarin, Z; Zayed, F; Al-Mehaisen, L; Alchalabi, H; Khader, Y

    2010-05-01

    The objective of this retrospective study was to investigate the indications, interventions and clinical outcome of pregnant and newly delivered women admitted to the multidisciplinary intensive care unit at the King Abdullah University Hospital in Jordan over a 7-year period from January 2002 to December 2008. The collected data included demographic characteristics of the patients, mode of delivery, pre-existing medical conditions, reason for admission, specific intervention, length of stay and maternal outcome. A total of 43 women required admission to the intensive care unit (ICU), which represented 0.37% of all deliveries. The majority (95.3%) of patients were admitted to the ICU postpartum. The most common reasons for admissions were (pre)eclampsia (48.8%) and obstetric haemorrhage (37.2). The remainder included adult respiratory distress syndrome (6.9%), pulmonary embolism (2.3%) and neurological disorders (4.6%). Mechanical ventilation was required to support 18.6% of patients and transfusion of red blood cells was needed for 48.8% of patients. There were three maternal deaths (6.9%). A multidisciplinary team approach is essential to improve the management of hypertensive disorders and postpartum haemorrhage to achieve significant improvements in maternal outcome. A large, prospective study to know which women are at high risk of admission to the intensive care units and to prevent serious maternal morbidity and mortality is warranted.

  11. Diagnostic indicators for peptic ulcer perforation at a tertiary care hospital in Thailand

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    Suriya C

    2011-12-01

    Full Text Available Chutikarn Suriya1, Nongyao Kasatpibal2, Wipada Kunaviktikul2, Toranee Kayee31Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, 2Faculty of Nursing, Chiang Mai University, 3Department of Surgery, Nakornping Hospital, Chiang Mai, ThailandIntroduction: Limited data currently exists regarding the diagnostic indicators of peptic ulcer perforation for early detection among patients in Thailand. Delayed diagnosis and treatment for an ulcer can be life-threatening, resulting in shock or death.Objective: To determine the diagnostic indicators of peptic ulcer perforation.Material and methods: A cohort study was conducted in a tertiary care hospital in Thailand from 2005 to 2009. Peptic ulcer patients aged 15 years and over admitted to the surgical department were included. The diagnostic indicators used criteria of the patients' final diagnoses and operations, coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, which included patient profiles, gender, age, coexisting illnesses, personal habits, signs and symptoms, laboratory investigations, radiological finding, and treatment role. Exponential risk regression analyses to obtain relative risk (RR estimates for diagnostic indicators were analyzed using Stata® statistical software package, version 11 (StataCorp LP, College Station, TX.Results: The study included 1290 patients. Of these, 57% reported perforated peptic ulcer. Multivariate analysis showed five diagnostic indicators: signs and symptoms including intense abdominal pain (RR = 1.53, 95% confidence interval [CI] 1.14–2.06, tenderness (RR = 1.94, 95% CI 1.17–3.21, and guarding (RR = 1.52, 95% CI 1.05–2.20; X-ray with free air (RR = 2.80, 95% CI 2.08–3.77; and referral from other hospitals (RR = 1.37, 95% CI 1.03–1.82.Conclusion: Five diagnostic indicators for peptic ulcer perforation monitoring were suggested from this study. Improving diagnostic

  12. Dual indices for prioritizing investment in decentralized HIV services at Nigerian primary health care facilities.

    Science.gov (United States)

    Fronczak, Nancy; Oyediran, Kola' A; Mullen, Stephanie; Kolapo, Usman M

    2016-04-01

    Decentralizing health services, including those for HIV prevention and treatment, is one strategy for maximizing the use of limited resources and expanding treatment options; yet few methods exist for systematically identifying where investments for service expansion might be most effective, in terms of meeting needs and rapid availability of improved services. The Nigerian Government, the United States Government under the President's Emergency Plan for AIDS Relief (PEPFAR) program and other donors are expanding services for prevention of mother-to-child transmission (PMTCT) of HIV to primary health care facilities in Nigeria. Nigerian primary care facilities vary greatly in their readiness to deliver HIV/AIDS services. In 2012, MEASURE Evaluation assessed 268 PEPFAR-supported primary health care facilities in Nigeria and developed a systematic method for prioritizing these facilities for expansion of PMTCT services. Each assessed facility was scored based on two indices with multiple, weighted variables: one measured facility readiness to provide PMTCT services, the other measured local need for the services and feasibility of expansion. These two scores were compiled and the summary score used as the basis for prioritizing facilities for PMTCT service expansion. The rationale was that using need and readiness to identify where to expand PMTCT services would result in more efficient allocation of resources. A review of the results showed that the indices achieved the desired effect-that is prioritizing facilities with high need even when readiness was problematic and also prioritizing facilities where rapid scale-up was feasible. This article describes the development of the two-part index and discusses advantages of using this approach when planning service expansion. The authors' objective is to contribute to development of methodologies for prioritizing investments in HIV, as well as other public health arenas, that should improve cost-effectiveness and

  13. Maternal near miss: an indicator for maternal health and maternal care.

    Science.gov (United States)

    Chhabra, Pragti

    2014-07-01

    Maternal mortality is one of the important indicators used for the measurement of maternal health. Although maternal mortality ratio remains high, maternal deaths in absolute numbers are rare in a community. To overcome this challenge, maternal near miss has been suggested as a compliment to maternal death. It is defined as pregnant or recently delivered woman who survived a complication during pregnancy, childbirth or 42 days after termination of pregnancy. So far various nomenclature and criteria have been used to identify maternal near-miss cases and there is lack of uniform criteria for identification of near miss. The World Health Organization recently published criteria based on markers of management and organ dysfunction, which would enable systematic data collection on near miss and development of summary estimates. The prevalence of near miss is higher in developing countries and causes are similar to those of maternal mortality namely hemorrhage, hypertensive disorders, sepsis and obstructed labor. Reviewing near miss cases provide significant information about the three delays in health seeking so that appropriate action is taken. It is useful in identifying health system failures and assessment of quality of maternal health-care. Certain maternal near miss indicators have been suggested to evaluate the quality of care. The near miss approach will be an important tool in evaluation and assessment of the newer strategies for improving maternal health.

  14. Maternal near miss: An indicator for maternal health and maternal care

    Directory of Open Access Journals (Sweden)

    Pragti Chhabra

    2014-01-01

    Full Text Available Maternal mortality is one of the important indicators used for the measurement of maternal health. Although maternal mortality ratio remains high, maternal deaths in absolute numbers are rare in a community. To overcome this challenge, maternal near miss has been suggested as a compliment to maternal death. It is defined as pregnant or recently delivered woman who survived a complication during pregnancy, childbirth or 42 days after termination of pregnancy. So far various nomenclature and criteria have been used to identify maternal near-miss cases and there is lack of uniform criteria for identification of near miss. The World Health Organization recently published criteria based on markers of management and organ dysfunction, which would enable systematic data collection on near miss and development of summary estimates. The prevalence of near miss is higher in developing countries and causes are similar to those of maternal mortality namely hemorrhage, hypertensive disorders, sepsis and obstructed labor. Reviewing near miss cases provide significant information about the three delays in health seeking so that appropriate action is taken. It is useful in identifying health system failures and assessment of quality of maternal health-care. Certain maternal near miss indicators have been suggested to evaluate the quality of care. The near miss approach will be an important tool in evaluation and assessment of the newer strategies for improving maternal health.

  15. Development and assessment of indicators for quality of care in severe preeclampsia/eclampsia and postpartum hemorrhage.

    Science.gov (United States)

    Talungchit, Pattarawalai; Liabsuetrakul, Tippawan; Lindmark, Gunilla

    2013-01-01

    Severe preeclampsia/eclampsia and postpartum hemorrhage (PPH) are serious obstetric problems worldwide. Quality improvement of care measured by evidence-based indicators is recommended as a recent important strategy; however, the indicators for quality of care of these two conditions have not been established. This study aimed to develop such indicators and assess their validity, reliability, and feasibility at different contextual levels. Of 32 initially valid indicators for care of severe preeclampsia/eclampsia, after two rounds of Delphi technique, 21 and 30 indicators were agreed to be suitable to monitor care at district and referral hospitals. Of 13 initial indicators for PPH, 8 and 13 indicators were selected, respectively. The interrater reliability of indicators varied from 0.28 to 0.63. At least three-fourths of all indicators rated by local doctors and nurses were assessed as feasible in terms of relevance, measurability, and improvability. The process identified reliable and feasible performance indicators to monitor quality of care in severe preeclampsia/eclampsia and PPH for either basic or comprehensive emergency obstetric care (EmOC). The informative applicability of these indicators in clinical practice needs further evaluation.

  16. The use of outcome and process indicators to incentivize integrated care for frail older people: a case study of primary care services in Sweden

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    Anders Lars Anell

    2014-12-01

    Full Text Available Background: A number of reforms have been implemented in Swedish health care to support integrated care for frail older people and to reduce utilization of hospital care by this group. Outcomes and process indicators have been used in pay-for-performance (P4P schemes by both national and local governments to support developments.Objective: To analyse limitations in the use of outcome and process indicators to incentivize integrated care for elderly patients with significant health care needs in the context of primary care.Method: Data were collected from the Region Skåne county council. Eight primary care providers and associated community services were compared in a ranking exercise based on information from interviews and registered data. Registered data from 150 primary care providers were analysed in regression models.Results and conclusion: Both the ranking exercise and regression models revealed important problems related to risk-adjustment, attribution, randomness and measurement fixation when using indicators in P4P schemes and for external accountability purposes. Instead of using indicators in incentive schemes targeting individual providers, indicators may be used for diagnostic purposes and to support development of new knowledge, targeting local systems that move beyond organizational boundaries.

  17. Quality indicators for patient safety in primary care. A review and Delphi-survey by the LINNEAUS collaboration on patient safety in primary care

    Science.gov (United States)

    Frigola-Capell, Eva; Pareja-Rossell, Clara; Gens-Barber, Montse; Oliva-Oliva, Glòria; Alava-Cano, Fernando; Wensing, Michel; Davins-Miralles, Josep

    2015-01-01

    ABSTRACT Background: Quality indicators are measured aspects of healthcare, reflecting the performance of a healthcare provider or healthcare system. They have a crucial role in programmes to assess and improve healthcare. Many performance measures for primary care have been developed. Only the Catalan model for patient safety in primary care identifies key domains of patient safety in primary care. Objective: To present an international framework for patient safety indicators in primary care. Methods: Literature review and online Delphi-survey, starting from the Catalan model. Results: A set of 30 topics is presented, identified by an international panel and organized according to the Catalan model for patient safety in primary care. Most topic areas referred to specific clinical processes; additional topics were leadership, people management, partnership and resources. Conclusion: The framework can be used to organize indicator development and guide further work in the field. PMID:26339833

  18. Prevalence of Frailty Indicators and Association with Socioeconomic Status in Middle-Aged and Older Adults in a Swiss Region with Universal Health Insurance Coverage: A Population-Based Cross-Sectional Study

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    Idris Guessous

    2014-01-01

    Full Text Available Frailty prevalence in older adults has been reported but is largely unknown in middle-aged adults. We determined the prevalence of frailty indicators among middle-aged and older adults from a general Swiss population characterized by universal health insurance coverage and assessed the determinants of frailty with a special focus on socioeconomic status. Participants aged 50 and more from the population-based 2006–2010 Bus Santé study were included (N = 2,930. Four frailty indicators (weakness, shrinking, exhaustion, and low activity were measured according to standard definitions. Multivariate logistic regressions were used to determine associations. Overall, 63.5%, 28.7%, and 7.8% participants presented no frailty indicators, one frailty indicator, and two or more frailty indicators, respectively. Among middle-aged participants (50–65 years, 75.1%, 22.2%, and 2.7% presented 0, 1, and 2 or more frailty indicators. The number of frailty indicators was positively associated with age, hypertension, and current smoking and negatively associated with male gender, body mass index, waist-to-hip ratio, and serum total cholesterol level. Lower income level but not education was associated with higher number of frailty indicators. Frailty indicators are frequently encountered in both older and middle-aged adults from the Swiss general population. Despite universal health insurance coverage, household income is independently associated with frailty.

  19. An Analysis of Gap in TQM Indicators in Health Care Institutions (Case: Isfahan Khorshid Hospital

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    M Sadr-Bafghi

    2009-01-01

    Full Text Available Introduction: Many organizations, especially, service organizations, relative to their goals and mission, have a special view towards quality phenomena and its management and are turning to approaches such as TQM to help manage their business. This study examined the TQM indicators gap in Isfahan Khorshid hospital. As fuzzy set theory is better than the logical theory for estimating the linguistic factors, this paper tries to apply fuzzy approach to quality management in hospitals and analyzes the gap between personnel expectations and perception. Methods: This paper analyzes medical total quality management in a case (Internal Section of Khorshid Hospital, based on gap analysis model and fuzzy logic. A questionnaire was therefore applied to measure expectations and perceptions of hospital personnel. Results: This study results show that on the whole, there is a significant difference between TQM expectations and perceptions among K`horshid hospital personnel. Conclusions: Spurred by impressive results in other industries, this compelling and logical approach has begun to penetrate the thinking of health care accrediting agencies, business coalitions, private foundations and leading health care organizations. However, before making a commitment to TQM, hospital decision makers should thoroughly understand what it is they are committing to, and solve the main barriers such as the conflict between hospital management philosophies and TQM philosophies.

  20. DECISION ANALYSIS IN HEALTH COVERAGE

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    Gloria Beatriz, Orzuza

    2012-01-01

    Full Text Available In 2000 the Organization of the United Nations established eight Millennium Development Goals (MDGs. The fourth objective, reducing child mortality, looks specifically for reducing two thirds of the mortality of children under five years old between 1990 and 2015. One of the specific indicators to measure progress towards this goal is the proportion of children under one year old immunized against measles.In 2001, the United Nations Development Program (UNDP estimated that over 60% of the population who lived in developing nations is far away or losing ground on achievement of the MDGs in reducing rates of infant mortality. This situation is compounded by the lack of progress in deepening the analysis of the issue, the lack of research and indicators to assess features timely coverage of care and health services.This article aims to contribute to the selection of the strategy which would improve health coverage in Misiones, using one of the tools of decision theory, the decision matrix.

  1. [Evacuation plan of an intensive care unit: a new quality indicator?].

    Science.gov (United States)

    Sánchez-Palacios, M; Lorenzo Torrent, R; Santana-Cabrera, L; Martín García, J A; Campos, S G; Carrasco de Miguel, V

    2010-04-01

    The intensive care units must be prepared for a possible disaster, whether internal or external, in case it becomes necessary to evacuate the in-patients. They must have an Emergency and Self-protection Plan that includes the patient evacuation criteria and this must be known by all the personnel who work in the service. For that reason, the patients must be triaged, based on their attention priorities, according to their survival possibilities. Having an evacuation, known by all the personnel and updated by means of the performance of periodic drills, should be included as a quality indicator that must be met, since this would achieve better attention to the patient in case of a disaster situation requiring the evacuation of the ICU.

  2. Indications for performing flexible bronchoscopy: Trends over 34 years at a tertiary care hospital

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    Ankit Amar Gupta

    2015-01-01

    Full Text Available Background and Aim: Due to its easy maneuverability, patient comfort and documented safety as an outpatient procedure, flexible bronchoscopy (FB has replaced rigid bronchoscopy for routine diagnostic use. Herein, we report our 34-year experience with outpatient performance of FB. Materials and Methods: This was a retrospective analysis of all FB procedures performed between September 1979 and November 2013 (period I: 1979-1990; period II: 1991-2000; period III: 2001-2013 in a tertiary care hospital. Demographic profile of patients, indications for performing FB, and annual and seasonal trends were noted from the records. Results: A total of 24,814 bronchoscopies were performed during the study period. The mean (SD age of patients (71.6% males was 48.4 (15.5 years. The number of procedures performed per decade showed an absolute increase by 322%. The most common indication for FB was suspected bronchogenic carcinoma (32.2% followed by pulmonary infections (18.6% and interstitial lung diseases (13%. The proportion of annual cases due to interstitial lung diseases (3.9% in period I to 16.2% in period III increased over the years, whereas disorders such as hemoptysis and pleural effusion showed a declining trend as an indication for FB. A seasonal trend was observed for diseases such as sarcoidosis, bronchogenic carcinoma and pulmonary infections. Six deaths were encountered during the study period in patients undergoing FB. Conclusion: FB is increasingly being performed in the diagnosis of respiratory disorders and is a safe outpatient procedure. Although bronchogenic carcinoma remains a common indication for performing FB, benign conditions such as pulmonary infections and sarcoidosis constitute important indications in the Indian scenario.

  3. Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector.

    Science.gov (United States)

    Croes, R R; Krabbe-Alkemade, Y J F M; Mikkers, M C

    2017-01-03

    There is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a system involving managed competition and mandatory healthcare insurance. Information about the quality of care provided by hospitals has been publicly available since 2008. In this paper, we evaluate the relationship between quality scores for three diagnosis groups and the market power indicators of hospitals. We estimate the impact of competition on quality in an environment of liberalized pricing. For this research, we used unique price and production data relating to three diagnosis groups (cataract, adenoid and tonsils, bladder tumor) produced by Dutch hospitals in the period 2008-2011. We also used the quality indicators relating to these diagnosis groups. We reveal a negative relationship between market share and quality score for two of the three diagnosis groups studied, meaning that hospitals in competitive markets have better quality scores than those in concentrated markets. We therefore conclude that more competition is associated with higher quality scores.

  4. Improving fertility care. The role of guidelines, quality indicators and patients.

    NARCIS (Netherlands)

    Mourad, S.M.

    2010-01-01

    Clinical practice guidelines can help improve the quality of care, and decrease variation in delivered care between settings. However, as guidelines do not implement themselves, efforts should be made to improve current guideline implementation. For clinical fertility care, we performed a large mult

  5. Evaluation of the predictive indices for candidemia in an adult intensive care unit

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    Gilberto Gambero Gaspar

    2015-02-01

    Full Text Available INTRODUCTION: To evaluate predictive indices for candidemia in an adult intensive care unit (ICU and to propose a new index. METHODS: A prospective cohort study was conducted between January 2011 and December 2012. This study was performed in an ICU in a tertiary care hospital at a public university and included 114 patients staying in the adult ICU for at least 48 hours. The association of patient variables with candidemia was analyzed. RESULTS: There were 18 (15.8% proven cases of candidemia and 96 (84.2% cases without candidemia. Univariate analysis revealed the following risk factors: parenteral nutrition, severe sepsis, surgical procedure, dialysis, pancreatitis, acute renal failure, and an APACHE II score higher than 20. For the Candida score index, the odds ratio was 8.50 (95% CI, 2.57 to 28.09; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.78, 0.71, 0.33, and 0.94, respectively. With respect to the clinical predictor index, the odds ratio was 9.45 (95%CI, 2.06 to 43.39; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.89, 0.54, 0.27, and 0.96, respectively. The proposed candidemia index cutoff was 8.5; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.77, 0.70, 0.33, and 0.94, respectively. CONCLUSIONS: The Candida score and clinical predictor index excluded candidemia satisfactorily. The effectiveness of the candidemia index was comparable to that of the Candida score.

  6. Endocrine check-up in adolescents and indications for referral: A guide for health care providers

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    Vincenzo De Sanctis

    2014-01-01

    Full Text Available The American Academy of Pediatrics recommends that young people between the ages of 11 and 21 years should be seen annually by their pediatricians, since annual checkups can be an important opportunity for health evaluation and anticipatory guidance. Parents of infants and young children are accustomed to regularly visiting a pediatrician for their child′s checkups. Unfortunately, when children reach the teen years, these annual checkups may decrease in frequency. In routine check-ups and medical office visits, particular attention should be paid to the possibility of a developmental or endocrine disorder. Early diagnosis and treatment may prevent medical complications in adulthood and foster age-appropriate development. Our purpose is to acquaint readers with the concept, based on current scientific understanding, that some endocrine disorders may be associated with a wide range of deleterious health consequences including an increased risk of hypertension and hyperlipidemia, increased risk of coronary artery disease, type 2 diabetes, significant anxiety and lack of self-esteem. Understanding the milestones and developmental stages of adolescence is essential for pediatricians and all other health providers who care for adolescents. Treating adolescents involves knowledge of a variety of medical, social and legal information; in addition, close working relationships must be established within the adolescent′s network to create an effective care system. In summary, we underline the importance of a periodic endocrine checkup in adolescents in order to identify endocrine problems early and develop an approach to treatment for those patients who need help during this time. Indications for endocrine referral for professional and other healthcare providers are also included. These lists are clearly not intended to be comprehensive, but will hopefully serve as a guide for specific clinical circumstances.

  7. Assuring health coverage for all in India.

    Science.gov (United States)

    Patel, Vikram; Parikh, Rachana; Nandraj, Sunil; Balasubramaniam, Priya; Narayan, Kavita; Paul, Vinod K; Kumar, A K Shiva; Chatterjee, Mirai; Reddy, K Srinath

    2015-12-12

    Successive Governments of India have promised to transform India's unsatisfactory health-care system, culminating in the present government's promise to expand health assurance for all. Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavourably with other middle-income countries and India's regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of care. Here we make the case not only for more resources but for a radically new architecture for India's health-care system. India needs to adopt an integrated national health-care system built around a strong public primary care system with a clearly articulated supportive role for the private and indigenous sectors. This system must address acute as well as chronic health-care needs, offer choice of care that is rational, accessible, and of good quality, support cashless service at point of delivery, and ensure accountability through governance by a robust regulatory framework. In the process, several major challenges will need to be confronted, most notably the very low levels of public expenditure; the poor regulation, rapid commercialisation of and corruption in health care; and the fragmentation of governance of health care. Most importantly, assuring universal health coverage will require the explicit acknowledgment, by government and civil society, of health care as a public good on par with education. Only a radical restructuring of the health-care system that promotes health equity and eliminates impoverishment due to out-of-pocket expenditures will assure health for all Indians by 2022--a fitting way to mark the 75th year of India

  8. An investigation of patterns in hemodynamic data indicative of impending hypotension in intensive care

    Directory of Open Access Journals (Sweden)

    Lee Joon

    2010-10-01

    Full Text Available Abstract Background In the intensive care unit (ICU, clinical staff must stay vigilant to promptly detect and treat hypotensive episodes (HEs. Given the stressful context of busy ICUs, an automated hypotensive risk stratifier can help ICU clinicians focus care and resources by prospectively identifying patients at increased risk of impending HEs. The objective of this study was to investigate the possible existence of discriminatory patterns in hemodynamic data that can be indicative of future hypotensive risk. Methods Given the complexity and heterogeneity of ICU data, a machine learning approach was used in this study. Time series of minute-by-minute measures of mean arterial blood pressure, heart rate, pulse pressure, and relative cardiac output from 1,311 records from the MIMIC II Database were used. An HE was defined as a 30-minute period during which the mean arterial pressure was below 60 mmHg for at least 90% of the time. Features extracted from the hemodynamic data during an observation period of either 30 or 60 minutes were analyzed to predict the occurrence of HEs 1 or 2 hours into the future. Artificial neural networks (ANNs were trained for binary classification (normotensive vs. hypotensive and regression (estimation of future mean blood pressure. Results The ANNs were successfully trained to discriminate patterns in the multidimensional hemodynamic data that were predictive of future HEs. The best overall binary classification performance resulted in a mean area under ROC curve of 0.918, a sensitivity of 0.826, and a specificity of 0.859. Predicting further into the future resulted in poorer performance, whereas observation duration minimally affected performance. The low prevalence of HEs led to poor positive predictive values. In regression, the best mean absolute error was 9.67%. Conclusions The promising pattern recognition performance demonstrates the existence of discriminatory patterns in hemodynamic data that can indicate

  9. Incremental value of thoracic ultrasound in intensive care units:Indications,uses,and applications

    Institute of Scientific and Technical Information of China (English)

    Biagio Liccardo; Francesca Martone; Paolo Trambaiolo; Sergio Severino; Gian Alfonso Cibinel; Antonello D’Andrea

    2016-01-01

    Emergency physicians are required to care for unstable patients with life-threatening conditions, and thus must make decisions that are both quick and precise about unclear clinical situations. There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations. B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago. Its application in the diagnosis of thoracic diseases has always been considered limited, due to the presence of air in the lung and the presence of the bones of the thoracic cage, which prevent the progression of the ultrasound beam. However, the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds. At the bedside, thoracic ultrasound is based primarily on the analysis of these artifacts, with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly "water-rich" or "air-rich". The indications, contraindications, advantages, disadvantages, and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.

  10. Incremental value of thoracic ultrasound in intensive care units: Indications, uses, and applications.

    Science.gov (United States)

    Liccardo, Biagio; Martone, Francesca; Trambaiolo, Paolo; Severino, Sergio; Cibinel, Gian Alfonso; D'Andrea, Antonello

    2016-05-28

    Emergency physicians are required to care for unstable patients with life-threatening conditions, and thus must make decisions that are both quick and precise about unclear clinical situations. There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations. B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago. Its application in the diagnosis of thoracic diseases has always been considered limited, due to the presence of air in the lung and the presence of the bones of the thoracic cage, which prevent the progression of the ultrasound beam. However, the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds. At the bedside, thoracic ultrasound is based primarily on the analysis of these artifacts, with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly "water-rich" or "air-rich". The indications, contraindications, advantages, disadvantages, and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.

  11. The amount of care delivered : challenges of indices in oral health studies

    NARCIS (Netherlands)

    van Dommelen, Paula; Schuller, Annemarie A

    2016-01-01

    OBJECTIVES: Untreated dental caries is the most prevalent medical condition worldwide, with considerable variations in prevalence between regions and countries. The care index (CI) and the restorative index (RI) are generally used to make comparisons between and within countries of levels of care de

  12. The Effects of Scheduled Visitation on the Physiological Indices of Conscious Patients Admitted at intensive Care Units

    OpenAIRE

    2015-01-01

    Background: Visitation of patients admitted at intensive care units (ICUs) is a controversial issue in the field of health care. It is commonly believed that the presence of family members might bring about physiological changes, such as tachycardia and hypertension, in ICU patients. Aim: This study aimed to evaluate the effects of scheduled visitation on the physiological indices of conscious patients at the ICU. Method: This experimental study was conducted on 90 conscious patients admitted...

  13. Quality assessment of diagnosis and antibiotic treatment of infectious diseases in primary care: a systematic review of quality indicators

    OpenAIRE

    Saust, Laura Trolle; Monrad, Rikke Nygaard; Hansen, Malene Plejdrup; Arpi, Magnus; Bjerrum, Lars

    2016-01-01

    Objective To identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care. Design A systematic literature search was performed in PubMed and EMBASE. We included studies with a description of the development of QIs for diagnosis and antibiotic use in patients with infectious diseases in primary care. We extracted information about (1) type of infection; (2) target for quality assessment; (3) methodology used for developi...

  14. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    OpenAIRE

    Travers Catherine M; Morris John N; Jones Richard N; Wright Olivia; Martin-Khan Melinda; Brand Caroline A; Tropea Joannne; Gray Leonard C

    2011-01-01

    Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to...

  15. Using a summary measure for multiple quality indicators in primary care: the Summary QUality InDex (SQUID

    Directory of Open Access Journals (Sweden)

    Nemeth Lynne S

    2007-04-01

    Full Text Available Abstract Background Assessing the quality of primary care is becoming a priority in national healthcare agendas. Audit and feedback on healthcare quality performance indicators can help improve the quality of care provided. In some instances, fewer numbers of more comprehensive indicators may be preferable. This paper describes the use of the Summary Quality Index (SQUID in tracking quality of care among patients and primary care practices that use an electronic medical record (EMR. All practices are part of the Practice Partner Research Network, representing over 100 ambulatory care practices throughout the United States. Methods The SQUID is comprised of 36 process and outcome measures, all of which are obtained from the EMR. This paper describes algorithms for the SQUID calculations, various statistical properties, and use of the SQUID within the context of a multi-practice quality improvement (QI project. Results At any given time point, the patient-level SQUID reflects the proportion of recommended care received, while the practice-level SQUID reflects the average proportion of recommended care received by that practice's patients. Using quarterly reports, practice- and patient-level SQUIDs are provided routinely to practices within the network. The SQUID is responsive, exhibiting highly significant (p Conclusion The SQUID algorithm is feasible and straightforward, and provides a useful QI tool. Its statistical properties and clear interpretation make it appealing to providers, health plans, and researchers.

  16. INDICATIONS AND COMPLICATIONS OF CENTRAL VENOUS CATHETERIZATION IN CRITICALLY ILL CHILDREN IN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Shwetal Bhatt

    2012-02-01

    Full Text Available Background: Nothing can be more difficult, time consuming and frustrating than obtaining vascular access in critically ill pediatric patient1 .Central venous catheters are widely used in the care of critically ill patients. Methodology: This paper reviews our experience with central lines in 28 critically ill patients including neonates and non-neonates, in a study period of October 2008 to October 2009. Of the total 28 patients, central venous catheterizations was more in those who were more than a month age and of female sex. Results: The route of insertion was femoral in approximately 89% of our patients and insertion was successful in 24 patients. The most common indication we observed for catheter use was, venous access in shock (37.1% in neonates and for monitoring the central venous pressure (32% in non neonate patients of ARDS with pulmonary edema and Shock. The central line was removed in majority of patients (60% within 24-48hrs of insertion and was kept for maximum of six days in just one patient. Organism most frequently isolated was Acinetobacter. Recommendations made include, use strict aseptic measures by restricted number of skilled operators while inserting and during maintaining central line, routine confirmatory x-ray or fluoroscopy to check the position of central line before catheter use, if possible, use for central pressure monitoring recommended. Conclusion: We concluded that central venous catheterization is a safe and effective measure so we recommend timely and judicious use of percutaneous central venous catheter in paediatric critically ill patients of PICU and NICU. [National J of Med Res 2012; 2(1.000: 85-88

  17. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    Directory of Open Access Journals (Sweden)

    Travers Catherine M

    2011-10-01

    Full Text Available Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design The study will be conducted in three phases: 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation, 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will

  18. Quality indicators for patient safety in primary care. A review and Delphi-survey by the LINNEAUS collaboration on patient safety in primary care

    NARCIS (Netherlands)

    Frigola-Capell, E.; Pareja-Rossell, C.; Gens-Barber, M.; Oliva-Oliva, G.; Alava-Cano, F.; Wensing, M.; Davins-Miralles, J.

    2015-01-01

    BACKGROUND: Quality indicators are measured aspects of healthcare, reflecting the performance of a healthcare provider or healthcare system. They have a crucial role in programmes to assess and improve healthcare. Many performance measures for primary care have been developed. Only the Catalan model

  19. Self-care assessment as an indicator for clinical supervision in nursing

    Directory of Open Access Journals (Sweden)

    Sílvia Marlene Monteiro Teixeira

    2016-01-01

    Full Text Available Objective : to evaluate the needs of clinical supervision for nurses to assess the degree of dependence on self- care and planning of nursing interventions. Methods : analytical study, cross-cutting nature, collecting data from a sample of 110 patients. Results : it was shown the differences in the identification of the degree of dependence between registers and experts, as well as the selection of operations for each self-care and failures to the original assessment of the filling level (no evaluation self-care/no identification of the degree of dependence. Conclusion : there were gaps in the nursing process; they have proposed strategies such as clinical supervision sessions, training, case studies, protocols and guidance documents, to be included in a clinical supervision in nursing model.

  20. Self-care assessment as an indicator for clinical supervision in nursing

    Directory of Open Access Journals (Sweden)

    Sílvia Marlene Monteiro Teixeira

    2016-06-01

    Full Text Available Objective: to evaluate the needs of clinical supervision for nurses to assess the degree of dependence on self-care and planning of nursing interventions. Methods: analytical study, cross-cutting nature, collecting data from a sample of 110 patients. Results: it was shown the differences in the identification of the degree of dependence between registers and experts, as well as the selection of operations for each self-care and failures to the original assessment of the filling level (no evaluation self-care/no identification of the degree of dependence. Conclusion: there were gaps in the nursing process; they have proposed strategies such as clinical supervision sessions, training, case studies, protocols and guidance documents, to be included in a clinical supervision in nursing model.

  1. Medicare Coverage Database

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Coverage Database (MCD) contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed NCD...

  2. Hand rub consumption and hand hygiene compliance are not indicators of pathogen transmission in intensive care units.

    NARCIS (Netherlands)

    Eckmanns, T; Schwab, F; Bessert, J; Wettstein, R; Behnke, M; Grundmann, Hajo; Rüden, H; Gastmeier, P

    2006-01-01

    The objective of this study was to investigate whether nosocomial infection (NI) rates, hand hygiene compliance rates and the amount of alcohol-based hand rub used for hand disinfection are useful indicators of pathogen transmission in intensive care units (ICUs), and whether they could be helpful i

  3. The Effect of Increasing Meeting Time on the Physiological Indices of Patients Admitted to the Intensive Care Unit

    OpenAIRE

    2016-01-01

    Background Most hospitals have restricted visitation time in intensive care units (ICUs) for various reasons. Given the advantages of family presence and positive effect of emotional touching, talking and smiling on nervous system stimulation and vital signs of the patients. Objectives The present study aimed to determine the effect of increased visitation time on physiological indices of the patients hospitalized in ICUs. ...

  4. Reducing maternal mortality: better monitoring, indicators and benchmarks needed to improve emergency obstetric care. Research summary for policymakers.

    Science.gov (United States)

    Collender, Guy; Gabrysch, Sabine; Campbell, Oona M R

    2012-06-01

    Several limitations of emergency obstetric care (EmOC) indicators and benchmarks are analysed in this short paper, which synthesises recent research on this topic. A comparison between Sri Lanka and Zambia is used to highlight the inconsistencies and shortcomings in current methods of monitoring EmOC. Recommendations are made to improve the usefulness and accuracy of EmOC indicators and benchmarks in the future.

  5. Selecting process quality indicators for the integrated care of vulnerable older adults affected by cognitive impairment or dementia

    Directory of Open Access Journals (Sweden)

    Lebel Paule

    2007-11-01

    Full Text Available Abstract Background This study aimed at evaluating face and content validity, feasibility and reliability of process quality indicators developed previously in the United States or other countries. The indicators can be used to evaluate care and services for vulnerable older adults affected by cognitive impairment or dementia within an integrated service system in Quebec, Canada. Methods A total of 33 clinical experts from three major urban centres in Quebec formed a panel representing two medical specialties (family medicine, geriatrics and seven health or social services specialties (nursing, occupational therapy, psychology, neuropsychology, pharmacy, nutrition, social work, from primary or secondary levels of care, including long-term care. A modified version of the RAND®/University of California at Los Angeles (UCLA appropriateness method, a two-round Delphi panel, was used to assess face and content validity of process quality indicators. The appropriateness of indicators was evaluated according to a agreement of the panel with three criteria, defined as a median rating of 7–9 on a nine-point rating scale, and b agreement among panellists, judged by the statistical measure of the interpercentile range adjusted for symmetry. Feasibility of quality assessment and reliability of appropriate indicators were then evaluated within a pilot study on 29 patients affected by cognitive impairment or dementia. For measurable indicators the inter-observer reliability was calculated with the Kappa statistic. Results Initially, 82 indicators for care of vulnerable older adults with cognitive impairment or dementia were submitted to the panellists. Of those, 72 (88% were accepted after two rounds. Among 29 patients for whom medical files of the preceding two years were evaluated, 63 (88% of these indicators were considered applicable at least once, for at least one patient. Only 22 indicators were considered applicable at least once for ten or more out

  6. Cobertura real de la ley de atención de emergencia y del Seguro Obligatorio contra Accidentes de Tránsito (SOAT Coverage of the emergency health care law and the Compulsory Insurance against Road Traffic Crashes (SOAT

    Directory of Open Access Journals (Sweden)

    J. Jaime Miranda

    2010-06-01

    Full Text Available Objetivo. Determinar, desde la perspectiva de los pacientes, el grado de conocimiento y de cobertura real de la Ley de Atención de Emergencia y del Seguro Obligatorio Contra Accidentes de Tránsito (SOAT. Materiales y métodos. Estudio transversal de vigilancia activa en los servicios de emergencia de establecimientos de salud (EESS de tres ciudades del país con heterogeneidad económica, social y cultural (Lima, Pucallpa y Ayacucho. Resultados. De 644 encuestados, 77% negaron conocer la Ley de Atención de Emergencia (81% en Lima, 64% en Pucallpa y 93% en Ayacucho; pObjective. The aim of this study was to ascertain, from patients’ perspective, the degree of knowledge and the actual coverage of the Emergency Health Care Law and the Compulsory Insurance against Road Traffic Crashes (SOAT. Material and methods. A cross-sectional, active surveillance of emergency wards of selected health facilities in three Peruvian cities (Lima, Pucallpa y Ayacucho was conducted. Results. Out of 644 surveyed victims, 77% did not know about the law about provision of emergency health care (81% in Lima, 64% in Pucallpa y 93% in Ayacucho; p<0,001. Following the explanation of what this law entails, 46% reported to have received care according to the law specifications. As for SOAT, the health care related costs of 237 persons (37.2% were not covered by any insurance scheme (74% in Pucallpa, 34% in Ayacucho and 26% in Lima: p<0,001. Conclusions. In this study, the lack of knowledge about the provision of emergency health care law was important, and the coverage of care was deficient as nearly half of participants reported not to be treated by one or more of the entitlements stated in such law. Road traffic injuriesrelated health care costs were not covered by any insurance scheme in one of three victims. Improvements on citizens’ information about their rights and of effective law enforcement are badly needed to reach a universal and more equitable coverage in

  7. Validation of quality indicators for the organization of palliative care: a modified RAND Delphi study in seven European countries (the Europall project)

    NARCIS (Netherlands)

    Woitha, K.; Beek, K.; Ahmed, N.; Jaspers, B.; Mollard, J.M.; Ahmedzai, S.H.; Hasselaar, J.; Menten, J.; Vissers, K.; Engels, Y.M.

    2014-01-01

    BACKGROUND: Validated quality indicators can help health-care professionals to evaluate their medical practices in a comparative manner to deliver optimal clinical care. No international set of quality indicators to measure the organizational aspects of palliative care settings exists. AIM: To devel

  8. [Early rehabilitation care in the hospital--definition and indication. Results of the expert group "Early Rehabilitation Care in the Hospital"].

    Science.gov (United States)

    Leistner, K; Stier-Jarmer, M; Berleth, B; Braun, J; Koenig, E; Liman, W; Lüttje, D; Meindl, R; Pientka, L; Weber, G; Stucki, G

    2005-06-01

    As a result of the continuing development in recent medicine, and improvements of emergency services, an increasing number of patients are surviving serious disease and injury. This has increased the need for rehabilitation, starting already during the acute hospital stay. Early identification and rehabilitation may reduce overall costs and help patients to regain independence earlier. Since the eighties specialized early post-acute rehabilitation units have been increasingly implemented in German hospitals. With book 9 of the German Social Code (SGB IX) coming into effect in July 2001, early post-acute rehabilitation care in hospitals became accepted as a social right. However, the specifics of early rehabilitation care have not been defined. There is a lack of generally accepted indication criteria for early rehabilitation services. Similarly, the aims, objectives and methods need to be specified. It was the objective of a group of interested experts from different fields and backgrounds to achieve an interdisciplinary consensus in terms of conceptual definitions and terminology for all early rehabilitation care services in the acute hospital. The development of the definitions and criteria was achieved by using a modified Delphi-technique. By publishing this paper the group is providing information about its activities and results. Examples of typical cases from the various fields of early rehabilitation care were identified and described. Furthermore, the report points out a number of other problems in the area of early rehabilitation care, which have yet to be solved.

  9. Effective coverage: a metric for monitoring Universal Health Coverage.

    Directory of Open Access Journals (Sweden)

    Marie Ng

    2014-09-01

    Full Text Available A major challenge in monitoring universal health coverage (UHC is identifying an indicator that can adequately capture the multiple components underlying the UHC initiative. Effective coverage, which unites individual and intervention characteristics into a single metric, offers a direct and flexible means to measure health system performance at different levels. We view effective coverage as a relevant and actionable metric for tracking progress towards achieving UHC. In this paper, we review the concept of effective coverage and delineate the three components of the metric - need, use, and quality - using several examples. Further, we explain how the metric can be used for monitoring interventions at both local and global levels. We also discuss the ways that current health information systems can support generating estimates of effective coverage. We conclude by recognizing some of the challenges associated with producing estimates of effective coverage. Despite these challenges, effective coverage is a powerful metric that can provide a more nuanced understanding of whether, and how well, a health system is delivering services to its populations.

  10. Prospective encounter study of the degree of adherence to patient care indicators related to drug dispensing in Health Care facilities: A Sri Lankan perspective

    OpenAIRE

    Lukshmy Menik Hettihewa; Amarasinghe Isuru; Jayarathna Kalana

    2011-01-01

    The World Health Organization-recommended patient care indicators in Government Hospitals were assessed in 422 patients attending the Outpatient Department in selected hospitals of the Galle district in Southern Province. The average dispensing time (ADT), percentage of drugs actually dispensed (PDAD), percentage of drugs adequately labeled (PDAL) and patient′s knowledge on correct dosage (PKCD) were compared in these selected teaching hospitals (TH), general hospitals (GHs) and district hosp...

  11. Emergency room coverage: an evolving crisis.

    Science.gov (United States)

    Davison, Steven P

    2004-08-01

    Historically, a newly graduated plastic surgeon in the United States could build a practice from his or her emergency room coverage. The historical cliche was for the surgeon to be affable, able, and available, and from that basis one's practice would grow. Emergency room exposure was an avenue for starting a practice, developing recognition, and, after that, building a referral pattern. Recently, the cross-shifting influence of management care, rising malpractice insurance costs, and risk ratio are changing this cliche to a crisis. An evaluation of a 2 1/2-year exposure to emergency room coverage has revealed a completely different profile. A total of 300 patient visits resulting in 69 surgical operations were evaluated for insurance and remuneration history. The findings indicated a significant remuneration dilemma for emergency room coverage. Interestingly, a remuneration problem exists in a market different from what one would expect. In this study, a sample from a suburban hospital, rather than an inner-city university hospital, is the greater problem.

  12. Breastfeeding Evaluation Indicators System is a Promising Evaluation Tool for Preterm Infants in Neonatal Intensive Care Units (NICU).

    Science.gov (United States)

    Yu, Xiurong; Sun, Hongying; Lin, Xiangyun; Liu, Xiuxiang

    2016-10-26

    BACKGROUND Breast feeding can enhance preterm infants' neurodevelopmental outcome, regulate immune function development. This study aims to develop breastfeeding evaluation indicators system in neonatal intensive care units (NICU) and to provide theoretical basis for all-round evaluation of breast feeding quality for hospitalized preterm infants. MATERIAL AND METHODS This study was performed based on Avedis Donabedian's theory of medical care quality. Preterm infant breast feeding evaluation indicators system frame was initially formed by using literature review, clinical on-spot observation and expert consultation methods. By using specialists meeting method and Delphi method, evaluation indicators system for preterm infants breastfeeding was verified and established. Breastfeeding evaluation indicators system were performed in NICU of hospitals in Binzhou and Shanghai. Feasibility and usability of indicators system were examined. RESULTS Breastfeeding evaluation indicators system for preterm infants comprise 3 levels, including level 1 (3 indicators), level 2 (7 indicators), and level 3 (18 indicators). Recognition rates of importance for level 2 and 3 range from 94.4% to 100.0% and 80.6% to 100.0%, respectively. Mean of Likert rating for level 2 and 3 range from 3.31 to 3.89 and 3.03 to 3.97, which are all higher than the average value of 2.50. Kendall's coefficient and its significance test showed that consistency of experts' opinion for indicators' importance is high (Pquality in NICUs. CONCLUSIONS Indicators system is feasible and is a promising evaluation tool for continuously improving breastfeeding quality for preterm infants in NICUs.

  13. Key indicators of obstetric and neonatal care in the Republic of Sakha (Yakutia

    Directory of Open Access Journals (Sweden)

    Tatyana E. Burtseva

    2016-12-01

    Full Text Available In the absence of a medical birth registry, the official statistics are the only sources of information about pregnancy outcomes in the Republic of Sakha (Yakutia (RS. We analysed the official statistical data about birth rate, fertility, infant and maternal mortality in the RS in the period 2003–2014. Compared with all-Russian data, the RS had a higher birth rate, especially in rural districts. Maternal and infant mortality were also higher compared with all-Russian data, but had a decreasing trend. The majority of deaths occurred in the small level 1 units. We suggest that establishment of good predelivery transportation of pregnant women with high risk of complications from remote areas and centralization of risk deliveries with improved prenatal and neonatal care could improve the pregnancy outcome in Yakutia.

  14. Source-specific sewage pollution detection in urban river waters using pharmaceuticals and personal care products as molecular indicators.

    Science.gov (United States)

    Kiguchi, Osamu; Sato, Go; Kobayashi, Takashi

    2016-11-01

    Source-specific elucidation of domestic sewage pollution caused by various effluent sources in an urban river water, as conducted for this study, demands knowledge of the relation between concentrations of pharmaceuticals and personal care products (PPCPs) as molecular indicators (caffeine, carbamazepine, triclosan) and water quality concentrations of total nitrogen (T-N) and total phosphorous (T-P). River water and wastewater samples from the Asahikawa River Basin in northern Japan were analyzed using derivatization-gas chromatography/mass spectrometry. Caffeine, used as an indicator of domestic sewage in the Asahikawa River Basin, was more ubiquitous than either carbamazepine or triclosan (92-100 %). Its concentration was higher than any target compound used to assess the basin:  0.759) reflect the contribution of septic tank system effluents to the lower Asahikawa River Basin. Results of relative molecular indicators in combination with different molecular indicators (caffeine/carbamazepine and triclosan/carbamazepine) and cluster analysis better reflect the contribution of sewage than results obtained using concentrations of respective molecular indicators and cluster analysis. Relative molecular indicators used with water quality parameters (e.g., caffeine/T-N ratio) in this study provide results more clearly, relatively, and quantitatively than results obtained using molecular indicators alone. Moreover, the caffeine/T-N ratio reflects variations of caffeine flux from effluent sources. These results suggest strongly relative molecular indicators are also useful indicators, reflecting differences in spatial contributions of domestic sources for PPCPs in urban areas.

  15. Percutaneous endoscopic gastrostomy: an update on its indications, management, complications, and care

    Directory of Open Access Journals (Sweden)

    Alfredo J. Lucendo

    Full Text Available Background: Numerous disorders impairing or diminishing a patient's ability to swallow may benefit from a PEG tube placement. This is considered the elective feeding technique if a functional digestive system is present. Methods: A PubMed-based search restricted to the English literature from the last 20 years was conducted. References in the results were also reviewed to identify potential sources of information. Results: PEG feeding has consistently demonstrated to be more effective and safe than nasogastric tube feeding, having also replaced surgical and radiological gastrostomy techniques for long term feeding. PEG is considered a minimally invasive procedure to ensure an adequate source for enteral nutrition in institutionalized and at home patients. Acute and chronic conditions associated with risk of malnutrition and dysphagia benefit from PEG placement: Beyond degenerative neuro-muscular disorders, an increasing body of evidence supports the advantages of PEG tubes in patients with head and neck cancer and in a wide range of situations in pediatric settings. The safety of PEG placement under antithrombotic medication is discussed. While antibiotic prophylaxis reduces peristomal wound infection rates, co-trimoxazole solutions administered through a newly inserted catheter constitutes an alternative to intravenous antibiotics. Early feeding (3-6 hours after PEG placement firmly supports on safety evidences, additionally resulting in reduced costs and hospital stays. Complications of PEG are rare and the majority prevented with appropriated nursing cares. Conclusions: PEG feeding provides the most valuable access for nutrition in patients with a functional gastrointestinal system. Its high effectiveness, safety and reduced cost underlie increasing worldwide popularity.

  16. Medical coverage of gymnastics competitions.

    Science.gov (United States)

    Hecht, Suzanne S; Burton, Monique S

    2009-01-01

    Medical coverage of gymnastics competitions can be a challenging task for the sports medicine physician and other medical personnel because of the complexity and aerial nature of the sport. A broad understanding of the six gymnastics disciplines, along with the type of competitions, injury epidemiology, and the common acute gymnastics injuries will help sports medicine professionals in planning and delivering optimal care to the injured or ill gymnast.

  17. Ninety-day waiting period limitation and technical amendments to certain health coverage requirements under the Affordable Care Act. Final rule.

    Science.gov (United States)

    2014-02-24

    These final regulations implement the 90-day waiting period limitation under section 2708 of the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (Affordable Care Act), as amended, and incorporated into the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code. These regulations also finalize amendments to existing regulations to conform to Affordable Care Act provisions. Specifically, these rules amend regulations implementing existing provisions such as some of the portability provisions added by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) because those provisions of the HIPAA regulations have become superseded or require amendment as a result of the market reform protections added by the Affordable Care Act.

  18. Obstetric indications for admission to the intensive care unit of a tertiary referral center; an Iranian experience

    Directory of Open Access Journals (Sweden)

    Sousan Rasooli

    2014-04-01

    Full Text Available Objective: The aim of the present study was to evaluate the obstetric admissions to the intensive care unit (ICU in the setting of a tertiary referral hospital in an attempt to identify the risk factors influencing maternal outcome. Method: In a prospective, cross-sectional study, all parturient patients during pregnancy and up to 6 weeks postpartum admitted to the ICU of a tertiary referral hospital between 2013 and 2014 were evaluated. Demographic data, medical histories, pregnancy, and intrapartum and postpartum data were collected. Moreover, interventions and fetomaternal outcomes were noted. Results: Ninety nine obstetric patients were admitted to the ICU. Fifty seven percent of the admissions were postpartum. The main indications for admission were hypertensive disorders (37.3%, and obstetric hemorrhage (13.1%. Non-obstetric indications of ICU admission were the cardiac diseases. Conclusion: The major obstetric indications for admission in our study were hypertensive disorders of pregnancy and obstetric hemorrhage.     Keywords: Pregnancy; Intensive care unit; maternal mortality; morbidity

  19. Geographical Disparities in the Health of Iranian Women: Health Outcomes, Behaviors, and Health-care Access Indicators

    Science.gov (United States)

    Bayati, Mohsen; Feyzabadi, Vahid Yazdi; Rashidian, Arash

    2017-01-01

    Background: Women's health is a key factor affecting the health of the whole population. Tackling inequality in determinants of health is recognized as the main path toward reducing the inequality in health outcomes. This study aimed to analyze the provincial inequality in determinants of women's health and health care in Iran. Methods: Using the Moss's model (2002) as a comprehensive framework of determinants of women's health, including “geopolitical environment,” “culture, norms, sanctions,” “women's roles in reproduction and production,” “health-related mediators,” and “health outcome” categories, we chose 13 indicators. Afterward, using data sources including the Iranian Multiple Indicators of Demographics and Health Survey, the National Organization for Civil Registration, and Statistics Centre of Iran, we analyzed provincial inequality in these indicators in Iran (2011). Gini coefficient and Lorenz curve were used for measuring inequality. Results: Gini coefficients calculated as follows; life satisfaction level (0.027), literate women (0.398), women with proper knowledge about HIV/AIDS prevention (0.483), unemployed women (0.380), women without an income (0.384), women who use at least one type of mass media (0.389), women who used computer or internet (0.467), women who had received pregnancy care from a skill birth attendant (SBA) (0.420), women who had delivered with the help of an SBA (0.426), women who currently smoke cigarettes (0.603), women who currently consume hookah (0.561), women with at least one chronic disease (0.438), and women's deaths in 2010 and 2011 (0.393 and 0.359, respectively). Conclusions: We found large provincial disparities in determinants of women's health in Iran. Determinants such as lifestyle, health behavior, health knowledge, and health-care services availability should be considered by health policymakers in addressing the inequality in women's health at a provincial level.

  20. 19. Disparities in health care delivery and hospital outcomes between expatriates and nationals presenting with acute coronary syndromes in Saudi Arabia

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    Hussam AlFaleh

    2015-10-01

    Conclusion: Our findings indicate disparities in hospital care between NS, and SN ACS patients. NS patients had worse hospital outcomes potentially reflecting unequal health coverage, and access to care issues.

  1. Testing feasibility and reliability of a set of quality indicators to evaluate the organization of palliative care across Europe: a pilot study in 25 countries

    NARCIS (Netherlands)

    Woitha, K.; Hasselaar, J.G.; Beek, K.; Ahmed, N.; Jaspers, B.; Hendriks, J.C.M.; Radbruch, L.; Vissers, K.; Engels, Y.M.

    2015-01-01

    BACKGROUND: A well-organized palliative care service is a prerequisite for offering good palliative care. Reliable and feasible quality indicators are needed to monitor the quality of their organization. AIM: To test feasibility and reliability of a previously developed set of quality indicators in

  2. Can medical insurance coverage reduce disparities of income in elderly patients requiring long-term care? The case of the People’s Republic of China

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    Zhang ZY

    2014-05-01

    Full Text Available Zhenyu Zhang,1 Jianbing Wang,1 Mingjuan Jin,1 Mei Li,1 Litao Zhou,2 Fangyuan Jing,1 Kun Chen1 1Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People’s Republic of China; 2Quality Control Department, Zhejiang Hospital, Zhejiang, People’s Republic of China Background: The People’s Republic of China’s population is aging rapidly, partly because of the impact of the one-child policy and improvements in the health care system. Caring for bedridden seniors can be a challenge for many families in the People’s Republic of China.Objective: To identify the inequality of income among different age groups and social statuses, and evaluate the medical burden and health insurance compensation in the People’s Republic of China.Methods: We measured income inequality and insurance compensation levels among bedridden patients in Zhejiang province, People’s Republic of China. Factor analysis and Gini coefficients were used to evaluate degree of income inequality and insurance compensation level.Results: We found distinct regional disparities in Zhejiang province, including the aspects of income, expenses, and time. Gini coefficients of older adults with long-term care needs in urban and rural areas were 0.335 and 0.602, respectively. In all age groups, Gini coefficients increased after adjustment for medical expenditures, and the inequality persisted after insurance reimbursement was taken into consideration.Conclusion: A significant income disparity between rural and urban areas was observed. Inequality increased with age, and medical expenditure is a huge burden for older people with long-term care needs. Health insurance does not play an important role in reducing inequalities among patients who need long-term care services. Keywords: Gini coefficient, bedridden, long-term care, insurance

  3. Indicators of fatal outcome in severePlasmodium falciparummalaria:a study in a tertiary-care hospital in Thailand

    Institute of Scientific and Technical Information of China (English)

    NoppadonTangpukdee; KhinMyatWai; SantMuangnoicharoen; ShigeyukiKano; Nanthaporn Phophak; JanramTiemprasert; SrivichaKrudsood; PolratWilairatana

    2010-01-01

    Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severePlasmodium falciparum malaria admitted to the Hospital for Tropical Diseases, Bangkok, Thailand.Methods: We studied202adult malaria patients admitted to the Intensive Care Unit. A total of43 clinical variables were identified by univariate and logistic regression analyses, to eliminate confounding factors.Results: Regarding the statistical methods, only 6variables-jaundice, cerebral malaria, metabolic acidosis, body mass index, initial respiratory rate, and white blood cell count-were significant indicators of death, with adjusted odds ratios (95%CI)of 15.2 (2.1-32.3), 4.3 (2.3-12.6), 3.3 (2.3-5.7), 2.4 (1.9-3.5), 2.2 (1.5-2.6), and1.7 (1.2-3.1), respectively.Conclusions: Our study found that jaundice, cerebral malaria, metabolic acidosis, body mass index, initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodiumfalciparum malaria. Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas, to construct practical measures to address potentially fatal indicators in different settings.

  4. Immunization Coverage Among Juvenile Justice Detainees.

    Science.gov (United States)

    Gaskin, Gregory L; Glanz, Jason M; Binswanger, Ingrid A; Anoshiravani, Arash

    2015-07-01

    This study sought to (1) quantify the baseline immunization coverage of adolescents entering the juvenile justice system and (2) assess the effect of detention-based care on immunization coverage in youth. A cross-sectional retrospective chart review was performed of 279 adolescents detained at a large juvenile detention facility. Only 3% of adolescents had received all study immunizations prior to detention. Before detention, immunization coverage was significantly lower than that for the general adolescent population for all vaccines except the first doses of hepatitis A and varicella-zoster virus vaccines. Subsequent to detention, most individual immunization coverage levels increased and were significantly higher than in the general adolescent population. The routine administration of immunizations in the juvenile justice setting can help detained youth achieve levels of immunization coverage similar to their nondetained peers.

  5. The adequacy of college health insurance coverage.

    Science.gov (United States)

    McManus, M; Brauer, M; Weader, R; Newacheck, P

    1991-01-01

    This analysis of private health insurance plans offered in 100 four-year colleges and universities in 1988 indicates a tremendous diversity in plan options, benefits covered, cost-sharing requirements, and catastrophic protections. Consistent with relatively low premium prices, most student health insurance plans offer limited benefits and expose students to significant out-of-pocket medical cost liabilities. Only a minority of schools use financial incentives, such as preferred provider arrangements, to integrate their health insurance plans with their university health service system. We conclude that universities should carefully reexamine the adequacy of their health insurance plans and their relationship to student health centers. As more students rely on student health insurance as their only source of coverage, the quality of these plans assumes an even greater importance.

  6. Combining process indicators to evaluate quality of care for surgical patients with colorectal cancer: are scores consistent with short-term outcome?

    NARCIS (Netherlands)

    Kolfschoten, N.E.; Gooiker, G.A.; Bastiaannet, E.; Leersum, N.J. van; Velde, C.J. van de; Eddes, E.H.; Marang-van de Mheen, P.J.; Kievit, J.; Harst, E. van der; Wiggers, T.; Wouters, M.W.; Tollenaar, R.A.E.M.; Krieken, J.H. van

    2012-01-01

    OBJECTIVE: To determine if composite measures based on process indicators are consistent with short-term outcome indicators in surgical colorectal cancer care. DESIGN: Longitudinal analysis of consistency between composite measures based on process indicators and outcome indicators for 85 Dutch hosp

  7. Combining process indicators to evaluate quality of care for surgical patients with colorectal cancer : are scores consistent with short-term outcome?

    NARCIS (Netherlands)

    Kolfschoten, N. E.; Gooiker, G. A.; Bastiaannet, E.; van Leersum, N. J.; van de Velde, C. J. H.; Eddes, E. H.; Marang-van de Mheen, P. J.; Kievit, J.; van der Harst, E.; Wiggers, T.; Wouters, M. W. J. M.; Tollenaar, R. A. E. M.

    2012-01-01

    Objective: To determine if composite measures based on process indicators are consistent with short-term outcome indicators in surgical colorectal cancer care. Design: Longitudinal analysis of consistency between composite measures based on process indicators and outcome indicators for 85 Dutch hosp

  8. The Effects of Scheduled Visitation on the Physiological Indices of Conscious Patients Admitted at intensive Care Units

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    Hojat Rezaie

    2015-12-01

    Full Text Available Background: Visitation of patients admitted at intensive care units (ICUs is a controversial issue in the field of health care. It is commonly believed that the presence of family members might bring about physiological changes, such as tachycardia and hypertension, in ICU patients. Aim: This study aimed to evaluate the effects of scheduled visitation on the physiological indices of conscious patients at the ICU. Method: This experimental study was conducted on 90 conscious patients admitted at the ICU of Ganjavian Hospital in Dezful, Iran in 2014. Patients were randomly divided into two groups of intervention and control. In the control group, patient visits were carried out in accordance with normal procedures of the ward. In the intervention group, patients were visited by relatives and family members for 30 minutes, preferably in evening shifts. Physiological indices of the patients were recorded before, during and after scheduled visitation. Data analysis was performed in SPSS V.18 using independent T-test and one-way ANOVA with repeated measures. Results: In this study, mean age of patients in the intervention and control groups was 42.1±19.1 and 39.4±19.6 years, respectively. In the intervention group, systolic blood pressure had a more significant reduction at 10 and 30 minutes after visitation compared to the control group (independent T-test, P0.05. Implications for Practice: According to the results of this study, scheduled visitation by family members caused no significant differences in the physiological indices of ICU patients. It is recommended that future studies be conducted as to confirm this finding and revise patient visitation policies in hospitals.

  9. Indications and Types of Antibiotic Agents Used in 6 Acute Care Hospitals, 2009-2010: A Pragmatic Retrospective Observational Study.

    Science.gov (United States)

    Kelesidis, Theodoros; Braykov, Nikolay; Uslan, Daniel Z; Morgan, Daniel J; Gandra, Sumanth; Johannsson, Birgir; Schweizer, Marin L; Weisenberg, Scott A; Young, Heather; Cantey, Joseph; Perencevich, Eli; Septimus, Edward; Srinivasan, Arjun; Laxminarayan, Ramanan

    2016-01-01

    BACKGROUND To design better antimicrobial stewardship programs, detailed data on the primary drivers and patterns of antibiotic use are needed. OBJECTIVE To characterize the indications for antibiotic therapy, agents used, duration, combinations, and microbiological justification in 6 acute-care US facilities with varied location, size, and type of antimicrobial stewardship programs. DESIGN, PARTICIPANTS, AND SETTING Retrospective medical chart review was performed on a random cross-sectional sample of 1,200 adult inpatients, hospitalized (>24 hrs) in 6 hospitals, and receiving at least 1 antibiotic dose on 4 index dates chosen at equal intervals through a 1-year study period (October 1, 2009-September 30, 2010). METHODS Infectious disease specialists recorded patient demographic characteristics, comorbidities, microbiological and radiological testing, and agents used, dose, duration, and indication for antibiotic prescriptions. RESULTS On the index dates 4,119 (60.5%) of 6,812 inpatients were receiving antibiotics. The random sample of 1,200 case patients was receiving 2,527 antibiotics (average: 2.1 per patient); 540 (21.4%) were prophylactic and 1,987 (78.6%) were therapeutic, of which 372 (18.7%) were pathogen-directed at start. Of the 1,615 empirical starts, 382 (23.7%) were subsequently pathogen-directed and 1,231 (76.2%) remained empirical. Use was primarily for respiratory (27.6% of prescriptions) followed by gastrointestinal (13.1%) infections. Fluoroquinolones, vancomycin, and antipseudomonal penicillins together accounted for 47.1% of therapy-days. CONCLUSIONS Use of broad-spectrum empirical therapy was prevalent in 6 US acute care facilities and in most instances was not subsequently pathogen directed. Fluoroquinolones, vancomycin, and antipseudomonal penicillins were the most frequently used antibiotics, particularly for respiratory indications. Infect. Control Hosp. Epidemiol. 2015;37(1):70-79.

  10. Evolution of health coverage in Mexico: evidence of progress and challenges in the Mexican health system.

    Science.gov (United States)

    Urquieta-Salomón, José E; Villarreal, Héctor J

    2016-02-01

    To consolidate an effective and efficient universal health care coverage requires a deep understanding of the challenges faced by the health care system in providing services demanded by population in need. This study analyses the dynamics of health insurance coverage and effective access coverage to some health interventions in Mexico. It examines the evolution of inequalities and heterogeneous performance of the insurance subsystems incorporated under the Mexican health care system. Two types of coverage indicators were selected: health insurance and effective access to preventive health interventions intended for normative population. Data were drawn from National Health and Nutrition Surveys 2006 and 2012. The economic inequality was estimated using the Standardized Concentration Index by household per capita consumption expenditure as socioeconomic-status indicator. Approximately 75% of the population reported being covered by one of the existing insurance schemes, representing a huge step forward from 2006, when as much as 51.62% of the population had no health insurance. About 87% of this growth was attributable to the expansion of Non Contributory Health Insurance whereas 7% emanated from the Social Security subsystem. The results revealed that inequality in access to health insurance was virtually eradicated; however, traces of unequal access persisted in some subpopulations groups. Coverage indicators of effective access showed a slight improvement in the period analysed, but prenatal care and interventions to prevent chronic disease still presented a serious shortage. Furthermore, there was no evidence that inequities in coverage of these interventions have decreased in recent years. The results provided a mixed picture, generalizable to the system as a whole, expansion of insurance status represents one of the most remarkable advances that have not been accompanied by a significant improvement in effective access. In addition, existing inequalities are

  11. Indicators of malnutrition in children with cancer: A study of 690 patients from a tertiary care cancer center

    Directory of Open Access Journals (Sweden)

    R Srivastava

    2015-01-01

    Full Text Available Background: Large data pertaining to indicators of malnutrition in children with cancer is lacking from India. In view of this, we prospectively analyzed consecutive de novo childhood patients with cancer presenting at a tertiary care center. Materials And Methods: Height and weight of each child (n = 690 were compared with World Health Organization child growth standards-2006 for that particular age and sex to get weight-for-age, height-for-age, and weight-for-height indices and below 2SD of the reference median on these indices were considered as underweight, stunted, and wasted, respectively. Body mass index (BMI for age was also analyzed for thinness and obesity. Results: Prevalence of malnutrition based on Z-score for weight-for-age, height-for-age, weight-for-height, and BMI-for-age was 30%, 31%, 35%, and 41%, respectively. Weight-for-age (underweight was significantly associated (P = 0.018 with solid tumors. Height-for-age, weight-for-age, and BMI-for-age were significantly associated (P = 0.007, P = 0.016, and P ≤ 0.001, respectively with rural community. Conclusion: Malnutrition was observed in approximately one-third of children with cancer. Malnutrition is associated with solid tumors and those coming from rural community. Wasting has a higher prevalence in children with cancer in <5 years of age group.

  12. Monitoring vaccination coverage: Defining the role of surveys.

    Science.gov (United States)

    Cutts, Felicity T; Claquin, Pierre; Danovaro-Holliday, M Carolina; Rhoda, Dale A

    2016-07-29

    Vaccination coverage is a widely used indicator of programme performance, measured by registries, routine administrative reports or household surveys. Because the population denominator and the reported number of vaccinations used in administrative estimates are often inaccurate, survey data are often considered to be more reliable. Many countries obtain survey data on vaccination coverage every 3-5years from large-scale multi-purpose survey programs. Additional surveys may be needed to evaluate coverage in Supplemental Immunization Activities such as measles or polio campaigns, or after major changes have occurred in the vaccination programme or its context. When a coverage survey is undertaken, rigorous statistical principles and field protocols should be followed to avoid selection bias and information bias. This requires substantial time, expertise and resources hence the role of vaccination coverage surveys in programme monitoring needs to be carefully defined. At times, programmatic monitoring may be more appropriate and provides data to guide program improvement. Practical field methods such as health facility-based assessments can evaluate multiple aspects of service provision, costs, coverage (among clinic attendees) and data quality. Similarly, purposeful sampling or censuses of specific populations can help local health workers evaluate their own performance and understand community attitudes, without trying to claim that the results are representative of the entire population. Administrative reports enable programme managers to do real-time monitoring, investigate potential problems and take timely remedial action, thus improvement of administrative estimates is of high priority. Most importantly, investment in collecting data needs to be complemented by investment in acting on results to improve performance.

  13. The Nordic maintenance care program: what are the indications for maintenance care in patients with low back pain? A survey of the members of the Danish Chiropractors' Association

    Directory of Open Access Journals (Sweden)

    Hansen Signe F

    2010-09-01

    Full Text Available Abstract Background Maintenance care (MC is relatively commonly used among chiropractors. However, factual information is needed on its indications for use. Objectives This study had two objectives: 1 to describe which role patients' past history and treatment outcome play in chiropractors' decision to use MC in patients with low back pain, 2 to investigate if the chiropractors' clinical/educational background has an effect on the frequency of using MC and their indications for use of MC. Method An anonymous questionnaire was sent to all 413 chiropractors practising in Denmark. Its main part consisted of 3 sets of 4 questions relating to one basic case of low back pain. For each case, the chiropractors were asked if they would use MC as they self-defined the term (no/perhaps/yes. There were questions also on gender, age, educational and clinical background, and on the number of MC patients seen by these chiropractors. Their decision to recommend MC was reported. Associations between the demographic variables and 1 the frequency of MC-use and 2 their indications for use of MC were tested through multivariate analysis. Results The response rate was 72%. Non-indications for MC were: 1 a good outcome combined with no previous events, or 2 a past history of LBP and gradual worsening with treatment. Indications for MC were a good outcome combined with a previous history of low back pain between once a month and once a year. The mean proportion of MC patients per week were 22% (SD 19, ranging from 0% to 100%. The use of MC was highest among experienced chiropractors, those who were educated in North America, and clinic owners. However, in Denmark most chiropractors graduated before 1999, are educated abroad, whereas most chiropractors thereafter are educated in Denmark. Therefore, we cannot conclude whether this difference relates to education or years of experience. There were no associations detected between demographic variables and the indications

  14. Quality of Longer Term Mental Health Facilities in Europe : Validation of the Quality Indicator for Rehabilitative Care against Service Users' Views

    NARCIS (Netherlands)

    Killaspy, Helen; White, Sarah; Wright, Christine; Taylor, Tatiana L.; Turton, Penny; Kallert, Thomas; Schuster, Mirjam; Cervilla, Jorge A.; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitris; Gonidakis, Fragiskos; Caldas-de-Almeida, Jose Miguel; Cardoso, Graca; King, Michael

    2012-01-01

    Background: The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise wit

  15. Measuring coverage in MNCH: total survey error and the interpretation of intervention coverage estimates from household surveys.

    Directory of Open Access Journals (Sweden)

    Thomas P Eisele

    Full Text Available Nationally representative household surveys are increasingly relied upon to measure maternal, newborn, and child health (MNCH intervention coverage at the population level in low- and middle-income countries. Surveys are the best tool we have for this purpose and are central to national and global decision making. However, all survey point estimates have a certain level of error (total survey error comprising sampling and non-sampling error, both of which must be considered when interpreting survey results for decision making. In this review, we discuss the importance of considering these errors when interpreting MNCH intervention coverage estimates derived from household surveys, using relevant examples from national surveys to provide context. Sampling error is usually thought of as the precision of a point estimate and is represented by 95% confidence intervals, which are measurable. Confidence intervals can inform judgments about whether estimated parameters are likely to be different from the real value of a parameter. We recommend, therefore, that confidence intervals for key coverage indicators should always be provided in survey reports. By contrast, the direction and magnitude of non-sampling error is almost always unmeasurable, and therefore unknown. Information error and bias are the most common sources of non-sampling error in household survey estimates and we recommend that they should always be carefully considered when interpreting MNCH intervention coverage based on survey data. Overall, we recommend that future research on measuring MNCH intervention coverage should focus on refining and improving survey-based coverage estimates to develop a better understanding of how results should be interpreted and used.

  16. The greatest happiness of the greatest number? Policy actors' perspectives on the limits of economic evaluation as a tool for informing health care coverage decisions in Thailand

    Directory of Open Access Journals (Sweden)

    Russell Steve

    2008-09-01

    Full Text Available Abstract Background This paper presents qualitative findings from an assessment of the acceptability of using economic evaluation among policy actors in Thailand. Using cost-utility data from two economic analyses a hypothetical case scenario was created in which policy actors had to choose between two competing interventions to include in a public health benefit package. The two competing interventions, laparoscopic cholecystectomy (LC for gallbladder disease versus renal dialysis for chronic renal disease, were selected because they highlighted conflicting criteria influencing the allocation of healthcare resources. Methods Semi-structured interviews were conducted with 36 policy actors who play a major role in resource allocation decisions within the Thai healthcare system. These included 14 policy makers at the national level, five hospital directors, ten health professionals and seven academics. Results Twenty six out of 36 (72% respondents were not convinced by the presentation of economic evaluation findings and chose not to support the inclusion of a proven cost-effective intervention (LC in the benefit package due to ethical, institutional and political considerations. There were only six respondents, including three policy makers at national level, one hospital director, one health professional and one academic, (6/36, 17% whose decisions were influenced by economic evaluation evidence. Conclusion This paper illustrates limitations of using economic evaluation information in decision making priorities of health care, perceived by different policy actors. It demonstrates that the concept of maximising health utility fails to recognise other important societal values in making health resource allocation decisions.

  17. Premium subsidies for health insurance: excessive coverage vs. adverse selection.

    Science.gov (United States)

    Selden, T M

    1999-12-01

    The tax subsidy for employment-related health insurance can lead to excessive coverage and excessive spending on medical care. Yet, the potential also exists for adverse selection to result in the opposite problem-insufficient coverage and underconsumption of medical care. This paper uses the model of Rothschild and Stiglitz (R-S) to show that a simple linear premium subsidy can correct market failure due to adverse selection. The optimal linear subsidy balances welfare losses from excessive coverage against welfare gains from reduced adverse selection. Indeed, a capped premium subsidy may mitigate adverse selection without creating incentives for excessive coverage.

  18. Associação entre atenção básica em saúde bucal e indicadores socioeconômicos municipais Association between primary dental care and municipal socioeconomic indicators

    Directory of Open Access Journals (Sweden)

    Liliane Simara Fernandes

    2005-12-01

    Full Text Available OBJETIVO: Testar associações entre indicadores de atenção básica em saúde bucal e indicadores municipais socioeconômicos e de provisão de serviços odontológicos. MÉTODOS: Estudo ecológico realizado nos 293 municípios do Estado de Santa Catarina, no período 2000 a 2003. Foram utilizados indicadores de atenção básica a saúde bucal: (1 Cobertura; (2 Razão entre procedimentos odontológicos coletivos e a população de zero a 14 anos de idade; (3 razão entre exodontias de dentes permanentes e procedimentos odontológicos individuais na atenção básica. As variáveis investigadas foram: razão entre o número total de dentistas por mil habitantes, razão entre o número total de dentistas cadastrados no Sistema Único de Saúde por mil habitantes, fluoretação da água de abastecimento, índice de desenvolvimento infantil, índice de desenvolvimento humano municipal e a população do município. Foram realizadas as análises pelos testes de Kruskall-Wallis, qui-quadrado e o teste de Spearman para avaliar a correlação entre as variáveis. RESULTADOS: A cobertura foi de 21,8%, a razão de procedimentos coletivos na população entre zero a 14 anos foi de 0,37 e a proporção de exodontias em relação ao total de procedimentos odontológicos individuais foi de 11,9%. Menores proporções de exodontias foram associadas às maiores proporções de dentistas no Sistema (pOBJECTIVE: To test associations between primary dental care indicators and municipal socioeconomic and dental service provision indicators. METHODS: An ecological study was carried out in the 293 municipalities of the State of Santa Catarina, Brazil, between 2000 and 2003. The primary dental care indicators utilized were: (1 coverage; (2 the ratio between preventive dental procedures and the size of the population aged zero to 14 years; and (3 the ratio between the numbers of extractions of permanent teeth and individual dental procedures within primary dental

  19. Effects of Motor Development Stimulation on Anthropometric Indices of Infants Aged 1-12 Months in Foster Care Homes

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    Arezou NikNezhad Jalali

    2015-12-01

    Full Text Available Background: The first three years of life have a pivotal role in growth and development of infants. Extra-uterine environment largely affects brain development of infants during the first year of life.However,no specific programs are available for brain development stimulation in foster homes. Aim: This study aimed to evaluate the effects of motor development stimulation package on anthropometric indices of infants staying in foster homes. Method: This experimental study was conducted on 50 infants aged 1-12 months at Ali Asghar foster home of Mashhad, Iran in 2013. Infants were randomly divided into two groups of intervention (n=25 and control (n=25. Motor development stimulation packages were used for intervention group three times a week for eight consecutive weeks (24 sessions, two hours each. Anthropometric indices of infants were evaluated using standard instruments before and after intervention. Data analysis was performed in SPSS V.11.5 using independent T-test and Mann-Whitney U test. Results: In this study, mean age of infants in intervention and control groups was 6.04±3.48 and 4.3±3.70 months, respectively. In total, 68% of infants were male, and 32% were female. After intervention, Mann-Whitney test results showed no statistically significant difference in height (P=0.47 and head circumference (P=0.11 of infants between the groups. However, independent T-test showed a statistically significant difference in body weight of infants (P=0.007 between the groups after intervention with the stimulation care package. Implications for Practice: According to the results of this study, use of evidence-based motor development stimulation package for eight weeks resulted in increased weight of infants, while it had no effect on height and head circumference. Therefore, it is recommended that complementary studies be conducted in this regard.

  20. Identifying patients with advanced chronic conditions for a progressive palliative care approach: a cross-sectional study of prognostic indicators related to end-of-life trajectories

    Science.gov (United States)

    Amblàs-Novellas, J; Murray, S A; Espaulella, J; Martinez-Muñoz, M; Blay, C; Gómez-Batiste, X

    2016-01-01

    Objectives 2 innovative concepts have lately been developed to radically improve the care of patients with advanced chronic conditions (PACC): early identification of palliative care (PC) needs and the 3 end-of-life trajectories in chronic illnesses (acute, intermittent and gradual dwindling). It is not clear (1) what indicators work best for this early identification and (2) if specific clinical indicators exist for each of these trajectories. The objectives of this study are to explore these 2 issues. Setting 3 primary care services, an acute care hospital, an intermediate care centre and 4 nursing homes in a mixed urban–rural district in Barcelona, Spain. Participants 782 patients (61.5% women) with a positive NECPAL CCOMS-ICO test, indicating they might benefit from a PC approach. Outcome measures The characteristics and distribution of the indicators of the NECPAL CCOMS-ICO tool are analysed with respect to the 3 trajectories and have been arranged by domain (functional, nutritional and cognitive status, emotional problems, geriatric syndromes, social vulnerability and others) and according to their static (severity) and dynamic (progression) properties. Results The common indicators associated with early end-of-life identification are functional (44.3%) and nutritional (30.7%) progression, emotional distress (21.9%) and geriatric syndromes (15.7% delirium, 11.2% falls). The rest of the indicators showed differences in the associations per illness trajectories (ppalliative approach. PMID:27645556

  1. Prospective encounter study of the degree of adherence to patient care indicators related to drug dispensing in Health Care facilities: A Sri Lankan perspective.

    Science.gov (United States)

    Hettihewa, Lukshmy Menik; Isuru, Amarasinghe; Kalana, Jayarathna

    2011-04-01

    The World Health Organization-recommended patient care indicators in Government Hospitals were assessed in 422 patients attending the Outpatient Department in selected hospitals of the Galle district in Southern Province. The average dispensing time (ADT), percentage of drugs actually dispensed (PDAD), percentage of drugs adequately labeled (PDAL) and patient's knowledge on correct dosage (PKCD) were compared in these selected teaching hospitals (TH), general hospitals (GHs) and district hospitals (DHs) in Galle. ADT in DH (1.16 min) and GH (1.07 min) were high when compared with ADT in TH (0.81 min). PDAD was 100% in DH, 97.79% in GH and lowest in TH (94.64%). PDAL was highest (22.66%) in TH, 17.57% in GH and lowest in DH (1.57%). PKCD was 100% in GH and lowest in DH (0%) and only 50% in TH in Galle district. We noted that there was a significant difference in ADT in all three categories (P PKCD was 0% due to negligence in dispensing practices. We also noted a 100% PKCD only in GH due to the practice of a well-prepared correct labeling system in GH. We noticed that these patients were provided drugs with inadequate labeling and that patients had only a poor knowledge about the drug administration schedule. We conclude that there was a low dispenser-patient ratio in all three hospitals and that there was a need for an implementation plan for proper dispensing techniques by introducing a well-prepared drug labeling system in a printed format.

  2. Prospective encounter study of the degree of adherence to patient care indicators related to drug dispensing in Health Care facilities: A Sri Lankan perspective

    Directory of Open Access Journals (Sweden)

    Lukshmy Menik Hettihewa

    2011-01-01

    Full Text Available The World Health Organization-recommended patient care indicators in Government Hospitals were assessed in 422 patients attending the Outpatient Department in selected hospitals of the Galle district in Southern Province. The average dispensing time (ADT, percentage of drugs actually dispensed (PDAD, percentage of drugs adequately labeled (PDAL and patient′s knowledge on correct dosage (PKCD were compared in these selected teaching hospitals (TH, general hospitals (GHs and district hospitals (DHs in Galle. ADT in DH (1.16 min and GH (1.07 min were high when compared with ADT in TH (0.81 min. PDAD was 100% in DH, 97.79% in GH and lowest in TH (94.64%. PDAL was highest (22.66% in TH, 17.57% in GH and lowest in DH (1.57%. PKCD was 100% in GH and lowest in DH (0% and only 50% in TH in Galle district. We noted that there was a significant difference in ADT in all three categories (P < 0.05. We noted that dispensers spend only a short dispensing time and showed a tendency for dispensing errors. We found that PDAL was very low in all hospitals but PDAD was significantly high. Even though the ADT was high in DH, PKCD was 0% due to negligence in dispensing practices. We also noted a 100% PKCD only in GH due to the practice of a well-prepared correct labeling system in GH. We noticed that these patients were provided drugs with inadequate labeling and that patients had only a poor knowledge about the drug administration schedule. We conclude that there was a low dispenser-patient ratio in all three hospitals and that there was a need for an implementation plan for proper dispensing techniques by introducing a well-prepared drug labeling system in a printed format.

  3. Drug Plan Coverage Rules

    Science.gov (United States)

    ... works with other insurance Find health & drug plans Drug plan coverage rules Note Call your Medicare drug ... shingles vaccine) when medically necessary to prevent illness. Drugs you get in hospital outpatient settings In most ...

  4. The Effect of Increasing Meeting Time on the Physiological Indices of Patients Admitted to the Intensive Care Unit

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    Mahmoudi

    2016-04-01

    Full Text Available Background Most hospitals have restricted visitation time in intensive care units (ICUs for various reasons. Given the advantages of family presence and positive effect of emotional touching, talking and smiling on nervous system stimulation and vital signs of the patients. Objectives The present study aimed to determine the effect of increased visitation time on physiological indices of the patients hospitalized in ICUs. Materials and Methods This clinical trial study was conducted in the ICUs of Vail-e-Asr hospital in Arak city, Iran. A total of 60 subjects were randomly assigned to the intervention and control groups with visitation time for 10 minutes 3 times a day and 10 minutes once a day, respectively. Then, the patients’ physiological indices were measured before, during, and 10 and 30 minutes after the hospital visiting hours. Data were analyzed using SPSS version 20. Results Findings showed no statistically significant differences among mean values of all physiological indices in measurement stages before, during, and 10 and 30 minutes after the visitation times in the control group (P > 0.05. While, in the intervention group, systolic blood pressure (SBP measurements at 9 (previous mean: 126.9, 30 minutes later: 111.9, 12:00 PM (previous mean: 126.9, 30 minutes later: 114.9, and 3:00 PM (previous mean: 125.2, 30 minutes later: 105.8, diastolic blood pressure (DBP measurements at 9:00 AM (previous mean: 87.4, 30 minutes later: 83.2, 12:00 PM (previous mean: 86.6, 30 minutes later: 81.7, and 3:00 PM (previous mean: 87.1, 30 minutes later: 85.0, heart rate (HR measurements at 9:00 AM (previous mean: 90, 30 minutes later: 78.4, 12:00 PM (previous mean: 89.8, 30 minutes later: 78.6, and 3:00 PM (previous mean: 89.3, 30 minutes later: 78.3, repertory rate (RR measurements at 9:00 AM (previous mean: 20.9, 30 minutes later: 15.0, 12:00 PM (previous mean: 20.6, 30 minutes later: 15.4, and 3:00 PM (previous mean: 21.0, 30 minutes later: 15

  5. 32 CFR 199.8 - Double coverage.

    Science.gov (United States)

    2010-07-01

    ... (for example, the Indian Health Service); or (v) State Victims of Crime Compensation Programs. (c... by a double coverage plan and recover, under § 199.12, the TRICARE costs of health care incurred on..., the amount payable by CHAMPUS shall be the amount of the actual out-of-pocket costs incurred by...

  6. Improvement of clinical quality indicators through reorganization of the acute care by establishing an emergency department-a register study based on data from national indicators

    DEFF Research Database (Denmark)

    Mattsson, Maria Søe; Mattsson, N.; Jørsboe, H. B.

    2014-01-01

    -square test was used for analysing significant differences from pre-and post intervention and Z-test to compare the experimental groups to the control group (HOL). P ... significantly improved after the reorganization in NFS and HOL (p ...-intervention data were compared for both NFS and HOL (p = 0.024). Conclusions: During the organisation of the new EDs, several of the indicators improved and the overall 30 days mortality decreased in the five diseases. The development of a common set of indicators for monitoring acute treatment at EDs in Denmark...

  7. Immunisation coverage, 2012.

    Science.gov (United States)

    Hull, Brynley P; Dey, Aditi; Menzies, Rob I; Brotherton, Julia M; McIntyre, Peter B

    2014-09-30

    This, the 6th annual immunisation coverage report, documents trends during 2012 for a range of standard measures derived from Australian Childhood Immunisation Register (ACIR) data, and National Human Papillomavirus (HPV) Vaccination Program Register data. These include coverage at standard age milestones and for individual vaccines included on the National Immunisation Program (NIP) and coverage in adolescents and adults. The proportion of Australian children 'fully vaccinated' at 12, 24 and 60 months of age was 91.7%, 92.5% and 91.2%, respectively. For vaccines available on the NIP but not assessed during 2012 for 'fully vaccinated' status or for eligibility for incentive payments (rotavirus and pneumococcal at 12 months and meningococcal C and varicella at 24 months) coverage varied. Although pneumococcal vaccine had similar coverage at 12 months to other vaccines, coverage was lower for rotavirus at 12 months (83.6%) and varicella at 24 months (84.4%). Although 'fully vaccinated' coverage at 12 months of age was lower among Indigenous children than non-Indigenous children in all jurisdictions, the extent of the difference varied, reaching a 15 percentage point differential in South Australia but only a 0.4 percentage point differential in the Northern Territory. Overall, Indigenous coverage at 24 months of age exceeded that at 12 months of age nationally and for all jurisdictions, but as receipt of varicella vaccine at 18 months is excluded from calculations, this represents delayed immunisation, with some contribution from immunisation incentives. The 'fully vaccinated' coverage estimates for vaccinations due by 60 months of age for Indigenous children exceeded 90% at 91% in 2012. Unlike in 2011, at 60 months of age, there was no dramatic variation in coverage between Indigenous and non-Indigenous children for individual jurisdictions. As previously documented, vaccines recommended for Indigenous children only, hepatitis A and pneumococcal vaccine, had

  8. Patients' mobility as an indicator for (in)efficiency:a panel data analysis on Italian health care authorities.

    Science.gov (United States)

    Mafrolla, Elisabetta; D'Amico, Eugenio

    2013-02-19

    This paper investigates the influence of internal managerial patterns of heath care authorities on the decision of patients to migrate towards different health care organizations to avail treatments. The efficiency and productivity issues are analyzed, considering the (passive) migration as a proxy for the (in)efficient service availed. We follow the "vote by feet" theorization by Tiebout , assuming that citizens can choose to avail a health treatment in a public service provider different from their resident one. The choice for a center that is far from home implies a negative judgment to the alternative health care supplier that is closer to the patient. Testing Fixed Effects Panel Model on a sample of Italian health care authorities, a strong correlation is found among variables in our model and some relevant dependence is tested between patients' mobility behavior and their resident authorities' efficiency in allocating resources on the proper operating cost. Spending in the proper way on health care could bring about an enhancement of performances. Instead, wasting resources is immediately perceived by the patient, who consequently seems to move to a different health care authority. JEL CODE: M48.

  9. Are medical residents a "core group" for future improvement of influenza vaccination coverage in health-care workers? A study among medical residents at the University Hospital of Palermo (Sicily).

    Science.gov (United States)

    Amodio, Emanuele; Tramuto, Fabio; Maringhini, Guido; Asciutto, Rosario; Firenze, Alberto; Vitale, Francesco; Costantino, Claudio; Calamusa, Giuseppe

    2011-10-19

    Despite international recommendations, vaccination coverage among European healthcare workers, including physicians, is widely recognized as unsatisfactory. In order to plan tailored vaccination campaigns and increase future coverage, we investigated reasons for refusing vaccination and determinants associated with influenza vaccine uptake among young health care workers. A survey was carried out during September and October 2010 on medical residents attending post-graduate Schools of the Medical Faculty at the University of Palermo (Italy). Each participant completed an anonymous web-based questionnaire including items on demographic and occupational characteristics, knowledge, attitudes and behaviours with regard to influenza and influenza vaccination, and main sources of information. A total of 202 (66.9%) out of 302 medical residents participated in the survey. During the 2009-2010 influenza vaccine campaign, 44 residents (21.8%) were vaccinated against seasonal influenza and 84 (41.6%) against pandemic influenza A (H1N1) 2009. For the impending 2010-2011 influenza season, 45 (22.3%) stated their intention to get vaccinated against seasonal influenza, 40 (19.8%) were uncertain and 117 (57.9%) were opposed. Considering themselves to be a high risk group for developing influenza was significantly associated with vaccination against both 2009-2010 seasonal (adj-OR=1.46; 95% CI=1.05-2.04) and pandemic A (H1N1) influenza (adj-OR 1.38; 95% CI=1.08-1.75). Intention to get vaccinated against 2010-2011 seasonal influenza was significantly more frequent in participants who had a high perception of efficacy/safety (adj-OR=1.49; 95% CI=1.05-2.12). After adjusting for confounding, vaccinations against seasonal 2009-2010 influenza, pandemic influenza A (H1N1) 2009 and seasonal 2010-2011 influenza were significantly more frequent in residents who were vaccinated against influenza at least once in the previous five influenza seasons. Influenza vaccination among medical

  10. Quality of longer term mental health facilities in Europe: validation of the quality indicator for rehabilitative care against service users' views.

    Directory of Open Access Journals (Sweden)

    Helen Killaspy

    Full Text Available BACKGROUND: The Quality Indicator for Rehabilitative Care (QuIRC is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care. METHOD: At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit's therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables. RESULTS: 1750/2495 (70% users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users' autonomy and experiences of care. Associations between QuIRC ratings and service users' ratings of their quality of life and the unit's therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning. A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy. CONCLUSIONS: Ratings of the quality of longer term mental health facilities made by service managers were positively associated with service users' autonomy and experiences of care

  11. Moving to universal coverage? Trends in the burden of out-of-pocket payments for health care across social groups in India, 1999-2000 to 2011-12.

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    Anup Karan

    Full Text Available In the background of ongoing health sector reforms in India, the paper investigates the magnitude and trends in out-of-pocket and catastrophic payments for key population sub-groups. Data from three rounds of nationally representative consumer expenditure surveys (1999-2000, 2004-05 and 2011-12 were pooled to assess changes over time in a range of out-of-pocket -related outcome indicators for the poorest 20% households, scheduled caste and tribe households and Muslims households relative to their better-off/majority religion counterparts. Our results suggest that the poorest 20% of households experienced a decline in the proportion reporting any OOP for inpatient care relative to the top 20% and Muslim households saw an increase in the proportion reporting any inpatient OOP relative to non-Muslim households during 2000-2012. The change in the proportion of Muslim households or SC/ST households reporting any OOP for outpatient care was similar to that for their respective more advantaged counterparts; but the poorest 20% of households experienced a faster increase in the proportion reporting any OOP for outpatient care than their top 20% counterparts. SC/ST, Muslim and the poorest 20% of households experienced as faster increase in the share of outpatient OOP in total household spending relative to their advantaged counterparts. We conclude that the financial burden of out of pocket spending increased faster among the disadvantaged groups relative to their more advantaged counterparts. Although the poorest 20% saw a relative decline in OOP spending on inpatient care as a share of household spending, this is likely the result of foregoing inpatient care, than of accessing benefits from the recent expansion of cashless publicly financed insurance schemes for inpatient care. Our results highlight the need to explore the reasons underlying the lack of effectiveness of existing public health financing programs and public sector health services in

  12. Integrating “Best of Care” Protocols into Clinicians' Workflow via Care Provider Order Entry: Impact on Quality-of-Care Indicators for Acute Myocardial Infarction

    OpenAIRE

    Ozdas, Asli; Speroff, Theodore; Waitman, L. Russell; Ozbolt, Judy; Butler, Javed; Miller, Randolph A.

    2006-01-01

    Objective: In the context of an inpatient care provider order entry (CPOE) system, to evaluate the impact of a decision support tool on integration of cardiology “best of care” order sets into clinicians' admission workflow, and on quality measures for the management of acute myocardial infarction (AMI) patients.

  13. Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care

    NARCIS (Netherlands)

    Parker, D.; Wensing, M.; Esmail, A.; Valderas, J.M.

    2015-01-01

    BACKGROUND: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture. OBJECTIVE: To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance

  14. Comparison of midwifery care to medical care in hospitals in the Quebec pilot projects study: clinical indicators. L'Equipe dEvaluation des Projets-Pilotes Sages-Femmes.

    Science.gov (United States)

    Fraser, W; Hatem-Asmar, M; Krauss, I; Maillard, F; Bréart, G; Blais, R

    2000-01-01

    The purpose of this study was to compare indicators of process and outcome of midwifery services provided in the Quebec pilot projects to those associated with standard hospital-based medical services. Women receiving each type of care (961 per group) were matched on the basis of socio-demographic characteristics and level of obstetrical risk. We found midwifery care to be associated with less obstetrical intervention and a reduction in selected indicators of maternal morbidity (caesarean section and severe perineal injury). For neonatal outcome indicators, midwifery care was associated with a mixture of benefits and risks: fewer babies with preterm birth and low birthweight, but a trend toward a higher stillbirth ratio and more frequent requirement for neonatal resuscitation. The study design does not permit to conclude that the associations were causal in nature. However, the high stillbirth rate observed in the group of women who were selected for midwife care raises concerns both regarding the appropriateness of the screening procedures for admission to such care and regarding the quality of care itself.

  15. Nursing challenges for universal health coverage: a systematic review

    Directory of Open Access Journals (Sweden)

    Mariana Cabral Schveitzer

    2016-01-01

    Full Text Available Objectives to identify nursing challenges for universal health coverage, based on the findings of a systematic review focused on the health workforce' understanding of the role of humanization practices in Primary Health Care. Method systematic review and meta-synthesis, from the following information sources: PubMed, CINAHL, Scielo, Web of Science, PsycInfo, SCOPUS, DEDALUS and Proquest, using the keyword Primary Health Care associated, separately, with the following keywords: humanization of assistance, holistic care/health, patient centred care, user embracement, personal autonomy, holism, attitude of health personnel. Results thirty studies between 1999-2011. Primary Health Care work processes are complex and present difficulties for conducting integrative care, especially for nursing, but humanizing practices have showed an important role towards the development of positive work environments, quality of care and people-centered care by promoting access and universal health coverage. Conclusions nursing challenges for universal health coverage are related to education and training, to better working conditions and clear definition of nursing role in primary health care. It is necessary to overcome difficulties such as fragmented concepts of health and care and invest in multidisciplinary teamwork, community empowerment, professional-patient bond, user embracement, soft technologies, to promote quality of life, holistic care and universal health coverage.

  16. Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providers

    Directory of Open Access Journals (Sweden)

    Vien X Nguyen

    2010-11-01

    Full Text Available Vien X Nguyen1, Vi Thuy Le Nguyen2, Cuong C Nguyen11Department of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA; 2Department of Pharmacy, Banner Baywood Medical Center, Mesa, AZ, USAAbstract: The field of endoscopy has revolutionized the diagnosis and treatment of ­gastrointestinal (GI diseases in recent years. Besides the ‘traditional’ endoscopic ­procedures (esophagogastroduodenoscopy, colonoscopy, flexible sigmoidoscopy, and endoscopic retrograde cholangiopancreatography, advances in imaging technology (endoscopic ultrasonography, ­wireless capsule endoscopy, and double balloon enteroscopy have allowed GI specialists to detect and manage disorders throughout the digestive system. This article reviews various ­endoscopic procedures and provides up-to-date endoscopic indications based on the ­recommendations of American Society for Gastrointestinal Endoscopy and American Cancer Society for primary care providers in order to achieve high-quality and cost-effective care.Keywords: endoscopy, endoscopic indications, endoscopic procedures, imaging, primary care, gastrointestinal disorders, appropriate use

  17. How to implement quality indicators successfully in palliative care services: perceptions of team members about facilitators of and barriers to implementation.

    NARCIS (Netherlands)

    Leemans, K.; Block, L. van den; Stichele, R. Vander; Francke, A.L.; Deliens, L.; Cohen, J.

    2015-01-01

    Purpose: There is an increasing demand for the use of quality indicators in palliative care.With previous research about implementation in this field lacking, we aimed to evaluate the barriers to and facilitators of implementation. Methods: Three focus group interviews were organized with 21 caregiv

  18. Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

    Directory of Open Access Journals (Sweden)

    Mathoulin-Pélissier Simone

    2012-07-01

    Full Text Available Abstract Background Colorectal cancer (CRC care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care. Methods CRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery, and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥12 lymph nodes (LN, non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively. Results We included 1,206 patients, 825 (68% with colon and 381 (32% with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location; whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals. Conclusions Although some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care

  19. [The Swedish stroke register indicates differences in stroke care. Unconscious discrimination might explain some of the differences].

    Science.gov (United States)

    Eriksson, Marie; Glader, Eva-Lotta; Norrving, Bo; Asplund, Kjell

    2015-12-15

    In this article, results from a series of studies on the relationships between socioeconomic factors and stroke processes (stroke unit care, acute reperfusion treatment, secondary prevention with oral anticoagulants and statins) and outcomes (long-term survival, return to work and risk of suicide and suicide attempts) are summarized. The overall pattern is that acute and secondary prevention interventions and prognosis are better in patients with a high compared with a low level of education, better in people with high than low income, better in people who are cohabitant than single. As to country of birth, a more complex pattern has emerged. Unmeasured confounding may possibly explain part of the difference, but the socioeconomic gradients remain after adjustment for multiple potential confounders, leaving the possibility that there is an element of unconscious discrimination in stroke care.

  20. Assessment of WHO/INRUD core drug use indicators in two tertiary care hospitals of Bahawalpur, Punjab, Pakistan

    OpenAIRE

    Atif, Muhammad; Sarwar, Muhammad Rehan; Azeem, Muhammad; Umer, Danial; Rauf, Abdul; Rasool, Arslan; Ahsan, Muhammad; Scahill, Shane

    2016-01-01

    Background Medicines are a main therapeutic intervention provided within hospitals and their proper use in the outpatient setting is important for patients and the community. The objective of this study was to evaluate drug use patterns in the outpatient departments (OPDs) of two tertiary care hospitals (Bahawal Victoria Hospital and Civil Hospital) in the Bahawalpur district of the Punjab province of Pakistan by employing the standard World Health Organization/International Network of Ration...

  1. Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Dubourg, Dominique; Makokha, Anselimo;

    2014-01-01

    BackgroundDeveloping countries with high maternal mortality need to invest in indicators that not only provide information about how many women are dying, but also where, and what can be done to prevent these deaths. The unmet Obstetric Needs (UONs) concept provides this information. This concept...... in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The main outcome measures in the study were...

  2. Preferences of diabetes patients and physicians: A feasibility study to identify the key indicators for appraisal of health care values

    Directory of Open Access Journals (Sweden)

    Deutschmann Marc

    2010-11-01

    Full Text Available Abstract Background Evidence-based medicine, the Institute of Medicine (IOM and the German Institute for Quality and Efficiency in Health Care (IQWiG, support the inclusion of patients' preferences in health care decisions. In fact there are not many trials which include an assessment of patient's preferences. The aim of this study is to demonstrate that preferences of physicians and of patients can be assessed and that this information may be helpful for medical decision making. Method One of the established methods for assessment of preferences is the conjoint analysis. Conjoint analysis, in combination with a computer assisted telephone interview (CATI, was used to collect data from 827 diabetes patients and 60 physicians, which describe the preferences expressed as levels of four factors in the management and outcome of the disease. The first factor described the main treatment effect (reduction of elevated HbA1c, improved well-being, absence of side effects, and no limitations of daily life. The second factor described the effect on the body weight (gain, no change, reduction. The third factor analyzed the mode of application (linked to meals or flexible application. The fourth factor addressed the type of product (original brand or generic product. Utility values were scaled and normalized in a way that the sum of utility points across all levels is equal to the number of attributes (factors times 100. Results The preference weights confirm that the reduction of body weight is at least as important for patients - especially obese patients - and physicians as the reduction of an elevated HbA1c. Original products were preferred by patients while general practitioners preferred generic products. Conclusion Using the example of diabetes, the difference between patients' and physicians' preferences can be assessed. The use of a conjoint analysis in combination with CATI seems to be an effective approach for generation of data which are needed

  3. Child immunization coverage in rural hard-to-reach Haor areas of Bangladesh: possible alternative strategies.

    Science.gov (United States)

    Uddin, Md Jasim; Larson, Charles P; Oliveras, Elizabeth; Khan, Azharul Islam; Quaiyum, Md Abdul; Chandra Saha, Nirod

    2009-01-01

    This article assessed the status of childhood vaccination coverage and the possibility of using selected alternative vaccination strategies in rural hard-to-reach haor (low lying) areas of Bangladesh. Data were collected through survey, in-depth interviews, group discussion, and observations of vaccination sessions. Complete immunization coverage among 12- to 23-month-old children was found to be significantly lower in study areas when compared with the national coverage levels. The study identified reasons for low complete immunization coverage in hard-to-reach areas, including irregular/cancelled extended program on immunization (EPI) sessions, less time spent in EPI spots by field staff, and absence of any alternative strategy for remote areas. The findings indicated that the existing service delivery strategy is not sufficient to improve immunization coverage in hard-to-reach areas. However, most of the strategies assessed are considered possible to implement by health care providers in hard-to-reach areas. The study suggested that before implementing alternative strategies in hard-to-reach areas, feasibility and effectiveness of the possible strategies need to be tested to identify evidence-based strategies.

  4. 护理质量指标的设计与应用%Design and application of nursing care quality indicators

    Institute of Scientific and Technical Information of China (English)

    陈玉枝

    2014-01-01

    High medical quality is deeply concerned by medical institutions, patients&family members, and health authorities. Care quality is the key component of nursing management. It is also the evaluation of how the performances close to patients, clinic, and the society. In this paper, the author introduced the deifnition of care quality, how to set up the care quality indicators, how to use scientiifc methods in collecting and analyzing data to ifnd the reasons why the quality indicators did not achieve the ideal level, and how to implement interventions to continuously improve the care quality.%高医疗质量深受医疗机构、病人、家属及卫生主管部门所重视,护理质量是护理管理的关键,也是在评价贴近病人、贴近临床、贴近社会的表现,本文介绍了护理质量的定义,如何制定护理质量指标,运用科学性的方法收集资料,测量与分析,以了解质量未达理想的原因,进行改善,达持续改善的目标。

  5. Coverage Metrics for Model Checking

    Science.gov (United States)

    Penix, John; Visser, Willem; Norvig, Peter (Technical Monitor)

    2001-01-01

    When using model checking to verify programs in practice, it is not usually possible to achieve complete coverage of the system. In this position paper we describe ongoing research within the Automated Software Engineering group at NASA Ames on the use of test coverage metrics to measure partial coverage and provide heuristic guidance for program model checking. We are specifically interested in applying and developing coverage metrics for concurrent programs that might be used to support certification of next generation avionics software.

  6. 5 CFR 875.413 - Is it possible to have coverage reinstated?

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Is it possible to have coverage... SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Coverage § 875.413 Is it possible... Carrier will reinstate your coverage if it receives proof satisfactory to it, within 6 months from...

  7. Observed-predicted length of stay for an acute psychiatric department, as an indicator of inpatient care inefficiencies. Retrospective case-series study.

    Directory of Open Access Journals (Sweden)

    Marot Milagros

    2004-02-01

    Full Text Available Abstract Background Length of stay (LOS is an important indicator of efficiency for inpatient care but it does not achieve an adequate performance if it is not adjusted for the case mix of the patients hospitalized during the period considered. After two similar studies for Internal Medicine and Surgery respectively, the aims of the present study were to search for Length of Stay (LOS predictors in an acute psychiatric department and to assess the performance of the difference: observed-predicted length of stay, as an indicator of inpatient care inefficiencies. Methods Retrospective case-series of patients discharged during 1999 from the Psychiatric Department from General Hospital "Hermanos Ameijeiras" in Havana, Cuba. The 374 eligible medical records were randomly split into two groups of 187 each. We derived the function for estimating the predicted LOS within the first group. Possible predictors were: age; sex; place of residence; diagnosis, use of electroconvulsive therapy; co morbidities; symptoms at admission, medications, marital status, and response to treatment. LOS was the dependent variable. A thorough exam of the patients' records was the basis to assess the capacity of the function for detecting inefficiency problems, within the second group. Results The function explained 37% of LOS variation. The strongest influence on LOS came from: age (p = 0.002, response to treatment (p Conclusions This study demonstrates the importance of possible predictors of LOS, in an acute care Psychiatric department. The proposed indicator can be readily used to detect inefficiencies.

  8. Integrating “Best of Care” Protocols into Clinicians' Workflow via Care Provider Order Entry: Impact on Quality-of-Care Indicators for Acute Myocardial Infarction

    Science.gov (United States)

    Ozdas, Asli; Speroff, Theodore; Waitman, L. Russell; Ozbolt, Judy; Butler, Javed; Miller, Randolph A.

    2006-01-01

    Objective: In the context of an inpatient care provider order entry (CPOE) system, to evaluate the impact of a decision support tool on integration of cardiology “best of care” order sets into clinicians' admission workflow, and on quality measures for the management of acute myocardial infarction (AMI) patients. Design: A before-and-after study of physician orders evaluated (1) per-patient use rates of standardized acute coronary syndrome (ACS) order set and (2) patient-level compliance with two individual recommendations: early aspirin ordering and beta-blocker ordering. Measurements: The effectiveness of the intervention was evaluated for (1) all patients with ACS (suspected for AMI at the time of admission) (N = 540) and (2) the subset of the ACS patients with confirmed discharge diagnosis of AMI (n = 180) who comprise the recommended target population who should receive aspirin and/or beta-blockers. Compliance rates for use of the ACS order set, aspirin ordering, and beta-blocker ordering were calculated as the percentages of patients who had each action performed within 24 hours of admission. Results: For all ACS admissions, the decision support tool significantly increased use of the ACS order set (p = 0.009). Use of the ACS order set led, within the first 24 hours of hospitalization, to a significant increase in the number of patients who received aspirin (p = 0.001) and a nonsignificant increase in the number of patients who received beta-blockers (p = 0.07). Results for confirmed AMI cases demonstrated similar increases, but did not reach statistical significance. Conclusion: The decision support tool increased optional use of the ACS order set, but room for additional improvement exists. PMID:16357360

  9. Chiropractic Use by Urban and Rural Residents with Insurance Coverage

    Science.gov (United States)

    Lind, Bonnie K.; Diehr, Paula K.; Grembowski, David E.; Lafferty, William E.

    2009-01-01

    Purpose: To describe the use of chiropractic care by urban and rural residents in Washington state with musculoskeletal diagnoses, all of whom have insurance coverage for this care. The analyses investigate whether restricting the analyses to insured individuals attenuates previously reported differences in the prevalence of chiropractic use…

  10. The Dimensions and Specific Indicators Used to Define Competence and Quality in Medical Care: A Review of the Literature.

    Science.gov (United States)

    Ironside, Roderick A.; Richardson, Adele

    This literature review has been prepared as one aid in the process of outlining indicators of minimally acceptable performance of practicing licensed physicians in the service of the Department of Health in Puerto Rico as part of the University of Puerto Rico's Special Curso de Perfeccionamiento, a course that was developed for unlicensed…

  11. Warfarin reversal emerging as the major indication for fresh frozen plasma use at a tertiary care hospital.

    Science.gov (United States)

    Ozgonenel, Bulent; O'Malley, Barbara; Krishen, Priya; Eisenbrey, A B

    2007-12-01

    Because of the increase in the use of warfarin in the population in recent years, reversal of warfarin-related coagulopathy has become common in daily hospital practice. Transfusion of fresh frozen plasma (FFP) is the preferred treatment method for urgent warfarin reversal in the USA. We have undertaken a 1-month audit of FFP usage to ascertain the impact of warfarin use on the consumption of FFP. Sixty percent of the 376 units of FFP that were transfused during the study month were used to reverse warfarin effects. The most common reason to reverse warfarin was bleeding. Thirty-three percent of the units were used for the treatment of other coagulopathies, 7% were used in therapeutic plasmapheresis, and banks of hospitals serving a predominantly elderly patient population should anticipate a higher consumption of FFP. Careful monitoring of warfarin therapy, stringent implementation of the warfarin reversal guidelines, and the introduction of newer products for warfarin reversal would help reduce the consumption of FFP.

  12. Clinical, behavioural and social indicators for poor glycaemic control around the time of transfer to adult care

    DEFF Research Database (Denmark)

    Castensøe-Seidenfaden, P; Jensen, Andreas Kryger; Smedegaard, Heidi

    2017-01-01

    last paediatric and first adult visit, comorbidity, learning disability and/or mental health conditions and family structure. We examined associations between acute hospital admissions, low visit attendance rate, loss to follow-up and baseline HbA1c level. RESULTS: Among 126 participants, the mean HbA1......c level was 80 mmol/mol (9.4%) pre-transfer but decreased by an average of 3 mmol/mol (0.3%) each year post-transfer (P = 0.005). Young people with a learning disability and/or a mental health condition had worse glycaemic control (P = 0.041) and the mean HbA1c of those with divorced parents was 14...... mmol/mol (1.2%) higher (P = 0.014). Almost one-third of participants were admitted to the hospital for acute diabetes care. Low visit attendance rate, high baseline HbA1c level, learning disability and/or mental health conditions and divorced parents predicted acute hospital admissions. CONCLUSIONS...

  13. Effects of Music Intervention on State Anxiety and Physiological Indices in Patients Undergoing Mechanical Ventilation in the Intensive Care Unit.

    Science.gov (United States)

    Lee, Chiu-Hsiang; Lee, Chien-Ying; Hsu, Ming-Yi; Lai, Chiung-Ling; Sung, Yi-Hui; Lin, Chung-Ying; Lin, Long-Yau

    2017-03-01

    Patients in intensive care units (ICUs) often experience stress and anxiety. Although stress and anxiety can be pharmacologically attenuated, some drugs cause adverse side effects such as bradycardia, immobility, and delirium. There is thus a need for an alternative treatment with no substantial adverse effects. Music intervention is a potential alternative. In the present study, we used cortisol levels, subjective questionnaires, and physiological parameters to explore the anxiety-reducing effects of music intervention in a sample of ICU patients on mechanical ventilation. Patients admitted to the ICU for ≥ 24 hr were randomly assigned to the music intervention ( n = 41) or control group ( n = 44). Music group patients individually listened to music from 4:00 to 4:30 p.m.; control group patients wore headphones but heard no music for the same 30 min. Anxiety was measured using serum cortisol levels, the Chinese Version of the State-Trait Anxiety Inventory, the Visual Analogue Scale for Anxiety, heart rate, and blood pressure. After adjusting for demographics, analysis of covariance showed that the music group had significantly better scores for all posttest measures ( p < .02) and pre-post differences ( p < .03) except for diastolic blood pressure. Because of music intervention's low cost and easy administration, clinical nurses may want to use music to reduce stress and anxiety for ICU patients. A single 30-min session might work immediately without any adverse effects. However, the duration of the effect is unclear; thus, each patient's mood should be monitored after the music intervention.

  14. Indicadores de atenção básica em saúde bucal: associação com as condições socioeconômicas, provisão de serviços, fluoretação de águas e a estratégia de saúde da família no Sul do Brasil Primary dental care indicators: association with socioeconomic status, dental care, water fluoridation and Family Health Program in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Tatiana Konrad Fischer

    2010-03-01

    Full Text Available Foram analisados os indicadores de saúde bucal do pacto de atenção básica do SUS (cobertura, razão de exodontias em relação aos procedimentos individuais e cobertura de procedimentos coletivos na população de até 14 anos de idade em municípios do Sul do Brasil (n = 1159 entre 2000 e 2005. Além disso, foram testadas as associações dos indicadores com variáveis socioeconômicas, de provisão de serviços odontológicos, fluoretação de águas e cobertura da saúde bucal na estratégia de saúde da família. Associaram-se positivamente com o aumento da cobertura, o Estado (RS com a menor, população rural, IDH, número de dentistas pela população e cobertura da saúde bucal no PSF. Para razão de exodontias foram associados o Estado (SC e RS maiores, negativamente com população rural, IDH, número de dentistas pela população e cobertura da saúde bucal no PSF e positivamente o índice de Gini. Procedimentos coletivos foram associados negativamente ao índice de Gini, intensidade de indigência e razão do número de dentistas pela população e positivamente com o Estado (menor no RS, população rural, IDH e cobertura da saúde bucal no PSF.This paper analyzed the primary dental care indicators of the Brazilian National Health System (SUS considering coverage of dental care, ratio between dental extraction and dental procedures, and coverage of preventive measures among children up to 14 years-old in the municipalities from the southern region of Brazil (n=1,159 between the years 2000 and 2005. In addition, the association of these indicators with socioeconomic indicators, dental care, water fluoridation and coverage of oral health care by the Family Health Program (FHP was tested. The increase in the coverage of dental care was positively associated with the percentage of rural population, Human Development Index (HDI, number of dentists per capita, and FHP coverage. Dental extraction was negatively associated with

  15. Depression and anxiety, an Indicated Prevention (DIP protocol in homes for the elderly: feasibility and (cost effectiveness of a stepped care programme

    Directory of Open Access Journals (Sweden)

    Beekman Aartjan TF

    2007-03-01

    Full Text Available Abstract Background Depressive and anxiety disorders are a very common, serious and underdetected problem in homes for the elderly. Elderly persons in residential homes are at high risk for developing major depressive and anxiety disorders, and, therefore, deserve attention with regard to prevention. Methods/Design This protocol describes a randomised trial on the feasibility and (cost effectiveness of a stepped-care programme for prevention of depressive and anxiety disorders in homes for the elderly. The main outcome measure is the incidence of depressive and anxiety disorder in one year with a two years follow up. Secondary outcomes are symptoms of depression and anxiety, quality of life, direct health care costs and satisfaction with treatment. Discussion The number of studies examining the effects of preventive interventions on the incidence of mental disorders in the elderly population is very small. However, indicated prevention by means of a stepped-care programme seems to be an important option for decreasing the burden of illness for residents and their caregivers. This study contributes to the body of knowledge in this field. Positive effects may contribute to further use and development of tailored, (cost- effective and easy to use interventions in a preventive stepped-care programme. Trial Registration The Dutch Cochrane Centre, ISRCTN27540731

  16. [Utilization and coverage of a Food and Nutritional Surveillance System in Rio Grande do Sul state, Brazil].

    Science.gov (United States)

    Jung, Natália Miranda; Bairros, Fernanda de Souza; Neutzling, Marilda Borges

    2014-05-01

    This article seeks to describe the utilization and coverage percentage of the Nutritional and Food Surveillance System (SISVAN-Web) in the Regional Health Offices of Rio Grande do Sul in 2010 and to assess its correlation with socio-economic, demographic and health system organization variables at the time. It is an ecological study that used secondary data from the SISVAN-Web, the Department of Primary Health Care, the IT Department of the Unified Health System and the Brazilian Institute of Geography and Statistics. The evaluation of utilization and coverage data was restricted to nutritional status. The percentage of utilization of SISVAN-Web refers to the number of cities that fed the system. Total coverage was defined as the percentage of individuals in all stages of the life cycle monitored by SISVAN-Web. It was found that 324 cities fed the application, corresponding to a utilization percentage of 65.3%. Greater system coverage was observed in all Regional Health Coordination (RHC) Units for ages 0 to 5 years and 5-10 years. There was a significant association between the percentage of utilization of SISVAN-Web and Family Health Strategy coverage in each RHC Unit. The results of this study indicated low percentages of utilization and coverage of SISVAN-Web in Rio Grande do Sul.

  17. Treatment of osteoporosis in an older home care population

    OpenAIRE

    Maxwell Colleen J; Vik Shelly A; Hanley David A

    2005-01-01

    Abstract Background Previous research indicates that many patients with fractures indicative of underlying osteoporosis are not receiving appropriate diagnostic follow-up and therapy. We assessed osteoporosis treatment coverage in older home care clients with a diagnosis of osteoporosis and/or prevalent fracture. Methods Subjects included 330 home care clients, aged 65+, participating in a longitudinal study of medication adherence and health-related outcomes. Data on clients' demographic, he...

  18. The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004–5

    Directory of Open Access Journals (Sweden)

    Armstrong David

    2006-11-01

    Full Text Available Abstract Background The descriptive information now available for primary care in the UK is unique in international terms. Under the 'Quality and Outcomes Framework' (QOF, data for 147 performance indicators are available for each general practice. We aimed to determine the relationship between the quality of primary care, as judged by the total QOF score, social deprivation and practice characteristics. Methods We obtained QOF data for each practice in England and linked these with census derived data (deprivation indices and proportion of patients born in a developing country. Characteristics of practices were also obtained. QOF and census data were available for 8480 practices. Results The median QOF score was 999.7 out of a possible maximum of 1050 points. Three characteristics were independently associated with higher QOF scores: training practices, group practices and practices in less socially deprived areas. In a regression model, these three factors explained 14.6% of the variation in QOF score. Higher list sizes per GP, turnover of registered patients, chronic disease prevalence, proportions of elderly patients or patients born in a developing country did not contribute to lower QOF scores in the final model. Conclusion Socially deprived areas experience a lower quality of primary care, as judged by QOF scores. Social deprivation itself is an independent predictor of lower quality. Training and group practices are independent predictors of higher quality but these types of practices are less well represented in socially deprived areas.

  19. Compliance with clinical practice guidelines for breast cancer treatment: a population-based study of quality-of-care indicators in Italy

    Directory of Open Access Journals (Sweden)

    Sacerdote Carlotta

    2013-01-01

    Full Text Available Abstract Background It has been documented that variations exist in breast cancer treatment despite wide dissemination of clinical practice guidelines. The aim of this population-based study was to evaluate the impact of regional guidelines (Piedmont guidelines, PGL for breast cancer diagnosis and treatment on quality-of-care indicators in the Northwestern Italian region of Piedmont. Methods We included two samples of women aged 50–69 years with incident breast cancer treated in Piedmont before and after the introduction of PGL: 600 in 2002 (pre-PGL and 621 in 2004 (post-PGL. Patients were randomly selected among all incident breast cancer cases identified through the hospital discharge records database. We extracted clinical data on breast cancer cases from medical charts and ascertained vital status through linkage with town offices. We assessed compliance with 14 quality-of-care indicators from PGL recommendations, before and after their introduction in clinical practice. Results Among patients with invasive lesions, 77.1% (N = 368 and 77.5% (N = 383 in the pre-PGL and post-PGL groups, respectively, received breast conservative surgery (BCS as a first-line treatment. Following BCS, 87.7% received radiotherapy in 2002, compared to 87.9% in 2004. Of all patients at medium-to-high risk of distant metastasis, 65.5% (N = 268 and 63.6% (N = 252 received chemotherapy in 2002 and in 2004, respectively. Among the 117 patients with invasive lesions and negative estrogen receptor status in 2002, hormonal therapy was prescribed in 23 of them (19.6%. The incorrect prescription of hormonal therapy decreased to 10.8% (N = 10 among the 92 estrogen receptor-negative patients in 2004 (p Compliance with PGL recommendations was already high in the pre-PGL group, although some quality-of-care indicators did not reach the standard. In the pre/post analysis, 8 out of 14 quality-of-care indicators showed an improvement from 2002 to 2004, but only 4 out of 14

  20. Socio-economic inequality of immunization coverage in India.

    Science.gov (United States)

    Lauridsen, Jørgen; Pradhan, Jalandhar

    2011-08-05

    To our knowledge, the present study provides a first time assessment of the contributions of socioeconomic determinants of immunization coverage in India using the recent National Family Health Survey data. Measurement of socioeconomic inequalities in health and health care, and understanding the determinants of such inequalities in terms of their contributions, are critical for health intervention strategies and for achieving equity in health care. A decomposition approach is applied to quantify the contributions from socio-demographic factors to inequality in immunization coverage. The results reveal that poor household economic status, mother's illiteracy, per capita state domestic product and proportion of illiterate at the state level is systematically related to 97% of predictable socioeconomic inequalities in full immunization coverage at the national level. These patterns of evidence suggest the need for immunization strategies targeted at different states and towards certain socioeconomic determinants as pointed out above in order to reduce socioeconomic inequalities in immunization coverage.JEL Classification: I10, I12.

  1. Development and feasibility of a set of quality indicators relative to the timeliness and organisation of care for new breast cancer patients undergoing surgery

    Directory of Open Access Journals (Sweden)

    Ferrua Marie

    2012-06-01

    Full Text Available Abstract Background Because breast cancer is a major public health issue, it is particularly important to measure the quality of the care provided to patients. Survival rates are affected by the timeliness of care, and waiting times constitute key quality criteria. The aim of this study was to develop and validate a set of quality indicators (QIs relative to the timeliness and organisation of care in new patients with infiltrating, non-inflammatory and metastasis-free breast cancer undergoing surgery. The ultimate aim was to use these QIs to compare hospitals. Methods The method of QI construction and testing was developed by COMPAQ-HPST. We first derived a set of 8 QIs from consensus guidelines with the aid of experts and professional associations and then tested their metrological properties in a panel of 60 volunteer hospitals. We assessed feasibility using a grid exploring 5 dimensions, discriminatory power using the Gini coefficient as a measure of dispersion, and inter-observer reliability using the Kappa coefficient. Results Overall, 3728 records were included in the analyses. All 8 QIs showed acceptable feasibility (but one QI was subject to misinterpretation, fairly strong agreement between observers (Kappa = 0.66, and wide variations in implementation among hospitals (Gini coefficient  Conclusions Of the 8 QIs, 3 are ready for nationwide implementation (time to surgery, time to postoperative multidisciplinary team meeting (MDTM, conformity of MDTM. Four are suitable for use only in hospitals offering surgery with on-site postoperative treatment (waiting time to first appointment after surgery, patient information, time to first postoperative treatment, and traceability of information relating to prognosis. Currently, in the French healthcare system, a patient receives cancer care from different institutions whose databases cannot as yet be easily merged. Nationwide implementation of QIs covering the entire care pathway will thus

  2. Perplexity analysis of obesity news coverage.

    Science.gov (United States)

    McFarlane, Delano J; Elhadad, Noémie; Kukafka, Rita

    2009-11-14

    An important task performed during the analysis of health news coverage is the identification of news articles that are related to a specific health topic (e.g. obesity). This is often done using a combination of keyword searching and manual encoding of news content. Statistical language models and their evaluation metric, perplexity, may help to automate this task. A perplexity study of obesity news was performed to evaluate perplexity as a measure of the similarity of news corpora to obesity news content. The results of this study showed that perplexity increased as news coverage became more general relative to obesity news (obesity news approximately 187, general health news approximately 278, general news approximately 378, general news across multiple publishers approximately 382). This indicates that language model perplexity can measure the similarity news content to obesity news coverage, and could be used as the basis for an automated health news classifier.

  3. Strategies for expanding health insurance coverage in vulnerable populations

    OpenAIRE

    2014-01-01

    Background Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. Objectives To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), pa...

  4. Coverage and Connectivity Issue in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Rachit Trivedi

    2013-04-01

    Full Text Available Wireless sensor networks (WSNs are an emerging area of interest in research and development. It finds use in military surveillance, health care, environmental monitoring, forest fire detection and smart environments. An important research issue in WSNs is the coverage since cost, area and lifetime are directly validated to it.In this paper we present an overview of WSNs and try to refine the coverage and connectivity issues in wireless sensor networks.

  5. The quest for universal health coverage: achieving social protection for all in Mexico.

    Science.gov (United States)

    Knaul, Felicia Marie; González-Pier, Eduardo; Gómez-Dantés, Octavio; García-Junco, David; Arreola-Ornelas, Héctor; Barraza-Lloréns, Mariana; Sandoval, Rosa; Caballero, Francisco; Hernández-Avila, Mauricio; Juan, Mercedes; Kershenobich, David; Nigenda, Gustavo; Ruelas, Enrique; Sepúlveda, Jaime; Tapia, Roberto; Soberón, Guillermo; Chertorivski, Salomón; Frenk, Julio

    2012-10-06

    Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries.

  6. Treatment Contact Coverage for Probable Depressive and Probable Alcohol Use Disorders in Four Low- and Middle-Income Country Districts: The PRIME Cross-Sectional Community Surveys

    Science.gov (United States)

    De Silva, Mary J.; Ssebunnya, Joshua; Breuer, Erica; Murhar, Vaibhav; Luitel, Nagendra P.; Medhin, Girmay; Kigozi, Fred; Shidhaye, Rahul; Fekadu, Abebaw; Jordans, Mark; Patel, Vikram; Tomlinson, Mark; Lund, Crick

    2016-01-01

    Context A robust evidence base is now emerging that indicates that treatment for depression and alcohol use disorders (AUD) delivered in low and middle-income countries (LMIC) can be effective. However, the coverage of services for these conditions in most LMIC settings remains unknown. Objective To describe the methods of a repeat cross-sectional survey to determine changes in treatment contact coverage for probable depression and for probable AUD in four LMIC districts, and to present the baseline findings regarding treatment contact coverage. Methods Population-based cross-sectional surveys with structured questionnaires, which included validated screening tools to identify probable cases. We defined contact coverage as being the proportion of cases who sought professional help in the past 12 months. Setting Sodo District, Ethiopia; Sehore District, India; Chitwan District, Nepal; and Kamuli District, Uganda Participants 8036 adults residing in these districts between May 2013 and May 2014 Main Outcome Measures Treatment contact coverage was defined as having sought care from a specialist, generalist, or other health care provider for symptoms related to depression or AUD. Results The proportion of adults who screened positive for depression over the past 12 months ranged from 11.2% in Nepal to 29.7% in India and treatment contact coverage over the past 12 months ranged between 8.1% in Nepal to 23.5% in India. In Ethiopia, lifetime contact coverage for probable depression was 23.7%. The proportion of adults who screened positive for AUD over the past 12 months ranged from 1.7% in Uganda to 13.9% in Ethiopia and treatment contact coverage over the past 12 months ranged from 2.8% in India to 5.1% in Nepal. In Ethiopia, lifetime contact coverage for probable AUD was 13.1%. Conclusions Our findings are consistent with and contribute to the limited evidence base which indicates low treatment contact coverage for depression and for AUD in LMIC. The planned follow up

  7. Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013-2017.

    Science.gov (United States)

    Wilson, Sarah J; Baxendale, Sallie; Barr, William; Hamed, Sherifa; Langfitt, John; Samson, Séverine; Watanabe, Masako; Baker, Gus A; Helmstaedter, Christoph; Hermann, Bruce P; Smith, Mary-Lou

    2015-05-01

    The International League Against Epilepsy (ILAE) Diagnostic Methods Commission charged the Neuropsychology Task Force with the job of developing a set of recommendations to address the following questions: (1) What is the role of a neuropsychological assessment? (2) Who should do a neuropsychological assessment? (3) When should people with epilepsy be referred for a neuropsychological assessment? and (4) What should be expected from a neuropsychological assessment? The recommendations have been broadly written for health care clinicians in established epilepsy settings as well as those setting up new services. They are based on a detailed survey of neuropsychological assessment practices across international epilepsy centers, and formal ranking of specific recommendations for advancing clinical epilepsy care generated by specialist epilepsy neuropsychologists from around the world. They also incorporate the latest research findings to establish minimum standards for training and practice, reflecting the many roles of neuropsychological assessment in the routine care of children and adults with epilepsy. The recommendations endorse routine screening of cognition, mood, and behavior in new-onset epilepsy, and describe the range of situations when more detailed, formal neuropsychological assessment is indicated. They identify a core set of cognitive and psychological domains that should be assessed to provide an objective account of an individual's cognitive, emotional, and psychosocial functioning, including factors likely contributing to deficits identified on qualitative and quantitative examination. The recommendations also endorse routine provision of feedback to patients, families, and clinicians about the implications of the assessment results, including specific clinical recommendations of what can be done to improve a patient's cognitive or psychosocial functioning and alleviate the distress of any difficulties identified. By canvassing the breadth and depth

  8. Medicare Coverage: You Cannot Play the Game If You Do Not Know the Rules.

    Science.gov (United States)

    Schaum, Kathleen Dianne

    2013-12-01

    WOUND CARE STAKEHOLDERS SHOULD REMEMBER THAT MEDICARE REIMBURSEMENT REQUIRES THREE PARTS: a relevant code, a published Medicare payment rate, and positive coverage or coverage based upon medical necessity. Qualified healthcare professionals, scientists, and manufacturers should establish a monthly routine, where they personally review revisions to pertinent National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). These documents provide specific guidelines for positive coverage by the specific Medicare Administrative Contractor that processes the Medicare claims in a specific jurisdiction. When given an opportunity to provide comments on draft coverage determinations, wound care stakeholders should take advantage of the opportunity of educating the contractor medical director. After a LCD has become active, wound care stakeholders can and should request revisions, through the LCD Reconsideration Process, when new clinical evidence becomes available.

  9. Dinâmica da composição e cobertura de espécies de macrófitas aquáticas e a escolha de indicadores de impacto ambiental em um rio com ecoturismo Composition and coverage dynamics of aquatic macrophytes species and the choose of environmental impact indicators in a river with ecotourism tour

    Directory of Open Access Journals (Sweden)

    Antônio dos Santos Junior

    2011-12-01

    Full Text Available ResumoEstudos sobre ecologia de macrófitas aquáticas em ambiente natural no Brasil são relativamente escassos. Anualmente, um grande número de turistas é recebido para a prática da flutuação nas águas do rio Sucuri, Bonito, Estado de Mato Grosso do Sul. Os objetivos deste estudo foram: (1 descrever a composição e a cobertura relativa das espécies de macrófitas aquáticas no Rio Sucuri, (2 investigar o padrão de desbaste das macrófitas aquáticas no decorrer do ano e (3 eleger espécies com potencial de serem indicadoras de impacto ambiental da atividade turística. Foi empregado o método do intercepto em linha modificado para amostrar a composição e cobertura relativa das espécies de macrófitas aquáticas. Foram identificadas dezessete espécies macrófitas aquáticas. Durante o estudo foram observadas variações na composição e cobertura relativa das espécies de macrófitas aquáticas. Gomphrena elegans Mart. foi a espécie dominante em termos de cobertura relativa. Duas espécies apresentaram as características consideradas importantes para a indicação de impactos da atividade turística, considerando os resultados de cobertura relativa, frequência e desbaste: Nymphaea gardneriana Planch. e Myriophyllum aquaticum (Vell. Verdc. Assim, é sugerido que o monitoramento dos impactos do turismo sobre as macrófitas seja realizado na sua organização biológica populacional.AbstractEcologic studies around aquatic macrophytes in natural environment in Brazil are relatively scarce. Annually, many tourists have been received for floating practice on Sucuri river, in Bonito, Mato Grosso do Sul state. The aims of this research were: (1 describing the composition and the relative coverage of aquatic macrophytes in Sucuri river, (2 investigating the pattern of thinning of aquatic macrophytes during the year, and (3 electing species, such as indicators of environmental impact done by tourism. Intercept line method modified was

  10. Financing universal coverage in Malaysia: a case study.

    Science.gov (United States)

    Chua, Hong Teck; Cheah, Julius Chee Ho

    2012-01-01

    One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this paper seeks to evaluate the progress and capacity of a middle income country in terms of health financing for universal coverage, and also to highlight some of the key underlying health systems challenges.The WHO Health Financing Strategy for the Asia Pacific Region (2010-2015) was used as the framework to evaluate the Malaysian healthcare financing system in terms of the provision of universal coverage for the population, and the Malaysian National Health Accounts (2008) provided the latest Malaysian data on health spending. Measuring against the four target indicators outlined, Malaysia fared credibly with total health expenditure close to 5% of its GDP (4.75%), out-of-pocket payment below 40% of total health expenditure (30.7%), comprehensive social safety nets for vulnerable populations, and a tax-based financing system that fundamentally poses as a national risk-pooled scheme for the population.Nonetheless, within a holistic systems framework, the financing component interacts synergistically with other health system spheres. In Malaysia, outmigration of public health workers particularly specialist doctors remains an issue and financing strategies critically needs to incorporate a comprehensive workforce compensation strategy to improve the health workforce skill mix. Health expenditure information is systematically collated, but feedback from the private sector remains a challenge. Service delivery-wise, there is a need to enhance financing capacity to expand preventive

  11. Annual immunisation coverage report, 2010.

    Science.gov (United States)

    Hull, Brynley; Dey, Aditi; Menzies, Rob; McIntyre, Peter

    2013-03-31

    This, the fourth annual immunisation coverage report, documents trends during 2010 for a range of standard measures derived from Australian Childhood Immunisation Register (ACIR) data. These include coverage at standard age milestones and for individual vaccines included on the National Immunisation Program (NIP). For the first time, coverage from other sources for adolescents and the elderly are included. The proportion of children 'fully vaccinated' at 12, 24 and 60 months of age was 91.6%, 92.1% and 89.1% respectively. For vaccines available on the NIP but not currently assessed for 'fully immunised' status or for eligibility for incentive payments (rotavirus and pneumococcal at 12 months and meningococcal C and varicella at 24 months) coverage varied. Although pneumococcal vaccine had similar coverage at 12 months to other vaccines, coverage was lower for rotavirus at 12 months (84.7%) and varicella at 24 months (83.0%). Overall coverage at 24 months of age exceeded that at 12 months of age nationally and for most jurisdictions, but as receipt of varicella vaccine at 18 months is excluded from calculations, this represents delayed immunisation, with some contribution from immunisation incentives. The 'fully immunised' coverage estimates for immunisations due by 60 months increased substantially in 2009, reaching almost 90% in 2010, probably related to completed immunisation by 60 months of age being introduced in 2009 as a requirement for GP incentive payments. As previously documented, vaccines recommended for Indigenous children only (hepatitis A and pneumococcal polysaccharide vaccine) had suboptimal coverage at around 57%. Delayed receipt of vaccines by Indigenous children at the 60-month milestone age improved from 56% to 62% but the disparity in on-time vaccination between Indigenous and non-Indigenous children at earlier age milestones did not improve. Coverage data for human papillomavirus (HPV)from the national HPV register are consistent with high

  12. Towards Preserving Model Coverage and Structural Code Coverage

    Directory of Open Access Journals (Sweden)

    Raimund Kirner

    2009-01-01

    Full Text Available Embedded systems are often used in safety-critical environments. Thus, thorough testing of them is mandatory. To achieve a required structural code-coverage criteria it is beneficial to derive the test data at a higher program-representation level than machine code. Higher program-representation levels include, beside the source-code level, languages of domain-specific modeling environments with automatic code generation. For a testing framework with automatic generation of test data this will enable high retargetability of the framework. In this article we address the challenge of ensuring that the structural code coverage achieved at a higher program representation level is preserved during the code generations and code transformations down to machine code. We define the formal properties that have to be fullfilled by a code transformation to guarantee preservation of structural code coverage. Based on these properties we discuss how to preserve code coverage achieved at source-code level. Additionally, we discuss how structural code coverage at model level could be preserved. The results presented in this article are aimed toward the integration of support for preserving structural code coverage into compilers and code generators.

  13. Human resources for health and universal health coverage: fostering equity and effective coverage.

    Science.gov (United States)

    Campbell, James; Buchan, James; Cometto, Giorgio; David, Benedict; Dussault, Gilles; Fogstad, Helga; Fronteira, Inês; Lozano, Rafael; Nyonator, Frank; Pablos-Méndez, Ariel; Quain, Estelle E; Starrs, Ann; Tangcharoensathien, Viroj

    2013-11-01

    Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose.

  14. Expanding the universe of universal coverage: the population health argument for increasing coverage for immigrants.

    Science.gov (United States)

    Nandi, Arijit; Loue, Sana; Galea, Sandro

    2009-12-01

    As the US recession deepens, furthering the debate about healthcare reform is now even more important than ever. Few plans aimed at facilitating universal coverage make any mention of increasing access for uninsured non-citizens living in the US, many of whom are legally restricted from certain types of coverage. We conducted a critical review of the public health literature concerning the health status and access to health services among immigrant populations in the US. Using examples from infectious and chronic disease epidemiology, we argue that access to health services is at the intersection of the health of uninsured immigrants and the general population and that extending access to healthcare to all residents of the US, including undocumented immigrants, is beneficial from a population health perspective. Furthermore, from a health economics perspective, increasing access to care for immigrant populations may actually reduce net costs by increasing primary prevention and reducing the emphasis on emergency care for preventable conditions. It is unlikely that proposals for universal coverage will accomplish their objectives of improving population health and reducing social disparities in health if they do not address the substantial proportion of uninsured non-citizens living in the US.

  15. An equitable way to pay for universal coverage.

    Science.gov (United States)

    Rasell, E

    1999-01-01

    This article describes a way to finance universal health care coverage that preserves much of the current financing system and replaces funds obtained from regressive sources with revenue from more progressive ones. New funding would be needed for 24 percent of health expenditures and would be raised through an increase in the federal personal income tax. Premiums are eliminated since their cost is the same to everyone regardless of income. Cost sharing and out-of-pocket spending for medically necessary services are also abolished. In a more equitably financed system, employers would pay a new payroll tax that raised the same amount of money they currently spend for employee health insurance premiums; this would require a payroll tax of about 7 percent. Revenue from an increase in federal personal income taxes would replace household out-of-pocket expenditures for medically necessary services and payments for insurance premiums. For the average, middle-income family, the tax increase would total $731 in 1998. In exchange for the tax increase, no American or American employer would need to buy health insurance or face out-of-pocket charges for any medically indicated health care.

  16. [Coverage characterization of pre-natal in Maranhão State, Brazil].

    Science.gov (United States)

    Costa, Geny Rose Cardoso; Chein, Maria Bethânia da Costa; Gama, Mônica Elinor Alves; Coelho, Leidyane Silva Caldas; da Costa, Andreia Susana Vieira; Cunha, Carlos Leonardo Figueiredo; Brito, Luciane Maria Oliveira

    2010-01-01

    The purpose of the study was to characterize the coverage of prenatal care in the State of Maranhão. A population-based study, descriptive in 30 municipalities of the State of Maranhão, with 2075 women of childbearing age, with previous pregnancy, from July 2008 to Januray 2009. The results demonstrated that the units of family health accounted for 45.9% of the care of pregnant women and that 46.8% reported carrying out consultations six or more prenatal care during last pregnancy and 64.6% started prenatal in the first three months of pregnancy. The coverage of prenatal care, without regard to adequacy, was 85.6%, however, when considering the coverage of adequate prenatal as established by Brazilian Health Ministry was 43.4%. Although coverage of prenatal above 80%, less than half is considered adequate, showing a gap in primary care quality.

  17. Cross-cultural adaptation and reliability testing of the Tilburg Frailty Indicator for optimizing care of Polish patients with frailty syndrome

    Directory of Open Access Journals (Sweden)

    Uchmanowicz I

    2014-06-01

    Full Text Available Izabella Uchmanowicz,1 Beata Jankowska-Polańska,1 Maria Łoboz-Rudnicka,2 Stanislaw Manulik,3 Krystyna Łoboz-Grudzień,1,2 Robbert JJ Gobbens4 1Department of Clinical Nursing, Wroclaw Medical University, 2Department of Cardiology, T Marciniak Memorial Hospital, 3Primary Care Practice, Wroclaw, Poland; 4Research and Development Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands Background: Frail older people are at high risk of developing adverse outcomes, such as disability, mortality, hospitalization, and institutionalization. Previous research suggests that the Tilburg Frailty Indicator (TFI is a valid and reliable instrument for measuring frailty. The aim of this study was to adapt and to test the reliability of the Polish version of the TFI. Method: A standard guideline was used for translation and cultural adaptation of the English version of the TFI into Polish. The study included 100 Polish patients (mean age 68.2±6.5 years, among them 42 men and 58 women. Cronbach’s alpha was used for analysis of the internal consistency of the TFI. Results: The mean total TFI score was 6.7±3.1. Forty patients scored ≥5, which corresponded to being frail. Cronbach’s alpha reliability coefficients of the instrument ranged from 0.68 to 0.72 and item-total correlation ranged from 0.12 to 0.52. Conclusion: The TFI is valid and reproducible for assessment of frailty syndrome among a Polish population. The Polish adaptation of the TFI proved a useful and fast tool for assessing frailty. Keywords: internal consistency, validity, older individuals, aging

  18. Coverage, access, and affordability under health reform: learning from the Massachusetts model.

    Science.gov (United States)

    Long, Sharon K; Stockley, Karen; Nordahl, Kate Willrich

    While the impacts of the Affordable Care Act will vary across the states given their different circumstances, Massachusetts' 2006 reform initiative, the template for national reform, provides a preview of the potential gains in insurance coverage, access to and use of care, and health care affordability for the rest of the nation. Under reform, uninsurance in Massachusetts dropped by more than 50%, due, in part, to an increase in employer-sponsored coverage. Gains in health care access and affordability were widespread, including a 28% decline in unmet need for doctor care and a 38% decline in high out-of-pocket costs.

  19. Location Refinement and Power Coverage Analysis Based on Distributed Antenna

    Institute of Scientific and Technical Information of China (English)

    赵晓楠; 侯春萍; 汪清; 陈华; 浦亮洲

    2016-01-01

    To establish wireless channel suitable for the cabin environment, the power coverage was investigated with distributed antenna system and centralized antenna system based on the actual measurement of channel im-pulse response. The results indicated that the distributed antenna system has more uniform power coverage than the centralized antenna system. The average relative errors of receiving power of both antennas were calculated. The optimal position of the centralized antenna was obtained by Gaussian function refinement, making the system achieve a better transmission power with the same coverage effect, and providing a reference for antenna location in the future real communication in the cabin.

  20. Challenges for the German Health Care System.

    Science.gov (United States)

    Dietrich, C F; Riemer-Hommel, P

    2012-06-01

    The German Health Care System (GHCS) faces many challenges among which an aging population and economic problems are just a few. The GHCS traditionally emphasised equity, universal coverage, ready access, free choice, high numbers of providers and technological equipment; however, real competition among health-care providers and insurance companies is lacking. Mainly in response to demographic changes and economic challenges, health-care reforms have focused on cost containment and to a lesser degree also quality issues. In contrast, generational accounting, priorisation and rationing issues have thus far been completely neglected. The paper discusses three important areas of health care in Germany, namely the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improving measures as the variables of interest. Health Information Technology (HIT) has been identified as an important quality improvement tool. Health Indicators have been introduced as possible instruments for the priorisation debate.

  1. [Follow-up Care in the Field of Medical Rehabilitation Concerning Psychosomatic Indications Based on the New Conceptual Framework of the German Pension Insurance].

    Science.gov (United States)

    Boes, N

    2016-12-01

    Mental disorders rank first amongst all causes for disability pensions and second in the field of medical rehabilitation. Especially alarming is the significantly lower age of entry of the mentally ill disability pensioners, compared to those with other indications. Mentally ill people often look back at a long history of diseases before getting in contact with the German pension insurance. In this regard the German pension insurance, which is obligated to effectively support people in order to keep them in working life until reaching the regular retirement age, is facing a big challenge, which stands right next to further demands, due to the demographic change, the increase of chronic diseases, multimorbidity, retirement age of 67 and changes in the working environment.With their activities in the field of medical rehabilitation the German pension insurance is aiming at the reintegration of people whose working capacity is endangered or reduced into the labor force or to prevent them from leaving it early. One of the main challenges notably in the field of mental diseases is to keep the success of the medical rehabilitation long-lasting. In this regard the post-rehabilitation provisions of the German pension insurances offer support according to § 31 I 1 Nr. 1 Social Insurance Code VI, if so required.On January 1st, 2016 the German pension insurance has adopted a new conceptual framework in the field of post rehabilitation which is presented in the following article, covering the range of psychosomatic indications. The aim of the new conceptual framework, which has to be implemented within the next three years, is to establish a nationwide, uniformed and preferably comprehensive follow-up care concept, which can be referred to by everyone, regardless which agency of the German pension insurance is in charge.

  2. Coverage Related Issues in Networks

    CERN Document Server

    Dossena, Marida

    2011-01-01

    Wireless sensor networks consisting of great number of cheap and tiny sensor nodes which are used for military environment controlling, natural events recording, traffic monitoring, robot navigation, and etc. Such a networks encounter with various types of challenges like energy consumption, routing, coverage, reliability. The most significant types of these problems are coverage that originated from the nodes energy consumption constrained. In order to dominate this problem different kinds of methods has been presented where the majority of them based on theoretical methods and used unbalanced and calculated distributions. In all of the proposed methods a large numbers of nodes are used. In this paper our attempt is based on using a few numbers of sensors in order to cover the vast area of environment. We proposed an algorithm that divides the desired environment to several areas and in each of these areas by using the genetic algorithm improve the coverage. The proposed method is simulated in MATLAB softwar...

  3. Mediating Trust in Terrorism Coverage

    DEFF Research Database (Denmark)

    Mogensen, Kirsten

    crisis. While the framework is presented in the context of television coverage of a terror-related crisis situation, it can equally be used in connection with all other forms of mediated trust. Key words: National crisis, risk communication, crisis management, television coverage, mediated trust.......Mass mediated risk communication can contribute to perceptions of threats and fear of “others” and/or to perceptions of trust in fellow citizens and society to overcome problems. This paper outlines a cross-disciplinary holistic framework for research in mediated trust building during an acute...

  4. Immunisation coverage annual report, 2011.

    Science.gov (United States)

    Hull, Brynley P; Dey, Aditi; Menzies, Rob I; Brotherton, Julia M; McIntyre, Peter B

    2013-12-31

    This, the 5th annual immunisation coverage report, documents trends during 2011 for a range of standard measures derived from Australian Childhood Immunisation Register data, and National Human Papillomavirus (HPV) Vaccination Program Register data. The proportion of children 'fully vaccinated' at 12, 24 and 60 months of age was 91.4%, 92.2% and 89.5% respectively. Although pneumococcal vaccine had similar coverage at 12 months to other vaccines, coverage was lower for rotavirus at 12 months (83.8%) and varicella at 24 months (83.9%). By late 2011, the percentage of children who received the 1st dose of DTPa vaccine dose at less than 8 weeks of age was greater than 50% in 3 jurisdictions, the Australian Capital Territory, Victoria, and Queensland and at 70% for New South Wales and Tasmania. Although coverage at 12 months of age was lower among Indigenous children than non-Indigenous children in all jurisdictions, the extent of the difference varied. Overall, coverage at 24 months of age exceeded that at 12 months of age nationally. At 60 months of age, there was dramatic variation between individual jurisdictions, ranging from coverage 8% lower in Indigenous children in South Australia to 6% higher in the Northern Territory. As previously documented, vaccines recommended for Indigenous children only (hepatitis A and pneumococcal polysaccharide vaccine) had suboptimal coverage at 60% and 68%, respectively. On-time receipt (before 49 months of age) of vaccines by Indigenous children at the 60-month milestone age improved between 2010 (18%) and 2011 (19%) but the disparity in on-time vaccination between Indigenous and non-Indigenous children increased at all 3 age milestones. The percentage of vaccine objectors in 2011 (1.7%) has increased from 2007 when it was 1.1%. Coverage data for the 3rd dose of HPV from the national HPV register in the school catch up program was 71% but was substantially lower for the catch-up program for women outside school (39

  5. Politics and Universal Health Coverage--The Post-2015 Global Health Agenda.

    Science.gov (United States)

    Gupta, Vin; Kerry, Vanessa B; Goosby, Eric; Yates, Robert

    2015-09-24

    What political, social, and economic factors allow a movement toward universal health coverage to take hold in some low- and middle-income countries? Can we use that knowledge to help other such countries achieve health care for all?

  6. Cribado de retinopatía diabética mediante retinografía midriática en atención primaria Coverage and results of a screening program for diabetic retinopathy using mydriatic retinography in primary health care

    Directory of Open Access Journals (Sweden)

    Carmen Vargas-Sánchez

    2011-06-01

    Full Text Available OBJETIVOS: Conocer la cobertura de un programa de cribado de retinopatía diabética en atención primaria y la concordancia entre médicos de familia (MF y oftalmólogos. MATERIAL Y MÉTODOS: Estudio observacional transversal. Revisión de retinografías midriáticas de pacientes con diabetes mellitus tipo 2 (2007-2008 solicitadas por MF de tres centros de salud urbanos en Jaén,España. RESULTADOS: En total 296 retinografías (2007 y 380 (2008 (cobertura=26%±2.4.Retinografías patológicas: 181 MF (27%±1.3 y 59 (9%±0.3 oftalmólogos. Concordancia global moderada (kappa=0.408±0.039, que mejora del primer al segundo año (0.34 y 0.45; pOBJECTIVE: To identify the coverage of a diabetic retinopathy screening program in primary health care and to assess agreement between ophthalmologists and family physicians (FP regarding retinography evaluations of diabetic patients. MATERIALS AND METHODS: Cross-sectional observational study,with a review of diabetic patients' mydriatic retinographies (2007-2008 from three urban primary health centers (PHC(Jaén-Spain. RESULTS: A total of 296 retinographies in 2007 and 380 in 2008 (coverage=26%±2,4 were reviewed. Pathological retinographies were identified by 181 FPs (27%±1,3 and 59 (9%±0,3 ophthalmologists.Total agreement was moderate (kappa=0,408±0,039.Agreement was better in the latter year (0,45 vs 0,34; p<0,001 test χ2. FP evaluations showed 97% sensitivity,80% specificity,33% positive predictive value, 100% negative predictive value, 4, 88 positive likelihood ratio and 0,04 negative likelihood ratio. We find variability in coverage and agreement between PHC. CONCLUSIONS: Mydriatic retinographies performed and evaluated by FPs are useful to retinopathy screening of diabetic patients. Coverage, predictive values and likelihood ratio were better in the latter year, although the interpretation should be homogenized.

  7. Tetanus, diphtheria, pertussis vaccination coverage before, during, and after pregnancy - 16 States and New York City, 2011.

    Science.gov (United States)

    Ahluwalia, Indu B; Ding, Helen; D'Angelo, Denise; Shealy, Kristen H; Singleton, James A; Liang, Jennifer; Rosenberg, Kenneth D

    2015-05-22

    In June 2011, the Advisory Committee on Immunizations Practices (ACIP) recommended 1 dose of a tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during pregnancy for women who had not received Tdap previously. Before 2011, Tdap was recommended for unvaccinated women either before pregnancy or postpartum. In October 2012, ACIP expanded the 2011 recommendation, advising pregnant women to be vaccinated with Tdap during each pregnancy to provide maternal antibodies for each infant. The optimal time for vaccination is at 27-36 weeks' gestation as recommended by ACIP. In response to ACIP's Tdap recommendation for pregnant women in 2011, CDC added a supplemental question to the Pregnancy Risk Assessment Monitoring System (PRAMS) survey to determine women's Tdap vaccination status before, during, or after their most recent delivery. This report describes overall and state-specific Tdap vaccination coverage around the time of pregnancy using data from 6,852 sampled women who delivered a live-born infant during September-December 2011 in one of 16 states or New York City (NYC). Among the 17 jurisdictions, the median percentage of women with live births who reported any Tdap vaccination was 55.7%, ranging from 38.2% in NYC to 76.6% in Nebraska. The median percentage who received Tdap before pregnancy was 13.9% (range = 7.7%-20.1%), during pregnancy was 9.8% (range = 3.8%-14.2%), and after delivery was 30.9% (range = 13.6%-46.5%). The PRAMS data indicate a wide variation in Tdap vaccination coverage among demographic groups, with generally higher postpartum coverage for non-Hispanic white women, those who started prenatal care in the first trimester, and those who had private health insurance coverage. This information can be used for promoting evidence-based strategies to communicate the importance of ACIP guidelines related to Tdap vaccination coverage to women and their prenatal care providers.

  8. TEST COVERAGE ANALYSIS BASED ON PROGRAM SLICING

    Institute of Scientific and Technical Information of China (English)

    Chen Zhenqiang; Xu Baowen; Guanjie

    2003-01-01

    Coverage analysis is a structural testing technique that helps to eliminate gaps in atest suite and determines when to stop testing. To compute test coverage, this letter proposes anew concept coverage about variables, based on program slicing. By adding powers accordingto their importance, the users can focus on the important variables to obtain higher test coverage.The letter presents methods to compute basic coverage based on program structure graphs. Inmost cases, the coverage obtained in the letter is bigger than that obtained by a traditionalmeasure, because the coverage about a variable takes only the related codes into account.

  9. Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Dubourg, Dominique; Makokha, Anselimo

    2014-01-01

    in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The main outcome measures in the study were...

  10. Assessing the effect of increased managed care on hospitals.

    Science.gov (United States)

    Mowll, C A

    1998-01-01

    This study uses a new relative risk methodology developed by the author to assess and compare certain performance indicators to determine a hospital's relative degree of financial vulnerability, based on its location, to the effects of increased managed care market penetration. The study also compares nine financial measures to determine whether hospital in states with a high degree of managed-care market penetration experience lower levels of profitability, liquidity, debt service, and overall viability than hospitals in low managed care states. A Managed Care Relative Financial Risk Assessment methodology composed of nine measures of hospital financial and utilization performance is used to develop a high managed care state Composite Index and to determine the Relative Financial Risk and the Overall Risk Ratio for hospitals in a particular state. Additionally, financial performance of hospitals in the five highest managed care states is compared to hospitals in the five lowest states. While data from Colorado and Massachusetts indicates that hospital profitability diminishes as the level of managed care market penetration increases, the overall study results indicate that hospitals in high managed care states demonstrate a better cash position and higher profitability than hospitals in low managed care states. Hospitals in high managed care states are, however, more heavily indebted in relation to equity and have a weaker debt service coverage capacity. Moreover, the overall financial health and viability of hospitals in high managed care states is superior to that of hospitals in low managed care states.

  11. Universal health coverage: The way forward

    Directory of Open Access Journals (Sweden)

    Ashok Kumar Jindal

    2014-01-01

    Full Text Available Universal health coverage (UHC is the means to provide accessible and appropriate health services to all citizens without financial hardships. India, an emerging economy with demographic window of opportunity has been facing dual burden of diseases in midst of multiple transitions. Health situation in the country despite quantum improvements in recent past has enormous challenges with urban-rural and interstate differentials. Successful national programs exists, but lack ability to provide and sustain UHC. Achieving UHC require sustained mechanisms for health financing and to provide financial protection through national health packages. There is a need to ensure universal access to medicines, vaccines and emerging technologies along with development of Human Resources for Health (HRH. Health service, management, and institutional reforms are required along with enhanced focus on social determinants of health and citizen engagement. UHC is the way for providing health assurance and enlarging scope of primary health care to nook and corners of the country.

  12. Is Crime News Coverage Excessive?

    Science.gov (United States)

    Graber, Doris A.

    1979-01-01

    Reports on the frequency and manner in which various crime and noncrime news topics were presented in selected newspapers and television newscasts in 1976. Examines news flow data to determine whether news output was inflexible, and whether crime news coverage distorted the amount of real-life crime. (PD)

  13. State discretion over Medicaid coverage for mental health and addiction services.

    Science.gov (United States)

    Burns, Marguerite E

    2015-03-01

    Approximately one-third of adults who enroll in Medicaid because of a disability have a serious mental illness. Arguably, this population stands to benefit from insurance coverage that complies with the Mental Health Parity and Addiction Equity Act (MHPAEA). The MHPAEA and the Affordable Care Act (ACA) do not guarantee such coverage for this beneficiary group; however, they provide a variety of mechanisms by which states may provide parity-compliant coverage for mental health and substance use disorder treatment. This column explains key interactions between the MHPAEA, the ACA, and the Medicaid program that permit states to determine whether and how to provide parity-consistent coverage to beneficiaries with disabilities.

  14. Estudo das condições de saúde das crianças do Município de São Paulo (Brasil, 1984/1985: IX - Cobertura e qualidade da assistência materno-infantil A study of children's health in S. Paulo city (Brazil, 1984/1985: IX - Coverage and quality of maternal and child care

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Monteiro

    1988-06-01

    características relacionadas à qualidade da assistência, sendo imprescindível, sobretudo nos estratos populacionais de pior nível sócio-econômico, elevar a cobertura da assistência pré-natal precoce e a cobertura de puericultura após o primeiro ano de vida. Um item especialmente preocupante relacionado à assistência ao parto foi a alta incidência de cesareanas, uma das maiores já registrada em uma população.A survey of 1,016 randomly selected children under five years of age was carried out in S. Paulo city, Brazil, with a view to studying the epidemiology of health conditions. The quality and the coverage of maternal and child care were observed. Both characteristics were estimated by means of domiciliary interviews. The prenatal care coverage was 92.9%. In 70% of the cases prenatal care started in the first quarter of pregnancy and the number of visits was 6 or more. Ninety-nine percent of the children were born in hospitals and in 47.1% of the cases caesarean section was mentioned. Ninety-eight percent of the children went, at least once, to well-baby clinics, about two thirds of them during the first two months of life. With regard to the activities provided by those clinics, a great concentration of visits in the first year of life (averaging 7.7 visits per child was observed as well as a high percentage of immunized children (Sabin 86.7%, DPT 85.1%, BCG 89.0%, Measles 85.9%, a striking decrease of visits after 12 months of age and a very small proportion of children attended by an odontology specialist (19.5%. Considering the global coverage of maternal and infant care, minimal differences were observed between socioeconomic strata. Nevertheless the differences were impressive when qualitative aspects of the care were taken into account. Compared with other surveys made in Brazil, the present one shows that the situation of S. Paulo city is better than that of other urban areas of the country. It was also observed that there has been an increase in

  15. A Localized Coverage Preserving Protocol for Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Yuheng Liu

    2009-01-01

    Full Text Available In a randomly deployed and large scale wireless sensor network, coverage-redundant nodes consume much unnecessary energy. As a result, turning off these redundant nodes can prolong the network lifetime, while maintaining the degree of sensing coverage with a limited number of on-duty nodes. None of the off-duty eligibility rules in the literature, however, are sufficient and necessary conditions for eligible nodes. Hence redundancy or blind points might be incurred. In this paper we propose a complete Eligibility Rule based on Perimeter Coverage (ERPC for a node to determine its eligibility for sleeping. ERPC has a computational complexity of O(N2log(N, lower than the eligibility rule in the Coverage Control Protocol (CCP, O(N3, where N is the number of neighboring nodes. We then present a Coverage Preserving Protocol (CPP to schedule the work state of eligible nodes. The main advantage of CPP over the Ottawa protocol lies in its ability to configure the network to any specific coverage degree, while the Ottawa protocol does not support different coverage configuration. Moreover, as a localized protocol, CPP has better adaptability to dynamic topologies than centralized protocols. Simulation results indicate that CPP can preserve network coverage with fewer active nodes than the Ottawa protocol. In addition, CPP is capable of identifying all the eligible nodes exactly while the CCP protocol might result in blind points due to error decisions. Quantitative analysis and experiments demonstrate that CPP can extend the network lifetime significantly while maintaining a given coverage degree.

  16. Universal coverage in the United States: lessons from experience of the 20th century.

    Science.gov (United States)

    Davis, K

    2001-03-01

    Both the rising numbers of uninsured Americans and the recent presidential election have put the issue of universal health insurance coverage back on the national agenda. Lack of health insurance is a major barrier to care for 44 million Americans, and lack of high-quality, comprehensive insurance is a barrier to millions more. Universal coverage is one of the best ways to ensure that all Americans have equitable access to quality care, and it also contributes to the financial stability of health care providers, especially those in the urban safety net. A wide variety of ideas to expand health care coverage were proposed, and in some cases enacted, during the last century. At the beginning of the 21st century, the American health care system is made up of varied elements, ranging from employer-sponsored health insurance for the majority of working-age adults to the public Medicare program for the elderly. While this patchwork system leaves many Americans without health insurance, it also creates many different ways to expand coverage, including various options in both the private and public sectors. By understanding how the current health care system developed, how the various proposals for universal health coverage gained and lost political and public support, and the pros and cons of the various alternatives available to expand coverage, we create a solid base from which to solve the problem of the uninsured in the 21st century.

  17. Coverage of cervical cancer screening in Catalonia for the period 2008-2011 among immigrants and Spanish-born women.

    Directory of Open Access Journals (Sweden)

    Vanesa eRodriguez-Sales

    2013-12-01

    Full Text Available Background: The Public Health system in Catalonia, Spain provides a free of charge opportunistic cervical cancer screening. In June 2006 a revised recommendations for cervical cancer screening was introduced to increase coverage and to promote a three-year interval between screening tests. Aim: This study examines cervical cancer screening coverage and prevalence of cytology abnormalities in Catalonia by immigration status.Methods: The study analyses the cytologies registered among women aged 25-65 that have been attended at the Primary Health Centers (PHC for any reason (n=1,242,105 during 2008-11. Coverage was estimated from Governmental data base Information System Primary Care (SISAP that includes 77% of PHC. The database is anonymous, and includes information on age, country of birth, diagnostic center and cytology results Results: During the period 2008-2011, 758,690 smears were performed in a total of 595,868 women over 14 years, of whom 18.3% were immigrants. Cytology coverage was higher among immigrant women compared to Spanish born (51.2% and 39% respectively. Immigrant women also had a higher prevalence of abnormal Paps compared to the Spanish population, 4.9% and 3.3% respectively.Conclusion: Immigrant women in Catalonia have a good access to the Public Health Services and to cervical cancer screening facilities. The higher prevalence of abnormal cytologies in immigrant women compared to native women indicates the relevance to prioritize cervical cancer screening activities on a regular base in new comers.

  18. -Net Approach to Sensor -Coverage

    Directory of Open Access Journals (Sweden)

    Fusco Giordano

    2010-01-01

    Full Text Available Wireless sensors rely on battery power, and in many applications it is difficult or prohibitive to replace them. Hence, in order to prolongate the system's lifetime, some sensors can be kept inactive while others perform all the tasks. In this paper, we study the -coverage problem of activating the minimum number of sensors to ensure that every point in the area is covered by at least sensors. This ensures higher fault tolerance, robustness, and improves many operations, among which position detection and intrusion detection. The -coverage problem is trivially NP-complete, and hence we can only provide approximation algorithms. In this paper, we present an algorithm based on an extension of the classical -net technique. This method gives an -approximation, where is the number of sensors in an optimal solution. We do not make any particular assumption on the shape of the areas covered by each sensor, besides that they must be closed, connected, and without holes.

  19. A influência da mídia nos atendimentos cardiológicos de urgência: o caso Bussunda Impact of media coverage on cardiac emergency care: the Bussunda case

    Directory of Open Access Journals (Sweden)

    Juliana Sobreira Taberner

    2007-08-01

    . OBJECTIVE: To analyze the impact of this media coverage on the emergency service at a Heart Hospital in Brazil (InCor. METHODS: Demographic profiles of patients collected from the InCor's database were analyzed in the days following the death of an important TV personality (Group B. These patients were compared to a Control Group represented by those attended during the first semester of 2006. RESULTS: When compared to the Control Group, Group B disclosed the following significant statistical changes: patients were younger and more of them were male. These findings reflect a change of profile in the control group tending to a greater similarity with the characteristics of the TV personality (man, 43 years old. These changes remained significant for four days (age and one day (gender. Furthermore, the greater demand for the cardiologic emergency service was not followed by an increased number of deaths and hospitalizations for acute myocardial infarction. CONCLUSION: Media exposure on the circumstances of premature death by myocardial infarction of an important TV personality was associated with an increase in the number and a change in the profile of the patients seeking the emergency room at the InCor Heart Hospital. Differently from a situation such as catastrophes, this phenomenon was not followed by an increase in the incidence of myocardial infarction

  20. Coverage of abortion controversial in both public and private plans.

    Science.gov (United States)

    Sollom, T

    1996-09-01

    During 1995-96, 17 of 50 US states used their own resources, either voluntarily or under state court order, to pay for all or most abortions for low-income women. Alaska, Maryland, New York, and Washington are the only states to voluntarily pay for these abortions. Anti-choice legislators in California, Illinois, New York, and West Virginia tried unsuccessfully to cut funding for these abortions. Arkansas is the only state to circumvent direct payment for abortions for low-income women. Alabama, Mississippi, and South Dakota still are not complying with the court order but remain in the Medicaid program. Massachusetts has passed legislation to allow health insurance to cover abortions for state and city employees, thereby undoing a 17-year ban on the use of public funds for abortions for employees or their spouses. On the other hand, Virginia's governor has unilaterally, via an executive order, eliminated health insurance coverage for most abortions for state employees and their dependents. Anti-choice legislators have shepherded legislation that prohibit private insurance coverage for abortion unless women pay an extra premium in Idaho, Kentucky, Missouri, and North Dakota. Legislators in Illinois and Minnesota have passed state subsidized health care reform programs that exclude abortion from coverage except when the mother's life is endangered. There appears to be a loophole in the MinnesotaCare program that allows women to obtain state-financed abortions for other reasons, so antifunding lawmakers will introduce a bill in 1997 to close the loophole. The loophole is a result of a conflict between state and federal laws as a result of a 1995 federal waiver granted to Minnesota. The waiver allows pregnant women who earn up to 275% of the federal poverty level to be eligible for either MinnesotaCare or Medicaid. Abortion-rights legislators find MinnesotaCare's exclusion of abortion coverage to be a violation of the court order. They plan to submit a bill in 1997 to

  1. The development of the Quality Indicator for Rehabilitative Care (QuIRC: a measure of best practice for facilities for people with longer term mental health problems

    Directory of Open Access Journals (Sweden)

    Visser Ellen

    2011-03-01

    Full Text Available Abstract Background Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and community based mental health units, including the degree to which human rights, social inclusion and autonomy are promoted. Method The domains of care included in the toolkit were identified from a systematic literature review, international expert Delphi exercise, and review of care standards in ten European countries. The draft toolkit comprised 154 questions for unit managers. Inter-rater reliability was tested in 202 units across ten countries at different stages of deinstitutionalisation and development of community mental health services. Exploratory factor analysis was used to corroborate the allocation of items to domains. Feedback from those using the toolkit was collected about its usefulness and ease of completion. Results The toolkit had excellent inter-rater reliability and few items with narrow spread of response. Unit managers found the content highly relevant and were able to complete it in around 90 minutes. Minimal refinement was required and the final version comprised 145 questions assessing seven domains of care. Conclusions Triangulation of qualitative and quantitative evidence directed the development of a robust and comprehensive international quality assessment toolkit for units in highly variable socioeconomic and political contexts.

  2. Assessing Measurement Error in Medicare Coverage

    Data.gov (United States)

    U.S. Department of Health & Human Services — Assessing Measurement Error in Medicare Coverage From the National Health Interview Survey Using linked administrative data, to validate Medicare coverage estimates...

  3. Bundled automobile insurance coverage and accidents.

    Science.gov (United States)

    Li, Chu-Shiu; Liu, Chwen-Chi; Peng, Sheng-Chang

    2013-01-01

    This paper investigates the characteristics of automobile accidents by taking into account two types of automobile insurance coverage: comprehensive vehicle physical damage insurance and voluntary third-party liability insurance. By using a unique data set in the Taiwanese automobile insurance market, we explore the bundled automobile insurance coverage and the occurrence of claims. It is shown that vehicle physical damage insurance is the major automobile coverage and affects the decision to purchase voluntary liability insurance coverage as a complement. Moreover, policyholders with high vehicle physical damage insurance coverage have a significantly higher probability of filing vehicle damage claims, and if they additionally purchase low voluntary liability insurance coverage, their accident claims probability is higher than those who purchase high voluntary liability insurance coverage. Our empirical results reveal that additional automobile insurance coverage information can capture more driver characteristics and driving behaviors to provide useful information for insurers' underwriting policies and to help analyze the occurrence of automobile accidents.

  4. Research on influenza A (H1N1)vaccine coverage and influential factors among health-care workers in the Bao'an District, City of Shenzhen%深圳市宝安区医务人员甲型H1N1流感疫苗接种率及影响因素研究

    Institute of Scientific and Technical Information of China (English)

    李苑; 刘开钳; 于宝柱; 吴泰顺; 马智超

    2011-01-01

    目的 了解深圳市宝安区医务人员甲型H1N1流感疫苗接种率及其影响因素.方法 在宝安区区级医院、街道医院以及所辖社区健康服务中心中随机抽取770名医务人员作为调查对象,进行不记名问卷调查.采用卡方检验和Logistic回归分析分别对疫苗接种率的影响因素进行单因素和多因素分析.结果 宝安区医务人员甲型H1N1流感疫苗接种率为55.03%,未接种的主要原因是担心出现疫苗不良反应,占39.10%.影响疫苗接种率的因素分别为高文化程度(大专:OR=0.462,95%CI 0.269~0.794;大学及以上:OR=0.250,95%CI 0.140~0.446)、医疗岗位为护士(OR=0.392,95%CI 0.228~0.675)、工作年限≤5年(OR=0.303,95%CI 0.197~0.465)、知道甲流疫苗接种时间(OR=1.413,95%CI 1.022~1.953)和近3年接种过季节性流感疫苗(OR=3.822,95%CI 2.634~5.544)等.结论 宝安区医务人员甲流疫苗接种率较高,但仍需加强甲流疫苗有效性和安全性宣传,重点为大专以上文化程度、护士、工作年限小于5年、不知道甲流接种时间和近3年无季节性流感疫苗接种史等人群.%Objective To study influenza A (H1N1) vaccine coverage and influenitial factors among health-care workers in the Bao'an District, City of Shenzhen.Methods A random sample of 770 health-care workers from Bao'an District was sampled, Workers at township hospitals and community health service centers responded to an anonymous questionnaire.The x2 test and logistic regression analysis were used in univariate analysis and multivariate analysis to evaluate factors influencing vaccine coverage.Results Influenza A (H1N1) vaccine coverage of health-care workers in Bao'an District was 55.03%.The main reason for not being vaccinated, which was given by 39.10% of respondents, concerned side effects.The factors influencing vaccine coverage were level of education (junior college: OR= 0.462, 95 % CI= 0.269-0.794; college or higher: OR=0.250, 95

  5. The development of the Quality Indicator for Rehabilitative Care (QuIRC) : a measure of best practice for facilities for people with longer term mental health problems

    NARCIS (Netherlands)

    Killaspy, Helen; White, Sarah; Wright, Christine; Taylor, Tatiana L.; Turton, Penny; Schuetzwohl, Matthias; Schuster, Mirjam; Cervilla, Jorge A.; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Adamowski, Tomasz; Ploumpidis, Dimitri; Gonidakis, Fragiskos; Caldas-de-Almeida, Jose; Cardoso, Graca; King, Michael B.

    2011-01-01

    Background: Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at

  6. Assessment of the quality of fall detection and management in primary care in the Netherlands based on the ACOVE quality indicators

    OpenAIRE

    Askari, M.; Eslami, S.; van Rijn, M.; Medlock, S.; Moll van Charante, E. P.; van der Velde, N.; Rooij, S.E. de; Abu-Hanna, A.

    2016-01-01

    Summary We determined adherence to nine fall-related ACOVE quality indicators to investigate the quality of management of falls in the elderly population by general practitioners in the Netherlands. Our findings demonstrate overall low adherence to these indicators, possibly indicating insufficiency in the quality of fall management. Most indicators showed a positive association between increased risk for functional decline and adherence, four of which with statistical significance. Introduct...

  7. Assessment of the quality of fall detection and management in primary care in the Netherlands based on the ACOVE quality indicators

    NARCIS (Netherlands)

    Askari, M; Eslami, S; van Rijn, M; Medlock, S; Moll van Charante, E P; van der Velde, N; de Rooij, S E; Abu-Hanna, A

    2016-01-01

    UNLABELLED: We determined adherence to nine fall-related ACOVE quality indicators to investigate the quality of management of falls in the elderly population by general practitioners in the Netherlands. Our findings demonstrate overall low adherence to these indicators, possibly indicating insuffici

  8. Quality along the continuum: a health facility assessment of intrapartum and postnatal care in Ghana.

    Directory of Open Access Journals (Sweden)

    Robin C Nesbitt

    Full Text Available To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate "effective coverage" of skilled attendance in Brong Ahafo, Ghana.We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC, emergency newborn care (EmNC and non-medical quality. Linking the health facility assessment to surveillance data we estimated "effective coverage" of skilled attendance as the proportion of births in facilities of high quality.Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as "low" or "substandard" for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was "low" or "substandard" in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with "high" or "highest" quality in all dimensions.Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated "effective coverage" of skilled attendance at 18%, thus revealing a large "quality gap." Effective coverage could be a meaningful indicator of progress towards

  9. Clinical coverage of an archetype repository over SNOMED-CT.

    Science.gov (United States)

    Yu, Sheng; Berry, Damon; Bisbal, Jesus

    2012-06-01

    Clinical archetypes provide a means for health professionals to design what should be communicated as part of an Electronic Health Record (EHR). An ever-growing number of archetype definitions follow this health information modelling approach, and this international archetype resource will eventually cover a large number of clinical concepts. On the other hand, clinical terminology systems that can be referenced by archetypes also have a wide coverage over many types of health-care information. No existing work measures the clinical content coverage of archetypes using terminology systems as a metric. Archetype authors require guidance to identify under-covered clinical areas that may need to be the focus of further modelling effort according to this paradigm. This paper develops a first map of SNOMED-CT concepts covered by archetypes in a repository by creating a so-called terminological Shadow. This is achieved by mapping appropriate SNOMED-CT concepts from all nodes that contain archetype terms, finding the top two category levels of the mapped concepts in the SNOMED-CT hierarchy, and calculating the coverage of each category. A quantitative study of the results compares the coverage of different categories to identify relatively under-covered as well as well-covered areas. The results show that the coverage of the well-known National Health Service (NHS) Connecting for Health (CfH) archetype repository on all categories of SNOMED-CT is not equally balanced. Categories worth investigating emerged at different points on the coverage spectrum, including well-covered categories such as Attributes, Qualifier value, under-covered categories such as Microorganism, Kingdom animalia, and categories that are not covered at all such as Cardiovascular drug (product).

  10. Minimum essential coverage and other rules regarding the shared responsibility payment for individuals. Final regulations.

    Science.gov (United States)

    2014-11-26

    This document contains final regulations relating to the requirement to maintain minimum essential coverage enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the TRICARE Affirmation Act and Public Law 111-173 (collectively, the Affordable Care Act). These final regulations provide individual taxpayers with guidance under section 5000A of the Internal Revenue Code on the requirement to maintain minimum essential coverage and rules governing certain types of exemptions from that requirement.

  11. Effective coverage and systems effectiveness for malaria case management in sub-Saharan African countries.

    Directory of Open Access Journals (Sweden)

    Katya Galactionova

    Full Text Available Scale-up of malaria preventive and control interventions over the last decade resulted in substantial declines in mortality and morbidity from the disease in sub-Saharan Africa and many other parts of the world. Sustaining these gains will depend on the health system performance. Treatment provides individual benefits by curing infection and preventing progression to severe disease as well as community-level benefits by reducing the infectious reservoir and averting emergence and spread of drug resistance. However many patients with malaria do not access care, providers do not comply with treatment guidelines, and hence, patients do not necessarily receive the correct regimen. Even when the correct regimen is administered some patients will not adhere and others will be treated with counterfeit or substandard medication leading to treatment failures and spread of drug resistance. We apply systems effectiveness concepts that explicitly consider implications of health system factors such as treatment seeking, provider compliance, adherence, and quality of medication to estimate treatment outcomes for malaria case management. We compile data for these indicators to derive estimates of effective coverage for 43 high-burden Sub-Saharan African countries. Parameters are populated from the Demographic and Health Surveys and other published sources. We assess the relative importance of these factors on the level of effective coverage and consider variation in these health systems indicators across countries. Our findings suggest that effective coverage for malaria case management ranges from 8% to 72% in the region. Different factors account for health system inefficiencies in different countries. Significant losses in effectiveness of treatment are estimated in all countries. The patterns of inter-country variation suggest that these are system failures that are amenable to change. Identifying the reasons for the poor health system performance and

  12. 深圳市宝安区托幼机构人员甲型H1N1流感疫苗接种率及其影响因素%Vaccination Coverage of Influenza A (H1N1) and the Influential Factors Among Child-care Staff in Bao'an District of Shenzhen City

    Institute of Scientific and Technical Information of China (English)

    周海庄; 李苑; 刘开钳; 吴泰顺; 马智超

    2012-01-01

    Objective To understand the vaccination coverage of influenza A (H1N1) and the its influential factors among child - care staff in Bao'an district of Shenzhen. Methods A survey of random sampling was carried out for 530 health - care workers from 100 kindergartens with anonymous questionnaire. Descriptive statistical analysis, Rank sum test, x2 test and Logistic regression analysis were used for univariate analysis and multiva-riate analysis to evaluate influential factors of vaccine coverage. Results The vaccination coverage rate of influenza A ( H1N1 ) in child - care staff in Bao'an district of Shenzhen was 39. 96%% , the main reason for un - inoculation was concerning about side effects. The multivariate analysis showed that the sex [ male, odds ratio (OR) = 3.193, 95% confidence interval (CI) - 1. 285 - 7. 936 ] , being sanitarian and nursery governess (sanitarian, OR = 12.583, 95% CI = 2.825 - 56.082; nursery governess, OR = 7.581, 95% CI = 1. 881 - 30. 554) , length of service (11 -15, OR =6. 299, 95% CI = 1. 169-33. 945) and with a seasonal influenza vaccination in the past three years (vaccinated, OR =8. 856, 95% CI =4. 139 - 18. 703; obscurity, OR = 4. 322, 95% CI = 1. 588 - 11. 766) were correlated with influenza A ( H1N1) vaccination (P < 0. 05 ). Conclusion The child - care staff in Bao'an had high vaccination coverage of influenza A ( H1N1). It is important to strengthen the propaganda of the effectiveness and security of influenza A (H1N1) vaccine, especially to women, being teacher, people who have length of service less than five years and without the history of seasonal influenza vaccination in the past three years.%目的 了解深圳市宝安区托幼机构人员甲型H1N1流行性感冒(甲流)疫苗接种率及其影响因素.方法 随机抽取深圳市宝安区100家托幼机构530人作为面访匿名问卷调查对象.采用描述性分析、秩和检验、x 2检验和Logistic回归分析分别对疫苗接种率的影响因素进行单

  13. Vaccination coverage among persons with asthma -- United States, 2010-2011 influenza season.

    Science.gov (United States)

    2013-12-01

    Asthma was the most common underlying condition among persons hospitalized with pandemic influenza A (H1N1) virus infection in 2009. Although persons with asthma are not more likely than others to get influenza, influenza can make asthma symptoms worse, trigger asthma attacks, and lead to pneumonia or other complications that result in hospitalization and even death. During 1964-2010, the Advisory Committee on Immunization Practices (ACIP) recommended that all adults and children aged ≥6 months with asthma receive an influenza vaccination annually. Beginning with the 2010-11 influenza season, ACIP expanded its annual vaccination recommendation to include all persons aged ≥6 months, while emphasizing that protection of persons at higher risk for influenza-related complications continue as a focus of vaccination efforts. To provide the first update of national vaccination coverage among persons aged ≥2 years with asthma since the new ACIP recommendation, CDC analyzed data from the 2010 and 2011 National Health Interview Survey (NHIS). This report describes the results of that analysis, which indicated that influenza vaccination during the 2010-11 season among persons with asthma was 50%, up from 36% 5 years earlier. However, vaccination coverage across all age groups, including among those with health insurance, a usual place for health care, and one or more health-care visits in the past 12 months, remained well below Healthy People 2020 targets of 80% for children aged 6 months-17 years and 90% for adults aged ≥18 years who are at high risk. These findings highlight the need to educate health-care providers and persons with asthma about the importance of annual influenza vaccination.

  14. Feedback-Based Coverage Directed Test Generation: An Industrial Evaluation

    Science.gov (United States)

    Ioannides, Charalambos; Barrett, Geoff; Eder, Kerstin

    Although there are quite a few approaches to Coverage Directed test Generation aided by Machine Learning which have been applied successfully to small and medium size digital designs, it is not clear how they would scale on more elaborate industrial-level designs. This paper evaluates one of these techniques, called MicroGP, on a fully fledged industrial design. The results indicate relative success evidenced by a good level of code coverage achieved with reasonably compact tests when compared to traditional test generation approaches. However, there is scope for improvement especially with respect to the diversity of the tests evolved.

  15. Television coverage of mental illness in Canada: 2013-2015.

    Science.gov (United States)

    Whitley, Rob; Wang, JiaWei

    2017-02-01

    The aim of this study is to assess television news coverage of mental illness in Canadian media, including change over time. Data consist of news clips mentioning terms including 'mental illness' (N = 579). These were systematically collected and coded over 3 years (2013-2015) using a media retrieval software. Trend analysis indicated a significant linear increase for positively oriented coverage. In 2013, less than 10% of clips had a positive overall tone, whereas in 2015, this figure reached over 40%. Articles linking mental illness to violence significantly decreased, though these remain over 50%. Improvement may be due to educational initiatives targeted at journalists.

  16. Putting the 'care' back into aged care.

    Science.gov (United States)

    Beadnell, Cathy

    2006-04-01

    Aged care is well and truly back on the political agenda in Australia. While the mainstream media has recently exposed a number of horrific cases of alleged abuse in aged care facilities it has done little to highlight the failings of social policy over time or to foster debate on how to improve the care of older Australians. What are the barriers to providing safe and quality aged care to a growing number of our citizens and how do we overcome them? If you relied on the recent media coverage for your impression of aged care you could be forgiven for thinking it is all bad news. But there are facilities providing high quality care and stories of nurses working wonders in the face of adversity. Cathy Beadnell considers some of the broader cultural and workforce issues in aged care.

  17. Is Distance to Provider a Barrier to Care for Medicaid Patients with Breast, Colorectal, or Lung Cancer?

    Science.gov (United States)

    Scoggins, John F.; Fedorenko, Catherine R.; Donahue, Sara M. A.; Buchwald, Dedra; Blough, David K.; Ramsey, Scott D.

    2012-01-01

    Purpose: Distance to provider might be an important barrier to timely diagnosis and treatment for cancer patients who qualify for Medicaid coverage. Whether driving time or driving distance is a better indicator of travel burden is also of interest. Methods: Driving distances and times from patient residence to primary care provider were…

  18. [EEG bispectral index as an indicator of the electrical activity of the central nervous system in children during anesthetic maintenance and intensive care].

    Science.gov (United States)

    Lazarev, V V; Subbotin, V V

    2009-01-01

    The paper presents different investigators' data on the use of the bispectral (BIS) index in children during anesthetic maintenance and intensive care. The most of publications deal with the use of the BIS index during anesthesia with sevoflurane, which shows its high efficiency in estimating the depth of sleep. There are positive aspects in the use of the BIS index in the evaluation of sedative tolerance and central nervous system function, when brain death is diagnosed, cerebral oxygenation adequateness, etc. Data are given on the ambiguity of BIS index values in infants less than a year of age.

  19. [Transforming health systems based on primary care].

    Science.gov (United States)

    Durán-Arenas, Luis; Salinas-Escudero, Guillermo; Granados-García, Víctor; Martínez-Valverde, Silvia

    2012-01-01

    Access to health services is a social basic determinant of health in Mexico unlike what happens in developed countries. The demand for health services is focused on primary care, but the design meets only the supply of hospital care services. So it generates a dissonance between the needs and the effective design of health services. In addition, the term affiliation refers to population contributing or in the recruitment process, that has been counted as members of these social security institutions (SS) and Popular Insurance (SP). In the case of Instituto Mexicano del Seguro Social (IMSS) three of four contributors are in contact with health services; while in the SP, this indicator does not exist. Moreover, the access gap between health services is found in the health care packages so that members of the SS and SP do not have same type of coverage. The question is: which model of health care system want the Mexicans? Primary care represents the first choice for increasing the health systems performance, as well as to fulfill their function of social protection: universal access and coverage based on needs, regardless whether it is a public or private health insurance. A central aspect for development of this component is the definition of the first contact with the health system through the creation of a primary health care team, led by a general practitioner as the responsible of a multidisciplinary health team. The process addresses the concepts of primary care nursing, consumption of inputs (mainly medical drugs), maintenance and general services. Adopting a comprehensive strategy that will benefit all Mexicans equally and without discrimination, this primary care system could be financed with a total operating cost of approximately $ 22,809 million by year.

  20. Operationalizing universal health coverage in Nigeria through social health insurance

    Directory of Open Access Journals (Sweden)

    Arnold Ikedichi Okpani

    2015-01-01

    Full Text Available Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC. One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper, we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria's federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC, it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme.

  1. Analysis of k-Coverage in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Rasmi Ranjan Patra

    2011-09-01

    Full Text Available Recently, a concept of wireless sensor networks has attracted much attention due to its wide-range of potential applications. Wireless sensor networks also pose a number of challenging optimization problems. One of the fundamental problems in sensor networks is the coverage problem, which reflects the quality of service that can be provided by a particular sensor network. The coverage concept is depending from several points of view due to a variety of sensors and a wide-range of their applications. One fundamental issue in sensor networks is the coverage problem, which reflects how well a sensor network is monitored or tracked by sensors. In this paper, we formulate this problem as a decision problem, whose goal is to determine the degree of coverage of a sensor network, which is covered by at least k sensors, where k is a predefined value. The sensing ranges of sensors can be same or different. Performance evaluation of our protocol indicates that degree of coverage of wireless sensor networks can be determined within small period of time. Therefore energy consumption of the sensor networks can be minimized.

  2. 77 FR 8725 - Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under...

    Science.gov (United States)

    2012-02-15

    ... Health Resources and Services Administration (HRSA) that were issued on August 1, 2011 (HRSA Guidelines... Contraceptives and the Impact of Contraceptive Coverage Mandates, Perspectives on Sexual and Reproductive Health..., preventive care and screenings provided for in binding comprehensive health plan coverage...

  3. Sideline coverage of youth football.

    Science.gov (United States)

    Rizzone, Katie; Diamond, Alex; Gregory, Andrew

    2013-01-01

    Youth football is a popular sport in the United States and has been for some time. There are currently more than 3 million participants in youth football leagues according to USA Football. While the number of participants and overall injuries may be higher in other sports, football has a higher rate of injuries. Most youth sporting events do not have medical personnel on the sidelines in event of an injury or emergency. Therefore it is necessary for youth sports coaches to undergo basic medical training in order to effectively act in these situations. In addition, an argument could be made that appropriate medical personnel should be on the sideline for collision sports at all levels, from youth to professional. This article will discuss issues pertinent to sideline coverage of youth football, including coaching education, sideline personnel, emergency action plans, age and size divisions, tackle versus flag football, and injury prevention.

  4. Collaborative Mobile Charging and Coverage

    Institute of Scientific and Technical Information of China (English)

    吴杰

    2014-01-01

    Wireless energy charging using mobile vehicles has been a viable research topic recently in the area of wireless networks and mobile computing. This paper gives a short survey of recent research conducted in our research group in the area of collaborative mobile charging. In collaborative mobile charging, multiple mobile chargers work together to accomplish a given set of ob jectives. These ob jectives include charging sensors at different frequencies with a minimum number of mobile chargers and reaching the farthest sensor for a given set of mobile chargers, subject to various constraints, including speed and energy limits of mobile chargers. Through the process of problem formulation, solution construction, and future work extension for problems related to collaborative mobile charging and coverage, we present three principles for good practice in conducting research. These principles can potentially be used for assisting graduate students in selecting a research problem for a term project, which can eventually be expanded to a thesis/dissertation topic.

  5. Activity Monitoring and Heart Rate Variability as Indicators of Fall Risk: Proof-of-Concept for Application of Wearable Sensors in the Acute Care Setting.

    Science.gov (United States)

    Razjouyan, Javad; Grewal, Gurtej Singh; Rishel, Cindy; Parthasarathy, Sairam; Mohler, Jane; Najafi, Bijan

    2017-03-02

    Growing concern for falls in acute care settings could be addressed with objective evaluation of fall risk. The current proof-of-concept study evaluated the feasibility of using a chest-worn sensor during hospitalization to determine fall risk. Physical activity and heart rate variability (HRV) of 31 volunteers admitted to a 29-bed adult inpatient unit were recorded using a single chest-worn sensor. Sensor data during the first 24-hour recording were analyzed. Participants were stratified using the Hendrich II fall risk assessment into high and low fall risk groups. Univariate analysis revealed age, daytime activity, nighttime side lying posture, and HRV were significantly different between groups. Results suggest feasibility of wearable technology to consciously monitor physical activity, sleep postures, and HRV as potential markers of fall risk in the acute care setting. Further study is warranted to confirm the results and examine the efficacy of the proposed wearable technology to manage falls in hospitals. [Journal of Gerontological Nursing, xx(x), xx-xx.].

  6. 上海市松江区《全覆盖孕产期系统保健管理》项目效果评估%Effect evaluation of "complete coverage system health care management during pregnant period" project in Songjiang district in Shanghai

    Institute of Scientific and Technical Information of China (English)

    王芳; 杨青; 杜秉新; 陈秀华

    2012-01-01

    目的:探讨《全覆盖孕产期系统保健管理》对孕产妇死亡、围产儿死亡、孕产妇系统管理的影响.方法:开展全社会孕情排摸提高早孕建册率、评估孕期妊娠风险加强重点孕妇管理、设立危重抢救中心提高抢救技能与设立抢救“绿色”通道积极应对危重抢救、政府经济支持设立外来孕产妇住院分娩点及免费产后访视、开展孕产期全程健康教育等方法.结果:评估项目前后(2008年、2011年)非本市孕产妇的系统管理率、早孕建册率、产前检查(产检)≥5次率、产后访视率、围产儿死亡率均有明显改变,经x2检验,差异都具有统计学意义(P<0.05).结论:项目对降低孕产妇死亡率、围产儿死亡率效果明显,对提高孕产妇系统管理率有一定的作用.%Objective: To explore the effect of "complete systematical health care management during pregnant period" project on maternal death, perinatal death, and maternal system management. Methods: The system management rate, the registration rate of early pregnancy, the rate of prenatal examination≥5 times, the postpartum visit rate, and the perinatal mortality of migrant pregnant women before and after implementation of "complete coverage systematical health care management during pregnant period" project (2008 and 2011, respectively) were evaluated. The contents of the project included conducting maternal investigation to improve the registration rate of early pregnancy, assessing pregnancy risk, enhancing management of key pregnant women, establishing critically ill rescue center, improving rescue skills, setting up green channel of maternal rescue to cope with rescue of critically ill patients, founding hospital delivery sites of migrant pregnant women and performing free postpartum visit based on economic support from the government, and carrying out health education during the whole course of pregnant period. Results: There was statistically significant

  7. [Universal coverage of health services in Mexico].

    Science.gov (United States)

    2013-01-01

    The reforms made in recent years to the Mexican Health System have reduced inequities in the health care of the population, but have been insufficient to solve all the problems of the MHS. In order to make the right to health protection established in the Constitution a reality for every citizen, Mexico must warrant effective universal access to health services. This paper outlines a long-term reform for the consolidation of a health system that is akin to international standards and which may establish the structural conditions to reduce coverage inequity. This reform is based on a "structured pluralism" intended to avoid both a monopoly exercised within the public sector and fragmentation in the private sector, and to prevent falling into the extremes of authoritarian procedures or an absence of regulation. This involves the replacement of the present vertical integration and segregation of social groups by a horizontal organization with separation of duties. This also entails legal and fiscal reforms, the reinforcement of the MHS, the reorganization of health institutions, and the formulation of regulatory, technical and financial instruments to operationalize the proposed scheme with the objective of rendering the human right to health fully effective for the Mexican people.

  8. Universal coverage in the land of smiles: lessons from Thailand's 30 Baht health reforms.

    Science.gov (United States)

    Hughes, David; Leethongdee, Songkramchai

    2007-01-01

    Thailand became one of a handful of lower-middle-income countries providing universal health care coverage when it introduced reforms in 2001. Following the 2006 military coup, the coverage reforms are being reappraised by Thai policymakers. In this paper we take the opportunity to assess the program's achievements and problems. We describe the characteristics of the universal insurance program--the 30 Baht Scheme--and the purchaser-provider system that Thailand adopted.

  9. The development of leadership outcome-indicators evaluating the contribution of clinical specialists and advanced practitioners to health care: a secondary analysis.

    LENUS (Irish Health Repository)

    Elliott, Naomi

    2014-05-01

    To report a secondary analysis of data collected from the case study phase of a national study of advanced practitioners and to develop leadership outcome-indicators appropriate for advanced practitioners.

  10. Evaluation of the indication for surgical extraction of third molars according to the oral surgeon and the primary care dentist. Experience in the Master of Oral Surgery and Implantology at Barcelona University Dental School

    OpenAIRE

    Fuster Torres, M. Angeles; Gargallo Albiol, Jordi; Berini Aytés, Leonardo; Gay Escoda, Cosme

    2008-01-01

    Introduction: Third molar extraction is the most frequent procedure in oral surgery. The present study evaluates the indication of third molar extraction as established by the primary care dentist (PCD) and the oral surgeon, and compares the justification for extraction with the principal reason for patient consultation. Patients and method: A descriptive study was made of 319 patients subjected to surgical removal of a third molar in the context of the Master of Oral Surgery and Implantology...

  11. Health care in Costa Rica: boom and crisis.

    Science.gov (United States)

    Mesa-Lago, C

    1985-01-01

    In 1960-1980 Costa Rica experienced a health boom, achieving significant improvements which moved that country into the number two position in Latin America for indicators such as population coverage, infant mortality, life expectancy and health services. In addition, there was a gradual process of integration of health services. But in the same period, the cost of health care as a percentage of GNP increased almost 5-fold and in 1980 was the fourth highest in the region. The economic crisis of the 1980s aggravated the financial difficulties; to cope with them, the government introduced an austere program to reduce costs and plans to transform the current model of health care into a more efficient one capable of maintaining Costa Rica's high health standards in the future. The paper is divided into five sections: summary of the historical development of health care, and description of its current organization and of its gradual process of integration; estimation of population coverage and its trends, evaluation of inequalities in coverage, and identification of the non-covered group; analysis of health-care financing and its sources, as well of the recent financial desequilibrium, its causes and measures to restore the equilibrium; description of health care benefits and their differences among groups and regions, analysis of the country's advances in health-care facilities and standards, and measurement of the impact of the health care system in income distribution; and description of the rising cost of health care and the current crisis, analysis of the causes of both phenomena, and review of the measures that have been and should be implemented to solve these problems.

  12. Asymmetric k-Center with Minimum Coverage

    DEFF Research Database (Denmark)

    Gørtz, Inge Li

    2008-01-01

    In this paper we give approximation algorithms and inapproximability results for various asymmetric k-center with minimum coverage problems. In the k-center with minimum coverage problem, each center is required to serve a minimum number of clients. These problems have been studied by Lim et al. [A....... Lim, B. Rodrigues, F. Wang, Z. Xu, k-center problems with minimum coverage, Theoret. Comput. Sci. 332 (1–3) (2005) 1–17] in the symmetric setting....

  13. 29 CFR 825.114 - Inpatient care.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Inpatient care. 825.114 Section 825.114 Labor Regulations... LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility,...

  14. Indicadores da qualidade dos registros e da assistência ambulatorial em Maringá, (estado do Paraná, Brasil, 1991: um exercício de avaliação Indicators of quality for medical records and ambulatory care in Maringá (state of Paraná, Brazil, 1991: an exercise in evaluation

    Directory of Open Access Journals (Sweden)

    Maria José Scochi

    1994-09-01

    Full Text Available Buscou-se indicadores de qualidade da assistência passíveis de análise a partir de registros rotineiros na rede ambulatorial de serviços de saúde da Secretaria Municipal de Saúde de Maringá, Paraná (Brasil. Foram avaliados os atendimentos realizados em três Núcleos Integrados de Saúde (NIS com o objetivo de verificar se o que foi registrado permite a formulação de indicadores de qualidade. Pesquisou-se todos os prontuários dos 7.813 pacientes atendidos durante o mês de outubro de 1991. Foram formulados indicadores de qualidade de registro, procedência da clientela, demanda, cobertura e resolutividade por unidade de saúde. Em 49,7% dos prontuários, as hipóteses diagnósticas (HD estavam ausentes e em 14,8% haviam HD ilegíveis; 78% dos atendimentos foram destinados a moradores que residiam na área de abrangência das unidades; a cobertura de gestantes foi baixa 37%; 70% das crianças menores de um ano da comunidade foram atendidas no mês, e as pessoas atendidas tiveram em média três consultas médicas no ano precedente, 4,3% dos prontuários dos usuários atendidos apresentava registro de encaminhamentos para outros serviços. Os prontuários nestes três núcleos funcionam precariamente como fonte de informação, tanto para uso interno como para avaliação. Apesar destas insuficiências foi possível extrair alguns indicadores de qualidade, sendo necessário, melhoras significativas na qualidade do preenchimento, para sustentar avaliações mais aprofundadas.This study sought to establish health-care quality indicators based on data from routine clinical records produced by the Municipal Health Department in Maringá, Paraná State. Records for 7813 patients seen in the month of October 1991 at three Integrated Health Centers (IHC were assessed to determine whether the recorded information allowed for the formulation of quality indicators. Indicators of data quality, demand, coverage, resolubility, and geographic

  15. The role of institutional design and organizational practice for health financing performance and universal coverage.

    Science.gov (United States)

    Mathauer, Inke; Carrin, Guy

    2011-03-01

    Many low- and middle income countries heavily rely on out-of-pocket health care expenditure. The challenge for these countries is how to modify their health financing system in order to achieve universal coverage. This paper proposes an analytical framework for undertaking a systematic review of a health financing system and its performance on the basis of which to identify adequate changes to enhance the move towards universal coverage. The distinctive characteristic of this framework is the focus on institutional design and organizational practice of health financing, on which health financing performance is contingent. Institutional design is understood as formal rules, namely legal and regulatory provisions relating to health financing; organizational practice refers to the way organizational actors implement and comply with these rules. Health financing performance is operationalized into nine generic health financing performance indicators. Inadequate performance can be caused by six types of bottlenecks in institutional design and organizational practice. Accordingly, six types of improvement measures are proposed to address these bottlenecks. The institutional design and organizational practice of a health financing system can be actively developed, modified or strengthened. By understanding the incentive environment within a health financing system, the potential impacts of the proposed changes can be anticipated.

  16. Health insurance coverage in Jamaica: Multivariate Analyses using two cross-sectional survey data for 2002 and 2007

    Directory of Open Access Journals (Sweden)

    Paul Andrew Bourne

    2009-10-01

    Full Text Available Introduction: Health insurance is established as an indicator of health care-seeking behaviour. Despite this reality, no study existed in Jamaica that examines those factors that determine private health insurance coverage. This study bridges the gap in the literature as it seeks to determine correlates of private health insurance coverage. The aim of this study is to understand those who possess Health insurance coverage in Jamaica so as to aid public health policy formulation.Method: This study used two secondary cross-sectional data from the Jamaica Survey of Living Conditions (JSLC. The JSLC was commissioned by the PIOJ and the Statistical Institute of Jamaica (STATIN in 1988. The surveys were taken from a national cross-sectional survey of 25 018 respondents (for 2002 and 6,782 people (for 2007 from the 14 parishes across Jamaica. The JSLC is a self-administered questionnaire where respondents are asked to recall detailed information on particular activities. The questionnaire was modelled from the World Bank’s Living Standards Measurement Study (LSMS household survey. There are some modifications to the LSMS, as JSLC is more focused on policy impacts. The surveys used stratified random probability sampling technique to draw the original sample of respondents. Descriptive statistics were used to provide background information on the sample, and logistic regression was to determine predictors of private health insurance coverage.Results: Health insurance coverage can be predicted by socio-demographic factors (such as area of residence; education, marital status, social support, social class, gender, age, and economic (consumption and income. The findings revealed some similarities and dissimilarities between data for 2002 and 2007. Area of residence, consumption, educational level, marital status, income and social support were determinants over the two periods. Asset ownership was a factor in 2002 but not in 2007. For 2007, age, gender

  17. A clinical study of rate and indications of cesarean section, maternal and fetal outcomes at tertiary care center in north western Rajasthan

    Directory of Open Access Journals (Sweden)

    Suniti Verma

    2016-08-01

    Conclusions: The rate of cesarean section is progressively increasing in the last 5 years. The most common indication is previous cesarean section. The outcome in elective is better than emergency. [Int J Reprod Contracept Obstet Gynecol 2016; 5(8.000: 2791-2794

  18. Social and Affective Concerns High-Ability Adolescents Indicate They Would Like to Discuss with a Caring Adult: Implications for Educators

    Science.gov (United States)

    Jen, Enyi; Wu, Jiaxi; Gentry, Marcia

    2016-01-01

    This exploratory study investigated the social and affective concerns of 280 high-ability students in Grades 5 through 12 who participated in a summer residential program. Content analysis of responses from an open-ended survey indicated that high-ability adolescents expressed concerns regarding feelings and emotions, future aspirations, and…

  19. Health insurance and access to care among welfare leavers.

    Science.gov (United States)

    Danziger, Sheldon; Davis, Matthew M; Orzol, Sean; Pollack, Harold A

    2008-01-01

    This analysis explores the effects of the 1996 welfare reform on health insurance coverage and access to care among former recipients of cash aid. Using panel data from the Women's Employment Study, which conducted five interviews between 1997 and 2003 in one Michigan county, we find that 25% of welfare leavers lacked health insurance coverage in fall 2003. Uninsured adults were significantly more likely than others to report that they could not afford a medical or dental visit during the year prior to the 2003 interview. Fixed-effect logistic regression analysis indicates that women who had been off the welfare rolls for at least 12 months (the duration of transitional Medicaid) were significantly more likely to be uninsured than women who had made more recent welfare exits, and were significantly more likely to report financial obstacles to the receipt of medical and dental care.

  20. Demographic and Indication-Specific Characteristics Have Limited Association With Social Network Engagement: Evidence From 24,954 Members of Four Health Care Support Groups

    Science.gov (United States)

    2017-01-01

    Background Digital health social networks (DHSNs) are widespread, and the consensus is that they contribute to wellness by offering social support and knowledge sharing. The success of a DHSN is based on the number of participants and their consistent creation of externalities through the generation of new content. To promote network growth, it would be helpful to identify characteristics of superusers or actors who create value by generating positive network externalities. Objective The aim of the study was to investigate the feasibility of developing predictive models that identify potential superusers in real time. This study examined associations between posting behavior, 4 demographic variables, and 20 indication-specific variables. Methods Data were extracted from the custom structured query language (SQL) databases of 4 digital health behavior change interventions with DHSNs. Of these, 2 were designed to assist in the treatment of addictions (problem drinking and smoking cessation), and 2 for mental health (depressive disorder, panic disorder). To analyze posting behavior, 10 models were developed, and negative binomial regressions were conducted to examine associations between number of posts, and demographic and indication-specific variables. Results The DHSNs varied in number of days active (3658-5210), number of registrants (5049-52,396), number of actors (1085-8452), and number of posts (16,231-521,997). In the sample, all 10 models had low R2 values (.013-.086) with limited statistically significant demographic and indication-specific variables. Conclusions Very few variables were associated with social network engagement. Although some variables were statistically significant, they did not appear to be practically significant. Based on the large number of study participants, variation in DHSN theme, and extensive time-period, we did not find strong evidence that demographic characteristics or indication severity sufficiently explain the variability in

  1. Clinical Indicators of Late-Onset Sepsis Workup in Very Low-Birth-Weight Infants in the Neonatal Intensive Care Unit.

    Science.gov (United States)

    Das, Anirudha; Shukla, Sonia; Rahman, Nazia; Gunzler, Douglas; Abughali, Nazha

    2016-07-01

    Background Late-onset sepsis (LOS) in very low-birth-weight (VLBW) infants is associated with significant morbidity and mortality. Objectives To determine the incidence of LOS workup, association, and predictive value of clinical indicators leading to culture-positive versus culture-negative sepsis workup. Methods All sepsis workups performed after 7 days of life, in neonates with birth weight of birth weight, corrected gestational age, and chronological age, at the time of workup. The clinical indicators leading to the performance of sepsis workup were compared between cases and controls. Results The incidence of culture-positive workup was 87/345 (25.2%) and that of LOS was 84/279 (30.1%). Among various clinical indicators, hypothermia and apnea were significantly associated with culture-positive sepsis workup (p = 0.015 and 0.004, respectively), with a positive predictive value of 81.2 and 71.4%, respectively. Conclusion In VLBW infants, one-fourth of sepsis workups resulted in a positive culture. Apnea and hypothermia were the most significant predictors of culture-positive workup after matching for GA, birth weight, chronological age, and corrected GA at the time of the workup.

  2. Construction of care service quality evaluation indicator for elderly institution in Chongqing based on SERVQUAL Model%SERVQUAL模型构建重庆市养老机构照护服务的质量评价指标

    Institute of Scientific and Technical Information of China (English)

    李培; 沈军

    2014-01-01

    目的 构建重庆市养老机构照护服务质量评价指标并确定各指标权重.方法 以SERVQUAL模型为指导,采用Delphi法确立评价指标,通过层次分析法计算各指标权重并进行指标一致性检验.结果 确立了重庆市养老机构照护服务质量评价5个一级指标、20个二级指标.其中一级指标分别为“有形性”“可靠性”“响应性”“安全性”“移情性”.各级指标一致性比率(CR)均<0.10,具有满意的一致性检验结果.结论 构建重庆市养老机构照护服务质量评价指标的方法较科学,指标较全面,可在一定程度上提高养老机构的照护服务质量,为养老机构照护质量评价提供一定的参考依据.%Objective To set up care service quality evaluation indicators and establish weight coefficient for assessment of elderly institution in Chongqing.Methods SEVQUAL Model was used as the theoretical guidance,through Delphi expert inquiry,analytic hierarchy process (AHP),the weight of each indicator in five grades and consistency check was calculated.Results The care serv ice quality evaluation indicators contained five first-grade indexes and twenty second-grade indexes.The first-grade indexes included tangibles,reliability,responsiveness,assurance,empathy,respectively.The results of the consisten-cy check of the single grade sorts had a satisfying consistency(CR<0.10).Conclusions The scientific meth-ods and comprehensive indicators were applied to the construction of care service quality e-valuation indicators for elderly institution in Chongqing.In some degree,this construction of indicators may improve quality of care service and provide useful reference evidence for quality assessment in elderly in-stitution.

  3. The importance of Leadership towards universal health coverage in Low Income Countries.

    Science.gov (United States)

    Gonani, A; Muula, A S

    2015-03-01

    Universal health coverage--defined as access to the full range of the most appropriate health care and technology for all people at the lowest possible price or with social health protection--was the goal of the 1978 Alma-Ata Conference on Primary Health Care in Kazakhstan. Many low-income (developing) countries are currently unable to reach this goal despite having articulated the same in their health-related documents. In this paper we argue that, over 30 years on, inadequate political and technical leadership has prevented the realization of universal health coverage in low-income countries.

  4. 5 CFR 610.101 - Coverage.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 610.101 Section 610.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS HOURS OF DUTY Weekly and Daily Scheduling of Work § 610.101 Coverage. This subpart applies to each employee to whom subpart A of part...

  5. CDMA coverage under mobile heterogeneous network load

    NARCIS (Netherlands)

    Saban, Dorin; Berg, van den Hans; Boucherie, Richard J.; Endrayanto, Irwan

    2002-01-01

    We analytically investigate coverage (determined by the uplink) under non-homogeneous and moving traffic load of third generation UMTS mobile networks. In particular, for different call assignment policies, we investigate cell breathing and the movement of the coverage gap occurring between cells wh

  6. 5 CFR 531.402 - Employee coverage.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Employee coverage. 531.402 Section 531... GENERAL SCHEDULE Within-Grade Increases § 531.402 Employee coverage. (a) Except as provided in paragraph (b) of this section, this subpart applies to employees who— (1) Are classified and paid under...

  7. Impact of invitation schemes on screening coverage

    DEFF Research Database (Denmark)

    Jacobsen, Katja Kemp; von Euler-Chelpin, My Catarina; Vejborg, Ilse;

    2017-01-01

    Background: The porpuse of mammography screening is to decrease breast cancer mortality. To achieve this a high coverage by examination is needed. Within an organized screening programme, we examined the impact of changes in the invitation schedule on the interplay between coverage and participat...

  8. Prediction of difficult intubations using conventional indicators; Does rapid sequence intubation ease difficult intubations? A prospective randomised study in a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Gangadharan Lakshmi

    2011-01-01

    Full Text Available Background : Endotracheal intubations performed in the Emergency Department. Aims : To assess whether conventional indicators of difficult airway can predict a difficult intubation in the Emergency Setting and to investigate the effect of rapid sequence intubation (RSI on ease of intubation. Settings and Design : A prospective randomized study was designed involving 60 patients requiring intubation, over a period of 4 months. Materials and Methods : Demographic profile, details of methods used, airway assessment, ease of intubation, and Cormack and Lehane score were recorded. Airway assessment score and ease of intubation criteria were devised and assessed. Statistical Analysis : Descriptive statistical analysis was carried out. Chi-square/2 × 2, 2 × 3, 3 × 3, Fisher Exact test have been used to find the significance of study parameters on categorical scale between two or more groups. Results : Patients with a Mallampatti score of three or four were found to have worse laryngoscopic views (Cormack-Lehane score, 3 or 4. Of all airway indicators assessed, an increased Mallampatti score was found to have significant correlation with increased difficulty in intubation. The use of RSI was associated with better laryngoscopic views, and easier intubations. Conclusions : An airway assessment using the Mallampatti score is invaluable as a tool to predict a difficult airway and should be performed routinely if possible. RSI aids intubation ease. If not otherwise contraindicated, it should be performed routinely for all intubations in the ED.

  9. Impact of conflict on infant immunisation coverage in Afghanistan: a countrywide study 2000–2003

    Directory of Open Access Journals (Sweden)

    Seino Kaoruko

    2007-06-01

    Full Text Available Abstract Background Infant immunisation is an effective public health intervention to reduce the morbidity and mortality of vaccine preventable diseases. However, some developing countries fail to achieve desirable vaccination coverage; Afghanistan is one such country. The present study was performed to evaluate the progress and variation in infant immunisation coverage by district and region in Afghanistan and to assess the impact of conflict and resource availability on immunisation coverage. Results This study analysed reports of infant immunisation from 331 districts across 7 regions of Afghanistan between 2000 and 2003. Geographic information system (GIS analysis was used to visualise the distribution of immunisation coverage in districts and to identify geographic inequalities in the process of improvement of infant immunisation coverage. The number of districts reporting immunisation coverage increased substantially during the four years of the study. Progress in Bacillus Calmette-Guerin (BCG immunisation coverage was observed in all 7 regions, although satisfactory coverage of 80% remained unequally distributed. Progress in the third dose of Diphtheria-Pertussis-Tetanus (DPT3 immunisation differed among regions, in addition to the unequal distribution of immunisation coverage in 2000. The results of multivariate logistic regression analysis indicated a significant negative association between lack of security in the region and achievement of 80% coverage of immunisation regardless of available resources for immunisation, while resource availability showed no relation to immunisation coverage. Conclusion Although progress was observed in all 7 regions, geographic inequalities in these improvements remain a cause for concern. The results of the present study indicated that security within a country is an important factor for affecting the delivery of immunisation services.

  10. Prescribing pattern and WHO core prescribing indicators in post-operative patients of Gynaecology department of a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Bhanu P. Kolasani

    2016-12-01

    Full Text Available Background: Prescription pattern analysis is an essential tool to provide an insight regarding the existing drug usage and to ensure rational drug therapy. Even though drugs used for gynecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and WHO core prescribing indicators among post-operative patients of Gynaecology department in our institute. Methods: A prospective observational study was conducted in 76 post-operative patients of Gynaecology department for a period of six months. Each prescription was analyzed for demographic data, total number and various categories of drugs prescribed, the percentage of individual drugs prescribed in each category, the dosage forms and the percentage of drugs prescribed by generic name, and from essential drug list were also analyzed. Results: A total of 990 medications were prescribed among which anti-microbial agents (32.52% were the most commonly prescribed category followed by analgesics (19.60% and Intravenous fluids (13.53%. Metronidazole (27.02% was the most commonly prescribed antimicrobial, Diclofenac (68.04% was the commonly prescribed analgesics and Ringer lactate (38.81% was the commonly prescribed Intravenous fluid. Most commonly prescribed antiulcer drug was ranitidine (75.0%, antiemetic was Ondansetron (76.39%. Majority of drugs (72.54% were prescribed by generic name. Average number of drugs per prescription was 13.03. Percentages of encounters with antibiotics were 32.52%. The percentage of drugs prescribed from the National List of Essential Medicines (NLEM was 82.16%. Injection (57.78% was the most common drug formulation. Conclusions: Antimicrobial agents and analgesics were the most commonly prescribed drugs. Prescription by generic name was high, usage of antibiotics and injections were also high and Poly-pharmacy was common, especially among antimicrobial

  11. Does health insurance continuity among low-income adults impact their children's insurance coverage?

    Science.gov (United States)

    Yamauchi, Melissa; Carlson, Matthew J; Wright, Bill J; Angier, Heather; DeVoe, Jennifer E

    2013-02-01

    Parent's insurance coverage is associated with children's insurance status, but little is known about whether a parent's coverage continuity affects a child's coverage. This study assesses the association between an adult's insurance continuity and the coverage status of their children. We used data from a subgroup of participants in the Oregon Health Care Survey, a three-wave, 30-month prospective cohort study (n = 559). We examined the relationship between the length of time an adult had health insurance coverage and whether or not all children in the same household were insured at the end of the study. We used a series of univariate and multivariate logistic regression models to identify significant associations and the rho correlation coefficient to assess collinearity. A dose response relationship was observed between continuity of adult coverage and the odds that all children in the household were insured. Among adults with continuous coverage, 91.4% reported that all children were insured at the end of the study period, compared to 83.7% of adults insured for 19-27 months, 74.3% of adults insured for 10-18 months, and 70.8% of adults insured for fewer than 9 months. This stepwise pattern persisted in logistic regression models: adults with the fewest months of coverage, as compared to those continuously insured, reported the highest odds of having uninsured children (adjusted odds ratio 7.26, 95% confidence interval 2.75, 19.17). Parental health insurance continuity is integral to maintaining children's insurance coverage. Policies to promote continuous coverage for adults will indirectly benefit children.

  12. Toward a 21st-century health care system: Recommendations for health care reform

    NARCIS (Netherlands)

    K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)

    2009-01-01

    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a

  13. The Role of Practical Advice in Bioterrorism News Coverage.

    Science.gov (United States)

    Swain, Kristen Alley

    2015-01-01

    This study examined the role of crisis advice appearing in US news coverage of the 2001 anthrax attacks. Coverage of any crisis can spark public outrage, including fear, speculation, and contradictory or confusing evidence, especially when the stories do not contain practical advice. Five coders analyzed 833 news stories from 272 major US newspapers, the Associated Press, National Public Radio, and 4 major US television networks. Practical advice appeared in only a quarter of the stories, even though practical advice for self-protection was mentioned 3 times more often than the vague advice that simply advised people not to panic. Public health officials provided the most practical advice, while scientists provided the least practical advice. Stories containing practical advice also provided more elucidating information, explaining why the threat was low, reducible, treatable, and detectable. Over the 3 phases of the anthrax crisis, an inverse relationship appeared between the amount of news coverage containing practical advice compared to "outrage rhetoric." Stories mentioned practical advice more often during the post-impact phase than earlier in the crisis. Elucidating, explanatory advice emphasized actions, risk comparisons, and tradeoffs. The findings indicate that when journalists use credible sources to provide practical advice and avoid speculation, their coverage can prevent the spread of misinformation and confusion during a bioterror attack. Also, journalists should provide context and sourcing when discussing advice during the outbreak and impact phases of the crisis, because these explanations could counteract outrage and threat distortion.

  14. Insurance coverage policies for personalized medicine.

    Science.gov (United States)

    Hresko, Andrew; Haga, Susanne B

    2012-10-30

    Adoption of personalized medicine in practice has been slow, in part due to the lack of evidence of clinical benefit provided by these technologies. Coverage by insurers is a critical step in achieving widespread adoption of personalized medicine. Insurers consider a variety of factors when formulating medical coverage policies for personalized medicine, including the overall strength of evidence for a test, availability of clinical guidelines and health technology assessments by independent organizations. In this study, we reviewed coverage policies of the largest U.S. insurers for genomic (disease-related) and pharmacogenetic (PGx) tests to determine the extent that these tests were covered and the evidence basis for the coverage decisions. We identified 41 coverage policies for 49 unique testing: 22 tests for disease diagnosis, prognosis and risk and 27 PGx tests. Fifty percent (or less) of the tests reviewed were covered by insurers. Lack of evidence of clinical utility appears to be a major factor in decisions of non-coverage. The inclusion of PGx information in drug package inserts appears to be a common theme of PGx tests that are covered. This analysis highlights the variability of coverage determinations and factors considered, suggesting that the adoption of personal medicine will affected by numerous factors, but will continue to be slowed due to lack of demonstrated clinical benefit.

  15. Insurance Coverage Policies for Personalized Medicine

    Directory of Open Access Journals (Sweden)

    Andrew Hresko

    2012-10-01

    Full Text Available Adoption of personalized medicine in practice has been slow, in part due to the lack of evidence of clinical benefit provided by these technologies. Coverage by insurers is a critical step in achieving widespread adoption of personalized medicine. Insurers consider a variety of factors when formulating medical coverage policies for personalized medicine, including the overall strength of evidence for a test, availability of clinical guidelines and health technology assessments by independent organizations. In this study, we reviewed coverage policies of the largest U.S. insurers for genomic (disease-related and pharmacogenetic (PGx tests to determine the extent that these tests were covered and the evidence basis for the coverage decisions. We identified 41 coverage policies for 49 unique testing: 22 tests for disease diagnosis, prognosis and risk and 27 PGx tests. Fifty percent (or less of the tests reviewed were covered by insurers. Lack of evidence of clinical utility appears to be a major factor in decisions of non-coverage. The inclusion of PGx information in drug package inserts appears to be a common theme of PGx tests that are covered. This analysis highlights the variability of coverage determinations and factors considered, suggesting that the adoption of personal medicine will affected by numerous factors, but will continue to be slowed due to lack of demonstrated clinical benefit.

  16. Quality indicators

    DEFF Research Database (Denmark)

    Hjorth-Andersen, Christian

    1991-01-01

    to the issue of how well these indicators perform, using market data provided by consumer magazines from 3 countries. The results strongly indicate that price is a poor quality indicator. The paper also presents some evidence which suggests that seller reputation and easily observable characteristics are also......In recent literature it has been suggested that consumers need have no knowledge of product quality as a number of quality indicators (or signals) may be used as substitutes. Very little attention has been paid to the empirical verification of these studies. The present paper is devoted...... poor indicators...

  17. Can a universal coverage system temper the underwriting cycle?

    Science.gov (United States)

    Gabel, J R; Jensen, G A

    1992-01-01

    The health insurance industry has experienced a pronounced six-year cycle of earnings for nearly three decades--three years of profits followed by three years of losses. This profitability cycle triggers a turbulent pricing cycle. After reviewing three schools of thought about the causes of the cycle, in this article we examine new evidence to determine the probable impact on the cycle of a private-public, universal coverage, national health plan. We find no evidence of a cycle in the pricing and use of health care services. Since 1985, the relationship between the overall economy and health insurance trends has weakened. We conclude that the root causes of the cycle are essentially internal to the insurance industry, and, therefore, national health care reform will have little impact on the underwriting cycle.

  18. Affordable Care Act and Diabetes Mellitus.

    Science.gov (United States)

    Shi, Qian; Nellans, Frank P; Shi, Lizheng

    2015-12-01

    The Affordable Care Act (ACA) has the potential for great impact on U.S. health care, especially for chronic disease patients requiring long-term care and management. The act was designed to improve insurance coverage, health care access, and quality of care for all Americans, which will assist patients with diabetes mellitus in acquiring routine monitoring and diabetes-related complication screening for better health management and outcomes. There is great potential for patients with diabetes to benefit from the new policy mandating health insurance coverage and plan improvement, Medicaid expansion, minimum coverage guarantees, and free preventative care. However, policy variability among states and ACA implementation present challenges to people with diabetes in understanding and optimizing ACA impact. This paper aims to select the most influential components of the ACA as relates to people with diabetes and discuss how the ACA may improve health care for this vulnerable population.

  19. A Survey on Coverage Control Protocols in Wireless Sensor Networks

    OpenAIRE

    2013-01-01

    Coverage control algorithms play an important role in Wireless sensor network. Effective coverage control algorithms sense its coverage area with less energy spent. These coverage control models falls under various approaches like clustering, evolutionary, mobility based approaches. This paper makes a detailed survey on coverage control protocols coming under various classifications. In addition, it also discussed several protocols working mechanism with its evaluation metrics.

  20. Waste indicators

    Energy Technology Data Exchange (ETDEWEB)

    Dall, O.; Lassen, C.; Hansen, E. [Cowi A/S, Lyngby (Denmark)

    2003-07-01

    The Waste Indicator Project focuses on methods to evaluate the efficiency of waste management. The project proposes the use of three indicators for resource consumption, primary energy and landfill requirements, based on the life-cycle principles applied in the EDIP Project. Trial runs are made With the indicators on paper, glass packaging and aluminium, and two models are identified for mapping the Danish waste management, of which the least extensive focuses on real and potential savings. (au)

  1. Care of critically ill surgical patients using the 80-hour Accreditation Council of Graduate Medical Education work-week guidelines: a survey of current strategies.

    Science.gov (United States)

    Gordon, Chad R; Axelrad, Alex; Alexander, James B; Dellinger, R Phillip; Ross, Steven E

    2006-06-01

    As a result of the recently mandated work-hour restrictions, it has become more difficult to provide 24-hour intensive care unit (ICU) in-house coverage by the general surgical residents. To assess the current state of providing appropriate continuous care to surgical critical care patients during the era of resident work-hour constraints, a national survey was conducted by the Association of Program Directors of Surgery. The results revealed that 37 per cent of programs surveyed have residents other than general surgery housestaff providing cross-coverage and writing orders for surgical ICU patients. Residents in emergency medicine, anesthesia, family medicine, otorhinolaryngology, obstetrics/gynecology, internal medicine, urology, and orthopedic surgery have provided this cross-coverage. Some found it necessary to use physician extenders (i.e., nurse practitioners or physician assistants), thereby decreasing the burden of surgical housestaff coverage. The results indicated that 30 per cent use physician extenders to help cover the ICU during daytime hours and 11 per cent used them during nighttime hours. In addition, 24 per cent used a "night-float" system in an attempt to maintain continuous care, yet still adhere to the mandated guidelines. In conclusion, our survey found multiple strategies, including the use of physician extenders, a "night-float" system, and the use of nongeneral surgical residents in an attempt to provide continuous coverage for surgical ICU patients. The overall outcome of these new strategies still needs to be assessed before any beneficial results can be demonstrated.

  2. Repeat retail clinic visits: impact of insurance coverage and age of patient.

    Science.gov (United States)

    Angstman, Kurt B; Bernard, Matthew E; Rohrer, James E; Garrison, Gregory M; Maclaughlin, Kathy L

    2012-12-01

    As retail clinics provide a less costly alternative for health care, it would be reasonable to expect an increase in multiple (repeat) retail visits by those patients who may have expenses for receiving primary care. If costs were not a significant factor, then repeat visits should not be significantly different between these patients and those with coverage for primary care visits. The hypothesis for this study was that patients with the potential for out-of-pocket expenses would have a higher frequency of repeat retail clinic visits within 180 days compared to those with primary care coverage. A retrospective chart review was conducted of 5703 patients utilizing a retail clinic in Rochester, Minnesota from January 1, 2009 through June 30, 2009. The first visit to the retail clinic was considered the index visit and the chart was reviewed for repeat retail clinic visits within the next 180 days. Using a multiple logistic regression model, the odds of a pediatric patient (N=2344) having a repeat retail visit within 180 days of the index visit were not significantly impacted by insurance coverage (P=0.4209). Of the 3359 adult patients, those with unknown coverage had a 25.6% higher odds ratio of repeat retail clinic visits than those with insurance coverage (odds ratio 1.2557, confidence interval 1.0421-1.5131). This study suggested that when cost is an issue, the adult patient may favor retail clinics for episodic, low-acuity health care. In contrast, the pediatric population did not, suggesting that other factors, such as convenience, may play more of a role in the choice of episodic health care for this age group.

  3. Exact Gap Computation for Code Coverage Metrics in ISO-C

    CERN Document Server

    Richter, Dirk; 10.4204/EPTCS.80.4

    2012-01-01

    Test generation and test data selection are difficult tasks for model based testing. Tests for a program can be meld to a test suite. A lot of research is done to quantify the quality and improve a test suite. Code coverage metrics estimate the quality of a test suite. This quality is fine, if the code coverage value is high or 100%. Unfortunately it might be impossible to achieve 100% code coverage because of dead code for example. There is a gap between the feasible and theoretical maximal possible code coverage value. Our review of the research indicates, none of current research is concerned with exact gap computation. This paper presents a framework to compute such gaps exactly in an ISO-C compatible semantic and similar languages. We describe an efficient approximation of the gap in all the other cases. Thus, a tester can decide if more tests might be able or necessary to achieve better coverage.

  4. Performance Evaluation of a Dual Coverage System for Internet of Things Environments

    Directory of Open Access Journals (Sweden)

    Omar Said

    2016-01-01

    Full Text Available A dual coverage system for Internet of Things (IoT environments is introduced. This system is used to connect IoT nodes regardless of their locations. The proposed system has three different architectures, which are based on satellites and High Altitude Platforms (HAPs. In case of Internet coverage problems, the Internet coverage will be replaced with the Satellite/HAP network coverage under specific restrictions such as loss and delay. According to IoT requirements, the proposed architectures should include multiple levels of satellites or HAPs, or a combination of both, to cover the global Internet things. It was shown that the Satellite/HAP/HAP/Things architecture provides the largest coverage area. A network simulation package, NS2, was used to test the performance of the proposed multilevel architectures. The results indicated that the HAP/HAP/Things architecture has the best end-to-end delay, packet loss, throughput, energy consumption, and handover.

  5. 5 CFR 9701.402 - Coverage.

    Science.gov (United States)

    2010-01-01

    ... Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Performance Management § 9701.402 Coverage. (a) This subpart applies to eligible...

  6. Measuring populations to improve vaccination coverage

    Science.gov (United States)

    Bharti, Nita; Djibo, Ali; Tatem, Andrew J.; Grenfell, Bryan T.; Ferrari, Matthew J.

    2016-10-01

    In low-income settings, vaccination campaigns supplement routine immunization but often fail to achieve coverage goals due to uncertainty about target population size and distribution. Accurate, updated estimates of target populations are rare but critical; short-term fluctuations can greatly impact population size and susceptibility. We use satellite imagery to quantify population fluctuations and the coverage achieved by a measles outbreak response vaccination campaign in urban Niger and compare campaign estimates to measurements from a post-campaign survey. Vaccine coverage was overestimated because the campaign underestimated resident numbers and seasonal migration further increased the target population. We combine satellite-derived measurements of fluctuations in population distribution with high-resolution measles case reports to develop a dynamic model that illustrates the potential improvement in vaccination campaign coverage if planners account for predictable population fluctuations. Satellite imagery can improve retrospective estimates of vaccination campaign impact and future campaign planning by synchronizing interventions with predictable population fluxes.

  7. Media Coverage of Nuclear Energy after Fukushima

    Energy Technology Data Exchange (ETDEWEB)

    Oltra, C.; Roman, P.; Prades, A.

    2013-07-01

    This report presents the main findings of a content analysis of printed media coverage of nuclear energy in Spain before and after the Fukushima accident. Our main objective is to understand the changes in the presentation of nuclear fission and nuclear fusion as a result of the accident in Japan. We specifically analyze the volume of coverage and thematic content in the media coverage for nuclear fusion from a sample of Spanish print articles in more than 20 newspapers from 2008 to 2012. We also analyze the media coverage of nuclear energy (fission) in three main Spanish newspapers one year before and one year after the accident. The results illustrate how the media contributed to the presentation of nuclear power in the months before and after the accident. This could have implications for the public understanding of nuclear power. (Author)

  8. Broadcast Network Coverage with Multicell Cooperation

    Directory of Open Access Journals (Sweden)

    Hongxiang Li

    2010-01-01

    Full Text Available Multicell cooperation has been identified as one of the underlying principles for future wireless communication systems. This paper studies the benefits of multicell cooperation in broadcast TV network from an information theoretical perspective. We define outage capacity as the figure of merit and derive the broadcast coverage area to evaluate such system. Specifically, we calculate the broadcast coverage area with given common information rate and outage probabilities when multiple base stations collaboratively transmit the broadcast signals. For the general MIMO case where receivers have multiple antennas, we provide simulation results to illustrate the expanded coverage area. In all cases, our results show that the coverage of a TV broadcast network can be significantly improved by multicell cooperation.

  9. Coverage for SCS Pre-1941 Aerial Photography

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This shapefile was generated by the U.S. Bureau of Land Management (BLM) at the New Mexico State Office to show the coverage for the Pre-1941 aerial photography...

  10. Measuring populations to improve vaccination coverage

    Science.gov (United States)

    Bharti, Nita; Djibo, Ali; Tatem, Andrew J.; Grenfell, Bryan T.; Ferrari, Matthew J.

    2016-01-01

    In low-income settings, vaccination campaigns supplement routine immunization but often fail to achieve coverage goals due to uncertainty about target population size and distribution. Accurate, updated estimates of target populations are rare but critical; short-term fluctuations can greatly impact population size and susceptibility. We use satellite imagery to quantify population fluctuations and the coverage achieved by a measles outbreak response vaccination campaign in urban Niger and compare campaign estimates to measurements from a post-campaign survey. Vaccine coverage was overestimated because the campaign underestimated resident numbers and seasonal migration further increased the target population. We combine satellite-derived measurements of fluctuations in population distribution with high-resolution measles case reports to develop a dynamic model that illustrates the potential improvement in vaccination campaign coverage if planners account for predictable population fluctuations. Satellite imagery can improve retrospective estimates of vaccination campaign impact and future campaign planning by synchronizing interventions with predictable population fluxes. PMID:27703191

  11. Length and coverage of inhibitory decision rules

    KAUST Repository

    Alsolami, Fawaz

    2012-01-01

    Authors present algorithms for optimization of inhibitory rules relative to the length and coverage. Inhibitory rules have a relation "attribute ≠ value" on the right-hand side. The considered algorithms are based on extensions of dynamic programming. Paper contains also comparison of length and coverage of inhibitory rules constructed by a greedy algorithm and by the dynamic programming algorithm. © 2012 Springer-Verlag.

  12. Hospitalizations for ambulatory care-sensitive conditions, Minas Gerais, Southeastern Brazil, 2000 and 2010

    Directory of Open Access Journals (Sweden)

    Rita Maria Rodrigues-Bastos

    2014-12-01

    Full Text Available OBJECTIVE To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program. METHODS An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses. RESULTS The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD = 10.42 in 2000 to 14.92/thousand inhabitants (SD = 10.04 in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly. CONCLUSIONS Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.

  13. 42 CFR 403.766 - Requirements for coverage and payment of RNHCI home services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Requirements for coverage and payment of RNHCI home services. 403.766 Section 403.766 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Care Institutions-Benefits, Conditions of Participation, and Payment § 403.766 Requirements...

  14. Hospital Coding Practice, Data Quality, and DRG-Based Reimbursement under the Thai Universal Coverage Scheme

    Science.gov (United States)

    Pongpirul, Krit

    2011-01-01

    In the Thai Universal Coverage scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group (DRG) reimbursement. Questionable quality of the submitted DRG codes has been of concern whereas knowledge about hospital coding practice has been lacking. The objectives of this thesis are (1) To explore hospital coding…

  15. 42 CFR 416.41 - Condition for coverage-Governing body and management.

    Science.gov (United States)

    2010-10-01

    ... so as to provide quality health care in a safe environment, and develops and maintains a disaster... 42 Public Health 3 2010-10-01 2010-10-01 false Condition for coverage-Governing body and management. 416.41 Section 416.41 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT...

  16. Cooperative Cloud Service Aware Mobile Internet Coverage Connectivity Guarantee Protocol Based on Sensor Opportunistic Coverage Mechanism

    Directory of Open Access Journals (Sweden)

    Qin Qin

    2015-01-01

    Full Text Available In order to improve the Internet coverage ratio and provide connectivity guarantee, based on sensor opportunistic coverage mechanism and cooperative cloud service, we proposed the coverage connectivity guarantee protocol for mobile Internet. In this scheme, based on the opportunistic covering rules, the network coverage algorithm of high reliability and real-time security was achieved by using the opportunity of sensor nodes and the Internet mobile node. Then, the cloud service business support platform is created based on the Internet application service management capabilities and wireless sensor network communication service capabilities, which is the architecture of the cloud support layer. The cooperative cloud service aware model was proposed. Finally, we proposed the mobile Internet coverage connectivity guarantee protocol. The results of experiments demonstrate that the proposed algorithm has excellent performance, in terms of the security of the Internet and the stability, as well as coverage connectivity ability.

  17. Factors associated with vaccination coverage in children Angola.

    Science.gov (United States)

    Oliveira, Manuel Falcão Saturnino de; Martinez, Edson Zangiacomi; Rocha, Juan Stuardo Yazlle

    2014-12-01

    OBJECTIVE To analyze vaccination coverage and factors associated with a complete immunization scheme in children Angola, in 2010. Data were obtained from interviews, questionnaires, child immunization histories, and maternal health histories. The statistical analysis used generalized linear models, in which the dependent variable followed a binary distribution (vaccinated, unvaccinated) and the association function was logarithmic and had the children's individual, familial, and socioeconomic factors as independent variables. RESULTS Vaccination coverage was 37.0%, higher in children < 1 year (55.0%) and heterogeneous across neighborhoods; 52.0% of children of both sexes had no immunization records. The prevalence rate of vaccination significantly varied according to child age, mother's level of education, family size, ownership of household appliances, and destination of domestic waste. CONCLUSIONS Vulnerable groups with vaccination coverage below recommended levels continue to be present. Some factors indicate inequalities that represent barriers to full immunization, indicating the need to implement more equitable policies. The knowledge of these factors contributes to planning immunization promotion measures that focus on the most vulnerable groups.

  18. Solar Indices

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collection includes a variety of indices related to solar activity contributed by a number of national and private solar observatories located worldwide. This...

  19. Standard wound coverage techniques for extremity war injury.

    Science.gov (United States)

    Kumar, Anand R

    2006-01-01

    Reconstruction of extremity war injuries begins with aggressive forward resuscitative care and stabilization of the trauma patient. After serial care in progressively better supported medical environments, definitive management is done at the level V military treatment facility. Aggressive forward care coupled with rapid air transport has enabled increasingly complex care to be administered at the continental United States military facilities; however, it has also made the decision between limb salvage and amputation more challenging. Yet to be determined are (1) the optimal timing of definitive wound closure or coverage in coordination with fracture stabilization and (2) the optimal types of flap for both upper and lower extremity reconstruction. Records of patients with complex lower and upper extremity wounds who were treated at the National Naval Medical Center between September 2004 and June 2006 reveal useful short-term data. Longer-term data, such as fracture union rate, time to ambulation, range of motion and global function of salvaged limbs, patient satisfaction with limb salvage, and average cost, are not yet available.

  20. Indicadores de gênero da assistência de enfermagem às mulheres Indicadores de género de la asistencia a las mujeres Gender indicators of nursing care for women

    Directory of Open Access Journals (Sweden)

    Enilda Rosendo do Nascimento

    2004-10-01

    care from a gender perspective. The construction of the indicators occurred by means of an investigation that analyzed women's ideas about the pre-natal nursing assistance provided to them, based on the identifications of actions that promote autonomy, merit, and participation. Data collecting was based on a semi-structured interview with 14 women that are users of pre-natal nursing care and accepted to participate in this study and had also been cared by a nurse in a previous pregnancy or during the present one. Two kinds of gender indicators in nursing care were built: practical indicators and strategic gender indicators.

  1. Effect of Antenna Parameters on the Field Coverage in Tunnel Environments

    Directory of Open Access Journals (Sweden)

    Dawei Li

    2016-01-01

    Full Text Available Radio wave propagation in confined spaces is consequent upon the reflections of boundaries; thus, the radiation characteristics of the antenna have significant influence on the field coverage in the confined space. This paper investigates the effects of antenna parameters on field coverage characteristics in a tunnel environment. A modified modal method is proposed to analyse the wave propagation properties along the tunnel. The relationships between the amplitudes of modes and the antenna parameters, including the beam width, beam direction, and antenna location, are analysed. The results indicate that by properly selecting the antenna parameters, optimum field coverage in tunnel environments can be realized.

  2. Chinese newspaper coverage of genetically modified organisms

    Directory of Open Access Journals (Sweden)

    Du Li

    2012-06-01

    Full Text Available Abstract Background Debates persist around the world over the development and use of genetically modified organisms (GMO. News media has been shown to both reflect and influence public perceptions of health and science related debates, as well as policy development. To better understand the news coverage of GMOs in China, we analyzed the content of articles in two Chinese newspapers that relate to the development and promotion of genetically modified technologies and GMOs. Methods Searching in the Chinese National Knowledge Infrastructure Core Newspaper Database (CNKI-CND, we collected 77 articles, including news reports, comments and notes, published between January 2002 and August 2011 in two of the major Chinese newspapers: People’s Daily and Guangming Daily. We examined articles for perspectives that were discussed and/or mentioned regarding GMOs, the risks and benefits of GMOs, and the tone of news articles. Results The newspaper articles reported on 29 different kinds of GMOs. Compared with the possible risks, the benefits of GMOs were much more frequently discussed in the articles. 48.1% of articles were largely supportive of the GM technology research and development programs and the adoption of GM cottons, while 51.9% of articles were neutral on the subject of GMOs. Risks associated with GMOs were mentioned in the newspaper articles, but none of the articles expressed negative tones in regards to GMOs. Conclusion This study demonstrates that the Chinese print media is largely supportive of GMOs. It also indicates that the print media describes the Chinese government as actively pursuing national GMO research and development programs and the promotion of GM cotton usage. So far, discussion of the risks associated with GMOs is minimal in the news reports. The media, scientists, and the government should work together to ensure that science communication is accurate and balanced.

  3. Prohibit, constrain, encourage, or purchase: how should we engage with the private health-care sector?

    Science.gov (United States)

    Montagu, Dominic; Goodman, Catherine

    2016-08-06

    The private for-profit sector's prominence in health-care delivery, and concern about its failures to deliver social benefit, has driven a search for interventions to improve the sector's functioning. We review evidence for the effectiveness and limitations of such private sector interventions in low-income and middle-income countries. Few robust assessments are available, but some conclusions are possible. Prohibiting the private sector is very unlikely to succeed, and regulatory approaches face persistent challenges in many low-income and middle-income countries. Attention is therefore turning to interventions that encourage private providers to improve quality and coverage (while advancing their financial interests) such as social marketing, social franchising, vouchers, and contracting. However, evidence about the effect on clinical quality, coverage, equity, and cost-effectiveness is inadequate. Other challenges concern scalability and scope, indicating the limitations of such interventions as a basis for universal health coverage, though interventions can address focused problems on a restricted scale.

  4. Polar constellations design for discontinuous coverage

    Science.gov (United States)

    Sarno, Salvatore; Graziano, Maria Daniela; D'Errico, Marco

    2016-10-01

    A novel constellation design method is developed for discontinuous coverage of the globe and polar caps. It integrates and extends the applicability of the coverage regions and mitigates the limitations of the existing techniques based on streets-of-coverage (SOC) theory. In particular, the visibility conditions of the targets are mapped in the (Ω, u)-domain to identify the number of satellites per plane and the distance between successive orbits, whereas the planes are arranged around the equator exploiting satellites both in ascending and descending phase. The proposed approach is applied to design potential space segments in polar LEO supporting the existing maritime surveillance services over the globe and on the future polar routes. Results show they require a smaller total number of satellites with respect to the SOC-based configurations for revisit times less than one hour and wide range of swaths. In details, it is observed a reduction between 6% and 22% for global coverage and between 24% and 33% for the coverage of polar caps.

  5. The Effect of Increased Coverage of Participatory Women’s Groups on Neonatal Mortality in Bangladesh: A Cluster Randomized Trial

    Science.gov (United States)

    Fottrell, Edward; Azad, Kishwar; Kuddus, Abdul; Younes, Layla; Shaha, Sanjit; Nahar, Tasmin; Aumon, Bedowra Haq; Hossen, Munir; Beard, James; Hossain, Tanvir; Pulkki-Brannstrom, Anni-Maria; Skordis-Worrall, Jolene; Prost, Audrey; Costello, Anthony; Houweling, Tanja A. J.

    2016-01-01

    Importance Community-based interventions can reduce neonatal mortality when health systems are weak. Population coverage of target groups may be an important determinant of their effect on behavior and mortality. A women’s group trial at coverage of 1 group per 1414 population in rural Bangladesh showed no effect on neonatal mortality, despite a similar intervention having a significant effect on neonatal and maternal death in comparable settings. Objective To assess the effect of a participatory women’s group intervention with higher population coverage on neonatal mortality in Bangladesh. Design A cluster randomized controlled trial in 9 intervention and 9 control clusters. Setting Rural Bangladesh. Participants Women permanently residing in 18 unions in 3 districts and accounting for 19 301 births during the final 24 months of the intervention. Interventions Women’s groups at a coverage of 1 per 309 population that proceed through a participatory learning and action cycle in which they prioritize issues that affected maternal and neonatal health and design and implement strategies to address these issues. Main Outcomes and Measures Neonatal mortality rate. Results Analysis included 19 301 births during the final 24 months of the intervention. More than one-third of newly pregnant women joined the groups. The neonatal mortality rate was significantly lower in the intervention arm (21.3 neonatal deaths per 1000 live births vs 30.1 per 1000 in control areas), a reduction in neonatal mortality of 38% (risk ratio, 0.62 [95% CI, 0.43-0.89]) when adjusted for socioeconomic factors. The cost-effectiveness was US $220 to $393 per year of life lost averted. Cause-specific mortality rates suggest reduced deaths due to infections and those associated with prematurity/low birth weight. Improvements were seen in hygienic home delivery practices, newborn thermal care, and breastfeeding practices. Conclusions and Relevance Women’s group community mobilization, delivered

  6. Do registro ao indicador: gestão da produção da informação assistencial nos hospitais From records to indicators: the management of health care information production in hospitals

    Directory of Open Access Journals (Sweden)

    Denise Schout

    2007-08-01

    Full Text Available A valorização da utilização de indicadores assistenciais no monitoramento do desempenho dos sistemas de serviços de saúde cresceu de forma significativa nas últimas décadas. A expansão do Sistema Único de Saúde/SUS e do Sistema de Saúde Suplementar, e as formas de gestão adotadas estimularam o uso de indicadores na avaliação do desempenho, qualidade e segurança nos hospitais, sendo propostos sistemas de indicadores. Não houve uma correspondente preocupação com as condições de produção dos dados e informações para esses indicadores nos serviços de saúde. O artigo discute algumas das condições necessárias para a qualidade nos indicadores para a gestão da assistência nos hospitais: uma cultura de valorização da informação clínica, administrativa e de pesquisa, compartilhada por todos, e a adequada gestão dos registros clínicos, estatísticas hospitalares e sistemas de informações hospitalares. Não existem propostas prontas para a gestão da informação nos hospitais, fazendo-se necessário desenvolver uma capacidade institucional de incorporar e utilizar, na forma mais adequada para cada instituição e contexto, competências e recursos materiais e humanos diversificados, para que a gestão da informação se transforme em um processo dinâmico e parte da gestão do serviço como um todo.Utilization of health care indicators in the monitoring of health system performance has become increasingly important in the last decades. The expansion of the public National Health System, Sistema Único de Saúde/SUS, growth of the private health sector and implementation of specific types of health care regulation models stimulated the utilization of indicators in the evaluation of hospital care quality and performance and proposals of national indicator systems. This was not accompanied with a corresponding investment in the conditions in which the needed data and information are produced in health services. The

  7. The path towards universal health coverage in the Arab uprising countries Tunisia, Egypt, Libya, and Yemen.

    Science.gov (United States)

    Saleh, Shadi S; Alameddine, Mohamad S; Natafgi, Nabil M; Mataria, Awad; Sabri, Belgacem; Nasher, Jamal; Zeiton, Moez; Ahmad, Shaimaa; Siddiqi, Sameen

    2014-01-25

    The constitutions of many countries in the Arab world clearly highlight the role of governments in guaranteeing provision of health care as a right for all citizens. However, citizens still have inequitable health-care systems. One component of such inequity relates to restricted financial access to health-care services. The recent uprisings in the Arab world, commonly referred to as the Arab spring, created a sociopolitical momentum that should be used to achieve universal health coverage (UHC). At present, many countries of the Arab spring are considering health coverage as a priority in dialogues for new constitutions and national policy agendas. UHC is also the focus of advocacy campaigns of a number of non-governmental organisations and media outlets. As part of the health in the Arab world Series in The Lancet, this report has three overarching objectives. First, we present selected experiences of other countries that had similar social and political changes, and how these events affected their path towards UHC. Second, we present a brief overview of the development of health-care systems in the Arab world with regard to health-care coverage and financing, with a focus on Egypt, Libya, Tunisia, and Yemen. Third, we aim to integrate historical lessons with present contexts in a roadmap for action that addresses the challenges and opportunities for progression towards UHC.

  8. The building blocks of health reform: achieving universal coverage and health system savings.

    Science.gov (United States)

    Davis, Karen; Schoen, Cathy; Collins, Sara R

    2008-05-01

    The presidential election has focused public attention on the need for health system reform--to ensure health insurance for all, to make health care more accessible and responsive to patients, and to slow the growth in health care cost. This issue brief sets forth a framework for expanding health coverage that offers Americans a choice of a product modeled on Medicare to those under age 65, made available through a national insurance connector. Coupled with reforms to Medicare provider payment, expansion of preventive health care, and improved information, such a strategy has the potential to achieve near-universal coverage and improve quality and access, while generating health system savings of $1.6 trillion over 10 years.

  9. Conceptualising the lack of health insurance coverage.

    Science.gov (United States)

    Davis, J B

    2000-01-01

    This paper examines the lack of health insurance coverage in the US as a public policy issue. It first compares the problem of health insurance coverage to the problem of unemployment to show that in terms of the numbers of individuals affected lack of health insurance is a problem comparable in importance to the problem of unemployment. Secondly, the paper discusses the methodology involved in measuring health insurance coverage, and argues that the current method of estimation of the uninsured underestimates the extent that individuals go without health insurance. Third, the paper briefly introduces Amartya Sen's functioning and capabilities framework to suggest a way of representing the extent to which individuals are uninsured. Fourth, the paper sketches a means of operationalizing the Sen representation of the uninsured in terms of the disability-adjusted life year (DALY) measure.

  10. Resolution, coverage, and geometry beyond traditional limits

    Energy Technology Data Exchange (ETDEWEB)

    Ronen, Shuki; Ferber, Ralf

    1998-12-31

    The presentation relates to the optimization of the image of seismic data and improved resolution and coverage of acquired data. Non traditional processing methods such as inversion to zero offset (IZO) are used. To realize the potential of saving acquisition cost by reducing in-fill and to plan resolution improvement by processing, geometry QC methods such as DMO Dip Coverage Spectrum (DDCS) and Bull`s Eyes Analysis are used. The DDCS is a 2-D spectrum whose entries consist of the DMO (Dip Move Out) coverage for a particular reflector specified by it`s true time dip and reflector normal strike. The Bull`s Eyes Analysis relies on real time processing of synthetic data generated with the real geometry. 4 refs., 6 figs.

  11. Web based geoprocessing tool for coverage data handling

    Science.gov (United States)

    Kumar, K.; Saran, S.

    2014-11-01

    With the advancements in GIS technologies and extensive use of OGC Web Services, geospatial resources and services are becoming progressively copious and convenient over the network. The application of OGC WCS (Web Coverage Service) and WFS (Web Feature Service) standards for geospatial raster and vector data has resulted in an opulent pool of interoperable geodata resources waiting to be used for analytical or modelling purposes. The issue of availing geospatial data processing with the aid of standardised web services was attended to by the OGC WPS (Web Processing Service) 1.0.0 specifications (Schut, 2007) which elucidate WPS as a standard interface which serves for the promulgation of geo-processes and consumption of those processes by the clients. This paper outlines the design and implementation of a geo-processing tool utilizing coverage data. The geo-process selected for application is the calculation of Normalized Difference Vegetative Index (NDVI), one of the globally used indices for vegetation cover monitoring. The system is realised using the Geospatial Data Abstraction Library (GDAL) and Python. The tool accesses the WCS server using the parameters defined in the XML request. The geo-process upon execution, performs the computations over the coverage data and generates the NDVI output. Since open source technology and standards are being used more often, especially in the field of scientific research, so our implementation is also built by using open source tools only.

  12. The Icelandic media coverage of the constitutional assembly election

    Directory of Open Access Journals (Sweden)

    Guðbjörg Hildur Kolbeins

    2012-12-01

    Full Text Available On November 27, 2010, the people of Iceland elected 25 individuals to the country’s constitutional assembly. As there were 522 candidates for the 25 seats in the assembly, the media were faced with a new dilemma, i.e. how to ensure impartiality and objectivity in their coverage of the candidates and the subject matter. The present study compares the media coverage of the constitutional assembly election to two other national elections; the general election in the spring of 2009 and the municipal election in the spring of 2010. All news stories in the 13 major print, broadcast and online news outlets in Iceland were coded two weeks prior to each election. The results indicate that the national media almost ignored the constitutional assembly election in comparison to the other elections. There were 632 news stories on the general election, 590 stories on the municipal election but only 165 stories on the constitutional assembly election. The lack of coverage of the candidates for the constitutional assembly seems to reveal that the traditional media, i.e. the print and broadcast media, and the online media did not know how to best serve and inform the public in the democratic process.

  13. Health literacy and the Affordable Care Act: a policy analysis for children with special health care needs in the USA

    Directory of Open Access Journals (Sweden)

    Keim-Malpass J

    2015-04-01

    Full Text Available Jessica Keim-Malpass,1 Lisa C Letzkus,1,2 Christine Kennedy1 1University of Virginia School of Nursing, 2University of Virginia Children’s Hospital, Charlottesville, VA, USA Abstract: Children with special health care needs (CSHCN represent populations with chronic health conditions that are often high utilizers of health care. Limited health literacy has emerged as a key indicator of adverse health outcomes, and CSHCN from limited health literacy families are particularly vulnerable. The purpose of this policy analysis is to outline key provisions in the Affordable Care Act (ACA that incorporate health literacy approaches for implementation and have implications for CSHCN in the USA. Several key provisions are incorporated in the ACA that involve health literacy and have implications for CSHCN. These include: expansion of public insurance coverage and simplifying the enrollment process, provisions assuring equity in health care and communication among all populations, improving access to patient-centered medical homes that can offer care coordination, ensuring enhanced medication safety by changing liquid medication labeling requirements, and provisions to train health care providers on literacy issues. More research is needed to determine how provisions pertaining to health literacy in the ACA are implemented in various states. Keywords: children, special health care needs, health literacy, Affordable Care Act, health policy  

  14. The professional perspective on patient involvement in the development of quality indicators: a qualitative analysis using the example of chronic heart failure in the German health care setting

    Directory of Open Access Journals (Sweden)

    Pohontsch NJ

    2015-01-01

    Full Text Available Nadine Janis Pohontsch,1 Heidrun Herzberg,2 Stefanie Joos,3 Felix Welti,4 Martin Scherer,1 Eva Blozik1 1Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamberg, Germany; 2Faculty of Health, Nursing, Management, Neubrandenburg University of Applied Sciences, Neubrandenburg, Germany; 3Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany; 4Faculty of Human Sciences, University of Kassel, Kassel, Germany Purpose: There is an international consensus that quality indicators (QIs of health care ought to represent patient-relevant aspects. Therefore, patient involvement in the development process is essential. However, there is no methodological gold standard for involving patients in QI development. The aim of this study is to explore experts’ views on the representation of patient-relevant aspects in the QI development process using the QIs developed in the context of the German National Disease Management Guideline for Heart Failure as an example. Methods: Semi-structured, open telephone interviews were conducted with 15 German experts (patient representatives, physicians, researchers, and methodologists involved in guideline development or quality assessment. Interview themes were the relevance of the exemplary set of QIs for patients, as well as the legitimacy of, competence of, and collaboration with the patient representative who participated in the development process. Interviews were fully transcribed and content analyzed. Deductive categories derived from the research questions were supplemented by inductively formed categories during the review of the interview material.Results: The qualitative analysis suggests a discrepancy between the guidelines’ QIs and those relevant to patients from an expert’s point of view, such as physician-patient communication and quality of counseling. Experts reported only minor communication and cooperation

  15. Migrant tuberculosis screening in the EU/EEA: yield, coverage and limitations.

    Science.gov (United States)

    Klinkenberg, E; Manissero, D; Semenza, J C; Verver, S

    2009-11-01

    A systematic literature review was performed with the objective of assessing the effectiveness of tuberculosis (TB) screening methods and strategies in migrants in European Union/European Economic Area (including Switzerland) countries. Extracted data on yield and coverage were used as indicators of effectiveness. Reported yields varied considerably between studies and countries. Considering only the 14 studies representative of national screening programmes, a median yield of TB disease of 0.18% (interquartile range 0.10-0.35%) was reported. The data did not indicate differences in effectiveness between the three main strategies: 1) screening at port of entry; 2) screening just after arrival in reception/holding centres; and 3) screening in the community following arrival in European Union countries. The variation seen probably reflects variation in risk factors for TB, in particular the composition of the migrants entering the country. Recommendations include the need for improved data for guiding the optimal frequency and duration of screening; assessment and improvement of cost-effectiveness; access to healthcare for migrants, including illegal migrants; ensuring a continuum of care for those screened; and consideration of screening for latent TB infection with caution. Finally, screening should be a component of a wider approach, rather than a stand-alone intervention.

  16. [Increasing immunization coverage in adults and elderly by creating structural relationships with general practitioners].

    Science.gov (United States)

    Conversano, M; Busatta, M; Cipriani, R; Battista, T; Sponselli, G M; Caputi, G; Pesare, A

    2012-01-01

    In order to reach vaccination coverage in adults, the elderly and in high risk subjects, a tight network of collaboration between preventive medicine specialists and general practitioners must be created in the same way that they must be created with pediatricians. In fact, this strategy has brought about very high coverage rates in childhood vaccinations. The solution to propose once again would thus be to develop partnerships between the protagonists of the network (community health district, department of prevention, general practitioners, primary care physicians) so that synergies may be created which permit the realisation of common and specific training programs.

  17. Measuring progress towards universal health coverage: with an application to 24 developing countries

    OpenAIRE

    2016-01-01

    textabstractThe last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. We propose a ‘mashup’ index that captures both aspects of UHC: that everyone—irrespective of their ability-to-pay—gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care. We break service coverage into prevention and treatment, and financial protection into i...

  18. Drug coverage insurance as a novel element of private health insurance in Poland.

    Science.gov (United States)

    Czerw, Aleksandra; Religioni, Urszula

    2013-01-01

    In recent years, there have been observed increased costs of health care in Poland. The patient's out of pocket expenses on drug have grown too. To the above, the insurance companies have offered patients drug coverage insurance policies since recently. Drug insurance policy covers the cost of purchasing pharmaceutical products not reimbursed by the National Health Fund is a modern product on the Polish health insurance market. The aim of the article is to characterize drug coverage insurance policies on the health insurance market in Poland. The Polish insurance market and entities offered these types of insurance are also presented.

  19. Extreme sports: injuries and medical coverage.

    Science.gov (United States)

    Young, Craig C

    2002-10-01

    Extreme sports (including in-line skating, snowboarding, mountain bicycling, extreme skiing, rock climbing, indoor tackle football, kickboxing, skateboarding, and ultra-endurance racing) are growing in popularity. Often these sports are designed to expose athletes to greater thrills and risks than are found in traditional sporting activities. Despite this increased risk of injury, athletes competing in these sports often have little or no formal medical coverage. This article reviews what is known about this emerging area of sports medicine to assist physicians in preparing for medical coverage of these athletes and their competitions.

  20. Rodeo medicine: considerations in event coverage.

    Science.gov (United States)

    Young, Eliot J; Markey, Keith L

    2010-01-01

    Rodeo is an increasingly popular but dangerous sport, with injury rates higher than any other sport. While there are several organizations that oversee many of the rodeo competitions in the U.S., most events are non-sanctioned. Several factors contribute to the risk for injury, and medical coverage is usually volunteer-based. This article describes the common events that occur in most rodeo competitions, highlights the injuries most often documented in rodeo injury reporting, and suggests guidelines for preparation of medical coverage of a typical rodeo event.

  1. Extracellular polymeric bacterial coverages as minimal surfaces

    CERN Document Server

    Saa, A; Saa, Alberto; Teschke, Omar

    2005-01-01

    Surfaces formed by extracellular polymeric substances enclosing individual and some small communities of {\\it Acidithiobacillus ferrooxidans} on plates of hydrophobic silicon and hydrophilic mica are analyzed by means of atomic force microscopy imaging. Accurate nanoscale descriptions of such coverage surfaces are obtained. The good agreement with the predictions of a rather simple but realistic theoretical model allows us to conclude that they correspond, indeed, to minimal area surfaces enclosing a given volume associated with the encased bacteria. This is, to the best of our knowledge, the first shape characterization of the coverage formed by these biomolecules, with possible applications to the study of biofilms.

  2. Emerging challenges in implementing universal health coverage in Asia.

    Science.gov (United States)

    Bredenkamp, Caryn; Evans, Timothy; Lagrada, Leizel; Langenbrunner, John; Nachuk, Stefan; Palu, Toomas

    2015-11-01

    As countries in Asia converge on the goal of universal health coverage (UHC), some common challenges are emerging. One is how to ensure coverage of the informal sector so as to make UHC truly universal; a second is how to design a benefit package that is responsive and appropriate to current health challenges, yet fiscally sustainable; and a third is how to ensure "supply-side readiness", i.e. the availability and quality of services, which is a necessary condition for translating coverage into improvements in health outcomes. Using examples from the Asia region, this paper discusses these three challenges and how they are being addressed. On the first challenge, two promising approaches emerge: using general revenues to fully cover the informal sector, or employing a combination of tax subsidies, non-financial incentives and contributory requirements. The former can produce fast results, but places pressure on government budgets and may induce informality, while the latter will require a strong administrative mandate and systems to track the ability-to-pay. With respect to benefit packages, we find considerable variation in the nature and rigor of processes underlying the selection and updating of the services included. Also, in general, packages do not yet focus sufficiently on non-communicable diseases (NCDs) and related preventive outpatient care. Finally, there are large variations and inequities in the supply-side readiness, in terms of availability of infrastructure, equipment, essential drugs and staffing, to deliver on the promises of UHC. Health worker competencies are also a constraint. While the UHC challenges are common, experience in overcoming these challenges is varied and many of the successes appear to be highly context-specific. This implies that researchers and policymakers need to rigorously, and regularly, assess different approaches, and share these findings across countries in Asia - and across the world.

  3. Indonesia's road to universal health coverage: a political journey.

    Science.gov (United States)

    Pisani, Elizabeth; Olivier Kok, Maarten; Nugroho, Kharisma

    2016-09-06

    In 2013 Indonesia, the world's fourth most populous country, declared that it would provide affordable health care for all its citizens within seven years. This crystallised an ambition first enshrined in law over five decades earlier, but never previously realised. This paper explores Indonesia's journey towards universal health coverage (UHC) from independence to the launch of a comprehensive health insurance scheme in January 2014. We find that Indonesia's path has been determined largely by domestic political concerns - different groups obtained access to healthcare as their socio-political importance grew.A major inflection point occurred following the Asian financial crisis of 1997. To stave off social unrest, the government provided health coverage for the poor for the first time, creating a path dependency that influenced later policy choices. The end of this programme coincided with decentralisation, leading to experimentation with several different models of health provision at the local level. When direct elections for local leaders were introduced in 2005, popular health schemes led to success at the polls. UHC became an electoral asset, moving up the political agenda. It also became contested, with national policy-makers appropriating health insurance programmes that were first developed locally, and taking credit for them.The Indonesian experience underlines the value of policy experimentation, and of a close understanding of the contextual and political factors that drive successful UHC models at the local level. Specific drivers of success and failure should be taken into account when scaling UHC to the national level. In the Indonesian example, UHC became possible when the interests of politically and economically influential groups were either satisfied or neutralised. While technical considerations took a back seat to political priorities in developing the structures for health coverage nationally, they will have to be addressed going forward to

  4. 42 CFR 440.330 - Benchmark health benefits coverage.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Benchmark health benefits coverage. 440.330 Section... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Benchmark Benefit and Benchmark-Equivalent Coverage § 440.330 Benchmark health benefits coverage. Benchmark coverage is...

  5. 20 CFR 404.1412 - Compensation quarters of coverage.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Compensation quarters of coverage. 404.1412... the Railroad Retirement Program § 404.1412 Compensation quarters of coverage. As used in this subpart, a compensation quarter of coverage is any quarter of coverage computed with respect to...

  6. 29 CFR 2.13 - Audiovisual coverage prohibited.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Audiovisual coverage prohibited. 2.13 Section 2.13 Labor Office of the Secretary of Labor GENERAL REGULATIONS Audiovisual Coverage of Administrative Hearings § 2.13 Audiovisual coverage prohibited. The Department shall not permit audiovisual coverage of...

  7. 42 CFR 457.1010 - Purchase of family coverage.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Purchase of family coverage. 457.1010 Section 457... Waivers: General Provisions § 457.1010 Purchase of family coverage. A State may purchase family coverage that includes coverage for targeted low-income children if the State establishes that— (a) Purchase...

  8. 7 CFR 1737.31 - Area Coverage Survey (ACS).

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false Area Coverage Survey (ACS). 1737.31 Section 1737.31... Studies-Area Coverage Survey and Loan Design § 1737.31 Area Coverage Survey (ACS). (a) The Area Coverage Survey (ACS) is a market forecast of service requirements of subscribers in a proposed service area....

  9. Evaluating Living Standard Indicators

    Directory of Open Access Journals (Sweden)

    Birčiaková Naďa

    2015-09-01

    Full Text Available This paper deals with the evaluation of selected available indicators of living standards, divided into three groups, namely economic, environmental, and social. We have selected six countries of the European Union for analysis: Bulgaria, the Czech Republic, Hungary, Luxembourg, France, and Great Britain. The aim of this paper is to evaluate indicators measuring living standards and suggest the most important factors which should be included in the final measurement. We have tried to determine what factors influence each indicator and what factors affect living standards. We have chosen regression analysis as our main method. From the study of factors, we can deduce their impact on living standards, and thus the value of indicators of living standards. Indicators with a high degree of reliability include the following factors: size and density of population, health care and spending on education. Emissions of carbon dioxide in the atmosphere also have a certain lower degree of reliability.

  10. On Connected Target k-Coverage in Heterogeneous Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Jiguo Yu

    2016-01-01

    Full Text Available Coverage and connectivity are two important performance evaluation indices for wireless sensor networks (WSNs. In this paper, we focus on the connected target k-coverage (CTC k problem in heterogeneous wireless sensor networks (HWSNs. A centralized connected target k-coverage algorithm (CCTC k and a distributed connected target k-coverage algorithm (DCTC k are proposed so as to generate connected cover sets for energy-efficient connectivity and coverage maintenance. To be specific, our proposed algorithms aim at achieving minimum connected target k-coverage, where each target in the monitored region is covered by at least k active sensor nodes. In addition, these two algorithms strive to minimize the total number of active sensor nodes and guarantee that each sensor node is connected to a sink, such that the sensed data can be forwarded to the sink. Our theoretical analysis and simulation results show that our proposed algorithms outperform a state-of-art connected k-coverage protocol for HWSNs.

  11. [Relationships between understory vegetation coverage and environmental factors in Pinus massoniana plantations from aerial seeding].

    Science.gov (United States)

    Zhao, Fang; Ouyang, Xun-zhi

    2015-04-01

    The relationships between understory vegetation coverage and environmental factors in Pinus massoniana plantations from aerial seeding were studied by using principal component analysis, redundancy analysis and variation partitioning. The selected environmental factors in total explained 74.2% variation of the understory vegetation coverage. At low altitude, stand characteristics were the key factor to influence the understory vegetation coverage. Stand characteristics, soil property and topographic factor were respectively explained 55.0% (including 29.1% for separateness and 25.9% for interaction with other factors), 38. 9% (including 12.1% for separateness and 26.8% for interaction with other factors) and 9.0% (including 5.6% for separateness and 3.4% for interaction with other factors) of the total variation. Average diameter at breast height and canopy density affected mostly and positively correlated with the coverage of bryophyta, graminoid and shurb groups at significant level. Noncapillary porosity and soil water content showed a highly significant positive correlation to dicranopteris coverage, whereas average diameter at breast height, canopy density, soil nutrients and enzyme activity significantly negatively correlated with it. The coverage of graminoid, bryophyta and shurb groups showed the positive correlations, which indicated the three groups could promote each other, while the dicranopteris coverage had significant negative correlation with the three groups mentioned above.

  12. On Connected Target k-Coverage in Heterogeneous Wireless Sensor Networks.

    Science.gov (United States)

    Yu, Jiguo; Chen, Ying; Ma, Liran; Huang, Baogui; Cheng, Xiuzhen

    2016-01-15

    Coverage and connectivity are two important performance evaluation indices for wireless sensor networks (WSNs). In this paper, we focus on the connected target k-coverage (CTC k) problem in heterogeneous wireless sensor networks (HWSNs). A centralized connected target k-coverage algorithm (CCTC k) and a distributed connected target k-coverage algorithm (DCTC k) are proposed so as to generate connected cover sets for energy-efficient connectivity and coverage maintenance. To be specific, our proposed algorithms aim at achieving minimum connected target k-coverage, where each target in the monitored region is covered by at least k active sensor nodes. In addition, these two algorithms strive to minimize the total number of active sensor nodes and guarantee that each sensor node is connected to a sink, such that the sensed data can be forwarded to the sink. Our theoretical analysis and simulation results show that our proposed algorithms outperform a state-of-art connected k-coverage protocol for HWSNs.

  13. Coverage analysis for sensor networks based on Clifford algebra

    Institute of Scientific and Technical Information of China (English)

    XIE WeiXin; CAO WenMing; MENG Shan

    2008-01-01

    The coverage performance is the foundation of information acquisition in distrib-uted sensor networks. The previously proposed coverage work was mostly based on unit disk coverage model or ball coverage model in 2D or 3D space, respectively. However, most methods cannot give a homogeneous coverage model for targets with hybrid types. This paper presents a coverage analysis approach for sensor networks based on Clifford algebra and establishes a homogeneous coverage model for sensor networks with hybrid types of targets. The effectiveness of the approach is demonstrated with examples.

  14. Social indicators.

    Science.gov (United States)

    Sheldon, E B; Parke, R

    1975-05-16

    The notions of social indicators and social accounting, expressed by analogy with the national economic accounts, generated excitement in the 1960's, and the interest continues to grow if we may judge from governmental activity and the publication of programmatic and research papers. But the concepts which focused much of the early enthusiasm gave exaggerated promise of policy applications and provided an unproductive basis for research. The essential theoretical prerequisites for developing a system of social accounts-defining the variables and the interrelationships among them-are missing. It is now realized that evaluation research, particularly experimentation, must be relied on for evaluation of government programs. Through the development and analysis of descriptive time series and the modeling of social processes, we will be able to describe the state of the society and its dynamics and thus improve immensely our ability to state problems in a productive fashion, obtain clues as to promising lines of endeavor, and ask good questions. But these activities cannot measure program effectiveness. Finally, we must be skeptical about definitions of the social indicators enterprise which confine it to social engineering efforts. The issue is not whether social indicators are useful for policy but, rather, how this usefulness comes about. The interest in social indicators has stimulated a revival of interest in quantitative, comparative, social analysis (60), in the analysis of social change, in conceptual and measurement work on such topics as prejudice, crime, and learning, and in the development of models of social processes. The fruit of these efforts will be more directly a contribution to the policy-maker's cognition than to his decisions. Decision emerges from a mosaic of inputs, including valuational and political, as well as technical components. The work we have described deals with only one type of input; it is a contribution to the intellectual mapping

  15. 2010 A(H1N1 vaccination in pregnant women in Brazil: identifying coverage and associated factors

    Directory of Open Access Journals (Sweden)

    Raul Andres Mendoza-Sassi

    2015-06-01

    Full Text Available We studied vaccination coverage and its associated factors in the 2010 pandemic influenza vaccination of Brazilian pregnant women. A cross-sectional study of pregnant women who had given birth was performed in a municipality in southern Brazil, in 2010. Data about vaccination against A(H1N1 and sociodemographic characteristics, morbidities and prenatal care were collected. Statistical analysis was performed using a Poisson regression. Coverage was 77.4%. Most were vaccinated in the public sector (97.6% and in the second trimester (47%. Associated factors that increased vaccination were marriage, older age, first income quartile, prenatal care and influenza before pregnancy. Education and skin color were not significantly associated with vaccination. The vaccination campaign was extensive and exhibited no inequality. Prenatal care was the factor that most affected vaccination coverage, reflecting its importance for vaccination campaign success.

  16. A Survey on Coverage Control Protocols in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    V.Nivedhitha

    2013-04-01

    Full Text Available Coverage control algorithms play an important role in Wireless sensor network. Effective coverage control algorithms sense its coverage area with less energy spent. These coverage control models falls under various approaches like clustering, evolutionary, mobility based approaches. This paper makes a detailed survey on coverage control protocols coming under various classifications. In addition, it also discussed several protocols working mechanism with its evaluation metrics.

  17. The 2007-09 recession and health insurance coverage.

    Science.gov (United States)

    Holahan, John

    2011-01-01

    Loss of employment and declining incomes meant that five million Americans lost employment-based health insurance during the recent economic recession (2007-09). All groups of Americans were affected, but the growth in the number of uninsured people was particularly noticeable for whites, native-born citizens, and residents of the Midwest and South. Adults did not benefit nearly as much as children from public programs designed to offset the decline in employer-sponsored insurance and thus bore all of the burden of rising uninsurance. Throughout the past decade, even in good economic times, the number of Americans with employer-sponsored insurance has fallen, and the number of uninsured Americans has increased. This finding underscores the importance of planned coverage expansions under the Affordable Care Act.

  18. Priority-setting for achieving universal health coverage.

    Science.gov (United States)

    Chalkidou, Kalipso; Glassman, Amanda; Marten, Robert; Vega, Jeanette; Teerawattananon, Yot; Tritasavit, Nattha; Gyansa-Lutterodt, Martha; Seiter, Andreas; Kieny, Marie Paule; Hofman, Karen; Culyer, Anthony J

    2016-06-01

    Governments in low- and middle-income countries are legitimizing the implementation of universal health coverage (UHC), following a United Nation's resolution on UHC in 2012 and its reinforcement in the sustainable development goals set in 2015. UHC will differ in each country depending on country contexts and needs, as well as demand and supply in health care. Therefore, fundamental issues such as objectives, users and cost-effectiveness of UHC have been raised by policy-makers and stakeholders. While priority-setting is done on a daily basis by health authorities - implicitly or explicitly - it has not been made clear how priority-setting for UHC should be conducted. We provide justification for explicit health priority-setting and guidance to countries on how to set priorities for UHC.

  19. Aplicabilidade de indicador de qualidade subjetivo em Terapia Intensiva Aplicación de indicadores subjectivos de calidad en Terapia Intensiva Application of subjective quality indicators in Intensive Care

    Directory of Open Access Journals (Sweden)

    Sônia Regina de Oliveira e Silva de Souza

    2006-04-01

    , 2004. Thirty-two clients participated in this study just after hospital discharge. Data collection was possible through a questionaire. We consider that the clients showed some kind of satisfaction related to nursing intensive care, and the problem that really annoys them is the physical and ambiental stressors. The study shows questions that need a continuous discussion considering the stress, once it is a part of the activities and the atmosphere of intensive care and it also detaches the relavence of a work using indicatives of subjective quality in the Intensive Care.

  20. 76 FR 7767 - Student Health Insurance Coverage

    Science.gov (United States)

    2011-02-11

    ... Proposed Rule A. Introduction The U.S. Government Accountability Office (GAO) has estimated that most... employees. 62 FR 16985, 16992 (April 8, 1997). As noted earlier in the introduction, it is believed that... student health insurance coverage to revise or amend their current business or marketing agreements...

  1. Open Problem: Analyzing Ant Robot Coverage

    Science.gov (United States)

    2010-01-01

    Efficient and inefficient ant coverage methods. Annals of Mathematics and Artificial Intelligence, 31, 41–76. The proofs can be found in the technical...Wagner, I., & Bruckstein, A. (2001). Special issue on ant robotics. Annals of Mathematics and Artificial Intelligence, 31. Wagner, I., Lindenbaum, M

  2. Binning metagenomic contigs by coverage and composition

    NARCIS (Netherlands)

    Alneberg, J.; Bjarnason, B.S.; Bruijn, de I.; Schirmer, M.; Quick, J.; Ijaz, U.Z.; Lahti, L.M.; Loman, N.J.; Andersson, A.F.; Quince, C.

    2014-01-01

    Shotgun sequencing enables the reconstruction of genomes from complex microbial communities, but because assembly does not reconstruct entire genomes, it is necessary to bin genome fragments. Here we present CONCOCT, a new algorithm that combines sequence composition and coverage across multiple sam

  3. 44 CFR 17.610 - Coverage.

    Science.gov (United States)

    2010-10-01

    ... SECURITY GENERAL GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (GRANTS) § 17.610 Coverage. (a) This... the laws or regulations of a foreign government. A determination of such inconsistency may be made only by the agency head or his/her designee. (c) The provisions of 2 CFR part 3000 apply to...

  4. 5 CFR 930.103 - Coverage.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Coverage. 930.103 Section 930.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED... ensure the safe and efficient operation of such vehicles....

  5. Dynamic Coverage of Mobile Sensor Networks

    CERN Document Server

    Liu, Benyuan; Nain, Philippe; Towsley, Don

    2011-01-01

    In this paper we study the dynamic aspects of the coverage of a mobile sensor network resulting from continuous movement of sensors. As sensors move around, initially uncovered locations are likely to be covered at a later time. A larger area is covered as time continues, and intruders that might never be detected in a stationary sensor network can now be detected by moving sensors. However, this improvement in coverage is achieved at the cost that a location is covered only part of the time, alternating between covered and not covered. We characterize area coverage at specific time instants and during time intervals, as well as the time durations that a location is covered and uncovered. We further characterize the time it takes to detect a randomly located intruder. For mobile intruders, we take a game theoretic approach and derive optimal mobility strategies for both sensors and intruders. Our results show that sensor mobility brings about unique dynamic coverage properties not present in a stationary sens...

  6. 5 CFR 630.602 - Coverage.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 630.602 Section 630.602 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ABSENCE AND LEAVE Home Leave... Code, for the accumulation of a maximum of 45 days of annual leave earns and may be granted home...

  7. Immunization coverage: role of sociodemographic variables.

    Science.gov (United States)

    Sharma, Bhuwan; Mahajan, Hemant; Velhal, G D

    2013-01-01

    Children are considered fully immunized if they receive one dose of BCG, three doses of DPT and polio vaccine each, and one measles vaccine. In India, only 44% of children aged 12-23 months are fully vaccinated and about 5% have not received any vaccination at all. Even if national immunization coverage levels are sufficiently high to block disease transmission, pockets of susceptibility may act as potential reservoirs of infection. This study was done to assess the immunization coverage in an urban slum area and determine various sociodemographic variables affecting the same. A total of 210 children were selected from study population using WHO's 30 cluster sampling method. Coverage of BCG was found to be the highest (97.1%) while that of measles was the lowest. The main reason for noncompliance was given as child's illness at the time of scheduled vaccination followed by lack of knowledge regarding importance of immunization. Low education status of mother, high birth order, and place of delivery were found to be positively associated with low vaccination coverage. Regular IEC activities (group talks, role plays, posters, pamphlets, and competitions) should be conducted in the community to ensure that immunization will become a "felt need" of the mothers in the community.

  8. Spatial Coverage Planning for Exploration Robots

    Science.gov (United States)

    Gaines, Daniel; Estlin, Tara; Chouinard, Caroline

    2007-01-01

    A report discusses an algorithm for an onboard planning and execution technology to support the exploration and characterization of geological features by autonomous rovers. A rover that is capable of deciding which observations are more important relieves the engineering team from much of the burden of attempting to make accurate predictions of what the available rover resources will be in the future. Instead, the science and engineering teams can uplink a set of observation requests that may potentially oversubscribe resources and let the rover use observation priorities and its current assessment of available resources to make decisions about which observations to perform and when to perform them. The algorithm gives the rover the ability to model spatial coverage quality based on data from different scientific instruments, to assess the impact of terrain on coverage quality, to incorporate user-defined priorities among subregions of the terrain to be covered, and to update coverage quality rankings of observations when terrain knowledge changes. When the rover is exploring large geographical features such as craters, channels, or boundaries between two different regions, an important factor in assessing the quality of a mission plan is how the set of chosen observations spatially cover the area of interest. The algorithm allows the rover to evaluate which observation to perform and to what extent the candidate observation will increase the spatial coverage of the plan.

  9. 5 CFR 730.103 - Coverage.

    Science.gov (United States)

    2010-01-01

    ...) NOTIFICATION OF POST-EMPLOYMENT RESTRICTIONS § 730.103 Coverage. (a) The following individuals are subject to the post-employment conflict-of-interest restrictions in 18 U.S.C. 207(c), as amended by section 1125... executive, who is paid at a rate of basic pay equal to or greater than 86.5 percent of the rate for level...

  10. 29 CFR 1603.101 - Coverage.

    Science.gov (United States)

    2010-07-01

    ... STATE AND LOCAL GOVERNMENT EMPLOYEE COMPLAINTS OF EMPLOYMENT DISCRIMINATION UNDER SECTION 304 OF THE GOVERNMENT EMPLOYEE RIGHTS ACT OF 1991 Administrative Process § 1603.101 Coverage. Section 304 of the Government Employee Rights Act of 1991 applies to employment, which includes application for employment,...

  11. True Public Access Defibrillator Coverage is Overestimated

    NARCIS (Netherlands)

    Sun, Christopher L.F.; Demirtas, Derya; Brooks, Steven C.; Morrison, Laurie J.; Chan, Timothy C.Y.

    2015-01-01

    Background: Out-of-hospital cardiac arrests (OHCAs) occur at all times of the day and night. Immediate access to an AED increases survival. However, most public-location AEDs are placed in buildings without 24 hour access. Objective: To measure fixed-location public AED coverage of OHCAs by time

  12. 5 CFR 890.102 - Coverage.

    Science.gov (United States)

    2010-01-01

    ... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL... appointment established under § 772.102 of this chapter. (e) The Office of Personnel Management makes the... his/her coverage or the determination of when 365 days in nonpay status ends....

  13. 5 CFR 734.401 - Coverage.

    Science.gov (United States)

    2010-01-01

    ... United States Customs Service; (12) The Office of Law Enforcement of the Bureau of Alcohol, Tobacco, and... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) POLITICAL ACTIVITIES OF FEDERAL EMPLOYEES Employees in Certain Agencies and Positions § 734.401 Coverage....

  14. Determinants of vaccination coverage in rural Nigeria

    Directory of Open Access Journals (Sweden)

    Meurice Francois P

    2008-11-01

    Full Text Available Abstract Background Childhood immunization is a cost effective public health strategy. Expanded Programme on Immunisation (EPI services have been provided in a rural Nigerian community (Sabongidda-Ora, Edo State at no cost to the community since 1998 through a privately financed vaccination project (private public partnership. The objective of this survey was to assess vaccination coverage and its determinants in this rural community in Nigeria Methods A cross-sectional survey was conducted in September 2006, which included the use of interviewer-administered questionnaire to assess knowledge of mothers of children aged 12–23 months and vaccination coverage. Survey participants were selected following the World Health Organization's (WHO immunization coverage cluster survey design. Vaccination coverage was assessed by vaccination card and maternal history. A child was said to be fully immunized if he or she had received all of the following vaccines: a dose of Bacille Calmette Guerin (BCG, three doses of oral polio (OPV, three doses of diphtheria, pertussis and tetanus (DPT, three doses of hepatitis B (HB and one dose of measles by the time he or she was enrolled in the survey, i.e. between the ages of 12–23 months. Knowledge of the mothers was graded as satisfactory if mothers had at least a score of 3 out of a maximum of 5 points. Logistic regression was performed to identify determinants of full immunization status. Results Three hundred and thirty-nine mothers and 339 children (each mother had one eligible child were included in the survey. Most of the mothers (99.1% had very positive attitudes to immunization and > 55% were generally knowledgeable about symptoms of vaccine preventable diseases except for difficulty in breathing (as symptom of diphtheria. Two hundred and ninety-five mothers (87.0% had a satisfactory level of knowledge. Vaccination coverage against all the seven childhood vaccine preventable diseases was 61.9% although it

  15. Cervical cancer screening policies and coverage in Europe

    DEFF Research Database (Denmark)

    Anttila, Ahti; von Karsa, Lawrence; Aasmaa, Auni;

    2009-01-01

    The aim of the study was to compare current policy, organisation and coverage of cervical cancer screening programmes in the European Union (EU) member states with European and other international recommendations. According to the questionnaire-based survey, there are large variations in cervical...... with education, training and communication among women, medical professionals and authorities are required, accordingly. The study indicates that, despite substantial efforts, the recommendations of the Council of the EU on organised population-based screening for cervical cancer are not yet fulfilled. Decision......-makers and health service providers should consider stronger measures or incentives in order to improve cervical cancer control in Europe....

  16. GIS coverages of the Castle Mountain Fault, south central Alaska

    Science.gov (United States)

    Labay, Keith A.; Haeussler, Peter J.

    2001-01-01

    The Castle Mountain fault is one of several major east-northeast-striking faults in southern Alaska, and it is the only fault with had historic seismicity and Holocene surface faulting. This report is a digital compilation of three maps along the Castle Mountain fault in south central Alaska. This compilation consists only of GIS coverages of the location of the fault, line attributes indicating the certainty of the fault location, and information about scarp height, where measured. The files are presented in ARC/INFO export file format and include metadata.

  17. Influenza vaccination coverage among medical residents: an Italian multicenter survey.

    Science.gov (United States)

    Costantino, Claudio; Mazzucco, Walter; Azzolini, Elena; Baldini, Cesare; Bergomi, Margherita; Biafiore, Alessio Daniele; Bianco, Manuela; Borsari, Lucia; Cacciari, Paolo; Cadeddu, Chiara; Camia, Paola; Carluccio, Eugenia; Conti, Andrea; De Waure, Chiara; Di Gregori, Valentina; Fabiani, Leila; Fallico, Roberto; Filisetti, Barbara; Flacco, Maria E; Franco, Elisabetta; Furnari, Roberto; Galis, Veronica; Gallea, Maria R; Gallone, Maria F; Gallone, Serena; Gelatti, Umberto; Gilardi, Francesco; Giuliani, Anna R; Grillo, Orazio C; Lanati, Niccolò; Mascaretti, Silvia; Mattei, Antonella; Micò, Rocco; Morciano, Laura; Nante, Nicola; Napoli, Giuseppe; Nobile, Carmelo Giuseppe; Palladino, Raffaele; Parisi, Salvatore; Passaro, Maria; Pelissero, Gabriele; Quarto, Michele; Ricciardi, Walter; Romano, Gabriele; Rustico, Ennio; Saponari, Anita; Schioppa, Francesco S; Signorelli, Carlo; Siliquini, Roberta; Trabacchi, Valeria; Triassi, Maria; Varetta, Alessia; Ziglio, Andrea; Zoccali, Angela; Vitale, Francesco; Amodio, Emanuele

    2014-01-01

    Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011-2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P<0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011-2012 season (P<0.001). "To avoid spreading influenza among patients" was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future.

  18. International measles incidence and immunization coverage.

    Science.gov (United States)

    Hall, Robert; Jolley, Damien

    2011-07-01

    Measles is exquisitely sensitive to immunization programs. We investigated the decline in measles incidence after immunization with 1 or 2 doses of measles-containing vaccine (MCV), with or without supplementary immunization activities (SIAs). Using data from the World Health Organization, we modeled the impact of measles immunization using a negative binomial regression model. All countries offer measles immunization, and 192 of 193 countries offer a second dose of MCV (MCV2), using either a routine second dose, SIAs, or both. The incidence of measles fell from a median of 70.9 cases/100,000/year when coverage with a first dose of MCV (MCV1) was in the range of 0%-39% to a median of .9 cases/100,000/year when MCV1 coverage was 90%-100%, in both cases with no MCV2. Further reductions followed the introduction of MCV2 and SIAs. Modeling showed that each 1% increase in MCV1 coverage was followed by a 2.0% decrease in incidence in the same and following years (95% confidence interval [CI], 2.0%-1.9%, and 2.1%-1.9%, respectively). For a second dose, a rise of 1% in MCV2 coverage was followed by a decrease in measles incidence by .4% (95% CI, .3%-.5%) in the same year and .3% (95% CI, .2%-.5%) in the following year. SIAs were followed by decreases of measles incidence by 40.3% (95% CI, 46.3%-33.8%) in the same year and 45.2% (95% CI, 51.1%-48.7%) in the following year. A herd immunity effect was demonstrated with MCV1 coverage of >80%, and SIAs are an extraordinarily effective strategy for measles control.

  19. Treatment of osteoporosis in an older home care population

    Directory of Open Access Journals (Sweden)

    Maxwell Colleen J

    2005-02-01

    Full Text Available Abstract Background Previous research indicates that many patients with fractures indicative of underlying osteoporosis are not receiving appropriate diagnostic follow-up and therapy. We assessed osteoporosis treatment coverage in older home care clients with a diagnosis of osteoporosis and/or prevalent fracture. Methods Subjects included 330 home care clients, aged 65+, participating in a longitudinal study of medication adherence and health-related outcomes. Data on clients' demographic, health and functional status and service utilization patterns were collected using the Minimum Data Set for Home Care (MDS-HC. A medication review included prescribed and over-the-counter medications taken in the past 7 days. Criteria for indications for osteoporosis therapy included diagnosis of osteoporosis or a recent fracture. Coverage for treatment was examined for anti-osteoporotic therapies approved for use in 2000. Results Of the 330 home care clients, 78 (24% had a diagnosis of osteoporosis (n = 47 and/or had sustained a recent fracture (n = 34. Drug data were available for 77/78 subjects. Among the subjects with osteoporosis or a recent fracture, 45.5% were receiving treatment for osteoporosis; 14% were receiving only calcium and vitamin D, and an additional 31% were receiving drug therapy (bisphosphonate or hormone replacement therapy. The remaining 54.5% of subjects were not receiving any approved osteoporosis therapy. Conclusions The high prevalence of undertreatment among a population of older adults with relatively high access to health care services raises concern regarding the adequacy of diagnosis and treatment of osteoporosis in the community.

  20. Promoting Justices: Media Coverage of Judicial Nominations in Israel

    Directory of Open Access Journals (Sweden)

    Bryna Bogoch

    2014-10-01

    Full Text Available This paper compares the framing of the coverage of judicial appointments in Israel in 2008 in two newspapers with nomination news from preceding years and to the patterns of press coverage in the U.S. A content analysis of 101 Supreme Court nomination articles indicated that unlike the political frame of American coverage, the press in Israel preserves its ostensible commitment to the professionalism of judges while linking the Supreme Court to political maneuvering in the selection of candidates. These findings are discussed within the context of the media's role in constructing judicial nominations as a debate about the role of the Supreme Court in Israeli society. Este artículo compara el marco de la cobertura de los nombramientos judiciales en Israel en 2008 en dos periódicos, con noticias de nombramientos de años anteriores y en los Estados Unidos, con los patrones de cobertura de prensa en los EE.UU. Un análisis de contenido de 101 artículos de nombramientos de la Corte Suprema indicó que, a diferencia del marco político de la cobertura de América, la prensa en Israel consierva su aparente compromiso con la profesionalidad de los jueces, a pesar de que relaciona la Corte Suprema con maniobras políticas en la selección de candidatos. Estos resultados se discuten en el contexto del papel de los medios de comunicación en la construcción de los nombramientos judiciales como un debate sobre el papel de la Corte Suprema en la sociedad israelí. DOWNLOAD THIS PAPER FROM SSRN: http://ssrn.com/abstract=2478756

  1. Public Health Workers and Vaccination Coverage in Eastern China: A Health Economic Analysis

    Directory of Open Access Journals (Sweden)

    Yu Hu

    2014-05-01

    no effect on vaccination coverage. Conclusions: A higher density of PHWs (VP would improve the availability of immunization services over time and space, which may increase the possibility of achieving a higher childhood vaccination coverage rate. It was indicated that the level of GDP per person had no association with the improved vaccination coverage after controlling for other potential factors. Our findings implicated that PHW density was a major constraint on immunization coverage in Zhejiang Province.

  2. Insights into the effect of coverage on CO adsorption and dissociation over Rh(1 0 0) surface: A theoretical study

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Xiaojun [Key Laboratory of Coal Science and Technology of Ministry of Education and Shanxi Province, Taiyuan University of Technology, Taiyuan 030024, Shanxi (China); Zhang, Riguang, E-mail: zhangriguang@tyut.edu.cn [Key Laboratory of Coal Science and Technology of Ministry of Education and Shanxi Province, Taiyuan University of Technology, Taiyuan 030024, Shanxi (China); Ling, Lixia [Key Laboratory of Coal Science and Technology of Ministry of Education and Shanxi Province, Taiyuan University of Technology, Taiyuan 030024, Shanxi (China); Research Institute of Special Chemicals, Taiyuan University of Technology, Taiyuan 030024, Shanxi (China); Wang, Baojun, E-mail: wangbaojun@tyut.edu.cn [Key Laboratory of Coal Science and Technology of Ministry of Education and Shanxi Province, Taiyuan University of Technology, Taiyuan 030024, Shanxi (China)

    2014-11-30

    Graphical abstract: - Highlights: • The adsorption energies gradually decrease with the increasing of CO coverage on Rh(1 0 0). • CO reaches the saturated adsorption with the coverage of 12/12 ML on Rh(1 0 0). • Both CO desorption and dissociation co-exist at the coverage less than or equal to 2/12 ML. • Only molecule CO adsorption is favored at the coverage greater than or equal to 3/12 ML. • Only molecule CO adsorption form exists in syngas conversion on Rh catalyst. - Abstract: The adsorption, dissociation and desorption of CO at different coverage over Rh(1 0 0) surface have been systematically investigated using density functional theory method together with the periodic slab model. Our results show that at the coverage less than or equal to 4/12 ML, CO favored the most stable bridge site adsorption, and the adsorption energies of CO have little difference; while at the coverage greater than or equal to 5/12 ML, the lateral repulsive interaction begins to affect the adsorption structures and the corresponding adsorption energies of adsorbed CO molecules, and the interaction will be stronger with the increasing of CO coverage, which leads to CO migration over Rh(1 0 0) surface when CO coverage is greater than or equal to 10/12 ML. The adsorption energies of these CO molecules will decrease successively until the saturated adsorption with the CO coverage of 12/12 ML. Further calculations on CO dissociation indicate that when CO coverage is greater than or equal to 3/12 ML, the dissociation of adsorbed CO molecules will be unfavorable both kinetically and thermodynamically, suggesting that only molecule CO adsorption are favored. Considering the catalytic activity of Rh(1 0 0) surface toward CO dissociation and the higher CO coverage under the continuous supply of CO in syngas conversion, it is to be expected that only molecule CO adsorption exist on Rh catalyst.

  3. Large Reductions In Amenable Mortality Associated With Brazil's Primary Care Expansion And Strong Health Governance.

    Science.gov (United States)

    Hone, Thomas; Rasella, Davide; Barreto, Mauricio; Atun, Rifat; Majeed, Azeem; Millett, Christopher

    2017-01-01

    Strong health governance is key to universal health coverage. However, the relationship between governance and health system performance is underexplored. We investigated whether expansion of the Brazilian Estratégia de Saúde da Família (ESF; family health strategy), a community-based primary care program, reduced amenable mortality (mortality avoidable with timely and effective health care) and whether this association varied by municipal health governance. Fixed-effects longitudinal regression models were used to identify the relationship between ESF coverage and amenable mortality rates in 1,622 municipalities in Brazil over the period 2000-12. Municipal health governance was measured using indicators from a public administration survey, and the resulting scores were used in interactions. Overall, increasing ESF coverage from 0 percent to 100 percent was associated with a reduction of 6.8 percent in rates of amenable mortality, compared with no increase in ESF coverage. The reductions were 11.0 percent for municipalities with the highest governance scores and 4.3 percent for those with the lowest scores. These findings suggest that strengthening local health governance may be vital for improving health services effectiveness and health outcomes in decentralized health systems.

  4. Immunization coverage and timeliness of vaccination in Italian children with chronic diseases.

    Science.gov (United States)

    Pandolfi, E; Carloni, E; Marino, M G; Ciofi degli Atti, M L; Gesualdo, F; Romano, M; Giannattasio, A; Guarino, A; Carloni, R; Borgia, P; Volpe, E; Perrelli, F; Pizzuti, R; Tozzi, A E

    2012-07-20

    Since children with chronic diseases represent a primary target for immunization strategies, it is important that their immunization coverage and timeliness of vaccines is optimal. We performed a study to measure immunization coverage and timeliness of vaccines in children with type 1 diabetes, HIV infection, Down syndrome, cystic fibrosis, and neurological diseases. A total of 275 children aged 6 months-18 years were included in the study. Coverage for diphtheria-tetanus-pertussis (DTP), polio (Pol), and hepatitis B (HBV) vaccines approximated 85% at 24 months, while measles-mumps-rubella (MMR) coverage was 62%. Immunization coverage for seasonal influenza was 59%. The analysis of timeliness revealed that there was heterogeneity among children with different chronic diseases. A proportional hazard model showed that children with HIV infection had the longest time to complete three doses of DTP, Pol, and HBV, and those with neurological diseases received the first dose of MMR later than the other categories. Causes of missing or delayed vaccination mostly included a concurrent acute disease. Children with chronic diseases should be strictly monitored for routine and recommended vaccinations, and health care providers and families should be properly informed to avoid false contraindications.

  5. Employment status and differences in the one-year coverage of physician visits: different needs or unequal access to services?

    Directory of Open Access Journals (Sweden)

    Kivimäki Mika

    2006-10-01

    Full Text Available Abstract Background The dichotomy employed vs. unemployed is still a relevant, but rather crude measure of status in current labour markets. Also, studies concerning the association of employment status with health have to specify the type of the employment as well as the characteristics of the unemployment. This study aims to reveal differences and potential inequalities in physician visits among seven groups in the core-periphery structures of the labour markets. Methods A total of 16 000 Finns responded to a postal survey in 2003. Their visits to physicians in public primary health care, occupational health care, private health services, hospital outpatient clinics and dental care services during previous year were measured as indicators of service utilisation. Participants were classified as employees having a permanent or fixed-term and full-time or part-time contract and as those experiencing short-term, prolonged or long-term unemployment. Differences in the one-year coverage of physician visits between these groups of employees were analysed using logistic regression analyses where differences in the need for services were controlled for by including demographics and self-rated health assessments in the models. Results Permanently employed respondents had visited a physician most often, and the need-adjusted regression models showed significantly lower odds ratios for a visit among fixed-term employees (OR 0.65, 95% CI 0.53–0.81 and in particular among the long-term unemployed (OR 0.21, 95% CI 0.14–0.31. A stratified analysis according to health care sector showed the lowest odds ratios in occupational health care and private physicians (ORs between 0.05 and 0.73 and also low odds ratios for dentists (ORs between 0.45 and 0.91, whereas visits to public primary health care were more common among non-permanent employees and the unemployed (ORs between 1.46 and 2.39. Conclusion The use of physician services varies according to labour

  6. Setting the scene: the challenges of universal health coverage and the contribution of management education.

    Science.gov (United States)

    Tarricone, Rosanna

    2013-01-01

    The last decades are being characterized by global trends such as population growth, aging, escalation of non communicable diseases and technological innovation. These unprecedented changes are moving faster than economic growth and threaten universal health coverage. What is at stake nowadays is governments' and healthcare systems' ability to renovate themselves and develop new paradigms aimed at finding innovative solutions to manage the new global forces so to maintain universal access to care in a changing environment. We have to be imaginative because if we keep relying on current paradigms to answer already too far-ahead complex problems, we will fail. And here education has a role to play. Although the recent years have seen a steep increase in the offerings of post-graduate management education programs in health and healthcare, the majority of these programs are still traditionally conceived and designed, aiming to train students to deal with specific, domestic, current problems. With the promise of making students the best specialists on Earth, to get the highest return on his or her investment in education, the performance of these programs is often measured in terms of earnings maximization. Although an indicator of success, this often incentivizes individuals to be context-based, individualistic, short-sighted and self-focused. Education has the greatest potential to foster imagination, to leverage diversity, to exploit team-working and free creative thinking. Education can substantially contribute to anticipate the impact of global forces by but an endeavor is needed to design programs and measures performances differently.

  7. Global Moon Coverage via Hyperbolic Flybys

    Science.gov (United States)

    Buffington, Brent; Strange, Nathan; Campagnola, Stefano

    2012-01-01

    The scientific desire for global coverage of moons such as Jupiter's Galilean moons or Saturn's Titan has invariably led to the design of orbiter missions. These orbiter missions require a large amount of propellant needed to insert into orbit around such small bodies, and for a given launch vehicle, the additional propellant mass takes away from mass that could otherwise be used for scientific instrumentation on a multiple flyby-only mission. This paper will present methods--expanding upon techniques developed for the design of the Cassini prime and extended missions--to obtain near global moon coverage through multiple flybys. Furthermore we will show with proper instrument suite selection, a flyby-only mission can provide science return similar (and in some cases greater) to that of an orbiter mission.

  8. Perplexity Analysis of Obesity News Coverage

    OpenAIRE

    McFarlane, Delano J.; Elhadad, Noémie; Kukafka, Rita

    2009-01-01

    An important task performed during the analysis of health news coverage is the identification of news articles that are related to a specific health topic (e.g. obesity). This is often done using a combination of keyword searching and manual encoding of news content. Statistical language models and their evaluation metric, perplexity, may help to automate this task. A perplexity study of obesity news was performed to evaluate perplexity as a measure of the similarity of news corpora to obesit...

  9. Analyst Coverage and Tax Reporting Aggressiveness

    OpenAIRE

    McInerney, Megan Michelle

    2010-01-01

    The role of analysts in corporate governance has been examined extensively in the accounting literature. Two conflicting representations of the influence of analysts have emerged. Analysts are either viewed as external monitors of corporate behavior, thereby reducing agency costs; or they are viewed as exerting additional pressure on management to meet earnings forecasts, which may contribute to aggressive corporate behavior. Studies exist that examine the impact of analyst coverage in a f...

  10. Measuring Progress towards Universal Health Coverage

    OpenAIRE

    2015-01-01

    The last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. This paper proposes a ‘mashup’ index that captures both aspects of UHC: that everyone—irrespective of their ability-to-pay—gets the health services they need; and that nobody suffers undue financial hardship as a result of re...

  11. Double Barrier Coverage in Dense Sensor Networks

    Institute of Scientific and Technical Information of China (English)

    Cheng-Dong Jiang; Guo-Liang Chen

    2008-01-01

    When a sensor network is deployed to detect objects penetrating a protected region, it is not necessary to have every point in the deployment region covered by a sensor. It is enough if the penetrating objects are detected at some point in their trajectory. If a sensor network guarantees that every penetrating object will be detected by two distinct sensors at the same time somewhere in this area, we say that the network provides double barrier coverage (DBC). In this paper, we propose a new planar structure of Sparse Delaunay Triangulation (SparseDT), and prove some elaborate attributes of it. We develop theoretical foundations for double barrier coverage, and propose efficient algorithms with NS2 simulator using which one can activate the necessary sensors to guarantee double barrier coverage while the other sensors go to sleep. The upper and lower bounds of number of active nodes are determined, and we show that high-speed target will be detected efficiently with this configuration.

  12. Universal Health Coverage through Community Nursing Services: China vs. Hong Kong

    Science.gov (United States)

    Chan, Wai Yee; Fung, Ita M; Chan, Eric

    2017-01-01

    ABSTRACT Objective: this article looks at how the development of community nursing services in China and Hong Kong can enhance universal health coverage. Methods: literature and data review have been utilized in this study. Results: nursing services have evolved much since the beginning of the nursing profession. The development of community nursing services has expanded the scope of nursing services to those in need of, not just hospital-level nursing care, but more holistic care to improve health and quality of life. Conclusion: despite the one-country-two-systems governance and the difference in population and geography, Hong Kong and China both face the aging population and its complications. Community nursing services help to pave the road to Universal Health Coverage. PMID:28146178

  13. The impact of insurance coverage during insurance reform on diagnostic resolution of cancer screening abnormalities.

    Science.gov (United States)

    Kapoor, Alok; Battaglia, Tracy A; Isabelle, Alexis P; Hanchate, Amresh D; Kalish, Richard L; Bak, Sharon; Mishuris, Rebecca G; Shroff, Swati M; Freund, Karen M

    2014-02-01

    We examined the impact of Massachusetts insurance reform on the care of women at six community health centers with abnormal breast and cervical cancer screening to investigate whether stability of insurance coverage was associated with more timely diagnostic resolution. We conducted Cox proportional hazards models to predict time from cancer screening to diagnostic resolution, examining the impact of 1) insurance status at time of screening abnormality, 2) number of insurance switches over a three-year period, and 3) insurance history over a three-year period. We identified 1,165 women with breast and 781 with cervical cancer screening abnormalities. In the breast cohort, Medicaid insurance at baseline, continuous public insurance, and losing insurance predicted delayed resolution. We did not find these effects in the cervical cohort. These data provide evidence that stability of health insurance coverage with insurance reform nationally may improve timely care after abnormal cancer screening in historically underserved women.

  14. [Impact of parental attitudes on infant vaccinal coverage in Benin].

    Science.gov (United States)

    Makoutode, M; Mohamed, S; Paraïso, N M; Guevart, E; Akpaka Nago, M R; Bessaoud, K

    2009-06-01

    Few studies have addressed the impact of parental attitudes on vaccinal coverage in early childhood. The purpose of this descriptive-analytical transverse study was to assess this problem in a cohort of parents with a 12- to 23-month-old child randomly identified by cluster analysis in five communities in the Oueme department. Data were collected using a questionnaire and tabulation sheet. Statistical analysis was performed by logistic regression using the stepwise digression method. Most of the 438 parents in the study cohort (74.2%) were between 21 and 35 years of age. More than half had not attended school and less than 20% were unemployed. The proportion refusing vaccination for their children was 35% among parents who had to walk more than 30 minutes back and forth to the health care facility and 38% among parents who had poor knowledge about vaccination. The refusal rate was 1.4 times higher for parents with no education than for parents who had attended school (P=0.005). Poor parental knowledge about vaccination was significantly correlated with refusal of vaccination (pstrategies aimed at enhancing parental knowledge and understanding about vaccination should be promoted at health care facilities as well as through other channels, e.g., news media and public events such as social and religious gatherings.

  15. Inconsistent journalism: the coverage of chronic diseases in the Mexican press.

    Science.gov (United States)

    Mercado-Martinez, F J; Robles-Silva, L; Moreno-Leal, N; Franco-Almazan, C

    2001-01-01

    The mass media are recognized by many social scientists as important sources of medical information for lay people and as a positive influence on those working in the health care professions. However, there is a lack of study about print and mass media reporting on major health problems in developing countries such as Mexico. This article presents the findings of a study conducted to identify specific messages that the Mexican print media convey to the general reader about chronic diseases, especially one of the most important and pervasive, diabetes. We undertook a comprehensive review and content analysis of secondary source media reporting in the Boletin (Bulletin)--published by the Department of Education and Health, Universidad Autónoma Metropolitana, Xochimilco. The Boletin summarizes all articles related to health matters published in 12 national daily newspapers and 3 magazines. Our study covered all issues of the Boletin from 1992 through 1996. Our findings indicate that at times the press and popular print media disseminate an incomplete and often biased picture of chronic diseases prevalent in Mexico. Specifically, the press gives equal or more important coverage of acute diseases, or to AIDS, than to other major chronic conditions. The press also reproduces the biomedical model of disease and does not address topics important to certain segments of the population, including the patient. Moreover, the media may present an overly idealized impression of the capability of health services. Consequently, this failure to address the issues of certain widespread, chronic illnesses is severe enough to ask about the role of the press in medical health care reform. We conclude by suggesting areas for further research.

  16. Utilizing collagen membranes for guided tissue regeneration-based root coverage.

    Science.gov (United States)

    Wang, Hom-Lay; Modarressi, Marmar; Fu, Jia-Hui

    2012-06-01

    Gingival recession is a common clinical problem that can result in hypersensitivity, pain, root caries and esthetic concerns. Conventional soft tissue procedures for root coverage require an additional surgical site, thereby causing additional trauma and donor site morbidity. In addition, the grafted tissues heal by repair, with formation of long junctional epithelium with some connective tissue attachment. Guided tissue regeneration-based root coverage was thus developed in an attempt to overcome these limitations while providing comparable clinical results. This paper addresses the biologic foundation of guided tissue regeneration-based root coverage, and describes the indications and contraindications for this technique, as well as the factors that influence outcomes. The step-by-step clinical techniques utilizing collagen membranes are also described. In comparison with conventional soft tissue procedures, the benefits of guided tissue regeneration-based root coverage procedures include new attachment formation, elimination of donor site morbidity, less chair-time, and unlimited availability and uniform thickness of the product. Collagen membranes, in particular, benefit from product biocompatibility with the host, while promoting chemotaxis, hemostasis, and exchange of gas and nutrients. Such characteristics lead to better wound healing by promoting primary wound coverage, angiogenesis, space creation and maintenance, and clot stability. In conclusion, collagen membranes are a reliable alternative for use in root coverage procedures.

  17. A comparative analysis of coverage decisions for outpatient pharmaceuticals: evidence from Denmark, Norway and Sweden.

    Science.gov (United States)

    Grepstad, Mari; Kanavos, Panos

    2015-02-01

    This study analyses the reasons for differences and similarities in coverage recommendations for outpatient pharmaceuticals in Denmark, Norway and Sweden, following HTA appraisals. A comparative analysis of all outpatient drug appraisals carried out between January 2009 and December 2012, including an analysis of divergent coverage recommendations made by all three countries was performed. Agreement levels between HTA agencies were measured using kappa scores. Consultations with stakeholders in the three countries were carried out to complement the discussion on HTA processes and reimbursement outcomes. Nineteen outpatient drug-indication pairs appraised in each of the three countries were identified, of which 6 pairs (32%) had divergent coverage recommendations. An uneven distribution of coverage recommendations was observed, with the highest overlap in appraisals between Norway and Sweden (free-marginal kappa 0.89). Similarities were found in priority setting principles, mode of appraisal and reasoning for coverage recommendations. The study shows that health economic evaluation is less prominent or explicit in outpatient drug appraisals in Denmark than in Norway and Sweden, that all three countries could benefit from improved communication between appraisers and manufacturers, and that final coverage recommendations rely on factors other than safety, comparative efficacy or cost-effectiveness.

  18. Some Families Who Purchased Health Coverage Through The Massachusetts Connector Wound Up With High Financial Burdens

    OpenAIRE

    Galbraith, Alison A.; Sinaiko, Anna D.; Soumerai, Stephen B.; Ross-Degnan, Dennis; Dutta-Linn, M. Maya; Lieu, Tracy A.

    2013-01-01

    Health insurance exchanges created under the Affordable Care Act will offer coverage to people who lack employer-sponsored insurance or have incomes too high to qualify for Medicaid. However, plans offered through an exchange may include high levels of cost sharing. We surveyed families participating in unsubsidized plans offered in the Massachusetts Commonwealth Health Insurance Connector Authority, an exchange created prior to the 2010 national health reform law, and found high levels of fi...

  19. Expanding insurance coverage through tax credits, consumer choice, and market enhancements: the American Medical Association proposal for health insurance reform.

    Science.gov (United States)

    Palmisano, Donald J; Emmons, David W; Wozniak, Gregory D

    2004-05-12

    Recent reports showing an increase in the number of uninsured individuals in the United States have given heightened attention to increasing health insurance coverage. The American Medical Association (AMA) has proposed a system of tax credits for the purchase of individually owned health insurance and enhancements to individual and group health insurance markets as a means of expanding coverage. Individually owned insurance would enable people to maintain coverage without disruption to existing patient-physician relationships, regardless of changes in employers or in work status. The AMA's plan would empower individuals to choose their health plan and give patients and their physicians more control over health care choices. Employers could continue to offer employment-based coverage, but employees would not be limited to the health plans offered by their employer. With a tax credit large enough to make coverage affordable and the ability to choose their own coverage, consumers would dramatically transform the individual and group health insurance markets. Health insurers would respond to the demands of individual consumers and be more cautious about increasing premiums. Insurers would also tailor benefit packages and develop new forms of coverage to better match the preferences of individuals and families. The AMA supports the development of new health insurance markets through legislative and regulatory changes to foster a wider array of high-quality, affordable plans.

  20. Medicare Program; End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program Bid Surety Bonds, State Licensure and Appeals Process for Breach of Contract Actions, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program and Fee Schedule Adjustments, Access to Care Issues for Durable Medical Equipment; and the Comprehensive End-Stage Renal Disease Care Model. Final rule.

    Science.gov (United States)

    2016-11-04

    This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2017. It also finalizes policies for coverage and payment for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. This rule also sets forth requirements for the ESRD Quality Incentive Program, including the inclusion of new quality measures beginning with payment year (PY) 2020 and provides updates to programmatic policies for the PY 2018 and PY 2019 ESRD QIP. This rule also implements statutory requirements for bid surety bonds and state licensure for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). This rule also expands suppliers' appeal rights in the event of a breach of contract action taken by CMS, by revising the appeals regulation to extend the appeals process to all types of actions taken by CMS for a supplier's breach of contract, rather than limit an appeal for the termination of a competitive bidding contract. The rule also finalizes changes to the methodologies for adjusting fee schedule amounts for DMEPOS using information from CBPs and for submitting bids and establishing single payment amounts under the CBPs for certain groupings of similar items with different features to address price inversions. Final changes also are made to the method for establishing bid limits for items under the DMEPOS CBPs. In addition, this rule summarizes comments on the impacts of coordinating Medicare and Medicaid Durable Medical Equipment for dually eligible beneficiaries. Finally, this rule also summarizes comments received in response to a request for information related to the Comprehensive ESRD Care Model and future payment models affecting renal care.

  1. 28 CFR 55.7 - Termination of coverage.

    Science.gov (United States)

    2010-07-01

    ... VOTING RIGHTS ACT REGARDING LANGUAGE MINORITY GROUPS Nature of Coverage § 55.7 Termination of coverage... the applicable language minority group is equal to or less than the national illiteracy rate....

  2. 1990 point population coverage for the Conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a point coverage of the 1990 Census of Population and Housing for the conterminous United States. (Alaska and Hawaii are available separately). The coverage...

  3. Deciphering the complex intermediate role of health coverage through insurance in the context of well-being by network analysis

    CERN Document Server

    Cifuentes, Myriam Patricia

    2016-01-01

    Recent initiatives that overstate health insurance coverage for well-being conflict with the recognized antagonistic facts identified by the determinants of health that identify health care as an intermediate factor. By using a network of controlled interdependences among multiple social resources including health insurance, which we reconstructed from survey data of the U.S. and Bayesian networks structure learning algorithms, we examined why health insurance through coverage, which in most countries is the access gate to health care, is just an intermediate factor of well-being. We used social network analysis methods to explore the complex relationships involved at general, specific and particular levels of the model. All levels provide evidence that the intermediate role of health insurance relies in a strong relationship to income and reproduces its unfair distribution. Some signals about the most efficient type of health coverage emerged in our analyses.

  4. 42 CFR 457.420 - Benchmark health benefits coverage.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Benchmark health benefits coverage. 457.420 Section 457.420 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... State Plan Requirements: Coverage and Benefits § 457.420 Benchmark health benefits coverage....

  5. 29 CFR 2.12 - Audiovisual coverage permitted.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Audiovisual coverage permitted. 2.12 Section 2.12 Labor Office of the Secretary of Labor GENERAL REGULATIONS Audiovisual Coverage of Administrative Hearings § 2.12 Audiovisual coverage permitted. The following are the types of hearings where the...

  6. 42 CFR 435.350 - Coverage for certain aliens.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Coverage for certain aliens. 435.350 Section 435... ISLANDS, AND AMERICAN SAMOA Optional Coverage of the Medically Needy § 435.350 Coverage for certain aliens... treatment of an emergency medical condition, as defined in § 440.255(c) of this chapter, to those...

  7. 42 CFR 436.330 - Coverage for certain aliens.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Coverage for certain aliens. 436.330 Section 436... Coverage of the Medically Needy § 436.330 Coverage for certain aliens. If an agency provides Medicaid to... condition, as defined in § 440.255(c) of this chapter to those aliens described in § 436.406(c) of...

  8. 42 CFR 436.128 - Coverage for certain qualified aliens.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart....

  9. 42 CFR 457.475 - Limitations on coverage: Abortions.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Limitations on coverage: Abortions. 457.475 Section... State Plan Requirements: Coverage and Benefits § 457.475 Limitations on coverage: Abortions. (a) General rule. FFP under title XXI is not available in expenditures for an abortion, or in expenditures for...

  10. Women’s autonomy and men's involvement in child care and feeding as predictors of infant and young child anthropometric indices in coffee farming households of Jimma Zone, South West of Ethiopia

    Science.gov (United States)

    Abate, Kalkidan Hassen; Belachew, Tefera

    2017-01-01

    Background Most of child mortality and under nutrition in developing world were attributed to suboptimal childcare and feeding, which needs detailed investigation beyond the proximal factors. This study was conducted with the aim of assessing associations of women’s autonomy and men’s involvement with child anthropometric indices in cash crop livelihood areas of South West Ethiopia. Methods Multi-stage stratified sampling was used to select 749 farming households living in three coffee producing sub-districts of Jimma zone, Ethiopia. Domains of women’s Autonomy were measured by a tool adapted from demographic health survey. A model for determination of paternal involvement in childcare was employed. Caring practices were assessed through the WHO Infant and young child feeding practice core indicators. Length and weight measurements were taken in duplicate using standard techniques. Data were analyzed using SPSS for windows version 21. A multivariable linear regression was used to predict weight for height Z-scores and length for age Z-scores after adjusting for various factors. Results The mean (sd) scores of weight for age (WAZ), height for age (HAZ), weight for height (WHZ) and BMI for age (BAZ) was -0.52(1.26), -0.73(1.43), -0.13(1.34) and -0.1(1.39) respectively. The results of multi variable linear regression analyses showed that WHZ scores of children of mothers who had autonomy of conducting big purchase were higher by 0.42 compared to children's whose mothers had not. In addition, a child whose father was involved in childcare and feeding had higher HAZ score by 0.1. Regarding age, as for every month increase in age of child, a 0.04 point decrease in HAZ score and a 0.01 point decrease in WHZ were noted. Similarly, a child living in food insecure households had lower HAZ score by 0.29 compared to child of food secured households. As family size increased by a person a WHZ score of a child is decreased by 0.08. WHZ and HAZ scores of male child was

  11. Chemical information science coverage in Chemical Abstracts.

    Science.gov (United States)

    Wiggins, G

    1987-02-01

    For many years Chemical Abstracts has included in its coverage publications on chemical documentation or chemical information science. Although the bulk of those publications can be found in section 20 of Chemical Abstracts, many relevant articles were found scattered among 39 other sections of CA in 1984-1985. In addition to the scattering of references in CA, the comprehensiveness of Chemical Abstracts as a secondary source for chemical information science is called into question. Data are provided on the journals that contributed the most references on chemical information science and on the languages of publication of relevant articles.

  12. Insights into the effect of coverage on CO adsorption and dissociation over Rh(1 0 0) surface: A theoretical study

    Science.gov (United States)

    Zhao, Xiaojun; Zhang, Riguang; Ling, Lixia; Wang, Baojun

    2014-11-01

    The adsorption, dissociation and desorption of CO at different coverage over Rh(1 0 0) surface have been systematically investigated using density functional theory method together with the periodic slab model. Our results show that at the coverage less than or equal to 4/12 ML, CO favored the most stable bridge site adsorption, and the adsorption energies of CO have little difference; while at the coverage greater than or equal to 5/12 ML, the lateral repulsive interaction begins to affect the adsorption structures and the corresponding adsorption energies of adsorbed CO molecules, and the interaction will be stronger with the increasing of CO coverage, which leads to CO migration over Rh(1 0 0) surface when CO coverage is greater than or equal to 10/12 ML. The adsorption energies of these CO molecules will decrease successively until the saturated adsorption with the CO coverage of 12/12 ML. Further calculations on CO dissociation indicate that when CO coverage is greater than or equal to 3/12 ML, the dissociation of adsorbed CO molecules will be unfavorable both kinetically and thermodynamically, suggesting that only molecule CO adsorption are favored. Considering the catalytic activity of Rh(1 0 0) surface toward CO dissociation and the higher CO coverage under the continuous supply of CO in syngas conversion, it is to be expected that only molecule CO adsorption exist on Rh catalyst.

  13. Socio-economic inequalities in the use of postnatal care in India.

    Directory of Open Access Journals (Sweden)

    Abhishek Singh

    Full Text Available OBJECTIVES: First, our objective was to estimate socio-economic inequalities in the use of postnatal care (PNC compared with those in the use of care at birth and antenatal care. Second, we wanted to compare inequalities in the use of PNC between facility births and home births and to determine inequalities in the use of PNC among mothers with high-risk births. METHODS AND FINDINGS: Rich-poor ratios and concentration indices for maternity care were estimated using the third round of the District Level Household Survey conducted in India in 2007-08. Binary logistic regression models were used to examine the socio-economic inequalities associated with use of PNC after adjusting for relevant socio-economic and demographic characteristics. PNC for both mothers and newborns was substantially lower than the care received during pregnancy and child birth. Only 44% of mothers in India at the time of survey received any care within 48 hours after birth. Likewise, only 45% of newborns received check-up within 24 hours of birth. Mothers who had home births were significantly less likely to have received PNC than those who had facility births, with significant differences across the socio-economic strata. Moreover, the rich-poor gap in PNC use was significantly wider for mothers with birth complications. CONCLUSIONS: PNC use has been unacceptably low in India given the risks of mortality for mothers and babies shortly after birth. However, there is evidence to suggest that effective use of pregnancy and childbirth care in health facilities led to better PNC. There are also significant socio-economic inequalities in access to PNC even for those accessing facility-based care. The coverage of essential PNC is inadequate, especially for mothers from economically disadvantaged households. The findings suggest the need for strengthening PNC services to keep pace with advances in coverage for care at birth and prenatal services in India through targeted policy

  14. Development of trip coverage analysis methodology - CATHENA trip coverage analysis model

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jong Ho; Ohn, M. Y.; Cho, C. H.; Huh, J. Y.; Na, Y. H.; Lee, S. Y.; Kim, B. G.; Kim, H. H.; Kim, S. W.; Bae, C. J.; Kim, T. M.; Kim, S. R.; Han, B. S.; Moon, B. J.; Oh, M. T. [Korea Power Engineering Co., Yongin (Korea)

    2001-05-01

    This report describes the CATHENA model for trip coverage analysis. This model is prepared based on the Wolsong 2 design data and consist of primary heat transport system, shutdown system, steam and feedwater system, reactor regulating system, heat transport pressure and inventory control system, and steam generator level and pressure control system. The new features and modified parts from the Wolsong 2 CATHENA LOCA Model required for trip coverage analysis is described. this model is tested by simulation of steady state at 100 % FP and at several low powers. Also, the cases of power rundown and power runup are tested. 17 refs., 124 figs., 19 tabs. (Author)

  15. Predicting population coverage of T-cell epitope-based diagnostics and vaccines

    Directory of Open Access Journals (Sweden)

    Newman Mark J

    2006-03-01

    Full Text Available Abstract Background T cells recognize a complex between a specific major histocompatibility complex (MHC molecule and a particular pathogen-derived epitope. A given epitope will elicit a response only in individuals that express an MHC molecule capable of binding that particular epitope. MHC molecules are extremely polymorphic and over a thousand different human MHC (HLA alleles are known. A disproportionate amount of MHC polymorphism occurs in positions constituting the peptide-binding region, and as a result, MHC molecules exhibit a widely varying binding specificity. In the design of peptide-based vaccines and diagnostics, the issue of population coverage in relation to MHC polymorphism is further complicated by the fact that different HLA types are expressed at dramatically different frequencies in different ethnicities. Thus, without careful consideration, a vaccine or diagnostic with ethnically biased population coverage could result. Results To address this issue, an algorithm was developed to calculate, on the basis of HLA genotypic frequencies, the fraction of individuals expected to respond to a given epitope set, diagnostic or vaccine. The population coverage estimates are based on MHC binding and/or T cell restriction data, although the tool can be utilized in a more general fashion. The algorithm was implemented as a web-application available at http://epitope.liai.org:8080/tools/population. Conclusion We have developed a web-based tool to predict population coverage of T-cell epitope-based diagnostics and vaccines based on MHC binding and/or T cell restriction data. Accordingly, epitope-based vaccines or diagnostics can be designed to maximize population coverage, while minimizing complexity (that is, the number of different epitopes included in the diagnostic or vaccine, and also minimizing the variability of coverage obtained or projected in different ethnic groups.

  16. Changes in drug utilization during a gap in insurance coverage: an examination of the medicare Part D coverage gap.

    Directory of Open Access Journals (Sweden)

    Jennifer M Polinski

    2011-08-01

    Full Text Available BACKGROUND: Nations are struggling to expand access to essential medications while curbing rising health and drug spending. While the US government's Medicare Part D drug insurance benefit expanded elderly citizens' access to drugs, it also includes a controversial period called the "coverage gap" during which beneficiaries are fully responsible for drug costs. We examined the impact of entering the coverage gap on drug discontinuation, switching to another drug for the same indication, and drug adherence. While increased discontinuation of and adherence to essential medications is a regrettable response, increased switching to less expensive but therapeutically interchangeable medications is a positive response to minimize costs. METHODS AND FINDINGS: We followed 663,850 Medicare beneficiaries enrolled in Part D or retiree drug plans with prescription and health claims in 2006 and/or 2007 to determine who reached the gap spending threshold, n = 217,131 (33%. In multivariate Cox proportional hazards models, we compared drug discontinuation and switching rates in selected drug classes after reaching the threshold between all 1,993 who had no financial assistance during the coverage gap (exposed versus 9,965 multivariate propensity score-matched comparators with financial assistance (unexposed. Multivariate logistic regressions compared drug adherence (≤ 80% versus >80% of days covered. Beneficiaries reached the gap spending threshold on average 222 d ±79. At the drug level, exposed beneficiaries were twice as likely to discontinue (hazard ratio [HR]  = 2.00, 95% confidence interval [CI] 1.64-2.43 but less likely to switch a drug (HR  = 0.60, 0.46-0.78 after reaching the threshold. Gap-exposed beneficiaries were slightly more likely to have reduced adherence (OR  = 1.07, 0.98-1.18. CONCLUSIONS: A lack of financial assistance after reaching the gap spending threshold was associated with a doubling in discontinuing essential

  17. Armenian media coverage of science topics

    Science.gov (United States)

    Mkhitaryan, Marie

    2016-12-01

    The article discusses features and issues of Armenian media coverage on scientific topics and provides recommendations on how to promote scientific topics in media. The media is more interested in social or public reaction rather than in scientific information itself. Medical science has a large share of the global media coverage. It is followed by articles about environment, space, technology, physics and other areas. Armenian media mainly tends to focus on a scientific topic if at first sight it contains something revolutionary. Media primarily reviews whether that scientific study can affect the Armenian economy and only then decides to refer to it. Unfortunately, nowadays the perception of science is a little distorted in media. We can often see headlines of news where is mentioned that the scientist has made "an invention". Nowadays it is hard to see the border between a scientist and an inventor. In fact, the technological term "invention" attracts the media by making illusionary sensation and ensuring large audience. The report also addresses the "Gitamard" ("A science-man") special project started in 2016 in Mediamax that tells about scientists and their motivations.

  18. Presumptive Eligibility for Medicaid and CHIP Coverage

    Data.gov (United States)

    U.S. Department of Health & Human Services — Health care providers and Head Start programs can play a major role in finding and enrolling uninsured children through presumptive eligibility. States can authorize...

  19. A Sweep Coverage Scheme Based on Vehicle Routing Problem

    Directory of Open Access Journals (Sweden)

    Li Shu

    2013-04-01

    Full Text Available As an emerging coverage problem in wireless sensor networks, sweep coverage which introducing mobile sensors to cover points of interest within certain time interval can satisfy monitoring request in some particular application scenarios with less number of nodes than the conventional static coverage approach. In this work, aiming to support dynamical POI coverage and data delivery simultaneously, a novel sweep coverage scheme, named VRPSC(Vehicle Routing Problem based Sweep Coverage, is proposed by modeling the minimum number of required sensors problem in sweep coverage as a Vehicle Routing Problem (VRP. In VRPSC, an insertion algorithm is first introduced to create the initial scanning routes for POIs, and then the Simulated Annealing is employed to optimize these routes. The simulation results show that the VRPSC scheme achieves better performance than existing schemes. 

  20. Monitoring of vegetation coverage based on high-resolution images

    Institute of Scientific and Technical Information of China (English)

    Zhang Li; Li Li-juan; Liang Li-qiao; Li Jiu-yi

    2007-01-01

    Measurement of vegetation coverage on a small scale is the foundation for the monitoring of changes in vegetation coverage and of the inversion model of monitoring vegetation coverage on a large scale by remote sensing. Using the object-oriented analytical software,Definiens Professional 5,a new method for calculating vegetation coverage based on high-resolution images(aerial photographs or near-surface photography)is proposed. Our research supplies references to remote sensing measurements of vegetation coverage on a small scale and accurate fundamental data for the inversion model of vegetation coverage on a large and intermediatc scale to improve the accuracy of remote sensing monitoring of changes in vegetation coverage.

  1. LTE-Advanced Radio and Network Optimization: Basic Coverage and Interference Constraints

    DEFF Research Database (Denmark)

    Velez, Fernando J.; Sousa, Sofia; Flores, Jessica Acevedo

    2016-01-01

    In cellular optimization, the UL and DL the values from carrier-to-noise-plus-interference ratio (CNIR) from/at the mobile station are very important parameters. From a detailed analysis of its variation with the coverage and reuse distances for different values of the Channel Quality Indicator...

  2. Social Gerontology--Integrative and Territorial Aspects: A Citation Analysis of Subject Scatter and Database Coverage

    Science.gov (United States)

    Lasda Bergman, Elaine M.

    2011-01-01

    To determine the mix of resources used in social gerontology research, a citation analysis was conducted. A representative sample of citations was selected from three prominent gerontology journals and information was added to determine subject scatter and database coverage for the cited materials. Results indicate that a significant portion of…

  3. Young Adults Seeking Medical Care: Do Race and Ethnicity Matter?

    Science.gov (United States)

    ... Order from the National Technical Information Service NCHS Young Adults Seeking Medical Care: Do Race and Ethnicity Matter? ... insurance coverage differ by race and ethnicity for young adults? More than one-half of Hispanic young adults ...

  4. Human resources for health and universal health coverage: fostering equity and effective coverage

    OpenAIRE

    2013-01-01

    Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC.

  5. Déficit de base à admissão na unidade de terapia intensiva: um indicador de mortalidade precoce Base deficit at intensive care unit admission: an early mortality indicator

    Directory of Open Access Journals (Sweden)

    Iara Serra Azul Machado Bezerra

    2007-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O déficit de base é considerado um indicador de lesão tissular, choque e reanimação. O objetivo deste estudo foi estabelecer uma associação entre o déficit de base na admissão dos pacientes internados em unidade de terapia intensiva (UTI e seu prognóstico. MÉTODO: Estudo retrospectivo com análise de 110 pacientes admitidos consecutivamente na UTI, durante o período de 01 de junho a 31 de dezembro de 2006. RESULTADOS: Houve predomínio do sexo feminino, com idade média de 54,2 ± 18,7 anos. O tempo médio de permanência foi 6,5 ± 7,4 dias e o APACHE médio foi de 21 ± 8,1 pontos. A razão de mortalidade padronizada foi 0,715. A mortalidade dos pacientes com déficit de base superior a 6 mEq/L foi maior (38,9% que a daqueles com déficit menor (ou excesso (20,6%; p BACKGROUND AND OBJECTIVES: Base deficit is considered an indicator of tissue injury, shock and resuscitation. The objective of this study was to establish an association between base deficit obtained on the admission of patients in intensive care unit (ICU and their prognosis. METHODS: A retrospective study with analysis of 110 patients admitted consecutively in the ICU, during the period of June to December 2006. RESULTS: There was a predominance of women, with age mean 54.2 ± 18.7 years old. Length of stay in ICU was 6.5 ± 7.4 days and the mean APACHE II score was 21 ± 8.1 points. The standardized mortality ratio was 0.715. Mortality was higher in patients with base deficit > 6 mEq/L (38.9% than in those with base deficit 6 mEq/L is a marker of significant mortality.

  6. Adsorption of chlorine on Ag(111): No subsurface Cl at low coverage

    Science.gov (United States)

    Gava, Paola; Kokalj, Anton; de Gironcoli, Stefano; Baroni, Stefano

    2008-10-01

    The adsorption of molecular and atomic chlorine on perfect Ag(111) surface has been studied and characterized by means of extensive density-functional-theory calculations. For the molecular adsorption, we find that the dissociation of Cl2 proceeds with an almost vanishing barrier. As for the adsorption of atomic Cl, on-surface, subsurface, and substitutional adsorptions are considered as a function of the coverage. At coverage lower than 1/2 ML, the on-surface adsorption displays the most exothermic chemisorption energies, whereas the mixed on-surface+subsurface and on-surface+substitutional adsorption modes become competitive with pure on-surface adsorption at about 1/2 ML of coverage and at higher coverages even preferred. The analysis of the adsorption free energy as a function of chlorine chemical potential reveals that the on-surface (3×3)R30° adsorption phase is thermodynamically the most stable over a very broad range of Cl chemical potential. The mixed adsorption modes become thermodynamically more stable at high coverage for values of the Cl chemical potential that are substantially larger than those needed to form silver chloride. This finding seems to indicate that the formation of mixed adsorption phases, if they would ever occur, cannot be due to thermodynamic equilibrium but can only result from kinetic effects. We also find that the presence of open surface steps does not stabilize the subsurface Cl adsorption at low coverage. However due to the stronger Cl-surface interaction near steps, the mixed on-surface+subsurface adsorption on Ag(210) at high coverage becomes thermodynamically the most stable phase at Cl chemical potential close to that needed for the formation of bulk AgCl.

  7. A Practical Approach to Modified Condition/Decision Coverage

    Science.gov (United States)

    Hayhurst, Kelly J.; Veerhusem, Dan S.

    2001-01-01

    Testing of software intended for safety-critical applications in commercial transport aircraft must achieve modified condition/decision coverage (MC/DC) of the software structure. This requirement causes anxiety for many within the aviation software community. Results of a survey of the aviation software industry indicate that many developers believe that meeting the MC/DC requirement is difficult, and the cost is exorbitant. Some of the difficulties stem, no doubt, from the scant information available on the subject. This paper provides a practical 5-step approach for assessing MC/DC for aviation software products, and an analysis of some types of errors expected to be caught when MC/DC is achieved1.

  8. Overturning anti-miscegenation laws: news media coverage of the Lovings' legal case against the state of Virginia.

    Science.gov (United States)

    Hoewe, Jennifer; Zeldes, Geri Alumit

    2012-01-01

    This study fills a gap in scholarship by exploring historical news coverage of interracial relationships. It examines coverage by The New York Times, Washington Post and Times-Herald, and Chicago Tribune of the progression of the landmark civil rights case of Loving v. Virginia, in which the Supreme Court overturned Virginia's anti-miscegenation law, which prohibited marriage between any White and non-White person. An analysis of the frames and sources used in these publications' news stories about the case indicate all three publications' coverage favored the Lovings.

  9. Improving HSDPA Indoor Coverage and Throughput by Repeater and Dedicated Indoor System

    Directory of Open Access Journals (Sweden)

    2009-03-01

    Full Text Available The target of the paper is to provide guidelines for indoor planning and optimization using an outdoor-to-indoor repeater or a dedicated indoor system. The paper provides practical information for enhancing the performance of high-speed downlink packet access (HSDPA in an indoor environment. The capabilities of an outdoor-to-indoor analog WCDMA repeater are set against a dedicated indoor system and, furthermore, compared to indoor coverage of a nearby macrocellular base station. An extensive measurement campaign with varying system configurations was arranged in different indoor environments. The results show that compared to dedicated indoor systems, similar HSDPA performance can be provided by extending macrocellular coverage inside buildings using an outdoor-to-indoor repeater. According to the measurements, the pilot coverage planning threshold of about −80 dBm ensures a 2500 kbps throughput for shared HSDPA connections. Improving the coverage above −80 dBm seems to provide only small advantage in HSDPA throughput. Of course, the pilot planning thresholds may change if different channel power allocations are used. In addition, network performance can be further improved by increasing the antenna density in the serving distributed antenna system. Finally, good performance of repeater implementation needs careful repeater gain setting and donor antenna siting.

  10. Improving HSDPA Indoor Coverage and Throughput by Repeater and Dedicated Indoor System

    Directory of Open Access Journals (Sweden)

    Isotalo Tero

    2008-01-01

    Full Text Available Abstract The target of the paper is to provide guidelines for indoor planning and optimization using an outdoor-to-indoor repeater or a dedicated indoor system. The paper provides practical information for enhancing the performance of high-speed downlink packet access (HSDPA in an indoor environment. The capabilities of an outdoor-to-indoor analog WCDMA repeater are set against a dedicated indoor system and, furthermore, compared to indoor coverage of a nearby macrocellular base station. An extensive measurement campaign with varying system configurations was arranged in different indoor environments. The results show that compared to dedicated indoor systems, similar HSDPA performance can be provided by extending macrocellular coverage inside buildings using an outdoor-to-indoor repeater. According to the measurements, the pilot coverage planning threshold of about −80 dBm ensures a 2500 kbps throughput for shared HSDPA connections. Improving the coverage above −80 dBm seems to provide only small advantage in HSDPA throughput. Of course, the pilot planning thresholds may change if different channel power allocations are used. In addition, network performance can be further improved by increasing the antenna density in the serving distributed antenna system. Finally, good performance of repeater implementation needs careful repeater gain setting and donor antenna siting.

  11. How choices in exchange design for states could affect insurance premiums and levels of coverage.

    Science.gov (United States)

    Blavin, Fredric; Blumberg, Linda J; Buettgens, Matthew; Holahan, John; McMorrow, Stacey

    2012-02-01

    The Affordable Care Act gives states the option to create health insurance exchanges from which individuals and small employers can purchase health insurance. States have considerable flexibility in how they design and implement these exchanges. We analyze several key design options being considered, using the Urban Institute's Health Insurance Policy Simulation Model: creating separate versus merged small-group and nongroup markets, eliminating age rating in these markets, removing the small-employer credit, and setting the maximum number of employees for firms in the small-group market at 50 versus 100 workers. Among our findings are that merging the small-group and nongroup markets would result in 1.7 million more people nationwide participating in the exchanges and, because of greater affordability of nongroup coverage, approximately 1.0 million more people being insured than if the risk pools were not merged. The various options generate relatively small differences in overall coverage and cost, although some, such as reducing age rating bands, would result in higher costs for some people while lowering costs for others. These cost effects would be most apparent among people who purchase coverage without federal subsidies. On the whole, we conclude that states can make these design choices based on local support and preferences without dramatic repercussions for overall coverage and cost outcomes.

  12. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications ... a team of specially-trained health care providers. Critical care usually takes place in an intensive care ...

  13. Tracheostomy care

    Science.gov (United States)

    Respiratory failure - tracheostomy care; Ventilator - tracheostomy care; Respiratory insufficiency - tracheostomy care ... Before you leave the hospital, health care providers will teach you how ... and suction the tube Keep the air you breathe moist Clean ...

  14. Achieving Universal Coverage; Lessons From The Experience of Other Countries for National Health Insurance Implementation in Indonesia

    Directory of Open Access Journals (Sweden)

    Misnaniarti Misnaniarti

    2015-08-01

    Full Text Available Indonesia is not the only country that will lead to universal coverage. Several countries took an initiative to develop social security, through Universal Health Coverage (UHC to achieve health insurance and welfare for all residents. Even, some countries have already reached universal health coverage since a few years ago. The purpose of this paper is to assess the achievement of universal coverage of the health insurance implementation in several countries. In general, some countries require considerable time to achieve universal coverage. Mechanisms and stages that need attention is on the univeral registration aspects that cover the entire population, progressive and continuous funding sources, comprehensive benefits package, the expansion of gradual coverage for diseases that can cause catastrophic expenditure, increasing capacity and mobilizing supporting resource. National Health Insurance policy in some countries can improve access to care, utilization and quality of quality health services to all citizens. Indonesia is expected to learn from the experience of other countries to achieve UHC, so that the projection of the entire population of Indonesia to have health insurance in 2019 will be reached soon.

  15. Optimizing coverage of metal oxide nanoparticle prepared by pulsed laser deposition on nonenzymatic glucose detection.

    Science.gov (United States)

    Kaneko, Satoru; Ito, Takeshi; Hirabayashi, Yasuo; Ozawa, Takeshi; Okuda, Tetsuya; Motoizumi, Yu; Hirai, Kiyohito; Naganuma, Yasuhiro; Soga, Masayasu; Yoshimoto, Mamoru; Suzuki, Koji

    2011-04-15

    Metal oxide nanoparticles prepared by pulsed laser deposition (PLD) were applied to nonenzymatic glucose detection. NiO nanoparticles with size of 3 nm were deposited on glassy carbon (GC) and silicon substrates at room temperature in an oxygen atmosphere. Transmission electron microscope (TEM) image showed nanoparticles with the size of 3 nm uniformly scattered on the Si(001) substrate. Unlike co-sputtering nanoparticle and carbon simultaneously, the PLD method can easily control the surface coverage of nanoparticles on the surface of substrate by deposition time. Cyclic voltammetry was performed on the samples deposited on the GC substrates for electrochemical detection of glucose. The differences between peak currents with and without glucose was used to optimize the coverage of nanoparticles on carbon electrode. The results indicated that optimal coverage of nanoparticles on carbon electrode.

  16. Child health insurance coverage and household activity toward child development in four South American countries.

    Science.gov (United States)

    Wehby, George L

    2014-05-01

    We evaluate the association between child health insurance coverage and household activities that enhance child development. We use micro-level data on a unique sample of 2,370 children from four South American countries. Data were collected by physicians via in-person interviews with the mothers. The regression models compare insured and uninsured children seen within the same pediatric care practice for routine well-child care and adjust for several demographic and socioeconomic characteristics. We also stratify these analyses by selective household demographic and socioeconomic characteristics and by country. We find that insurance coverage is associated with increasingly engaging the child in development-enhancing household activity in the total sample. This association significantly varies with ethnic ancestry and is more pronounced for children of Native or African ancestry. When stratifying by country, a significant positive association is observed for Argentina, with two other countries having positive but insignificant associations. The results suggest that insurance coverage is associated with enhanced household activity toward child development. However, other data and research are needed to estimate the causal relationship.

  17. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

    Science.gov (United States)

    Bryant-Lukosius, Denise; Valaitis, Ruta; Martin-Misener, Ruth; Donald, Faith; Peña, Laura Morán; Brousseau, Linda

    2017-01-01

    ABSTRACT Objective: to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries. PMID:28146177

  18. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

    Directory of Open Access Journals (Sweden)

    Denise Bryant-Lukosius

    Full Text Available ABSTRACT Objective: to examine advanced practice nursing (APN roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries.

  19. Mobile Geometric Graphs: Detection, Coverage and Percolation

    CERN Document Server

    Peres, Yuval; Sousi, Perla; Stauffer, Alexandre

    2010-01-01

    We consider the following dynamic Boolean model introduced by van den Berg, Meester and White (1997). At time 0, let the nodes of the graph be a Poisson point process in R^d with constant intensity and let each node move independently according to Brownian motion. At any time t, we put an edge between every pair of nodes if their distance is at most r. We study three features in this model: detection (the time until a target point---fixed or moving---is within distance r from some node of the graph), coverage (the time until all points inside a finite box are detected by the graph), and percolation (the time until a given node belongs to the infinite connected component of the graph). We obtain precise asymptotics for these features by combining ideas from stochastic geometry, coupling and multi-scale analysis.

  20. [Pilot study on compulsory vaccination coverage].

    Science.gov (United States)

    Grandolfo, M E; Lauria, L; Medda, E; Bucciarelli, M; Andreozzi, S; Salinetti, S; Sitzia, G; Bernacchia, R

    1999-01-01

    The disappearance of diphtheria and poliomyelitis is the best evidence of the efficacy of the vaccination strategies adopted in Italy. The active offer of the prophylaxis, reinforced by law, has characterised the operational aspects of the strategy. The active surveillance system is the main tool to take under control the effectiveness of health services responsible for vaccination. This system could be more easily implemented if the health services will be given a specific software aiming to handle and evaluate vaccination registers. The present pilot study, performed in the regions Marche and Sardegna, is an example of active surveillance and it is based on the ARVA software produced by the Istituto Superiore di Sanità. The results show a good level of coverage (> 95%) within the second year of life. Unsatisfactory results were obtained on the timing of vaccinations, as recommended by the vaccination schedule, mostly for the third doses.