Sample records for care delivery r01

  1. Innovation in Health Care Delivery. (United States)

    Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R


    As reimbursement transitions from a volume-based to a value-based system, innovation in health care delivery will be needed. The process of innovation begins with framing the problem that needs to be solved along with the strategic vision that has to be achieved. Similar to scientific testing, a hypothesis is generated for a new solution to a problem. Innovation requires conducting a disciplined form of experimentation and then learning from the process. This manuscript will discuss the different types of innovation, and the key steps necessary for successful innovation in the health care field.

  2. Optimizing Cancer Care Delivery through Implementation Science

    Directory of Open Access Journals (Sweden)

    Heather B Neuman


    Full Text Available The 2013 Institute of Medicine report investigating cancer care concluded that the cancer care delivery system is in crisis due to an increased demand for care, increasing complexity of treatment, decreasing work force and rising costs. Engaging patients and incorporating evidence-based care into routine clinical practice are essential components of a high quality cancer delivery system. However, a gap currently exists between the identification of beneficial research findings and application in clinical practice. Implementation research strives to address this gap. In this review, we discuss key components of high quality implementation research. We then apply these concepts to a current cancer care delivery challenge in women’s health, specifically the implementation of a surgery decision aid for women newly diagnosed with breast cancer.

  3. Redefining global health-care delivery. (United States)

    Kim, Jim Yong; Farmer, Paul; Porter, Michael E


    Initiatives to address the unmet needs of those facing both poverty and serious illness have expanded significantly over the past decade. But many of them are designed in an ad-hoc manner to address one health problem among many; they are too rarely assessed; best practices spread slowly. When assessments of delivery do occur, they are often narrow studies of the cost-effectiveness of a single intervention rather than the complex set of them required to deliver value to patients and their families. We propose a framework for global health-care delivery and evaluation by considering efforts to introduce HIV/AIDS care to resource-poor settings. The framework introduces the notion of care delivery value chains that apply a systems-level analysis to the complex processes and interventions that must occur, across a health-care system and over time, to deliver high-value care for patients with HIV/AIDS and cooccurring conditions, from tuberculosis to malnutrition. To deliver value, vertical or stand-alone projects must be integrated into shared delivery infrastructure so that personnel and facilities are used wisely and economies of scale reaped. Two other integrative processes are necessary for delivering and assessing value in global health: one is the alignment of delivery with local context by incorporating knowledge of both barriers to good outcomes (from poor nutrition to a lack of water and sanitation) and broader social and economic determinants of health and wellbeing (jobs, housing, physical infrastructure). The second is the use of effective investments in care delivery to promote equitable economic development, especially for those struggling against poverty and high burdens of disease. We close by reporting our own shared experience of seeking to move towards a science of delivery by harnessing research and training to understand and improve care delivery.

  4. Models of care and delivery

    DEFF Research Database (Denmark)

    Lundgren, Jens


    Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good...... outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP), or a mixture of the two, depending on the setting. Key factors explaining...... this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV-related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV-specific visits in a shared care model with GPs. A similar shared-model approach...

  5. Redesigning ambulatory care business processes supporting clinical care delivery. (United States)

    Patterson, C; Sinkewich, M; Short, J; Callas, E


    The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care.

  6. The delivery of primary care services.

    NARCIS (Netherlands)

    Wilson, A.; Windak, A.; Oleszczyk, M.; Wilm, S.; Hasvold, T.; Kringos, D.


    This chapter will be devoted to the dimensions which have been grouped in the framework as “process” and that focus on essential features of service delivery in primary care. In addition to the breadth of services delivered, a comparative overview will be provided of variation in access to services,

  7. ACO model should encourage efficient care delivery. (United States)

    Toussaint, John; Krueger, David; Shortell, Stephen M; Milstein, Arnold; Cutler, David M


    The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model: finance spending and targets, attribution, and quality performance.

  8. A new model for health care delivery

    Directory of Open Access Journals (Sweden)

    Kepros John P


    Full Text Available Abstract Background The health care delivery system in the United States is facing cost and quality pressures that will require fundamental changes to remain viable. The optimal structures of the relationships between the hospital, medical school, and physicians have not been determined but are likely to have a large impact on the future of healthcare delivery. Because it is generally agreed that academic medical centers will play a role in the sustainability of this future system, a fundamental understanding of the relative contributions of the stakeholders is important as well as creativity in developing novel strategies to achieve a shared vision. Discussion Core competencies of each of the stakeholders (the hospital, the medical school and the physicians must complement the others and should act synergistically. At the same time, the stakeholders should determine the common core values and should be able to make a meaningful contribution to the delivery of health care. Summary Health care needs to achieve higher quality and lower cost. Therefore, in order for physicians, medical schools, and hospitals to serve the needs of society in a gratifying way, there will need to be change. There needs to be more scientific and social advances. It is obvious that there is a real and urgent need for relationship building among the professionals whose duty it is to provide these services.

  9. Initiatives to Enhance Primary Care Delivery

    Directory of Open Access Journals (Sweden)

    Jan L. Losby


    Full Text Available Objectives: Increasing demands on primary care providers have created a need for systems-level initiatives to improve primary care delivery. The purpose of this article is to describe and present outcomes for 2 such initiatives: the Pennsylvania Academy of Family Physicians’ Residency Program Collaborative (RPC and the St Johnsbury Vermont Community Health Team (CHT. Methods: Researchers conducted case studies of the initiatives using mixed methods, including secondary analysis of program and electronic health record data, systematic document review, and interviews. Results: The RPC is a learning collaborative that teaches quality improvement and patient centeredness to primary care providers, residents, clinical support staff, and administrative staff in residency programs. Results show that participation in a higher number of live learning sessions resulted in a significant increase in patient-centered medical home recognition attainment and significant improvements in performance in diabetic process measures including eye examinations (14.3%, P = .004, eye referrals (13.82%, P = .013, foot examinations (15.73%, P = .003, smoking cessation (15.83%, P = .012, and self-management goals (25.45%, P = .001. As a community-clinical linkages model, CHT involves primary care practices, community health workers (CHWs, and community partners. Results suggest that CHT members successfully work together to coordinate comprehensive care for the individuals they serve. Further, individuals exposed to CHWs experienced increased stability in access to health insurance (P = .001 and prescription drugs (P = .000 and the need for health education counseling (P = .000. Conclusion: Findings from this study indicate that these 2 system-level strategies have the promise to improve primary care delivery. Additional research can determine the extent to which these strategies can improve other health outcomes.

  10. A telemedicine health care delivery system (United States)

    Sanders, Jay H.


    The Interactive Telemedicine Systems (ITS) system was specifically developed to address the ever widening gap between our medical care expertise and our medical care delivery system. The frustrating reality is that as our knowledge of how to diagnose and treat medical conditions has continued to advance, the system to deliver that care has remained in an embryonic stage. This has resulted in millions of people being denied their most basic health care needs. Telemedicine utilizes an interactive video system integrated with biomedical telemetry that allows a physician at a base station specialty medical complex or teaching hospital to examine and treat a patient at multiple satellite locations, such as rural hospitals, ambulatory health centers, correctional institutions, facilities caring for the elderly, community hospital emergency departments, or international health facilities. Based on the interactive nature of the system design, the consulting physician at the base station can do a complete history and physical examination, as if the patient at the satellite site was sitting in the physician's office. This system is described.

  11. Guidelines for Psychological Practice in Health Care Delivery Systems (United States)

    American Psychologist, 2013


    Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…

  12. The application of design principles to innovate clinical care delivery. (United States)

    Brennan, Michael D; Duncan, Alan K; Armbruster, Ryan R; Montori, Victor M; Feyereisn, Wayne L; LaRusso, Nicholas F


    Clinical research centers that support hypothesis-driven investigation have long been a feature of academic medical centers but facilities in which clinical care delivery can be systematically assessed and evaluated have heretofore been nonexistent. The Institute of Medicine report "Crossing the Quality Chasm" identified six core attributes of an ideal care delivery system that in turn relied heavily on system redesign. Although manufacturing and service industries have leveraged modern design principles in new product development, healthcare has lagged behind. In this article, we describe a methodology utilized by our facility to study the clinical care delivery system that incorporates modern design principles.

  13. Technological Advances in Nursing Care Delivery. (United States)

    Sullivan, Debra Henline


    Technology is rapidly changing the way nurses deliver patient care. The Health Information Technology for Economic and Clinical Health Act of 2009 encourages health care providers to implement electronic health records for meaningful use of patient information. This development has opened the door to many technologies that use this information to streamline patient care. This article explores current and new technologies that nurses will be working with either now or in the near future.

  14. Lower Costs, Better Care- Reforming Our Health Care Delivery (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...

  15. A global health delivery framework approach to epilepsy care in resource-limited settings. (United States)

    Cochran, Maggie F; Berkowitz, Aaron L


    The Global Health Delivery (GHD) framework (Farmer, Kim, and Porter, Lancet 2013;382:1060-69) allows for the analysis of health care delivery systems along four axes: a care delivery value chain that incorporates prevention, diagnosis, and treatment of a medical condition; shared delivery infrastructure that integrates care within existing healthcare delivery systems; alignment of care delivery with local context; and generation of economic growth and social development through the health care delivery system. Here, we apply the GHD framework to epilepsy care in rural regions of low- and middle-income countries (LMIC) where there are few or no neurologists.

  16. Controlled drug delivery systems towards new frontiers in patient care

    CERN Document Server

    Rossi, Filippo; Masi, Maurizio


    This book offers a state-of-the-art overview of controlled drug delivery systems, covering the most important innovative applications. The principles of controlled drug release and the mechanisms involved in controlled release are clearly explained. The various existing polymeric drug delivery systems are reviewed, and new frontiers in material design are examined in detail, covering a wide range of polymer modification techniques. The concluding chapter is a case study focusing on use of a drug-eluting stent. The book is designed to provide the reader with a complete understanding of the mechanisms and design of controlled drug delivery systems, and to this end includes numerous step-by-step tutorials. It illustrates how chemical engineers can advance medical care by designing polymeric delivery systems that achieve either temporal or spatial control of drug delivery and thus ensure more effective therapy that eliminates the potential for both under-and overdosing.

  17. Accountable Care Units: A Disruptive Innovation in Acute Care Delivery. (United States)

    Castle, Bryan W; Shapiro, Susan E


    Accountable Care Units are a disruptive innovation that has moved care on acute care units from a traditional silo model, in which each discipline works separately from all others, to one in which multiple disciplines work together with patients and their families to move patients safely through their hospital stay. This article describes the "what," "how," and "why" of the Accountable Care Units model as it has evolved in different locations across a single health system and includes the lessons learned as different units and hospitals continue working to implement the model in their complex care environments.

  18. The role of reengineering in health care delivery. (United States)

    Boland, P


    Health care reengineering is a powerful methodology that helps organizations reorder priorities, provide more cost-effective care, and increase value to customers. It should be driven by what the customer wants and what the market needs. Systemwide reengineering integrates three levels of activity: managing community and health plan partnerships; consolidating overlapping delivery system functions among participating providers and vendors; and redesigning administrative functions, clinical services, and caregiving programs to improve health status. Reengineering is not a panacea; it is a critical core competency and requisite skill for health care organizations if they are to succeed under managed care in the future.

  19. Defining and measuring integrated patient care: promoting the next frontier in health care delivery.

    NARCIS (Netherlands)

    Singer, S.J.; Burgers, J.S.; Friedberg, M.; Rosenthal, M.B.; Leape, L.; Schneider, E.


    Integration of care is emerging as a central challenge of health care delivery, particularly for patients with multiple, complex chronic conditions. The authors argue that the concept of "integrated patient care" would benefit from further clarification regarding (a) the object of integration and (b


    Directory of Open Access Journals (Sweden)

    Olawale Ibrahim Olateju


    Full Text Available We examine the TQM Strategies and health care delivery in Nigeria, and the various means of measuring service quality. Nigeria continues to suffer outbreaks of various diseases cholera, malaria, cerebrospinal meningitis, measles, yellow fever, Bird flu e.t.c., all these diseases combine to cause high morbidity and mortality in the population. To assess the situation this paper looks at the relevant indicators like Annual Budgets by Government, Individual’s income, the role of Nigerian Medical Association (NMA and various health care agencies vested with the sole responsibility for elaborating standards for products and processes in Health care Delivery.The paper also examines the implication of Government Budget estimates on the Life expectancy of an average Nigerian. The findings necessitated the need for the government to seek support from WHO to assist in strengthening the health care system by advocating and providing technical support to health sector reforms.

  1. Health care expenditure for hospital-based delivery care in Lao PDR

    Directory of Open Access Journals (Sweden)

    Douangvichit Daovieng


    Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family

  2. High-quality chronic care delivery improves experiences of chronically ill patients receiving care

    NARCIS (Netherlands)

    J.M. Cramm (Jane); A.P. Nieboer (Anna)


    markdownabstract__Abstract__ Objective. Investigate whether high-quality chronic care delivery improved the experiences of patients. Design. This study had a longitudinal design. Setting and Participants. We surveyed professionals and patients in 17 disease management programs targeting patients wi

  3. Health care delivery in the future. (United States)

    Harnar, R


    India's health care system, despite several significant achievements, suffers from some weaknesses and deficiencies. There has been a preoccupation with the promotion of curative and clinical services through city based hospitals which have essentially catered to certain sections of the urban population. The concept of health in its totality, with preventive and promotive health care services in addition to the curative, has yet to be made operational. There has been an overdependence on the states for health care measures and voluntary and local effort has not been able to accept responsibility in any significant way. The involvement of the people in solving their health problems has been almost nonexistent. Health needs to be viewed as part of the strategy of human resources development. Horizontal and vertical linkages must be obtained among all the interrelated programs--protected water supply environmental sanitation and hygiene, nutrition, education, family planning, and maternal and child welfare. Only with such linkages can the benefits of the various programs be optimized. An attack on the problems of diseases cannot be completely successful unless it is accompanied by an attack on poverty. For this reason the 6th plan assigns a high priority to programs of promotion, or gainful employment, eradication of poverty, population control, and meeting the basic human needs of the population. The Alma Alta Declaration of 1977 has become the accepted health policy of India, simplified into the slogan "health for all by 2000." To realize this goaL, the Planning Commission recommends in the 6th 5-Year Plan a restructing and reorientation of the country's health services. The proposed alternative scheme is more decentralized and provides for many more people to be trained at the grassroots level. People would be involved in tackling their health problems and community participation would be encouraged. Finally, the alternative strongly urges the screening of patients

  4. Fatigue and the delivery of medical care

    LENUS (Irish Health Repository)

    Murphy, JFA


    Lack of sleep has well established effects on physiological, cognitive and behavioural functionality. Sleep deprivation can adversely affect clinical performance as severely as alcohol according to some sources. Sleep deficiency may be due to loss of one night’s sleep or repeated interruptions of sleep. Chronic sleep degrades the ability to recognise one’s ability to recognise the impairments induced by sleep loss. The problem of sleep deprivation has vexed acute medical practice for decades. Improvement has been painfully slow. The problem is that all 168 hours throughout every week of every year have to be covered and there are a finite number of doctors to shoulder the burden. There are many strongly held views about how best to provide night-time and week-end care. Constructive innovations are thin on the ground. The biggest gap is between administration and doctors with financial considerations being the limiting factor. It is, however, generally accepted on all sides that sleep loss and fatigue can have adverse effects on both patients and doctors.

  5. Future of Health Care Delivery in Iran, Opportunities and Threats

    Directory of Open Access Journals (Sweden)

    R Majdzadeh


    Full Text Available Background: The aim of this study was to determine the impact of important social and technological trends on health care delivery, in the context of developing “Iran's Health System Reform Plan by 2025”.Methods: A detailed review of the national and international literature was done to identify the main trends affecting health system. To collect the experts’ opinions about important trends and their impact on health care delivery, Focus Group Discussions (FGDs and semi-structured in-depth interviews techniques were used. The study was based on the STEEP model. Final results were approved in an expert’s panel session.Results: The important social and technological trends, affecting health system in Iran in the next 15 years are demographic transition, epidemiologic transition, increasing bio-environmental pollution, increasing slums, increasing private sector partnership in health care delivery, moving toward knowledge-based society, development of information and communication technology, increasing use of high technologies in health system, and development of traditional and alternative medicine. The opportunities and threats resulting from the above mentioned trends were also assessed in this study.Conclusion: Increasing healthcare cost due tosome trends like demographic and epidemiologic transition and uncontrolled increase in using new technologies in health care is one of the most important threats that the health system will be facing. The opportunities that advancement in technology and moving toward knowledge-based society create are important and should not be ignored.

  6. A clinician-driven home care delivery system. (United States)

    August, D A; Faubion, W C; Ryan, M L; Haggerty, R H; Wesley, J R


    The financial, entrepreneurial, administrative, and legal forces acting within the home care arena make it difficult for clinicians to develop and operate home care initiatives within an academic setting. HomeMed is a clinician-initiated and -directed home care delivery system wholly owned by the University of Michigan. The advantages of a clinician-directed system include: Assurance that clinical and patient-based factors are the primary determinants of strategic and procedural decisions; Responsiveness of the system to clinician needs; Maintenance of an important role for the referring physician in home care; Economical clinical research by facilitation of protocol therapy in ambulatory and home settings; Reduction of lengths of hospital stays through clinician initiatives; Incorporation of outcome analysis and other research programs into the mission of the system; Clinician commitment to success of the system; and Clinician input on revenue use. Potential disadvantages of a clinician-based system include: Entrepreneurial, financial, and legal naivete; Disconnection from institutional administrative and data management resources; and Inadequate clinician interest and commitment. The University of Michigan HomeMed experience demonstrates a model of clinician-initiated and -directed home care delivery that has been innovative, profitable, and clinically excellent, has engendered broad physician, nurse, pharmacist, and social worker enthusiasm, and has supported individual investigator clinical protocols as well as broad outcomes research initiatives. It is concluded that a clinician-initiated and -directed home care program is feasible and effective, and in some settings may be optimal.

  7. 45 CFR 50.5 - Waivers for the delivery of health care service. (United States)


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

  8. The Cardiovascular Intensive Care Unit-An Evolving Model for Health Care Delivery. (United States)

    Loughran, John; Puthawala, Tauqir; Sutton, Brad S; Brown, Lorrel E; Pronovost, Peter J; DeFilippis, Andrew P


    Prior to the advent of the coronary care unit (CCU), patients having an acute myocardial infarction (AMI) were managed on the general medicine wards with reported mortality rates of greater than 30%. The first CCUs are believed to be responsible for reducing mortality attributed to AMI by as much as 40%. This drastic improvement can be attributed to both advances in medical technology and in the process of health care delivery. Evolving considerably since the 1960s, the CCU is now more appropriately labeled as a cardiac intensive care unit (CICU) and represents a comprehensive system designed for the care of patients with an array of advanced cardiovascular disease, an entity that reaches far beyond its early association with AMI. Grouping of patients by diagnosis to a common physical space, dedicated teams of health care providers, as well as the development and implementation of evidence-based treatment algorithms have resulted in the delivery of safer, more efficient care, and most importantly better patient outcomes. The CICU serves as a platform for an integrated, team-based patient care delivery system that addresses a broad spectrum of patient needs. Lessons learned from this model can be broadly applied to address the urgent need to improve outcomes and efficiency in a variety of health care settings.

  9. Social networks--the future for health care delivery. (United States)

    Griffiths, Frances; Cave, Jonathan; Boardman, Felicity; Ren, Justin; Pawlikowska, Teresa; Ball, Robin; Clarke, Aileen; Cohen, Alan


    With the rapid growth of online social networking for health, health care systems are experiencing an inescapable increase in complexity. This is not necessarily a drawback; self-organising, adaptive networks could become central to future health care delivery. This paper considers whether social networks composed of patients and their social circles can compete with, or complement, professional networks in assembling health-related information of value for improving health and health care. Using the framework of analysis of a two-sided network--patients and providers--with multiple platforms for interaction, we argue that the structure and dynamics of such a network has implications for future health care. Patients are using social networking to access and contribute health information. Among those living with chronic illness and disability and engaging with social networks, there is considerable expertise in assessing, combining and exploiting information. Social networking is providing a new landscape for patients to assemble health information, relatively free from the constraints of traditional health care. However, health information from social networks currently complements traditional sources rather than substituting for them. Networking among health care provider organisations is enabling greater exploitation of health information for health care planning. The platforms of interaction are also changing. Patient-doctor encounters are now more permeable to influence from social networks and professional networks. Diffuse and temporary platforms of interaction enable discourse between patients and professionals, and include platforms controlled by patients. We argue that social networking has the potential to change patterns of health inequalities and access to health care, alter the stability of health care provision and lead to a reformulation of the role of health professionals. Further research is needed to understand how network structure combined with

  10. Adapting chronic care models for diabetes care delivery inlow-and-middle-income countries: A review

    Institute of Scientific and Technical Information of China (English)


    A contextual review of models for chronic care was doneto develop a context-adapted chronic care model-basedservice delivery model for chronic conditions includingdiabetes. The Philippines was used as the setting ofa low-to-middle-income country. A context-basednarrative review of existing models for chronic carewas conducted. A situational analysis was done at thegrassroots level, involving the leaders and members ofthe community, the patients, the local health system andthe healthcare providers. A second analysis making useof certain organizational theories was done to explore onimproving feasibility and acceptability of organizing carefor chronic conditions. The analyses indicated that carefor chronic conditions may be introduced, consideringthe needs of people with diabetes in particular andthe community in general as recipients of care, andthe issues and factors that may affect the healthcareworkers and the health system as providers of thiscare. The context-adapted chronic care model-basedservice delivery model was constructed accordingly.Key features are incorporation of chronic care in thehealth system's services; assimilation of chronic caredelivery with the other responsibilities of the healthcareworkers but with redistribution of certain tasks; andensuring that the recipients of care experience thewhole spectrum of basic chronic care that includes educationand promotion in the general population, riskidentification, screening, counseling including self-caredevelopment, and clinical management of the chroniccondition and any co-morbidities, regardless of level ofcontrol of the condition. This way, low-to-middle incomecountries can introduce and improve care for chronicconditions without entailing much additional demand ontheir limited resources.

  11. Women's self-perception and self-care practice: implications for health care delivery. (United States)

    Mendias, E P; Clark, M C; Guevara, E B


    Mexican American women experience unique health care needs related to integration of Mexican and American cultures. To learn how to better promote self-care practices and service utilization in women of Mexican origin living in Texas, researchers used a qualitative approach to interview a convenience sample of 11 low-income women attending a health clinic. Researchers collected narrative data about the women's perceptions of health, wellness, and self-care. Using the matrix approach described by Miles and Huberman, we organized findings around women's roles, including participants' descriptions of themselves, their health and wellness awareness, self-care practices for health/illness and wellness/nonwellness, barriers to self-care, origin of self-care practices, and perceptions of life control. Implications for health planning and service delivery are presented.

  12. Short and long term improvements in quality of chronic care delivery predict program sustainability. (United States)

    Cramm, Jane Murray; Nieboer, Anna Petra


    Empirical evidence on sustainability of programs that improve the quality of care delivery over time is lacking. Therefore, this study aims to identify the predictive role of short and long term improvements in quality of chronic care delivery on program sustainability. In this longitudinal study, professionals [2010 (T0): n=218, 55% response rate; 2011 (T1): n=300, 68% response rate; 2012 (T2): n=265, 63% response rate] from 22 Dutch disease-management programs completed surveys assessing quality of care and program sustainability. Our study findings indicated that quality of chronic care delivery improved significantly in the first 2 years after implementation of the disease-management programs. At T1, overall quality, self-management support, delivery system design, and integration of chronic care components, as well as health care delivery and clinical information systems and decision support, had improved. At T2, overall quality again improved significantly, as did community linkages, delivery system design, clinical information systems, decision support and integration of chronic care components, and self-management support. Multilevel regression analysis revealed that quality of chronic care delivery at T0 (pquality changes in the first (pmanagement programs based on the chronic care model improved the quality of chronic care delivery over time and that short and long term changes in the quality of chronic care delivery predicted the sustainability of the projects.

  13. Management plan and delivery of care in Graves' ophthalmopathy patients. (United States)

    Yang, Morgan; Perros, Petros


    Most patients with Graves' orbitopathy have mild disease that requires no or minimal intervention. For the minority of patients with moderate or severe disease, multiple medical and surgical treatments may be required at different stages. It is crucial that such patients are monitored closely and treatments applied with care in the right sequence. Medical treatments should be used as early as possible and only during the active phase of the disease. Rehabilitative surgery is indicated in the inactive phase of the disease and should follow the sequence: surgical decompression followed by eye muscle surgery, followed by lid surgery. Delivery of care in a coordinated fashion that makes use of best available expertise is important and best implemented through a Combined Thyroid Eye clinic.

  14. The influence of distance and quality of care on place of delivery in rural Ghana



    Facility delivery is an important aspect of the strategy to reduce maternal and newborn mortality. Geographic access to care is a strong determinant of facility delivery, but few studies have simultaneously considered the influence of facility quality, with inconsistent findings. In rural Brong Ahafo region in Ghana, we combined surveillance data on 11,274 deliveries with quality of care data from all 64 delivery facilities in the study area. We used multivariable multilevel logistic regressi...

  15. Confronting the Care Delivery Challenges Arising from Precision Medicine

    Directory of Open Access Journals (Sweden)

    S. Percy Ivy


    Full Text Available Understanding the biology of cancer at the cellular and molecular levels, and the application of such knowledge to the patient, has opened new opportunities and uncovered new obstacles to quality cancer care delivery. Benefits include our ability to now understand that many, if not, most cancers are not one-size-fits-all. Cancers are a variety of diseases for which intervention may be very different. This approach is beginning to bear fruit in gynecologic cancers where we are investigating therapeutic optimization at a more focused level, that while not yet precision care, is perhaps much improved. Obstacles to quality care for patients come from many directions. These include incomplete understanding of the role of the mutant proteins in the cancers, the narrow spectrum of agents, and broader mutational profiles in solid tumors, and the sometimes overzealous application of the findings of genetic testing. This has been further compromised by the unbridled use of social media by all stakeholders in cancer care often without scientific qualification, where anecdote sometimes masquerades as fact. The only current remedy is to wave the flag of caution, encourage all patients who undergo genetic testing, either germline or somatic, to do so with the oversight of genetic counselors and physician scientists knowledgeable in the pathways involved. This aspiration is accomplished with well designed clinical trials that inform next steps in this complex and ever evolving process.

  16. Point-of-care technology: integration for improved delivery of care. (United States)

    Gregory, Debbie; Buckner, Martha


    The growing complexity of technology, equipment, and devices involved in patient care delivery can be staggering and overwhelming. Technology is intended to be a tool to help clinicians, but it can also be a frustrating hindrance if not thoughtfully planned and strategically aligned. Critical care nurses are key partners in the collaborations needed to improve safety and quality through health information technology (IT). Nurses must advocate for systems that are interoperable and adapted to the context of care experiences. The involvement and collaboration between clinicians, information technology specialists, biomedical engineers, and vendors has never been more relevant and applicable. Working together strategically with a shared vision can effectively provide a seamless clinical workflow, maximize technology investments, and ultimately improve patient care delivery and outcomes. Developing a strategic integrated clinical and IT roadmap is a critical component of today's health care environment. How can technology strategy be aligned from the executive suite to the bedside caregiver? What is the model for using clinical workflows to drive technology adoption? How can the voice of the critical care nurse strengthen this process? How can success be assured from the initial assessment and selection of technology to a sustainable support model? What is the vendor's role as a strategic partner and "co-caregiver"?

  17. Health care delivery and the training of surgeons. (United States)

    MacLean, L D


    Most countries have mastered the art of cost containment by global budgeting for public expenditure. It is not as yet clear whether the other option, managed care, or managed competition will accomplish cost control in America. Robert Evans, a Canadian health care expert, remains skeptical. He says, "HMO's are the future, always have been and always will be." With few exceptions, the amount spent on health care is not a function of the system but of the gross domestic product per person. Great Britain is below the line expected for expenditure, which may be due to truly impressive waiting lists. The United States is above the line, which is probably related to the overhead costs to administer the system and the strong demand by patients for prompt and highly sophisticated diagnostic measures and treatments. Canada is on the line, but no other country has subscribed to the Canadian veto on private insurance. Reform or changes are occurring in all countries and will continue to do so. For example, we are as terrified of managed care in Canada as you are of our brand of socialized insurance. We distrust practice by protocol just as you abhor waiting lists. From my perspective as a surgeon, I envision an ideal system that would cover all citizens, would maintain choice of surgeon by patients, would provide mechanisms for cost containment that would have the active and continuous participation of the medical profession, and would provide for research and development. Any alteration in health care delivery in the United States that compromises biomedical research and development will be a retrogressive, expensive step that could adversely affect the health of nations everywhere. Finally, a continuing priority of our training programs must be to ensure that the surgeon participating in this system continues to treat each patient as an individual with concern for his or her own needs.

  18. Complicated deliveries, critical care and quality in emergency obstetric care in Northern Tanzania. (United States)

    Olsen, Ø E; Ndeki, S; Norheim, O F


    Our objective was to determine the availability and quality of obstetric care to improve resource allocation in northern Tanzania. We surveyed all facilities providing delivery services (n=129) in six districts in northern Tanzania using the UN Guidelines for monitoring emergency obstetric care (EmOC). The three last questions in this audit outline are examined: Are the right women (those with obstetric complications) using emergency obstetric care facilities (Met Need)? Are sufficient quantities of critical services being provided (cesarean section rate (CSR))? Is the quality of the services adequate (case fatality rate (CFR))? Complications are calculated using Plan 3 of the UN Guidelines to assess the value of routine data for EmOC indicator monitoring. Nearly 60% of the expected complicated deliveries in the study population were conducted at EmOC qualified health facilities. 81.2% of the expected complicated deliveries are conducted in any facility (including facilities not qualifying as EmOC facilities). There is an inadequate level of critical services provided (CSR 4.6). Voluntary agencies provide most of these services in rural settings. All indicators show large variations with the setting (urban/rural location, level and ownership of facilities). Finally, there is large variation in the CFR with only one facility meeting the minimum accepted level. Utilization and quality of critical obstetric services at lower levels and in rural districts must be improved. The potential for improving the resource allocation within lower levels of the health care system is discussed. Given the small number of qualified facilities yet relatively high Met Need, we argue that it is neither the mothers' ignorance nor their lack of ability to get to a facility that is the main barrier to receiving quality care when needed, but rather the lack of quality care at the facility. Little can be concluded using the CFR to describe the quality of services provided.

  19. Short and long term improvements in quality of chronic care delivery predict program sustainability

    NARCIS (Netherlands)

    J.M. Cramm (Jane); A.P. Nieboer (Anna)


    markdownabstractEmpirical evidence on sustainability of programs that improve the quality of care delivery over time is lacking. Therefore, this study aims to identify the predictive role of short and long term improvements in quality of chronic care delivery on program sustainability. In this lon

  20. Thriving Children, Striving Families: A Blueprint for Streamlined Delivery of Child Day Care Collaboration Plan. (United States)

    Bassler, Elissa J.; And Others

    Upcoming federal and state changes in welfare and social services will have a profound effect on the delivery of early childhood care and education in Illinois. In October, 1995, the Day Care Action Council of Illinois convened a meeting of early childhood experts and advocates. From this retreat, a vision for a new system of the delivery of child…

  1. The influence of distance and quality of care on place of delivery in rural Ghana (United States)

    Nesbitt, Robin C.; Lohela, Terhi J.; Soremekun, Seyi; Vesel, Linda; Manu, Alexander; Okyere, Eunice; Grundy, Chris; Amenga-Etego, Seeba; Owusu-Agyei, Seth; Kirkwood, Betty R.; Gabrysch, Sabine


    Facility delivery is an important aspect of the strategy to reduce maternal and newborn mortality. Geographic access to care is a strong determinant of facility delivery, but few studies have simultaneously considered the influence of facility quality, with inconsistent findings. In rural Brong Ahafo region in Ghana, we combined surveillance data on 11,274 deliveries with quality of care data from all 64 delivery facilities in the study area. We used multivariable multilevel logistic regression to assess the influence of distance and several quality dimensions on place of delivery. Women lived a median of 3.3 km from the closest delivery facility, and 58% delivered in a facility. The probability of facility delivery ranged from 68% among women living 1 km from their closest facility to 22% among those living 25 km away, adjusted for confounders. Measured quality of care at the closest facility was not associated with use, except that facility delivery was lower when the closest facility provided substandard care on the EmOC dimension. These results do not imply, however, that we should increase geographic accessibility of care without improving facility quality. While this may be successful in increasing facility deliveries, such care cannot be expected to reduce maternal and neonatal mortality. PMID:27506292

  2. The influence of distance and quality of care on place of delivery in rural Ghana. (United States)

    Nesbitt, Robin C; Lohela, Terhi J; Soremekun, Seyi; Vesel, Linda; Manu, Alexander; Okyere, Eunice; Grundy, Chris; Amenga-Etego, Seeba; Owusu-Agyei, Seth; Kirkwood, Betty R; Gabrysch, Sabine


    Facility delivery is an important aspect of the strategy to reduce maternal and newborn mortality. Geographic access to care is a strong determinant of facility delivery, but few studies have simultaneously considered the influence of facility quality, with inconsistent findings. In rural Brong Ahafo region in Ghana, we combined surveillance data on 11,274 deliveries with quality of care data from all 64 delivery facilities in the study area. We used multivariable multilevel logistic regression to assess the influence of distance and several quality dimensions on place of delivery. Women lived a median of 3.3 km from the closest delivery facility, and 58% delivered in a facility. The probability of facility delivery ranged from 68% among women living 1 km from their closest facility to 22% among those living 25 km away, adjusted for confounders. Measured quality of care at the closest facility was not associated with use, except that facility delivery was lower when the closest facility provided substandard care on the EmOC dimension. These results do not imply, however, that we should increase geographic accessibility of care without improving facility quality. While this may be successful in increasing facility deliveries, such care cannot be expected to reduce maternal and neonatal mortality.

  3. Clinical outcomes of HIV care delivery models in the US: a systematic review. (United States)

    Kimmel, April D; Martin, Erika G; Galadima, Hadiza; Bono, Rose S; Tehrani, Ali Bonakdar; Cyrus, John W; Henderson, Margaret; Freedberg, Kenneth A; Krist, Alexander H


    With over 1 million people living with HIV, the US faces national challenges in HIV care delivery due to an inadequate HIV specialist workforce and the increasing role of non-communicable chronic diseases in driving morbidity and mortality in HIV-infected patients. Alternative HIV care delivery models, which include substantial roles for advanced practitioners and/or coordination between specialty and primary care settings in managing HIV-infected patients, may address these needs. We aimed to systematically review the evidence on patient-level HIV-specific and primary care health outcomes for HIV-infected adults receiving outpatient care across HIV care delivery models. We identified randomized trials and observational studies from bibliographic and other databases through March 2016. Eligible studies met pre-specified eligibility criteria including on care delivery models and patient-level health outcomes. We considered all available evidence, including non-experimental studies, and evaluated studies for risk of bias. We identified 3605 studies, of which 13 met eligibility criteria. Of the 13 eligible studies, the majority evaluated specialty-based care (9 studies). Across all studies and care delivery models, eligible studies primarily reported mortality and antiretroviral use, with specialty-based care associated with mortality reductions at the clinician and practice levels and with increased antiretroviral initiation or use at the clinician level but not the practice level. Limited and heterogeneous outcomes were reported for other patient-level HIV-specific outcomes (e.g., viral suppression) as well as for primary care health outcomes across all care delivery models. No studies addressed chronic care outcomes related to aging. Limited evidence was available across geographic settings and key populations. As re-design of care delivery in the US continues to evolve, better understanding of patient-level HIV-related and primary care health outcomes, especially

  4. Situational awareness, relational coordination and integrated care delivery to hospitalized elderly in the Netherlands: A comparison between hospitals

    NARCIS (Netherlands)

    J.M. Hartgerink (Jacqueline); J.M. Cramm (Jane); A.J. de Vos (Annemarie); T.J.E.M. Bakker (Ton); E.W. Steyerberg (Ewout); J.P. Mackenbach (Johan); A.P. Nieboer (Anna)


    markdownabstract__Abstract__ Background: It is known that interprofessional collaboration is crucial for integrated care delivery, yet we are still unclear about the underlying mechanisms explaining effectiveness of integrated care delivery to older patients. In addition, we lack research comparing

  5. Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records. (United States)

    Monroe, C Douglas; Chin, Karen Y


    The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

  6. Health Care Delivery Meets Hospitality: A Pilot Study in Radiology. (United States)

    Steele, Joseph Rodgers; Jones, A Kyle; Clarke, Ryan K; Shoemaker, Stowe


    The patient experience has moved to the forefront of health care-delivery research. The University of Texas MD Anderson Cancer Center Department of Diagnostic Radiology began collaborating in 2011 with the University of Houston Conrad N. Hilton College of Hotel and Restaurant Management, and in 2013 with the University of Nevada, Las Vegas, William F. Harrah College of Hotel Administration, to explore the application of service science to improving the patient experience. A collaborative pilot study was undertaken by these 3 institutions to identify and rank the specific needs and expectations of patients undergoing imaging procedures in the MD Anderson Department of Diagnostic Radiology. We first conducted interviews with patients, providers, and staff to identify factors perceived to affect the patient experience. Next, to confirm these factors and determine their relative importance, we surveyed more than 6,000 patients by e-mail. All factors considered important in the interviews were confirmed as important in the surveys. The surveys showed that the most important factors were acknowledgment of the patient's concerns, being treated with respect, and being treated like a person, not a "number"; these factors were more important than privacy, short waiting times, being able to meet with a radiologist, and being approached by a staff member versus having one's name called out in the waiting room. Our work shows that it is possible to identify and rank factors affecting patient satisfaction using techniques employed by the hospitality industry. Such factors can be used to measure and improve the patient experience.

  7. Closing the delivery gaps in pediatric HIV care in Togo, West Africa: using the care delivery value chain framework to direct quality improvement. (United States)

    Fiori, Kevin; Schechter, Jennifer; Dey, Monica; Braganza, Sandra; Rhatigan, Joseph; Houndenou, Spero; Gbeleou, Christophe; Palerbo, Emmanuel; Tchangani, Elfamozo; Lopez, Andrew; Bensen, Emily; Hirschhorn, Lisa R


    Providing quality care for all children living with HIV/AIDS remains a global challenge and requires the development of new healthcare delivery strategies. The care delivery value chain (CDVC) is a framework that maps activities required to provide effective and responsive care for a patient with a particular disease across the continuum of care. By mapping activities along a value chain, the CDVC enables managers to better allocate resources, improve communication, and coordinate activities. We report on the successful application of the CDVC as a strategy to optimize care delivery and inform quality improvement (QI) efforts with the overall aim of improving care for Pediatric HIV patients in Togo, West Africa. Over the course of 12 months, 13 distinct QI activities in Pediatric HIV/AIDS care delivery were monitored, and 11 of those activities met or exceeded established targets. Examples included: increase in infants receiving routine polymerase chain reaction testing at 2 months (39-95%), increase in HIV exposed children receiving confirmatory HIV testing at 18 months (67-100%), and increase in patients receiving initial CD4 testing within 3 months of HIV diagnosis (67-100%). The CDVC was an effective approach for evaluating existing systems and prioritizing gaps in delivery for QI over the full cycle of Pediatric HIV/AIDS care in three specific ways: (1) facilitating the first comprehensive mapping of Pediatric HIV/AIDS services, (2) identifying gaps in available services, and (3) catalyzing the creation of a responsive QI plan. The CDVC provided a framework to drive meaningful, strategic action to improve Pediatric HIV care in Togo.

  8. 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.

  9. COPD care delivery pathways in five European Union countries: mapping and health care professionals’ perceptions

    Directory of Open Access Journals (Sweden)

    Kayyali R


    studied care pathways. General practitioners/family doctors are responsible for liaising between different teams/services, except in Greece where this is done through pulmonologists. Ireland and the UK are the only countries with services for patients at home to shorten unnecessary hospital stay. HCPs emphasized lack of communication, limited resources, and poor patient engagement as issues in the current pathways. Furthermore, no specified role exists for pharmacists and informal carers.Conclusion: Service and professional integration between care settings using a unified system targeting COPD and comorbidities is a priority. Better communication between health care providers, establishing a clear role for informal carers, and enhancing patients’ engagement could optimize current care pathways resulting in a better integrated system. Keywords: COPD, comorbidities, care delivery pathway, comparative analysis

  10. The Effect of Kangaroo Mother Care Immediately after Delivery on Mother-infant Attachment 3 Months after Delivery

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    Fatemeh Zahra Karimi


    Full Text Available Background  The aim of this study was determine the effect of kangaroo mother care (KMC immediately after delivery on mother-infant attachment 3-month after delivery. Materials and Methods: In this RCT study, 72 mother-infant pairs were randomly divided in to kangaroo mother care and routine care groups.The intervention group received kangaroo mother care (KMC in the first two hours post birth. The control group just received routine hospital care. Mothers in the intervention group were encouraged to keep the baby in KMC as much as possible during the day and night throughout the neonatal period. Participants were followed up for three months after birth. The Main outcome measure was mother-infant attachment at 3 months postpartum and maternal anxiety about the baby at the same time. The data was collected by questionnaire (demographic information of parents and neonates and maternal attachment scale. Analysis was performed using SPSS software (version 14. Results: There was no significant difference between two groups regarding their baseline data. Mean maternal attachment score in the KMC group and in the routine care group at three months after delivery was 52.40±3.30 and 49.86±4.18 respectively, which was significantly higher in the KMC group (P

  11. Clients' initiatives and caregivers' responses in the organizational dynamics of care delivery. (United States)

    Kajamaa, Anu; Hilli, Angelique


    Our aim with this article is to develop a typology for the analysis of client-caregiver encounters in health care. We first observed client-caregiver interactions in the homes of home care clients and during the care processes of surgical patients. We then conducted a data-driven analysis to identify the clients' initiatives and the degree of engagement in the responses they received. The clients shaped their care by commenting on, questioning, ensuring, and enriching their care. The responses from the caregivers consisted of neutral acceptance, disregard, and shared expansive development of the clients' initiatives. The typology developed from these will be a tool to widen our understanding of the complex interactions in care delivery and of the different conceptualizations of care that actors hold. In future studies this typology will help in the analysis of the organizational dynamics of health care delivery.

  12. Vaginal delivery for breech presentation should be an option: experience in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Isha Gutgutia


    Conclusions: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill and confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 562-565

  13. Developments in the delivery of emergency care in Japan and the present state of our hospital's emergency care. (United States)

    Tonouchi, S


    Japan is far behind Western nations in emergency care, such as the United States where paramedics are placed under the M-ICU system and France in which the SAMU system is in force. This paper is an attempt to introduce developments in the delivery of emergency care in the Japanese rural setting and the present state of emergency care delivered at our hospitals, while checking them against national policy.

  14. Situational awareness, relational coordination and integrated care delivery to hospitalized elderly in The Netherlands: a comparison between hospitals



    markdownabstract__Abstract__ Background: It is known that interprofessional collaboration is crucial for integrated care delivery, yet we are still unclear about the underlying mechanisms explaining effectiveness of integrated care delivery to older patients. In addition, we lack research comparing integrated care delivery between hospitals. Therefore, this study aims to (i) provide insight into the underlying components 'relational coordination' and 'situational awareness' of integrated care...

  15. Managed care contracting issues in integrated delivery systems. (United States)

    Stewart, E E


    This article is a checklist for use by health care providers in reviewing proposed managed care contracting agreements. This checklist is not an exhaustive list, but is intended to be used as a framework for review.

  16. Doula--a new model of delivery (continuous, nonprofessional care during the delivery). (United States)

    Guzikowski, W


    In the last few years world literature examined advantages related to the presence and support of an nonprofessional person (doula) during a delivery. Aside from encouraging the husbands to take an active part in the delivery there was a rise in popularity of doula's help. The results of frequency questionnaire analysis show that in Poland parturients, first and foremost, expect support of a professional personnel (midwife, midwifery students).

  17. The delivery of preventive care to clients of community health services



    Background Smoking, poor nutrition, risky alcohol use, and physical inactivity are the primary behavioral risks for common causes of mortality and morbidity. Evidence and guidelines support routine clinician delivery of preventive care. Limited evidence describes the level delivered in community health settings. The objective was to determine the: prevalence of preventive care provided by community health clinicians; association between client and service characteristics and receipt of care; ...

  18. Managing care in an integrated delivery system via an Intranet. (United States)

    Halamka, J D; Hughes, M; Mack, J; Hurwitz, M; Davis, F; Wood, D; Borten, K; Saal, A K


    The CareGroup Provider Service Network is a managed care contracting organization which provides central administrative services for over 1800 physicians and 200,000 managed care lives. Services include utilization management, disease management and credentialing for the entire network. The management model of the Provider Service Network empowers local physician groups with information and education. To meet the managed care information needs of the network, we implemented an intranet-based executive information system, PSNWeb, which retrieves data from a managed care data warehouse. The project required the integration of diverse technologies and development of a complex security/confidentiality infrastructure to deliver information to 8 major clinician groups, each with different information needs.

  19. Getting the basics right. Care delivery in nursing homes. (United States)

    Rantz, Marilyn J; Grando, Victoria; Conn, Vicki; Zwygart-Staffacher, Mary; Hicks, Lanis; Flesner, Marcia; Scott, Jill; Manion, Pam; Minner, Donna; Porter, Rose; Maas, Meridean


    In this study, the key exemplar processes of care in facilities with good resident outcomes were described. It follows that with description of these processes, it is feasible to teach facilities about the basics of care and the ways to systematically approach care so they can adopt these care processes and improve resident outcomes. However, for this to happen key organizational commitments must be in place for staff to consistently provide the basics of care. Nursing leadership must have a consistent presence over time, they must be champions of using team and group processes involving staff throughout the facility, and they must actively guide quality improvement processes. Administrative leadership must be present and express the expectation that high quality care is expected for residents, and that workers are expected to contribute to the quality improvement effort. If facilities are struggling with achieving average or poor resident outcomes, they must first make an effort to find nursing and administrative leaders who are willing to stay with the organization. These leaders must be skilled with team and group processes for decision-making and how to implement and use a quality improvement program to improve care. These leaders must be skilled at building employee relations and at retention strategies so residents are cared for by consistent staff who know them. The results of this study illustrate the simplicity of the basics of care that residents in nursing facilities need. The results also illustrate the complexity of the care processes and the organizational systems that must be in place to achieve good outcomes. Achieving these outcomes is the challenge facing those currently working in and leading nursing facilities.

  20. Care delivery pathways for Chronic Obstructive Pulmonary Disease in England and the Netherlands: a comparative study

    Directory of Open Access Journals (Sweden)

    Cecile MA Utens


    Full Text Available Introduction':' A remarkable difference in care delivery pathways for Chronic Obstructive Pulmonary Disease (COPD is the presence of hospital-at-home for COPD exacerbations in England and its absence in the Netherlands. The objective of this paper is to explain this difference. Methods':' Descriptive COPD statistics and care delivery pathways on all care levels within the institutional context, followed by a comparison of care delivery pathways and an explanation of the difference with regard to hospital-at-home. Results: The Netherlands and England show broad similarities in their care delivery pathways for COPD patients. A major difference is the presence of hospital-at-home for COPD exacerbations in England and its absence in the Netherlands. Three possible explanations for this difference are presented: differences in the urgency for alternatives (higher urgency for alternative treatment models in England, the differences in funding (funding in England facilitated the development of hospital-at-home and the differences in the substitution of tasks to nurses (substitution to nurses has taken place to a larger extent in England. Discussion and Conclusion: The difference between the Netherlands and England regarding hospital-at-home for COPD exacerbations can be explained in three ways. Hospital-at-home has proved to be a safe alternative for hospital care for selected patients, and should be considered as a treatment option for COPD exacerbations in the Netherlands.

  1. A Labor and Delivery Patient Classification System Based on Direct Nursing Care Time (United States)


    determine apgar score , label cord blood, clamp umbilical cord, stabilize neonate’s temperature, and complete identification of neonate. PL-form general...second practical exercise, based on a different written patient scenario, was returned to the nurse researchers. The researchers scored the exercise to...Bolton, L. B. (no date). Determinants of nursing care. Labor and Delivery. An obstetrical acuity scoring system for labor and delivery. Los Angeles, CA

  2. Drivers of Prenatal Care Quality and Uptake of Supervised Delivery Services in Ghana


    Atinga, RA; Baku, AA; Adongo, PB


    Background: In spite of the introduction of free maternal healthcare in Ghana, utilization of supervised delivery services continues to be low due partly to poor quality of antenatal care (ANC). Aim: The study sought to identify the determinants of perceived quality of ANC and uptake of skilled delivery services. Subjects and Methods: A total of 363 expectant mothers were randomly selected in urban health facilities for interview. Logistic regression models were computed to examine the relati...

  3. The risks and opportunities of the globalization of health care delivery. (United States)

    Thompson, Steven; Hasham, Salim


    The pace and scale of globalization in health care services delivery have accelerated over the past decade. There have been numerous collaborations in health care service delivery between the private sector in North America and Europe with public and private entities in various emerging markets. These partnerships can be extremely fruitful, but also carry significant challenges. Johns Hopkins Medicine International (JHI) has been active for more than a decade in supporting international partners in building capacity and improving delivery systems. In addressing the challenges of globalization we have learned a number of lessons and have come up with several innovations to better help providers in emerging markets respond to the health care needs unique to their regions.

  4. Creating a Patient-Centered Health Care Delivery System: A Systematic Review of Health Care Quality From the Patient Perspective. (United States)

    Mohammed, Khaled; Nolan, Margaret B; Rajjo, Tamim; Shah, Nilay D; Prokop, Larry J; Varkey, Prathibha; Murad, Mohammad H


    Patient experience is one of key domains of value-based purchasing that can serve as a measure of quality and be used to improve the delivery of health services. The aims of this study are to explore patient perceptions of quality of health care and to understand how perceptions may differ by settings and condition. A systematic review of multiple databases was conducted for studies targeting patient perceptions of quality of care. Two reviewers screened and extracted data independently. Data synthesis was performed following a meta-narrative approach. A total of 36 studies were included that identified 10 quality dimensions perceived by patients: communication, access, shared decision making, provider knowledge and skills, physical environment, patient education, electronic medical record, pain control, discharge process, and preventive services. These dimensions can be used in planning and evaluating health care delivery. Future research should evaluate the effect of interventions targeting patient experience on patient outcomes.

  5. The impact of racism on the delivery of health care and mental health services. (United States)

    Hollar, M C


    This article presents research findings useful in formulating a Best Practices Model for the delivery of mental health services to underserved minority populations. Aspects of the role of racism in health care delivery and public health planning are explored. An argument is made for inclusion of the legacy of the slavery experience and the history of racism in America in understanding the current health care crisis in the African-American population. The development of an outline in APA DSM IV for the use of cultural formulations in psychiatric diagnosis is discussed.

  6. The patient as the pivot point for quality in health care delivery. (United States)

    Lengnick-Hall, C A


    Health care enterprises make comprehensive and durable changes in people. This human-centered purpose defines the fundamental nature of quality in health care settings. Traditional perspectives of quality and familiar views of customer satisfaction are inadequate to manage the complex relationships between the health care delivery firm and its patients. Patients play four roles in health care systems that must be reflected when defining and measuring quality in these settings: patient as supplier, patient as product, patient as participant, and patient as recipient. This article presents a conceptual model of quality that incorporates these diverse patient roles. The strategic and managerial implications of the model are also discussed.

  7. Pharmaceutical care and home delivery of medication to patients with chronic myeloid leukemia

    Directory of Open Access Journals (Sweden)

    Begoña San José Ruiz


    Full Text Available Objectives: To describe the implementation of a new model face to face and remote pharmaceutical care with home delivery of tyronsine kinase inhibitors medicines for patients with chronic myeloid leukemia. Methods: Patients with chronic myeloid leukemia were selected to start this new model of care. Four characteristics were taken into account for the choice: chronicity of the disease, frequency of doctor visits, pharmaceutical care value and conservation of tyronsine kinase inhibitors medicines at room temperature. Results: Out of 68 patients with chronic myeloid leukemia and treated with tyronsine kinase inhibitors, 42 were selected due to the frequency of their hematologist visits. An introductory letter and a questionnaire about their preferences were sent to these patients.Sixteen of them expressed their desire to participate. The legal department designed a confidentiality contract, as well as a model of informed consent. A logistic distribution model based on defined routes and timetables was established. Prior to inclusion, pharmaceutical care was performed in a face to face consultation and the communication way was established for the followings remote consultations. Home delivery had a monthly cost of 13.2 € (including VAT per patient. All the patients who started this program continue in it. To date, 5 deliveries per patient have been conducted Conclusions: It is possible to establish an alternative model of pharmaceutical care with home delivery of medication, keeping the pharmacist-patient relationship, avoiding travel, ensuring the confidentiality and rationalizing the stocks

  8. Impact of care coordination on Australia's mental health service delivery system. (United States)

    Brophy, Lisa; Hodges, Craig; Halloran, Kieran; Grigg, Margaret; Swift, Mary


    Care coordination models have developed in response to the recognition that Australia's health and welfare service system can be difficult to access, navigate and is often inefficient in caring for people with severe and persistent mental illness (SPMI) and complex care and support needs. This paper explores how the Australian Government's establishment of the Partners in Recovery (PIR) initiative provides an opportunity for the development of more effective and efficient models of coordinated care for the identified people with SPMI and their families and carers. In conceptualising how the impact of the PIR initiative could be maximised, the paper explores care coordination and what is known about current best practice. The key findings are the importance of having care coordinators who are well prepared for the role, can demonstrate competent practice and achieve better systemic responses focused on the needs of the client, thus addressing the barriers to effective care and treatment across complex service delivery systems.

  9. Why we need interprofessional education to improve the delivery of safe and effective care

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    Scott Reeves


    Full Text Available Interprofessional education (IPE is an activity that involves two or more professions who learn interactively together to improve collaboration and the quality of care. Research has continually revealed that health and social care professionals encounter a range of problems with interprofessional coordination and collaboration which impact on the quality and safety of care. This empirical work resulted in policymakers across health care education and practice to invest in IPE to help resolve this collaborative failures. It is anticipated that IPE will provide health and social care professionals with the abilities required to work together effectively in providing safe high quality care to patients. Through a discussion of a range of key professional, educational and organization issues related to IPE, this paper argues that this form of education is an important strategy to improve the delivery of safe and effective care

  10. Home delivery and newborn care practices among urban women in western Nepal: a questionnaire survey

    Directory of Open Access Journals (Sweden)

    Giri Sabitri


    Full Text Available Abstract Background About 98% of newborn deaths occur in developing countries, where most newborns deaths occur at home. In Nepal, approximately, 90% of deliveries take place at home. Information about reasons for delivering at home and newborn care practices in urban areas of Nepal is lacking and such information will be useful for policy makers. Methods A cross-sectional survey was carried out in the immunisation clinics of Pokhara city, western Nepal during January and February, 2006. Two trained health workers administered a semi-structured questionnaire to the mothers who had delivered at home. Results A total of 240 mothers were interviewed. Planned home deliveries were 140 (58.3% and 100 (41.7% were unplanned. Only 6.2% of deliveries had a skilled birth attendant present and 38 (15.8% mothers gave birth alone. Only 46 (16.2% women had used a clean home delivery kit and only 92 (38.3% birth attendants had washed their hands. The umbilical cord was cut after expulsion of placenta in 154 (64.2% deliveries and cord was cut using a new/boiled blade in 217 (90.4% deliveries. Mustard oil was applied to the umbilical cord in 53 (22.1% deliveries. Birth place was heated throughout the delivery in 88 (64.2% deliveries. Only 100 (45.8% newborns were wrapped within 10 minutes and 233 (97.1% were wrapped within 30 minutes. Majority (93.8% of the newborns were given a bath soon after birth. Mustard oil massage of the newborns was a common practice (144, 60%. Sixteen (10.8% mothers did not feed colostrum to their babies. Prelacteal feeds were given to 37(15.2% newborns. Initiation rates of breast-feeding were 57.9% within one hour and 85.4% within 24 hours. Main reasons cited for delivering at home were 'preference' (25.7%, 'ease and convenience' (21.4% for planned deliveries while 'precipitate labor' (51%, 'lack of transportation' (18% and 'lack of escort' during labor (11% were cited for the unplanned ones. Conclusion High-risk home delivery and

  11. Instructional design and delivery of a virtual short course of pharmaceutical care and evaluating participants’ satisfaction



    Abstract Introduction: There is more need for pharmacy managers’ development regarding pharmaceutical care after Heath Reform Project. In this study, we designed, delivered and evaluated a virtual one-year short course of pharmaceutical care for pharmacy managers. Methods: We interviewed with five hospital pharmacy managers for educational need assessment. Then we developed the curriculum and performed a systematic instructional design for its blended delivery. Faculty members participa...

  12. Chiropractor perceptions and practices regarding interprofessional service delivery in the Danish primary care context

    DEFF Research Database (Denmark)

    Myburgh, Corrie; Christensen, Henrik Wulff; Fogh-Schultz, Anders Lyck


    For the past 20 years, chiropractors have enjoyed access to the Danish health care system and have been free to build integrated health care delivery partnerships. An electronic survey of chiropractic clinics around Denmark was conducted in order to observe interprofessional practice trends. From...... practice to be important and as a group, perceive themselves to be offering such models of service provision. Medical practitioners are perceived as desirable, but under utilized partners....

  13. Deliveries among diabetic females; a tertiary care experience

    Directory of Open Access Journals (Sweden)

    Qummry Ali Hindi


    Full Text Available Objectives: To determine the cesarean section (CS rate in a consecutive series of pregnant women with Diabetes Mellitus. Material and Methods: This retrospective patients’ files review of deliveries happened to diabetic mothers was carried out from 1st January, 2005 to 31st December, 2006 in the department of Obstetrics and Gynecology of Alnoor Specialist Hospital, Makkah, Saudi Arabia. Results: Among all subjects (118, Saudi national women predominated 101(86%. Majority belonged to the age group of 36-40 years, i.e., 38(32% and 52(44% was diagnosed as gestational diabetes mellitus. However, 89(75% of pregnancies were terminated through CS. Conclusion: Majority were delivered by CS.

  14. Retail and Real Estate: The Changing Landscape of Care Delivery. (United States)

    Mason, Scott A


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

  15. The compatibility of telehealth with health-care delivery. (United States)

    Vuononvirta, Tiina; Timonen, Markku; Keinänen-Kiukaanniemi, Sirkka; Timonen, Olavi; Ylitalo, Kirsti; Kanste, Outi; Taanila, Anja


    There is no clear understanding about the concept of technology adoption in the health-care environment. Compatibility is one of the factors affecting telehealth adoption. We investigated the key factors of telehealth's compatibility with health centre activities. Qualitative research was carried out in 2007-2009, with 55 interviews in seven health centres and in one special care hospital. The people interviewed were physicians, nurses and physiotherapists. After analysing the interview material, we concluded that compatibility has three aspects: individual, process and organizational compatibility. Individual compatibility was manifested in four different ways: from the viewpoints of professionals, patients, communication and cooperation. Three aspects of process compatibility were introduced: scheduling, resources and complexity of processes. Modest organizing efforts with telehealth and even a lack of interest can be expressions of organizational compatibility. Functional and user-friendly technology is a basic precondition for telehealth compatibility. With thorough organizing, most of the compatibility challenges can be solved.

  16. Individual and Area Level Factors Associated with Prenatal, Delivery, and Postnatal Care in Pakistan. (United States)

    Budhwani, Henna; Hearld, Kristine Ria; Harbison, Hanne


    This research examines individual and area level factors associated with maternal health care utilization in Pakistan. The 2012-2013 Pakistan Demographic and Health Surveys data was used to model five outcomes: prenatal care within the first trimester, four plus prenatal visits, birth attendance by a skilled attendant, birth in a medical facility, and receipt of postnatal care. Less than half of births were to mothers receiving prenatal care in the first trimester, and approximately 57 % had trained personnel at delivery. Over half were born to mothers who received postnatal care. Evidence was found to support the positive effect of individual level variables, education and wealth, on the utilization of maternal health care across all five measures. Although, this study did not find unilateral differences between women residing in rural and urban settings, rural women were found to have lower odds of utilizing prenatal services as compared to mothers in urban environments. Additionally, women who cited distance as a barrier, had lower odds of receiving postnatal health care, but still engaged in prenatal services and often had a skilled attendant present at delivery. The odds of utilizing prenatal care increased when women resided in an area where prenatal utilization was high, and this variability was found across measures across provinces. The results found in this paper highlight the uneven progress made around improving prenatal, delivery, and postnatal care in Pakistan; disparities persist which may be attributed to factors both at the individual and community level, but may be addressed through a consorted effort to change national policy around women's health which should include the promotion of evidence based interventions such as incentivizing health care workers, promoting girls' education, and improving transportation options for pregnant women and recent mothers with the intent of ultimately lowering the Maternal Mortality Rate as recommended in the U

  17. The role of psychologists in health care delivery. (United States)

    Wahass, Saeed H


    Advances in the biomedical and the behavioral sciences have paved the way for the integration of medical practice towards the biopsychosocial approach. Therefore, dealing with health and illness overtakes looking for the presence or absence of the disease and infirmity (the biomedical paradigm) to the biopsychosocial paradigm in which health means a state of complete physical, psychological and social well-being. Psychology as a behavioral health discipline is the key to the biopsychosocial practice, and plays a major role in understanding the concept of health and illness. The clinical role of psychologists as health providers is diverse with the varying areas of care giving (primary, secondary and tertiary care) and a variety of subspecialties. Overall, psychologists assess, diagnose, and treat the psychological problems and the behavioral dysfunctions resulting from, or related to physical and mental health. In addition, they play a major role in the promotion of healthy behavior, preventing diseases and improving patients' quality of life. They perform their clinical roles according to rigorous ethical principles and code of conduct. This article describes and discusses the significant role of clinical health psychology in the provision of health care, following a biopsychosocial perspective of health and illness. Professional and educational issues have also been discussed.

  18. Obstacles to the delivery of primary palliative care as perceived by GPs.

    NARCIS (Netherlands)

    Groot, M.M.; Vernooij-Dassen, M.J.F.J.; Verhagen, C.A.H.H.V.; Crul, B.J.P.; Grol, R.P.T.M.


    INTRODUCTION: In order to facilitate GPs in their work and increase the possibilities for patients to remain at home, it is important to identify the obstacles which hinder the delivery of primary palliative care. From previous research we learned about some of the problems experienced by GPs. In th

  19. Generic project definitions for improvement of health care delivery: A case-base approach

    NARCIS (Netherlands)

    Niemeijer, G.C.; Does, R.J.M.M.; de Mast, J.; Trip, A.; van den Heuvel, J.


    Background: The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. Methods: This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning a

  20. Community health workers and health care delivery: evaluation of a women's reproductive health care project in a developing country.

    Directory of Open Access Journals (Sweden)

    Abdul Wajid

    Full Text Available BACKGROUND: As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH services in two areas with different levels of service in Punjab, Pakistan. METHODS: A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA. Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. RESULTS: The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. CONCLUSIONS: Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an

  1. 45 CFR 61.9 - Reporting civil judgments related to the delivery of a health care item or service. (United States)


    ... judgments related to the delivery of a health care item or service. (a) Who must report. Federal and State... practitioners related to the delivery of a health care item or service (regardless of whether the civil judgment... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reporting civil judgments related to the...

  2. Situational awareness, relational coordination and integrated care delivery to hospitalized elderly in The Netherlands: a comparison between hospitals

    NARCIS (Netherlands)

    J.M. Hartgerink (Jacqueline); J.M. Cramm (Jane); J.B.M. Vos; T.J.E.M. Bakker (Ton); E.W. Steyerberg (Ewout); J.P. Mackenbach (Johan); A.P. Nieboer (Anna)


    markdownabstractAbstract Background: It is known that interprofessional collaboration is crucial for integrated care delivery, yet we are still unclear about the underlying mechanisms explaining effectiveness of integrated care delivery to older patients. In addition, we lack research comparing in

  3. An integrated model for inner-city health-care delivery: the Deaconess Center. (United States)

    James, D M


    Under the auspices of the Buffalo General Hospital and the faculty of medicine of the State University of New York at Buffalo, a comprehensive delivery system for primary care has been established in a local inner-city neighborhood. At the Deaconess Family Medicine Center, located within an inner-city location of Buffalo, New York, several divisions have been integrated to provide comprehensive patient-oriented primary care. These divisions include a primary care clinic, an urgent care clinic, a substance abuse clinic, and a community pediatrics clinic. Professional services are provided by attending physicians and residents. The horizontal integration of these four divisions is in turn vertically integrated with the tertiary care teaching hospital inpatient and obstetrical services, providing a continuum of patient care. The horizontal integration serves as an entry point for patients to enter the hospital's health-care system, while the vertical integration capability serves to capture any specialized referrals or inpatient needs. This article discusses the structure of the center, with special reference to service integration, service delivery, and patient capture; medical education; and the place of integrated units in the strategic plan of a tertiary care hospital.

  4. Association Between the Safe Delivery App and Quality of Care and Perinatal Survival in Ethiopia

    DEFF Research Database (Denmark)

    Lund, Stine; Boas, Ida Marie; Bedesa, Tariku


    facilities. Analyses were performed based on the intention-to-treat principle. Interventions: Health care workers in intervention facilities received a smartphone with the SDA. The SDA is a training tool in emergency obstetric and neonatal care that uses visual guidance in animated videos with clinical......Importance: Health apps in low-income countries are emerging tools with the potential to improve quality of health care services, but few apps undergo rigorous scientific evaluation. Objective: To determine the effects of the safe delivery app (SDA) on perinatal survival and on health care workers......’ knowledge and skills in neonatal resuscitation. Design, Setting, and Participants: In a cluster-randomized clinical trial in 5 rural districts of Ethiopia, 73 health care facilities were randomized to the mobile phone intervention or to standard care (control). From September 1, 2013, to February 1, 2015...

  5. Learning to Learn: towards a Relational and Transformational Model of Learning for Improved Integrated Care Delivery

    Directory of Open Access Journals (Sweden)

    John Diamond


    Full Text Available Health and social care systems are implementing fundamental changes to organizational structures and work practices in an effort to achieve integrated care. While some integration initiatives have produced positive outcomes, many have not. We reframe the concept of integration as a learning process fueled by knowledge exchange across diverse professional and organizational communities. We thus focus on the cognitive and social dynamics of learning in complex adaptive systems, and on learning behaviours and conditions that foster collective learning and improved collaboration. We suggest that the capacity to learn how to learn shapes the extent to which diverse professional groups effectively exchange knowledge and self-organize for integrated care delivery.

  6. Disruptive innovation in health care delivery: a framework for business-model innovation. (United States)

    Hwang, Jason; Christensen, Clayton M


    Disruptive innovation has brought affordability and convenience to customers in a variety of industries. However, health care remains expensive and inaccessible to many because of the lack of business-model innovation. This paper explains the theory of disruptive innovation and describes how disruptive technologies must be matched with innovative business models. The authors present a framework for categorizing and developing business models in health care, followed by a discussion of some of the reasons why disruptive innovation in health care delivery has been slow.

  7. 205_WS: Improving the Delivery of Primary Care Through Risk Stratification

    DEFF Research Database (Denmark)

    Kinder, Karen; Kristensen, Troels; Abrams, Chad

    Objectives The aim of this workshop is to provide an insight into how information gained through applications of risk stratification in the primary health care sector, from integrated care networks to primary care clinics and finally at the individual clinician level can improve the delivery....... – Pharmaceutical Management. Method Each session will be comprised of presentations illustrating real world case-mix applications. The workshop would conclude with a plenary session which would summarize the take home messages of the three sessions. Other considerations The participants will experience first...

  8. Quality audit--a review of the literature concerning delivery of continence care. (United States)

    Swaffield, J


    This paper outlines the role of quality audit within the framework of quality assurance, presenting the concurrent and retrospective approaches available. The literature survey provides a review of the limited audit tools available and their application to continence services and care delivery, as well as attempts to produce tools from national and local standard setting. Audit is part of a process; it can involve staff, patients and their relatives and the team of professionals providing care, as well as focusing on organizational and management levels. In an era of market delivery of services there is a need to justify why audit is important to continence advisors and managers. Effectiveness, efficiency and economics may drive the National Health Service, but quality assurance, which includes standards and audit tools, offers the means to ensure the quality of continence services and care to patients and auditing is also required in the purchaser/provider contracts for patient services. An overview and progress to date of published and other a projects in auditing continence care and service is presented. By outlining and highlighting the audit of continence service delivery and care as a basis on which to build quality assurance programmes, it is hoped that this knowledge will be shared through the setting up of a central auditing clearing project.

  9. Policy challenges for the pediatric rheumatology workforce: Part II. Health care system delivery and workforce supply

    Directory of Open Access Journals (Sweden)

    Henrickson Michael


    Full Text Available Abstract The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team. United States health care lacks a coherent policy direction for the management of high cost chronic conditions, including rheumatic diseases. A fundamental restructure of United States health care delivery must urgently occur which places the patient at the center of care. For the pediatric rheumatology workforce, reimbursement policies and the actions of health plans and insurers are consistent barriers to chronic disease improvement. United States reimbursement policy and overall fragmentation of health care services pose specific challenges for widespread implementation of the chronic care model. Team-based multidisciplinary care, care coordination and self-management are integral to improve outcomes. Pediatric rheumatology demand in the United States far exceeds available workforce supply. This article reviews the career

  10. Models in the delivery of depression care: A systematic review of randomised and controlled intervention trials

    Directory of Open Access Journals (Sweden)

    Clack Dannielle


    Full Text Available Abstract Background There is still debate as to which features, types or components of primary care interventions are associated with improved depression outcomes. Previous reviews have focused on components of collaborative care models in general practice settings. This paper aims to determine the effective components of depression care in primary care through a systematic examination of both general practice and community based intervention trials. Methods Fifty five randomised and controlled research trials which focused on adults and contained depression outcome measures were identified through PubMed, PsycInfo and the Cochrane Central Register of Controlled Trials databases. Trials were classified according to the components involved in the delivery of treatment, the type of treatment, the primary focus or setting of the study, detailed features of delivery, and the discipline of the professional providing the treatment. The primary outcome measure was significant improvement on the key depression measure. Results Components which were found to significantly predict improvement were the revision of professional roles, the provision of a case manager who provided direct feedback and delivered a psychological therapy, and an intervention that incorporated patient preferences into care. Nurse, psychologist and psychiatrist delivered care were effective, but pharmacist delivery was not. Training directed to general practitioners was significantly less successful than interventions that did not have training as the most important intervention. Community interventions were effective. Conclusion Case management is important in the provision of care in general practice. Certain community models of care (education programs have potential while others are not successful in their current form (pharmacist monitoring.

  11. Delivery and Payment Redesign to Reduce Disparities in High Risk Postpartum Care. (United States)

    Howell, Elizabeth A; Padrón, Norma A; Beane, Susan J; Stone, Joanne; Walther, Virginia; Balbierz, Amy; Kumar, Rashi; Pagán, José A


    Purpose This paper describes the implementation of an innovative program that aims to improve postpartum care through a set of coordinated delivery and payment system changes designed to use postpartum care as an opportunity to impact the current and future health of vulnerable women and reduce disparities in health outcomes among minority women. Description A large health care system, a Medicaid managed care organization, and a multidisciplinary team of experts in obstetrics, health economics, and health disparities designed an intervention to improve postpartum care for women identified as high-risk. The program includes a social work/care management component and a payment system redesign with a cost-sharing arrangement between the health system and the Medicaid managed care plan to cover the cost of staff, clinician education, performance feedback, and clinic/clinician financial incentives. The goal is to enroll 510 high-risk postpartum mothers. Assessment The primary outcome of interest is a timely postpartum visit in accordance with NCQA healthcare effectiveness data and information set guidelines. Secondary outcomes include care process measures for women with specific high-risk conditions, emergency room visits, postpartum readmissions, depression screens, and health care costs. Conclusion Our evidence-based program focuses on an important area of maternal health, targets racial/ethnic disparities in postpartum care, utilizes an innovative payment reform strategy, and brings together insurers, researchers, clinicians, and policy experts to work together to foster health and wellness for postpartum women and reduce disparities.

  12. Arkansas: a leading laboratory for health care payment and delivery system reform. (United States)

    Bachrach, Deborah; du Pont, Lammot; Lipson, Mindy


    As states' Medicaid programs continue to evolve from traditional fee-for-service to value-based health care delivery, there is growing recognition that systemwide multipayer approaches provide the market power needed to address the triple aim of improved patient care, improved health of populations, and reduced costs. Federal initiatives, such as the State Innovation Model grant program, make significant funds available for states seeking to transform their health care systems. In crafting their reform strategies, states can learn from early innovators. This issue brief focuses on one such state: Arkansas. Insights and lessons from the Arkansas Health Care Payment Improvement Initiative (AHCPII) suggest that progress is best gained through an inclusive, deliberative process facilitated by committed leadership, a shared agreement on root problems and opportunities for improvement, and a strategy grounded in the state's particular health care landscape.

  13. An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans. (United States)

    Warner, Echo L; Wu, Yelena P; Hacking, Claire C; Wright, Jennifer; Spraker-Perlman, Holly L; Gardner, Emmie; Kirchhoff, Anne C


    Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care.

  14. Infants of borderline viability: the ethics of delivery room care. (United States)

    Brunkhorst, Jessica; Weiner, Julie; Lantos, John


    For more than half a century neonatologists and ethicists alike have struggled with ethical dilemmas surrounding infants born at the limits of viability. Both doctors and parents face difficult decisions. Do we try to save these babies, knowing that such efforts are likely to be unsuccessful? Or do we provide only comfort care, knowing that, in doing so, you will inevitably allow some babies to die who might have been saved? In this paper, we review the outcome data on these babies and offer ten suggestions for doctors: (1) accept that there is a 'gray zone' during which decisions are not black and white; (2) do not place too much emphasis on gestational age; (3) dying is generally not in an infant's best interest; (4) impairment does not necessarily equal poor quality of life; (5) just because the train has left the station doesn't mean you can't get off; (6) respect powerful emotions; (7) be aware of the self-fulfilling prophecies; (8) time lag likely skews all outcome data; (9) statistics can be both confused and confusing; (10) never abandon parents.

  15. Community health workers in primary care practice: redesigning health care delivery systems to extend and improve diabetes care in underserved populations. (United States)

    Collinsworth, Ashley; Vulimiri, Madhulika; Snead, Christine; Walton, James


    New, comprehensive, approaches for chronic disease management are needed to ensure that patients, particularly those more likely to experience health disparities, have access to the clinical care, self-management resources, and support necessary for the prevention and control of diabetes. Community health workers (CHWs) have worked in community settings to reduce health care disparities and are currently being deployed in some clinical settings as a means of improving access to and quality of care. Guided by the chronic care model, Baylor Health Care System embedded CHWs within clinical teams in community clinics with the goal of reducing observed disparities in diabetes care and outcomes. This study examines findings from interviews with patients, CHWs, and primary care providers (PCPs) to understand how health care delivery systems can be redesigned to effectively incorporate CHWs and how embedding CHWs in primary care teams can produce informed, activated patients and prepared, proactive practice teams who can work together to achieve improved patient outcomes. Respondents indicated that the PCPs continued to provide clinical exams and manage patient care, but the roles of diabetes education, nutritional counseling, and patient activation were shifted to the CHWs. CHWs also provided patients with social support and connection to community resources. Integration of CHWs into clinical care teams improved patient knowledge and activation levels, the ability of PCPs to identify and proactively address specific patient needs, and patient outcomes.

  16. Facility Delivery, Postnatal Care and Neonatal Deaths in India: Nationally-Representative Case-Control Studies.

    Directory of Open Access Journals (Sweden)

    Shaza A Fadel

    Full Text Available Clinical studies demonstrate the efficacy of interventions to reduce neonatal deaths, but there are fewer studies of their real-life effectiveness. In India, women often seek facility delivery after complications arise, rather than to avoid complications. Our objective was to quantify the association of facility delivery and postnatal checkups with neonatal mortality while examining the "reverse causality" in which the mothers deliver at a health facility due to adverse perinatal events.We conducted nationally representative case-control studies of about 300,000 live births and 4,000 neonatal deaths to examine the effect of, place of delivery and postnatal checkup on neonatal mortality. We compared neonatal deaths to all live births and to a subset of live births reporting excessive bleeding or obstructed labour that were more comparable to cases in seeking care.In the larger study of 2004-8 births, facility delivery without postnatal checkup was associated with an increased odds of neonatal death (Odds ratio = 2.5; 99% CI 2.2-2.9, especially for early versus late neonatal deaths. However, use of more comparable controls showed marked attenuation (Odds ratio = 0.5; 0.4-0.5. Facility delivery with postnatal checkup was associated with reduced odds of neonatal death. Excess risks were attenuated in the earlier study of 2001-4 births.The combined effect of facility deliveries with postnatal checks ups is substantially higher than just facility delivery alone. Evaluation of the real-life effectiveness of interventions to reduce child and maternal deaths need to consider reverse causality. If these associations are causal, facility delivery with postnatal check up could avoid about 1/3 of all neonatal deaths in India (~100,000/year.

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

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


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

  18. Making pragmatic choices: women’s experiences of delivery care in Northern Ethiopia

    Directory of Open Access Journals (Sweden)

    Gebrehiwot Tesfay


    Full Text Available Abstract Background In 2003, the Ethiopian Ministry of Health launched the Health Extension Programme (HEP, which was intended to increase access to reproductive health care. Despite enormous effort, utilization of maternal health services remains limited, and the reasons for the low utilization of the services offered through the HEP previously have not been explored in depth. This study explores women’s experiences and perceptions regarding delivery care in Tigray, a northern region of Ethiopia, and enables us to make suggestions for better implementation of maternal health care services in this setting. Methods We used six focus group discussions with 51 women to explore perceptions and experiences regarding delivery care. The data were analysed by means of grounded theory. Results One core category emerged, ‘making pragmatic choices’, which connected the categories ‘aiming for safer deliveries’, ‘embedded in tradition’, and ‘medical knowledge under constrained circumstances’. In this setting, women – aiming for safer deliveries – made choices pragmatically between the two available models of childbirth. On the one hand, choice of home delivery, represented by the category ‘embedded in tradition’, was related to their faith, the ascendancy of elderly women, the advantages of staying at home and the custom of traditional birth attendants (TBAs. On the other, institutional delivery, represented by the category ‘medical knowledge under constrained circumstances’, and linked to how women appreciated medical resources and the support of health extension workers (HEWs but were uncertain about the quality of care, emphasized the barriers to transportation. In Tigray women made choices pragmatically and seemed to not feel any conflict between the two available models, being supported by traditional birth attendants, HEWs and husbands in their decision-making. Representatives of the two models were not as open to

  19. 41 CFR 102-42.30 - Who is responsible for the security, care and handling, and delivery of gifts and decorations to... (United States)


    ... the security, care and handling, and delivery of gifts and decorations to GSA, and all costs... security, care and handling, and delivery of gifts and decorations to GSA, and all costs associated with... Disposition § 102-42.30 Who is responsible for the security, care and handling, and delivery of gifts...

  20. Value Assessment at the Point of Care: Incorporating Patient Values throughout Care Delivery and a Draft Taxonomy of Patient Values. (United States)

    Armstrong, Melissa J; Mullins, C Daniel


    Incorporation of patient values is a key element of patient-centered care, but consistent incorporation of patient values at the point of care is lacking. Shared decision making encourages incorporation of patient values in decision making, but associated tools often lack guidance on value assessment. In addition, focusing on patient values relating only to specific decisions misses an opportunity for a more holistic approach to value assessment that could impact other aspects of clinical encounters, including health care planning, communication, and stakeholder involvement. In this commentary, we propose a taxonomy of values underlying patient decision making and provide examples of how these impact provision of health care. The taxonomy describes four categories of patient values: global, decisional, situational, and external. Global values are personal values impacting decision making at a universal level and can include value traits and life priorities. Decisional values are the values traditionally conceptualized in decision making, including considerations such as efficacy, toxicity, quality of life, convenience, and cost. Situational values are values tied to a specific moment in time that modify patients' existing global and decisional values. Finally, discussion of external values acknowledges that many patients consider values other than their own when making decisions. Recognizing the breadth of values impacting patient decision making has implications for both overall health care delivery and shared decision making because value assessments focusing only on decisional values may miss important patient considerations. This draft taxonomy highlights different values impacting decision making and facilitates a more complete value assessment at the point of care.

  1. Toward a Learning Health-care System - Knowledge Delivery at the Point of Care Empowered by Big Data and NLP. (United States)

    Kaggal, Vinod C; Elayavilli, Ravikumar Komandur; Mehrabi, Saeed; Pankratz, Joshua J; Sohn, Sunghwan; Wang, Yanshan; Li, Dingcheng; Rastegar, Majid Mojarad; Murphy, Sean P; Ross, Jason L; Chaudhry, Rajeev; Buntrock, James D; Liu, Hongfang


    The concept of optimizing health care by understanding and generating knowledge from previous evidence, ie, the Learning Health-care System (LHS), has gained momentum and now has national prominence. Meanwhile, the rapid adoption of electronic health records (EHRs) enables the data collection required to form the basis for facilitating LHS. A prerequisite for using EHR data within the LHS is an infrastructure that enables access to EHR data longitudinally for health-care analytics and real time for knowledge delivery. Additionally, significant clinical information is embedded in the free text, making natural language processing (NLP) an essential component in implementing an LHS. Herein, we share our institutional implementation of a big data-empowered clinical NLP infrastructure, which not only enables health-care analytics but also has real-time NLP processing capability. The infrastructure has been utilized for multiple institutional projects including the MayoExpertAdvisor, an individualized care recommendation solution for clinical care. We compared the advantages of big data over two other environments. Big data infrastructure significantly outperformed other infrastructure in terms of computing speed, demonstrating its value in making the LHS a possibility in the near future.

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

    Directory of Open Access Journals (Sweden)

    Jean-Claude Henrard


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

  3. Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services. (United States)

    Silver, Julie K; Raj, Vishwa S; Fu, Jack B; Wisotzky, Eric M; Smith, Sean Robinson; Kirch, Rebecca A


    Palliative care and rehabilitation practitioners are important collaborative referral sources for each other who can work together to improve the lives of cancer patients, survivors, and caregivers by improving both quality of care and quality of life. Cancer rehabilitation and palliative care involve the delivery of important but underutilized medical services to oncology patients by interdisciplinary teams. These subspecialties are similar in many respects, including their focus on improving cancer-related symptoms or cancer treatment-related side effects, improving health-related quality of life, lessening caregiver burden, and valuing patient-centered care and shared decision-making. They also aim to improve healthcare efficiencies and minimize costs by means such as reducing hospital lengths of stay and unanticipated readmissions. Although their goals are often aligned, different specialized skills and approaches are used in the delivery of care. For example, while each specialty prioritizes goal-concordant care through identification of patient and family preferences and values, palliative care teams typically focus extensively on using patient and family communication to determine their goals of care, while also tending to comfort issues such as symptom management and spiritual concerns. Rehabilitation clinicians may tend to focus more specifically on functional issues such as identifying and treating deficits in physical, psychological, or cognitive impairments and any resulting disability and negative impact on quality of life. Additionally, although palliative care and rehabilitation practitioners are trained to diagnose and treat medically complex patients, rehabilitation clinicians also treat many patients with a single impairment and a low symptom burden. In these cases, the goal is often cure of the underlying neurologic or musculoskeletal condition. This report defines and describes cancer rehabilitation and palliative care, delineates their

  4. Effect of computer use in the consultation on the delivery of care.


    Brownbridge, G; Evans, A.; Wall, T


    The effects of the use of a computer on the delivery of care in consultations in general practice were examined. In this trial a computer system provided for the review and update of patients' medical histories, notes on doctor-patient contacts, and information on repeat prescribing. Thirty consultations in which the computer system was used and 30 consultations in which no computer was used were matched individually for the doctor consulted, the sex and age of the patient, and the presenting...

  5. Predictors of Clients' Satisfaction with Delivery of Animal Health Care Services in Periurban Ghana


    Paa Kobina Turkson


    The study used logistic regression modelling to determine predictors of satisfaction with delivery of animal health care services for 889 clients (livestock and poultry keepers) in periurban Ghana. Of the 15 indicators tested as predictors of satisfaction in this study, 8 were included in the best fit model. These were accessibility, availability of services, service charge, effectiveness, efficiency, quality of services, meeting client needs, and getting help. Efficiency and effectiveness we...

  6. Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries (United States)

    McWilliams, J. Michael; Chernew, Michael E.; Zaslavsky, Alan M.; Hamed, Pasha; Landon, Bruce E.


    Background The Medicare accountable care organization (ACO) programs rely on delivery system integration and provider risk sharing to lower spending while improving quality of care. Methods Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5,000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We compared spending and quality of care between larger and smaller provider groups and examined how size-related differences varied by 2 factors considered central to ACO performance: group primary care orientation (measured by the primary care share of large groups’ specialty mix) and provider risk sharing (measured by county health maintenance organization penetration and its relationship to financial risk accepted by different group types for managed care patients). Spending and quality of care measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Results Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference: +$849), higher 30-day readmission rates (+1.3% percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (−$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Conclusions Spending

  7. Service Quality of Delivered Care from the Perception of Women with Caesarean Section and Normal Delivery

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    Jafar S. Tabrizi


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

  8. Rapid Process Optimization: A Novel Process Improvement Methodology to Innovate Health Care Delivery. (United States)

    Wiler, Jennifer L; Bookman, Kelly; Birznieks, Derek B; Leeret, Robert; Koehler, April; Planck, Shauna; Zane, Richard


    Health care systems have utilized various process redesign methodologies to improve care delivery. This article describes the creation of a novel process improvement methodology, Rapid Process Optimization (RPO). This system was used to redesign emergency care delivery within a large academic health care system, which resulted in a decrease: (1) door-to-physician time (Department A: 54 minutes pre vs 12 minutes 1 year post; Department B: 20 minutes pre vs 8 minutes 3 months post), (2) overall length of stay (Department A: 228 vs 184; Department B: 202 vs 192), (3) discharge length of stay (Department A: 216 vs 140; Department B: 179 vs 169), and (4) left without being seen rates (Department A: 5.5% vs 0.0%; Department B: 4.1% vs 0.5%) despite a 47% increased census at Department A (34 391 vs 50 691) and a 4% increase at Department B (8404 vs 8753). The novel RPO process improvement methodology can inform and guide successful care redesign.

  9. Exploring information systems outsourcing in U.S. hospital-based health care delivery systems. (United States)

    Diana, Mark L


    The purpose of this study is to explore the factors associated with outsourcing of information systems (IS) in hospital-based health care delivery systems, and to determine if there is a difference in IS outsourcing activity based on the strategic value of the outsourced functions. IS sourcing behavior is conceptualized as a case of vertical integration. A synthesis of strategic management theory (SMT) and transaction cost economics (TCE) serves as the theoretical framework. The sample consists of 1,365 hospital-based health care delivery systems that own 3,452 hospitals operating in 2004. The findings indicate that neither TCE nor SMT predicted outsourcing better than the other did. The findings also suggest that health care delivery system managers may not be considering significant factors when making sourcing decisions, including the relative strategic value of the functions they are outsourcing. It is consistent with previous literature to suggest that the high cost of IS may be the main factor driving the outsourcing decision.

  10. Infection control in delivery care units, Gujarat state, India: A needs assessment

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    Ramani KV


    Full Text Available Abstract Background Increasingly, women in India attend health facilities for childbirth, partly due to incentives paid under government programs. Increased use of health facilities can alleviate the risks of infections contracted in unhygienic home deliveries, but poor infection control practices in labour and delivery units also cause puerperal sepsis and other infections of childbirth. A needs assessment was conducted to provide information on procedures and practices related to infection control in labour and delivery units in Gujarat state, India. Methods Twenty health care facilities, including private and public primary health centres and referral hospitals, were sampled from two districts in Gujarat state, India. Three pre-tested tools for interviewing and for observation were used. Data collection was based on existing infection control guidelines for clean practices, clean equipment, clean environment and availability of diagnostics and treatment. The study was carried out from April to May 2009. Results Seventy percent of respondents said that standard infection control procedures were followed, but a written procedure was only available in 5% of facilities. Alcohol rubs were not used for hand cleaning and surgical gloves were reused in over 70% of facilities, especially for vaginal examinations in the labour room. Most types of equipment and supplies were available but a third of facilities did not have wash basins with "hands-free" taps. Only 15% of facilities reported that wiping of surfaces was done immediately after each delivery in labour rooms. Blood culture services were available in 25% of facilities and antibiotics are widely given to women after normal delivery. A few facilities had data on infections and reported rates of 3% to 5%. Conclusions This study of current infection control procedures and practices during labour and delivery in health facilities in Gujarat revealed a need for improved information systems

  11. Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative

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    Kwedza Ru K


    Full Text Available Abstract Background Australia's Aboriginal and Torres Strait Islander (Indigenous populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. Methods We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4 were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems. Results The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician. Conclusion Participating services had both strengths and weaknesses in the delivery of maternal

  12. COPD care delivery pathways in five European Union countries: mapping and health care professionals’ perceptions (United States)

    Kayyali, Reem; Odeh, Bassel; Frerichs, Inéz; Davies, Nikki; Perantoni, Eleni; D’arcy, Shona; Vaes, Anouk W; Chang, John; Spruit, Martijn A; Deering, Brenda; Philip, Nada; Siva, Roshan; Kaimakamis, Evangelos; Chouvarda, Ioanna; Pierscionek, Barbara; Weiler, Norbert; Wouters, Emiel FM; Raptopoulos, Andreas; Nabhani-Gebara, Shereen


    Background COPD is among the leading causes of chronic morbidity and mortality in the European Union with an estimated annual economic burden of €25.1 billion. Various care pathways for COPD exist across Europe leading to different responses to similar problems. Determining these differences and the similarities may improve health and the functioning of health services. Objective The aim of this study was to compare COPD patients’ care pathway in five European Union countries including England, Ireland, the Netherlands, Greece, and Germany and to explore health care professionals’ (HCPs) perceptions about the current pathways. Methods HCPs were interviewed in two stages using a qualitative, semistructured email interview and a face-to-face semistructured interview. Results Lack of communication among different health care providers managing COPD and comorbidities was a common feature of the studied care pathways. General practitioners/family doctors are responsible for liaising between different teams/services, except in Greece where this is done through pulmonologists. Ireland and the UK are the only countries with services for patients at home to shorten unnecessary hospital stay. HCPs emphasized lack of communication, limited resources, and poor patient engagement as issues in the current pathways. Furthermore, no specified role exists for pharmacists and informal carers. Conclusion Service and professional integration between care settings using a unified system targeting COPD and comorbidities is a priority. Better communication between health care providers, establishing a clear role for informal carers, and enhancing patients’ engagement could optimize current care pathways resulting in a better integrated system. PMID:27881915

  13. Zorg rond zwangerschap, bevalling en kraambed in Wageningen 1979 [Care for pregnancy, delivery, childbed in city of Wageningen 1979

    NARCIS (Netherlands)

    Brouwer, M.


    Description of situation concerning care of pregnancy, childbirth and childbed in Wageningen, the Netherlands. Diagnosis of pregnancy / supervision of pregnancy ( zwangerschapsbegeleiding ) / place of delivery / maternity home / controls of pregnancy / gymnastics course for parents / evaluation of p

  14. 42 CFR 440.385 - Delivery of benchmark and benchmark-equivalent coverage through managed care entities. (United States)


    ... 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...

  15. Metrics for Radiologists in the Era of Value-based Health Care Delivery. (United States)

    Sarwar, Ammar; Boland, Giles; Monks, Annamarie; Kruskal, Jonathan B


    Accelerated by the Patient Protection and Affordable Care Act of 2010, health care delivery in the United States is poised to move from a model that rewards the volume of services provided to one that rewards the value provided by such services. Radiology department operations are currently managed by an array of metrics that assess various departmental missions, but many of these metrics do not measure value. Regulators and other stakeholders also influence what metrics are used to assess medical imaging. Metrics such as the Physician Quality Reporting System are increasingly being linked to financial penalties. In addition, metrics assessing radiology's contribution to cost or outcomes are currently lacking. In fact, radiology is widely viewed as a contributor to health care costs without an adequate understanding of its contribution to downstream cost savings or improvement in patient outcomes. The new value-based system of health care delivery and reimbursement will measure a provider's contribution to reducing costs and improving patient outcomes with the intention of making reimbursement commensurate with adherence to these metrics. The authors describe existing metrics and their application to the practice of radiology, discuss the so-called value equation, and suggest possible metrics that will be useful for demonstrating the value of radiologists' services to their patients.

  16. Health care delivery and change: thoughts on Lema's "... of dinosaurs, dodos and anesthesia personnel". (United States)

    Gunn, I P


    Problems in health care delivery relative to access, costs, and quality have been debated for more than a quarter of a century. Health care costs have significantly increased since the implementation of the Medicare/Medicaid legislation. Cost containment has been high on the agendas of government officials, legislators, health policy decision makers, business leaders, and economists since the 1980s. There has been a shift toward market medicine and managed care as a means for cost containment. Although some costs were contained for a short period, they are once again rising significantly, and there is growing dissatisfaction with this shift. The United States is not alone in this dilemma. Mark Lema, MD, PHD, editor of the ASA Newsletter, wrote a thought-provoking editorial in the July 1999 issue, raising concerns about change, relationships, reimbursement, and demise relative to anesthesia personnel. In response, this article primarily raises the issue of health manpower mix as a major factor in the cost of health care delivery regarding these systems. Whereas change is inevitable, it is difficult for state and federal governments in the United States to force change because of the number of special interests involved in campaign financing involving elected government officials. It is nevertheless important for health professionals to be involved in the changes that come about, or change will be made for them. It is essential to renew society, institutions, and individuals in order to prevent decay and obsolescence. If we don't make the future, the future will make us.

  17. Global Health Care Justice, Delivery Doctors and Assisted Reproduction: Taking a Note From Catholic Social Teachings. (United States)

    Richie, Cristina


    This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the wealthy. After exploring specific discrepancies in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution.

  18. Health insurance determines antenatal, delivery and postnatal care utilisation: evidence from the Ghana Demographic and Health Surveillance data


    Browne, Joyce L.; Kayode, Gbenga A; Arhinful, Daniel; Fidder, Samuel A J; Grobbee, Diederick E; Klipstein-Grobusch, Kerstin


    OBJECTIVE: This study aims to evaluate the effect of maternal health insurance status on the utilisation of antenatal, skilled delivery and postnatal care. DESIGN: A population-based cross-sectional study. SETTING AND PARTICIPANTS: We utilised the 2008 Demographic and Health Survey data of Ghana, which included 2987 women who provided information on maternal health insurance status. PRIMARY OUTCOMES: Utilisation of antenatal, skilled delivery and postnatal care. STATISTICAL ANALYSES: Multivar...

  19. Teleophthalmology: A Model for Eye Care Delivery in Rural and Underserved Areas of India

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    Vijayaraghavan Prathiba


    Full Text Available Objectives. To describe the application of teleophthalmology in rural and underserved areas of India. Study Design. This paper describes the major teleophthalmology projects in India and its benefits. Results. Teleophthalmology is the use of telecommunication for electronic transfer of health-related data from rural and underserved areas of India to specialities in urban cities. The MDRF/WDF Rural Diabetes Project has proved to be very beneficial for improvement of quality health care in Tamilnadu and can be replicated at the national level. This community outreach programme using telemedicine facilities has increased awareness of eye diseases, improved access to specialized health care, helped in local community empowerment, and provided employment opportunities. Early detection of sight threatening disorders by teleophthalmology and prompt treatment can help decrease visual impairment. Conclusion. Teleophthalmology can be a very effective model for improving eye care delivery system in rural and underserved areas of India.

  20. Free-standing cancer centers: rationale for improving cancer care delivery. (United States)

    Lokich, J J; Silvers, S; Brereton, H; Byfield, J; Bick, R


    Free-standing cancer centers (FSCC) represent a growing trend in cancer care delivery within community practice. The critical components to FSCC are multidisciplinary cancer care, a complete menu of direct care and support services, a commitment to clinical trials and clinical investigation, and a comprehensive program for quality assurance. The advantages of FSCC to the community, to hospital programs, to the practicing surgical, medical, and radiation oncologists, and to the third-party carriers, including health maintenance organizations, are detailed. The development of an FSCC depends on the resolution of issues of (a) competition (between hospitals, hospitals and physicians, therapeutic disciplines, regional comprehensive cancer centers and FSCCs) and (b) concerns about conflict of interest. The ideal model of FSCC may well be represented by the joint venture of community hospital(s) and the community oncologists.

  1. Value-added care: a paradigm shift in patient care delivery. (United States)

    Upenieks, Valda V; Akhavan, Jaleh; Kotlerman, Jenny


    Spiraling costs in health care have placed hospitals in a constant state of transition. As a result, nursing practice is now influenced by numerous factors and has remained in a continuous state of flux. Multiple changes within the last 2 decades in nurse/patient ratio and blend of front-line nurses are examples of this transition. To reframe the nursing practice into an economic equation that captures the cost, quality, and service, a paradigm shift in thinking is needed in order to assess work redesign. Nursing productivity must be evaluated in terms of value-added care, a vision that goes beyond direct care activities and includes team collaboration, physician rounding, increased RN-to-aide communication, and patient centeredness; all of which are crucial to the nurse's role and the patient's well-being. The science of appropriating staffing depends on assessment and implementation of systematic changes best illustrated through a "systems theory" framework. A throughput transformation is required to create process changes with input elements (number of front-line nurses) in order to increase time spent in value-added care and to decrease waste activities with an improvement in efficiency, quality, and service. The purpose of this pilot study was two-fold: (a) to gain an understanding of how much time RNs spent in value-added care, and (b) whether increasing the combined level of RNs and unlicensed assistive personnel increased the amount of time spent in value-added care compared to time spent in necessary tasks and waste.

  2. Capturing patients' experiences to change Parkinson's disease care delivery: a multicenter study. (United States)

    van der Eijk, Martijn; Faber, Marjan J; Post, Bart; Okun, Michael S; Schmidt, Peter; Munneke, Marten; Bloem, Bastiaan R


    Capturing patients' perspectives has become an essential part of a quality of care assessment. The patient centeredness questionnaire for PD (PCQ-PD) has been validated in The Netherlands as an instrument to measure patients' experiences. This study aims to assess the level of patient centeredness in North American Parkinson centers and to demonstrate the PCQ-PD's potential as a quality improvement instrument. 20 Parkinson Centers of Excellence participated in a multicenter study. Each center asked 50 consecutive patients to complete the questionnaire. Data analyses included calculating case mix-adjusted scores for overall patient centeredness (scoring range 0-3), six subscales (0-3), and quality improvement (0-9). Each center received a feedback report on their performance. The PCQ-PD was completed by 972 PD patients (median 50 per center, range 37-58). Significant differences between centers were found for all subscales, except for emotional support (p < 0.05). The information subscale (mean 1.62 SD 0.62) and collaboration subscale (mean 2.03 SD 0.58) received the lowest experience ratings. 14 centers (88 %) who returned the evaluation survey claimed that patient experience scores could help to improve the quality of care. Nine centers (56 %) utilized the feedback to change specific elements of their care delivery process. PD patients are under-informed about critical care issues and experience a lack of collaboration between healthcare professionals. Feedback on patients' experiences facilitated Parkinson centers to improve their delivery of care. These findings create a basis for collecting patients' experiences in a repetitive fashion, intertwined with existing quality of care registries.

  3. Client's satisfaction with delivery of animal health-care services in peri-urban Ghana. (United States)

    Turkson, P K


    I assessed the satisfaction in July-August 2005 of 889 livestock and poultry owners with animal health-care services delivery in peri-urban Ghana and determined factors associated with that satisfaction (and with being the owner of poultry versus of other livestock with or without poultry). Overall, 48% of the respondents were satisfied or very satisfied with service delivery, with only 8% in the very satisfied category. Of the 401 owners of poultry and 488 owners of other livestock, 52% and 45%, respectively, reported being satisfied or very satisfied with veterinary services delivery. I found significant differences between poultry and livestock owners in 11 of 15 indicators of quality of animal health-care services; significantly higher proportions of poultry owners gave positive assessments in nine of the indicators. All but one of the 15 indicators tested was significantly and positively associated with satisfaction among all owners, overall. The indicators are proposed as a checklist for Qualitative Rapid Appraisal of Veterinary Services.

  4. An ICT-Based Diabetes Management System Tested for Health Care Delivery in the African Context

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    Claude Takenga


    Full Text Available The demand for new healthcare services is growing rapidly. Improving accessibility of the African population to diabetes care seems to be a big challenge in most countries where the number of care centers and medical staff is reduced. Information and communication technologies (ICT have great potential to address some of these challenges faced by several countries in providing accessible, cost-effective, and high-quality health care services. This paper presents the Mobil Diab system which is a telemedical approach proposed for the management of long-term diseases. The system applies modern mobile and web technologies which overcome geographical barriers, and increase access to health care services. The idea of the system is to involve patients in the therapy process and motivate them for an active participation. For validation of the system in African context, a trial was conducted in the Democratic Republic of Congo. 40 Subjects with diabetes divided randomly into control and intervention groups were included in the test. Results show that Mobil Diab is suitable for African countries and presents a number of benefits for the population and public health care system. It improves clinical management and delivery of diabetes care services by enhancing access, quality, motivation, reassurance, efficiency, and cost-effectiveness.

  5. Considering an integrated nephrology care delivery model: six principles for quality. (United States)

    Hamm, L Lee; Hostetter, Thomas H; Shaffer, Rachel N


    In 2012, 27 organizations will initiate participation in the Medicare Shared Savings Program as Accountable Care Organizations. This level of participation reflects the response of Centers for Medicare and Medicaid Services to criticism that the program as outlined in the proposed rule was overly burdensome, prescriptive, and too risky. Centers for Medicare and Medicaid Service made significant changes in the final rule, making the Accountable Care Organization program more attractive to these participants. However, none of these changes addressed the serious concerns raised by subspecialty societies-including the American Society of Nephrology-regarding care of patients with multiple chronic comorbidities and complex and end stage conditions. Virtually all of these concerns remain unaddressed, and consequently, Accountable Care Organizations will require guidance and partnership from the nephrology community to ensure that these patients are identified and receive the individualized care that they require. Although the final rule fell short of addressing the needs of patients with kidney disease, the Centers for Medicare and Medicaid Innovation presents an opportunity to test the potentially beneficial concepts of the Accountable Care Organization program within this patient population. The American Society of Nephrology Accountable Care Organization Task Force developed a set of principles that must be reflected in a possible pilot program or demonstration project of an integrated nephrology care delivery model. These principles include preserving a leadership role for nephrologists, encompassing care for patients with later-stage CKD and kidney transplants as well as ESRD, enabling the participation of a diversity of dialysis provider sizes and types, facilitating research, and establishing monitoring systems to identify and address preferential patient selection or changes in outcomes.

  6. Creating patient value in glaucoma care : applying quality costing and care delivery value chain approaches

    NARCIS (Netherlands)

    D.F. de Korne (Dirk); J.C.A. Sol (Kees); T. Custers (Thomas); E. van Sprundel (Esther); B.M. van Ineveld (Martin); H.G. Lemij (Hans); N.S. Klazinga (Niek)


    textabstractPurpose: The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains. Design/methodology/approach: In a retrospective case study an in-depth evaluation of the use of a quality cost model (QC

  7. Delivery of Services of Day Care Workers In Sta. Maria, Laguna

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    Full Text Available This study focused on the determination of the delivery of services of day care workers in the municipality of Sta. Maria, Province of Laguna during the first semester of school year 2012-2013. Descriptive research was used in this study. Among the key findings were that Day Care Workers with respect to interactional relationship accomplished the functions with outstanding adequacy such as constantly giving feedback and praises on the performance of children, along with workers and parents coordination and cooperation, with verbal interpretation of Always Observe. In terms of instructional quality both group of respondents perceived that day care workers in-charge had adequate abilities and competencies concerning their education and trainings in connection with teaching small children with verbal interpretation of Always Observe. The parents had confidence to the day care workers in-charge of their children aside from regularly consulting the day care workers about their children’s progress with verbal interpretation of Always Observe. There were only 871 households who availed of the services of day care centers in which 27 workers were employed and each of them assigned to handle an average of 33 children. Notable along with other findings was the day care workers and parents had the same perception as to the extent of services provided by the Day Care Center with respect to interactional relationship, instructional quality and parental participation. Subsequently the study ensued with these five factual remarks: Children’s interactions with parents in the centers were the direct mechanisms through which children learn. The educational qualification and the capability of the day care workers to handle small children were the primary essentials in children’s learning. Parents’ participation in the day care centers premises brought harmonious relationship between the Day Care Workers and children as well. The capacity of day care worker

  8. Leadership Perspectives on Operationalizing the Learning Health Care System in an Integrated Delivery System (United States)

    Psek, Wayne; Davis, F. Daniel; Gerrity, Gloria; Stametz, Rebecca; Bailey-Davis, Lisa; Henninger, Debra; Sellers, Dorothy; Darer, Jonathan


    Introduction: Healthcare leaders need operational strategies that support organizational learning for continued improvement and value generation. The learning health system (LHS) model may provide leaders with such strategies; however, little is known about leaders’ perspectives on the value and application of system-wide operationalization of the LHS model. The objective of this project was to solicit and analyze senior health system leaders’ perspectives on the LHS and learning activities in an integrated delivery system. Methods: A series of interviews were conducted with 41 system leaders from a broad range of clinical and administrative areas across an integrated delivery system. Leaders’ responses were categorized into themes. Findings: Ten major themes emerged from our conversations with leaders. While leaders generally expressed support for the concept of the LHS and enhanced system-wide learning, their concerns and suggestions for operationalization where strongly aligned with their functional area and strategic goals. Discussion: Our findings suggests that leaders tend to adopt a very pragmatic approach to learning. Leaders expressed a dichotomy between the operational imperative to execute operational objectives efficiently and the need for rigorous evaluation. Alignment of learning activities with system-wide strategic and operational priorities is important to gain leadership support and resources. Practical approaches to addressing opportunities and challenges identified in the themes are discussed. Conclusion: Continuous learning is an ongoing, multi-disciplinary function of a health care delivery system. Findings from this and other research may be used to inform and prioritize system-wide learning objectives and strategies which support reliable, high value care delivery. PMID:27683668

  9. What's the diagnosis? Organisational culture and palliative care delivery in residential aged care in New Zealand. (United States)

    Frey, Rosemary; Boyd, Michal; Foster, Sue; Robinson, Jackie; Gott, Merryn


    Organisational culture has been shown to impact on resident outcomes in residential aged care (RAC). This is particularly important given the growing number of residents with high palliative care needs. The study described herein (conducted from January 2013 to March 2014) examined survey results from a convenience sample of 46 managers, alongside interviews with a purposively selected sample of 23 bereaved family members in order to explore the perceptions of organisational culture within New Zealand RAC facilities in one large urban District Health Board. Results of the Organisational Culture Assessment Instrument (OCAI) completed by managers indicated a preference for a 'Clan' and the structured 'Hierarchy' culture. Bereaved family interviews emphasised both positive and negative aspects of communication, leadership and teamwork, and relationship with residents. Study results from both managers' OCAI survey scores and next of kin interviews indicate that while the RAC facilities are culturally oriented towards providing quality care for residents, they may face barriers to adopting organisational processes supportive of this goal.

  10. Why do some women still prefer traditional birth attendants and home delivery?: a qualitative study on delivery care services in West Java Province, Indonesia

    Directory of Open Access Journals (Sweden)

    Titaley Christiana R


    Full Text Available Abstract Background Trained birth attendants at delivery are important for preventing both maternal and newborn deaths. West Java is one of the provinces on Java Island, Indonesia, where many women still deliver at home and without the assistance of trained birth attendants. This study aims to explore the perspectives of community members and health workers about the use of delivery care services in six villages of West Java Province. Methods A qualitative study using focus group discussions (FGDs and in-depth interviews was conducted in six villages of three districts in West Java Province from March to July 2009. Twenty FGDs and 165 in-depth interviews were conducted involving a total of 295 participants representing mothers, fathers, health care providers, traditional birth attendants and community leaders. The FGD and in-depth interview guidelines included reasons for using a trained or a traditional birth attendant and reasons for having a home or an institutional delivery. Results The use of traditional birth attendants and home delivery were preferable for some community members despite the availability of the village midwife in the village. Physical distance and financial limitations were two major constraints that prevented community members from accessing and using trained attendants and institutional deliveries. A number of respondents reported that trained delivery attendants or an institutional delivery were only aimed at women who experienced obstetric complications. The limited availability of health care providers was reported by residents in remote areas. In these settings the village midwife, who was sometimes the only health care provider, frequently travelled out of the village. The community perceived the role of both village midwives and traditional birth attendants as essential for providing maternal and health care services. Conclusions A comprehensive strategy to increase the availability, accessibility, and

  11. The importance of older patients ’ experiences with care delivery for their quality of life after hospitalization

    NARCIS (Netherlands)

    J.M. Hartgerink (Jacqueline); J.M. Cramm (Jane); T.J.E.M. Bakker (Ton); J.P. Mackenbach (Johan); A.P. Nieboer (Anna)


    markdownabstractAbstract Background:Older patients’experiences with care delivery may be important for their quality of life over time.Evidence is however lacking. Therefore, this study aims to identify the longitudinal relationship between older patients’experiences with hospital care, perceived

  12. Jewish laws, customs, and practice in labor, delivery, and postpartum care. (United States)

    Noble, Anita; Rom, Miriam; Newsome-Wicks, Mona; Engelhardt, Kay; Woloski-Wruble, Anna


    Many communities throughout the world, especially in the United States and Israel, contain large populations of religiously observant Jews. The purpose of this article is to provide a comprehensive, descriptive guide to specific laws, customs, and practices of traditionally, religious observant Jews for the culturally sensitive management of labor, delivery, and postpartum. Discussion includes intimacy issues between husband and wife, dietary laws, Sabbath observance, as well as practices concerning prayer, communication trends, modesty issues, and labor and birth customs. Health care professionals can tailor their practice by integrating their knowledge of specific cultures into their management plan.

  13. Using information technology for an improved pharmaceutical care delivery in developing countries. Study case: Benin. (United States)

    Edoh, Thierry Oscar; Teege, Gunnar


    One of the problems in health care in developing countries is the bad accessibility of medicine in pharmacies for patients. Since this is mainly due to a lack of organization and information, it should be possible to improve the situation by introducing information and communication technology. However, for several reasons, standard solutions are not applicable here. In this paper, we describe a case study in Benin, a West African developing country. We identify the problem and the existing obstacles for applying standard ECommerce solutions. We develop an adapted system approach and describe a practical test which has shown that the approach has the potential of actually improving the pharmaceutical care delivery. Finally, we consider the security aspects of the system and propose an organizational solution for some specific security problems.

  14. Explaining the de-prioritization of primary prevention: Physicians' perceptions of their role in the delivery of primary care

    Directory of Open Access Journals (Sweden)

    Kuo Christina L


    Full Text Available Abstract Background While physicians are key to primary preventive care, their delivery rate is sub-optimal. Assessment of physician beliefs is integral to understanding current behavior and the conceptualization of strategies to increase delivery. Methods A focus group with regional primary care physician (PCP Opinion Leaders was conducted as a formative step towards regional assessment of attitudes and barriers regarding preventive care delivery in primary care. Following the PRECEDE-PROCEED model, the focus group aim was to identify conceptual themes that characterize PCP beliefs and practices regarding preventive care. Seven male and five female PCPs (family medicine, internal medicine participated in the audiotaped discussion of their perceptions and behaviors in delivery of primary preventive care. The transcribed audiotape was qualitatively analyzed using grounded theory methodology. Results The PCPs' own perceived role in daily practice was a significant barrier to primary preventive care. The prevailing PCP model was the "one-stop-shop" physician who could provide anything from primary to tertiary care, but whose provision was dominated by the delivery of immediate diagnoses and treatments, namely secondary care. Conclusions The secondary-tertiary prevention PCP model sustained the expectation of immediacy of corrective action, cure, and satisfaction sought by patients and physicians alike, and, thereby, de-prioritized primary prevention in practice. Multiple barriers beyond the immediate control of PCP must be surmounted for the full integration of primary prevention in primary care practice. However, independent of other barriers, physician cognitive value of primary prevention in practice, a base mediator of physician behavior, will need to be increased to frame the likelihood of such integration.

  15. Towards a new moral paradigm in health care delivery: accounting for individuals. (United States)

    Katz, Meir


    For years, commentators have debated how to most appropriately allocate scarce medical resources over large populations. In this paper, I abstract the major rationing schema into three general approaches: rationing by price, quantity, and prioritization. Each has both normative appeal and considerable weakness. After exploring them, I present what some commentators have termed the "moral paradigm" as an alternative to broader philosophies designed to encapsulate the universe of options available to allocators (often termed the market, professional, and political paradigms). While not itself an abstraction of any specific viable rationing scheme, it provides a strong basis for the development of a new scheme that offers considerable moral and political appeal often absent from traditionally employed rationing schema. As I explain, the moral paradigm, in its strong, absolute, and uncompromising version, is economically untenable. This paper articulates a modified version of the moral paradigm that is pluralist in nature rather than absolute. It appeals to the moral, emotional, and irrational sensibilities of each individual person. The moral paradigm, so articulated, can complement any health care delivery system that policy-makers adopt. It functions by granting individuals the ability to appeal to an administrative adjudicatory board designated for this purpose. The adjudicatory board would have the expertise and power to act in response to the complaints of individual aggrieved patients, including those complaints that stem from the moral, religious, ethical, emotional, irrational, or other subjective positions of the patient, and would have plenary power to affirm the denial of access to medical care or to mandate the provision of such care. The board must be designed to facilitate its intended function while creating structural limitations on abuse of power and other excess. I make some specific suggestions on matters of structure and function in the hope of

  16. An Innovative Program in the Science of Health Care Delivery: Workforce Diversity in the Business of Health. (United States)

    Essary, Alison C; Wade, Nathaniel L


    According to the most recent statistics from the National Center for Education Statistics, disparities in enrollment in undergraduate and graduate education are significant and not improving commensurate with the national population. Similarly, only 12% of graduating medical students and 13% of graduating physician assistant students are from underrepresented racial and ethnic groups. Established in 2012 to promote health care transformation at the organization and system levels, the School for the Science of Health Care Delivery is aligned with the university and college missions to create innovative, interdisciplinary curricula that meet the needs of our diverse patient and community populations. Three-year enrollment trends in the program exceed most national benchmarks, particularly among students who identify as Hispanic and American Indian/Alaska Native. The Science of Health Care Delivery program provides students a seamless learning experience that prepares them to be solutions-oriented leaders proficient in the business of health care, change management, innovation, and data-driven decision making. Defined as the study and design of systems, processes, leadership and management used to optimize health care delivery and health for all, the Science of Health Care Delivery will prepare the next generation of creative, diverse, pioneering leaders in health care.

  17. Delivery of eye and vision services in Aboriginal and Torres Strait Islander primary health care centres

    Directory of Open Access Journals (Sweden)

    Anthea M Burnett


    Full Text Available Background: Routine eye and vision assessments are vital for the detection and subsequent management of vision loss, which is particularly important for Aboriginal and Torres Strait Islander people, who face higher rates of vision loss than other Australians. In order to guide improvements, this paper will describe patterns, variations and gaps in these eye and vision assessments for Aboriginal and Torres Strait Islander people. Methods: Clinical audits from 124 primary health care centres (sample size 15,175 from five Australian States and Territories were conducted during 2005-2012. Main outcome measure was adherence to current guidelines for delivery of eye and vision assessments to adults with diabetes, those without a diagnosed major chronic disease and children attending primary health care centres. Results: Overall delivery of recommended eye and vision assessments varied widely between health centres. Of the adults with diabetes, 45% had a visual acuity assessment recorded within the previous 12 months (health centre range 0-88%, and 33% had a retinal examination recorded (health centre range 0-73%. Of the adults with no diagnosed major chronic disease, 31% had a visual acuity assessment recorded within the previous two years (health centre range 0-30%, and 13% had received an examination for trichiasis (health centre range 0-40%. In children, 49% had a record of a vision assessment (health centre range 0-97%, and 25% had a record of an examination for trachoma within the previous 12 months (health centre range 0-63%. Conclusions: There was considerable range, and variation in the recorded delivery of scheduled eye and vision assessments across health centres. Sharing the successful strategies of the better-performing health centres to support focused improvements in key areas of need may increase overall rates of eye examinations – important for the timely detection, referral and treatment of eye conditions affecting Aboriginal and

  18. The Impact of Direct Provision Accommodation for Asylum Seekers on Organisation and Delivery of Local Primary Care and Social Care Services: A Case Study

    LENUS (Irish Health Repository)

    Pieper, Hans-Olaf


    Abstract Background Many western countries have policies of dispersal and direct provision accommodation (state-funded accommodation in an institutional centre) for asylum seekers. Most research focuses on its effect on the asylum seeking population. Little is known about the impact of direct provision accommodation on organisation and delivery of local primary care and social care services in the community. The aim of this research is to explore this issue. Methods In 2005 a direct provision accommodation centre was opened in a rural area in Ireland. A retrospective qualitative case study was designed comprising in-depth interviews with 37 relevant stakeholders. Thematic analysis following the principles of framework analysis was applied. Results There was lack of advance notification to primary care and social care professionals and the community about the new accommodation centre. This caused anxiety and stress among relevant stakeholders. There was insufficient time to plan and prepare appropriate primary care and social care for the residents, causing a significant strain on service delivery. There was lack of clarity about how primary care and social care needs of the incoming residents were to be addressed. Interdisciplinary support systems developed informally between healthcare professionals. This ensured that residents of the accommodation centre were appropriately cared for. Conclusions Direct provision accommodation impacts on the organisation and delivery of local primary care and social care services. There needs to be sufficient advance notification and inter-agency, inter-professional dialogue to manage this. Primary care and social care professionals working with asylum seekers should have access to training to enhance their skills for working in cross-cultural consultations.

  19. Essential basic and emergency obstetric and newborn care: from education and training to service delivery and quality of care. (United States)

    Otolorin, Emmanuel; Gomez, Patricia; Currie, Sheena; Thapa, Kusum; Dao, Blami


    Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego's programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings.

  20. Older men’s satisfaction (or dissatisfaction with health care delivery in St Catherine, Jamaica

    Directory of Open Access Journals (Sweden)

    Paul A Bourne


    Full Text Available Paul A Bourne1, Chloe Morris1, Christopher AD Charles2, Maureen D Kerr-Campbell3, Denise Eldemire-Shearer11Department of Community Health and Psychiatry and 2King Graduate School, Monroe College, Bronx, and Center for Victim Support, Harlem Hospital Center, New York; 3Systems Development Unit, Main Library, Faculty of Humanities and Education, The University of the West Indies, Mona, JamaicaAbstract: Patient satisfaction and quality of life are becoming increasingly important among the more traditional clinical outcomes in the monitoring and evaluation of health care delivery. This study explored patient’s self-rated health and patient satisfaction with health care ­providers, and examined whether health care providers are a barrier to patient care. The sample consisted of 2000 men aged 55 years and older in the parish of St Catherine, Jamaica. A 132-item ­questionnaire was used to collect the data. Descriptive statistics was used to provide information about their satisfaction with the health care system. Seventy-four percent of the sample indicated good self-rated health status (excellent, 19.0%. Forty-seven percent of the sample had sought advice from a health care provider in the last 12 months; 14.1% understood the advice of the clinician, community health aide (19.9%, pharmacist (15.4%, nurse (2.1% and nurse aide (4.6%. The respondents indicated that community health aides contributed more to improving their health (43.4% when compared with nurses (34.8%, clinicians (17.5%, and herbalists (3.7%. Furthermore, 31.7% indicated that their medical doctors were hospitable and 4.2% were knowledgeable. Negative self-rated health, perceived lack of knowledge among doctors, lack of understanding of advice from health care providers, are just some of the factors associated with dissatisfaction of patients with chronic conditions. These findings provide a framework and foundation from which further studies on effective intervention aimed at

  1. Involving private health care providers in delivery of TB care: global strategy. (United States)

    Uplekar, Mukund


    Most poor countries have a large and growing private medical sector. Evidence suggests that a large proportion of tuberculosis patients in many high TB- burden countries first approach a private health care provider. Further, private providers manage a significant proportion of tuberculosis cases. Surprisingly though, there is virtually no published evidence on linking private providers to tuberculosis programmes. As a part of global efforts to control tuberculosis through effective DOTS implementation, the World Health Organization has recently begun addressing the issue of private providers in TB control through an evolving global strategy. As a first step, a global assessment of private providers' participation in tuberculosis programmes was undertaken. The findings of the assessment were discussed and debated in a consultation involving private practitioners, TB programme managers and policy makers. Their recommendations have contributed to the evolving global strategy called Public-Private Mix for DOTS implementation (PPM DOTS). This paper presents the guiding principles of PPM DOTS and major elements of the global strategy. These include: informed advocacy; setting-up "learning projects"; scaling-up successful projects and formulation of regional, national and local strategies; developing practical tools to facilitate PPM DOTS and pursuing an operational research agenda to help better design and shape PPM DOTS strategies. Encouraging results from some ongoing project sites are discussed. The paper concludes that concerted global efforts and local input are required for a sustained period to help achieve productive engagement of private practitioners in DOTS implementation. Such efforts have to be targeted as much towards national tuberculosis programmes as towards private providers and their associations. Continued apathy in this area could not only potentially delay achieving global targets for TB control but also undo, in the long run, the hard

  2. Towards a Better Health Care Delivery System: The Tamil Nadu model. (United States)

    Parthasarathi, R; Sinha, S P


    The Tamil Nadu model of public health is renowned for its success in providing quality health services at an affordable cost especially to the rural people. Tamil Nadu is the only state with a distinctive public health cadre in the district level and also the first state to enact a Public Health Act in 1939. Tamil Nadu has gained significant ground in the various aspects of health in the last few decades largely because of the significant reforms in its health sector which dates back to 1980s which saw rigorous expansion of rural health infrastructure in the state besides deployment of thousands of multipurpose health workers as village health nurses in rural areas. Effective implementation of Universal Immunization Programme, formation of Tamil Nadu Medical Services Corporation for regulating the drug procurement and promoting generic drugs, early incorporation of indigenous system of medicine into health care service, formulation of a health policy in 2003 by the state with special emphasis on low-income, disadvantaged communities alongside efficient implementation of The Tamil Nadu Health Systems Project (TNHSP) are the major factors which contributed for the success of the state. The importance of good political commitment and leadership in the health gains of the state warrants special mention. Moreover, the economic growth of the state, improved literacy rate, gender equality, and lowered fertility rate in the last few decades and contributions from the private sector have their share in the public health success of the state. In spite of some flaws and challenges, the Tamil Nadu Model remains the prototype health care delivery system in resource-limited settings which can be emulated by other states also toward a better health care delivery system.

  3. Where there is no morphine: The challenge and hope of palliative care delivery in Tanzania

    Directory of Open Access Journals (Sweden)

    Kristopher Hartwig


    Full Text Available Background: In Tanzania, a country of 42 million, access to oral morphine is rare.Aim: To demonstrate the effectiveness of palliative care teams in reducing patients’ pain and in increasing other positive life qualities in the absence of morphine; and to document the psychological burden experienced by their clinical providers, trained in morphine delivery, as they observed their patients suffering and in extreme pain.Setting: One hundred and forty-fie cancer patients were included from 13 rural hospitals spread across Tanzania.Method: A mixed method study beginning with a retrospective quantitative analysis of cancer patients who were administered the APCA African POS tool four times. Bivariate analyses of the scores at time one and four were compared across the domains. The qualitative arm included an analysis of interviews with six nurses, each with more than fie years’ palliative care experience and no access to strong opioids.Results: Patients and their family caregivers identifid statistically signifiant (p < 0.001 improvements in all of the domains. Thematic analysis of nurse interviews described the patient and family benefis from palliative care but also their great distress when ‘bad cases’ arose who would likely benefi only from oral morphine.Conclusion: People living with chronic cancer-related pain who receive palliative care experience profound physical, spiritual and emotional benefis even without oral morphine. These results demonstrate the need for continued advocacy to increase the availability of oral morphine in these settings in addition to palliative care services.

  4. Feasibility of two modes of treatment delivery for child anxiety in primary care. (United States)

    Chavira, Denise A; Drahota, Amy; Garland, Ann F; Roesch, Scott; Garcia, Maritza; Stein, Murray B


    In this study, we examine the feasibility of cognitive behavior therapy (CBT) for children with anxiety in primary care, using two modes of treatment delivery. A total of 48 parents and youth (8-13) with anxiety disorders were randomly assigned to receive 10-sessions of CBT either delivered by a child anxiety specialist in the primary care clinic or implemented by the parent with therapist support by telephone (i.e., face-to-face or therapist-supported bibliotherapy). Feasibility outcomes including satisfaction, barriers to treatment participation, safety, and dropout were assessed. Independent evaluators, blind to treatment condition, administered the Anxiety Disorders Interview Schedule for Children (ADIS) and the Clinical Global Impression of Improvement (CGI-I) at baseline, post-treatment and 3-month follow-up; clinical self-report questionnaires were also administered. Findings revealed high satisfaction, low endorsement of barriers, low drop out rates, and no adverse events across the two modalities. According to the CGI-I, 58.3%-75% of participants were considered responders (i.e., much or very much improved) at the various time points. Similar patterns were found for remission from "primary anxiety disorder" and "all anxiety disorders" as defined by the ADIS. Clinically significant improvement was seen on the various parent and child self-report measures of anxiety. Findings suggest that both therapy modalities are feasible and associated with significant treatment gains in the primary care setting. ( unique identifier: NCT00769925).

  5. Home care and the new economy. Creating a new model for service delivery. (United States)

    Sobolewski, S; Marren, J


    The strategy undertaken by the VNSNY for its survival has been to create a new service delivery model. The design of the SDM is based on a study of organizations, within and outside of health care, that face common challenges in the home health industry today: increased competition, declining reimbursement with escalating costs, and demands for improved outcomes and customer satisfaction. The model that emerged contained several important strategies in its design, including the alignment of team goals with organizational strategic objectives, restructuring teams as multidisciplinary units, redefining the work of teams to include practice improvement and supporting team learning, increasing members' accountability for team not individual performance. The SDM continues to evolve and improve during the process of implementation as lessons emerge from our experience with teams. Preliminary results indicate that the efforts have begun to show improvements in outcomes.

  6. Forceps Delivery (United States)

    ... delivery. If your health care provider does an episiotomy — an incision in the tissue between the vagina ... the tissue between your vagina and your anus (episiotomy) to help ease the delivery of your baby. ...

  7. Providing free maternal health care: ten lessons from an evaluation of the national delivery exemption policy in Ghana


    Witter, Sophie; Adjei, Sam; Armar-Klemesu, Margaret; Graham, Wendy


    Background: There is a growing movement, globally and in the Africa region, to reduce financial barriers to health care generally, but with particular emphasis on high priority services and vulnerable groups. Objective: This article reports on the experience of implementing a national policy to exempt women from paying for delivery care in public, mission and private health facilities in Ghana. Design: Using data from a complex evaluation which was carried out in 2005-2006, lessons are drawn ...

  8. Reframing HIV care: putting people at the centre of antiretroviral delivery (United States)

    Duncombe, Chris; Rosenblum, Scott; Hellmann, Nicholas; Holmes, Charles; Wilkinson, Lynne; Biot, Marc; Bygrave, Helen; Hoos, David; Garnett, Geoff


    The delivery of HIV care in the initial rapid scale-up of HIV care and treatment was based on existing clinic-based models, which are common in highly resourced settings and largely undifferentiated for individual needs. A new framework for treatment based on variable intensities of care tailored to the specific needs of different groups of individuals across the cascade of care is proposed here. Service intensity is characterised by four delivery components: (i) types of services delivered, (ii) location of service delivery, (iii) provider of health services and (iv) frequency of health services. How these components are developed into a service delivery framework will vary across countries and populations, with the intention being to improve acceptability and care outcomes. The goal of getting more people on treatment before they become ill will necessitate innovative models of delivering both testing and care. As HIV programmes expand treatment eligibility, many people entering care will not be ‘patients’ but healthy, active and productive members of society 1. To take the framework to scale, it will be important to: (i) define which individuals can be served by an alternative delivery framework; (ii) strengthen health systems that support decentralisation, integration and task shifting; (iii) make the supply chain more robust; and (iv) invest in data systems for patient tracking and for programme monitoring and evaluation. La délivrance des soins du VIH dans le déploiement initial rapide des soins et du traitement du VIH a été basée sur des modèles existants dans les cliniques, qui sont courants dans les régions bénéficiant d’importantes ressources et largement indifférenciées pour les besoins individuels. Un nouveau cadre est proposé ici pour le traitement basé selon les intensités variables de soins, adaptés aux besoins spécifiques des différents groupes de personnes à travers la cascade de soins. L’intensité des services est caract

  9. A systematic review of care delivery models and economic analyses in lymphedema: health policy impact (2004-2011). (United States)

    Stout, N L; Weiss, R; Feldman, J L; Stewart, B R; Armer, J M; Cormier, J N; Shih, Y-C T


    A project of the American Lymphedema Framework Project (ALFP), this review seeks to examine the policy and economic impact of caring for patients with lymphedema, a common side effect of cancer treatment. This review is the first of its kind undertaken to investigate, coordinate, and streamline lymphedema policy initiatives in the United States with potential applicability worldwide. As part of a large scale literature review aiming to systematically evaluate the level of evidence of contemporary peer-reviewed lymphedema literature (2004 to 2011), publications on care delivery models, health policy, and economic impact were retrieved, summarized, and evaluated by a team of investigators and clinical experts. The review substantiates lymphedema education models and clinical models implemented at the community, health care provider, and individual level that improve delivery of care. The review exposes the lack of economic analysis related to lymphedema. Despite a dearth of evidence, efforts towards policy initiatives at the federal and state level are underway. These initiatives and the evidence to support them are examined and recommendations for translating these findings into clinical practice are made. Medical and community-based disease management interventions, taking on a public approach, are effective delivery models for lymphedema care and demonstrate great potential to improve cancer survivorship care. Efforts to create policy at the federal, state, and local level should target implementation of these models. More research is needed to identify costs associated with the treatment of lymphedema and to model the cost outlays and potential cost savings associated with comprehensive management of chronic lymphedema.

  10. Aviation and the delivery of medical care in remote regions: the Lesotho HIV experience. (United States)

    Furin, Jennifer; Shutts, Mike; Keshavjee, Salmaan


    In many regions of the world plagued by high burdens of disease, there is difficulty in accessing basic medical care. This is often due to logistical constraints and a lack of infrastructure such as roads. Medical aviation can play a major role in addressing some of these crucial issues as it allows for the rapid transport of patients, personnel, and medications to remote-and sometimes otherwise inaccessible-areas. Lesotho is a mountainous nation of 2 million people that provides a good example of medical aviation as a cornerstone in the delivery of health care. The population has a reported HIV seroprevalence of 25%, and many patients live in rural areas that are inaccessible by road. Mission Aviation Fellowship has joined forces with a medical team from the nongovernmental organization Partners In Health in an effort to launch a comprehensive program to address HIV and related problems in rural Lesotho. This medical aviation partnership has allowed for the provision of HIV prevention and treatment services to thousands of people living in the mountains. This commentary describes how medical aviation has been crucial in developing models to address complex, serious health problems in remote settings.

  11. Existing infrastructure for the delivery of emergency care in post-conflict Rwanda: An initial descriptive study

    Directory of Open Access Journals (Sweden)

    Leana S. Wen


    Conclusion: Despite ongoing challenges, the infrastructure for the delivery of emergency care is much improved since 1994, and Rwanda’s continuing progress can serve as a model for EM development in other developing and/or post-conflict countries in Africa.

  12. Health insurance determines antenatal, delivery and postnatal care utilisation : evidence from the Ghana Demographic and Health Surveillance data

    NARCIS (Netherlands)

    Browne, Joyce L; Kayode, Gbenga A; Arhinful, Daniel; Fidder, Samuel A J; Grobbee, Diederick E; Klipstein-Grobusch, Kerstin


    OBJECTIVE: This study aims to evaluate the effect of maternal health insurance status on the utilisation of antenatal, skilled delivery and postnatal care. DESIGN: A population-based cross-sectional study. SETTING AND PARTICIPANTS: We utilised the 2008 Demographic and Health Survey data of Ghana, wh

  13. Outcomes for Youth with Severe Emotional Disturbance: A Repeated Measures Longitudinal Study of a Wraparound Approach of Service Delivery in Systems of Care (United States)

    Painter, Kirstin


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

  14. Knowledge and attitudes of Saudi intensive care unit nurses regarding oral care delivery to mechanically ventilated patients with the effect of healthcare quality accreditation

    Directory of Open Access Journals (Sweden)

    A K Alotaibi


    Full Text Available Introduction: Ventilator-associated pneumonia is a major morbid outcome among intensive care unit (ICU patients. Providing oral care for intubated patients is an important task by the ICU nursing staff in reducing the mortality and morbidity. The objectives of this study were to evaluate the attitudes and knowledge of ICU nurses regarding oral care delivery to critically ill patients in Saudi Arabian ICUs. The findings were further correlated to the presence of healthcare quality accreditation of the institution. Materials and Methods: The nurses′ knowledge, attitudes, and healthcare quality accreditation status of the hospital were recorded. Two hundred fifteen nurses conveniently selected from 10 random hospitals were included in this study from Riyadh city, Saudi Arabia. This is a cross-sectional study in the form of a questionnaire. Results: When comparing the knowledge of the participants to their level of education, there was no statistically significant difference between the two groups of nurses. The majority of the nurses agreed that the oral cavity is difficult to clean and that oral care delivery is a high priority for mechanically ventilated patients. Furthermore, there was no statistically significant difference in the attitudes between nurses working in accredited and nonaccredited hospitals. Conclusion: The presence of healthcare quality accreditation did not reflect any significance in attitudes or knowledge of the ICU nurses in regard to mechanically ventilated patients. Factors affecting oral care delivery should be evaluated on the personal and institutional level to achieve better understanding of them.

  15. 77 FR 46764 - Clinical Studies of Safety and Effectiveness of Orphan Products Research Project Grant (R01) (United States)


    ... Products Research Project Grant (R01) AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY... substantially contribute to, market approval of these products. Applicants must include in the application's... either help support product approval or provide essential data needed for product development....

  16. 75 FR 47602 - Clinical Studies of Safety and Effectiveness of Orphan Products Research Project Grant (R01) (United States)


    ... Products Research Project Grant (R01) AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY... substantially contribute to, market approval of these products. Applicants must include in the application's... proposed study will either help support product approval or provide essential data needed for...

  17. An analysis of the women's health movement and its impact on the delivery of health care within the United States. (United States)

    Geary, M S


    Active in the United States for the past 25 years, the women's health movement was originally an outgrowth of the larger feminist movement and shares many of the same assumptions. The women's health movement has been successful in increasing public awareness of the problems involved in the delivery of health care to women and effecting changes in that health care. This article seeks to identify societal contributions and specific events that resulted in the occurrence of this social reform movement, enumerate some of the accomplishments, and suggest why health care providers would benefit by understanding this phenomenon.

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


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


    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...

  19. Predictors of ante-natal care, delivery and infant feeding practices among rural women in Madhya Pradesh, India

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    Indrapal Ishwarji Meshram


    Full Text Available Background: Maternal and infant mortality rates and prevalence of under nutrition are high in the State Madhya Pradesh. Regular ante-natal check-ups (ANC, delivery by trained health personnel, delivery practices and optimal infant feeding practices are important to reduce maternal and infant mortality. Objectives: The aim was to assess antenatal care, delivery and infant feeding practices of mothers of <1-year-old children in Madhya Pradesh. Materials and Methods: This was community-based cross-sectional study carried out in the rural areas of Madhya Pradesh by adopting systematic random sampling procedure. Data were collected from 5324 mothers having <1-year-old children. Information on household (HH socioeconomic and demographic particulars was collected from the mothers. Bivariate and multivariate analysis was performed to study the association between dependent and independent variables. Results and Interpretations: About 36% mothers had undergone at least three ante-natal check-ups and 73% delivered either at government or private hospitals. Only 26% mothers initiated breastfeeding within 1-h of birth and 92% fed colostrum. Step-wise regression analysis showed that ante-natal care for <3 times was significantly (P < 0.01 higher among women with high parity (≥5, illiterate women, and among lower socioeconomic group,s while home delivery was higher among women with high parity (≥5 (odds ratio [OR]: 2.3, among Scheduled Caste and Tribe women (OR: 1.5, illiteracy of head of HH (OR: 2, and among lower socioeconomic groups (OR: 1.3. Discarding colostrum was higher among illiterate women (OR: 1.6, belonging to lower socioeconomic groups (OR: 1.4 and delivery conducted by untrained person (OR: 3.9, while initiation of breastfeeding after 1-h of childbirth was higher among ≥30 years women (OR: 1.9, illiterate women (OR: 1.4, and delivery by untrained person (OR: 2.9. Conclusions: It was observed that antenatal care, delivery and infant and

  20. Implementation of a 4-tier Cloud-Based Architecture for Collaborative Health Care Delivery

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    N. A. Azeez


    Full Text Available Cloud services permit healthcare providers to ensure information handling and allow different service resources such as Software as a Service (SaaS, Platform as a Service (PaaS and Infrastructure as a Service (IaaS on the Internet, given that security and information proprietorship concerns are attended to. Health Care Providers (HCPs in Nigeria however, have been confronted with various issues because of their method of operations. Amongst the issues are ill-advised methods of data storage and unreliable nature of patient medical records. Apart from these challenges, trouble in accessing quality healthcare services, high cost of medical services, and wrong analysis and treatment methodology are not left out. Cloud Computing has relatively possessed the capacity to give proficient and reliable method for securing medical information and the need for data mining tools in this form of distributed system will go a long way in achieving the objective set out for this project. The aim of this research therefore is to implement a cloud-based architecture that is suitable to integrate Healthcare Delivery into the cloud to provide a productive mode of operation. The proposed architecture consists of four phases (4-Tier; a User Authentication and Access Control Engine (UAACE which prevents unauthorized access to patient medical records and also utilizes standard encryption/decoding techniques to ensure privacy of such records. The architecture likewise contains a Data Analysis and Pattern Prediction Unit (DAPPU which gives valuable data that guides decision making through standard Data mining procedures as well as Cloud Service Provider (CSP and Health Care Providers (HCPs. The architecture which has been implemented on CloudSim has proved to be efficient and reliable base on the results obtained when compared with previous work.

  1. The impact of organisational culture on the delivery of person-centred care in services providing respite care and short breaks for people with dementia. (United States)

    Kirkley, Catherine; Bamford, Claire; Poole, Marie; Arksey, Hilary; Hughes, Julian; Bond, John


    Ensuring the development and delivery of person-centred care in services providing respite care and short breaks for people with dementia and their carers has a number of challenges for health and social service providers. This article explores the role of organisational culture in barriers and facilitators to person-centred dementia care. As part of a mixed-methods study of respite care and short breaks for people with dementia and their carers, 49 telephone semi-structured interviews, two focus groups (N= 16) and five face-to-face in-depth interviews involving front-line staff and operational and strategic managers were completed in 2006-2007. Qualitative thematic analysis of transcripts identified five themes on aspects of organisational culture that are perceived to influence person-centred care: understandings of person-centred care, attitudes to service development, service priorities, valuing staff and solution-focused approaches. Views of person-centred care expressed by participants, although generally positive, highlight a range of understandings about person-centred care. Some organisations describe their service as being person-centred without the necessary cultural shift to make this a reality. Participants highlighted resource constraints and the knowledge, attitudes and personal qualities of staff as a barrier to implementing person-centred care. Leadership style, the way that managers' support and value staff and the management of risk were considered important influences. Person-centred dementia care is strongly advocated by professional opinion leaders and is prescribed in policy documents. This analysis suggests that person-centred dementia care is not strongly embedded in the organisational cultures of all local providers of respite-care and short-break services. Provider organisations should be encouraged further to develop a shared culture at all levels of the organisation to ensure person-centred dementia care.

  2. Developing IntegRATE: a fast and frugal patient-reported measure of integration in health care delivery

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    Glyn Elwyn


    Full Text Available Background: Efforts have been made to measure integration in health care delivery, but few existing instruments have adopted a patient perspective, and none is sufficiently generic and brief for administration at scale. We sought to develop a brief and generic patient-reported measure of integration in health care delivery.Methods: Drawing on both existing conceptualisations of integrated care and research on patients’ perspectives, we chose to focus on four distinct domains of integration: information sharing,consistent advice, mutual respect and role clarity. We formulated candidate items and conducted cognitive interviews with end users to further develop and refine the items. We then pilot-tested the measure.Results: Four rounds of cognitive interviews were conducted (n = 14 and resulted in a four-item measure that was both relevant and understandable to end users. The pilot administration of the measure (n = 15 further confirmed the relevance and interpretability of items and demonstrated that the measure could be completed in less than one minute.Conclusions: This new measure, IntegRATE, represents a patient-reported measure of integration in health care delivery that is conducive to use in both routine performance monitoring and research. The psychometric properties of the measure will be assessed in the next stage of development. 

  3. Household cost of antenatal care and delivery services in a rural community of Kaduna state, northwestern Nigeria

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    Mohd Nasiq Sambo


    Full Text Available Background: Maternal mortality remains a leading cause of death among women of reproductive age. While Nigeria has only two percent of the global population, it contributes 10% to the global maternal mortality burden. Antenatal care (ANC reduces the incidence of maternal mortality. However, financial capability affects access to antenatal care. Thus, the rural poor are at a higher risk of maternal mortality. Materials and Methods: A cross-sectional descriptive study involving 135 women (pregnant women and those who are 6 weeks postpartum. Structured interviewer-administered questionnaires were used for data collection. Data analysis was carried out using statistical package for social sciences software (version 17. Results: The average amount spent on booking and initial laboratory investigations were N77 (half a dollar and N316 ($2, respectively. Per ANC visit, average amount spent on drugs and transportation were N229 ($1.5 and N139 ($0.9 respectively. For delivery, the average amount spent was N1500 ($9.6. On an average, ANC plus delivery cost about N3,365.00 ($22. There was a statistically significant association between husband′s income and ANC attendance (X 2 = 2.451, df = 2, P = 0.048. Conclusion: Cost of Antenatal care and delivery services were not catastrophic but were a barrier to accessing antenatal care and facility-based delivery services in the study area. ANC attendance was associated with the income of household heads. Pro-poor policies and actions are needed to address this problem, as it will go a long way in reducing maternal mortality in this part of the country.

  4. The facilitators and impediment factors of midwifery student′s empowerment in pregnancy and delivery care: A qualitative study

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    Mojgan Janighorban


    Full Text Available Background: The organizational environment and its existing context may deeply affect on empowerment of individuals. In educational institutions as well as other organizations, students are going to be powerful when opportunities for growth and achievement of power are provided for them in learning and educational environments. This study has been carried out to explain the facilitators and impediment factors of midwifery student′s empowerment in pregnancy and delivery care. Materials and Methods: The current qualitative study has been conducted with participation of 15 midwifery senior students, 10 midwifery academic teachers, and 2 employed midwives in educational hospitals. The given data were collected through individual and group semi-structured interviews, and there were analyzed using directed content analysis method. Results: Three main categories of opportunity for acquisition of knowledge, opportunity for acquisition of clinical skills and opportunity for acquisition of clinical experiences formed structure of access to opportunity in the course of an explanation of facilitators and impediment factors for midwifery student′s empowerment in pregnancy and delivery care. Conclusion: To prepare and train the skilled midwives for giving care services to mothers during pregnancy and on delivery and after this period, the academic teachers and clinical instructors should pay due attention to providing the needed opportunities to acquire the applied knowledge and proficiency in the required skills for clinical work and the necessary clinical experiences in these individuals during college period.

  5. Maternal health care professionals' perspectives on the provision and use of antenatal and delivery care: a qualitative descriptive study in rural Vietnam

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    Krantz Gunilla


    Full Text Available Abstract Background High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. Method The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Conclusion Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and

  6. Association of antenatal care with facility delivery and perinatal survival – a population-based study in Bangladesh

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    Pervin Jesmin


    Full Text Available Abstract Background Antenatal Care (ANC during pregnancy can play an important role in the uptake of evidence-based services vital to the health of women and their infants. Studies report positive effects of ANC on use of facility-based delivery and perinatal mortality. However, most existing studies are limited to cross-sectional surveys with long recall periods, and generally do not include population-based samples. Methods This study was conducted within the Health and Demographic Surveillance System (HDSS of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b in Matlab, Bangladesh. The HDSS area is divided into an icddr,b service area (SA where women and children receive care from icddr,b health facilities, and a government SA where people receive care from government facilities. In 2007, a new Maternal, Neonatal, and Child Health (MNCH program was initiated in the icddr,b SA that strengthened the ongoing maternal and child health services including ANC. We estimated the association of ANC with facility delivery and perinatal mortality using prospectively collected data from 2005 to 2009. Using a before-after study design, we also determined the role of ANC services on reduction of perinatal mortality between the periods before (2005 – 2006 and after (2008–2009 implementation of the MNCH program. Results Antenatal care visits were associated with increased facility-based delivery in the icddr,b and government SAs. In the icddr,b SA, the adjusted odds of perinatal mortality was about 2-times higher (odds ratio (OR 1.91; 95% confidence intervals (CI: 1.50, 2.42 among women who received ≤1 ANC compared to women who received ≥3 ANC visits. No such association was observed in the government SA. Controlling for ANC visits substantially reduced the observed effect of the intervention on perinatal mortality (OR 0.64; 95% CI: 0.52, 0.78 to non-significance (OR 0.81; 95% CI: 0.65, 1.01, when comparing cohorts before

  7. The nutrition care profile: an aid to delivery of quality nutrition care in a small community hospital. (United States)

    Frey, P W; Littleton, E M


    In an effort to improve nutrition care in a small community hospital with one registered dietitian (R.D.), a system using a nutrition care profile (NCP) and a certified dietetic assistant (C.D.A.) was developed. The NCP includes criteria recognized in the literature or through clinical experience to be indicators of nutrition care needs. The profile is completed by the C.D.A. and reviewed by the R.D., who determines priorities for the patient's nutrition care needs. The NCP has proved to be an effective and efficient tool for prioritizing and systematizing follow-up of nutrition care needs. Indeed, because the NCP form is itself so effective as a follow-up tool for dietary records, the R.D. has found she must make a conscious effort to document nutrition care in the medical record.

  8. Transition to a New Cancer Care Delivery System: Opportunity for Empowerment of the Role of the Advanced Practice Provider (United States)

    McCorkle, Ruth; Engelking, Constance; Knobf, M. Tish; Lazenby, Mark; Davies, Marianne; Sipples, Rebecca; Ercolano, Ellyn; Lyons, Catherine


    The purpose of the study was to obtain an in-depth understanding of the perceptions of advanced practice providers (APPs) with respect to their current roles in the context of the transition to a new cancer care delivery system, as well as factors that may influence their ability to practice at their level of training and education. Five focus groups were conducted with 15 APPs (11 nurse practitioners, 4 physician assistants). Data were collected by a recorder at each focus group. Four investigators reviewed the data from each group for accuracy and to generate an initial set of codes. Codes were compared across reviewers until consensus was reached and final themes were agreed upon. The mean age of the participants was 43.5 years (range: 27 to 63 years). The APPs practiced for an average of 11 years (range: 1 to 27 years), with a mean of 6.5 years in oncology (range: 1 to 11 years). Six themes were generated from the data related to the APP role during the transition to a new oncology care system: experiencing role tension, facing communication barriers, seeking mentorship, dealing with fragmented care, recognizing the need for professional growth, and navigating a new system. Our findings may inform administrators about the role of the APP in quality care delivery. These findings may empower APPs to practice to the full scope of their training and educational preparation, thereby facilitating their goals for professional development. PMID:25031925

  9. Nurse clinic versus home delivery of evidence-based community leg ulcer care: A randomized health services trial

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    Buchanan Maureen


    Full Text Available Abstract Background International studies report that nurse clinics improve healing rates for the leg ulcer population. However, these studies did not necessarily deliver similar standards of care based on evidence in the treatment venues (home and clinic. A rigorous evaluation of home versus clinic care is required to determine healing rates with equivalent care and establish the acceptability of clinic-delivered care. Methods Health Services RCT was conducted where mobile individuals were allocated to either home or nurse clinic for leg ulcer management. In both arms, care was delivered by specially trained nurses, following an evidence protocol. Primary outcome: 3-month healing rates. Secondary outcomes: durability of healing (recurrence, time free of ulcers, HRQL, satisfaction, resource use. Data were collected at base-line, every 3 months until healing occurred, with 1 year follow-up. Analysis was by intention to treat. Results 126 participants, 65 randomized to receive care in their homes, 61 to nurse-run clinics. No differences found between groups at baseline on socio-demographic, HRQL or clinical characteristics. mean age 69 years, 68% females, 84% English-speaking, half with previous episode of ulceration, 60% ulcers at inclusion 2 for Conclusion Our findings indicate that organization of care not the setting where care is delivered influences healing rates. Key factors are a system that supports delivery of evidence-based recommendations with care being provided by a trained nursing team resulting in equivalent healing rates, HRQL whether care is delivered in the home or in a community nurse-led clinic. Trial registration Protocol Registration System: NCT00656383

  10. 'The Best Health Care Delivery System in the World'? Women's health and maternity/newborn care trends in Philadelphia, PA, United States-1997-2011: a case report. (United States)

    McCool, William F; Guidera, Mamie; Janis, Jaclyn


    Despite being ranked number one globally in terms of health care cost per capita, the United States (US) has ranked as low as 37th in the world in terms of health care system performance. This poor performance for one of the most developed nations in the world has been reflected in the underachieved attempts of the multiple US health care systems at improving maternal and newborn health, according to the goals set in 2000 by the United Nations with Millennium Development Goals (MDG's) 5: Improve Maternal Health, and 4: Reduce Child Mortality. This paper will examine the progress, or lack thereof, over a period of 15 years of the fifth largest urban area in the US - Philadelphia, Pennsylvania - in its delivery of health care to pregnant women and their newborns. Using data collected from national, state, and city health agencies, trends concerning pregnancy care will be presented and compared to the target goals of MDG-5 and MDG-4, as well as Healthy People 2020, a US government-based initiative to improve health care of all Americans. Findings will demonstrate that urban areas such as Philadelphia are on a path of not reaching goals that have been set by the United Nations and the US government, and by some indicators are moving away in a negative direction from these goals.

  11. Toward a Learning Health-care System – Knowledge Delivery at the Point of Care Empowered by Big Data and NLP (United States)

    Kaggal, Vinod C.; Elayavilli, Ravikumar Komandur; Mehrabi, Saeed; Pankratz, Joshua J.; Sohn, Sunghwan; Wang, Yanshan; Li, Dingcheng; Rastegar, Majid Mojarad; Murphy, Sean P.; Ross, Jason L.; Chaudhry, Rajeev; Buntrock, James D.; Liu, Hongfang


    The concept of optimizing health care by understanding and generating knowledge from previous evidence, ie, the Learning Health-care System (LHS), has gained momentum and now has national prominence. Meanwhile, the rapid adoption of electronic health records (EHRs) enables the data collection required to form the basis for facilitating LHS. A prerequisite for using EHR data within the LHS is an infrastructure that enables access to EHR data longitudinally for health-care analytics and real time for knowledge delivery. Additionally, significant clinical information is embedded in the free text, making natural language processing (NLP) an essential component in implementing an LHS. Herein, we share our institutional implementation of a big data-empowered clinical NLP infrastructure, which not only enables health-care analytics but also has real-time NLP processing capability. The infrastructure has been utilized for multiple institutional projects including the MayoExpertAdvisor, an individualized care recommendation solution for clinical care. We compared the advantages of big data over two other environments. Big data infrastructure significantly outperformed other infrastructure in terms of computing speed, demonstrating its value in making the LHS a possibility in the near future. PMID:27385912

  12. Bridging the Gaps in Obstetric Care: Perspectives of Service Delivery Providers on Challenges and Core Components of Care in Rural Georgia. (United States)

    Pinto, Meredith; Rochat, Roger; Hennink, Monique; Zertuche, Adrienne D; Spelke, Bridget


    Objectives In 2011, a workforce assessment conducted by the Georgia Maternal and Infant Health Research Group found that 52 % of Primary Care Service Areas outside metropolitan Atlanta, Georgia, had an overburdened or complete lack of obstetric care services. In response to that finding, this study's aim was twofold: to describe challenges faced by providers who currently deliver or formerly delivered obstetric care in these areas, and to identify essential core components that can be integrated into alternative models of care in order to alleviate the burden placed on the remaining obstetric providers. Methods We conducted 46 qualitative in-depth interviews with obstetricians, maternal-fetal medicine specialists, certified nurse midwives, and maternal and infant health leaders in Georgia. Interviews were digitally recorded, transcribed verbatim, uploaded into MAXQDA software, and analyzed using a Grounded Theory Approach. Results Providers faced significant financial barriers in service delivery, including low Medicaid reimbursement, high proportions of self-pay patients, and high cost of medical malpractice insurance. Further challenges in provision of obstetric care in this region were related to patient's late initiation of prenatal care and lacking collaboration between obstetric providers. Essential components of effective models of care included continuity, efficient use of resources, and risk-appropriate services. Conclusion Our analysis revealed core components of improved models of care that are more cost effective and would expand coverage. These components include closer collaboration among stakeholder populations, decentralization of services with effective use of each type of clinical provider, improved continuity of care, and system-wide changes to increase Medicaid benefits.

  13. Comparison of the Effects of Maternal Supportive Care and Acupressure (BL32 Acupoint on Pregnant Women’s Pain Intensity and Delivery Outcome

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    Marzieh Akbarzadeh


    Full Text Available Delivery is considered as one of the most painful experiences of women’s life. The present study aimed to compare the effects of supportive care and acupressure on the pregnant women’s pain intensity and delivery outcome. In this experimental study, 150 pregnant women were randomly divided into supportive care, acupressure, and control groups. The intensity of pain was measured using Visual Analogue Scale (VAS. The supportive care group received both physical and emotional cares. In the acupressure group, on the other hand, BL32 acupoint was pressed during the contractions. Then, the data were analyzed using descriptive and inferential statistics. The results revealed significant difference among the three groups regarding the intensity of pain after the intervention (P<0.001. Besides, the highest rate of natural vaginal delivery was observed in the supportive care group (94% and the acupressure group (92%, while the highest rate of cesarean delivery was related to the control group (40% and the difference was statistically significant (P<0.001. The results showed that maternal supportive care and acupressure during labor reduced the intensity of pain and improved the delivery outcomes. Therefore, these methods can be introduced to the medical team as effective strategies for decreasing delivery pain. This trial is registered with the Iranian Registry of Clinical Trial Code IRCT2014011011706N5.

  14. Dynamics of Antenatal Care and Birth Delivery Preferences in Puskesmas Kassi-Kassi, Makassar City, South Sulawesi

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    Syarifah Nuraini


    Full Text Available Background: Riskesdas 2010 illustrates that birth deliveries by health workers in low-income community reached 69.3%; while deliveries were conducted health workers at health facilities only reached 55.4%. This illustrates that the health facility or program that has given local or central government has not run optimally. Methods:This study aims to determine antenatal care and birth delivery preferences in the community and what factors underlie the preference. The location of research is precisely in the area of Puskesmas Kassi-kassi, Makassar City. Results showed that the mother already has the knowledge, attitudes and behavior quite well in maintaining health. Society does not always take advantage of government facilities. Antinatal care is mostly done in the doctor or midwife in private practice for reasons of convenience and prestige; while health centers for labor is still the main choice for the cheapest. Conclusion: Urban community in Kassi Health Center area have many option other than health center the quality only type of services is factor related to costumer choice because they are able to finance the cost. Recommendation: Government need to involve the private sector and do not ignore the social economic and culture condition for the successful of program.

  15. Students' Attitudes, Academic Performance and Preferences for Content Delivery in a Very Large Self-Care Course Redesign. (United States)

    Camiel, Lana Dvorkin; Mistry, Amee; Schnee, David; Tataronis, Gary; Taglieri, Catherine; Zaiken, Kathy; Patel, Dhiren; Nigro, Stefanie; Jacobson, Susan; Goldman, Jennifer


    Objective. To evaluate students' performance/attitudes toward a flipped team-based learning (TBL) format in a "very large" self-care course based on student content delivery preference. Design. Third-year students enrolled in the course were surveyed regarding elements of redesign and homework completion. Additionally, their performance and incoming grade point average were evaluated. Assessment. A survey was completed by 286 of 305 students. Nineteen percent of respondents preferred traditional content delivery, whereas 30% preferred flipped TBL, 48% preferred a mixed format, and 3% had no preference. The grades achieved in the course were: A (49%), B (48%), C (3%) and D (0%). The majority completed "all" or "most" of the homework, appreciated attributes of course redesign, felt home preparation and in-class activities engaged them, and reported improved communication/evaluation skills. Content delivery preference significantly affected attitudes. Conclusion. Students positively received a flipped team-based learning classroom format, especially those who preferred flipped TBL or mixed content delivery. A minority with preference for traditional teaching style did not enjoy the new format; however, their academic performance did not differ significantly from those who did.

  16. Students’ Attitudes, Academic Performance and Preferences for Content Delivery in a Very Large Self-Care Course Redesign (United States)

    Mistry, Amee; Schnee, David; Tataronis, Gary; Taglieri, Catherine; Zaiken, Kathy; Patel, Dhiren; Nigro, Stefanie; Jacobson, Susan; Goldman, Jennifer


    Objective. To evaluate students’ performance/attitudes toward a flipped team-based learning (TBL) format in a “very large” self-care course based on student content delivery preference. Design. Third-year students enrolled in the course were surveyed regarding elements of redesign and homework completion. Additionally, their performance and incoming grade point average were evaluated. Assessment. A survey was completed by 286 of 305 students. Nineteen percent of respondents preferred traditional content delivery, whereas 30% preferred flipped TBL, 48% preferred a mixed format, and 3% had no preference. The grades achieved in the course were: A (49%), B (48%), C (3%) and D (0%). The majority completed “all” or “most” of the homework, appreciated attributes of course redesign, felt home preparation and in-class activities engaged them, and reported improved communication/evaluation skills. Content delivery preference significantly affected attitudes. Conclusion. Students positively received a flipped team-based learning classroom format, especially those who preferred flipped TBL or mixed content delivery. A minority with preference for traditional teaching style did not enjoy the new format; however, their academic performance did not differ significantly from those who did. PMID:27293234

  17. Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women.

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    Elysia Larson

    Full Text Available In order to develop patient-centered care we need to know what patients want and how changing socio-demographic factors shape their preferences.We fielded a structured questionnaire that included a discrete choice experiment to investigate women's preferences for place of delivery care in four rural districts of Pwani Region, Tanzania. The discrete choice experiment consisted of six attributes: kind treatment by the health worker, health worker medical knowledge, modern equipment and medicines, facility privacy, facility cleanliness, and cost of visit. Each woman received eight choice questions. The influence of potential supply- and demand- side factors on patient preferences was evaluated using mixed logit models.3,003 women participated in the discrete choice experiment (93% response rate completing 23,947 choice tasks. The greatest predictor of health facility preference was kind treatment by doctor (β = 1.13, p<0.001, followed by having a doctor with excellent medical knowledge (β = 0.89 p<0.001 and modern medical equipment and drugs (β = 0.66 p<0.001. Preferences for all attributes except kindness and cost were changed with changes to education, primiparity, media exposure and distance to nearest hospital.Care quality, both technical and interpersonal, was more important than clinic inputs such as equipment and cleanliness. These results suggest that while basic clinic infrastructure is necessary, it is not sufficient for provision of high quality, patient-centered care. There is an urgent need to build an adequate, competent, and kind health workforce to raise facility delivery and promote patient-centered care.

  18. Illicit drug use as a challenge to the delivery of end-of-life care services to homeless persons: perceptions of health and social services professionals. (United States)

    McNeil, Ryan; Guirguis-Younger, Manal


    Homeless persons tend to die younger than the housed population and have complex, often unmet, end-of-life care needs. High levels of illicit drug use among this population are a particular challenge for health and social services professionals involved in end-of-life care services delivery. This article explores the challenges of end-of-life care services to homeless illicit drug users based on data collected during a national study on end-of-life care services delivery to homeless persons in Canada. The authors conducted qualitative interviews with 50 health and social services professionals involved in health services delivery to homeless persons in five cities. Interviews were transcribed verbatim and analysed thematically. Themes were organised into two domains. First, barriers preventing homeless illicit drug users from accessing end-of-life care services, such as competing priorities (e.g. withdrawal management), lack of trust in healthcare providers and discrimination. Second, challenges to end-of-life care services delivery to this population in health and social care settings, including non-disclosure of illicit drug use, pain and symptom management, interruptions in care, and lack of experience with addictions. The authors identify a need for increased research on the role of harm reduction in end-of-life care settings to address these challenges.

  19. An Innovative Approach to Health Care Delivery for Patients with Chronic Conditions (United States)

    Bourn, Scott; Skoufalos, Alexis; Beck, Eric H.; Castillo, Daniel J.


    Abstract Although the health care reform movement has brought about positive changes, lingering inefficiencies and communication gaps continue to hamper system-wide progress toward achieving the overarching goal—higher quality health care and improved population health outcomes at a lower cost. The multiple interrelated barriers to improvement are most evident in care for the population of patients with multiple chronic conditions. During transitions of care, the lack of integration among various silos and inadequate communication among providers cause delays in delivering appropriate health care services to these vulnerable patients and their caregivers, diminishing positive health outcomes and driving costs ever higher. Long-entrenched acute care-focused treatment and reimbursement paradigms hamper more effective deployment of existing resources to improve the ongoing care of these patients. New models for care coordination during transitions, longitudinal high-risk care management, and unplanned acute episodic care have been conceived and piloted with promising results. Utilizing existing resources, Mobile Integrated Healthcare is an emerging model focused on closing these care gaps by means of a round-the-clock, technologically sophisticated, physician-led interprofessional team to manage care transitions and chronic care services on-site in patients' homes or workplaces. PMID:27563751

  20. A management information system to plan and monitor the delivery of health-care services in government hospitals in India. (United States)

    Ramani, K V


    Governments all over the world are getting increasingly concerned about their ability to meet their social obligations in the health sector. In this paper, we discuss the design and development of a management information system (MIS) to plan and monitor the delivery of healthcare services in government hospitals in India. Our MIS design is based on an understanding of the working of several municipal, district, and state government hospitals. In order to understand the magnitude and complexity of various issues faced by the government hospitals, we analyze the working of three large tertiary care hospitals administered by the Ahmedabad Municipal Corporation. The hospital managers are very concerned about the lack of hospital infrastructure and resources to provide a satisfactory level of service. Equally concerned are the government administrators who have limited financial resources to offer healthcare services at subsidized rates. A comprehensive hospital MIS is thus necessary to plan and monitor the delivery of hospital services efficiently and effectively.

  1. Implementation of health information technology to maximize efficiency of resource utilization in a geographically dispersed prenatal care delivery system. (United States)

    Cochran, Marlo Baker; Snyder, Russell R; Thomas, Elizabeth; Freeman, Daniel H; Hankins, Gary D V


    This study investigated the utilization of health information technology (HIT) to enhance resource utilization in a geographically dispersed tertiary care system with extensive outpatient and delivery services. It was initiated as a result of a systems change implemented after Hurricane Ike devastated southeast Texas. A retrospective database and electronic medical record review was performed, which included data collection from all patients evaluated 18 months prior (epoch I) and 18 months following (epoch II) the landfall of Hurricane Ike. The months immediately following the storm were omitted from the analysis, allowing time to establish a new baseline. We analyzed a total of 21,201 patients evaluated in triage at the University of Texas Medical Branch. Epoch I consisted of 11,280 patients and epoch II consisted of 9922 patients. Using HIT, we were able to decrease the number of visits to triage while simultaneously managing more complex patients in the outpatient setting with no clinically significant change in maternal or fetal outcome. This study developed an innovated model of care using constrained resources while providing quality and safety to our patients without additional cost to the health care delivery system.

  2. Bringing Big Data to the Forefront of Healthcare Delivery: The Experience of Carolinas HealthCare System. (United States)

    Dulin, Michael F; Lovin, Carol A; Wright, Jean A


    The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the health-care system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest health-care systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA) group in 2012. DA has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.

  3. Telepsychiatry: Effective, Evidence-Based, and at a Tipping Point in Health Care Delivery? (United States)

    Hilty, Donald; Yellowlees, Peter M; Parrish, Michelle B; Chan, Steven


    Patient-centered health care questions how to deliver quality, affordable, and timely care in a variety of settings. Telemedicine empowers patients, increases administrative efficiency, and ensures expertise gets to the place it is most needed--the patient. Telepsychiatry or telemental health is effective, well accepted, and comparable to in-person care. E-models of care offer variety, flexibility, and positive outcomes in most settings, and clinicians are increasingly interested in using technology for care, so much so that telepsychiatry is now being widely introduced around the world.

  4. Factors Affecting the Involvement of Day Centre Care Staff in the Delivery of Physiotherapy to Adults with Intellectual Disabilities: An Exploratory Study in One London Borough (United States)

    Middleton, M. -J.; Kitchen, S. S.


    Background: Physiotherapists for adults with intellectual disabilities often work in day centres, relying on care staff to support programmes. This study investigates factors affecting physiotherapy delivery in 4 day centres in one London borough. Materials and Method: Semi-structured interviews were carried out with day centre care staff,…

  5. The global role of health care delivery science: learning from variation to build health systems that avoid waste and harm. (United States)

    Mulley, Albert G


    This paper addresses the fourth theme of the Indiana Global Health Research Working Conference, Clinical Effectiveness and Health Systems Research. It explores geographic variation in health care delivery and health outcomes as a source of learning how to achieve better health outcomes at lower cost. It focuses particularly on the relationship between investments made in capacities to deliver different health care services to a population and the value thereby created by that care for individual patients. The framing begins with the dramatic variation in per capita health care expenditures across the nations of the world, which is largely explained by variations in national wealth. The 1978 Declaration of Alma Ata is briefly noted as a response to such inequities with great promise that has not as yet been realized. This failure to realize the promise of Alma Ata grows in significance with the increasing momentum for universal health coverage that is emerging in the current global debate about post-2015 development goals. Drawing upon work done at Dartmouth over more than three decades, the framing then turns to within-country variations in per capita expenditures, utilization of different services, and health outcomes. A case is made for greater attention to the question of value by bringing better information to bear at both the population and individual levels. Specific opportunities to identify and reduce waste in health care, and the harm that is so often associated with it, are identified by learning from outcome variations and practice variations.

  6. Emergency caesarean delivery in a patient with cerebral malaria-leptospira co infection: Anaesthetic and critical care considerations

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    Sukhen Samanta


    Full Text Available Malaria-leptospira co-infection is rarely detected. Emergency surgery in such patients has not been reported. We describe such a case of a 24-year-old primigravida at term pregnancy posted for emergency caesarean delivery who developed pulmonary haemorrhage, acute respiratory distress syndrome, acute kidney injury, and cerebral oedema. Here, we discuss the perioperative management, pain management (with transverse abdominis plane block, intensive care management (special reference to management of pulmonary haemorrhage with intra pulmonary factor VIIa and the role of plasmapheresis in leptospira related jaundice with renal failure.

  7. The role of the electronic medical record (EMR in care delivery development in developing countries: a systematic review

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    Faustine Williams


    Conclusions The potential of EMR systems to transform medical care practice has been recognised over the past decades, including the enhancement of healthcare delivery and facilitation of decisionmaking processes. Some benefits of an EMR system include accurate medication lists, legible notes and prescriptions and immediately available charts. In spite of challenges facing the developing world such as lack of human expertise and financial resource, most studies have shown how feasible it could be with support from developed nations to design and implement an EMR system that fits into this environment.

  8. Fostering maternal and newborn care in India the Yashoda way: does this improve maternal and newborn care practices during institutional delivery?

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    Beena Varghese

    Full Text Available BACKGROUND: The Yashoda program, named after a legendary foster-mother in Indian mythology, under the Norway-India Partnership Initiative was launched as a pilot program in 2008 to improve the quality of maternal and neonatal care at facilities in select districts of India. Yashodas were placed mainly at district hospitals, which are high delivery load facilities, to provide support and care to mothers and newborns during their stay at these facilities. This study presents the results from the evaluation of this intervention in two states in India. METHODS: Data collection methods included in-depth interviews with healthcare providers and mothers and a survey of mothers who had recently delivered within a quasi-experimental design. Fifty IDIs were done and 1,652 mothers who had delivered in the past three months were surveyed during 2010 and 2011. RESULTS: A significantly higher proportion of mothers at facilities with Yashodas (55 percent to 97 percent received counseling on immunization, breastfeeding, family planning, danger signs, and nutrition compared to those in control districts (34 percent to 66 percent. Mothers in intervention facilities were four to five times more likely to receive postnatal checks than mothers in control facilities. Among mothers who underwent cesarean sections, initiation of breastfeeding within five hours was 50 percent higher in intervention facilities. Mothers and families also reported increased support, care and respect at intervention facilities. CONCLUSION: Yashoda as mothers' aide thus seems to be an effective intervention to improve quality of maternal and newborn care in India. Scaling up of this intervention is recommended in district hospitals and other facilities with high volume of deliveries.

  9. Are managed care organizations in the United States impeding the delivery of primary care by nurse practitioners? A 2012 update on managed care organization credentialing and reimbursement practices. (United States)

    Hansen-Turton, Tine; Ware, Jamie; Bond, Lisa; Doria, Natalie; Cunningham, Patrick


    In 2014, the Affordable Care Act will create an estimated 16 million newly insured people. Coupled with an estimated shortage of over 60,000 primary care physicians, the country's public health care system will be at a challenging crossroads, as there will be more patients waiting to see fewer doctors. Nurse practitioners (NPs) can help to ease this crisis. NPs are health care professionals with the capability to provide important and critical access to primary care, particularly for vulnerable populations. However, despite convincing data about the quality of care provided by NPs, many managed care organizations (MCOs) across the country do not credential NPs as primary care providers, limiting the ability of NPs to be reimbursed by private insurers. To assess current credentialing practices of health plans across the United States, a brief telephone survey was administered to 258 of the largest health maintenance organizations (HMOs) in the United States, operated by 98 different MCOs. Results indicated that 74% of these HMOs currently credential NPs as primary care providers. Although this represents progress over prior assessments, findings suggest that just over one fourth of major HMOs still do not recognize NPs as primary care providers. Given the documented shortage of primary care physicians in low-income communities in the United States, these credentialing policies continue to diminish the ability of NPs to deliver primary care to vulnerable populations. Furthermore, these policies could negatively impact access to care for thousands of newly insured Americans who will be seeking a primary care provider in 2014.

  10. 分级诊疗政策内涵与理论基础初探%Coordinated care delivery:theory and policy implications

    Institute of Scientific and Technical Information of China (English)

    肖月; 赵琨


    Concept of coordinated care delivery is clearly defined,before a comparative analysis is made between such a concept and the integrated care delivery concept which is popular overseas and similar.On such basis,a theory framework is established for building and implementing such care delivery in line with the integrated theory of care delivery systems.Coordinated care delivery system now in place in China aims at rationally delivering medical resources,services and patients to primary institutions,by means of efficiently distributing resources and service systems and integrating care delivery flows,thus offering patients with cost effective and appropriate services and optimizing the care delivery system.%在明确分级诊疗概念的基础上,将分级诊疗的概念与国外分级诊疗有近似意义的整合型服务提供、协同医疗服务等概念进行比较分析,并结合诊疗服务体系整合的理论,阐述构建和实施分级诊疗制度的理论框架。现阶段我国分级诊疗体系是通过有效布局资源和服务体系,整合诊疗服务流程,实现医疗资源、服务和患者的合理下沉,为患者提供便捷价廉的适宜服务,最终实现诊疗服务体系效率优化。

  11. Interprofessional primary care protocols: a strategy to promote an evidence-based approach to teamwork and the delivery of care. (United States)

    Goldman, Joanne; Meuser, Jamie; Lawrie, Lynne; Rogers, Jess; Reeves, Scott


    Primary care reform involving interprofessional team-based care is a global phenomenon. In Ontario, Canada, 150 Family Health Teams (FHTs) have been approved in the past few years. The transition to a FHT is complex involving many changes and the processes for collaborative teamwork are not clearly delineated. To support the transition to team-based care in FHTs, a project was undertaken to develop and implement a series of interprofessional protocols in four clinical areas. These interprofessional protocols would contain relevant and evidence-based resources to support both a team and evidence-based approach to care. This paper reports on a qualitative study to examine the process of interprofessional protocol development and pilot implementation. Adopting an exploratory case study approach (Robson, 2002 ), 36 interviews were conducted with health professionals and community group members who participated in the creation and piloting of the protocols, and with project managers. In addition, observational and documentary data were gathered on the protocol development and implementation processes. The findings from the protocol development stage demonstrate the value of the focus on evidence and team, the process of assessing and targeting FHT needs, inter-organizational and interprofessional sharing, the importance of facilitation and support, and expectations for implementation. The findings from the pilot implementation stage report on the importance of champions and leaders, the implementation strategies used, FHT and organizational factors affecting implementation, and outcomes achieved. Findings are discussed in relation to the knowledge translation and interprofessional literature. Research is ongoing to examine the effectiveness of dissemination of the protocols to FHTs across the province of Ontario and its impact on health care outcomes.

  12. NCI will no longer support investigator-initiated phase III clinical trials through R01 and P01s grants | Division of Cancer Prevention (United States)

    The NCI has traditionally provided support for all phases of clinical trials and interventions via grants and cooperative agreements (including the R03, R21, R01, P01, U01, U10, and UM1 mechanisms). Historically, the majority of early phase trials have been conducted under R03, R21, R01, P01, U01, and UM1 activity codes, whereas most Phase III clinical trials have been conducted under the U10 activity code, with a limited number of Phase III clinical trials performed under the R01, P01, and U01 activity codes... |

  13. [Lactation behavior and delivery care in a group of women from a Mexican rural community]. (United States)

    Pérez-Gil Romo, S E; de la Paz Andrade Contreras, M; Rueda Arroniz, F; Ysunza-Ogazón, A


    This article presents a brief discussion on the role that "medical practice" plays, related to the type of infant lactation after delivery, and breast-feeding practice during the first months of life. Data on hospital routines and how these predispose artificial feeding practices are seen from a critical angle. The information presented in this paper corresponds to a project carried out in a rural community of the state of México, called Malinalco, where the lactation behavior of 65 women after birth of the child, was followed as of their last period of pregnancy. The main objectives of the study were to determine the relationship between the place of delivery (hospital or home delivery) and the type of lactation practiced by the mothers, as well as to determine the infants nutritional status during their first year of life. Results showed that the greater part of women from the sample were young others (less than 30 years old) with one or two children. As to the place where delivery took place, 72% of the sample were attended by midwives at their own homes, and at last 65% practiced breast feeding exclusively during the first three months. No significant correlation between these two indicators (place of delivery and type of lactation) was found, although a tendency to a more prolonged breast-feeding practice was observed in those women who delivered at home. Problems related to weaning practices were detected, since they start this only with bean broth after five months of life. Finally, information on nutritional status during the first 12 months of life, shows serious nutritional problem after the child's third month of life, since the normality percentage starts decreasing while there occurs a significant increase of 1st an 2nd degree malnutrition.

  14. Eleven Years of Primary Health Care Delivery in an Academic Nursing Center. (United States)

    Hildebrandt, Eugenie; Baisch, Mary Jo; Lundeen, Sally P.; Bell-Calvin, Jean; Kelber, Sheryl


    Client visits to an academic community nursing center (n=25,495) were coded and analyzed. Results show expansion of nursing practice and services, strong case management, and management of illness care. The usefulness of computerized clinical documentation system and of the Lundeen conceptional model of community nursing care was demonstrated.…

  15. Creating a Culture of Ethical Practice in Health Care Delivery Systems. (United States)

    Rushton, Cynda Hylton


    Undisputedly, the United States' health care system is in the midst of unprecedented complexity and transformation. In 2014 alone there were well over thirty-five million admissions to hospitals in the nation, indicating that there was an extraordinary number of very sick and frail people requiring highly skilled clinicians to manage and coordinate their complex care across multiple care settings. Medical advances give us the ability to send patients home more efficiently than ever before and simultaneously create ethical questions about the balance of benefits and burdens associated with these advances. Every day on every shift, nurses at the bedside feel an intense array of ethical issues. At the same time, administrators, policy-makers, and regulators struggle to balance commitments to patients, families, staff members, and governing boards. Ethical responsibilities and the fiduciary, regulatory, and community service goals of health care institutions are not mutually exclusive; they must go hand in hand. If they do not, our health care system will continue to lose valued professionals to moral distress, risk breaking the public's trust, and potentially undermine patient care. At this critical juncture in health care, we must look to new models, tools, and skills to confront contemporary ethical issues that impact clinical practice. The antidote to the current reality is to create a new health care paradigm grounded in compassion and sustained by a culture of ethical practice.

  16. A General Review of Factors Related to the Health Care Delivery Process: A Working Bibliography. (United States)


    1972, 23, 87-89. Greenley , J. R., & Kirk, S. A. Organizational characteristics of agencies and the distribution of services to applicants. Journal of...Structure of the Health Care Process (Cont.) Greenley , J. R., & Kirk, S. Organizational influences on access to health care. Social Science and Medicine

  17. Increasing the delivery of health care services to migrant farm worker families through a community partnership model. (United States)

    Connor, Ann; Rainer, Laura P; Simcox, Jordan B; Thomisee, Karen


    The Farm Worker Family Health Program (FWFHP) is a 13-year community partnership model designed to increase delivery of health care services for migrant farm worker families. During a yearly 2-week immersion experience, 90 students and faculty members provide health care services, including physical examinations, health screenings, health education, physical therapy, and dental care for 1,000 migrant farm workers and migrant children. Students and faculty members gain a deeper appreciation of the health and social issues that migrant farm worker families face by providing health care services in the places where migrant families live, work, and are educated. Although the model is not unique, it is significant because of its sustained history, interdisciplinary collaboration among community and academic partners, mutual trust and connections among the partners, and the way the program is tailored to meet the needs of the population served. The principles of social responsibility and leadership frame the FWFHP experience. This community partnership model can be replicated by others working with at-risk populations in low-resource settings.

  18. Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis

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    Aremu O


    .Conclusion: Home delivery, which cuts across all socioeconomic strata, is a common practice among women in Nigeria. Initiatives that would encourage the appropriate use of healthcare facilities at little or no cost to the most disadvantaged should be accorded the utmost priority.Keywords: delivery care, maternal health services utilization, multilevel discrete choice, Nigeria, socioeconomic disadvantaged, neigborhood, health policy

  19. Proceedings from the Turner Resource Network symposium: the crossroads of health care research and health care delivery. (United States)

    Backeljauw, Philippe F; Bondy, Carolyn; Chernausek, Steven D; Cernich, Joseph T; Cole, David A; Fasciano, Laura P; Foodim, Joan; Hawley, Scott; Hong, David S; Knickmeyer, Rebecca C; Kruszka, Paul; Lin, Angela E; Lippe, Barbara M; Lorigan, Gary A; Maslen, Cheryl L; Mauras, Nelly; Page, David C; Pemberton, Victoria L; Prakash, Siddharth K; Quigley, Charmian A; Ranallo, Kelly C; Reiss, Allan L; Sandberg, David E; Scurlock, Cindy; Silberbach, Michael


    Turner syndrome, a congenital condition that affects ∼1/2,500 births, results from absence or structural alteration of the second sex chromosome. There has been substantial effort by numerous clinical and genetic research groups to delineate the clinical, pathophysiological, cytogenetic, and molecular features of this multisystem condition. Questions about the molecular-genetic and biological basis of many of the clinical features remain unanswered, and health care providers and families seek improved care for affected individuals. The inaugural "Turner Resource Network (TRN) Symposium" brought together individuals with Turner syndrome and their families, advocacy group leaders, clinicians, basic scientists, physician-scientists, trainees and other stakeholders with interest in the well-being of individuals and families living with the condition. The goal of this symposium was to establish a structure for a TRN that will be a patient-powered organization involving those living with Turner syndrome, their families, clinicians, and scientists. The TRN will identify basic and clinical questions that might be answered with registries, clinical trials, or through bench research to promote and advocate for best practices and improved care for individuals with Turner syndrome. The symposium concluded with the consensus that two rationales justify the creation of a TRN: inadequate attention has been paid to the health and psychosocial issues facing girls and women who live with Turner syndrome; investigations into the susceptibility to common disorders such as cardiovascular or autoimmune diseases caused by sex chromosome deficiencies will increase understanding of disease susceptibilities in the general population.

  20. Quality and effectiveness of different approaches to primary care delivery in Brazil

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    Trindade Thiago G


    Full Text Available Abstract Background Since 1994, Brazil has developed a primary care system based on multidisciplinary teams which include not only a physician and a nurse, but also 4–6 lay community health workers. This system now consists of 26,650 teams, covering 46% of the Brazilian population. Yet relatively few investigations have examined its effectiveness, especially in contrast with that of the traditional multi-specialty physician team approach it is replacing, or that of other existing family medicine approaches placing less emphasis on lay community health workers. Primary health care can be defined through its domains of access to first contact, continuity, coordination, comprehensiveness, community orientation and family orientation. These attributes can be ascertained via instruments such as the Primary Care Assessment Tool (PCATool, and correlated with the effectiveness of care. The objectives of our study are to validate the adult version of this instrument in Portuguese, identify the extent (quality of primary care present in different models of primary care services, and correlate this extent with measures of process and outcomes in patients with diabetes, hypertension and coronary heart disease (CHD. Methods/Design We are conducting a population-based cross-sectional study of primary care in the municipality of Porto Alegre. We will interview a random sample totaling 3000 adults residing in geographic areas covered by four distinct models of primary care of the Brazilian national health system or, alternatively, by one nationally prominent complementary health care service, as well as the physicians and nurses of the health teams of these services. Interviews query perceived quality of care (PCATool-Adult Version, patient satisfaction, and process indicators of management of diabetes, hypertension and known CHD. We are measuring blood pressure, anthropometrics and, in adults with known diabetes, glycated hemoglobin. Discussion We hope to

  1. Serving transgender people: clinical care considerations and service delivery models in transgender health. (United States)

    Wylie, Kevan; Knudson, Gail; Khan, Sharful Islam; Bonierbale, Mireille; Watanyusakul, Suporn; Baral, Stefan


    The World Professional Association for Transgender Health (WPATH) standards of care for transsexual, transgender, and gender non-conforming people (version 7) represent international normative standards for clinical care for these populations. Standards for optimal individual clinical care are consistent around the world, although the implementation of services for transgender populations will depend on health system infrastructure and sociocultural contexts. Some clinical services for transgender people, including gender-affirming surgery, are best delivered in the context of more specialised facilities; however, the majority of health-care needs can be delivered by a primary care practitioner. Across high-income and low-income settings alike, there often remains a dearth of educational programming for health-care professionals in transgender health, although the best evidence supports introducing modules on transgender health early during clinical education of clinicians and allied health professionals. While these challenges remain, we review the increasing evidence and examples of the defined roles of the mental health professional in transgender health-care decisions, effective models of health service provision, and available surgical interventions for transgender people.

  2. The success of the Washington Department of Labor and Industries Managed Care Pilot Project: the occupational medicine-based delivery model. (United States)

    Sparks, P J; Feldstein, A


    The Washington State Managed Care Pilot Project (MCP) tested the effects of experience-rated capitation on medical and disability costs, quality of care, worker satisfaction with medical care, and employer satisfaction in MCP-covered workers, compared with matched fee-for-service controls. In the MCP, medical costs were reduced by approximately 27%, functional outcomes remained the same, workers were less satisfied with their treatment and access to care initially, and employers were-much more satisfied with the quality and speed of the information received from the providers. The authors believe that it was the occupational medicine-based delivery model, working in conjunction with the method of reimbursement and the cultural context of managed care, that was the most significant innovation leading to the MCP successes. This article describes the occupational medicine-based delivery model implemented for the MCP.

  3. Meeting community health worker needs for maternal health care service delivery using appropriate mobile technologies in Ethiopia.

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    Alex Little

    Full Text Available BACKGROUND: Mobile health applications are complex interventions that essentially require changes to the behavior of health care professionals who will use them and changes to systems or processes in delivery of care. Our aim has been to meet the technical needs of Health Extension Workers (HEWs and midwives for maternal health using appropriate mobile technologies tools. METHODS: We have developed and evaluated a set of appropriate smartphone health applications using open source components, including a local language adapted data collection tool, health worker and manager user-friendly dashboard analytics and maternal-newborn protocols. This is an eighteen month follow-up of an ongoing observational research study in the northern of Ethiopia involving two districts, twenty HEWs, and twelve midwives. RESULTS: Most health workers rapidly learned how to use and became comfortable with the touch screen devices so only limited technical support was needed. Unrestricted use of smartphones generated a strong sense of ownership and empowerment among the health workers. Ownership of the phones was a strong motivator for the health workers, who recognised the value and usefulness of the devices, so took care to look after them. A low level of smartphones breakage (8.3%,3 from 36 and loss (2.7% were reported. Each health worker made an average of 160 mins of voice calls and downloaded 27Mb of data per month, however, we found very low usage of short message service (less than 3 per month. CONCLUSIONS: Although it is too early to show a direct link between mobile technologies and health outcomes, mobile technologies allow health managers to more quickly and reliably have access to data which can help identify where there issues in the service delivery. Achieving a strong sense of ownership and empowerment among health workers is a prerequisite for a successful introduction of any mobile health program.

  4. The Shifting Sands of Health Care Delivery: Curriculum Revision and Integration of Community Health Nursing. (United States)

    Conger, Cynthia O'Neill; Baldwin, Joan H.; Abegglen, JoAnn; Callister, Lynn C.


    Brigham Young University's nursing curriculum was revised to reflect the community-driven nature of primary health care. Curricular threads of inquiry, practice, stewardship, spirituality, and service are the framework for integrating community health nursing practice. (SK)

  5. Scope of practice issues in the delivery of pediatric health care. (United States)


    The American Academy of Pediatrics (AAP) believes that optimal pediatric health care depends on a team-based approach with supervision by a physician leader, preferably a pediatrician. The pediatrician, here defined to include not only pediatric generalists but all pediatric medical subspecialists, all surgical specialists, and internal medicine/pediatric physicians, is uniquely qualified to manage, coordinate, and supervise the entire spectrum of pediatric care, from diagnosis through all stages of treatment, in all practice settings. The AAP recognizes the valuable contributions of nonphysician clinicians, including nurse practitioners and physician assistants, in delivering optimal pediatric care. However, the expansion of the scope of practice of nonphysician pediatric clinicians raises critical public policy and child health advocacy concerns. Pediatricians should serve as advocates for optimal pediatric care in state legislatures, public policy forums, and the media and should pursue opportunities to resolve scope of practice conflicts outside state legislatures. The AAP affirms the importance of appropriate documentation and standards in pediatric education, training, skills, clinical competencies, examination, regulation, and patient care to ensure safety and quality health care for all infants, children, adolescents, and young adults.

  6. Investigating the health care delivery system in Japan and reviewing the local public hospital reform

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    Zhang X


    Full Text Available Xing Zhang, Tatsuo Oyama National Graduate Institute for Policy Studies, Tokyo, Japan Abstract: Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described. Keywords: health care system, health care resource, public hospital, multivariate regression model, financial performance

  7. Health Care Delivery Practices in Huntington’s Disease Specialty Clinics: An International Survey (United States)

    Frich, Jan C.; Rae, Daniela; Roxburgh, Richard; Miedzybrodzka, Zofia H.; Edmondson, Mary; Pope, Erika Bjorklund; Goodman, LaVonne; Haddad, Monica S.; Giuliano, Joe; Nelson, Eugene C.; Guttman, Mark; Nance, Martha


    Background: Little is known about the organization of clinical services for Huntington’s disease (HD). Objective: To describe how health care services are organized and delivered in HD-clinics taking part in or eligible for the Enroll-HD study. Methods: In 2014, a 69-item survey was administered to sites taking part in or eligible for the Enroll-HD study. Results: Of 231 sites surveyed, 121 (52.2%) sites in Europe, North America, Latin America, and Oceania responded. Most sites in the sample serve large populations, with 61.1% serving more than 1.5 million people, and a further 33% serving >500,000. Almost all (86.0%) centers see patients from outside their region. The majority of centers (59.7%) follow 50–199 patients, 21.9% care for more than 200. Most centers provide care in all stages of HD, and nearly all review pre-symptomatic cases. Multidisciplinary case reviews are offered in 54.5% of sites, with outreach clinics offered by 48.1%. Videoconferencing and telemedicine are used by 23.6%. Separate consultations for caregivers are offered in more than half of the centers. Most centers (70.4%) report following published guidelines or local care pathways for HD. Conclusions: Most centers serve a large population and use a multidisciplinary approach. The survey gives insight into factors underpinning HD service delivery globally. There is a need for more in-depth studies of clinical practice to understand how services are organized and how such features may be associated with quality of care. PMID:27372053

  8. Maternal Satisfaction about Prenatal and Postnatal Cares in Vaginal and Cesarean Section Delivery at Teaching and Non- teaching Hospitals of Tabriz/ Iran

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    Somayyeh Naghizadeh


    Full Text Available Objectives: The main goal of care services is provide and promote mankind's health. Patient satisfaction is recognized as an important parameter for assessing the quality of patient care services. Spatially mothers' satisfaction from delivery is very important because it influence on family and society psychological health. The aim of this study was comparing maternal satisfaction about prenatal and postnatal cares in vaginal and cesarean section delivery at teaching and nonteaching hospitals of Tabriz/ Iran. Materials and Methods: This is a descriptive-comparative study. We selected 454 women who had been hospitalized for delivery in Alzahra, Talegani (teaching and 29Bahman (nonteaching Tabriz/Iran hospitals. For data collection, we used a questionnaire. Spss/ver13, Descriptive statistic, Independent t test, ANOVA and correlation tests were used for data analysis. Results: Findings indicated the highest level of satisfaction in both kind of hospitals was about physical and the lowest one was about informational aspect in women who had vaginal delivery, accordingly these rates about cesarean section was about physical and about informational and emotional aspects in labor. The analysis of data showed significant difference between mothers' satisfaction with all aspects of care in the teaching and non- teaching hospitals (P < 0.001. Conclusion: The results showed that the highest rank from mothers' satisfaction was in the physical and the lowest rank was in informational category. Mothers were satisfied from vaginal delivery in all aspects. Rate of satisfaction in nonteaching were more than teaching hospitals.

  9. Comparison of the effects of maternal supportive care and acupressure (BL32 acupoint) on pregnant women's pain intensity and delivery outcome. (United States)

    Akbarzadeh, Marzieh; Masoudi, Zahra; Hadianfard, Mohammad Javad; Kasraeian, Maryam; Zare, Najaf


    Delivery is considered as one of the most painful experiences of women's life. The present study aimed to compare the effects of supportive care and acupressure on the pregnant women's pain intensity and delivery outcome. In this experimental study, 150 pregnant women were randomly divided into supportive care, acupressure, and control groups. The intensity of pain was measured using Visual Analogue Scale (VAS). The supportive care group received both physical and emotional cares. In the acupressure group, on the other hand, BL32 acupoint was pressed during the contractions. Then, the data were analyzed using descriptive and inferential statistics. The results revealed significant difference among the three groups regarding the intensity of pain after the intervention (P acupressure group (92%), while the highest rate of cesarean delivery was related to the control group (40%) and the difference was statistically significant (P acupressure during labor reduced the intensity of pain and improved the delivery outcomes. Therefore, these methods can be introduced to the medical team as effective strategies for decreasing delivery pain. This trial is registered with the Iranian Registry of Clinical Trial Code IRCT2014011011706N5.

  10. Differences in primary health care delivery to Australia’s Indigenous population: a template for use in economic evaluations

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    Ong Katherine S


    Full Text Available Abstract Background Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia’s Indigenous population. A template has been developed which can adapt mainstream health intervention data to the Indigenous setting. Methods The ‘Indigenous Health Service Delivery Template’ has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs, and mainstream general practitioner (GP practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream health intervention data to allow its economic evaluation as if delivered from an ACCHS. Results The template indicates that more resources are required in the delivery of health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly. Conclusions The Indigenous Health Service Delivery Template reveals significant differences in the way health interventions are delivered from ACCHSs compared to

  11. Design and Delivery of a Tailored Intervention to Implement Recommendations for Multimorbid Patients Receiving Polypharmacy into Primary Care Practices

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    Cornelia Jäger


    Full Text Available Introduction. Managing polypharmacy is particularly demanding for general practitioners as coordinators of care. Recently, a German guideline for polypharmacy in primary care has been published. This paper describes the content and delivery of a tailored intervention, which aims at improving the implementation of guideline recommendations for polypharmacy into practice, considering individual barriers. Materials and Methods. Firstly, barriers for implementation and the corresponding strategies to address them have been identified. On this basis, an intervention consisting of a workshop for health care professionals and educational materials for patients has been developed. The workshop focused on knowledge, awareness, and skills. The educational materials included a tablet computer. Practice teams will elaborate individual concepts of how to implement the recommendations into their practice. The workshop has been evaluated by the participants by means of a questionnaire. Results. During the workshop 41 possible sources of medication errors and 41 strategies to improve medication management have been identified. Participants evaluated the workshop overall positively, certifying its relevancy to practice. Discussion. The concept of the workshop seemed appropriate to impart knowledge about medication management to the participants. It will have to be evaluated, if the intervention finally resulted in an improved implementation of the guideline recommendations.

  12. Patient satisfaction with HIV/AIDS care and treatment in the decentralization of services delivery in Vietnam.

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    Bach Xuan Tran

    Full Text Available OBJECTIVE: We evaluated the patient satisfaction with HIV/AIDS care and treatment and its determinants across levels of health service administration in Vietnam. METHODS: We interviewed 1016 patients at 7 hospitals and health centers in three epicenters, including Hanoi, Hai Phong, and Ho Chi Minh City. The Satisfaction with HIV/AIDS Treatment Interview Scale (SATIS was developed, and 3 dimensions were constructed using factor analysis, namely "Quality and Convenience"; "Availability and Responsiveness"; and "Competence of health care workers". RESULTS: In a band score of (0; 10, the mean scores of all domains were large; it was the highest in "Competence of health workers" (9.34±0.84, and the lowest in "Quality and Convenience" (9.03±1.04. The percentages of respondents completely satisfied with overall service quality and treatment outcomes were 42.4% and 18.8%, respectively. In multivariate analysis, factors related to higher satisfaction included female sex, older age, and living with spouses or partners. Meanwhile, lower satisfaction was found among patients who were attending provincial and district clinics; in the richest group; had higher CD4 count; and drug users. CONCLUSION: This study highlights the importance of improving the quality of HIV/AIDS services at the provincial and district clinics. Potential strategies include capacity building for health workers, integrative service delivery, engagements of family members in treatment supports, and additional attention and comprehensive care for drug users with HIV/AIDS.

  13. Changing trends in eclampsia and increasing cesarean delivery and ndash; an interesting retrospective study from a tertiary care hospital of Raipur, Chhattisgarh, India

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    Abha Singh


    Conclusions: Contrary to various studies hypertensive disorder to be the fourth most common cause of maternal death in developing countries, eclampsia came out to be the leading cause of maternal mortality in our study. Better antenatal and peripartum care can reduce its occurrence and related morbidity and mortality. Optimum outcome can be achieved by the speed with which the peripartum care is given. Cesarean delivery is preferable if vaginal delivery is not anticipated within 8 hrs as it gives better fetomaternal outcome. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1031-1035

  14. A decade of inequality in maternity care: antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991–2004

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    Ronsmans Carine


    Full Text Available Abstract Background Bangladesh is committed to the fifth Millennium Development Goal (MDG-5 target of reducing its maternal mortality ratio by three-quarters between 1990 and 2015. Since the early 1990s, Bangladesh has followed a strategy of improving access to facilities equipped and staffed to provide emergency obstetric care (EmOC. Methods We used data from four Demographic and Health Surveys conducted between 1993 and 2004 to examine trends in the proportions of live births preceded by antenatal consultation, attended by a health professional, and delivered by caesarean section, according to key socio-demographic characteristics. Results Utilization of antenatal care increased substantially, from 24% in 1991 to 60% in 2004. Despite a relatively greater increase in rural than urban areas, utilization remained much lower among the poorest rural women without formal education (18% compared with the richest urban women with secondary or higher education (99%. Professional attendance at delivery increased by 50% (from 9% to 14%, more rapidly in rural than urban areas, and caesarean sections trebled (from 2% to 6%, but these indicators remained low even by developing country standards. Within these trends there were huge inequalities; 86% of live births among the richest urban women with secondary or higher education were attended by a health professional, and 35% were delivered by caesarean section, compared with 2% and 0.1% respectively of live births among the poorest rural women without formal education. The trend in professional attendance was entirely confounded by socioeconomic and demographic changes, but education of the woman and her husband remained important determinants of utilization of obstetric services. Conclusion Despite commendable progress in improving uptake of antenatal care, and in equipping health facilities to provide emergency obstetric care, the very low utilization of these facilities, especially by poor women, is a

  15. Client assessment of animal health care delivery in peri-urban Ghana. (United States)

    Turkson, P K


    The study used a questionnaire to assess the delivery of veterinary services as perceived by users in four peri-urban areas in Ghana. Eight hundred and eighty nine respondents were interviewed: 10.7% were cattle farmers, 27.4% were small ruminant farmers, 14.2% were pig farmers, 45.1% were poultry farmers and 2.6% reared various animals on a part-time basis. Most of the animal health needs were either met by the owners (50.4%) or by veterinarians (41.6%). Veterinarians were mainly consulted for advice on animal health, disease diagnosis and treatments. Most respondents (65.7%) had no difficulty in getting help from government services. Higher proportions of interviewees perceived effectiveness, efficiency, service quality, staff attitude and technical competence as 'good' or 'very good'. However, equity and accessibility were thought to be 'fair' to 'very poor', and the cost of drugs was considered expensive' or 'very expensive'. The study identified strengths and weaknesses in the delivery of animal health services in peri-urban Ghana and this information could be used as a basis to improve the overall quality of these services in the future.

  16. The Teen Outreach Reproductive Challenge: Improving Adolescent Health Care Delivery through Peer Education Projects (United States)

    DeMairo, Pauline; Dischell, Jackie; Jouthe, Sorahya A.; Horner, Andrea


    The Teen Outreach Reproductive CHallenge (TORCH) is a peer education program that provides information on various topics relevant to adolescent sexual health to a diverse audience, ranging from teens to health care providers. This information is disseminated through various projects by a group of New York City high-school students who are…

  17. Commentary to Adam Oliver’s 'Incentivising improvements in health care delivery'

    DEFF Research Database (Denmark)

    Vrangbæk, Karsten


    The commentary discusses key issues for assessment of performance management within health care. It supports the ambition to develop more realistic understandings of performance management based on insights from behavioral economics as suggested by Adam Oliver. However, it also points to several...

  18. Capturing patients' experiences to change Parkinson's disease care delivery: a multicenter study

    NARCIS (Netherlands)

    Eijk, M. van; Faber, M.J.; Post, B.; Okun, M.S.; Schmidt, P.; Munneke, M.; Bloem, B.R.


    Capturing patients' perspectives has become an essential part of a quality of care assessment. The patient centeredness questionnaire for PD (PCQ-PD) has been validated in The Netherlands as an instrument to measure patients' experiences. This study aims to assess the level of patient centeredness i

  19. Survey of Oxygen Delivery Practices in UK Paediatric Intensive Care Units

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    Sainath Raman


    Full Text Available Purpose. Administration of supplemental oxygen is common in paediatric intensive care. We explored the current practice of oxygen administration using a case vignette in paediatric intensive care units (PICU in the united kingdom. Methods. We conducted an online survey of Paediatric Intensive Care Society members in the UK. The survey outlined a clinical scenario followed by questions on oxygenation targets for 5 common diagnoses seen in critically ill children. Results. Fifty-three paediatric intensive care unit members from 10 institutions completed the survey. In a child with moderate ventilatory requirements, 21 respondents (42% did not follow arterial partial pressure of oxygen (PaO2 targets. In acute respiratory distress syndrome, cardiac arrest, and sepsis, there was a trend to aim for lower PaO2 as the fraction of inspired oxygen (FiO2 increased. Conversely, in traumatic brain injury and pulmonary hypertension, respondents aimed for normal PaO2 even as the FiO2 increased. Conclusions. In this sample of clinicians PaO2 targets were not commonly used. Clinicians target lower PaO2 as FiO2 increases in acute respiratory distress syndrome, cardiac arrest, and sepsis whilst targeting normal range irrespective of FiO2 in traumatic brain injury and pulmonary hypertension.

  20. Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings

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    Ploeg Jenny


    Full Text Available Abstract Background Little is known about the impact of implementing nursing-oriented best practice guidelines on the delivery of patient care in either hospital or community settings. Methods A naturalistic study with a prospective, before and after design documented the implementation of six newly developed nursing best practice guidelines (asthma, breastfeeding, delirium-dementia-depression (DDD, foot complications in diabetes, smoking cessation and venous leg ulcers. Eleven health care organisations were selected for a one-year project. At each site, clinical resource nurses (CRNs worked with managers and a multidisciplinary steering committee to conduct an environmental scan and develop an action plan of activities (i.e. education sessions, policy review. Process and patient outcomes were assessed by chart audit (n = 681 pre-implementation, 592 post-implementation. Outcomes were also assessed for four of six topics by in-hospital/home interviews (n = 261 pre-implementation, 232 post-implementation and follow-up telephone interviews (n = 152 pre, 121 post. Interviews were conducted with 83/95 (87% CRN's, nurses and administrators to describe recommendations selected, strategies used and participants' perceived facilitators and barriers to guideline implementation. Results While statistically significant improvements in 5% to 83% of indicators were observed in each organization, more than 80% of indicators for breastfeeding, DDD and smoking cessation did not change. Statistically significant improvements were found in > 50% of indicators for asthma (52%, diabetes foot care (83% and venous leg ulcers (60%. Organizations with > 50% improvements reported two unique implementation strategies which included hands-on skill practice sessions for nurses and the development of new patient education materials. Key facilitators for all organizations included education sessions as well as support from champions and managers while key barriers were lack

  1. Cluster Randomized Trial of a Toolkit and Early Vaccine Delivery to Improve Childhood Influenza Vaccination Rates in Primary Care (United States)

    Zimmerman, Richard K.; Nowalk, Mary Patricia; Lin, Chyongchiou Jeng; Hannibal, Kristin; Moehling, Krissy K.; Huang, Hsin-Hui; Matambanadzo, Annamore; Troy, Judith; Allred, Norma J.; Gallik, Greg; Reis, Evelyn C.


    Purpose To increase childhood influenza vaccination rates using a toolkit and early vaccine delivery in a randomized cluster trial. Methods Twenty primary care practices treating children (range for n=536-8,183) were randomly assigned to Intervention and Control arms to test the effectiveness of an evidence-based practice improvement toolkit (4 Pillars Toolkit) and early vaccine supplies for use among disadvantaged children on influenza vaccination rates among children 6 months-18 years. Follow-up staff meetings and surveys were used to assess use and acceptability of the intervention strategies in the Intervention arm. Rates for the 2010-2011 and 2011-2012 influenza seasons were compared. Two-level generalized linear mixed modeling was used to evaluate outcomes. Results Overall increases in influenza vaccination rates were significantly greater in the Intervention arm (7.9 percentage points) compared with the Control arm (4.4 percentage points; P58% did not significantly increase. In regression analyses, a child's likelihood of being vaccinated was significantly higher with: younger age, white race (Odds ratio [OR]=1.29; 95% confidence interval [CI]=1.23-1.34), having commercial insurance (OR=1.30; 95%CI=1.25-1.35), higher pre-intervention practice vaccination rate (OR=1.25; 95%CI=1.16-1.34), and being in the Intervention arm (OR=1.23; 95%CI=1.01-1.50). Early delivery of influenza vaccine was rated by Intervention practices as an effective strategy for raising rates. Conclusions Implementation of a multi-strategy toolkit and early vaccine supplies can significantly improve influenza vaccination rates among children in primary care practices but the effect may be less pronounced in practices with moderate to high existing vaccination rates. PMID:24793941

  2. Use of antenatal services and delivery care among women in rural western Kenya: a community based survey

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    Rosen Daniel H


    Full Text Available Abstract Background Improving maternal health is one of the UN Millennium Development Goals. We assessed provision and use of antenatal services and delivery care among women in rural Kenya to determine whether women were receiving appropriate care. Methods Population-based cross-sectional survey among women who had recently delivered. Results Of 635 participants, 90% visited the antenatal clinic (ANC at least once during their last pregnancy (median number of visits 4. Most women (64% first visited the ANC in the third trimester; a perceived lack of quality in the ANC was associated with a late first ANC visit (Odds ratio [OR] 1.5, 95% confidence interval [CI] 1.0–2.4. Women who did not visit an ANC were more likely to have 90%, but provision of other services was low, e.g. malaria prevention (21%, iron (53% and folate (44% supplementation, syphilis testing (19.4% and health talks (14.4%. Eighty percent of women delivered outside a health facility; among these, traditional birth attendants assisted 42%, laypersons assisted 36%, while 22% received no assistance. Factors significantly associated with giving birth outside a health facility included: age ≥ 30 years, parity ≥ 5, low SES, 1 hour walking distance from the health facility. Women who delivered unassisted were more likely to be of parity ≥ 5 (AOR 5.7, 95% CI 2.8–11.6. Conclusion In this rural area, usage of the ANC was high, but this opportunity to deliver important health services was not fully utilized. Use of professional delivery services was low, and almost 1 out of 5 women delivered unassisted. There is an urgent need to improve this dangerous situation.

  3. Optimizing pain care delivery in outpatient facilities: experience in NCI, Cairo, Egypt. (United States)

    Hameed, Khaled Abdel


    As a result of increasing waiting lists of patients attending National Cancer Institute of Cairo, we are faced to provide high-quality pain care service through our outpatient pain clinic. The program description presented here shows the capacity of a 24 hours/7 days outpatient cancer pain management service to provide rapidly accessible, high-quality care to patients with complex pain and palliative care symptom burdens. In addition, this model avoids inpatient hospital admissions. Pain clinics of cancer are committed to helping patients and families identify and implement the treatments necessary to achieve optimum functional ability and the best possible quality of life. These clinics also help to communicate and work with the family physician, surgeon, and other physicians associated with patient treatment. Cancer pain is complex in its causes, and affects all parts of the body. It involves the tissues, body systems , and the mind. Being multidimensional, it is never adequately addressed with unidimensional treatment. Pain management must extend beyond physical approaches to include the psychological, social, and even spiritual aspects of the patient. Effective integrated treatment fosters self awareness and teaches appropriate and effective self care. With time, complex issues are managed, pain is reduced, and the patient moves toward peak physical and psychological functioning. These goals can be achieved by providing the highest quality pain management services. Patients attending the clinic get treated medically for their physical ailments. Their emotional and psychological problems also need to be attended with an atmosphere of love and care. The mission of the highest quality service is to obtain customer satisfaction with reduction of cost in a multidisciplinary (or better interdisciplinary) approach. This can be reached by proper identification of the customers either internal or external, assessing their needs, and implementing plans for their

  4. Challenges in Prevention and Care Delivery for Women with Cervical Cancer in Sub-Saharan Africa. (United States)

    Randall, Thomas C; Ghebre, Rahel


    Virtually all cases of invasive cervical cancer are associated with infection by high-risk strains of human papilloma virus. Effective primary and secondary prevention programs, as well as effective treatment for early-stage invasive cancer have dramatically reduced the burden of cervical cancer in high-income countries; 85% of the mortality from cervical cancer now occurs in low- and middle-income countries. This article provides an overview of challenges to cervical cancer care in sub-Saharan Africa (SSA) and identifies areas for programmatic development to meet the global development goal to reduce cancer-related mortality. Advanced stage at presentation and gaps in prevention, screening, diagnostic, and treatment capacities contribute to reduced cervical cancer survival. Cost-effective cervical cancer screening strategies implemented in low resource settings can reduce cervical cancer mortality. Patient- and system-based barriers need to be addressed as part of any cervical cancer control program. Limited human capacity and infrastructure in SSA are major barriers to comprehensive cervical cancer care. Management of early-stage, locally advanced or metastatic cervical cancer involves multispecialty care, including gynecology oncology, medical oncology, radiology, pathology, radiation oncology, and palliative care. Investment in cervical cancer care programs in low- and middle-income countries will need to include effective recruitment programs to engage women in the community to access cancer screening and diagnosis services. Though cervical cancer is a preventable and treatable cancer, the challenges to cervical control in SSA are great and will require a broadly integrated and sustained effort by multiple stakeholders before meaningful progress can be achieved.

  5. The use of remote presence for health care delivery in a northern Inuit community: a feasibility study

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    Ivar Mendez


    Full Text Available Objective. To evaluate the feasibility of remote presence for improving the health of residents in a remote northern Inuit community. Study design. A pilot study assessed patient’s, nurse’s and physician’s satisfaction with and the use of the remote presence technology aiding delivery of health care to a remote community. A preliminary cost analysis of this technology was also performed. Methods. This study deployed a remote presence RP-7 robot to the isolated Inuit community of Nain, Newfoundland and Labrador for 15 months. The RP-7 is wirelessly controlled by a laptop computer equipped with audiovisual capability and a joystick to maneuver the robot in real time to aid in the assessing and care of patients from a distant location. Qualitative data on physician’s, patient’s, caregiver’s and staff’s satisfaction were collected as well as information on its use and characteristics and the number of air transports required to the referral center and associated costs. Results. A total of 252 remote presence sessions occurred during the study period, with 89% of the sessions involving direct patient assessment or monitoring. Air transport was required in only 40% of the cases that would have been otherwise transported normally. Patients and their caregivers, nurses and physicians all expressed a high level of satisfaction with the remote presence technology and deemed it beneficial for improved patient care, workloads and job satisfaction. Conclusions. These results show the feasibility of deploying a remote presence robot in a distant northern community and a high degree of satisfaction with the technology. Remote presence in the Canadian North has potential for delivering a cost-effective health care solution to underserviced communities reducing the need for the transport of patients and caregivers to distant referral centers.

  6. Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study (United States)

    Boyle, Elaine M; Johnson, Samantha; Manktelow, Bradley; Seaton, Sarah E; Draper, Elizabeth S; Smith, Lucy K; Dorling, Jon; Marlow, Neil; Petrou, Stavros; Field, David J


    Objective To describe neonatal outcomes and explore variation in delivery of care for infants born late (34–36  weeks) and moderately (32–33 weeks) preterm (LMPT). Design/setting Prospective population-based study comprising births in four major maternity centres, one midwifery-led unit and at home between September 2009 and December 2010. Data were obtained from maternal and neonatal records. Participants All LMPT infants were eligible. A random sample of term-born infants (≥37 weeks) acted as controls. Outcome measures Neonatal unit (NNU) admission, respiratory and nutritional support, neonatal morbidities, investigations, length of stay and postnatal ward care were measured. Differences between centres were explored. Results 1146 (83%) LMPT and 1258 (79% of eligible) term-born infants were recruited. LMPT infants were significantly more likely to receive resuscitation at birth (17.5% vs 7.4%), respiratory (11.8% vs 0.9%) and nutritional support (3.5% vs 0.3%) and were less likely to be fed breast milk (64.2% vs 72.2%) than term infants. For all interventions and morbidities, a gradient of increasing risk with decreasing gestation was evident. Although 60% of late preterm infants were never admitted to a NNU, 83% required medical input on postnatal wards. Clinical management differed significantly between services. Conclusions LMPT infants place high demands on specialist neonatal services. A substantial amount of previously unreported specialist input is provided in postnatal wards, beyond normal newborn care. Appropriate expertise and planning of early care are essential if such infants are managed away from specialised neonatal settings. Further research is required to clarify optimal and cost-effective postnatal management for LMPT babies. PMID:25834169

  7. Optimal delivery of colorectal cancer follow-up care: improving patient outcomes

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    Jorgensen ML


    Full Text Available Mikaela L Jorgensen,1 Jane M Young,1,2 Michael J Solomon2,3 1Cancer Epidemiology and Services Research (CESR, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 2Surgical Outcomes Research Centre (SOuRCe, Sydney Local Health District and University of Sydney, Sydney, NSW, Australia; 3Discipline of Surgery, University of Sydney, Sydney, NSW, Australia Abstract: Colorectal cancer (CRC is the third most commonly diagnosed cancer worldwide. With population aging and increases in survival, the number of CRC survivors is projected to rise dramatically. The time following initial treatment is often described as a period of transition from intensive hospital-based care back into “regular life.” This review provides an overview of recommended follow-up care for people with CRC who have been treated with curative intent, as well as exploring the current state of the research that underpins these guidelines. For patients, key concerns following treatment include the development of recurrent and new cancers, late and long-term effects of cancer and treatment, and the interplay of these factors with daily function and general health. For physicians, survivorship care plans can be a tool for coordinating the surveillance, intervention, and prevention of these key patient concerns. Though much of the research in cancer survivorship to date has focused on surveillance for recurrent disease, many national guidelines differ in their conclusions about the frequency and timing of follow-up tests. Most CRC guidelines refer only briefly to the management of side effects, despite reports that many patients have a range of ongoing physiological, psychosocial, and functional needs. Guidance for surveillance and intervention is often limited by a small number of heterogeneous trials conducted in this patient group. However, recently released survivorship guidelines emphasize the potential for the effectiveness of

  8. The Science And Art Of Delivery: Accelerating The Diffusion Of Health Care Innovation. (United States)

    Parston, Greg; McQueen, Julie; Patel, Hannah; Keown, Oliver P; Fontana, Gianluca; Al Kuwari, Hanan; Al Kuwari, Hannan; Darzi, Ara


    There is a widely acknowledged time lag in health care between an invention or innovation and its widespread use across a health system. Much is known about the factors that can aid the uptake of innovations within discrete organizations. Less is known about what needs to be done to enable innovations to transform large systems of health care. This article describes the results of in-depth case studies aimed at assessing the role of key agents and agencies that facilitate the rapid adoption of innovations. The case studies-from Argentina, England, Nepal, Singapore, Sweden, the United States, and Zambia-represent widely varying health systems and economies. The implications of the findings for policy makers are discussed in terms of key factors within a phased approach for creating a climate for change, engaging and enabling the whole organization, and implementing and sustaining change. Purposeful and directed change management is needed to drive system transformation.

  9. Development of Portable Rapid Diagnostic Microbiology Systems for Support of Primary Health Care Delivery. (United States)


    should receive primary attention. In the collective opinion of the delegates to the Alma -Ata Con- ference in 1978, sponsored by the World Health...diagnostic challenge of tropical diseases as seen by an epidemiologist. Amer J Trop Med Hyg 28:171, 1979. 3. WHO (Ed): Alma -Ata 1978. Primary Health Care...World Health Organization, Geneva. p2. 4. Waddy BB: African epidemic cerebro -spinal, meningitis. J Trop Med Hyg 60:179, 19. 5. Sanborn WR: A portable

  10. Challenges in Prevention and Care Delivery for Women with Cervical Cancer in Sub-Saharan Africa


    Randall, Thomas C.; Ghebre, Rahel


    Virtually all cases of invasive cervical cancer are associated with infection by high-risk strains of human papilloma virus. Effective primary and secondary prevention programs, as well as effective treatment for early-stage invasive cancer have dramatically reduced the burden of cervical cancer in high-income countries; 85% of the mortality from cervical cancer now occurs in low- and middle-income countries. This article provides an overview of challenges to cervical cancer care in sub-Sahar...

  11. Achieving optimal delivery of follow-up care for prostate cancer survivors: improving patient outcomes

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    Hudson SV


    Full Text Available Shawna V Hudson,1 Denalee M O’Malley,2 Suzanne M Miller3 1Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Somerset, 2Rutgers School of Social Work, New Brunswick, NJ, 3Cancer Prevention and Control Program, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA Background: Prostate cancer is the most commonly diagnosed cancer in men in the US, and the second most prevalent cancer in men worldwide. High incidence and survival rates for prostate cancer have resulted in a large and growing population of long-term prostate cancer survivors. Long-term follow-up guidelines have only recently been developed to inform approaches to this phase of care for the prostate cancer population. Methods: A PubMed search of English literature through August 2014 was performed. Articles were retrieved and reviewed to confirm their relevance. Patient-reported measures that were used in studies of long-term prostate cancer survivors (ie, at least 2 years posttreatment were reviewed and included in the review. Results: A total of 343 abstracts were initially identified from the database search. After abstract review, 105 full-text articles were reviewed of which seven met inclusion criteria. An additional 22 articles were identified from the references of the included articles, and 29 were retained. From the 29 articles, 68 patient-reported outcome measures were identified. The majority (75% were multi-item scales that had been previously validated in existing literature. We identified four main areas of assessment: 1 physical health; 2 quality of life – general, physical, and psychosocial; 3 health promotion – physical activity, diet, and tobacco cessation; and 4 care quality outcomes. Conclusion: There are a number of well-validated measures that assess patient-reported outcomes that document key aspects of long-term follow-up with respect to patient symptoms and quality of life. However

  12. Improving clinical research and cancer care delivery in community settings: evaluating the NCI community cancer centers program

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    Fennell Mary L


    Full Text Available Abstract Background In this article, we describe the National Cancer Institute (NCI Community Cancer Centers Program (NCCCP pilot and the evaluation designed to assess its role, function, and relevance to the NCI's research mission. In doing so, we describe the evolution of and rationale for the NCCCP concept, participating sites' characteristics, its multi-faceted aims to enhance clinical research and quality of care in community settings, and the role of strategic partnerships, both within and outside of the NCCCP network, in achieving program objectives. Discussion The evaluation of the NCCCP is conceptualized as a mixed method multi-layered assessment of organizational innovation and performance which includes mapping the evolution of site development as a means of understanding the inter- and intra-organizational change in the pilot, and the application of specific evaluation metrics for assessing the implementation, operations, and performance of the NCCCP pilot. The assessment of the cost of the pilot as an additional means of informing the longer-term feasibility and sustainability of the program is also discussed. Summary The NCCCP is a major systems-level set of organizational innovations to enhance clinical research and care delivery in diverse communities across the United States. Assessment of the extent to which the program achieves its aims will depend on a full understanding of how individual, organizational, and environmental factors align (or fail to align to achieve these improvements, and at what cost.

  13. Policy implementation under stress: How the Affordable Care Act’s frontline workers cope with the challenges of public service delivery

    NARCIS (Netherlands)

    L.G. Tummers (Lars); P. Rocco (Philip)


    textabstractPublic service delivery in the contemporary American state is becoming increasingly challenging. As the implementation of the Affordable Care Act (ACA) shows, new social policies combine high technological and cognitive demands on citizens and government with budget austerity, decentrali

  14. [Attitudes regarding the delivery of formal and informal care: comparison of French and Chilean adolescents]. (United States)

    Pommier, J; Deschamps, J P; Romero, M I; Zubarew, T; Billot, L; Crema, D; Mouchtouris, A


    The representations that youth have of health professionals and young people's demands in terms of the operation and administration of services create an original and complex problematic. Clearly, this originality implies the important differences from one culture to another. For this very reason, it seemed that a comparative study relating the representations and attitudes confronted when care is sought by young people from countries with different cultural contexts would assist in comprehending why adolescents have such particular ways of using--or not using--formal and self-administered health services. An original open-ended response questionnaire was jointly designed and validated by a French and Chilean team. A mutually agreed upon sample of 957 school children, adolescents aged from 14 to 19, participated in the study in France and in Chili. The following correlations were found. In the event of a sleeping problem (or other general worry that is physically manifested), the mother is the privileged confidant, and in the specific case of a relationship or emotional problem, it is usually one of the adolescents' friends. The general practitioner is the favoured professional person in the event of a purely physical problem. When confronted with an emotional problem, one-third of adolescents say that they would not consider going to a consultation. The expectations of the French toward health professionals are more often within the "emotional" arena than those of the Chileans which generally concern the "medical/technical" field. The practice of self-administered care is qualitatively similar but the French prefer taking medication whereas the Chileans prefer the "little home remedies". The use of natural medicine is more widespread among young Chileans, but the types of medicine used are similar, namely herbal teas and other plant-based remedies and homeopathy. These results have a variety of implications, especially in terms of the need for training health

  15. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study (United States)

    Bello, Aminu K; Molzahn, Anita E; Girard, Louis P; Osman, Mohamed A; Okpechi, Ikechi G; Glassford, Jodi; Thompson, Stephanie; Keely, Erin; Liddy, Clare; Manns, Braden; Jinda, Kailash; Klarenbach, Scott; Hemmelgarn, Brenda; Tonelli, Marcello


    Objectives We assessed stakeholder perceptions on the use of an electronic consultation system (e-Consult) to improve the delivery of kidney care in Alberta. We aim to identify acceptability, barriers and facilitators to the use of an e-Consult system for ambulatory kidney care delivery. Methods This was a qualitative focus group study using a thematic analysis design. Eight focus groups were held in four locations in the province of Alberta, Canada. In total, there were 72 participants in two broad stakeholder categories: patients (including patients' relatives) and providers (including primary care physicians, nephrologists, other care providers and policymakers). Findings The e-Consult system was generally acceptable across all stakeholder groups. The key barriers identified were length of time required for referring physicians to complete the e-Consult due to lack of integration with current electronic medical records, and concerns that increased numbers of requests might overwhelm nephrologists and lead to a delayed response or an unsustainable system. The key facilitators identified were potential improvement of care coordination, dissemination of best practice through an educational platform, comprehensive data to make decisions without the need for face-to-face consultation, timely feedback to primary care providers, timeliness/reduced delays for patients' rapid triage and identification of cases needing urgent care and improved access to information to facilitate decision-making in patient care. Conclusions Stakeholder perceptions regarding the e-Consult system were favourable, and the key barriers and facilitators identified will be considered in design and implementation of an acceptable and sustainable electronic consultation system for kidney care delivery. PMID:28255097

  16. The influence of distance and level of care on delivery place in rural Zambia: a study of linked national data in a geographic information system.

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    Sabine Gabrysch

    Full Text Available BACKGROUND: Maternal and perinatal mortality could be reduced if all women delivered in settings where skilled attendants could provide emergency obstetric care (EmOC if complications arise. Research on determinants of skilled attendance at delivery has focussed on household and individual factors, neglecting the influence of the health service environment, in part due to a lack of suitable data. The aim of this study was to quantify the effects of distance to care and level of care on women's use of health facilities for delivery in rural Zambia, and to compare their population impact to that of other important determinants. METHODS AND FINDINGS: Using a geographic information system (GIS, we linked national household data from the Zambian Demographic and Health Survey 2007 with national facility data from the Zambian Health Facility Census 2005 and calculated straight-line distances. Health facilities were classified by whether they provided comprehensive EmOC (CEmOC, basic EmOC (BEmOC, or limited or substandard services. Multivariable multilevel logistic regression analyses were performed to investigate the influence of distance to care and level of care on place of delivery (facility or home for 3,682 rural births, controlling for a wide range of confounders. Only a third of rural Zambian births occurred at a health facility, and half of all births were to mothers living more than 25 km from a facility of BEmOC standard or better. As distance to the closest health facility doubled, the odds of facility delivery decreased by 29% (95% CI, 14%-40%. Independently, each step increase in level of care led to 26% higher odds of facility delivery (95% CI, 7%-48%. The population impact of poor geographic access to EmOC was at least of similar magnitude as that of low maternal education, household poverty, or lack of female autonomy. CONCLUSIONS: Lack of geographic access to emergency obstetric care is a key factor explaining why most rural deliveries

  17. Lumbosacral pain: Delivery of care to patients in the United Kingdom Podchufarova E.

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    E.V. Podchufarova


    Full Text Available Musculoskeletal pain syndromes are one of the most common causes of disability and referral to a medical specialist. Seven million consultations for lumbosacral pain are annually carried out in the United Kingdom.Examination of patients with back pain. Three levels of health care delivered to patients with back pain in the United Kingdom may be arbitrarily identified. Level 1 is outpatient: a general practitioner jointly with a manipulative therapist, a physiotherapist, a rehabilitation specialist, and mid-level health workers render care to patients with insignificant and mild pain syndrome; Level 2 is also outpatient, which involves the participation of a hospital or multidisciplinary team consultant, for example, in a musculoskeletal pain service or a specialized pain center; Level 3 is to deliver care at neurosurgical or orthopedic hospital, by applying invasive interventions. Acute back pain is a benign condition in the vast majority of cases; there is no need for additional instrumental and laboratory studies; but spinal X-ray study, computed tomography (СT scan, or magnetic resonance imaging (MRI, general blood and urine tests are required when marked neurological and somatic disorders are present.Management of patients with acute lumbosacral pain is to inform a patient about the benign nature of the disease; to exclude bed rest; to explain the need to maintain normal activity; to train how to correctly lift weights and to maintain normal posture; to refer for manual and exercise therapy in order to return to normal motor activity; to use proven effective medication. In most cases, acute back pain goes away spontaneously for a short period of time; an active treatment approach is considered to be optimal. Nonsteroidal anti-inflammatory drugs (NSAIDs and acetaminophen are used for analgesia if required. Patients who show no improvement after 4 weeks of treatment need rescreening for markers of potentially dangerous spinal diseases, as

  18. Service quality assessment of workers compensation health care delivery programs in New York using SERVQUAL. (United States)

    Arunasalam, Mark; Paulson, Albert; Wallace, William


    Preferred provider organizations (PPOs) provide healthcare services to an expanding proportion of the U.S. population. This paper presents a programmatic assessment of service quality in the workers' compensation environment using two different models: the PPO program model and the fee-for-service (FFS) payor model. The methodology used here will augment currently available research in workers' compensation, which has been lacking in measuring service quality determinants and assessing programmatic success/failure of managed care type programs. Results indicated that the SERVQUAL tool provided a reliable and valid clinical quality assessment tool that ascertained that PPO marketers should focus on promoting physician outreach (to show empathy) and accessibility (to show reliability) for injured workers.

  19. Utilization of delivery care among rural women in china: does the health insurance make a difference? a cross-sectional study

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    Wang Duolao


    Full Text Available Abstract Background Since 2003, the New Cooperative Medical Scheme (NCMS has been implemented throughout rural China, usually covering delivery services in its benefit package. The objective of this study was to compare the difference of utilization of delivery services, expenditures, and local women's perceived affordability between women with and without reimbursement from NCMS. Methods A cross-sectional survey was carried out in two rural counties in Shaanxi province, China, during December 2008-March 2009. Women giving birth from April 2008 to March 2009 were interviewed by a structured questionnaire to collect information on utilization of delivery services. Multivariable analyses were used to compare the differences in outcomes between women with and without reimbursement from NCMS. Results Of the total 1613 women interviewed, 747(46.3% got reimbursement to cover their expenditure on delivery care (NCMS group and 866(53.7% paid delivery services entirely out of their own pocket (Non-NCMS group. Compared with the Non-NCMS group, the NCMS group had significantly more women who delivered at hospital. The rate of Caesarean section (CS, proportion of women seeking higher level services, and length of hospitalization were similar between the two groups. The total hospital costs for delivery services in the NCMS group was significantly smaller and after being reimbursed, the out-of-pocket payment in the NCMS group was less than a half of that in the Non-NCMS group. Fewer women in the NCMS group than in the Non-NCMS group considered their payment for delivery services expensive. Conclusions There was no evidence of overuse delivery services among the women reimbursed by NCMS. Total hospital costs and women's costs for delivery services were found lower in the NCMS group, subsequently alleviation on women's perceived financial affordability.

  20. Knowledge attitude and practices for antenatal care and delivery of the mothers of tea garden in Jalpaiguri and Darjeeling districts, West Bengal

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    Prabir Kumar Manna, Debasis De and Debidas Ghosh


    Full Text Available The present study aimed to access the influence of socioeconomic factors on antenatal care and delivery practices of the mother of North Bengal. A community based study was carried out among 1772 families of the 7 blocks of the two districts. Various socio economic factors were considered for the antenatal care and delivery practices. We also tried to find out the relationship between antenatal check up with perinatal mortality. The study shows that the muslim mothers, Scheduled tribe mothers, non -educated and mothers with higher age group are less interested about ANC. Family income 2000/- month showing 62.42% ANC coverage. We found that only 7.11% mother used Govt. hospital and 2.65% used private clinic. The mother with medical problems and obstetric problems has high ANC coverage. So, socioeconomic factors significantly influence the antenatal coverage and delivery practices. Hence initiative may be taken at Government and non government levels to raise knowledge, attitude and practices for the improvement of antenatal care and delivery practices of the mother at these zones.

  1. Anesthesia and critical-care delivery in weightlessness: A challenge for research in parabolic flight analogue space surgery studies (United States)

    Ball, Chad G.; Keaney, Marilyn A.; Chun, Rosaleen; Groleau, Michelle; Tyssen, Michelle; Keyte, Jennifer; Broderick, Timothy J.; Kirkpatrick, Andrew W.


    BackgroundMultiple nations are actively pursuing manned exploration of space beyond low-earth orbit. The responsibility to improve surgical care for spaceflight is substantial. Although the use of parabolic flight as a terrestrial analogue to study surgery in weightlessness (0 g) is well described, minimal data is available to guide the appropriate delivery of anesthesia. After studying anesthetized pigs in a 0 g parabolic flight environment, our group developed a comprehensive protocol describing prolonged anesthesia in a parabolic flight analogue space surgery study (PFASSS). Novel challenges included a physically remote vivarium, prolonged (>10 h) anesthetic requirements, and the provision of veterinary operating room/intensive care unit (ICU) equivalency on-board an aircraft with physical dimensions of ethical approval, multiple ground laboratory sessions were conducted with combinations of anesthetic, pre-medication, and induction protocols on Yorkshire-cross specific pathogen-free (SPF) pigs. Several constant rate infusion (CRI) intravenous anesthetic combinations were tested. In each regimen, opioids were administered to ensure analgesia. Ventilation was supported mechanically with blended gradients of oxygen. The best performing terrestrial 1 g regime was flight tested in parabolic flight for its effectiveness in sustaining optimal and prolonged anesthesia, analgesia, and maintaining hemodynamic stability. Each flight day, a fully anesthetized, ventilated, and surgically instrumented pig was transported to the Flight Research Laboratory (FRL) in a temperature-controlled animal ambulance. A modular on-board surgical/ICU suite with appropriate anesthesia/ICU and surgical support capabilities was employed. ResultsThe mean duration of anesthesia (per flight day) was 10.28 h over four consecutive days. A barbiturate and ketamine-based CRI anesthetic regimen supplemented with narcotic analgesia by bolus administration offered the greatest prolonged hemodynamic

  2. Optimal delivery of follow-up care after surgery for Crohn’s disease: current perspectives

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    Campbell JP


    Full Text Available James P Campbell, Byron P Vaughn Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA Abstract: Despite improvements in medical therapies for Crohn’s disease (CD, up to 70% of patients require surgery within 10 years of diagnosis. Surgery is not curative, and almost all patients will experience endoscopic recurrence, and many will go on to clinical recurrence. Identifying patients at high-risk of endoscopic recurrence and standardizing postoperative assessments are essential in preventing clinical recurrence of CD. In this review, we discuss the assessment, monitoring, and treatment of postoperative CD patients. We address the various individual risk factors as well as composite risk factors. Medications used for primary CD treatment can be used in the postoperative setting to prevent endoscopic or clinical recurrence with varying efficacy, although the cost-effectiveness of these approaches are not fully understood. Future directions for postoperative CD management include evaluation of newer biologic agents such as anti-integrin therapy and fecal microbiota transplant for prevention of recurrence. Development of a standard preoperative risk assessment tool to clearly stratify those at high-risk of recurrence is necessary to guide empiric therapy. Lastly, the incorporation of noninvasive testing into disease monitoring will likely lead to early detection of endoscopic recurrence that will allow for tailored treatment to prevent clinical recurrence. Keywords: Crohn’s disease, postoperative care, postoperative recurrence

  3. Factors impacting the use of antenatal care and hospital child delivery services: a case study of rural residents in the Enshi Autonomous Prefecture, Hubei Province, China. (United States)

    Zhang, Yin; Chen, Minxing; Lu, Jun; Hao, Mo; Zhang, Changli; Sun, Mei; Li, Xiaohong; Chang, Fengshui


    This study was undertaken to understand the factors that impact whether rural women obtain antenatal care (ANC) and choose to use hospital delivery services in central and western China. We chose to conduct field research with the rural residents in Hubei Province through a combination of random sampling and purposive sampling methods. A mixed method approach was taken to analyze the factors impacting the use of ANC and hospital delivery services from the perspective of the villagers. Our results indicate that the quality of the available ANC services is poor. In particular, women who have special circumstances and unplanned pregnancies or who become pregnant prior to marriage are confronted with inadequate ANC and hospital child delivery services. The factors that impact whether women use or not use ANC and hospital delivery services and that cause women to choose hospital or home delivery can be understood at three levels: macro, middle, and micro. We strongly suggest that the policies and projects that promote maternal healthcare in rural areas be sustained with an added focus on including women with special circumstances. Village doctors can be enlisted to regularly visit pregnant women at home and to provide extra explanation about the ANC services available and the purpose of maternal healthcare. These findings and suggestions can be used by local health providers and decision-makers to improve the quality of ANC and hospital delivery services.

  4. Cost evaluation of reproductive and primary health care mobile service delivery for women in two rural districts in South Africa.

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    Kathryn Schnippel

    Full Text Available Cervical cancer screening is a critical health service that is often unavailable to women in under-resourced settings. In order to expand access to this and other reproductive and primary health care services, a South African non-governmental organization established a van-based mobile clinic in two rural districts in South Africa. To inform policy and budgeting, we conducted a cost evaluation of this service delivery model.The evaluation was retrospective (October 2012-September 2013 for one district and April-September 2013 for the second district and conducted from a provider cost perspective. Services evaluated included cervical cancer screening, HIV counselling and testing, syndromic management of sexually transmitted infections (STIs, breast exams, provision of condoms, contraceptives, and general health education. Fixed costs, including vehicle purchase and conversion, equipment, operating costs and mobile clinic staffing, were collected from program records and public sector pricing information. The number of women accessing different services was multiplied by ingredients-based variable costs, reflecting the consumables required. All costs are reported in 2013 USD.Fixed costs accounted for most of the total annual costs of the mobile clinics (85% and 94% for the two districts; the largest contributor to annual fixed costs was staff salaries. Average costs per patient were driven by the total number of patients seen, at $46.09 and $76.03 for the two districts. Variable costs for Pap smears were higher than for other services provided, and some services, such as breast exams and STI and tuberculosis symptoms screening, had no marginal cost.Staffing costs are the largest component of providing mobile health services to rural communities. Yet, in remote areas where patient volumes do not exceed nursing staff capacity, incorporating multiple services within a cervical cancer screening program is an approach to potentially expand access to

  5. Role of AYUSH workforce, therapeutics, and principles in health care delivery with special reference to National Rural Health Mission. (United States)

    Samal, Janmejaya


    Decades back AYUSH systems of medicine were limited to their own field with few exceptions in some states as health in India is a state issue. This took a reverse turn after the initiation of National Rural Health Mission (NRHM) in 2005 which brought the concept of "Mainstreaming of AYUSH and Revitalization of Local Health Traditions" utilizing the untapped AYUSH workforces, therapeutics and principles for the management of community health problems. As on 31/03/2012 AYUSH facilities were co-located in 468 District Hospitals, 2483 Community Health Centers and 8520 Primary Health Centers in the country. Several therapeutics are currently in use and few drugs have been included in the ASHA drug kit to treat common ailments in the community. At the same time Government of India has recognized few principles and therapeutics of Ayurveda as modalities of intervention to some of the community health problems. These include Ksharasutra (medicine coated thread) therapy for ano-rectal surgeries and Rasayana Chikitsa (rejuvenative therapy) for senile degenerative disorders etc. Similarly respective principles and therapeutics can also be utilized from other systems of AYUSH such as Yoga and Naturopathy, Unani, Siddha and Homoeopathy. Akin to Ayurveda these principles and therapeutics can also help in managing community health problems if appropriately implemented. This paper is a review on the role of AYUSH, as a system, in the delivery of health care in India with special reference to National Rural Health Mission.

  6. Rural health care delivery amidst federal retrenchment: lessons from the Robert Wood Johnson Foundation's Rural Practice Project. (United States)

    Moscovice, I S; Rosenblatt, R A


    This paper examines the experience of the Robert Wood Johnson Foundation's Rural Practice Project (RPP), a major non-governmental effort in the last decade concentrating on the direct delivery of rural health services. The nine RPP sites started prior to 1977 showed a slow but steady increase in their utilization levels and improvement in their financial status during their initial operational years. The tempo of their development was remarkably similar to that of federally sponsored practices in underserved rural areas. After four years of operation, all of the practices had completed their period of grant support; the practices survived in all cases, with almost all of the practices still retaining community sponsorship, salaried physicians, and a commitment to comprehensive care. Practices in sparsely populated rural areas and in areas with fewer hospital beds grew more slowly than those set in rural areas with higher population density and more ancillary resources. We conclude that the use of time-limited initial subsidies is an effective strategy in starting new rural practices in underserved areas and that those practices have a good chance of surviving their start-up phase.

  7. Secondary analysis of data can inform care delivery for Indigenous women in an acute mental health inpatient unit. (United States)

    Bradley, Pat; Cunningham, Teresa; Lowell, Anne; Nagel, Tricia; Dunn, Sandra


    There is a paucity of research exploring Indigenous women's experiences in acute mental health inpatient services in Australia. Even less is known of Indigenous women's experience of seclusion events, as published data are rarely disaggregated by both indigeneity and gender. This research used secondary analysis of pre-existing datasets to identify any quantifiable difference in recorded experience between Indigenous and non-Indigenous women, and between Indigenous women and Indigenous men in an acute mental health inpatient unit. Standard separation data of age, length of stay, legal status, and discharge diagnosis were analysed, as were seclusion register data of age, seclusion grounds, and number of seclusion events. Descriptive statistics were used to summarize the data, and where warranted, inferential statistical methods used SPSS software to apply analysis of variance/multivariate analysis of variance testing. The results showed evidence that secondary analysis of existing datasets can provide a rich source of information to describe the experience of target groups, and to guide service planning and delivery of individualized, culturally-secure mental health care at a local level. The results are discussed, service and policy development implications are explored, and suggestions for further research are offered.

  8. A Study to Ascertain the Feasibility of Joint Efforts to Establish a Comprehensive Health Care Delivery System Utilizing Hill-Burton Constructed Hospital, (United States)


    Closing Hospitals - Maybe Even Yours", Medical Economics (3 February 1975): 150. 3. "Senator Long Calls For Government Subsidy to Close Down, Convert...HN1 would enjoy limited • and known on- call responsibilities and vacations with adequate patient 61 coverage. In addition, other fringe benefits...Financial Manaerent (November 1975): 10-12. Holahan , John. "Foundations for Medical Care: An &Tperical Investigation of the Delivery of Health Services

  9. Setting standards at the forefront of delivery system reform: aligning care coordination quality measures for multiple chronic conditions. (United States)

    DuGoff, Eva H; Dy, Sydney; Giovannetti, Erin R; Leff, Bruce; Boyd, Cynthia M


    The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-Based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for healthcare providers and policy makers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs.

  10. Policy recommendations on accelerating coordinated care delivery%加快实施分级诊疗工作的政策建议

    Institute of Scientific and Technical Information of China (English)

    赵琨; 肖月


    我国分级诊疗工作面临诸多挑战,如何加快分级诊疗工作,实现资源、服务和患者下沉,解决困扰居民的看病难和看病贵问题,是卫生决策者面临的重大决策问题。本研究分析了我国分级诊疗工作的难点,并基于分析对分级诊疗体系的建设提出了近期和中远期政策建议,包括构建更加科学合理的医疗服务体系,分步实施分级诊疗,建立相关的激励和约束机制,加强社会宣传和医患教育等。%Coordinated care delivery is faced with various challenges to carry out in China,which are major decisions to make for decision makers,including how to push forward,how to deliver resources, services and patients to primary institutions,and how to ease the difficulties and affordability of seeing doctors.Based on analysis of roadblocks in coordinated care delivery in China,the authors provided near-term and long-term policy recommendations on the system,including how to build a scientific and reasonable healthcare delivery system,coordinated care delivery by stages,building incentives and constraint mechanisms,and enhancing public awareness and patient-doctor education.

  11. Selecting a dynamic simulation modeling method for health care delivery research-part 2: report of the ISPOR Dynamic Simulation Modeling Emerging Good Practices Task Force. (United States)

    Marshall, Deborah A; Burgos-Liz, Lina; IJzerman, Maarten J; Crown, William; Padula, William V; Wong, Peter K; Pasupathy, Kalyan S; Higashi, Mitchell K; Osgood, Nathaniel D


    In a previous report, the ISPOR Task Force on Dynamic Simulation Modeling Applications in Health Care Delivery Research Emerging Good Practices introduced the fundamentals of dynamic simulation modeling and identified the types of health care delivery problems for which dynamic simulation modeling can be used more effectively than other modeling methods. The hierarchical relationship between the health care delivery system, providers, patients, and other stakeholders exhibits a level of complexity that ought to be captured using dynamic simulation modeling methods. As a tool to help researchers decide whether dynamic simulation modeling is an appropriate method for modeling the effects of an intervention on a health care system, we presented the System, Interactions, Multilevel, Understanding, Loops, Agents, Time, Emergence (SIMULATE) checklist consisting of eight elements. This report builds on the previous work, systematically comparing each of the three most commonly used dynamic simulation modeling methods-system dynamics, discrete-event simulation, and agent-based modeling. We review criteria for selecting the most suitable method depending on 1) the purpose-type of problem and research questions being investigated, 2) the object-scope of the model, and 3) the method to model the object to achieve the purpose. Finally, we provide guidance for emerging good practices for dynamic simulation modeling in the health sector, covering all aspects, from the engagement of decision makers in the model design through model maintenance and upkeep. We conclude by providing some recommendations about the application of these methods to add value to informed decision making, with an emphasis on stakeholder engagement, starting with the problem definition. Finally, we identify areas in which further methodological development will likely occur given the growing "volume, velocity and variety" and availability of "big data" to provide empirical evidence and techniques

  12. Physicians’ attitudes towards office-based delivery of methadone maintenance therapy: results from a cross-sectional survey of Nova Scotia primary-care physicians

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    Dooley Jessica


    Full Text Available Abstract Background Approximately 90,000 Canadians use opioids each year, many of whom experience health and social problems that affect the individual user, families, communities and the health care system. For those who wish to reduce or stop their opioid use, methadone maintenance therapy (MMT is effective and supporting evidence is well-documented. However, access and availability to MMT is often inconsistent, with greater inequity outside of urban settings. Involving community based primary-care physicians in the delivery of MMT could serve to expand capacity and accessibility of MMT programs. Little is known, however, about the extent to which MMT, particularly office-based delivery, is acceptable to physicians. The aim of this study is to survey physicians about their attitudes towards MMT, particularly office-based delivery, and the perceived barriers and facilitators to MMT delivery. Methods In May 2008, facilitated by the College of Physicians and Surgeons of Nova Scotia, a cross-sectional, e-mail survey of 950 primary-care physicians practicing in Nova Scotia, Canada was administered via the OPINIO on-line survey software, to assess the acceptability of office-based MMT. Logistic regressions, adjusted for physician sociodemographic characteristics, were used to examine the association between physicians’ willingness to participate in office-based MMT, and a series of measures capturing physician attitudes and knowledge about treatment approaches, opioid use, and methadone, as well as perceived barriers to MMT. Results Overall, 19.8% of primary-care physicians responded to the survey, with 56% who indicated that they would be willing to be involved in MMT under current or similar circumstances; however, willingness was associated with numerous attitudinal and systemic factors. The barriers to involvement in MMT that were frequently cited included a lack of training or experience in MMT, lack of support services, and potential

  13. Making strides in women's mental health care delivery in rural Ethiopia: demographics of a female outpatient psychiatric cohort at Jimma University Specialized Hospital (2006-2008). (United States)

    Chemali, Zeina N; Borba, Christina Pc; Henderson, Tanya E; Tesfaye, Markos


    This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health care for women requires concerted efforts by multiple stake holders. Using our results, we advance concrete and practical suggestions for improving women's mental health in rural Ethiopia. We point out that the health care system needs to be responsive, allowing for change starting with gender rights, so that rural women have access to basic mental health services.

  14. Book review of Introduction to U.S. Health Policy: The Organization, Financing and Delivery of Health Care in America by Donald A. Barr

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    Chapman Audrey R


    Full Text Available Abstract Donald A. Barr's Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America (second edition, 2007 offers a lucid and informative overview of the U.S. health system and the dilemmas policy makers currently face. Barr has provided a balanced introduction to the way health care is organized, financed, and delivered in the United States. The thirteen chapters of the book are quite comprehensive in the topics they cover. Even those knowledgeable about the U.S. health care system are likely to find much to stimulate their thinking in the text. The book can also appropriately serve as a basic text for a health policy course or in the medical or nursing school curriculum.

  15. A community-based delivery system of intermittent preventive treatment of malaria in pregnancy and its effect on use of essential maternity care at health units in Uganda

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    Mbonye, Anthony K; Bygbjerg, I C; Magnussen, Pascal


    Community delivery of intermittent preventive treatment of malaria in pregnancy (IPTp) is one potential option that could mitigate malaria in pregnancy. However, there is concern that this approach may lead to complacency among women with low access to essential care at health units. A non...... approaches. Data on care-seeking practices before and after the intervention were collected. The majority of women with the new approaches accessed IPTp in the second trimester and adhered to two doses of sulfadoxine/pyrimethamine (SP) (1404/2081; 67.5%). Antenatal care (four recommended visits) increased...... from 3.4% (27/805) to 56.8% (558/983) (Pcare for malaria at health units increased from 16.7% (128/767) to 36.0% (146/405) (P

  16. A qualitative evaluation of the choice of traditional birth attendants for maternity care in 2008 Sierra Leone: implications for universal skilled attendance at delivery. (United States)

    Oyerinde, Koyejo; Harding, Yvonne; Amara, Philip; Garbrah-Aidoo, Nana; Kanu, Rugiatu; Oulare, Macoura; Shoo, Rumishael; Daoh, Kizito


    Maternal and newborn death is common in Sierra Leone; significant reductions in both maternal and newborn mortality require universal access to a skilled attendant during labor and delivery. When too few women use health facilities MDGs 4 and 5 targets will not be met. Our objectives were to identify why women use services provided by TBAs as compared to health facilities; and to suggest strategies to improve utilization of health facilities for maternity and newborn care services. Qualitative data from focus group discussions in communities adjacent to health facilities collected during the 2008 Emergency Obstetric and Newborn Care Needs Assessment were analyzed for themes relating to decision-making on the utilization of TBAs or health facilities. The prohibitive cost of services, and the geographic inaccessibility of health facilities discouraged women from using them while trust in the vast experience of TBAs as well as their compassionate care drew patients to them. Poor facility infrastructure, often absent staff, and the perception that facilities were poorly stocked and could not provide continuum of care services were barriers to facility utilization for maternity and newborn care. Improvements in infrastructure and the 24-hour provision of free, quality, comprehensive, and respectful care will minimize TBA preference in Sierra Leone.

  17. A Tale of Two Sites: Lessons on Leadership from the Implementation of a Long-term Care Delivery Model (CDM in Western Canada

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    Denise Cloutier


    Full Text Available Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators, and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists, working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change.

  18. A Tale of Two Sites: Lessons on Leadership from the Implementation of a Long-term Care Delivery Model (CDM) in Western Canada. (United States)

    Cloutier, Denise; Cox, Amy; Kampen, Ruth; Kobayashi, Karen; Cook, Heather; Taylor, Deanne; Gaspard, Gina


    Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM) designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators), and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists), working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change.

  19. A Tale of Two Sites: Lessons on Leadership from the Implementation of a Long-term Care Delivery Model (CDM) in Western Canada (United States)

    Cloutier, Denise; Cox, Amy; Kampen, Ruth; Kobayashi, Karen; Cook, Heather; Taylor, Deanne; Gaspard, Gina


    Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM) designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators), and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists), working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change. PMID:27417591

  20. Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach. (United States)

    Amador, Sarah; Goodman, Claire; Mathie, Elspeth; Nicholson, Caroline


    In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice. This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses) and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved. We uncovered evidence of both (i) identity mobilisation and (ii) context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i) the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii) development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process. Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care, by valuing their

  1. Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach (United States)

    Amador, Sarah; Mathie, Elspeth; Nicholson, Caroline


    In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice. This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses) and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved. We uncovered evidence of both (i) identity mobilisation and (ii) context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i) the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii) development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process. Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care, by valuing their

  2. Application Effect Analysis of Humane Care Nursing in Delivery%人文关怀护理在分娩中的应用效果分析

    Institute of Scientific and Technical Information of China (English)



    目的 人文关怀护理应用于分娩中的效果进行分析与总结.方法选取我院2012年11月~2014年11月共收治的66例足月妊娠产妇,将其随机分为研究组和参照组.前者给予人文关怀护理,后者仅给予常规护理,对比两组的产程时间、出血量及分娩方式等情况.结果 研究组的产程时间及出血量均少于参照组,剖宫产率、会阴侧切率也低于参照组,两组比较有统计学意义(P<0.05).结论 在产妇分娩中给予人文关怀护理,可有效缩短产程时间,降低剖宫产率及会阴侧切率,顺产率高.%Objective Humanistic care nursing in the delivery of the Results were analyzed and summarized. Methods 66 cases of full-term pregnancy treated women were randomly divided into study group and the reference group in November 2012 - November 2014. The former give humane care nursing, which is only given routine care, compared two groups of labor time, blood loss, and mode of delivery and so on. Results Labor time and bleeding volume study group than the reference group, the rate of cesarean section, episiotomy rate was significantly lower than the reference group, the two groups was statistically significant (P < 0.05). Conclusion Given the humane care in maternity care, which can effectively shorten labor time, reduce the cesarean section rate and episiotomy rate, birth rate.

  3. Protocol for the immediate delivery versus expectant care of women with preterm prelabour rupture of the membranes close to term (PPROMT Trial [ISRCTN44485060

    Directory of Open Access Journals (Sweden)

    Buchanan Sarah L


    Full Text Available Abstract Background Preterm prelabour rupture of membranes (PPROM complicates up to 2% of all pregnancies and is the cause of 40% of all preterm births. The optimal management of women with PPROM prior to 37 weeks, is not known. Furthermore, diversity in current clinical practice suggests uncertainty about the appropriate clinical management. There are two options for managing PPROM, expectant management (a wait and see approach or early planned birth. Infection is the main risk for women in which management is expectant. This risk need to be balanced against the risk of iatrogenic prematurity if early delivery is planned. The different treatment options may also have different health care costs. Expectant management results in prolonged antenatal hospitalisation while planned early delivery may necessitate intensive care of the neonate for problems associated with prematurity. Methods/Design We aim to evaluate the effectiveness of early planned birth compared with expectant management for women with PPROM between 34 weeks and 366 weeks gestation, in a randomised controlled trial. A secondary aim is a cost analysis to establish the economic impact of the two treatment options and establish the treatment preferences of women with PPROM close to term. The early planned birth group will be delivered within 24 hours according to local management protocols. In the expectant management group birth will occur after spontaneous labour, at term or when the attending clinician feels that birth is indicated according to usual care. Approximately 1812 women with PPROM at 34–366 weeks gestation will be recruited for the trial. The primary outcome of the study is neonatal sepsis. Secondary infant outcomes include respiratory distress, perinatal mortality, neonatal intensive care unit admission, assisted ventilation and early infant development. Secondary maternal outcomes include chorioamnionitis, postpartum infection treated with antibiotics, antepartum

  4. 分级诊疗工作进展及问题浅析%Analysis of progress and problems in coordinated care delivery

    Institute of Scientific and Technical Information of China (English)

    周瑞; 肖月; 赵琨; 史黎炜


    介绍了我国各地分级诊疗的探索情况及核心机制措施,并分析了各地分级诊疗的初步成效,各地分级诊疗工作带动了区域医疗资源的优化配置、落实了基层首诊、逐步建立了急慢分治的诊疗格局,也从政策、公立医院、基层医疗机构等方面分析了各地分级诊疗探索存在的问题,并据此提出分级诊疗的成功实施需要具备的要素,提出需要加强综合性政策支持、强化多部门协同,利用公立医院改革契机,探索分级诊疗实现的可行路径。%Authors described the patterns,core measures and mechanisms of coordinated care delivery in the localities and analyzed initial outcomes of this practice.It is found that such practice has optimized distribution of regional healthcare resources,implemented first visit to primary institutions, and the care delivery to separate emergency from outpatient service.In addition,the paper analyzed problems found in localities in terms of policy,public hospitals and primary institutions,and proposed elements required for coordinated care delivery system to succeed,such as enhanced policy support, enhanced multi-departmental coordination,and public hospital reform to explore feasible approaches.

  5. Team Cognition As a Means to Improve Care Delivery in Critically Ill Patients With Cancer After Hematopoietic Cell Transplantation. (United States)

    McNeese, Nathan J; Khera, Nandita; Wordingham, Sara E; Arring, Noel; Nyquist, Sharon; Gentry, Amy; Tomlinson, Brian; Cooke, Nancy J; Sen, Ayan


    Hematopoietic cell transplantation (HCT) is an important and complex treatment modality for a variety of hematologic malignancies and some solid tumors. Although outcomes of patients who have undergone HCT and require care in intensive care units (ICUs) have improved over time, mortality rates remain high and there are significant associated costs. Lack of a team-based approach to care, especially during critical illness, is detrimental to patient autonomy and satisfaction, and to team morale, ultimately leading to poor quality of care. In this manuscript, we describe the case of a patient who had undergone HCT and was in the ICU setting, where inconsistent team interaction among the various stakeholders delivering care resulted in a lack of shared goals and poor outcomes. Team cognition is cognitive processing at the team level through interactions among team members and is reflected in dynamic communication and coordination behaviors. Although the patient received multidisciplinary care as needed in a medically complicated case, a lack of team cognition and, particularly, inconsistent communication among the dynamic teams caring for the patient, led to mixed messages being delivered with high-cost implications for the health-care system and the family. This article highlights concepts and recommendations that begin a necessary in-depth assessment of implications for clinical care and initiate a research agenda that examines the effects of team cognition on HCT teams, and, more generally, critical care of the patient with cancer.

  6. 拉玛泽减痛分娩法联合分娩球护理对分娩结局的影响研究%Effect of Ramaze Pain Relief Delivery Method Combined with Delivery Ball Care on the Outcome of Delivery

    Institute of Scientific and Technical Information of China (English)



    目的:探讨拉玛泽减痛分娩法联合分娩球护理对分娩结局的影响。方法:选择2014年8月至2015年6月在我院产检并分娩的90例产妇为研究对象,以随机数字表法分组,观察组45例,对照组45例,对照组产妇接受常规分娩护理,观察组实施拉玛泽减痛分娩法配合分娩球护理,观察2组产妇分娩结局。结果:观察组产妇产程时间与对照组相比明显较短(P<0.05);观察组产妇胎位异常、宫缩乏力、胎儿宫内窘迫等情况发生率为4.44%,与对照组(33.33%)比较差异有统计学意义(P<0.05)。结论:拉玛泽减痛分娩法配合分娩球护理可缩短产程时间,降低难产率,减轻产妇痛苦,对改善母婴预后具有重要意义,值得推广。%Objective:To investigate the effect of Ramaze pain relief delivery method combined with delivery ball care on the outcome of delivery. Methods:A total of 90 puerpera who got antenatal examination and delivered in our hospital from Aug 2014 to Jun 2015 were selected and divided into 2 groups by random number table method. And 45 cases in the control group received conventional delivery care, while 45 cases in the observation group received Ramaze pain relief delivery method combined with delivery ball care. Their outcomes of delivery were observed. Results:Delivery process in the observation group were significantly shorter than in the control group (P<0.05) . The occurrence rate of maternal fetal abnormalities, uterine atony, fetal intrauterine distress in the observation group was 4.44%, which was significantly less than 33.33% in the control group (P<0.05) . Conclusions:Ramaze pain relief delivery method combined with delivery ball care can shorten delivery process,reduce the rate of dystocia,and reduce maternal pain. It is important in improving the prognosis of mothers and their infants,and worthy of promotion.

  7. Delivery of integrated diabetes care using logistics and information technology--the Joint Asia Diabetes Evaluation (JADE) program. (United States)

    Chan, Juliana C N; Ozaki, Risa; Luk, Andrea; Kong, Alice P S; Ma, Ronald C W; Chow, Francis C C; Wong, Patrick; Wong, Rebecca; Chung, Harriet; Chiu, Cherry; Wolthers, Troels; Tong, Peter C Y; Ko, Gary T C; So, Wing-Yee; Lyubomirsky, Greg


    Diabetes is a global epidemic, and many affected individuals are undiagnosed, untreated, or uncontrolled. The silent and multi-system nature of diabetes and its complications, with complex care protocols, are often associated with omission of periodic assessments, clinical inertia, poor treatment compliance, and care fragmentation. These barriers at the system, patient, and care-provider levels have resulted in poor control of risk factors and under-usage of potentially life-saving medications such as statins and renin-angiotensin system inhibitors. However, in the clinical trial setting, use of nurses and protocol with frequent contact and regular monitoring have resulted in marked differences in event rates compared to epidemiological data collected in the real-world setting. The phenotypic heterogeneity and cognitive-psychological-behavioral needs of people with diabetes call for regular risk stratification to personalize care. Quality improvement initiatives targeted at patient education, task delegation, case management, and self-care promotion had the largest effect size in improving cardio-metabolic risk factors. The Joint Asia Diabetes Evaluation (JADE) program is an innovative care prototype that advocates a change in clinic setting and workflow, coordinated by a doctor-nurse team and augmented by a web-based portal, which incorporates care protocols and a validated risk engine to provide decision support and regular feedback. By using logistics and information technology, supported by a network of health-care professionals to provide integrated, holistic, and evidence-based care, the JADE Program aims to establish a high-quality regional diabetes database to reflect the status of diabetes care in real-world practice, confirm efficacy data, and identify unmet needs. Through collaborative efforts, we shall evaluate the feasibility, acceptability, and cost-effectiveness of this "high tech, soft touch" model to make diabetes and chronic disease care more

  8. Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis (United States)

    Aremu, Olatunde; Lawoko, Stephen; Dalal, Koustuv


    Background High maternal mortality continues to be a major public health problem in most part of the developing world, including Nigeria. Understanding the utilization pattern of maternal healthcare services has been accepted as an important factor for reducing maternal deaths. This study investigates the effect of neighborhood and individual socioeconomic position on the utilization of different forms of place of delivery among women of reproductive age in Nigeria. Methods A population-based multilevel discrete choice analysis was performed using the most recent population-based 2008 Nigerian Demographic and Health Surveys data of women aged between 15 and 49 years. The analysis was restricted to 15,162 ever-married women from 888 communities across the 36 states of the federation including the Federal Capital Territory of Abuja. Results The choice of place to deliver varies across the socioeconomic strata. The results of the multilevel discrete choice models indicate that with every other factor controlled for, the household wealth status, women’s occupation, women’s and partner’s high level of education attainment, and possession of health insurance were associated with use of private and government health facilities for child birth relative to home delivery. The results also show that higher birth order and young maternal age were associated with use of home delivery. Living in a highly socioeconomic disadvantaged neighborhood is associated with home birth compared with the patronage of government health facilities. More specifically, the result revealed that choice of facility-based delivery is clustered around the neighborhoods. Conclusion Home delivery, which cuts across all socioeconomic strata, is a common practice among women in Nigeria. Initiatives that would encourage the appropriate use of healthcare facilities at little or no cost to the most disadvantaged should be accorded the utmost priority. PMID:21792338

  9. 浅析分级诊疗体系建设国际经验%International approaches to coordinated care delivery systems

    Institute of Scientific and Technical Information of China (English)

    肖月; 赵琨; 史黎炜; 丁干


    阐述了不同国家对分级诊疗体系建设的情况及经验,介绍了不同卫生筹资体制国家所采用的诊疗体系,以及多数国家确定各级各类医疗卫生服务机构的职责和服务范围情况以及确保患者有序流动的措施情况,最后归纳各国分级诊疗做法的四点经验并提出对我国分级诊疗工作的启示。%This paper summarized practices and experiences of other countries in coordinated care delivery system building,and described the care delivery systems used in various healthcare fundraising patterns.It is found that most countries have defined duties and service coverage of healthcare institutions at all the levels and measures to ensure rational patient flow.In the end,the paper concluded found experiences of these countries and inspirations for China.

  10. Delivery Complications Associated With Prenatal Care Access for Medicaid-Insured Mothers in Rural and Urban Hospitals (United States)

    Laditka, Sarah B.; Laditka, James N.; Bennett, Kevin J.; Probst, Janice C.


    Pregnancy complications affect many women. It is likely that some complications can be avoided through routine primary and prenatal care of reasonable quality. The authors examined access to health care during pregnancy for mothers insured by Medicaid. The access indicator is potentially avoidable maternity complications (PAMCs). Potentially…

  11. Understanding the association between employee satisfaction and family perceptions of the quality of care in hospice service delivery. (United States)

    York, Grady S; Jones, Janet L; Churchman, Richard


    Families often draw their conclusions about the quality of care received by a family member during the last months of life from their interactions with professional caregivers. A more comprehensive understanding of how these relationships influence the care experience should include an investigation of the association between employee job satisfaction and family perception of the quality of care. This cross-sectional study investigated the association at a regional hospice. Using the Kendall's tau correlation, employee satisfaction scores for care teams trended toward a positive correlation with family overall satisfaction scores from the Family Evaluation of Hospice Care (tau=0.47, P=0.10). A trend for differences in employee satisfaction between the care teams to associate with differences in overall family perceptions of the quality of care also was found using the Kruskal-Wallis analysis of variance (chi(2)(K-W)=9.236, P=0.075). Post hoc tests indicated that overall family perceptions of quality of care differed between the hospice's Residence Team and Non-Hospice Facilities Team. Finally, positive associations between employee satisfaction and the families' Intent to recommend hospice (tau=0.55, P=0.059) and Inform and communicate about patient (tau=0.55, P=0.059) were noted. Selected employee and family comments provide complementarity to further clarify or explain the respondent data. These results suggest that employee satisfaction is associated with family perceptions of the quality of hospice care. Opportunities for improving both employee job satisfaction and family perceptions of the quality of care are discussed.

  12. RW-R01铁路运输通信数字式语音记录仪维护与故障处理

    Institute of Scientific and Technical Information of China (English)



    The digital voice recorder for railway transportation communications can record the whole working process of command and dispatch and offer the data for analyzing and handling train operation accidents. Taking the maintenance of RW-RO1 type recorder as example, the ideas and approaches of failure handling are summed up.%铁路运输通信语音记录设备,完整记录指挥调度工作过程,为行车事故的分析处理提供依据。以西安局太中银线RW-R01记录仪维护为例,总结故障处理思路和办法。

  13. The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis. (United States)

    Battaglia, Tracy A; Darnell, Julie S; Ko, Naomi; Snyder, Fred; Paskett, Electra D; Wells, Kristen J; Whitley, Elizabeth M; Griggs, Jennifer J; Karnad, Anand; Young, Heather; Warren-Mears, Victoria; Simon, Melissa A; Calhoun, Elizabeth


    Patient navigation is emerging as a standard in breast cancer care delivery, yet multi-site data on the impact of navigation at reducing delays along the continuum of care are lacking. The purpose of this study was to determine the effect of navigation on reaching diagnostic resolution at specific time points after an abnormal breast cancer screening test among a national sample. A prospective meta-analysis estimated the adjusted odds of achieving timely diagnostic resolution at 60, 180, and 365 days. Exploratory analyses were conducted on the pooled sample to identify which groups had the most benefit from navigation. Clinics from six medical centers serving vulnerable populations participated in the Patient Navigation Research Program. Women with an abnormal breast cancer screening test between 2007 and 2009 were included and received the patient navigation intervention or usual care. Patient navigators worked with patients and their care providers to address patient-specific barriers to care to prevent delays in diagnosis. A total of 4675 participants included predominantly racial/ethnic minorities (74 %) with public insurance (40 %) or no insurance (31 %). At 60 days and 180 days, there was no statistically significant effect of navigation on achieving timely diagnostic care, but a benefit of navigation was seen at 365 days (aOR 2.12, CI 1.36-3.29). We found an equal benefit of navigation across all groups, regardless of race/ethnicity, language, insurance status, and type of screening abnormality. Patient navigation resulted in more timely diagnostic resolution at 365 days among a diverse group of minority, low-income women with breast cancer screening abnormalities. Trial registrations Identifiers: NCT00613275, NCT00496678, NCT00375024, NCT01569672.

  14. Medicaid Program; The Use of New or Increased Pass-Through Payments in Medicaid Managed Care Delivery Systems. Final rule. (United States)


    This rule finalizes changes to the pass-through payment transition periods and the maximum amount of pass-through payments permitted annually during the transition periods under Medicaid managed care contract(s) and rate certification(s). This final rule prevents increases in pass-through payments and the addition of new pass-through payments beyond those in place when the pass-through payment transition periods were established, in the final Medicaid managed care regulations effective July 5, 2016.

  15. Prediction of preterm delivery

    NARCIS (Netherlands)

    Wilms, F.F.


    Preterm delivery is in quantity and in severity an important issue in the obstetric care in the Western world. There is considerable knowledge on maternal and obstetric risk factors of preterm delivery. Of the women presenting with preterm labor, the majority is pregnant with a male fetus and in Cau

  16. Cost analysis of magnetically controlled growing rods compared with traditional growing rods for early-onset scoliosis in the US: an integrated health care delivery system perspective (United States)

    Polly, David W; Ackerman, Stacey J; Schneider, Karen; Pawelek, Jeff B; Akbarnia, Behrooz A


    Purpose Traditional growing rod (TGR) for early-onset scoliosis (EOS) is effective but requires repeated invasive surgical lengthenings under general anesthesia. Magnetically controlled growing rod (MCGR) is lengthened noninvasively using a hand-held magnetic external remote controller in a physician office; however, the MCGR implant is expensive, and the cumulative cost savings have not been well studied. We compared direct medical costs of MCGR and TGR for EOS from the US integrated health care delivery system perspective. We hypothesized that over time, the MCGR implant cost will be offset by eliminating repeated TGR surgical lengthenings. Methods For both TGR and MCGR, the economic model estimated the cumulative costs for initial implantation, lengthenings, revisions due to device failure, surgical-site infections, device exchanges (at 3.8 years), and final fusion, over a 6-year episode of care. Model parameters were estimated from published literature, a multicenter EOS database of US institutions, and interviews. Costs were discounted at 3.0% annually and represent 2015 US dollars. Results Of 1,000 simulated patients over 6 years, MCGR was associated with an estimated 270 fewer deep surgical-site infections and 197 fewer revisions due to device failure compared with TGR. MCGR was projected to cost an additional $61 per patient over the 6-year episode of care compared with TGR. Sensitivity analyses indicated that the results were sensitive to changes in the percentage of MCGR dual rod use, months between TGR lengthenings, percentage of hospital inpatient (vs outpatient) TGR lengthenings, and MCGR implant cost. Conclusion Cost neutrality of MCGR to TGR was achieved over the 6-year episode of care by eliminating repeated TGR surgical lengthenings. To our knowledge, this is the first cost analysis comparing MCGR to TGR – from the US provider perspective – which demonstrates the efficient provision of care with MCGR. PMID:27695352

  17. Effect of community-based behavior change communication on delivery and newborn health care practices in a resettlement colony of Delhi

    Directory of Open Access Journals (Sweden)

    Mamta Parashar


    Full Text Available Background: Neonatal morbidity and mortality in India continue to be high. Among other reasons, newborn care practices are major contributors for such high rates. Objective: To assess the effect of behavior change communication (BCC package among pregnant women regarding neonatal care. Materials and Methods: Semistructured and pretested schedule was used to interview 200 multigravidas on various aspects of neonatal care. Based on the preliminary data, BCC package was designed and implemented in intervention block in the community. Follow-up was done to find out change in their behavior. Statistical Analysis: Data were analyzed using Epi info and Fischer exact test and chi - square test were applied in the baseline data. A P value of less than 0.05 was considered significant. Effect of the BCC package is given in terms of relative risk. Results: BCC package increased 1.76 times higher number of deliveries conducted by trained dais in intervention group. There was significant improvement in using sterile cord tie (P = 0.01, applied nothing to the cord (P < 0.0001 and giving bath to their baby within 6 h of birth (P = 0.02 in intervention group as compared to nonintervention group. Significant difference was found between the two groups with regard to breastfeeding practices of baby. Harmful practices were reduced in the intervention group. Significant improvement was found in intervention group as compared to nonintervention group with regard to knowledge of danger signals, physiological variants, management of breastfeeding-related problems, and awareness of skin-to-skin technique for the management of hypothermic baby. Conclusion: Inadequate knowledge and adverse practices regarding neonatal care among mothers in study areas were found. BCC package had favorable impact on behavior of mothers for neonatal care in intervention group.

  18. Effect of Community-based Behavior Change Communication on Delivery and Newborn Health Care Practices in a Resettlement Colony of Delhi (United States)

    Parashar, Mamta; Singh, SV; Kishore, Jugal; Kumar, Ajay; Bhardwaj, Milan


    Background: Neonatal morbidity and mortality in India continue to be high. Among other reasons, newborn care practices are major contributors for such high rates. Objective: To assess the effect of behavior change communication (BCC) package among pregnant women regarding neonatal care. Materials and Methods: Semistructured and pretested schedule was used to interview 200 multigravidas on various aspects of neonatal care. Based on the preliminary data, BCC package was designed and implemented in intervention block in the community. Follow-up was done to find out change in their behavior. Statistical Analysis: Data were analyzed using Epi info and Fischer exact test and chi-square test were applied in the baseline data. A P value of less than 0.05 was considered significant. Effect of the BCC package is given in terms of relative risk. Results: BCC package increased 1.76 times higher number of deliveries conducted by trained dais in intervention group. There was significant improvement in using sterile cord tie (P = 0.01), applied nothing to the cord (P < 0.0001) and giving bath to their baby within 6 h of birth (P = 0.02) in intervention group as compared to nonintervention group. Significant difference was found between the two groups with regard to breastfeeding practices of baby. Harmful practices were reduced in the intervention group. Significant improvement was found in intervention group as compared to nonintervention group with regard to knowledge of danger signals, physiological variants, management of breastfeeding-related problems, and awareness of skin-to-skin technique for the management of hypothermic baby. Conclusion: Inadequate knowledge and adverse practices regarding neonatal care among mothers in study areas were found. BCC package had favorable impact on behavior of mothers for neonatal care in intervention group. PMID:23559703

  19. Australian health professionals' social media (Web 2.0) adoption trends: early 21st century health care delivery and practice promotion. (United States)

    Usher, Wayne T


    This study was concerned with identifying reasons behind patterns of social media (Web 2.0) usage associated with eight of Australia's major health professions. Attention was given to uncovering some of the more significant motivations for the resistance or adoption of Web 2.0 technologies for health care delivery and practice promotion by Australian health professionals. Surveys were developed from a common set of questions with specific variations between professions negotiated with professional health societies. Survey questions were constructed in an attempt to identify Web 2.0 adoption trends. An online survey ( was used to collect data. Initial data preparation involved the development of one integrated SPSS file to incorporate all responses from the eight surveys undertaken. Initial data analysis applied Frequencies and Crosstabs to the identified groups and provided a profile of respondents by key business and demographic characteristics. Of the 935 respondents, 9.5% of participants indicated that they used Web 2.0 for their professional work, 19.1% of them did not use it for work but used it for their personal needs and 71.3% of them did not use Web 2.0 at all. Participants have indicated that the main reason for 'choosing not to adopt' Web 2.0 applications as a way of delivering health care to their patients is due to the health professionals' lack of understanding of Web 2.0 (83.3%), while the main reason for 'choosing to adopt' Web 2.0 applications is the perception of Web 2.0 as a quick and effective method of communication (73.0%). This study has indicated that Australian health professionals 'choose not to adopt' Web 2.0 usage as a way of delivering health care primarily due to 'a lack of understanding as to how social media would be used in health care' (83.3%). This study identifies that Australian health professionals are interacting with Web 2.0 technologies in their private lives but are failing to see how such technologies

  20. Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach

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    Sarah Amador


    Full Text Available In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice. This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved. We uncovered evidence of both (i identity mobilisation and (ii context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process. Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care

  1. Barriers in the Delivery of Emergency Obstetric and Neonatal Care in Post-Conflict Africa: Qualitative Case Studies of Burundi and Northern Uganda.

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    Primus Che Chi

    Full Text Available Maternal and neonatal mortality and morbidity rates are particularly grim in conflict, post-conflict and other crisis settings, a situation partly blamed on non-availability and/or poor quality of emergency obstetric and neonatal care (EmONC services. The aim of this study was to explore the barriers to effective delivery of EmONC services in post-conflict Burundi and Northern Uganda, in order to provide policy makers and other relevant stakeholders context-relevant data on improving the delivery of these lifesaving services.This was a qualitative comparative case study that used 42 face-to-face semi-structured in-depth interviews and 4 focus group discussions for data collection. Participants were 32 local health providers and 37 staff of NGOs working in the area of maternal health. Data was analysed using the framework approach.The availability, quality and distribution of EmONC services were major challenges across the sites. The barriers in the delivery of quality EmONC services were categorised into two major themes; human resources-related challenges, and systemic and institutional failures. While some of the barriers were similar, others were unique to specific sites. The common barriers included shortage of qualified staff; lack of essential installations, supplies and medications; increasing workload, burn-out and turnover; and poor data collection and monitoring systems. Barriers unique to Northern Uganda were demoralised personnel and lack of recognition; poor referral system; inefficient drug supply system; staff absenteeism in rural areas; and poor coordination among key personnel. In Burundi, weak curriculum; poor harmonisation and coordination of training; and inefficient allocation of resources were the unique challenges. To improve the situation across the sites, efforts are ongoing to improve the training and recruitment of more staff; harmonise and strengthen the curriculum and training; increase the number of EmONC facilities

  2. Telemedicine delivery of patient education in remote Ontario communities: feasibility of an Advanced Clinician Practitioner in Arthritis Care (ACPAC)-led inflammatory arthritis education program (United States)

    Warmington, Kelly; Flewelling, Carol; Kennedy, Carol A; Shupak, Rachel; Papachristos, Angelo; Jones, Caroline; Linton, Denise; Beaton, Dorcas E; Lineker, Sydney


    Objective Telemedicine-based approaches to health care service delivery improve access to care. It was recognized that adults with inflammatory arthritis (IA) living in remote areas had limited access to patient education and could benefit from the 1-day Prescription for Education (RxEd) program. The program was delivered by extended role practitioners with advanced training in arthritis care. Normally offered at one urban center, RxEd was adapted for videoconference delivery through two educator development workshops that addressed telemedicine and adult education best practices. This study explores the feasibility of and participant satisfaction with telemedicine delivery of the RxEd program in remote communities. Materials and methods Participants included adults with IA attending the RxEd program at one of six rural sites. They completed post-course program evaluations and follow-up interviews. Educators provided post-course feedback to identify program improvements that were later implemented. Results In total, 123 people (36 in-person and 87 remote, across 6 sites) participated, attending one of three RxEd sessions. Remote participants were satisfied with the quality of the video-conference (% agree/strongly agree): could hear the presenter (92.9%) and discussion between sites (82.4%); could see who was speaking at other remote sites (85.7%); could see the slides (95.3%); and interaction between sites adequately facilitated (94.0%). Educator and participant feedback were consistent. Suggested improvements included: use of two screens (speaker and slides); frontal camera angles; equal interaction with remote sites; and slide modifications to improve the readability on screen. Interview data included similar constructive feedback but highlighted the educational and social benefits of the program, which participants noted would have been inaccessible if not offered via telemedicine. Conclusion Study findings confirm the feasibility of delivering the RxEd program

  3. Making strides in women’s mental health care delivery in rural Ethiopia: demographics of a female outpatient psychiatric cohort at Jimma University Specialized Hospital (2006–2008

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    Chemali ZN


    Full Text Available Zeina N Chemali,1,2 Christina PC Borba,1,2 Tanya E Henderson,3 Markos Tesfaye41Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3International and Human Rights Law Consultants, Cambridge, MA, USA; 4Department of Psychiatry, College of Public Health and Medical Sciences, Jimma University, Jimma, EthiopiaAbstract: This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health care for women requires concerted efforts by multiple stake holders. Using our results, we advance concrete and practical suggestions for improving women's mental health in rural Ethiopia. We point out that the health care system needs to be responsive, allowing for change starting with gender rights, so that rural women have access to basic mental health services.Keywords: global mental health, low income country, Africa, gender differences

  4. The impact of policies promoting health information technology on health care delivery in jails and local communities. (United States)

    Butler, Ben; Murphy, Judy


    The 1976 Supreme Court decision in Estelle v. Gamble declared that jails must provide medical treatment to detainees consistent with community standards of care. Yet despite their important role providing health care to about ten million people a year, jails remain largely siloed from the surrounding health care community, compromising inmates' health and adding to health care spending. Health information technology promises solutions. The current policy landscape, shaped by the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Affordable Care Act, is favorable to jails' implementation of health information technology (IT). In this article we examine how decisions largely external to jails-coming from the Supreme Court, Congress, and local policy makers-have contributed to the growth of health IT within jails and health information exchange between jails and local communities. We also discuss privacy concerns under the Health Insurance Portability and Affordability Act and other legislation. This article highlights a rare confluence of events that could improve the health of an overlooked population.

  5. Premature delivery

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    Bernardita Donoso Bernales


    Full Text Available Preterm delivery is the single most important cause of perinatal morbidity and mortality. In Chile, preterm births have increased in the past decade, although neonatal morbidity and mortality attributable to it shows a downward trend, thanks to improvements in neonatal care of premature babies, rather than the success of obstetric preventive and therapeutic strategies. This article describes clinical entities, disease processes and conditions that constitute predisposing factors of preterm birth, as well as an outline for the prevention and clinical management of women at risk of preterm birth.


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    Full Text Available INTRODUCTION: Flood is the most common natural disaster in the world both in the developed and developing nations. This year one of the greatest floods, worst in over a decade hit the nation in Jammu and Kashmir on 7th September 2014, due to continuous downpour for about 4 days. Study design: Observational. RESULTS: SKIMS Medical College and Hospital, Bemina was inundated first followed by the oldest tertiary care SMHS hospital. Health care was affected at all the three levels viz. primary, secondary and tertiary the total losses to the health care was estimated to be 200 million. CONCLUSION: More than 1.5 million of the population was affected. People were rendered homeless. Unlike flash flood the present flood in Kashmir was a plain flood which occurs due to extensive rainfall lasting several days.

  7. Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study

    DEFF Research Database (Denmark)

    Prompers, L.; Huijberts, M.; Apelqvist, J.


    Aims To determine current management and to identify patient-related factors and barriers that influence management strategies in diabetic foot disease. Methods The Eurodiale Study is a prospective cohort study of 1232 consecutive individuals presenting with a new diabetic foot ulcer in 14 centres...... suggest that current guidelines are too general and that healthcare organizational barriers and personal beliefs result in underuse of recommended therapies. Action should be undertaken to overcome these barriers and to guarantee the delivery of optimal care for the many individuals with diabetic foot...... across Europe. We determined the use of management strategies: referral, use of offloading, vascular imaging and revascularization. Results Twenty-seven percent of the patients had been treated for > 3 months before referral to a foot clinic. This varied considerably between countries (6-55%). At study...

  8. Employer-Based Screening for Diabetes and Prediabetes in an Integrated Health Care Delivery System: A Natural Experiments for Translation in Diabetes (NEXT-D) Study (United States)

    Adams, Sara R.; Wiley, Deanne M.; Fargeix, Andromache; George, Victoria; Neugebauer, Romain S.; Schmittdiel, Julie A.


    OBJECTIVE To evaluate an employer-based diabetes/prediabetes screening intervention that invited at-risk employees via letters, secure emails, and automated voice messages to complete blood glucose testing at a health plan facility. METHODS Quasi-experimental cohort study among health plan members insured by two employers that received the intervention and three employers that were selected as control sites. RESULTS The proportion of at-risk members that completed a screening was higher in the intervention group than in the control group (36% vs. 13%, P < .001, adjusted for patient characteristics). Among those screened in the intervention group, the presence of obesity, hypertension, hyperlipidemia, and tobacco use were significant predictors of having a result which indicated diabetes or prediabetes (P < .05, all comparisons). CONCLUSIONS A low-intensity, employer-based intervention conducted in collaboration with a health care delivery system effectively increased screening for diabetes/prediabetes. PMID:26539761

  9. Effects of emergency department crowding on the delivery of timely care in an inner-city hospital in the Netherlands

    NARCIS (Netherlands)

    N. van der Linden (Naomi); M.C. van der Linden (M. Christien); J. Richards (John); R. Derlet (Robert); Grootendorst, D.C. (Diana C.); C.L. van den Brand (Crispijn)


    textabstractBackground The impact of delays in emergency department (ED) care has not been described in European countries where ED crowding is not universally recognized. The aim of this study was to determine the relationship of ED crowding with delays in triage and treatment, and 24-h mortality i

  10. Predicting Level of Mental Health Care among Children Served in a Delivery System in a Rural State. (United States)

    Anderson, Rachel L.; Estle, George


    A study of 150 children and adolescents with reactive attachment disorder found that inpatient admission was related to limited psychosocial strengths, previous hospitalization, and history of sexual abuse. Most children admitted to inpatient care were rural and had never received community-based services. Implications for public health education,…


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    Rejane Marie Barbosa Davim


    Full Text Available Trata da experiência vivenciada por uma enfermeira obstetra com um casal grávido de seu terceiro filho. Destaca os modelos assistenciais que valorizam a mulher e o casal no processo do nascimento e parto. Descreve a assistência prestada a um casal durante o processo da gestação e parto realizado no domicílio. Ressalta que a experiência possibilitou a participação ativa do casal e filhos no processo do nascimento e parto, propiciando, fundamentalmente, satisfação à família e ao profissional.Este estudio trata de la experiencia vivida por una enfermera obstétrica con una pareja esperando su tercero hijo. Destaca los modelos asistenciales que valorizan la mujer y la pareja en el proceso del nacimiento y parto. Describe la atención prestada a una pareja durante el proceso de la gestación y parto realizado en la casa. Resalta que la experiencia hizo posible la participación activa de la pareja y de los hijos en el proceso del nacimiento y parto, propiciando fundamentalmente, satisfacción a familia y al profesional.This study presents the experience of an obstetric nurse and of a couple who had their third child. It focuses on care standards that value women and couples in the childbirth and delivery process. It describes the care given to a couple during the pregnancy stage and during home delivery. The experience enabled the active participation of the couple and their children in the childbirth process, which essencialy provided satisfaction to the family and to the professional.

  12. High rates of adherence and treatment success in a public and public-private HIV clinic in India: potential benefits of standardized national care delivery systems

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    Heylen Elsa


    Full Text Available Abstract Background The massive scale-up of antiretroviral treatment (ART access worldwide has brought tremendous benefit to populations affected by HIV/AIDS. Optimising HIV care in countries with diverse medical systems is critical; however data on best practices for HIV healthcare delivery in resource-constrained settings are limited. This study aimed to understand patient characteristics and treatment outcomes from different HIV healthcare settings in Bangalore, India. Methods Participants from public, private and public-private HIV healthcare settings were recruited between 2007 and 2009 and were administered structured interviews by trained staff. Self-reported adherence was measured using the visual analogue scale to capture adherence over the past month, and a history of treatment interruptions (defined as having missed medications for more than 48 hours in the past three months. In addition, CD4 count and viral load (VL were measured; genotyping for drug resistance-associated mutations was performed on those who were in virological failure (VL > 1000 copies/ml. Results A total of 471 individuals were included in the analysis (263 from the public facility, 149 from the public-private facility and 59 from the private center. Private facility patients were more likely to be male, with higher education levels and incomes. More participants reported ≥ 95% adherence among public and public-private groups compared to private participants (public 97%; private 88%; public-private 93%, p Conclusions Adherence and treatment success was significantly higher among patients from public and public-private settings compared with patients from private facilities. These results suggest a possible benefit of the standardized care delivery system established in public and public-private health facilities where counselling by a multi-disciplinary team of workers is integral to provision of ART. Strengthening and increasing public-private partnerships can

  13. Meeting the home-care needs of disabled older persons living in the community: does integrated services delivery make a difference?

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    Raîche Michel


    Full Text Available Abstract Background The PRISMA Model is an innovative coordination-type integrated-service-delivery (ISD network designed to manage and better match resources to the complex and evolving needs of elders. The goal of this study was to examine the impact of this ISD network on unmet needs among disabled older persons living in the community. Methods Using data from the PRISMA study, we compared unmet needs of elders living in the community in areas with or without an ISD network. Disabilities and unmet needs were assessed with the Functional Autonomy Measurement System (SMAF. We used growth-curve analysis to examine changes in unmet needs over time and the variables associated with initial status and change. Sociodemographic characteristics, level of disability, self-perceived health status, cognitive functioning, level of empowerment, and the hours of care received were investigated as covariates. Lastly, we report the prevalence of needs and unmet needs for 29 activities in both areas at the end of the study. Results On average, participants were 83 years old; 62% were women. They had a moderate level of disability and mild cognitive problems. On average, they received 2.07 hours/day (SD = 1.08 of disability-related care, mostly provided by family. The findings from growth-curve analysis suggest that elders living in the area where ISD was implemented and those with higher levels of disability experience better fulfillment of their needs over time. Besides the area, being a woman, living alone, having a higher level of disability, more cognitive impairments, and a lower level of empowerment were linked to initial unmet needs (r2 = 0.25; p Conclusions In spite of more than 30 years of home-care services in the province of Quebec, disabled older adults living in the community still have unmet needs. ISD networks such as the PRISMA Model, however, appear to offer an effective response to the long-term-care needs of the elderly.

  14. Connecting research discovery with care delivery in dementia: the development of the Indianapolis Discovery Network for Dementia

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    Boustani MA


    Full Text Available Malaz A Boustani,1–3 Amie Frame,1,2 Stephanie Munger,1,2 Patrick Healey,4 Jessie Westlund,5 Martin Farlow,6,7 Ann Hake,8 Mary Guerriero Austrom,6,9 Polly Shepard,10 Corby Bubp,10 Jose Azar,3 Arif Nazir,3 Nadia Adams,11 Noll L Campbell,1,2,12,13 Azita Chehresa,5 Paul Dexter2,31Indiana University Center for Aging Research, 2Regenstrief Institute, Inc, 3Department of Medicine, Indiana University School of Medicine (IUSM, 4St Vincent Health Network, 5Community Health Network, 6Indiana Alzheimer Disease Center, IUSM, 7Department of Neurology, IUSM, 8Eli Lilly and Company, 9Department of Psychiatry, IUSM, 10The Memory Clinic of Indianapolis, 11Indiana University Health, Indianapolis, IN, USA; 12Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN, USA; 13Department of Pharmacy, Wishard Health Services, Indianapolis, IN, USABackground: The US Institute of Medicine has recommended an integrated, locally sensitive collaboration among the various members of the community, health care systems, and research organizations to improve dementia care and dementia research.Methods: Using complex adaptive system theory and reflective adaptive process, we developed a professional network called the “Indianapolis Discovery Network for Dementia” (IDND. The IDND facilitates effective and sustainable interactions among a local and diverse group of dementia researchers, clinical providers, and community advocates interested in improving care for dementia patients in Indianapolis, Indiana.Results: The IDND was established in February 2006 and now includes more than 250 members from more than 30 local (central Indiana organizations representing 20 disciplines. The network uses two types of communication to connect its members. The first is a 2-hour face-to-face bimonthly meeting open to all members. The second is a web-based resource center ( To date, the network has: (1 accomplished the

  15. A conceptual framework for automating the operational and strategic decision-making process in the health care delivery system. (United States)

    Ruohonen, Toni; Ennejmy, Mohammed


    Making reliable and justified operational and strategic decisions is a really challenging task in the health care domain. So far, the decisions have been made based on the experience of managers and staff, or they are evaluated with traditional methods, using inadequate data. As a result of this kind of decision-making process, attempts to improve operations usually have failed or led to only local improvements. Health care organizations have a lot of operational data, in addition to clinical data, which is the key element for making reliable and justified decisions. However, it is progressively problematic to access it and make usage of it. In this paper we discuss about the possibilities how to exploit operational data in the most efficient way in the decision-making process. We'll share our future visions and propose a conceptual framework for automating the decision-making process.

  16. The Relationship between Patients’ Perceptions of Nurse Caring Behaviors and Patient Satisfaction with Labor and Delivery (United States)


    instrument (as explained previously) was administered to 57 patients and 57 nurses. Patients valued items such as knowing how to give shots, manage ...Administration Quarterly, 12, 1-11. Eriksen, L. (1987). Patient satisfaction: an indicator of nursing care quality? Nursing Management , 18, 31-35. Ford, M. (1981...too big to fit through my pelvis. 4. High blood pressure or preeclampsia or toxemia 5. Other (Please specify) 7. What is your current marital status? 1

  17. Delivery of enteral nutrition after the introduction of practice guidelines and participation of dietitians in pediatric critical care clinical teams. (United States)

    Gentles, Emma; Mara, Jackie; Diamantidi, Krystalia; Alfheeaid, Hani A; Spenceley, Neil; Davidson, Mark; Gerasimidis, Konstantinos


    Provision of optimal nutrition is often difficult to achieve in the critically ill child, but can improve with better nutritional support practices. This study evaluated the joint impact of the introduction of enteral feeding practice guidelines and participation of dietitians in daily ward rounds on enteral nutrition (EN) intake and practices in children in intensive care. Nutritional intake and EN practices were audited before (period A) and after (period B) the introduction of enteral feeding practice guidelines and participation of dietitians in daily ward rounds in a pediatric intensive care unit. Information was collected on a daily basis and nutritional intake was compared with predefined targets and the United Kingdom dietary reference values. There were 65 patients and 477 nutritional support days in period A and 65 patients and 410 nutritional support days in period B. Basal metabolic rate (BMR) energy requirements were achieved in a larger proportion of nutritional support days in period B (BMR achieved [% nutritional support days]; period A: 27% vs period B: 48.9%; Pnutritional intake in some patients in critical care, but can have limited benefit for children admitted for corrective heart surgery.

  18. Action on AMD. Optimising patient management: act now to ensure current and continual delivery of best possible patient care. (United States)

    Amoaku, W; Blakeney, S; Freeman, M; Gale, R; Johnston, R; Kelly, S P; McLaughlan, B; Sahu, D; Varma, D


    In recent years, there have been significant advances in the clinical management of patients with wet age-related macular degeneration (wet AMD)--a rapidly progressing and potentially blinding degenerative eye disease. Wet AMD is responsible for more than half of registered severe sight impairment (blindness) in the United Kingdom, and patients who are being treated for wet AMD require frequent and long-term follow-up for treatment to be most effective. The clinical workload associated with the frequent follow-up required is substantial. Furthermore, as more new patients are diagnosed and the population continues to age, the patient population will continue to increase. It is thus vital that clinical services continue to adapt so that they can provide a fast and efficient service for patients with wet AMD. This Action on AMD document has been developed by eye health-care professionals and patient representatives, the Action on AMD group. It is intended to highlight the urgent and continuing need for change within wet AMD services. This document also serves as a guide for eye health-care professionals, NHS commissioners, and providers to present possible solutions for improving NHS retinal and macular services. Examples of good practice and service development are considered and can be drawn upon to help services meet the recommended quality of care and achieve best possible outcomes.

  19. An online module series to prepare pharmacists to facilitate student engagement in patient-centered care delivery: development and evaluation

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    Kassam R


    Full Text Available Rosemin Kassam,1 Mona Kwong,1 John B Collins21Faculty of Pharmaceutical Sciences, 2Department of Educational Studies, University of British Columbia, Vancouver, CanadaIntroduction: Accreditation bodies across North America have adopted revised standards that place increased emphasis on experiential education and preceptors to promote and demonstrate patient-centered, pharmaceutical care practices to students. Since such practices are still evolving, challenges exist in recruiting skilled preceptors who are prepared to provide such opportunities. An online educational module series titled "A Guide to Pharmaceutical Care" (The Guide was developed and evaluated to facilitate this transition. The objectives of this paper are: (1 to describe the development of the modules; and (2 to present the evaluation results from its pilot testing.Methods: The Guide was developed as an online, self-directed training program. It begins by providing an overview of patient care (PC philosophy and practice, and then discusses the tools that facilitate PC. It also provides a range of tips to support students as they provide PC during their experiential learning. Pharmacists participating in the pilot study were recruited using purposive and snowball sampling techniques. A pre–post quantitative survey with additional open-ended questions was used to evaluate the modules.Results: The modules incorporated a variety of teaching strategies: self-reflection exercises, quizzes to review important concepts, quick tips, flash cards, and video clips to illustrate more in-depth learning. Thirty-two pharmacists completed the pre–post assessment and reported significant increases in their confidence because of this training. The most influenced outcome was "Application of techniques to facilitate learning opportunities that enable pharmacy students to practice pharmaceutical care competencies." They also indicated that the training clarified necessary changes in their

  20. Starving in the midst of plenty? A study of training needs for child and adolescent mental health service delivery in primary care. (United States)

    Madge, Nicola; Foreman, David; Baksh, Faiza


    Current UK child mental health policy seeks to engage primary care personnel in improving service delivery under the heading of 'Comprehensive CAMHS' but little is known about the size of this resource, the sufficiency of its training or its commitment to children's mental health. We surveyed local health, education and social services agencies within a UK Unitary Authority just outside London, using both questionnaire and focus group methodologies: 150 primary care personnel were identified in 14 teams. Of these 122 participated in the questionnaire survey, and 60 took part in focus groups. There was, approximately, one such team member for every 30 children with a mental health problem. Respondents reported deficiencies in skills and knowledge, but wanted training and support to increase their involvement provided it related to their daily practice, professional roles, and was developed in accordance with local needs and resources. Lack of training and organization impedes the effective deployment of a potentially huge resource for children with mental health problems. This could be addressed by appropriately tailored training courses, combined with managerial work on systems and remits. Such a programme would be needed to realize the National Service Framework's concept of a 'comprehensive CAMHS'.

  1. Balancing student/trainee learning with the delivery of patient care in the healthcare workplace: a protocol for realist synthesis (United States)

    Sholl, Sarah; Ajjawi, Rola; Allbutt, Helen; Butler, Jane; Jindal-Snape, Divya; Morrison, Jill; Rees, Charlotte


    Introduction A national survey was recently conducted to explore medical education research priorities in Scotland. The identified themes and underlying priority areas can be linked to current medical education drivers in the UK. The top priority area rated by stakeholders was: ‘Understanding how to balance service and training conflicts’. Despite its perceived importance, a preliminary scoping exercise revealed the least activity with respect to published literature reviews. This protocol has therefore been developed so as to understand how patient care, other service demands and student/trainee learning can be simultaneously facilitated within the healthcare workplace. The review will identify key interventions designed to balance patient care and student/trainee learning, to understand how and why such interventions produce their effects. Our research questions seek to address how identified interventions enable balanced patient care-trainee learning within the healthcare workplace, for whom, why and under what circumstances. Methods and analysis Pawson's five stages for undertaking a realist review underpin this protocol. These stages may progress in a non-linear fashion due to the iterative nature of the review process. We will: (1) clarify the scope of the review, identifying relevant interventions and existing programme theories, understanding how interventions act to produce their intended outcomes; (2) search journal articles and grey literature for empirical evidence from 1998 (introduction of the European Working Time Directive) on the UK multidisciplinary team working concerning these interventions, theories and outcomes, using databases such as ERIC, Scopus and CINAHL; (3) assess study quality; (4) extract data; and (5) synthesise data, drawing conclusions. Ethics and dissemination A formal ethical review is not required. These findings should provide an important understanding of how workplace-based interventions influence the balance of trainee

  2. User fee exemptions and excessive household spending for normal delivery in Burkina Faso: the need for careful implementation

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    Ameur Amal


    Full Text Available Abstract Background In 2006, the Parliament of Burkina Faso passed a policy to reduce the direct costs of obstetric services and neonatal care in the country’s health centres, aiming to lower the country’s high national maternal mortality and morbidity rates. Implementation was via a “partial exemption” covering 80% of the costs. In 2008 the German NGO HELP launched a pilot project in two health districts to eliminate the remaining 20% of user fees. Regardless of any exemptions, women giving birth in Burkina Faso’s health centres face additional expenses that often represent an additional barrier to accessing health services. We compared the total cost of giving birth in health centres offering partial exemption versus those with full exemption to assess the impact on additional out-of-pocket fees. Methods A case–control study was performed to compare medical expenses. Case subjects were women who gave birth in 12 health centres located in the Dori and Sebba districts, where HELP provided full fee exemption for obstetric services and neonatal care. Controls were from six health centres in the neighbouring Djibo district where a partial fee exemption was in place. A random sample of approximately 50 women per health centre was selected for a total of 870 women. Results There was an implementation gap regarding the full exemption for obstetric services and neonatal care. Only 1.1% of the sample from Sebba but 17.5% of the group from Dori had excessive spending on birth related costs, indicating that women who delivered in Sebba were much less exposed to excessive medical expenses than women from Dori. Additional out-of-pocket fees in the full exemption health districts took into account household ability to pay, with poorer women generally paying less. Conclusions We found that the elimination of fees for facility-based births benefits especially the poorest households. The existence of excessive spending related to direct costs of

  3. Training competent and effective Primary Health Care Workers to fill a void in the outer islands health service delivery of the Marshall Islands of Micronesia

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    Keni Bhalachandra H


    Full Text Available Abstract Background Human resources for health are non-existent in many parts of the world and the outer islands of Marshall Islands in Micronesia are prime examples. While the more populated islands with hospital facilities are often successful in recruiting qualified health professionals from overseas, the outer islands generally have very limited health resources, and are thus less successful. In an attempt to provide reasonable health services to these islands, indigenous people were trained as Health Assistants (HA to service their local communities. In an effort to remedy the effectiveness of health care delivery to these islands, a program to train mid-level health care workers (Hospital Assistants was developed and implemented by the Ministry of Health in conjunction with the hospital in Majuro, the capital city of the Marshall Islands. Methods A physician instructor with experience and expertise in primary health care in these regions conducted the program. The curriculum included training in basic health science, essentials of endemic disorders and their clinical management appropriate to the outer islands. Emphasis was given to prevention and health promotion as well as to the curative aspects. For clinical observation, the candidates were assigned to clinical departments of the Majuro hospital for 1 year during their training, as assistants to the nursing staff. This paper discusses the details of the training, the modalities used to groom the candidates, and an assessment of the ultimate effectiveness of the program. Results Out of 16 boys who began training, 14 candidates were successful in completing the program. In 1998 a similar program was conducted exclusively for women under the auspices of Asian Development Bank funding, hence women were not part of this program. Conclusion For developing countries of the Pacific, appropriately trained human resources are an essential component of economic progress, and the health workforce

  4. Progress and delivery of health care in Bhutan, the Land of the Thunder Dragon and Gross National Happiness. (United States)

    Tobgay, Tashi; Dorji, Tandin; Pelzom, Dorji; Gibbons, Robert V


    The Himalayan Kingdom of Bhutan is rapidly changing, but it remains relatively isolated, and it tenaciously embraces its rich cultural heritage. Despite very limited resources, Bhutan is making a concerted effort to update its health care and deliver it to all of its citizens. Healthcare services are delivered through 31 hospitals, 178 basic health unit clinics and 654 outreach clinics that provide maternal and child health services in remote communities in the mountains. Physical access to primary health care is now well sustained for more than 90% of the population. Bhutan has made progress in key health indicators. In the past 50 years, life expectancy increased by 18 years and infant mortality dropped from 102.8 to 49.3 per 1000 live births between 1984 and 2008. Bhutan has a rich medical history. One of the ancient names for Bhutan was 'Land of Medicinal Herbs' because of the diverse medicinal plants it exported to neighbouring countries. In 1967, traditional medicine was included in the National Health System, and in 1971, formal training for Drungtshos (traditional doctors) and sMenpas (traditional compounders) began. In 1982, Bhutan established the Pharmaceutical and Research Unit, which manufactures, develops and researches traditional herbal medicines. Despite commendable achievements, considerable challenges lie ahead, but the advances of the past few decades bode well for the future.

  5. Supporting the Delivery of Total Knee Replacements Care for Both Patients and Their Clinicians With a Mobile App and Web-Based Tool: Randomized Controlled Trial Protocol (United States)

    Li, Jane; Brindal, Emily; van Kasteren, Yasmin; Varnfield, Marlien; Reeson, Andrew; Berkovsky, Shlomo; Freyne, Jill


    Background Total knee replacement (TKR) surgeries have increased in recent years. Exercise programs and other interventions following surgery can facilitate the recovery process. With limited clinician contact time, patients with TKR have a substantial burden of self-management and limited communication with their care team, thus often fail to implement an effective rehabilitation plan. Objective We have developed a digital orthopedic rehabilitation platform that comprises a mobile phone app, wearable activity tracker, and clinical Web portal in order to engage patients with self-management tasks for surgical preparation and recovery, thus addressing the challenges of adherence to and completion of TKR rehabilitation. The study will determine the efficacy of the TKR platform in delivering information and assistance to patients in their preparation and recovery from TKR surgery and a Web portal for clinician care teams (ie, surgeons and physiotherapists) to remotely support and monitor patient progress. Methods The study will evaluate the TKR platform through a randomized controlled trial conducted at multiple sites (N=5) in a number of states in Australia with 320 patients undergoing TKR surgery; the trial will run for 13 months for each patient. Participants will be randomized to either a control group or an intervention group, both receiving usual care as provided by their hospital. The intervention group will receive the app and wearable activity tracker. Participants will be assessed at 4 different time points: 4 weeks before surgery, immediately before surgery, 12 weeks after surgery, and 52 weeks after surgery. The primary outcome measure is the Oxford Knee Score. Secondary outcome measures include quality of life (Short-Form Health Survey); depression, anxiety, and stress (Depression, Anxiety, and Stress Scales); self-motivation; self-determination; self-efficacy; and the level of satisfaction with the knee surgery and care delivery. The study will also

  6. History, law, and policy as a foundation for health care delivery for American Indian and Alaska native children. (United States)

    Thierry, Judith; Brenneman, George; Rhoades, Everett; Chilton, Lance


    Most American Indian and Alaska Native Children (AIAN) receive health care that is based on the unique historical legacy of tribal treaty obligations and a trust relationship of sovereign nation to sovereign nation. From colonial America to the early 21st century, the wellbeing of AIAN children has been impacted as federal laws were crafted for the health, education and wellbeing of its AIAN citizens. Important public laws are addressed in this article, highlighting the development of the Indian Health Service (IHS), a federal agency designed to provide comprehensive clinical and public health services to citizens of federally recognized tribes. The context during which various acts were made into law are described to note the times during which the policy making process took place. Policies internal and external to the IHS are summarized, widening the lens spanning the past 200 years and into the future of these first nations' youngest members.

  7. Progress in the capture, manipulation, and delivery of medical media and its impact on education, clinical care, and research. (United States)

    Bernardo, Theresa M; Malinowski, Robert P


    In this article, advances in the application of medical media to education, clinical care, and research are explored and illustrated with examples, and their future potential is discussed. Impact is framed in terms of the Sloan Consortium's five pillars of quality education: access; student and faculty satisfaction; learning effectiveness; and cost effectiveness. (Hiltz SR, Zhang Y, Turoff M. Studies of effectiveness of learning networks. In Bourne J, Moore J, ed. Elements of Quality Online Education. Needham, MA: Sloan-Consortium, 2002:15-45). The alternatives for converting analog media (text, photos, graphics, sound, video, animations, radiographs) to digital media and direct digital capture are covered, as are options for storing, manipulating, retrieving, and sharing digital collections. Diagnostic imaging is given particular attention, clarifying the difference between computerized radiography and digital radiography and explaining the accepted standard (DICOM) and the advantages of Web PACS. Some novel research applications of medical media are presented.

  8. Facility-based care for delivery and management of complications related to pregnancy and childbirth in Mexico

    Directory of Open Access Journals (Sweden)

    Bernardo Hernández


    Full Text Available OBJECTIVE: To describe the incidence and management of severe maternal and newborn complications in selected health facilities in Mexico. MATERIALS AND METHODS: As part of the WHO Multicountry Survey on Maternal and Newborn health, information was collected from medical records of women with deliveries and/or severe maternal complications during pregnancy or puerperium in 14 hospitals in Mexico City and the state of Guanajuato, Mexico. RESULTS: Of 13 311 women, 157 (12 per 1 000 live births had severe maternal complications including 4 maternal deaths. The most frequent complications were preeclampsia, postpartum hemorrhage, and chronic hypertension. Adverse perinatal outcomes were more frequent among women with severe maternal complications. A high use of uterotonics and parenteral antibiotics was found. A small proportion of women with eclampsia received magnesium sulfate. CONCLUSION: This study provides indicators on the incidence and management of maternal and neonatal complications in Mexico, which may be useful in studying and evaluating the performance of obstetric services.OBJETIVO: Describir la incidencia y manejo de complicaciones maternas y neonatales severas en hospitales seleccionados de México. MATERIAL Y MÉTODOS: En el marco de la Encuesta Multipaís de la OMS sobre Salud Materna y Neonatal, se recolectó información de los expedientes médicos de las mujeres que tuvieron su parto o experimentaron complicaciones maternas severas durante el embarazo o puerperio en 14 hospitales de la Ciudad de México y el estado de Guanajuato, México. RESULTADOS: De 13 311 mujeres, 157 (12/1 000 nacidos vivos tuvieron complicaciones maternas severas, incluyendo 4 muertes maternas. Las complicaciones más frecuentes fueron preeclampsia, hemorragia postparto e hipertensión crónica. Los resultados perinatales adversos fueron más frecuentes en las mujeres con complicaciones severas. Hubo un uso amplio de uterotónicos y antibi

  9. Prevalence of Childhood and Adolescent Overweight and Obesity from 2003 to 2010 in an Integrated Health Care Delivery System

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    Scott Gee


    Full Text Available An observational study of the Kaiser Permanente Northern California (KPNC BMI coding distributions was conducted to ascertain the trends in overweight and obesity prevalence among KPNC members aged 2–19 between the periods of 2003–2005 and 2009-2010. A decrease in the prevalence of overweight (−11.1% change and obesity (−3.6% change and an increase in the prevalence of healthy weight (+2.7% change were demonstrated. Children aged 2–5 had the greatest improvement in obesity prevalence (−11.5% change. Adolescents aged 12–19 were the only age group to not show a decrease in obesity prevalence. Of the racial and ethnic groups, Hispanics/Latinos had the highest prevalence of obesity across all age groups. The KPNC prevalence of overweight and obesity compares favorably to external benchmarks, although differences in methodologies limit our ability to draw conclusions. Physician counseling as well as weight management programs and sociodemographic factors may have contributed to the overall improvements in BMI in the KPNC population. Physician training, practice tools, automated BMI reminders and performance feedback improved the frequency and quality of physician counseling. BMI screening and counseling at urgent visits, in addition to well-child care visits, increased the reach and dose of physician counseling.

  10. Effectiveness, safety, and standard of service delivery: A patient-based survey at a pancha karma therapy unit in a secondary care Ayurvedic hospital

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    Sanjeev Rastogi


    Full Text Available Pancha karma is a modality of treatments commonly used in Ayurvedic hospitals. It has elaborate textual reference of its usage in various clinical conditions forming the basis of its extensive use in Ayurvedic clinical practice. Unfortunately, despite its unquestionable popularity and usage among Ayurvedic physicians and patients, it has not been evaluated rigorously on scientific parameters to identify its effectiveness, safety, and procedural standards. Considering the patient′s opinion as an important determinant in this perspective, this study aims at identifying the patient′s (actual recipients of pancha karma therapy perception toward the effectiveness, safety, and standard of service delivery concerning pancha karma through a structured survey at a pre-identified pancha karma therapy unit in a secondary care Ayurvedic hospital. Majority of the survey respondents considered these therapies as safe and effective (88%. Ninety-four percent respondents have expressed their satisfaction to the standard of services provided to them at the pancha karma unit of the hospital concerned.

  11. Medications for Pain Relief during Labor and Delivery (United States)

    ... FAQ086 LABOR, DELIVERY, AND POSTPARTUM CARE Medications for Pain Relief During Labor and Delivery • What are the types ... an epidural”) is the most common type of pain relief used during labor and delivery in the United ...

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

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    Landy Christine


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

  13. Study Protocol. IDUS – Instrumental delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery (United States)


    Background Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries. Trial registration Current Controlled Trials ISRCTN72230496 PMID:22970933

  14. Study Protocol. IDUS – Instrumental delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery

    Directory of Open Access Journals (Sweden)

    Murphy Deirdre J


    Full Text Available Abstract Background Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries. Trial registration Current Controlled Trials ISRCTN72230496

  15. Study Protocol. IDUS -- Instrumental delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery

    LENUS (Irish Health Repository)

    Murphy, Deirdre J


    AbstractBackgroundInstrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice.Methods\\/DesignA multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha.DiscussionIt is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries.Trial registrationCurrent Controlled Trials ISRCTN72230496

  16. Costs associated with implementation of computer-assisted clinical decision support system for antenatal and delivery care: case study of Kassena-Nankana district of northern Ghana.

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    Maxwell Ayindenaba Dalaba

    Full Text Available OBJECTIVE: This study analyzed cost of implementing computer-assisted Clinical Decision Support System (CDSS in selected health care centres in Ghana. METHODS: A descriptive cross sectional study was conducted in the Kassena-Nankana district (KND. CDSS was deployed in selected health centres in KND as an intervention to manage patients attending antenatal clinics and the labour ward. The CDSS users were mainly nurses who were trained. Activities and associated costs involved in the implementation of CDSS (pre-intervention and intervention were collected for the period between 2009-2013 from the provider perspective. The ingredients approach was used for the cost analysis. Costs were grouped into personnel, trainings, overheads (recurrent costs and equipment costs (capital cost. We calculated cost without annualizing capital cost to represent financial cost and cost with annualizing capital costs to represent economic cost. RESULTS: Twenty-two trained CDSS users (at least 2 users per health centre participated in the study. Between April 2012 and March 2013, users managed 5,595 antenatal clients and 872 labour clients using the CDSS. We observed a decrease in the proportion of complications during delivery (pre-intervention 10.74% versus post-intervention 9.64% and a reduction in the number of maternal deaths (pre-intervention 4 deaths versus post-intervention 1 death. The overall financial cost of CDSS implementation was US$23,316, approximately US$1,060 per CDSS user trained. Of the total cost of implementation, 48% (US$11,272 was pre-intervention cost and intervention cost was 52% (US$12,044. Equipment costs accounted for the largest proportion of financial cost: 34% (US$7,917. When economic cost was considered, total cost of implementation was US$17,128-lower than the financial cost by 26.5%. CONCLUSIONS: The study provides useful information in the implementation of CDSS at health facilities to enhance health workers' adherence to practice

  17. Comparative cost analysis of insecticide-treated net delivery strategies: sales supported by social marketing and free distribution through antenatal care. (United States)

    De Allegri, Manuela; Marschall, Paul; Flessa, Steffen; Tiendrebéogo, Justin; Kouyaté, Bocar; Jahn, Albrecht; Müller, Olaf


    Insecticide-treated nets (ITNs) are effective in substantially reducing malaria transmission. Still, ITN coverage in sub-Saharan Africa (SSA) remains extremely low. Policy makers are concerned with identifying the most suitable delivery mechanism to achieve rapid yet sustainable increases in ITN coverage. Little is known, however, on the comparative costs of alternative ITN distribution strategies. This paper aimed to fill this gap in knowledge by developing such a comparative cost analysis, looking at the cost per ITN distributed for two alternative interventions: subsidized sales supported by social marketing and free distribution to pregnant women through antenatal care (ANC). The study was conducted in rural Burkina Faso, where the two interventions were carried out alongside one another in 2006/07. Cost information was collected prospectively to derive both a financial analysis adopting a provider's perspective and an economic analysis adopting a societal perspective. The average financial cost per ITN distributed was US$8.08 and US$7.21 for sales supported by social marketing and free distribution through ANC, respectively. The average economic cost per ITN distributed was US$4.81 for both interventions. Contrary to common belief, costs did not differ substantially between the two interventions. Due to the district's ability to rely fully on the use of existing resources, financial costs associated with free ITN distribution through ANC were in fact even lower than those associated with the social marketing campaign. This represents an encouraging finding for SSA governments and points to the possibility to invest in programmes to favour free ITN distribution through existing health facilities. Given restricted budgets, however, free distribution programmes are unlikely to be feasible.

  18. Innovation in Health Care Delivery

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    Haluk Şengün


    Full Text Available Innovation has become the symbol of transforming into creative economy and is a process of development for new approaches, technologies and working methods. It is a whole of processes that makes information useable. The innovative capacity of the industry is considered to be one of the most important elements determining international competition. Developing innovation and support systems, providing the infrastructure and inspections required for running them effectively, forming industrial problem solving strategies tailored for individual countries, progressing in accordance with long-term, sustainable, consistent and predictable policies as a whole is the only viable method to implement innovations, which utilize manpower and economic resources, transform and change, use revolutions in life sciences for the good of the public and human welfare and are catalysts for national economy in the light of science. The revolutionary developments in technology in the recent years have caused crucial transformations in healthcare field through their improvements on presentation formats and quality in diagnosis and treatment services. The status of conceptual changes in healthcare industry, which is one of the major sources and utilizers of innovative practices, the place and importance of innovation in healthcare system in Turkey and in the world are synthesized in a holistic approach.

  19. La atención del parto en Chiapas, México: ¿dónde y quién los atiende Childbirth in Chiapas, Mexico: who provides delivery care and where?

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    Héctor Javier Sánchez-Pérez


    Full Text Available Objetivo. Identificar el sitio y el agente de atención del parto; analizar el agente de atención del parto según la atención prenatal (AP y factores sociodemográficos; identificar grupos con menor y mayor probabilidad de recibir atención por parte del personal de los servicios de salud; identificar los motivos de no atenderse en la unidad de salud más cercana al domicilio. Material y métodos. Se analizan datos sobre la atención del parto en 297 mujeres de la Región Fraylesca (Chiapas, usando modelos logit para la identificación de grupos. Resultados. El 32% de los partos ocurrieron en instituciones de salud, y 60%, en el hogar (mayoritariamente en condiciones higiénico-sanitarias desfavorables. Sólo 10% del grupo de mujeres con menos de cinco consultas de AP, una escolaridad menor al tercero de primaria y un jefe de hogar dedicado a labores agropecuarias, fue atendido por personal de salud. Conclusiones. Es necesario mejorar la cobertura, la aceptabilidad y la calidad de los servicios de salud e instrumentar un programa dirigido a incrementar el número de partos en condiciones higiénico-sanitarias adecuadas.Objective. To identify the place and provider of delivery care; to analyse the relationship between the type of delivery care provider and prenatal care and sociodemographic factors; to identify groups with greater and lesser probability of receiving attention at health centers and to identify the reasons for not attending the health center nearest to the household. Material and methods. Data on the delivery care of 297 women of La Fraylesca Region, Chiapas, were gathered using multivariate logit models to identify groups. Results. From the total, 32% of childbirths occurred at health centers and 60% at home (mostly with poor sanitary conditions. Only 10% of women with less than 5 prenatal visits, school level under 3 years and whose household head was a peasant were attended by health care personnel. Conclusions. The

  20. Study protocol. IDUS - Instrumental delivery & ultrasound: a multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery.

    LENUS (Irish Health Repository)

    Murphy, Deirdre J


    Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 - 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice.

  1. The shift of care delivery models in overseas and its revelation to China%国外护理服务模式转变及其对我国的启示

    Institute of Scientific and Technical Information of China (English)

    韦凤美; 赵龙


    个案管理、保健管理和保健协调是近四十多年来英、美等国护理界先后采用的服务模式。本文论述它们的发展演变、服务模式、实施要求和功能作用,并探讨其对我国护理的启示。%Case management, care management and care coordination are care delivery models adopted by the USA and the UK over the past four decades. In this article, a comparative study was conducted with a focus on their background, service methods, implement conditions and functions. At the end of the article, its revelation to us was discussed.

  2. Modalidad integral de atención de parto y su relación con el bienestar materno Integral mode of delivery care and its relationship to maternal well-being

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    María Teresa Valenzuela Mujica


    Full Text Available Justificación: Iniciativas mundiales de la salud hacen una llamada a humanizar la atención del parto, transformándose en una estrategia que aumenta el bienestar de la mujer. Objetivo: Relacionar la atención integral del parto con el nivel de bienestar materno. Método: Se realizó una revisión en las bases de datos Scielo, Science Direct, Pubmed y Cinahl. Se obtuvieron 16 artículos de investigación cuantitativa, 4 de cualitativa y 20 que aportaron al tema. Resultados: El bienestar es un concepto multidimensional, relacionado con la calidad de la atención obstétrica y aumenta cuando la mujer participa en una modalidad humanizada del parto, con menor cantidad de procedimientos invasivos, asume rol protagónico, destacándose el componente interpersonal relacionado con el buen trato de los profesionales de la salud. Conclusión: Es necesario desarrollar estrategias para el cuidado integral de la mujer en el parto, la sensibilización de los profesionales de la salud es clave en este proceso.Justification: Global Health Initiatives call for humane care delivery, could be a strategy that increases the welfare of women. Objective: To relate the integrated care delivery in maternal well-being. Method: A review in the Scielo database, Science Direct, PubMed and Cinahl. Was obtained 16 quantitative research articles, 4 of qualitative and 20 who contributed to the topic. Results: Wellness is a multidimensional concept related to the quality of obstetric care and increases when women participate in a humane mode of delivery, with less invasive procedures, takes lead role, highlighting the interpersonal component related to good treatment of health professionals. Conclusion: It is necessary to develop strategies for comprehensive care of women during childbirth, the awareness of health professionals is key in this process.

  3. 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


    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.

  4. Foster Care: State Practices for Assessing Health Needs, Facilitating Service Delivery, and Monitoring Children's Care. Report to the Chairman, Subcommittee on Income Security and Family Support, Committee on Ways and Means, House of Representatives. GAO-09-26 (United States)

    Brown, Kay; Bascetta, Cynthia A.


    Providing health care services for foster children, who frequently have significant health care needs, can be challenging. The Administration for Children and Families (ACF) oversees foster care, but state child welfare agencies are responsible for ensuring that these children receive health care services, which are often financed by Medicaid. In…

  5. The Quality of Healthcare Service Delivery in Nigeria: An Assessment of the Availability of Some Basic Medical Devices/Equipment in the Primary Health Care Centres in Delta State

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    Omuta GED


    Full Text Available Background: Ordinarily, accessibility implies locational proximity. However, this study limits its use to the quality of what is accessed. There is, therefore, service-delivery inaccessibility, when health care seekers can only access poor quality service, because of the poor quality of the equipment at the disposal of primary health care centres. Service-delivery equipment are, therefore, surrogate indicators of the quality of the health care services that are geographically accessible. Methodology: Both qualitative and quantitative approaches of investigation were deployed, using structured questionnaires and focus group discussions/key informant interviews, respectively. It covered nine local government areas, three each from the senatorial districts. The paper discusses three basic medical devices/equipment that determine the quality of services delivered by PHCs, namely available and functioning general purpose equipment; most commonly used methods of sterilization; and availability of different types of laboratory tests. The quantitative data were cleaned up, processed and analysed, using the SPSS 10.0. Results: There were variations in the availability of devices and equipment. Syringes/needles and stethoscopes were available in more than three-quarters of the centres, while less than ten (10 per cent had microscopes. About 15 per cent of the centres either had no methods of sterilization at all or used ‘inappropriate’ ones. In spite of the prevalence of malaria, only 28.89 per centres could test for the parasite. Conclusion: The quality of services were perceived as poor because the basic medical devices and equipment were either lacking or inadequate. Policy implication is that government should increase resource allocation to the PHC subsector to procure the basic facilities for efficient service delivery.

  6. Velhos dilemas no provimento de bens e serviços de saúde: uma comparação dos casos canadense, inglês e americano Old dilemmas in health care delivery: a comparison of the Canadian, English and American cases

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    Marcos de Barros Lisboa


    Full Text Available This paper systematizes some aspects related to the consequences of the institutional health system in the financing and delivery of health care services. The analysis is based on empirical evidences from United States, Canada and United Kingdom. The focus of this work is on the analysis of the impacts of the incentives that result from the contracts established between health care market agents in the management efficiency of the health care services.

  7. Managed care and economic dynamics. (United States)

    Riggs, J E


    Over the past several decades, health care delivery in the United States evolved in an environment lacking marketplace constraints. The unforeseen result was the current health care crisis--uncontrolled costs, shrinking access, and redundant technological capabilities. Managed care is a strategy to impose fiscal constraints on health care delivery. A diagrammatic analysis of the economic dynamics between consumers and producers in an open marketplace is compared with that of patients, providers, and payers under the health care scheme that produced the health care crisis and under managed care. Patient demands, expectations, and needs for health care are not subject to fiscal constraint under managed care since the dislinkage between consumer and payer still exits. Managed care does not impose true open marketplace fiscal constraints on health care delivery. Furthermore, any solution to the US health care crisis that used true marketplace fiscal constraints would necessitate fundamental changes in societal values concerning individual rights to health care.

  8. Tailoring a family-based alcohol intervention for Aboriginal Australians, and the experiences and perceptions of health care providers trained in its delivery



    Background Aboriginal Australians experience a disproportionately high burden of alcohol-related harm compared to the general Australian population. Alcohol treatment approaches that simultaneously target individuals and families offer considerable potential to reduce these harms if they can be successfully tailored for routine delivery to Aboriginal Australians. The Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT) are two related interventions th...

  9. Effect of Empathy Care on Psychological State and Delivery Outcomes on Primipara%同感心护理对初产妇心理状况及分娩结局的影响

    Institute of Scientific and Technical Information of China (English)

    郑惠容; 成金焕; 张金云; 邓海燕; 林洁容; 罗思媚


    目的:探讨同感心护理对初产妇的心理健康状况及分娩结局的影响。方法:将150例初产妇随机分为观察组75例和对照组75例。对观察组实施同感心护理,对照组实行传统护理。采用90项症状清单(SCL -90)评估心理健康状况。比较2组的心理健康状况和分娩结局(包括分娩方式、总产程时间、产后2 h 出血量及新生儿1min Ap-gar 评分)。结果:①观察组抑郁、焦虑因子分低于对照组(t =-2.127、-2.116,P <0.05);②观察组阴道分娩率高于对照组(χ2=72.516,P <0.05);观察组的总产程时间短于对照组(t =-2.454,P <0.05)。结论:同感心护理有利于减轻分娩初产妇的负性情绪,在一定程度上改善分娩结局。%Objective To explore the effect of empathy care on psychological state and delivery outcomes on primipa-ra. Method 150 primiparas were randomly divided into two groups:observation group 75 casesand control group 75 cases. the observation group received empathy care,and the control group received the routine nursing care. All subjects were evaluated by Symptom Checklist 90(SCL - 90)and delivery outcomes(including delivery route,total delivery time,postpartum hemorrhage and Apgar score). Results ①The scores of depressive,and anxiety factors in the observation group were lawer than that in the control group( t = - 2. 127、- 2. 116,P < 0. 05);②The rate of natural childbearing in the observation group was higher than that in the control group(χ2 = 72. 516,P < 0. 05);The total delivery time was shorter in the observation group than that in the control group(t = - 2. 454,P < 0. 05). Conclusion Empathy care may help release the negative emotions on primipara,to some extent,and improve delivery outcomes.

  10. Incidência de cesáreas segundo fonte de financiamento da assistência ao parto Incidence of cesarean delivery regarding the financial support source for delivery care

    Directory of Open Access Journals (Sweden)

    Marta Edna Holanda Diógenes Yazlle


    Full Text Available OBJETIVO: Estudar os tipos de partos de acordo com a categoria de internação da paciente, bem como as indicações de cesarianas mais freqüentemente referidas. MÉTODOS: A partir dos dados de um sistema de informações hospitalares, foi feita uma análise retrospectiva dos partos ocorridos no município de Ribeirão Preto, São Paulo, Brasil, no período de 1986-1995. Foram estudados: tipo de parto, categoria de admissão e diagnósticos referidos. RESULTADOS: Ocorreram 86.120 partos no período estudado, sendo 5,4% na categoria privada, 28,7% na categoria de pré-pagamento e 65,9% no sistema público (Sistema Único de Saúde -- SUS, observando-se uma diminuição nas categorias privada e SUS e aumento na categoria de pré-pagamento. A percentagem de cesáreas aumentou de 68,3% para 81,8% na categoria privada e de 69,1% para 77,9% na categoria pré-pagamento e diminuiu de 38,7% para 32,1% na categoria SUS. As principais indicações cesarianas referidas foram o sofrimento fetal, cujas incidências foram 9,5%, 10,9% e 9,0%, respectivamente, nas categorias particular, pré-pagamento e SUS; e distócia céfalo-pélvica cujas taxas foram 5,8%, 6,5% e 3,9%, respectivamente, nas mesmas categorias mencionadas. CONCLUSÃO: A incidência de cesariana variou segundo a categoria de internação, observando-se um gradiente crescente à medida que se elevou o padrão social das gestantes, não havendo correspondência com o risco obstétrico.OBJECTIVE: To study the types of delivery according to the category of patient admission and the most frequently reported indications for cesarean sections. METHODS: In a retrospective survey of deliveries performed in the municipality of Ribeirão Preto, São Paulo, Brazil, from 1986 to 1995, the type of delivery, category of admission and recorded diagnoses were assessed. Data were obtained from the Center of Hospital Data Processing of the Department of Social Medicine in the University of São Paulo, Ribeir

  11. Qualitative Evaluation of the Implementation of an Integrated Care Delivery Model for Chronic Patients with Multi-Morbidity in the Basque Country

    Directory of Open Access Journals (Sweden)

    María Luz Jauregui


    Full Text Available Introduction: The objective of this study was to assess a model for improving healthcare integration for patients with multiple chronic diseases in an integrated healthcare organisation in the Basque Country and to propose areas for improvement. Methods: We organised four nominal groups composed of representatives from different categories of clinicians involved in the development of an integrated healthcare organisation and in the integrated care of patients with multiple diseases, namely, internists, general practitioners, and primary care and hospital nurses. Results: The aspect rated most positively was the concept itself of an integrated care model, which is able to improve communication between levels of care, increase the quality of the care provided and enhance patient safety. Additionally, it was agreed that the role of assigned clinicians is a key element. The problems identified mostly concern its implementation in daily practice. Conclusions: The results of this study made it possible to suggest at least 8 areas of improvement to be implemented. These are related to: nurses’ roles; care and monitoring of stable patients; team work; communication with patients; coordination with social workers and between internists and family doctors; as well as the development of an office of medical services to lead the integration process.

  12. Key Elements of Building Coordinated Health Care Delivery System in China%我国目前分级诊疗工作中的几个关键环节探讨

    Institute of Scientific and Technical Information of China (English)

    周瑞; 赵琨; 齐雪然


    本文依据“知信行”行为改变理论,探讨分级诊疗体系建设中政府管医、医生行医、患者就医行为改变的关键要素,并探讨实现“大医院愿意放、基层愿意接、患者愿意去”的政策支撑和制度环境。本文提出:在认知上,分级诊疗是区域医疗服务体系规划的核心,是医改工作的风向标,是一项复杂的长期任务。在意愿上,若要大医院愿意放,需同步推进传统的财政补助方式、当前医疗服务定价机制的改革;若要基层愿意接,应设立财政专项补助、拉大绩效工资差;若要患者愿意去,应鼓励大医院专科医生坐诊基层、正确宣传基层首诊内涵、完善医保管理方式。在行动上,实行机构差异化考核、设立大医院基层部、打通药物目录等管理措施必须兼顾,协同推进分级诊疗体系建设。%According to the behavior changing theory of knowledge - attitude - practice,we explored the key elements regarding how government manages medical services,how doctors practice medicine,and how patients have medical services in the coordinated health care delivery system in China,and also explored the supporting polices and institutional environment to encourage major hospitals to make patient referral down to primary - level medical settings,primary - level medical settings to receive referral patients,and patients to have medical services in primary - level medical settings. This paper came up with following suggestions. In terms of cognition,we should realize that the coordinated health care delivery system is the core of planning for regional health care delivery system and benchmark of health care system reform,and is a complex long - term task. In terms of willingness,given the willingness of major hospitals to make patient referral down to primary - level medical settings,the reform of traditional financial aid mode and the current pricing mechanism of medical services

  13. Dimensiones culturales en el proceso de atención primaria infantil: perspectivas de las madres Cultural dimensions of the childhood primary health care delivery from the mothers' perceptions in the Araucania-Chile

    Directory of Open Access Journals (Sweden)

    Ana María Alarcón-Muñoz


    Full Text Available OBJETIVO: Explorar las dimensiones culturales en el proceso de atención primaria infantil desde la perspectiva de las madres que acuden a centros de salud primaria en la región de la Araucania, Chile. MATERIAL Y MÉTODOS: Estudio cualitativo realizado durante el año 2003 en la zona de mayor índice de etnicidad del país. Los participantes fueron 94 madres mapuches y no mapuches a quienes se le aplicó una entrevista en profundidad. RESULTADOS: Tres dimensiones culturales surgieron del análisis: a modelos explicativos de enfermedad asociados a factores culturales, político-económicos, y ambientales; b itinerario terapéutico que combina recursos de los sistemas indígena, popular y biomédico; y c falta de competencia cultural del sistema de atención. CONCLUSIONES: Las madres conciben las enfermedades infantiles articulando componentes mágico-religiosos, y naturales (frío, calor, humedad. La atención de salud infantil enfrenta un importante desafío comunicacional en la superación de barreras sociales y lingüísticas entre madres y personal de salud.OBJECTIVE: To explore the cultural dimensions of the childhood primary health care delivery process from the mothers' perceptions in the Araucania region of Chile. MATERIAL AND METHODS: Qualitative study performed in the year 2003 within the zone with the highest ethnicity rate of the country. Ninety four Mapuche and non-Mapuche mothers agreed to be in depth interviewed. RESULTS: The analysis drew three cultural dimensions: a Explanatory models of disease were associated with cultural, political-economy, and environmental factors; b The therapeutic itinerary blends indigenous, popular, and biomedical resources and; c Health care delivery process lacks of cultural competence. CONCLUSIONS: The mothers explain their children diseases articulating religious, magic, and natural (hot, cold, humidity causes. The main challenge of the primary healthcare delivery process is to overcome the

  14. Study on the influence of midwives and midwifery care on the delivery of quality%助产士助产护理对产妇分娩质量的影响研究

    Institute of Scientific and Technical Information of China (English)



    Objective To explore the effect of midwives and midwifery care on the quality of delivery. Methods Collect 346 cases of parturient in our hospital from 2011.1-2013.1, The parturient were randomly divided into experimental group and control group, experimental group use the routine midwifery care, control group use midwives and midwifery care. observe two groups of parturient labor effect and the amount of postpartum hemorrhage, compare parturient delivery quality of two groups. Results There were 148 cases of parturient in experimental group have a natural delivery , accounted for 86.05%,108 cases of parturient in control group have a natural delivery, accounted for 62.07 %, natural delivery rate of experimental group was significantly higher than the control group (P<0.01), has statistical significance; The experimental groups of parturients’ delivery time、vaginal deliv-ery rate、the rate of cesarean section、2 hours postpartum hemorrhage、the neonatal mortality rate、significantly lower than the con-trol group of parturient (P<0.01), has statistical significance. Conclusion In the process of parturient delivery,midwives and mid-wifery care can effectively improve the rate of natural delivery, reduced the rate of cesarean section, shorten the labor course, re-lieved the labor pain, reduced 2 hours postpartum hemorrhage, prevent postpartum hemorrhage. Effective reduced the rate of still-births and neonatal mortality;guarantee the parturient and neonatal health, can be widely used in clinical.%目的:探究助产士助产护理对产妇分娩质量的影响。方法选取2011年1月-2013年1月在我院分娩的346例产妇,随机分为实验组和对照组,对照组产妇采用常规护理分娩,实验组产妇采用助产士助产护理分娩,观察两组产妇的分娩效果和出血量,比较两组产妇的分娩质量。结果实验组产妇自然分娩148例,占86.05%,对照组产妇自然分娩108例,占62.07%,实验组产妇自

  15. Acute and impaired wound healing: pathophysiology and current methods for drug delivery, part 1: normal and chronic wounds: biology, causes, and approaches to care. (United States)

    Demidova-Rice, Tatiana N; Hamblin, Michael R; Herman, Ira M


    This is the first installment of 2 articles that discuss the biology and pathophysiology of wound healing, review the role that growth factors play in this process, and describe current ways of growth factor delivery into the wound bed. Part 1 discusses the latest advances in clinicians' understanding of the control points that regulate wound healing. Importantly, biological similarities and differences between acute and chronic wounds are considered, including the signaling pathways that initiate cellular and tissue responses after injury, which may be impeded during chronic wound healing.

  16. A Study to Develop an Improved Organizational Structure for the Provision of Administrative Support for the Delivery of Health Care at Fitzsimons Army Medical Center (United States)


    specialties. The medical education program also includes specialty training for intensive care nurses , nurse anesthetists and pediatric nurse ... Educational Level MPA MNA MHA *NOTE: Although the incumbent has been the Director of Nursing for three years, she has held the dual role of Assistant...Conducting necessary orientations for newly assigned personnel. b. Arranging the conduct of inservice education . c. Providing administrative support for

  17. 区县级医院医务人员新生儿复苏培训效果评估研究%Quality improvement of care delivery of neonatal resuscitation training in a primary health care facility

    Institute of Scientific and Technical Information of China (English)

    王宁; 王宝生; 高科; 王丽丽; 宋明卫; 徐峰; 张勇


    目的 探讨新法新生儿窒息复苏技术的合理培训在区县级医院推广的意义.方法 本院于2009年4月开始开展“中澳新生儿窒息复苏在农村地区有效机制探讨”项目,对医务人员进行窒息复苏培训.选择开展项目后(2009年4月至2012年3月)参加培训的医务人员为观察组,培训前为对照组,将培训前后医务人员在新生儿窒息复苏时自信心水平评估和执行新生儿窒息复苏流程评估进行比较,并对培训后医务人员窒息复苏考核合格率进行评估,考核满分38分,及格分33分.结果 观察组各专业医务人员新生儿窒息复苏自信心水平评估分值均高于对照组[儿科医师:(60.7±8.7)比(32.3 ±6.2),产科医师:(64.3±7.7)比(35.7±7.2),助产士/师:(65.0±6.8)比(36.3±7.5),麻醉医师(52.7±6.7)比(24.7±4.8),P均<0.05],执行新生儿窒息复苏流程能力的分值均高于对照组[儿科医师:(14.8±2.9)比(8.0±2.3),产科医师:(16.0±2.3)比(9.0±2.1),助产士/师:(17.0±2.4)比(9.0±2.2);麻醉医师:(14.0±2.7)比(6.3±2.5),P均<0.05].医务人员在规范化培训后新生儿窒息复苏考核平均分分别为:儿科医师(33.1±3.6)分,产科医师(33.4±3.7)分,助产士/师(33.2±2.1)分,麻醉医师(33.1±4.3)分;最终考核总合格率86.7%.结论 我院对新生儿窒息复苏技术的培训方法有效可行,可以在全国范围内推广.%Objective To evaluate the significance in improvement of infant care delivery by promoting Neonatal Resuscitation Training Program in county hospitals.Methods This prospective observational case controlled study is supported by an international grant for "Effective Application of Neonatal Asphyxia.Resuscitation Program in Rural Areas of China & Australia" since April of 2009.The observation and the controlled groups of this study recruited 60 medical providers in each group matched in age,position and year in practice.Baseline confident level of medical providers

  18. Two sides of the coin: patient and provider perceptions of health care delivery to patients from culturally and linguistically diverse backgrounds

    Directory of Open Access Journals (Sweden)

    Komaric Nera


    Full Text Available Abstract Background Australia is a culturally diverse nation with one in seven Australians born in a non-English speaking country. Culturally and Linguistically Diverse (CALD populations are at a high risk of developing preventable chronic diseases such as cardiovascular disease, type 2 diabetes mellitus, renal disease, and chronic respiratory disease, especially communities from the Pacific Islands, the Middle East, North Africa, the Indian subcontinent and China. Previous studies have shown that access to services may be a contributing factor. This study explores the experiences, attitudes and opinions of immigrants from different cultural and linguistic backgrounds and their health care providers with regard to chronic disease care. Methods Five focus groups were conducted comprising participants from an Arabic speaking background, or born in Sudan, China, Vietnam or Tonga. A total of 50 members participated. All focus groups were conducted in the participants’ language and facilitated by a trained multicultural health worker. In addition, 14 health care providers were interviewed by telephone. Interviews were digitally recorded and transcribed. All qualitative data were analysed with the assistance of QSR NVivo 8 software. Results Participants were generally positive about the quality and accessibility of health services, but the costs of health care and waiting times to receive treatment presented significant barriers. They expressed a need for greater access to interpreters and culturally appropriate communication and education. They mentioned experiencing racism and discriminatory practices. Health professionals recommended recruiting health workers from CALD communities to assist them to adequately elicit and address the needs of patients from CALD backgrounds. Conclusions CALD patients, carers and community members as well as health professionals all highlighted the need for establishing culturally tailored programs for chronic

  19. Interprofessional Care and Role of Team Leaders. (United States)

    Kaini, B K


    Interprofessional care is an essential part of the health service delivery system. It helps to achieve improved care and to deliver the optimal and desired health outcomes by working together, sharing and learning skills. Health care organisation is a collective sum of many leaders and followers. Successful delivery of interprofessional care relies on the contribution of interprofessional care team leaders and health care professionals from all groups. The role of the interprofessional care team leader is vital to ensuring continuity and consistency of care and to mobilise and motivate health care professionals for the effective delivery of health services. Medical professionals usually lead interprofessional care teams. Interprofessional care leaders require various skills and competencies for the successful delivery of interprofessional care.

  20. Novopen Echo® for the delivery of insulin: a comparison of usability, functionality and preference among pediatric subjects, their parents, and health care professionals

    DEFF Research Database (Denmark)

    Olsen, Birthe S; Lilleøre, Søren Kruse; Korsholm, Conny Nøhr


    Despite advances in insulin pen design and functionality, the selection of pens available for children with diabetes is limited. This study assessed the usability, functionality and attitudes towards NovoPen Echo®, a new durable insulin pen designed for pediatric patients that combines a simple...... memory function with half-increment dosing, versus NovoPen® Junior and HumaPen® Luxura™ HD in pediatric subjects, their parents, and health care professionals (HCPs)....

  1. Oral delivery of anticancer drugs

    DEFF Research Database (Denmark)

    Thanki, Kaushik; Gangwal, Rahul P; Sangamwar, Abhay T;


    The present report focuses on the various aspects of oral delivery of anticancer drugs. The significance of oral delivery in cancer therapeutics has been highlighted which principally includes improvement in quality of life of patients and reduced health care costs. Subsequently, the challenges...... incurred in the oral delivery of anticancer agents have been especially emphasized. Sincere efforts have been made to compile the various physicochemical properties of anticancer drugs from either literature or predicted in silico via GastroPlus™. The later section of the paper reviews various emerging...... trends to tackle the challenges associated with oral delivery of anticancer drugs. These invariably include efflux transporter based-, functional excipient- and nanocarrier based-approaches. The role of drug nanocrystals and various others such as polymer based- and lipid based...

  2. [Problems of delivery of health care for children of servicemen and educates of general educational institutions of the Ministry of Defence of the Russian Federation]. (United States)

    Shabalov, N P; Arsent'ev, V G; Tsiteladze, A A; Mikheev, A V


    On the basis of the legal, instructional-methodological data and evaluation of the organization of medical care for children and adolescents identified the main challenges of pediatric services for the optimization of the Russian Defense Ministry interagency medical personnel accompany the children and adolescents, pre-university students in military educational institutions, at the stage of military reform and optimize the structure of the military medical service. To provide medical assistance to children of servicemen and DVOU pupils in accordance with the standards of health required the integration of interagency efforts of the military-medical institutions and medical institutions of state and municipal health systems.

  3. Primary care research in Denmark

    DEFF Research Database (Denmark)

    Vedsted, Peter; Kallestrup, Per


    International Perspectives on Primary Care Research examines how the evidence base from primary care research can strengthen health care services and delivery, tackle the growing burden of disease, improve quality and safety, and increase a person-centred focus to health care. Demonstrating the i...

  4. 42 CFR 136a.15 - Health Service Delivery Areas. (United States)


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

  5. Client Satisfaction with Delivery Care Service and Associated Factors in the Public Health Facilities of Gamo Gofa Zone, Southwest Ethiopia: In a Resource Limited Setting

    Directory of Open Access Journals (Sweden)

    Rahel Tesfaye


    Full Text Available Background. Ensuring patient satisfaction is an important means of secondary prevention of maternal mortality. This study presents findings from a multidimensional study of client satisfaction from the Gamo Gofa Zone in Southwest Ethiopia. Methods. A facility based cross-sectional study using exit interviews was conducted from 2014. Client satisfaction was measured using a survey adopted from the Donabedian quality assessment framework. Thirteen health institutions were randomly sampled of 66 institutions in Gamo Gofa Zone. Logistic regression was used to determine predictors of client satisfaction. Results. The overall satisfaction level of the clients in this study was 79.1% with (95% CI; 75–82. Women attending health centres were more likely satisfied than women attending hospitals (χ2=83.7, df=12, P<0.001. The proportion of women who complained about an unfriendly attitude or unresentful care from health workers was higher in the hospitals (χ2=27.4, df=1, P<0.001. The presence of support persons during child birth improved client satisfaction (AOR = 6.23 95% CI; 2.75–14.1 and women who delivered with caesarean section are four times more likely satisfied than those who deliver vaginally (AOR 3.6 95% CI; 1.44–9.06. Client satisfaction was reduced if the women had to pay for the services (AOR = 0.27 95% CI; 0.09–81. Conclusions. The study shows that overall satisfaction level is good. More emphasis should be put on giving women friendly care, particularly at the hospitals.

  6. Client Satisfaction with Delivery Care Service and Associated Factors in the Public Health Facilities of Gamo Gofa Zone, Southwest Ethiopia: In a Resource Limited Setting. (United States)

    Tesfaye, Rahel; Worku, Amare; Godana, Wanzahun; Lindtjorn, Bernt


    Background. Ensuring patient satisfaction is an important means of secondary prevention of maternal mortality. This study presents findings from a multidimensional study of client satisfaction from the Gamo Gofa Zone in Southwest Ethiopia. Methods. A facility based cross-sectional study using exit interviews was conducted from 2014. Client satisfaction was measured using a survey adopted from the Donabedian quality assessment framework. Thirteen health institutions were randomly sampled of 66 institutions in Gamo Gofa Zone. Logistic regression was used to determine predictors of client satisfaction. Results. The overall satisfaction level of the clients in this study was 79.1% with (95% CI; 75-82). Women attending health centres were more likely satisfied than women attending hospitals (χ (2) = 83.7, df = 12, P < 0.001). The proportion of women who complained about an unfriendly attitude or unresentful care from health workers was higher in the hospitals (χ (2) = 27.4, df = 1, P < 0.001). The presence of support persons during child birth improved client satisfaction (AOR = 6.23 95% CI; 2.75-14.1) and women who delivered with caesarean section are four times more likely satisfied than those who deliver vaginally (AOR 3.6 95% CI; 1.44-9.06). Client satisfaction was reduced if the women had to pay for the services (AOR = 0.27 95% CI; 0.09-81). Conclusions. The study shows that overall satisfaction level is good. More emphasis should be put on giving women friendly care, particularly at the hospitals.

  7. Health care marketing management. (United States)

    Cooper, P D


    Health Care Marketing Management is the process of understanding the needs and the wats of a target market. Its purpose is to provide a viewpoint from which to integrate the analysis, planning, implementation (or organization) and control of the health care delivery system.

  8. Lean health care. (United States)

    Hawthorne, Henry C; Masterson, David J


    Principles of Lean management are being adopted more widely in health care as a way of improving quality and safety while controlling costs. The authors, who are chief executive officers of rural North Carolina hospitals, explain how their organizations are using Lean principles to improve quality and safety of health care delivery.

  9. Atenção médica à gestação e ao parto de mães adolescentes Medical care for teenage mothers during pregnancy and at delivery

    Directory of Open Access Journals (Sweden)

    Heloisa Bettiol


    Full Text Available Estudou-se em Ribeirão Preto, SP, Brasil, no período de 1º de junho de 1978 a 31 de maio de 1979, 98% do universo de nascidos vivos, totalizando 8878 crianças nascidas de parto único, sendo 6750 procedentes de Ribeirão Preto. Observou-se um aumento da proporção de mães adolescentes em Ribeirão Preto (14,1% quando comparada com estudo realizado 10 anos antes (11,7%. A idade materna menor de 20 anos esteve associada com os indicadores mais desfavoráveis para a saúde perinatal, no que diz respeito à atenção médica à gestação e ao parto. Essa situação ficou mais evidente entre as mães adolescentes de classes sociais menos favorecidas, revelando que o grupo de mães adolescentes não é homogêneo, mas apresenta diferentes proporções de risco para a saúde perinatal de acordo com as frações de classe social que existem no seu interior.Ninety-eight percent of all live births occuring in the city of Ribeirão Preto, state of São Paulo (Brazil, from June 1, 1978 to May 30, 1979 were studied, for a total of 8,878 single-delivery infants, 6,750 of whom were from this town. An increase in the proportion of teenage mothers in Ribeirão Preto (14.1% was observed in relation to a study carried out ten years before (11.7%. Maternal age of less than 20 years was associated with more unfavorable perinatal health indicators with respect to medical care and delivery. This situation was more evident among teenage mothers from underprivileged social classes, showing that the group of teenage mothers is not homogeneous but presents different risk rates for perinatal health according to the social strata of which the group is composed.

  10. Factores asociados a la demanda de servicios para la atención del parto en México Factors associated with the demand for delivery care in Mexico

    Directory of Open Access Journals (Sweden)

    Miguel Ángel González-Block


    Full Text Available Objetivo. Analizar los factores asociados a la utilización de la institución de atención del parto en México para documentar el proceso de integración funcional de instituciones de salud. Material y métodos. Se utilizó información de mujeres con último parto entre 2000 y 2005 en la Encuesta Nacional de Salud y Nutrición 2006. Se aplicó la prueba de ji cuadrada para probar diferencias entre institución utilizada y aseguramiento. Se usó regresión logística para identificar factores que favorecieron la demanda de instituciones diferentes a las de afiliación de la mujer. Resultados. El 62.6% de mujeres con seguridad social utilizó instituciones de afiliación y 13.4% instituciones públicas. Entre no aseguradas 43.3% utilizó instituciones públicas y 19% seguridad social; 64.3% de afiliadas al Seguro Popular se atendieron en instituciones públicas. Variables de acceso, nivel socioeconómico y condiciones de vida influyeron en la demanda referida. Conclusiones. El traslape para atención de partos institucionales documenta la existencia de integración funcional de facto entre instituciones de salud mexicanas.Objective. Analyze the factors associated with the utilization of delivery care institutions in Mexico in order to document the functional integration of health institutions. Materials and Methods. Based on the 2006 National Health and Nutrition Survey, information from women whose last birth was between 2000 and 2005 was used. Chi square was used to test differences between institutions used and health insurance type. A logistic regression was carried out to identify factors associated with the demand for institutions with which women were not affiliated. Results. Women with social security used in 62% of the cases the institution of their affiliation and 13.4% used public institutions. For uninsured women, 43.3% used public institutions and 19.0% social security institutions; 64.3% of the Seguro Popular affiliates were

  11. Obstetrical approach in breech presentation delivery

    Directory of Open Access Journals (Sweden)

    G. Grgić


    Full Text Available Although it is accompanied by a higher number of intrapartal complications and a higher rate of prenatal mortality and morbidity the breech presentation is not considered to be an unfavourable presentation for delivery. However, delivery with the breech presentation requires a detailed and very careful approach in assessment of the way delivery is to be conducted and a serious approach of an obstetrician when making a final decision. This often results in a high rate of caesarean sections in certain institutions which has been up to 80-100% of all the breech presentations.The objective of this retrospective study was to establish incidence of deliveries of the breech presentations and to determine a way of completing delivery depending on a parity of mother and a condition of the newborn at delivery in the five-year period. The results have shown that breech presentation occurred in 4.69% of the total number of deliveries. There was no statistically significant difference in the way the delivery had been completed neither in the condition of newborns as a result of the way the delivery was completed. 50.75% of deliveries were completed with cesarean section and 49.25% of women delivered the breech presentation vaginally. An average Apgar score for those delivered vaginally was 8.05 and 7.52 for babies delivered naturally. Breech presentation requires a serious prepartal analysis of delivery factors based on which a significant number of deliveries can be conducted vaginally with a satisfactory condition of newborns at delivery.

  12. Pharmacists belong in accountable care organizations and integrated care teams. (United States)

    Smith, Marie; Bates, David W; Bodenheimer, Thomas S


    Effective health care workforce development requires the adoption of team-based care delivery models, in which participating professionals practice at the full extent of their training in pursuit of care quality and cost goals. The proliferation of such new models as medical homes, accountable care organizations, and community-based care teams is creating new opportunities for pharmacists to assume roles and responsibilities commensurate with their capabilities. Some challenges to including pharmacists in team-based care delivery models, including the lack of payment mechanisms that explicitly provide for pharmacist services, have yet to be fully addressed by policy makers and others. Nevertheless, evolving models and strategies reveal a variety of ways to draw on pharmacists' expertise in such critical areas as medication management for high-risk patients. As Affordable Care Act provisions are implemented, health care workforce projections need to consider the growing number of pharmacists expected to play an increasing role in delivering primary care services.

  13. Freqüência de testagem rápida para o HIV durante a admissão para o parto em puérperas no Instituto Materno Infantil Prof. Fernando Figueira, IMIP HIV testing prevalence during antenatal care in women admitted for delivery at the Instituto Materno Infantil Professor Fernando Figueira, IMIP

    Directory of Open Access Journals (Sweden)

    Maria Celina Rocha Morimura


    Full Text Available OBJETIVOS: determinar a prevalência da testagem anti-HIV no pré-natal e internamento para o parto e identificar fatores associados à realização e recebimento do resultado dos testes em parturientes. MÉTODOS: estudo descritivo, com 400 puérperas atendidas no Centro de Atenção à Mulher do IMIP Instituto Materno Infantil Prof. Fernando Figueira, IMIP. RESULTADOS: chegaram à admissão para o parto sem o resultado do teste anti-HIV, 154 (38,5% mulheres. Dessas, foi solicitado "teste rápido" em 134 (87,0%, porém só foram colhidos em 130 (84,5%. Observou-se que: o número de consultas realizadas no pré-natal, (p=0,001 o número de profissionais que atenderam a mulher no pré-natal e a escolaridade (p=0,006 tiveram associação significativa com a realização do exame anti-HIV no pré-natal, mas não com o recebimento do mesmo. O aconselhamento e oferecimento do teste tanto no pré-natal como na admissão para o parto também apresentaram associação significativa com a realização do anti-HIV durante o pré-natal. CONCLUSÕES: a prevalência de testagem anti-HIV no pré-natal e/ou na triagem foi satisfatório no aspecto quantitativo, porém o recebimento do resultado tanto no pré-natal quanto na admissão para o parto , bem como o aconselhamento pós-teste, foi aquém do recomendado.OBJECTIVES: to determine HIV testing prevalence during antenatal care and hospital admission for delivery and identify factors associated to pregnant women testing and results delivery. METHODS: a descriptive study comprised of 400 puerperal women seen at the Women Care Center of Instituto Materno Infantil Professor Fernando Figueira, IMIP. RESULTS: one hundred and fifty four (38.5% women were admitted for delivery without having received the results of the anti-HIV test. One hundred and thirty four women (87.0% had been prescribed a "fast HIV test" but only 130 were tested (84.5%. The following was determined: the number of antenatal medical visits ((p<0

  14. Complications of labor and delivery: shoulder dystocia. (United States)

    Anderson, Jane E


    This article reviews one of the less common but most dreaded complications of labor and delivery, shoulder dystocia, an infrequent but potentially devastating event that results from impaction of the fetal shoulders in the maternal pelvis. Shoulder dystocia occurs most commonly in patients without identified risk factors, and can result in both maternal and fetal morbidity. Because the vast majority of cases of shoulder dystocia are unpredictable, obstetric care providers must be prepared to recognize dystocia and respond appropriately in every delivery. Detailed documentation is essential after any delivery complicated by shoulder dystocia.

  15. 32 CFR 728.71 - Ex-service maternity care. (United States)


    ... pregnancy, prenatal care, hospitalization, postnatal care, and, when requirements of SECNAVINST 6300.2A are met, abortions. Limit postnatal care to 6 weeks following delivery. Do not promise civilian...

  16. Effect of humanistic caring education deliveried by hospital-school integration on the ability of humanistic care of nursing undergraduates%院-校一体化人文关怀教育对实习护生人文关怀能力的影响

    Institute of Scientific and Technical Information of China (English)

    张伟; 周英华; 郭秀君


    Objective To investigate the effects of the humanistic caring education schema deliveried by hospital-school integration ( HIS) on the humanistic care ability of nursing undergraduates. Methods A total of 60 nursing students undergoing clinical practice was equally randomized into two groups. The students in group A were given HIS humanistic caring narrative education lessons about autobiography memory, patients-related narrative and self-examination once a week for three months. The students in group B received conventional humanistic caring lecture given by hospital once a week for three months. Results The total points calculated from the nursing student s humanistic caring ability scale in group A were similar to those in group B before coaching [(127. 96 + 24. 04) points vs. (128. 05±22. 17) points] (P>0. 05). After three-month coaching, the aggregate score of the humanistic care ability of nursing in group A was higher than that in group B [(171.92+19. 69) points vs. (139.11 + 21. 71) points] (P<0. 05). So did the aggregate score of empathy[(63. 44 + 11. 07) points vs. (55. 82 + 12.11) points] (P<0. 05). Conclussion The HIS humanistic caring narrative education can effectively improve the humanistic caring ability of nursing undergraduates.%目的 探讨院-校一体化(HIS)人文关怀教育模式对实习护生关怀能力的影响.方法 60名本科护理实习学生随机均分为实验组和对照组.实验组每周采用自传体记忆、患者病痛叙事、反思等叙事教育方法进行一次HIS人文关怀辅导课.对照组每周进行一次医院组织的常规人文关怀讲座.结果 辅导前,两组学生关怀能力总分相仿[(127.96±24.04)分vs.(128.05±22.17)分](P>0.05).实习3个月后,实验组护生关怀能力和共情能力测评得分均明显高于对照组[(171.92±19.69)分vs.(139.11±21.71)分和(63.44±11.07)分vs.(55.82±12.11)分](P<0.05).结论 HIS人文关怀教育模式能有效提高实习护生人文关怀能力.

  17. Outcomes of vaginal delivery and cesarean in Mashhad Ghaem University Hospital

    Directory of Open Access Journals (Sweden)

    Hassan Boskabadi


    Conclusion: The results of this study showed in comparison with cesarean delivery, normal vaginal delivery provides better outcomes in terms of breast problems, breast feeding status, duration of labor and duration of maternal hospitalization for both mother and infant. So, adopting careful instructions in management and administration of deliveries will help the prevalence of making decisions for normal vaginal delivery and the recovery of delivery outcomes.

  18. Managed care innovation and new product development. (United States)

    Clark, C S; Schuster, T B


    This article explores recent innovative activity by managed care payor plans nationwide with particular emphasis on emerging, new relationships between the plans and their purchasers, enrollees, provider panels, and competitors. Because they already practice what advocates of health care reform are now preaching, many managed care plans are leading the charge to transform our health care delivery and financing systems.

  19. Teamwork for eye care

    Directory of Open Access Journals (Sweden)

    M Babar Qureshi


    Full Text Available Human resource development (HRD – the development of the people who deliver health care – has been identified as one of the key pillars of eye health delivery. HRD is one of the essential building blocks of the World Health Organization (WHO Global Action Plan: ‘Towards universal eye health’. The importance of HRD is also recognised beyond eye care, as can be seen in the WHO Health Systems approach.

  20. Care assistant experiences of dementia care in long-term nursing and residential care environments. (United States)

    Talbot, Rebecca; Brewer, Gayle


    Care assistants have a unique insight into the lives of service users and those factors which may impede or enhance the delivery of high quality dementia oriented care. To address the paucity of research in this area, the present study examined care assistant experiences of dementia care in British long-term residential and nursing environments. Semi-structured interviews were conducted with eight care assistants and transcripts were analysed using interpretive phenomenological analysis. Super-ordinate themes emerging from the data were psychological wellbeing of the care assistant, barriers to effective dementia care, the dementia reality and organisational issues within the care environment. The study revealed important deficiencies in understanding and varying levels of dementia training. Whilst person centred strategies were being implemented, task orientated care remained dominant. Furthermore, care assistants reported taking the perspectives of those with dementia into account, and actively using these to develop relationship centred care.

  1. Maternal and obstetric risk factors associated with preterm delivery at a referral hospital in northern-eastern Tanzania

    Directory of Open Access Journals (Sweden)

    Theresia B. Temu


    Conclusion: The risk factors for preterm delivery identified in this study are consistent with previous studies. Clinicians and other health care providers should routinely assess women at high risk of preterm delivery during prenatal care to prevent the occurrence of preterm delivery and associated adverse perinatal outcomes.

  2. eDelivery (United States)

    US Agency for International Development — eDelivery provides the electronic packaging and delivery of closed and complete OPM investigation files to government agencies, including USAID, in a secure manner....

  3. Status of the CLIC Beam Delivery System

    CERN Document Server

    Tomás, R; Resta López, J; Rumolo, G; Schulte, D; Schuler, P; Bolzon, B; Brunetti, L; Brunetti, L; Geffroy, N; Jeremie, A; Seryi, A; Angal-Kalinin, D; Jackson, F


    The CLIC Beam Delivery System (BDS) is experiencing the careful revision from a large number of world wide experts. This was particularly enhanced by the successful CLIC’08 workshop held at CERN. Numerous new ideas, improvements and critical points are arising, establishing the path towards the Conceptual Design Report by 2010.

  4. Potentially Ineffective Care: Time for Earnest Reexamination

    Directory of Open Access Journals (Sweden)

    William L. Jackson


    Full Text Available The rising costs and suboptimal quality throughout the American health care system continue to invite critical inquiry, and practice in the intensive care unit setting is no exception. Due to their relatively large impact, outcomes and costs in critical care are of significant interest to policymakers and health care administrators. Measurement of potentially ineffective care has been proposed as an outcome measure to evaluate critical care delivery, and the Patient Protection and Affordable Care Act affords the opportunity to reshape the care of the critically ill. Given the impetus of the PPACA, systematic formal measurement of potentially ineffective care and its clinical, economic, and societal impact merits timely reconsideration.

  5. Coordinating Mental Health Care Across Primary Care and Schools: ADHD as a Case Example


    Power, Thomas J.; Blum, Nathan J.; Guevara, James P; Jones, Heather A.; Leslie, Laurel K.


    Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual and linguistic differences between healthcare and educational professionals, role restrictions among professionals, and privacy laws. Strategies for...

  6. 责任制助产护理对产科产妇分娩方式及母婴结局的影响%Effect of Responsibility Midwifery Care for Obstetric Maternal Node of Delivery and Maternal and Neonatal Outcomes

    Institute of Scientific and Technical Information of China (English)



    ObjectiveTo study the effect of responsibility midwifery care for obstetric maternal mode of delivery and maternal and neonatal outcomes.Methods A total of 70 cases of parturient, as the research object, randomly divided into observation group and control group, each of the 35 cases of patients. The control group was given conventional treatment; the observation group were used the whole responsibility midwifery care.ResultsThe observation group of fetal absorption can yield and cesarean section rate was significantly lower than the control group, were compared between the confinement effect has obvious difference,P < 0.05. The observation group uses the full responsibility midwifery care effects on mother and infant were significantly lower than the control group using the traditional service mode of delivery.Conclusion In order to improve obstetric maternal mode of delivery, security and safeguard the health of the newborn, the responsibility midwifery care delivery model, this method has a good effect in clinical use, it is worth popularizing in clinic.%目的:探讨责任制助产护理对产科产妇分娩方式及母婴结局的影响。方法选取我院临产的产妇共70例,作为本次研究的对象,随机分为观察组和对照组,每组患者各35例。对照组进行常规处理;观察组产妇采用全程责任制助产护理方式。结果观察组胎吸助产率和剖腹产率明显低于对照组,组间分娩效果比较具有明显差异,P <0.05。观察组采用的全程责任制助产护理方式对母婴结果的影响明显低于对照组组采用的传统服务分娩方式。结论要想提高产科产妇分娩方式的安全性并保障新生儿的健康,可以采用责任制助产护理分娩模式,该方法在临床使用过程中具有良好的效益,值得在临床上大力推广。

  7. Building the eye care team

    Directory of Open Access Journals (Sweden)

    Thulasiraj Ravilla


    Full Text Available Eye care services are people intensive. They require the right people (competence, in the right numbers (capacity, in the right mix (team with the right resources and processes (enabling conditions to ensure effective and sustainable delivery of patient care.

  8. 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)


    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 ( held a

  9. Spiritual Care Education of Health Care Professionals

    Directory of Open Access Journals (Sweden)

    Donia Baldacchino


    Full Text Available Nurses and health care professionals should have an active role in meeting the spiritual needs of patients in collaboration with the family and the chaplain. Literature criticizes the impaired holistic care because the spiritual dimension is often overlooked by health care professionals. This could be due to feelings of incompetence due to lack of education on spiritual care; lack of inter-professional education (IPE; work overload; lack of time; different cultures; lack of attention to personal spirituality; ethical issues and unwillingness to deliver spiritual care. Literature defines spiritual care as recognizing, respecting, and meeting patients’ spiritual needs; facilitating participation in religious rituals; communicating through listening and talking with clients; being with the patient by caring, supporting, and showing empathy; promoting a sense of well-being by helping them to find meaning and purpose in their illness and overall life; and referring them to other professionals, including the chaplain/pastor. This paper outlines the systematic mode of intra-professional theoretical education on spiritual care and its integration into their clinical practice; supported by role modeling. Examples will be given from the author’s creative and innovative ways of teaching spiritual care to undergraduate and post-graduate students. The essence of spiritual care is being in doing whereby personal spirituality and therapeutic use of self contribute towards effective holistic care. While taking into consideration the factors that may inhibit and enhance the delivery of spiritual care, recommendations are proposed to the education, clinical, and management sectors for further research and personal spirituality to ameliorate patient holistic care.

  10. Communicating to promote justice in the modern health care system. (United States)

    Kreps, G L


    The systemic prejudices and biases that often limit the effectiveness of health care delivery are examined. How the inherent imbalance in control between consumers and providers of health care, based on the micropolitics of sharing relevant health information, perpetuates a system of marginalization and alienation within health care delivery systems is discussed. Communication barriers that often confront many stigmatized groups of health care consumers, such as the poor, people with AIDS, minorities, the ill elderly, and women, are identified. Such prejudicial treatment is framed within a cultural ideologies model, leading to identification of communication strategies for promoting justice in the modern health care system and enhancing the quality of health care delivery.

  11. Integrated delivery systems. Evolving oligopolies. (United States)

    Malone, T A


    The proliferation of Integrated Delivery Systems (IDSs) in regional health care markets has resulted in the movement of these markets from a monopolistic competitive model of behavior to an oligopoly. An oligopoly is synonymous with competition among the few, as a small number of firms supply a dominant share of an industry's total output. The basic characteristics of a market with competition among the few are: (1) A mutual interdependence among the actions and behaviors of competing firms; (2) competition tends to rely on the differentiation of products; (3) significant barriers to entering the market exist; (4) the demand curve for services may be kinked; and (5) firms can benefit from economies of scale. An understanding of these characteristics is essential to the survival of IDSs as regional managed care markets mature.

  12. Colloidal drug delivery systems in vaccine delivery. (United States)

    Beg, Sarwar; Samad, Abdus; Nazish, Iram; Sultana, Ruksar; Rahman, Mahfoozur; Ahmad, Md Zaki; Akbar, Md


    Vaccines play a vital role in the field of community medicine to combat against several diseases of human existence. Vaccines primarily trigger the acquired immune system to develop long-lasting immunity against pathogens. Conventional approaches for vaccine delivery lacks potential to target a particular antigen to develop acquired immunity by specific antibodies. Recent advancements in vaccine delivery showed that inclusion of adjuvants in vaccine formulations or delivery of them in a carrier helps in achieving desired targeting ability, reducing the immunogenicity and significant augmentation in the immune response. Colloidal carriers (liposomes, niosomes, microspheres, proteosomes, virosomes and virus like particles (VLPs), antigen cochleates, dendrimers and carbon nanotubes) have been widely explored for vaccine delivery. Further, surface engineering of these carriers with ligands, functional moieties and monoclonal antibodies tend to enhance the immune recognition potential of vaccines by differentiation of antigen specific memory T-cells. The current review, therefore, provides an updated account on the recent advancements in various colloidal delivery systems in vaccine delivery, outlining the mechanism of immune response initiated by them along with potential applications and marketed instances in an explicit manner.

  13. Viewing eCare through Nurses' Eyes: A Phenomenological Study (United States)

    Willey, Jeffrey Allan


    Published research suggests that the future of health care will be dependent on new technologies that serve to decrease the need for increased numbers of critical-care nurses while also increasing the quality of patient care delivery. The eCare technology is one technology that provides this service in the intensive care unit (ICU) setting. The…

  14. Teamwork in obstetric critical care


    Guise, Jeanne-Marie; Segel, Sally


    Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well t...

  15. Advocacy for eye care

    Directory of Open Access Journals (Sweden)

    Thulasiraj D Ravilla


    Full Text Available The effectiveness of eye care service delivery is often dependant on how the different stakeholders are aligned. These stakeholders range from the ministries of health who have the capacity to grant government subsidies for eye care, down to the primary healthcare workers who can be enrolled to screen for basic eye diseases. Advocacy is a tool that can help service providers draw the attention of key stakeholders to a particular area of concern. By enlisting the support, endorsement and participation of a wider circle of players, advocacy can help to improve the penetration and effectiveness of the services provided. There are several factors in the external environmental that influence the eye care services - such as the availability of trained manpower, supply of eye care consumables, government rules and regulations. There are several instances where successful advocacy has helped to create an enabling environment for eye care service delivery. Providing eye care services in developing countries requires the support - either for direct patient care or for support services such as producing trained manpower or for research and dissemination. Such support, in the form of financial or other resources, can be garnered through advocacy.

  16. Avaliação da assistência ao parto em maternidade terciária do interior do Estado de São Paulo, Brasil Evaluation of delivery care in a tertiary maternity in the interior of State of São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Fernanda Cristina Manzini


    Full Text Available OBJETIVOS: avaliar a estrutura e o processo de assistência ao parto e ao recém-nascido desenvolvidos na maternidade e na unidade de neonatologia de uma instituição hospitalar de nível terciário do interior do Estado de São Paulo, Brasil. MÉTODOS: estudo descritivo, transversal, voltado para a análise da adesão às normas preconizadas pelo Ministério da Saúde e Organização Mundial da Saúde em relação ao parto, avaliando-se os recursos existentes e as atividades desenvolvidas durante a assistência. Os dados foram colhidos nos anos de 2004 e 2005, a partir de entrevista com o gestor da maternidade, análise de 293 prontuários amostradose observação de 29 partos realizados. RESULTADOS: a avaliação da estrutura evidenciou a disponibilidade de equipamentos, instrumentais e medicamentos, de obstetra, pediatra e anestesista eausência de quartos de pré-parto, parto e puerpério.Na análise do processo observouse, entre outras,frequências regulares relacionadas à verificação de pressão arterial e ausculta dos batimentos cardíacos fetais; o preenchimento do partograma foi satisfatório; na assistência ao recém-nascido, foram insatisfatórios o aleitamento na primeira hora de vida e ocontato pele a pele. CONCLUSÕES: algumas práticas úteis no partonormal foram pouco utilizadas. Percebese uma tendência à incorporação de práticas baseadas em evidências científicas, quando se considerou a realização de procedimentos como tricotomia, enteroclisma e episiotomia, demonstrando uma mudançapositiva na assistência ao parto.OBJECTIVES: to evaluated the structure and care provided on delivery and for newborns by the maternity an neonatal unit of a tertiary hospital of the interior of State of São Paulo, Brazil. METHODS: a crosscutting descriptive study was carried out in accordance with the desired standards of the Ministry of Health and World Health Organization regarding care on delivery, evaluating the resources and the

  17. Mobile technology: streamlining practice and improving care


    Blake, Holly


    The use of mobile phones in care delivery has the potential to improve the way in which care is delivered. When implemented effectively, mobile technologies can empower patients and enhance communication between patients and their health-care providers. When barriers are recognised and addressed, mobile technologies can change working lives, facilitating rapid access to information and supporting efficiency in practice.

  18. Family Day Care Zoning. Local Officials Guide. (United States)

    Cohen, Abby; And Others

    This guide discusses city planning issues related to family day care zoning. The guide is divided into five sections. The first section discusses child care as a planning issue and focuses on changes in working patterns of families and in residential neighborhoods. The second section describes components of the child care delivery system, which…

  19. Project delivery system (PDS)

    CERN Document Server


    As business environments become increasingly competitive, companies seek more comprehensive solutions to the delivery of their projects. "Project Delivery System: Fourth Edition" describes the process-driven project delivery systems which incorporates the best practices from Total Quality and is aligned with the Project Management Institute and ISO Quality Standards is the means by which projects are consistently and efficiently planned, executed and completed to the satisfaction of clients and customers.

  20. Strengthening of primary health care: Key to deliver inclusive health care

    Directory of Open Access Journals (Sweden)

    Rajiv Yeravdekar


    Full Text Available Inequity and poverty are the root causes of ill health. Access to quality health services on an affordable and equitable basis in many parts of the country remains an unfulfilled aspiration. Disparity in health care is interpreted as compromise in ′Right to Life.′ It is imperative to define ′essential health care,′ which should be made available to all citizens to facilitate inclusivity in health care. The suggested methods for this include optimal utilization of public resources and increasing public spending on health care. Capacity building through training, especially training of paramedical personnel, is proposed as an essential ingredient, to reduce cost, especially in tertiary care. Another aspect which is considered very important is improvement in delivery system of health care. Increasing the role of ′family physician′ in health care delivery system will improve preventive care and reduce cost of tertiary care. These observations underlie the relevance and role of Primary health care as a key to deliver inclusive health care. The advantages of a primary health care model for health service delivery are greater access to needed services; better quality of care; a greater focus on prevention; early management of health problems; and cumulative improvements in health and lower morbidity as a result of primary health care delivery.

  1. Do You Really Expect Me to Get MST Care in a VA Where Everyone is Male? Innovative Delivery of Evidence-Based Psychotherapy to Women with Military Sexual Trauma (United States)


    sexual trauma (MST) are at heightened risk of developing psychiatric difficulties such as post-traumatic stress disorder (PTSD). Although the Veterans...Based Psychotherapy to Women with Military Sexual Trauma PRINCIPAL INVESTIGATOR: Ronald Acierno, PhD CONTRACTING ORGANIZATION: Medical University of...a VA Where Everyone is Male? Innovative Delivery of Evidence-Based Psychotherapy to Women with Military Sexual Trauma 5a. CONTRACT NUMBER 5b

  2. The Effect of Midwifery Care for Aged Maternal on the Mode of Delivery and Birth Process%高龄产妇中实施助产护理干预后对分娩方式、产程的影响

    Institute of Scientific and Technical Information of China (English)



    目的:研究高龄产妇中实施助产护理干预后对分娩方式和产程的影响。方法选取我院2013年6月~2014年10月收治的高龄产妇80例为对象,将其随机分为2组,观察组40例,对照组40例。对照组采用常规护理的方式,观察组采用助产护理的方式,对产妇分娩时的方式、产程进行对比分析。结果观察组的护理效果优于对照组。结论对高龄产妇实施助产护理有利于提高产妇的自然分娩率,缩短生产时间。%Objective To discuss the effect of midwifery care for aged maternal on the mode of delivery and birth process.MethodsFrom June 2013 to October 2014, 80 cases of elderly women were taken as the object and randomly divided into two groups, 40 cases in observation group of, 40 cases in the control group. Control group received routine nursing care, observation group received nursing and midwifery, analyzed child birth and birth process.Results The nursing effect of the observation group was signiifcantly better than that of the control group.Conclusion Midwifery care for patients with advanced maternal age can greatly improve the rate of natural delivery of maternal, shorten production time.

  3. DEFENSE HEALTH CARE: Access to Care for Beneficiaries Who Have Not Enrolled in TRICARE’s Managed Care Option (United States)


    sections of this legislation outlining the tasks that DOD must perform to comply with the law. We interviewed officials in TMA’s office of Health Plan...inaccuracies in detail remain. Therefore, TMA attempted to update providers’ addresses and phone numbers and to ensure that providers were eligible...Delivery of placenta (separate procedure) 1.190 59514 Cesarean delivery only 1.175 59515 Cesarean delivery only; including postpartum care 1.126 59612

  4. Global Delivery Models

    DEFF Research Database (Denmark)

    Manning, Stephan; Larsen, Marcus M.; Bharati, Pratyush


    This article examines antecedents and performance implications of global delivery models (GDMs) in global business services. GDMs require geographically distributed operations to exploit both proximity to clients and time-zone spread for efficient service delivery. We propose and empirically show...... digitalized services, time zones increasingly affect....

  5. Grant R01CA128134 | Division of Cancer Prevention (United States)

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  6. Grant R01CA148817 | Division of Cancer Prevention (United States)

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  7. Grant R01CA154489 | Division of Cancer Prevention (United States)

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  8. Grant R01CA179511 | Division of Cancer Prevention (United States)

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  9. Grant R01CA170549 | Division of Cancer Prevention (United States)

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  10. Grant R01CA155297 | Division of Cancer Prevention (United States)

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  11. Grant R01CA107408 | Division of Cancer Prevention (United States)

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  12. Grant R01CA164782 | Division of Cancer Prevention (United States)

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  13. Grant R01CA155301 | Division of Cancer Prevention (United States)

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  14. Grant R01CA098286 | Division of Cancer Prevention (United States)

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  15. Grant R01CA132951 | Division of Cancer Prevention (United States)

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  16. Grant R01CA134620 | Division of Cancer Prevention (United States)

    The Division of Cancer Prevention (DCP) conducts and supports research to determine a person's risk of cancer and to find ways to reduce the risk. This knowledge is critical to making progress against cancer because risk varies over the lifespan as genetic and epigenetic changes can transform healthy tissue into invasive cancer.

  17. Institutional Care for Long-Term Mechanical Ventilation in Canada: A National Survey

    Directory of Open Access Journals (Sweden)

    Louise Rose


    Full Text Available INTRODUCTION: No national Canadian data define resource requirements and care delivery for ventilator-assisted individuals (VAIs requiring long-term institutional care. Such data will assist in planning health care services to this population.

  18. Intravenous drug delivery in neonates: lessons learnt. (United States)

    Sherwin, Catherine M T; Medlicott, Natalie J; Reith, David M; Broadbent, Roland S


    Intravenous drug administration presents a series of challenges that relate to the pathophysiology of the neonate and intravenous infusion systems in neonates. These challenges arise from slow intravenous flow rates, small drug volume, dead space volume and limitations on the flush volume in neonates. While there is a reasonable understanding of newborn pharmacokinetics, an appreciation of the substantial delay and variability in the rate of drug delivery from the intravenous line is often lacking. This can lead to difficulties in accurately determining the pharmacokinetic and pharmacodynamic relationship of drugs in the smallest patients. The physical variables that affect the passage of drugs through neonatal lines need to be further explored in order to improve our understanding of their impact on the delivery of drugs by this route in neonates. Through careful investigation, the underlying causes of delayed drug delivery may be identified and administration protocols can then be modified to ensure predictable, appropriate drug input kinetics.

  19. Potential Impact of Obstetrics and Gynecology Hospitalists on Safety of Obstetric Care. (United States)

    Srinivas, Sindhu K


    Staffing models are critical aspects of care delivery. Provider staffing on the labor and delivery unit has recently received heightened attention. Based on the general medicine hospitalist model, the obstetrics and gynecology hospitalist or laborist model of obstetric care was introduced more than a decade ago as a plausible model-of-care delivery to improve provider satisfaction, with the goal of also improving safety and outcomes through continuous coverage by providers whose sole focus was on the labor and delivery unit without other competing clinical duties. It is plausible that this model of provider staffing and care delivery will increase safety.

  20. Mesenteric venous thrombosis following vaginal delivery

    Directory of Open Access Journals (Sweden)

    Roopa Sachidananda


    Full Text Available Acute abdomen following an uneventful vaginal delivery is a rare occurrence. Diagnosis may be delayed due to pregnancy related comorbid conditions such as preeclampsia, hemolysis elevated, liver enzymes, low platelet (HELLP count syndrome, acute fatty liver of pregnancy (AFLP, etc. We describe a 21-year-old woman with pre-eclampsia, HELLP syndrome and AFLP with acute abdomen that was managed successfully in our intensive care unit.

  1. Coordinating Systems of Care Using Health Information Technology: Development of the ADHD Care Assistant (United States)

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


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

  2. The implementation of integrated care: The empirical validation of the development model for integrated care

    NARCIS (Netherlands)

    M.M.N. Minkman (Mirella); R.P. Vermeulen (Robert); C.T.B. Ahaus (Kees); R. Huijsman (Robbert)


    textabstractBackground: Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be

  3. The implementation of integrated care : The empirical validation of the development model for integrated care

    NARCIS (Netherlands)

    Minkman, M.M.N.; Vermeulen, Robbert; Ahaus, C.T.B.; Huijsman, R.


    Background: Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented

  4. Shared care in basic level palliative home care: organizational and interpersonal challenges

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjoern; Olesen, Frede; Jensen, Anders Bonde;


    palliative home care and the working culture among health professionals. The main issues: distribution of tasks, information exchange, availability, respect, and personal acquaintance are pivotal to improve the delivery of palliative home care, to training in palliative care and warrant future research....

  5. Relationship-Focused Child Care Practices: Quality of Care and Child Outcomes for Children in Poverty (United States)

    Owen, Margaret Tresch; Klausli, Julia F.; Mata-Otero, Ana-Maria; Caughy, Margaret O'Brien


    Research Findings: Child care delivery practices promoting continuous, primary caregiver-child relationships (relationship-focused child care) were evaluated for 223 preschool-age children (45% African American, 55% Latino) attending child care centers serving low-income children. Both relationship-focused and non-relationship-focused centers were…

  6. Newborns from deliveries with epidural anaesthesia

    Directory of Open Access Journals (Sweden)

    Avramović Lidija


    Full Text Available Introduction. The use of epidural anaesthesia in delivery with the purpose to reduce pain and fear in a pregnant woman has the influence on the physiological status of the woman in childbirth and the course of delivery. From the epidural space of the pregnant woman, one part of free anaesthetic comes in the foetal circulation through the mother's circulation and placenta and connects with the foetal proteins. A lower value of albumins and serum proteins in the foetal circulation give bigger free fraction of anaesthetic which is accumulated in the foetal liver, brain and heart full of blood. Objective. The aim of the study was to examine the influence of epidural anaesthesia on the newborn. Methods. Retrospective study of 6,398 documents of newborns was performed in our Clinic of Gynaecology and Obstetrics 'Narodni front' during 2006. The first group was made of 455 newborns from deliveries with epidural anaesthesia and the second was the control group of 5,943 remaining newborns. In both groups we analysed the following: sex, week of gestation, weight, Apgar score, measure of care and resuscitation, perinatal morbidity and then the obtained results were compared. Results. Most of deliveries were vaginal without obstetric intervention (86.6%. The number of deliveries finished with vacuum extractor (4.6% was statistically significantly bigger in the group with epidural anaesthesia than in the control group. Most of the newborns in the first group were born on time (96.5% in 39.0±1.0 week of gestation and with foetal weight 3448±412 grammes. There was no statistical significance in Apgar score between both groups. Epidural anaesthesia does not increase the degree of the newborn's injury. Lower pH of blood was found in the newborns from deliveries with vacuum extractor or operated on (the Ceasarean section. Conclusion. Application of epidural anaesthesia decreases duration of delivery and has no adverse effects on the newborn and hypoxic

  7. Global Delivery Models

    DEFF Research Database (Denmark)

    Manning, Stephan; Møller Larsen, Marcus; Bharati, Pratyush

    We investigate antecedents and contingencies of location configurations supporting global delivery models (GDMs) in global outsourcing. GDMs are a new form of IT-enabled client-specific investment promoting services provision integration with clients by exploiting client proximity and time......-zone spread allowing for 24/7 service delivery and access to resources. Based on comprehensive data we show that providers are likely to establish GDM configurations when clients value access to globally distributed talent pools and speed of service delivery, and in particular when services are highly...... commoditized. Findings imply that coordination across time zones increasingly affects international operations in business-to-business and born-global industries....

  8. Team networking in palliative care

    Directory of Open Access Journals (Sweden)

    Odette Spruyt


    Full Text Available "If you want to travel quickly, go alone. But if you want to travel far, you must go together". African proverb. The delivery of palliative care is often complex and always involves a group of people, the team, gathered around the patient and those who are close to them. Effective communication and functional responsive systems of care are essential if palliative care is to be delivered in a timely and competent way. Creating and fostering an effective team is one of the greatest challenges for providers of palliative care. Teams are organic and can be life giving or life sapping for their members.

  9. Leader of the Maternity care: Doctors or midwives

    DEFF Research Database (Denmark)

    Wagle, Rajendra R.


    Technology of delivery of health care for developing countries is not a resolved issue. Moreover, maternity care differs from other areas of health care in many ways. Developing countries have to carefully adapt to what has been done in developed countries. Recent debate and data on maternity hea...

  10. Critical Care (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 ...

  11. Tracheostomy care (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 ...

  12. Delivery by Cesarean Section (United States)

    ... Español Text Size Email Print Share Delivery by Cesarean Section Page Content Article Body More than one mother in three gives birth by Cesarean section in the United States (it is also called ...

  13. Transdermal delivery of proteins. (United States)

    Kalluri, Haripriya; Banga, Ajay K


    Transdermal delivery of peptides and proteins avoids the disadvantages associated with the invasive parenteral route of administration and other alternative routes such as the pulmonary and nasal routes. Since proteins have a large size and are hydrophilic in nature, they cannot permeate passively across the skin due to the stratum corneum which allows the transport of only small lipophilic drug molecules. Enhancement techniques such as chemical enhancers, iontophoresis, microneedles, electroporation, sonophoresis, thermal ablation, laser ablation, radiofrequency ablation and noninvasive jet injectors aid in the delivery of proteins by overcoming the skin barrier in different ways. In this review, these enhancement techniques that can enable the transdermal delivery of proteins are discussed, including a discussion of mechanisms, sterility requirements, and commercial development of products. Combination of enhancement techniques may result in a synergistic effect allowing increased protein delivery and these are also discussed.

  14. Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program. (United States)

    Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish


    In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

  15. A conceptual framework for future research on mode of delivery. (United States)

    Wu, Jennifer M; Viswanathan, Meera; Ivy, Julie S


    Our goal was to develop a comprehensive conceptual research framework on mode of delivery and to identify research priorities in this topic area through a Delphi process. We convened a multidisciplinary team of 16 experts (North Carolina Collaborative on Mode of Delivery) representing the fields of obstetrics and gynecology, neonatology, midwifery, epidemiology, psychometrics, decision sciences, bioethics, health care engineering, health economics, health disparities, and women's studies. We finalized the conceptual framework after multiple iterations, including revisions during a one-day in-person conference. The conceptual framework illustrates the causal pathway for mode of delivery and the complex interplay and relationships among patient, fetal, family, provider, cultural, and societal factors as drivers of change from intended to actual mode of delivery. This conceptual framework on mode of delivery will help put specific research ideas into a broader context and identify important knowledge gaps for future investigation.

  16. Nursing Informatics Education: From Automation to Connected Care. (United States)

    Skiba, Diane J


    The use of health information technologies has evolved over the last 50 years. These technologies have moved from the automation of data and data processing to connected care tools that are part of a health care ecosystem that provides the best care at the point of care. To correspondence with the evolution of technologies and their disruptions within the health care delivery system, there is a need to re-examine the necessary competencies of health care professionals.

  17. Awareness and perceptions of Turkish women towards delivery methods

    Directory of Open Access Journals (Sweden)

    Şükrü Yıldız


    Full Text Available Objective: Our aim is to identify the causes of the women’s preferences of vaginal delivery vs. cesarean section and their attitudes for an elective cesarean section. Methods: 400 healthy woman who had applied for antenatal care were included in the study. A questionnaire which is consisted of 21 questions, focused on preference toward mode of delivery and the etiology of these preferences was conducted as a face to face interview. According to history of delivery methods, women have separated into three groups as; women have never given birth/nulliparous (group 1, women who had only vaginal deliveries (group 2, and women who had at least one cesarean deliveries/previous cesarean section (group 3. Results: Of the 400 women questioned, 348 (%87 opted for vaginal delivery, whereas only 52 (%13 opted for an elective caesarean delivery. Ratios of cesarean delivery preference is high in group 3 (%47.5 than group 1( %26 and 2 (%2.7 . Main reasons for vaginal delivery preference: feeling of less pain, fast and easy recovery and less bleeding and infection risc for mothers were the most common preference reasons among all 3 groups. The most common reasons for choosing caesarean delivery were: ‘more comfortable and easy’ in group 1 and ‘tubal ligation demand’ in group 3. ‘Less pain’ and ‘fear of tearing (episiotomy’ also other common reasons for choosing cesarean delivery among all 3 groups. Conclusion: In order to reduce the rate of implemented cesarean section, it is substantially important to encourage educated women and those who have experienced advanced maternal age for increasing the rate of vaginal delivery. J Clin Exp Invest 2014; 5 (2: 173-178

  18. Vaginal delivery - discharge (United States)

    ... only plain water. Avoid bubble baths or oils. Episiotomy Care Most women heal without problems, although it ... the discomfort and speed the healing of your episiotomy . Other Self-care Try eating smaller meals than ...

  19. Building an international network for a primary care research program: reflections on challenges and solutions in the set-up and delivery of a prospective observational study of acute cough in 13 European countries

    Directory of Open Access Journals (Sweden)

    Veen Robert ER


    Full Text Available Abstract Background Implementing a primary care clinical research study in several countries can make it possible to recruit sufficient patients in a short period of time that allows important clinical questions to be answered. Large multi-country studies in primary care are unusual and are typically associated with challenges requiring innovative solutions. We conducted a multi-country study and through this paper, we share reflections on the challenges we faced and some of the solutions we developed with a special focus on the study set up, structure and development of Primary Care Networks (PCNs. Method GRACE-01 was a multi-European country, investigator-driven prospective observational study implemented by 14 Primary Care Networks (PCNs within 13 European Countries. General Practitioners (GPs recruited consecutive patients with an acute cough. GPs completed a case report form (CRF and the patient completed a daily symptom diary. After study completion, the coordinating team discussed the phases of the study and identified challenges and solutions that they considered might be interesting and helpful to researchers setting up a comparable study. Results The main challenges fell within three domains as follows: i selecting, setting up and maintaining PCNs; ii designing local context-appropriate data collection tools and efficient data management systems; and iii gaining commitment and trust from all involved and maintaining enthusiasm. The main solutions for each domain were: i appointing key individuals (National Network Facilitator and Coordinator with clearly defined tasks, involving PCNs early in the development of study materials and procedures. ii rigorous back translations of all study materials and the use of information systems to closely monitor each PCNs progress; iii providing strong central leadership with high level commitment to the value of the study, frequent multi-method communication, establishing a coherent ethos

  20. Utilization of Maternal Care Services in Urban area: Still an Issue of Modern World

    Directory of Open Access Journals (Sweden)

    Neha Bavarva, Prakash Patel, R K Bansal


    Conclusion: Though the overall rate of home delivery was less, most of the reasons cited for the home delivery are avoidable, especially when most mothers came into contact of health care system at least once."

  1. Is non-directive counseling for patient choice cesarean delivery ethically justified? (United States)

    Kalish, Robin B; McCullough, Laurence B; Chervenak, Frank A


    The current controversy concerning patient choice cesarean delivery potentially affects all women of child-bearing age and the physicians who care for them. The purpose of this paper is to address three salient issues within the patient choice cesarean delivery controversy. First, is performing patient choice cesarean delivery consistent with good professional medical practice? Second, how should physicians respond to or counsel patients who request patient choice cesarean delivery? And, third, should patient choice cesarean delivery be routinely offered to all pregnant women?

  2. Effect of Organizational Culture on Patient Access, Care Continuity, and Experience of Primary Care. (United States)

    Hung, Dorothy; Chung, Sukyung; Martinez, Meghan; Tai-Seale, Ming


    This study examined relationships between organizational culture and patient-centered outcomes in primary care. Generalized least squares regression was used to analyze patient access, care continuity, and reported experiences of care among 357 physicians in 41 primary care departments. Compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care. Understanding the unique effects of organizational culture can enhance the delivery of more patient-centered care.

  3. Huddles and Debriefings: Improving Communication on Labor and Delivery. (United States)

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


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

  4. Patient and health care professional views and experiences of computer agent-supported health care

    Directory of Open Access Journals (Sweden)

    Ron Neville


    Conclusions Patients and HCPs welcomed the introduction of agent technology to the delivery of health care. Widespread use will depend more on the trust patients place in their own GP than on technological issues.

  5. Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers. (United States)

    Taylor, Erin Fries; Machta, Rachel M; Meyers, David S; Genevro, Janice; Peikes, Deborah N


    Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.

  6. Reforming the health care system: implications for health care marketers. (United States)

    Petrochuk, M A; Javalgi, R G


    Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

  7. Modularity in Cancer Care Provision

    DEFF Research Database (Denmark)

    Gobbi, Chiara; Hsuan, Juliana


    The paper presents the findings of a case study research conducted within the Danish healthcare system aimed at analyzing how modularity is deployed in the process of delivery cancer care. Three cancer packages are presented into detailed describing the process of defining the diagnosis and treat...

  8. Vaginal delivery versus cesarean section for term breech delivery

    Directory of Open Access Journals (Sweden)

    Babović Ivana


    Full Text Available Background/Aim. The optimal method of delivery for breech presentation at term still remains a matter of controversy. This is probably due to the fact that the skills of vaginal breech delivery are being lost. The aim of this study was to examine risk factors: mother's age, parity, labor's duration, estimated neonatal birth weight for the mode of breech presentation delivery at term as well as the influence of the delivery mode on neonatal outcome. Methods. A retrospective study of 401 terms (more than 37 week's gestation breech deliveries at the Institute of Gynecology and Obstetrics, Belgrade, from 2007 to 2008 was made. The following groups with respect to mode of delivery were included: the group I - vaginal delivery (VD in 139 patients; the group II - urgent cesarean section (UCS in 128 patients; and the group III - elective cesarean section (ECS in 134 patients. Mother's age, parity, duration of VD, neonatal birth weight (BW, the Apgar score at 5th minute, and duration of stay in a neonatal intensive care unit (NICU vere determined. Neonatal mortality and major neonatal morbidity were compared according to the route of delivery. Fetuses and neonates with hemolytic disease and fetal and neonatal anomalies were excluded from the study. For statistical analyses we performed Student's t test, χ2 likelihood ratio, Kruskall-Wallis test, Mann Whitney test, and ANOVA. Results. The mean age of patients in the group I was 28.29 ± 4.97 years, in the group II 29.68 ± 5.92 years and in the group III 30.06 ± 5.41 years. Difference in mother's age between the group I and III was significant (p = 0.022. In the group III there were 73.9% nuliparous similarly to the gropu II (73.4%. We performed ECS in 54.6% of the nuliparous older than 35 years, and 54.4% multiparous younger than 35 years were delivered by VD. The use of oxytocin for stimulation of vaginal labor was not associated with its duration (p = 0.706. Lowset maneuver was performed in 88.5% of

  9. Community and Home-Based Care HIV Service Delivery Model in the Context of Paediatric HIV Management and Contributing to Health Systems Strengthening in a Resource-Limited Setting (Uganda): Operational Research



    This thesis is about the Tukula Fenna Project (TFP) that was set up at the Home Care Department of St. Raphael of St Francis Hospital (Nsambya Hospital) in Kampala, Uganda. In 2003, Associazione Casa Accoglienza alla vita “Padre Angelo” (ACAVPA) or “HOUSE FOR LIFE, Father Angelo” and other Italian partners; in particular, PENTA Foundation and University of Padova, Department of paediatrics collectively signed a memorandum of understanding (MoU) with Nsambya Hospital. The aim of the MoU was t...

  10. Puerperal infection from the perspective of humanized delivery care at a public maternity hospital Infección puerperal del punto de vista de la atención humanizada al parto en maternidad pública Infecção puerperal sob a ótica da assistência humanizada ao parto em maternidade pública

    Directory of Open Access Journals (Sweden)

    Elisângela Euripedes Resende Guimarães


    Full Text Available This is an epidemiological, prospective and non-concurrent study of the cohort type about puerperal infection from the perspective of humanized delivery care, based on information from 5,178 records of patients who went through the experience of humanized delivery. The study aimed at describing the women who underwent humanized delivery, determining the incidence and time for manifestation of puerperal infections and investigating the association between the infection and the risk factors. An accumulated puerperal infection rate of 2.92% was found. The risk factors associated to puerperal infection in Cesarean delivery were the duration of labor and the number of digital examinations. No variable behaved as a risk factor for infection in normal delivery. Cesarean delivery was an important risk factor for puerperal infection. The results reinforce the need to develop alternative forms of delivery care that provides effective conditions for normal delivery, in order to reduce the number of Cesarean sections.Se trata de un estudio epidemiológico, tipo cohorte, prospectivo y no concurrente, sobre infección puerperal del punto de vista de la atención humanizada a los partos. En este estudio, se objetivó caracterizar las puérperas sometidas al parto humanizado; determinar la incidencia de las infecciones en el puerperio, así como el intervalo de manifestación, y también verificar la asociación entre la infección y los factores de riesgo. Los datos fueron obtenidos de 5178 prontuarios de puérperas que pasaron por la experiencia del parto humanizado. Fue verificada una tasa de incidencia de infección en el puerperio acumulada del 2,92%. Los factores de riesgo asociados a la infección en el puerperio en la modalidad del parto cesareano fueron la duración del trabajo de parto (p=0,002 y el número de toques (p=0,011. Ninguna variable se comportó como factor de riesgo para infección en el parto normal. Sin embargo, el parto cesarea se

  11. Finding economies of scale and coordination of care along the continuum to achieve true system integration. (United States)

    Davies, Maura


    Is it time to reduce hospitals and replace them with digitally enabled distributed specialty service delivery channels that focus on ambulatory care, urgent care, and patient reactivation? Is delivery system integration immaterial if care is standardized and supported by integrated information systems? Maybe Lean methodology needs to be applied across the entire delivery systems, not just within its component functions and processes. Comments are offered on each of these perspectives.

  12. Understanding Business Models in Health Care. (United States)

    Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R


    The increasing focus on the costs of care is forcing health care organizations to critically look at their basic set of processes and activities, to determine what type of value they can deliver. A business model describes the resources, processes, and cost assumptions that an organization makes that will lead to the delivery of a unique value proposition to a customer. As health care organizations are beginning to transform their structure in preparation for a value-based delivery system, understanding business model theory can help in the redesign process.

  13. Hospice Care (United States)

    Hospice care is end-of-life care. A team of health care professionals and volunteers provides it. ... can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's ...

  14. Palliative Care (United States)

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

  15. [Usefulness of ultrasound in the delivery room]. (United States)

    Triunfo, S; Guariglia, L; Rosati, P; Scambia, G


    The use of diagnostic ultrasound and the diffusion of the technique improved the obstetric treatment and the usefulness of ultrasound increases in the delivery room for maternal and fetal care and as method of diagnosis of some obstetric complications. The knowledge of intrapartum ultrasound imaging can be considered useful for the obstetric team, since there is evidence that ultrasound can improve the obstetric management. The mean indications are described: fetal biometry and estimated fetal weight, amniotic fluid volume, fetal situation and presentation, placental localization and anatomy, assessment of size and location of uterine leiomyomas, fetal cardiac activity, evaluation of umbilical cord and fetal cardinal movements intrapartum. Besides, the use of ultrasound is reported in obstetric and postpartum complications. Actually ultrasonography, as a non-invasive, safety and low-cost technique, offers a diagnostic method in particular conditions during labour, delivery and postpartum.

  16. Thermostable Subunit Vaccines for Pulmonary Delivery

    DEFF Research Database (Denmark)

    Foged, Camilla


    -administrable, can be distributed independently of functioning freezers and refrigerators, and can be designed to induce mucosal and/or cell-mediated immunity, which is attractive for a number of diseases requiring stimulation of local mucosal immunity for protection. However, the design and delivery of thermostable...... dry powder-based vaccines represents a technological challenge: It calls for careful formulation and dosage form design, combined with cheap and efficient delivery devices, which must be engineered via a thorough understanding of the physiological barrier and the requirements for induction of mucosal...... immunity. Here, I review state of the art and perspectives in formulation design and processing methods for powder-based subunit vaccines intended for pulmonary administration, and present dry powder inhaler technologies suitable for translating these vaccines into clinical trials....

  17. A History of Abuse and Operative Delivery

    DEFF Research Database (Denmark)

    Schei, Berit; Lukasse, Mirjam; Ryding, Elsa Lena


    OBJECTIVE: The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult....... DESIGN: The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records....... The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary...

  18. Students' community health service delivery: experiences of involved parties. (United States)

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


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

  19. Birth after previous cesarean delivery: short-term maternal outcomes. (United States)

    Lydon-Rochelle, Mona T; Cahill, Alison G; Spong, Catherine Y


    An estimated 40% of the 1.3 million cesarean deliveries performed each year in the United States are repeat procedures. The appropriate clinical management approach for women with previous cesarean delivery remains challenging because options are limited. The risks and benefits of clinical management choices in the woman's health need to be quantified. Thus, we discuss the available published scientific data on (1) the short-term maternal outcomes of trial of labor after cesarean and elective repeat cesarean delivery, (2) the differences between outcomes for both, (3) the important factors that influence these outcomes, and (4) successful vs. unsuccessful vaginal birth after cesarean. For women with a previous cesarean delivery, a successful trial of labor offers several distinct, consistently reproducible advantages compared with elective repeat cesarean delivery, including fewer hysterectomies, fewer thromboembolic events, lower blood transfusion rates, and shorter hospital stay. However, when trial of labor after cesarean fails, emergency cesarean is associated with increased uterine rupture, hysterectomy, operative injury, blood transfusion, endometritis, and longer hospital stay. Care of women with a history of previous cesarean delivery involves a confluence of interactions between medical and nonmedical factors; however, the most important determinants of the short-term outcomes among these women are likely individualized counseling, accurate clinical diagnoses, and careful management during a trial of labor. We recommend a randomized controlled trial among women undergoing a TOLAC and a longitudinal cohort study among women with previous cesarean to evaluate adverse outcomes, with focused attention on both mother and the infant.

  20. A Medical Delivery Device

    DEFF Research Database (Denmark)


    The present invention relates to a medical delivery device comprising at least two membrane electrode assembly units each of which comprises three layers: an upper and a lower electrode and a selective ionic conductive membrane provided there-between. At least one of the three layers are shared...

  1. Global Delivery Models

    DEFF Research Database (Denmark)

    Manning, Stephan; Møller Larsen, Marcus; Bharati, Pratyush M.


    antecedents and contingencies of setting up GDM structures. Based on comprehensive data we show that providers are likely to establish GDM location configurations when clients value access to globally distributed talent and speed of service delivery, in particular when services are highly commoditized...

  2. Effects of continuity midwifery care on labor pain and duration of labor in vaginal birth after cesarean delivery%全程连续性助产护理对剖宫产术后阴道分娩产妇产痛程度及产程的影响

    Institute of Scientific and Technical Information of China (English)

    陈志芳; 吴宏荷; 孙晓琴; 吴迎春; 刘华华


    Objective:To investigate the effect of continuity midwifery care on labor pain and duration of labor in vaginal birth after cesarean(VBAC)delivery.Methods:A total of 1 12 pregnant women who preferred VBAC were randomly divided into the control group and the observation group,with 56 cases in each group.The control group was given conventional nursing at different phase of ges-tation,and the observation group was applied with continuity midwifery care.The condition of labor pain and anxiety were assessed by visual analog pain scale(VAS)and anxiety visual analog scale(VAS-A).The natural births rate,incidence of fetal distress,postpartum hemorrhage rate,amount of bleeding and duration of labor were observed and compared between two groups.Results:The VAS,VAS-A at 24 h after delivery and amount of bleeding were significant lower in the observation group than those of the control group(P 0.05).The duration of first stage of labor,second stage of labor and total stage of labor were significant shorter in the observation group than those of the controls(P <0.05 or P <0.01 ).Conclusion:The continuity of midwifery care is effective in impro-ving negative emotion and reducing the duration of labor and amount of bleeding in puerpera undergoing VBAC delivery.%目的:探讨全程连续性助产护理对剖宫产术后阴道分娩(VBAC)产妇产痛程度及产程的影响。方法:VBAC 产妇112例随机分为对照组和观察组,各56例。对照组采用常规阶段式护理,观察组采用全程连续性助产护理。采用视觉模拟疼痛量表(VAS)和视觉模拟焦虑量表(VAS-A)分别评估两组产痛和焦虑状况;比较两组自然分娩率、胎儿窘迫率、产后出血率、出血量,以及两组中自然分娩产妇的产程。结果:观察组产后24 h 的 VAS 评分、VAS-A 评分及产后出血量显著低于对照组(P <0.05或 P <0.01)。两组自然分娩率、出血率及胎儿窘迫率无显著差异(P >0

  3. Self-nanoemulsifying drug delivery systems for oral insulin delivery

    DEFF Research Database (Denmark)

    Li, Ping; Tan, Angel; Prestidge, Clive A


    This study aims at evaluating the combination of self-nanoemulsifying drug delivery systems (SNEDDS) and enteric-coated capsules as a potential delivery strategy for oral delivery of insulin. The SNEDDS preconcentrates, loaded with insulin-phospholipid complex at different levels (0, 2.5 and 10% w...

  4. Emergence of infection control surveillance in alternative health care settings. (United States)

    Clark, Pamela


    During the past decade, health care delivery has undergone enormous changes. The nationwide growth in managed care organizations and the changing methods of provider reimbursement are restructuring the entire health care system. Diversification and integration strategies have blurred historical separations between the activities of hospitals, nursing homes, physicians, and other providers. Services are being offered in and shifting to less costly settings, such as ambulatory clinics, work sites, and homes. Many factors have contributed to the increasing trend of health care delivery outside hospitals. This presentation will provide insight to the management and surveillance of infection prevention in these health care settings.

  5. Marketing: applications in a military health care setting. (United States)

    Roark, G A; Tucker, S L


    Military health care leaders must recognize the importance of satisfied consumers. As part of this recognition, the focus of military medicine must change from a coercive-power to a reward-power system. This change highlights the need for business practices such as marketing. Encouraging military health care administrators to learn and understand the applications of the marketing variables will enhance demand management and health care delivery for beneficiaries. This paper describes some applications of marketing variables, informs the military health care administrator about the process of marketing, and describes the utility of marketing in the current paradigm shift in military health care delivery.

  6. Nanotopography applications in drug delivery (United States)

    Walsh, Laura A; Allen, Jessica L; Desai, Tejal A


    Refinement of micro- and nanofabrication in the semiconductor field has led to innovations in biomedical technologies. Nanotopography, in particular, shows great potential in facilitating drug delivery. The flexibility of fabrication techniques has created a diverse array of topographies that have been developed for drug delivery applications. Nanowires and nanostraws deliver drug cytosolically for in vitro and ex vivo applications. In vivo drug delivery is limited by the barrier function of the epithelium. Nanowires on microspheres increase adhesion and residence time for oral drug delivery, while also increasing permeability of the epithelium. Low aspect ratio nanocolumns increase paracellular permeability, and in conjunction with microneedles increase transdermal drug delivery of biologics in vivo. In summary, nanotopography is a versatile tool for drug delivery. It can deliver directly to cells or be used for in vivo delivery across epithelial barriers. This editorial highlights the application of nanotopography in the field of drug delivery. PMID:26512871

  7. Wealth and antenatal care use: Implications for maternal health care utilisation in Ghana


    Arthur, Eric


    The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths....

  8. Economic and societal dimensions of nanotechnology-enabled drug delivery

    NARCIS (Netherlands)

    Kulve, te H.; Rip, A.


    Introduction: There is an increasing interest in nanotechnology-enabled drug delivery systems which are expected to have significant impacts for health care. The economic and societal aspects are uncertain, even ambiguous, at this stage of development, and often not addressed, or only as part of the

  9. Contrasting experiences with child health care services by mothers and professional caregivers in transitional housing. (United States)

    Amen, Maisha M; Pacquiao, Dula F


    The study examined experiences of mothers and health care providers with preventive child health care services using qualitative methods at a primary care clinic located in transitional housing for homeless families in an urban community with predominantly Black American residents. Participants were 20 mothers and 4 health care professionals. Three major domains emerged: (a). the infrastructure of the clinic and health care delivery poses barriers to mothers' access and use of services for their children; (b). specialized, biomedical-driven care produces fragmented care delivery not responsive to the comprehensive nature of problems of mothers and their children; and (c). organizational strategies for improving access and use of health care services are directed by health care providers' value orientations. Findings support existence of infrastructural characteristics of the health care system that maintains differential value orientations and power structure, and care delivery processes that are non responsive to racially diverse and poor mothers.

  10. Microprocessor controlled transdermal drug delivery. (United States)

    Subramony, J Anand; Sharma, Ashutosh; Phipps, J B


    Transdermal drug delivery via iontophoresis is reviewed with special focus on the delivery of lidocaine for local anesthesia and fentanyl for patient controlled acute therapy such as postoperative pain. The role of the microprocessor controller in achieving dosimetry, alternating/reverse polarity, pre-programmed, and sensor-based delivery is highlighted. Unique features such as the use of tactile signaling, telemetry control, and pulsatile waveforms in iontophoretic drug delivery are described briefly.

  11. Optimizing drugs for local delivery. (United States)

    Collingwood, S; Lock, R; Searcey, M


    An international panel of speakers together with approximately 70 delegates were brought together by The Society for Medicines Research's symposium on Optimising Drugs for Local Delivery, held on June 11, 2009 at the Novartis Institutes for Biomedical Research, Horsham, UK. The focus of the conference was on the delivery of drugs direct to the site of action and the consequences of this delivery route on delivery technologies, formulation science and molecular design.

  12. MEMS: Enabled Drug Delivery Systems. (United States)

    Cobo, Angelica; Sheybani, Roya; Meng, Ellis


    Drug delivery systems play a crucial role in the treatment and management of medical conditions. Microelectromechanical systems (MEMS) technologies have allowed the development of advanced miniaturized devices for medical and biological applications. This Review presents the use of MEMS technologies to produce drug delivery devices detailing the delivery mechanisms, device formats employed, and various biomedical applications. The integration of dosing control systems, examples of commercially available microtechnology-enabled drug delivery devices, remaining challenges, and future outlook are also discussed.

  13. What Is a Cesarean Delivery? (United States)

    ... are common complications? What is a high-risk pregnancy? What is labor? What is a cesarean delivery? Other FAQs NICHD Research Information Clinical Trials Resources and Publications What is a cesarean delivery? Skip sharing on social media links Share this: Page Content A cesarean delivery ...

  14. Telementoring Primary Care Clinicians to Improve Geriatric Mental Health Care. (United States)

    Fisher, Elisa; Hasselberg, Michael; Conwell, Yeates; Weiss, Linda; Padrón, Norma A; Tiernan, Erin; Karuza, Jurgis; Donath, Jeremy; Pagán, José A


    Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO(®) (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.

  15. Nonuse of Prenatal Care: Implications for Social Work Involvement. (United States)

    Bedics, Bonnie C.


    Interviewed 44 women who did not obtain prenatal care. Identified four categories of reasons for nonuse: women's lifestyles differed from mainstream; stressful events took priority over prenatal care; women attempted to receive care but were discouraged, turned away, or given poor information by service delivery system personnel; and women did not…

  16. Primary care obstetrics and perinatal health in the Netherlands.

    NARCIS (Netherlands)

    Hingstman, L.


    The Netherlands is the only industrialized country in which a large percentage of obstetric care takes place at home. Almost 31% of all deliveries are home confinements under supervision of a midwife or a general practitioner, and 84% of all postnatal care is given at home by maternity care assistan

  17. Annotated Bibliography of Intramural Research on Long-Term Care. (United States)

    National Center for Health Services Research and Health Care Technology Assessment (DHHS/PHS), Rockville, MD.

    As components of the National Center for Health Services Research Division of Intramural Research, the Long-Term Care Studies Program and the Aging Studies Program were established to define the problems of caring for the chronically ill and the elderly and to study the organization, financing, and delivery of health care services to these…

  18. Palliative Care (United States)

    ... you are a partner with the palliative care team as you all work toward the same goal — providing the best quality of life for your child for as ... Care for Children With Terminal Illness Managing Home Health Care Taking Care of You: Support ...

  19. Hospice care (United States)

    ... family a break (called respite care). Doctor services. Nursing care. Home health aide and homemaker services. Counseling. Medical ... may be given in other locations, including: A nursing home A ... in charge of care is called the primary care giver. This may ...

  20. Delivery strategies for antiparasitics. (United States)

    Kayser, Oliver; Kiderlen, Albrecht F


    Optimisation of drug carrier systems and drug delivery strategies that take into account the peculiarities of individual infectious agents and diseases are key elements of modern drug development. In the following, different aspects of a rational design for antiparasitic drug formulation will be reviewed, covering delivery systems such as nano- and microparticles, liposomes, emulsions and microemulsions, cochleates and bioadhesive macromolecules. Functional properties for each carrier system will be discussed as well as their therapeutic efficacy for parasitic diseases, including leishmaniasis, human African trypanosomiasis, human cryptosporidiosis, malaria and schistosomiasis. Critical issues for the application of drug carrier systems will be discussed, focusing on biopharmaceutical and pathophysiological parameters such as routes of application, improvement of body distribution and targeting intracellularly persisting pathogens.

  1. Social video content delivery

    CERN Document Server

    Wang, Zhi; Zhu, Wenwu


    This brief presents new architecture and strategies for distribution of social video content. A primary framework for socially-aware video delivery and a thorough overview of the possible approaches is provided. The book identifies the unique characteristics of socially-aware video access and social content propagation, revealing the design and integration of individual modules that are aimed at enhancing user experience in the social network context. The change in video content generation, propagation, and consumption for online social networks, has significantly challenged the traditional video delivery paradigm. Given the massive amount of user-generated content shared in online social networks, users are now engaged as active participants in the social ecosystem rather than as passive receivers of media content. This revolution is being driven further by the deep penetration of 3G/4G wireless networks and smart mobile devices that are seamlessly integrated with online social networking and media-sharing s...

  2. Pyomyositis after vaginal delivery.

    LENUS (Irish Health Repository)

    Gaughan, Eve


    Pyomyositis is a purulent infection of skeletal muscle that arises from haematogenous spread, usually with abscess formation. It can develop after a transient bacteraemia of any cause. This type of infection has never been reported before in the literature after vaginal delivery. A 34-year-old woman had progressive severe pain in the left buttock and thigh and weakness in the left lower limb day 1 post spontaneous vaginal delivery. MRI showed severe oedema of the left gluteus, iliacus, piriformis and adductor muscles of the left thigh and a small fluid collection at the left hip joint. She was diagnosed with pyomyositis. She had fever of 37.9°C immediately postpartum and her risk factors for bacteraemia were a mild IV cannula-associated cellulitis and labour itself. She required prolonged treatment with antibiotics before significant clinical improvement was noted.

  3. Mucoadhesive drug delivery systems

    Directory of Open Access Journals (Sweden)

    Rahamatullah Shaikh


    Full Text Available Mucoadhesion is commonly defined as the adhesion between two materials, at least one of which is a mucosal surface. Over the past few decades, mucosal drug delivery has received a great deal of attention. Mucoadhesive dosage forms may be designed to enable prolonged retention at the site of application, providing a controlled rate of drug release for improved therapeutic outcome. Application of dosage forms to mucosal surfaces may be of benefit to drug molecules not amenable to the oral route, such as those that undergo acid degradation or extensive first-pass metabolism. The mucoadhesive ability of a dosage form is dependent upon a variety of factors, including the nature of the mucosal tissue and the physicochemical properties of the polymeric formulation. This review article aims to provide an overview of the various aspects of mucoadhesion, mucoadhesive materials, factors affecting mucoadhesion, evaluating methods, and finally various mucoadhesive drug delivery systems (buccal, nasal, ocular, gastro, vaginal, and rectal.

  4. Cooperation in Care: Integration of care in networks by steering, coordination and learning

    NARCIS (Netherlands)

    J.D.H. van Wijngaarden (Jeroen)


    textabstractIntegration of care delivery is a central theme in many Western countries. This is stimulated through various developments in health care and expectations of policy makers, managers, practitioners and researchers. First of all healthcare needs are changing and costs are rising because

  5. Cationic Bolaamphiphiles for Gene Delivery (United States)

    Tan, Amelia Li Min; Lim, Alisa Xue Ling; Zhu, Yiting; Yang, Yi Yan; Khan, Majad


    Advances in medical research have shed light on the genetic cause of many human diseases. Gene therapy is a promising approach which can be used to deliver therapeutic genes to treat genetic diseases at its most fundamental level. In general, nonviral vectors are preferred due to reduced risk of immune response, but they are also commonly associated with low transfection efficiency and high cytotoxicity. In contrast to viral vectors, nonviral vectors do not have a natural mechanism to overcome extra- and intracellular barriers when delivering the therapeutic gene into cell. Hence, its design has been increasingly complex to meet challenges faced in targeting of, penetration of and expression in a specific host cell in achieving more satisfactory transfection efficiency. Flexibility in design of the vector is desirable, to enable a careful and controlled manipulation of its properties and functions. This can be met by the use of bolaamphiphile, a special class of lipid. Unlike conventional lipids, bolaamphiphiles can form asymmetric complexes with the therapeutic gene. The advantage of having an asymmetric complex lies in the different purposes served by the interior and exterior of the complex. More effective gene encapsulation within the interior of the complex can be achieved without triggering greater aggregation of serum proteins with the exterior, potentially overcoming one of the great hurdles faced by conventional single-head cationic lipids. In this review, we will look into the physiochemical considerations as well as the biological aspects of a bolaamphiphile-based gene delivery system.

  6. Starch Applications for Delivery Systems (United States)

    Li, Jason


    Starch is one of the most abundant and economical renewable biopolymers in nature. Starch molecules are high molecular weight polymers of D-glucose linked by α-(1,4) and α-(1,6) glycosidic bonds, forming linear (amylose) and branched (amylopectin) structures. Octenyl succinic anhydride modified starches (OSA-starch) are designed by carefully choosing a proper starch source, path and degree of modification. This enables emulsion and micro-encapsulation delivery systems for oil based flavors, micronutrients, fragrance, and pharmaceutical actives. A large percentage of flavors are encapsulated by spray drying in today's industry due to its high throughput. However, spray drying encapsulation faces constant challenges with retention of volatile compounds, oxidation of sensitive compound, and manufacturing yield. Specialty OSA-starches were developed suitable for the complex dynamics in spray drying and to provide high encapsulation efficiency and high microcapsule quality. The OSA starch surface activity, low viscosity and film forming capability contribute to high volatile retention and low active oxidation. OSA starches exhibit superior performance, especially in high solids and high oil load encapsulations compared with other hydrocolloids. The submission is based on research and development of Ingredion

  7. Managed care under siege. (United States)

    Epstein, R A


    Managed Care Organizations (MCOs) are frequently criticized for their marketing mistakes. Often that criticism is leveled against an implicit benchmark of an ideal competitive market or an ideal system of government provision. But any accurate assessment in the choice of health care organizations always requires a comparative measure of error rates. These are high in the provision of health care, given the inherent uncertainties in both the cost and effectiveness of treatment. But the continuous and rapid evolution of private health care mechanisms is, in the absence of regulation, more likely to secure access and contain costs than any system of government regulation. State regulation is subject to the risk of capture and to the sluggish and acquisitive behavior of state run monopolies. The proposed fixes for the MCOs (rights to specialists, access to physicians outside the network, guaranteed emergency room access) are likely, when imposed from without, to cost more than they are worth. The long-term risk is that markets will fail under regulation, paving the way for greater losses from massive government control of the health care delivery system.

  8. Transdermal Delivery of Proteins


    Kalluri, Haripriya; Banga, Ajay K.


    Transdermal delivery of peptides and proteins avoids the disadvantages associated with the invasive parenteral route of administration and other alternative routes such as the pulmonary and nasal routes. Since proteins have a large size and are hydrophilic in nature, they cannot permeate passively across the skin due to the stratum corneum which allows the transport of only small lipophilic drug molecules. Enhancement techniques such as chemical enhancers, iontophoresis, microneedles, electro...

  9. A four phase development model for integrated care services in the Netherlands

    NARCIS (Netherlands)

    M.M.N. Minkman (Mirella); C.T.B. Ahaus (Kees); R. Huijsman (Robbert)


    textabstractBackground. Multidisciplinary and interorganizational arrangements for the delivery of coherent integrated care are being developed in a large number of countries. Although there are many integrated care programs worldwide, the process of developing these programs and interorganizational

  10. A four phase development model for integrated care services in the Netherlands

    NARCIS (Netherlands)

    Minkman, Mirella M. N.; Ahaus, Kees T. B.; Huijsman, Robbert


    Background: Multidisciplinary and interorganizational arrangements for the delivery of coherent integrated care are being developed in a large number of countries. Although there are many integrated care programs worldwide, the process of developing these programs and interorganizational collaborati

  11. Recovering from Delivery (United States)

    ... stops producing milk — usually within a few days. Episiotomy Care Continue sitz baths (sitting in just a ... the bleeding increases had a C-section or episiotomy and the incision becomes very red or swollen ...

  12. Integrated care pathways and task shifting

    Directory of Open Access Journals (Sweden)

    Linda Panton


    Full Text Available Delivery of HIV care has evolved over the last 10 years, and nurse specialists are a driving force in developing new pathways to enhance patient care. Despite the continued rise in numbers of people living with HIV, the financial constraints on the NHS have unfortunately resulted in a reduction in service provision. Experienced nurses are integral to patient care management. They not only provide standardized care for stable patients, therefore increasing consultant capacity for the more complex medical patient, but have a degree of flexibility that allows newly diagnosed patients quick access to care and support. With a strong emphasis being placed on an integrated and collaborative multidisciplinary team approach, to ensure patients receive the same standard of care, Scotland's HIV centres follow an integrated care pathway. The nurse oversees the completion of this document and co-ordinates the pathway of care depending on the clinical need. Nurses develop and maintain necessary partnerships between primary care, specialist care, psychological services, social care and third sector support services. The nurse case load continues to expand and diversify. Stable patients may be maintained on therapy but are living with a stigmatized long-term chronic condition and rely on the nurse as a point of contact to access advice and support readily. The more chaotic and vulnerable clients with complex care needs require the nurse to co-ordinate their care, ensuring the appropriate agencies remain involved. Overseeing the transition of care to other units and tracing patients who are lost to follow up is also a necessity, as retention in care is paramount for the continued improvement in clinical outcomes. The contribution that specialist nurses make to the provision of HIV care is valuable and will continue to play a large role in the delivery of such care.

  13. Nanocarriers for skin delivery of cosmetic antioxidants

    Directory of Open Access Journals (Sweden)

    Lucia Montenegro


    Full Text Available The demand of natural skin care products is steadily growing since consumers perceive them as safe. Currently, cosmetic manufacturers are focusing their efforts on developing innovative natural products to address skin-aging signs, thus meeting consumers’ needs of healthy appearance and well-being. To prevent or treat skin aging, topical supplementation with antioxidant is regarded as one of the most promising strategies. However, most antioxidants presently used in skin care formulations show unfavorable physicochemical properties such as excessive lipophilicity or hydrophilicity, chemical instability and poor skin penetration that actively limit their effectiveness after topical application. Therefore, nanocarriers such as liposomes, niosomes, microemulsions and nanoparticles have been widely investigated as delivery systems for antioxidants to improve their beneficial effects in the treatment of skin aging. In this article, the antioxidants most commonly used in anti-aging cosmetic products will be reviewed along with the nanocarriers designed to improve their safety and effectiveness.

  14. Critical Care Glucose Point-of-Care Testing. (United States)

    Narla, S N; Jones, M; Hermayer, K L; Zhu, Y

    Maintaining blood glucose concentration within an acceptable range is a goal for patients with diabetes mellitus. Point-of-care glucose meters initially designed for home self-monitoring in patients with diabetes have been widely used in the hospital settings because of ease of use and quick reporting of blood glucose information. They are not only utilized for the general inpatient population but also for critically ill patients. Many factors affect the accuracy of point-of-care glucose testing, particularly in critical care settings. Inaccurate blood glucose information can result in unsafe insulin delivery which causes poor glucose control and can be fatal. Healthcare professionals should be aware of the limitations of point-of-care glucose testing. This chapter will first introduce glucose regulation in diabetes mellitus, hyperglycemia/hypoglycemia in the intensive care unit, importance of glucose control in critical care patients, and pathophysiological variables of critically ill patients that affect the accuracy of point-of-care glucose testing. Then, we will discuss currently available point-of-care glucose meters and preanalytical, analytical, and postanalytical sources of variation and error in point-of-care glucose testing.

  15. Skilled care at birth among rural women in Nepal: practice and challenges. (United States)

    Dhakal, Sulochana; van Teijlingen, Edwin; Raja, Edwin Amalraj; Dhakal, Keshar Bahadur


    In Nepal, most births take place at home, and many, particularly in rural areas, are not attended by a skilled birth attendant. The main objectives of the study were to assess the use of skilled delivery care and barriers to access such care in a rural community and to assess health problems during delivery and seeking care. This cross-sectional study was carried out in two Village Development Committees in Nepal in 2006. In total, 150 women who had a live birth in the 24 months preceding the survey were interviewed using a structured questionnaire. The sample population included married women aged 15-49 years. Forty-six (31%) women delivered their babies at hospital, and 104 (69%) delivered at home. The cost of delivery at hospital was significantly (p access skilled delivery care were: distance to hospital, lack of transportation, lack of awareness on delivery care, and cost. The main reasons for seeking intrapartum care were long labour, retained placenta, and excessive bleeding. Only a quarter of women sought care immediately after problems occurred. The main reasons seeking care late were: the woman or her family not perceiving that there was a serious problem, distance to health facility, and lack of transport. The use of skilled birth attendants at delivery among rural women in Nepal is very poor. Home delivery by unskilled birth attendants is still a common practice among them. Many associated factors relating to the use of skilled delivery care that were identified included age, education and occupation of women, and education and occupation of husbands. Therefore, the availability of skilled delivery care services at the community, initiation of a primary health centre with skilled staff for delivery, and increasing awareness among women to seek skilled delivery care are the best solution.

  16. Instruments to assess integrated care

    DEFF Research Database (Denmark)

    Lyngsø, Anne Marie; Godtfredsen, Nina Skavlan; Høst, Dorte


    INTRODUCTION: Although several measurement instruments have been developed to measure the level of integrated health care delivery, no standardised, validated instrument exists covering all aspects of integrated care. The purpose of this review is to identify the instruments concerning how to mea...... was prevalent. It is uncertain whether development of a single 'all-inclusive' model for assessing integrated care is desirable. We emphasise the continuing need for validated instruments embedded in theoretical contexts.......INTRODUCTION: Although several measurement instruments have been developed to measure the level of integrated health care delivery, no standardised, validated instrument exists covering all aspects of integrated care. The purpose of this review is to identify the instruments concerning how...... to measure the level of integration across health-care sectors and to assess and evaluate the organisational elements within the instruments identified. METHODS: An extensive, systematic literature review in PubMed, CINAHL, PsycINFO, Cochrane Library, Web of Science for the years 1980-2011. Selected...

  17. Evolution of self-care education. (United States)

    Ambizas, Emily M; Bastianelli, Karen M S; Ferreri, Stefanie P; Haines, Seena L; Orr, Katherine Kelly; Stutz, Misty M; Vanamburgh, Jenny A; Wilhelm, Miranda


    During the past 15 years, the curriculum content for nonprescription medication and self-care therapeutics has expanded significantly. Self-care courses ranging from stand-alone, required courses to therapeutic content and skills laboratories, have evolved in colleges and schools of pharmacy to accommodate rapid changes related to nonprescription medications and to meet the needs of students. The design of and content delivery methods used in self-care courses vary among institutions. Teaching innovations such as team-based learning, role playing/vignettes, videos, and social media, as well as interdisciplinary learning have enhanced delivery of this content. Given that faculty members train future pharmacists, they should be familiar with the new paradigms of Nonprescription Safe Use Regulatory Expansion (NSURE) Initiative, nonprescription medications for chronic diseases, and the growing trends of health and wellness in advancing patient-care initiatives. This paper reviews the significant changes that may be impacting self-care curriculums in the United States.

  18. Obstetric Care Consensus No. 4: Periviable Birth. (United States)


    Approximately 0.5% of all births occur before the third trimester of pregnancy, and these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. A recent executive summary of proceedings from a joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time for administration of antenatal steroids, antibiotics to prolong latency after preterm premature rupture of membranes or for intrapartum group B streptococci prophylaxis, and delivery, including cesarean delivery, for concern regarding fetal well-being or fetal malpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family counseling with the goal of

  19. Measuring integrated care

    DEFF Research Database (Denmark)

    Strandberg-Larsen, Martin


    Permanente has been put forward as an example for European healthcare systems to follow, although the evidence base is far from conclusive. The thesis has five objectives: 1) To contribute to the understanding of the concept of integration in healthcare systems and to identify measurement methods to capture...... the multi-dimensional aspects of integrated healthcare delivery. 2) To assess the level of integration of the Danish healthcare system. 3) To assess the use of joint health plans as a tool for coordination between the regional and local level in the Danish healthcare system. 4) To compare the inputs...... and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine...

  20. Home and community care sector accountability. (United States)

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


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

  1. Careful telemedicine planning limits costly liability exposure. (United States)

    Edelstein, S A


    Recent Federal and state legislation and new payment opportunities from Medicare, Medicaid, and private payers may make it possible to offer telemedicine as a viable, cost-effective alternative to traditional care delivery in communities where access to health care is limited. Originally, nonexistent payment and expensive technology held back telemedicine but, these barriers are giving way to specific applications that can yield dramatic cost savings for group practices in the delivery of medical care while adding features and benefits not typically available in traditional delivery settings. Before joining a telemedicine network, group practices need to negotiate a variety of legal issues related to the corporate practice of medicine, patient confidentiality and privacy, malpractice, informed consent, licensure and credentialing, intellectual property, Medicare and Medicaid payment, fraud and abuse, medical device regulation, and antitrust.

  2. Anticipating the effect of the Patient Protection and Affordable Care Act for patients with urologic cancer. (United States)

    Ellimoottil, Chandy; Miller, David C


    The Affordable Care Act seeks to overhaul the US health care system by providing insurance for more Americans, improving the quality of health care delivery, and reducing health care expenditures. Although the law's intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the Affordable Care Act, including the proposed insurance expansion, payment and delivery system reforms (e.g., bundled payments and Accountable Care Organizations), and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may affect patients with urologic cancers.

  3. Cultural and religious aspects of care in the intensive care unit within the context of patient-centred care. (United States)

    Danjoux, Nathalie; Hawryluck, Laura; Lawless, Bernard


    On January 31, 2007, Ontario's Critical Care Strategy hosted a workshop for healthcare providers examining cultural and religious perspectives on patient care in the intensive care unit (ICU). The workshop provided an opportunity for the Ministry of Health and Long-Term Care (MOHLTC) to engage service providers and discuss important issues regarding cultural and religious perspectives affecting critical care service delivery in Ontario. While a favourable response to the workshop was anticipated, the truly remarkable degree to which the more than 200 front-line healthcare providers, policy developers, religious and cultural leaders, researchers and academics who were in attendance embraced the need for this type of dialogue to take place suggests that discussion around this and other "difficult" issues related to care in a critical care setting is long overdue. Without exception, the depth of interest in being able to provide patient-centred care in its most holistic sense--that is, respecting all aspects of the patients' needs, including cultural and religious--is a top-of-mind issue for many people involved in the healthcare system, whether at the bedside or the planning table. This article provides an overview of that workshop, the reaction to it, and within that context, examines the need for a broad-based, non-judgmental and respectful approach to designing care delivery in the ICU. The article also addresses these complex and challenging issues while recognizing the constant financial and human resource constraints and the growing demand for care that is exerting tremendous pressure on Ontario's limited critical care resources. Finally, the article also explores the healthcare system's readiness and appetite for an informed, intelligent and respectful debate on the many issues that, while often difficult to address, are at the heart of ensuring excellence in critical care delivery.

  4. Multifunctional Nanoparticles for Drug Delivery Applications Imaging, Targeting, and Delivery

    CERN Document Server

    Prud'homme, Robert


    This book clearly demonstrates the progression of nanoparticle therapeutics from basic research to applications. Unlike other books covering nanoparticles used in medical applications, Multifunctional Nanoparticles for Drug Delivery Applications presents the medical challenges that can be reduced or even overcome by recent advances in nanoscale drug delivery. Each chapter highlights recent progress in the design and engineering of select multifunctional nanoparticles with topics covering targeting, imaging, delivery, diagnostics, and therapy.

  5. Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care



    Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need for various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technolog...

  6. Experts Foresee a Major Shift From Inpatient to Ambulatory Care


    Beans, Bruce E.


    An American Society of Health-System Pharmacists Research and Education Foundation report predicts trends in health care delivery and financing, drug development and therapeutics, pharmaceutical marketplace, pharmacy workforce, and more.

  7. What Role Does Obstetrical Care Play in Childbirth? (United States)

    ... Research Planning Scientific Resources Research A-Z Topics Obstetrics Overview Condition Information What medical care is provided? ... during labor and delivery. 4 American Board of Obstetrics and Gynecology. (n.d.). Frequently asked questions . Retrieved ...

  8. Beliefs and taboos related to the care after delivery: their meaning for a women group Creencias y tabúes relacionados al cuidado en el postparto: el significado para un grupo de mujeres Crenças e tabus relacionados ao cuidado no pós-parto: o significado para um grupo de mulheres

    Directory of Open Access Journals (Sweden)

    Juliana Stefanello


    Full Text Available OBJECTIVE: To identify the meaning of care in the puerperal phase, within the family context. METHODS: It is a qualitative research, developed with 12 puerperal women and their relatives, who helped them with care after delivery. Data collection was performed by means of semi-structured interviews. The data were analyzed based on the technique of thematic content analysis. RESULTS: In the postnatal period, care needs to be doubled, as it affects mother and child, besides the body vulnerability, which is open to diseases. In articulation with these ideas, the recommendations and restrictions as components of postpartum care are justified. CONCLUSION: Care in the puerperal phase is a feminine practice filled with beliefs and taboos that grants women with power of agents in this process, since she bears the knowledge of many generations at the same time that they act as subjects and reinvent the previously established systems, constructing themselves as mothers.OBJETIVO: Identificar los significados del cuidado en la fase puerperal en el contexto familiar. MÉTODOS: Se trata de una investigación cualitativa, desarrollada con 12 puérperas y respectivos familiares (11 que las auxiliaban en el cuidado del postparto. Se utilizó entrevistas semi-estructuradas. Los datos fueron analizados con base en la técnica de análisis de contenido, modalidad temática. RESULTADOS: En el puerperio es preciso tener un cuidado extremo, por tener efectos en la madre y el hijo además de la vulnerabilidad del cuerpo, susceptible a enfermedades. Articuladas a estas ideas es que se justifican las recomendaciones y restricciones como componentes del cuidado en el postparto. CONCLUSIÓN: El cuidado en la fase puerperal es una práctica femenina permeada de creencias y tabúes, que otorga a las mujeres un poder de agentes en ese proceso, ya que traen consigo conocimientos de muchas generaciones a la vez que actúan como sujetos y reinventan sistemas establecidos

  9. Pin care (United States)

    ... gov/pubmed/24302374 . Nagy K. Discharge instructions for wound cares. The American Association of the Surgery of Trauma. . Accessed May 13, 2016.

  10. Palliative Care (United States)

    ... possessions to others, write a letter or a poem or compose a song, or decide what they ... One Year Off Treatment Transitioning to Adult Care Long-Term Follow-Up Care Coping With Cancer Overview ...

  11. Metrology for drug delivery. (United States)

    Lucas, Peter; Klein, Stephan


    In various recently published studies, it is argued that there are underestimated risks with infusion technology, i.e., adverse incidents believed to be caused by inadequate administration of the drugs. This is particularly the case for applications involving very low-flow rates, i.e., metrological infrastructure for low-flow rates. Technical challenges such as these were the reason a European research project "Metrology for Drug Delivery" was started in 2011. In this special issue of Biomedical Engineering, the results of that project are discussed.

  12. Comparing Care

    NARCIS (Netherlands)

    Evert Pommer; Isolde Woittiez; John Stevens


    Home care is one of the most important means of compensating for disabilities and ensuring continuity in people's daily functioning. Home care services in the Netherlands have recently been transferred from a national social security provision for long-term care to a local social service. In most ot

  13. Health care law versus constitutional law. (United States)

    Hall, Mark A


    National Federation of Independent Business v. Sebelius, the Supreme Court's ruling on the Patient Protection and Affordable Care Act, is a landmark decision - both for constitutional law and for health care law and policy. Others will study its implications for constitutional limits on a range of federal powers beyond health care. This article considers to what extent the decision is also about health care law, properly conceived. Under one view, health care law is the subdiscipline that inquires how courts and government actors take account of the special features of medicine that make legal or policy issues especially problematic - rather than regarding health care delivery and finance more generically, like most any other economic or social enterprise. Viewed this way, the opinions from the Court's conservative justices are mainly about general constitutional law principles. In contrast, Justice Ruth Bader Ginsburg's dissenting opinion for the four more liberal justices is just as much about health care law as it is about constitutional law. Her opinion gives detailed attention to the unique features of health care finance and delivery in order to inform her analysis of constitutional precedents and principles. Thus, the Court's multiple opinions give a vivid depiction of the compelling contrasts between communal versus individualistic conceptions of caring for those in need, and between health care and health insurance as ordinary commodities versus ones that merit special economic, social, and legal status.

  14. Uniform guidelines improve client care. (United States)

    Barnett, B


    Uniform national guidelines on the delivery of family planning methods and services improve client care, assuming these guidelines are based on current scientific information. Compliance with these guidelines yields safe and efficient delivery of family planning services. Service providers need information, training, supplies, and guidelines to deliver quality services. Guidelines contribute to consistency among family planning programs in different settings. Even though clinics may not provide the same services, the guidelines allow them to provide the same standards of care. Specifically, eligibility criteria, contraindications, and follow-up schedules are the same regardless of the service delivery point. Various international health organizations (such as World Health Organization, USAID, Program for International Training in Health, International Planned Parenthood Federation, and Association for Voluntary Surgical Contraception) have developed guidelines for family planning service delivery. Governments can use these documents to develop national family planning guidelines and policies. They should adapt the guidelines to local needs and consider program resources. After development of the national guidelines, training, workshops, and dissemination of written materials should be provided for policymakers, physicians, nurses, and other health providers. Countries that have either developed or are working to draft their own national guidelines are Cameroon, Ghana, Mexico, and Nepal.

  15. Future trends in health and health care: implications for social work practice in an aging society. (United States)

    Spitzer, William J; Davidson, Kay W


    Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the "graying of America" promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.

  16. Early Childhood Service Delivery for Families Living with Childhood Disability: Disabling Families through Problematic Implicit Ideology (United States)

    Breen, Lauren J.


    The aim of this paper is to unpack the implicit ideology underpinning early childhood service delivery for families living with childhood disability. The family as the unit of care is central to the philosophy and practice of early childhood services. However, the practice of family-centred care can be problematic; it is based upon neo-liberal…

  17. Primary Care Clinics and Accountable Care Organizations

    Directory of Open Access Journals (Sweden)

    Judith Ortiz PhD


    Full Text Available Background: The Accountable Care Organization (ACO is one of the new models of health care delivery in the United States. To date, little is known about the characteristics of health care organizations that have joined ACOs. We report on the findings of a survey of primary care clinics, the objective of which was to investigate the opinions of clinic management about participation in ACOs and the characteristics of clinic organizational structure that may contribute to joining ACOs or be willing to do so. Methods: A 27-item survey questionnaire was developed and distributed by mail in 3 annual waves to all Rural Health Clinics (RHCs in 9 states. Two dependent variables—participation in ACOs and willingness to join ACOs—were created and analyzed using a generalized estimating equation approach. Results: A total of 257 RHCs responded to the survey. A small percentage (5.2% of the respondent clinics reported that they were participating in ACOs. Rural Health Clinics in isolated areas were 78% less likely to be in ACOs (odds ratio = 0.22, P = .059. Nonprofit RHCs indicated a higher willingness to join an ACO than for-profit RHCs (B = 1.271, P = .054. There is a positive relationship between RHC size and willingness to join an ACO (B = 0.402, P = .010. Conclusion: At this early stage of ACO development, many RHC personnel are unfamiliar with the ACO model. Rural providers’ limited technological and human resources, and the lack of ACO development in rural areas, may delay or prevent their participation in ACOs.

  18. Intrapartum considerations in prenatal care. (United States)

    Ehrenberg, Hugh M


    The epidemic of obesity continues to grow undaunted, promising to affect the lives of more women of childbearing age. The challenges facing those charged with obstetrical care of the obese may require variation in care from forethought and planning, to consultation or referral for care at specialized centers. The routine management of late pregnancy must take into account the increase in risk for late fetal loss, failed induction and trial of labor after cesarean delivery, and postcesarean complications, such as wound-related morbidity and venous thromboembolism. Awareness of prolonged labor curves and the risk of shoulder dystocia must also be part of the management of labor. The data regarding many interventions attempted on behalf of these at risk gravidas are rudimentary but may allow for modifications in care that will positively impact outcomes for mother and child.

  19. Teamwork in obstetric critical care. (United States)

    Guise, Jeanne-Marie; Segel, Sally


    Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well trained and competent medically, they have not traditionally been trained in how to work well as part of a team. Given the complexity and acuity of critical care medicine, which often relies on more than one medical team, teamwork skills are essential. This chapter discusses the history and importance of teamwork in high-reliability fields, reviews key concepts and skills in teamwork, and discusses approaches to training and working in teams.

  20. Magnetic targeted drug delivery

    Directory of Open Access Journals (Sweden)

    Timothy Wiedmann


    Full Text Available Lung cancer is the most common cause of death from cancer in both men and women. Treatment by intravenous or oral administration of chemotherapy agents results in serious and often treatment-limiting side effects. Delivery of drugs directly to the lung by inhalation of an aerosol holds the promise of achieving a higher concentration in the lung with lower blood levels. To further enhance the selective lung deposition, it may be possible to target deposition by using external magnetic fields to direct the delivery of drug coupled to magnetic particles. Moreover, alternating magnetic fields can be used to induce particle heating, which in turn controls the drug release rate with the appropriate thermal sensitive material.With this goal, superparamagetic nanoparticles (SPNP were prepared and characterized, and enhanced magnetic deposition was demonstrated in vitro and in vivo. SPNPs were also incorporated into a lipid-based/SPNP aerosol formulation, and drug release was shown to be controlled by thermal activation. Because of the inherent imaging potential of SPNPs, this use of nanotechnology offers the possibility of coupling the diagnosis of lung cancer to drug release, which perhaps will ultimately provide the “magic bullet” that Paul Ehrlich originally sought.