WorldWideScience

Sample records for care delivery r01

  1. Health care delivery systems.

    OpenAIRE

    Stevens, F; Zee, J. van der

    2007-01-01

    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective, meaningful, and socially accepted. From a sociological point of view, the analysis of health care delivery systems implies recognition of their distinct history over time, their specific values an...

  2. Health care delivery systems.

    NARCIS (Netherlands)

    Stevens, F.; Zee, J. van der

    2007-01-01

    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective,

  3. Care platforms: a basic building block for care delivery.

    Science.gov (United States)

    Bohmer, Richard M J; Lawrence, David M

    2008-01-01

    Without significant operational reform within the nation's health care delivery organizations, new financing models, payment systems, or structures are unlikely to realize their promise. Adapting insights from high-performing companies in other high-risk, high-cost, science- and technology-based industries, we propose the "care platform" as an organizing framework for internal operations in diversified provider organizations to increase the quality, reliability, and efficiency of care delivery. A care platform organizes "care production" around similar work, rather than organs or specialties; integrates standard and custom care processes; and surrounds them with specifically configured information and business systems. Such organizational designs imply new roles for physicians. PMID:18780920

  4. Optimizing Cancer Care Delivery through Implementation Science

    Directory of Open Access Journals (Sweden)

    Heather B Neuman

    2016-01-01

    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.

  5. Health care and health care delivery in Greenland

    OpenAIRE

    Niclasen, Birgit; Mulvad, Gert

    2012-01-01

    Objectives. To describe the health care system and health care delivery in Greenland. Study design and method. This was a literature study that included literature and articles searched in PubMed published from 1989 to 2009 about health care in Greenland. Results. The health care system is a publicly financed governmental responsibility. Its major challenges are limited economic resources, Greenland’s demographic structure, rapid epidemiological changes, increased public demand for specialize...

  6. Models of care and delivery

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2014-01-01

    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...

  7. Models of care and delivery

    Directory of Open Access Journals (Sweden)

    Jens Lundgren

    2014-11-01

    Full Text Available 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 with community clinics for injecting drug-dependent persons is also being implemented. Shared care models require oversight to ensure that primary responsibility is defined for the persons overall health situation, for screening of co-morbidities, defining indication to treat comorbidities, prescription of non-HIV medicines, etc. Intelligent bioinformatics platforms (i.e. generation of alerts if course of care deviates from a prior defined normality are being developed to assist in providing this oversight and to provide measure of quality. Although consensus exists to assess basic quality indicators of care, a comprehensive set of harmonized indicators are urgently needed to define best practise standards via benchmarking. Such a tool will be central to guide ongoing discussions on restructuring of models, as quality of care should not be compromised in this process.

  8. A telemedicine health care delivery system

    Science.gov (United States)

    Sanders, Jay H.

    1991-01-01

    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.

  9. Guidelines for Psychological Practice in Health Care Delivery Systems

    Science.gov (United States)

    American Psychologist, 2013

    2013-01-01

    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…

  10. Small area variations in health care delivery.

    Science.gov (United States)

    Wennberg, J; Gittelsohn

    1973-12-14

    Health information about total populations is a prerequisite for sound decision-making and planning in the health care field. Experience with a population-based health data system in Vermont reveals that there are wide variations in resource input, utilization of services, and expenditures among neighboring communities. Results show prima facie inequalities in the input of resources that are associated with income transfer from areas of lower expenditure to areas of higher expenditure. Variations in utilization indicate that there is considerable uncertainty about the effectiveness of different levels of aggregate, as well as specific kinds of, health services. Informed choices in the public regulation of the health care sector require knowledge of the relation between medical care systems and the population groups being served, and they should take into account the effect of regulation on equality and effectiveness. When population-based data on small areas are available, decisions to expand hospitals, currently based on institutional pressures, can take into account a community's regional ranking in regard to bed input and utilization rates. Proposals by hospitals for unit price increases and the regulation of the actuarial rate of insurance programs can be evaluated in terms of per capita expenditures and income transfer between geographically defined populations. The PSRO's can evaluate the wide variations in level of services among residents of different communities. Coordinated exercise of the authority vested in these regulatory programs may lead to explicit strategies to deal directly with inequality and uncertainty concerning the effectiveness of health care delivery. Population-based health information systems, because they can provide information on the performance of health care systems and regulatory agencies, are an important step in the development of rational public policy for health. PMID:4750608

  11. Breastfeeding: guidance received in prenatal care, delivery and postpartum care

    Directory of Open Access Journals (Sweden)

    Mayara Caroline Barbieri

    2014-07-01

    Full Text Available The aim of the study was to analyze the guidelines considering breastfeeding given by health professionals to women during prenatal care, delivery and postpartum care. Quantitative and descriptive work developed at Regional Pinheiros, Maringá-PR, from the registry in SisPreNatal, from May to August 2009. Data were collected through interviews conducted with parents at home, using a structured instrument. Participants were 36 mothers, most of whom received counseling for breastfeeding during prenatal (58.3%, maternity (87.6% and in nursing visits to newborn (84.6%. The prevalence of exclusive breastfeeding was 37.5%, even with the end of maternity leave. The rate is still below the recommended by the World Health Organization for exclusive breastfeeding. The present results may contribute to the monitoring of health actions and development of new strategies in the maintenance of exclusive breastfeeding.

  12. Oregon's experiment in health care delivery and payment reform: coordinated care organizations replacing managed care.

    Science.gov (United States)

    Howard, Steven W; Bernell, Stephanie L; Yoon, Jangho; Luck, Jeff; Ranit, Claire M

    2015-02-01

    To control Medicaid costs, improve quality, and drive community engagement, the Oregon Health Authority introduced a new system of coordinated care organizations (CCOs). While CCOs resemble traditional Medicaid managed care, they have differences that have been deliberately designed to improve care coordination, increase accountability, and incorporate greater community governance. Reforms include global budgets integrating medical, behavioral, and oral health care and public health functions; risk-adjusted payments rewarding outcomes and evidence-based practice; increased transparency; and greater community engagement. The CCO model faces several implementation challenges. If successful, it will provide improved health care delivery, better health outcomes, and overall savings. PMID:25480844

  13. Searching for the Holy Grail of Care Delivery Models.

    Science.gov (United States)

    Mensik, Jennifer

    2016-01-01

    Too often health care executives state the need for more research, knowledge, and information in staffing. Perhaps what we really need is education and support for innovation in operations. In looking for the holy grail of staffing solutions, focused attention will need to be placed on creating innovative care delivery models. Leaders who are tasked with developing innovative care delivery models must have a supportive environment and given time to be successful. PMID:27265951

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

    OpenAIRE

    R Majdzadeh; Rostamigooran, N; H Esmailzadeh; Rajabi, F.; L Doshmangir

    2013-01-01

    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 ...

  15. Health Care Delivery Performance: Service, Outcomes, and Resource Stewardship

    OpenAIRE

    Cowing, Michelle; Davino-Ramaya, Carrie M; Ramaya, Krishnan; Szmerekovsky, Joseph

    2009-01-01

    As competition intensifies within the health care industry, patient satisfaction and service quality are providing the evidentiary basis for patient outcomes. We propose a conceptual model of three interrelated areas, service, health outcomes, and resource stewardship, all affected by the clinician-patient relationship. Our model considers the perspectives of the health care organization, the clinician, and the patient to define a more comprehensive measure of health care delivery performance...

  16. Catalysts to Spiritual Care Delivery: A Content Analysis

    OpenAIRE

    Ramezani, Monir; Ahmadi, Fazlollah; Mohammadi, Eesa; Kazemnejad, Anoshirvan

    2016-01-01

    Background: Despite the paramount importance and direct relationship of spirituality and spiritual care with health and well-being, they are relatively neglected aspects of nursing care. Objectives: The aim of this study is to explore Iranian nurses’ perceptions and experiences of the facilitators of spiritual care delivery. Materials and Methods: For this qualitative content analysis study, a purposive maximum-variation sample of 17 nurses was recruited from teaching and private hospitals in...

  17. Lower Costs, Better Care- Reforming Our Health Care Delivery

    Data.gov (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...

  18. Foreseeable trends in health care delivery.

    Science.gov (United States)

    Blanton, W B

    1978-09-01

    "These trends represent the obvious call from society for health change: enlarged access to the system; reduction in the rate of rise in cost; equity in care; and increased quality in care. All of these elements except the cost objective requires not lessened but additional and redistributed resources. If this is pleasing, exert influence to reinforce the trends toward it. If not, speak now to modify the otherwise inevitable." PMID:706646

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

    CERN Document Server

    Rossi, Filippo; Masi, Maurizio

    2016-01-01

    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.

  20. 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.

    2011-01-01

    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

  1. Telemedicine in diabetes foot care delivery: health care professionals’ experience

    OpenAIRE

    Kolltveit, Beate-Christin Hope; Gjengedal, Eva; Graue, Marit; Iversen, Marjolein. M.; Thorne, Sally; Kirkevold, Marit

    2016-01-01

    Background Introducing new technology in health care is inevitably a challenge. More knowledge is needed to better plan future telemedicine interventions. Our aim was therefore to explore health care professionals’ experience in the initial phase of introducing telemedicine technology in caring for people with diabetic foot ulcers. Methods Our methodological strategy was Interpretive Description. Data were collected between 2014 and 2015 using focus groups (n = 10). Participants from home-bas...

  2. Cancer - the delivery of nursing care

    International Nuclear Information System (INIS)

    This and the preceding article (Nursing Mirror, Sept. 1, 1978) form a slightly shortened version of Chap. 5 from Vol. 2 of the book 'Oncology for Nurses and Health Care Professionals', ed. R. Tiffany, (Allen and Unwin, Oct. 1978). Teletherapy was dealt with in part 1. Part 2 is concerned with radiotherapy using radioisotope implants and applicators and unsealed sources, and with surgery and chemotherapy, including side effects of anti-tumour drugs. The physical and psychological effects on the patient of these forms of treatment are discussed, and nursing care and radiological safety precautions for both patients and nursing staff are described. (author)

  3. TQM STRATEGIES AND HEALTH CARE DELIVERIES: LESSONS FROM NIGERIA

    Directory of Open Access Journals (Sweden)

    Olawale Ibrahim Olateju

    2007-10-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Douangvichit Daovieng

    2012-01-01

    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

  5. Health care delivery for Alaska Natives: A brief overview

    OpenAIRE

    Sherry, Paul

    2004-01-01

    Objectives. Describe the Alaska Native Health Care delivery system and some of the historical elements that shaped it. Study Design. Retrospective program review. Methods. Retrospective review of existing administrative and clinical programs. Results. Over the last 10,000 -15,000 years the Alaska Native Health System developed from at traditional tribal based self-care system to a complex system that is interdependent on local, state, federal, and private insurance payers. The Alaska Tribal H...

  6. Fatigue and the delivery of medical care

    LENUS (Irish Health Repository)

    Murphy, JFA

    2011-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    R Majdzadeh

    2013-01-01

    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.

  8. A clinician-driven home care delivery system.

    Science.gov (United States)

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

    1993-12-01

    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. PMID:8242586

  9. Health care 2020: reengineering health care delivery to combat chronic disease.

    Science.gov (United States)

    Milani, Richard V; Lavie, Carl J

    2015-04-01

    Chronic disease has become the great epidemic of our times, responsible for 75% of total health care costs and the majority of deaths in the US. Our current delivery model is poorly constructed to manage chronic disease, as evidenced by low adherence to quality indicators and poor control of treatable conditions. New technologies have emerged that can engage patients and offer additional modalities in the treatment of chronic disease. Modifying our delivery model to include team-based care in concert with patient-centered technologies offers great promise in managing the chronic disease epidemic. PMID:25460529

  10. Brain-drain and health care delivery in developing countries

    Directory of Open Access Journals (Sweden)

    Yusuf Abdu Misau

    2010-09-01

    Full Text Available Migration of health workers ‘Brain drain’ is defined as the movement of health personnel in search of a better standard of living and life quality, higher salaries, access to advanced technology and more stable political conditions in different places worldwide. The debate about migration of health workers from the developing to the developed world has remained pertinent for decades now. Regardless of the push and pull factors, migration of health care workers from developing countries to developed ones, have done more harm than good on the health care deliveries in the developing countries. This article reviews the literature on the effects of cross-border migration of health care professionals.

  11. Preventive Care Delivery to Young Children With Sickle Cell Disease.

    Science.gov (United States)

    Bundy, David G; Muschelli, John; Clemens, Gwendolyn D; Strouse, John J; Thompson, Richard E; Casella, James F; Miller, Marlene R

    2016-05-01

    Preventive services can reduce the morbidity of sickle cell disease (SCD) in children but are delivered unreliably. We conducted a retrospective cohort study of children aged 2 to 5 years with SCD, evaluating each child for 14 months and expecting that he/she should receive ≥75% of days covered by antibiotic prophylaxis, ≥1 influenza immunization, and ≥1 transcranial Doppler ultrasound (TCD). We used logistic regression to quantify the relationship between ambulatory generalist and hematologist visits and preventive services delivery. Of 266 children meeting the inclusion criteria, 30% consistently filled prophylactic antibiotic prescriptions. Having ≥2 generalist, non-well child care visits or ≥2 hematologist visits was associated with more reliable antibiotic prophylaxis. Forty-one percent of children received ≥1 influenza immunizations. Children with ≥2 hematologist visits were most likely to be immunized (62% vs. 35% among children without a hematologist visit). Only 25% of children received ≥1 TCD. Children most likely to receive a TCD (42%) were those with ≥2 hematologist visits. One in 20 children received all 3 preventive services. Preventive services delivery to young children with SCD was inconsistent but associated with multiple visits to ambulatory providers. Better connecting children with SCD to hematologists and strengthening preventive care delivery by generalists are both essential. PMID:26950087

  12. Aligning payment reform and delivery innovation in emergency care.

    Science.gov (United States)

    Pines, Jesse M; McStay, Frank; George, Meaghan; Wiler, Jennifer L; McClellan, Mark

    2016-08-01

    Current alternative payment models (APMs) that move away from traditional fee-for-service payment often have explicit goals to reduce utilization in episodic settings, such as emergency departments (ED). We apply the new HHS payment reform taxonomy to illustrate a pathway to success for EDs in APMs. Despite the unique challenges faced by EDs, a variety of category 2 and 3 APMs may be applicable to EDs in the short- and long term to improve efficiency and value. Full and partially capitated models create incentives for longitudinal and episodic ED providers and payers to unite to create interventions to reduce costs. However, prospective attribution remains a challenge for EDs because of exogenous demand, which makes it important for EDs to be one of the components of capitated payment along with longitudinal providers who can exert greater control on overall care demands. The goal of payment and delivery reforms in ED care is to improve population health across the continuum of acute and longitudinal care. In order to deliver cost-conscious care, ED providers will need additional resources, expanded information, and new processes and metrics to facilitate cost-conscious decisions. Improved availability of electronic information across settings, evidence generated from developing and testing acute care-specific payment models, and engaging acute care providers directly in reform efforts will help meet these goals. PMID:27541697

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

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    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.

  14. Five focus strategies to organize health care delivery.

    Science.gov (United States)

    Peltokorpi, Antti; Linna, Miika; Malmström, Tomi; Torkki, Paulus; Lillrank, Paul Martin

    2016-03-14

    Purpose - The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations. Design/methodology/approach - First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies. Findings - The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes. Research limitations/implications - Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination. Practical implications - Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organization's strategy and key performance indicators. Originality/value - Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care. PMID:26959897

  15. Preparing a health care delivery system for Space Station

    Science.gov (United States)

    Logan, J. S.; Stewart, G. R.

    1985-01-01

    NASA's Space Station is viewed as the beginning of man's permanent presence in space. This paper presents the guidelines being developed by NASA's medical community in preparing a quality, permanent health care delivery system for Space Station. The guidelines will be driven by unique Space Station requirements such as mission duration, crew size, orbit altitude and inclination, EVA frequency and rescue capability. The approach will emphasize developing a health care system that is modular and flexible. It will also incorporate NASA's requirements for growth capability, commonality, maintainability, and advanced technology development. Goals include preventing unnecessary rescue attempts, as well as maintaining the health and safety of the crew. Proper planning will determine the levels of prevention, diagnosis, and treatment necessary to achieve these goals.

  16. Confronting the Care Delivery Challenges Arising from Precision Medicine.

    Science.gov (United States)

    Kohn, Elise C; Ivy, S Percy

    2016-01-01

    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, broader mutational profiles in solid tumors, and 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 a 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. PMID:27200294

  17. Organization and delivery of long-term care in Taiwan.

    Science.gov (United States)

    Chiu, H C

    2001-01-01

    Taiwan reached the World Health Organization (WHO) benchmark of 7% aged 65 and over for defining an aging population only as recently as 1993. With this proportion projected to double to 14% by 2020, Taiwan faces a rapid increase in need for long-term care. This article presents an account of the current service delivery system, which is divided between health and social affairs administrations, with a substantial role also taken by the Veteran Administration, and growing provision of facilities that operate outside the government-registered system. While a basic level of both institutional and community care services has developed, they are not organized into an integrated service system. Problems arising from the divisions and overlaps in responsibility are identified in relation to competition for resources, differences in regulation and eligibility, funding arrangements and misallocation of resources, and divergent views about the philosophical basis of long-term care. Other aspects of services fall under each jurisdiction, but there is also some overlap. A case study of Taiwan's second largest city, Kaohsiung City, reports the outcomes of these divisions as a thin spread of a range of services rather than a coordinated service network. Several planning exercises have been undertaken in recent years to address these problems, and although at an early stage of implementation, the outcomes of these plans are seen as shaping the future directions of long-term care in Taiwan. PMID:12216358

  18. Reorganization of craniofacial/cleft care delivery: the Massachusetts experience.

    Science.gov (United States)

    Borah, G L; Hagberg, N; Jakubiak, C; Temple, J

    1993-05-01

    Until 1989, the Commonwealth of Massachusetts operated a mandated care program known as Services for Handicapped Children (SHC) for children with cleft lip/palate or craniofacial anomalies. During the mid 1980s, the federal government reduced its block grant funds and encouraged the Commonwealth of Massachusetts to develop Project SERVE to address this changing fiscal reality. The principal outcome of Project SERVE was the recommendation that the SHC direct care programs, including all craniofacial and cleft palate clinics, should be dismantled over a number of years. However, due to the economic recession, all government funding was suddenly withdrawn from cleft palate teams and the state-run SHC clinics were abruptly dissolved. To treat patients left without coordinated care, former team members reassembled and began a new craniofacial team based at the University of Massachusetts Medical Center. Difficulties with the transition of the clinic included recruiting and retaining team members; remuneration procedures for team members; maintenance of patient records previously kept by the state; coordination of clinical/clerical responsibilities; identifying a physical locale to hold the clinics; and solicitation of referring health care provider referrals and follow-up. All these issues required specific interventions that are presented in this paper. Project SERVE, begun under federal auspices, in the Commonwealth of Massachusetts, has recently been promoted as a model for a new and improved approach to the management of cleft palate and craniofacial care delivery nationwide. Awareness of the potential for abrupt, radical change in funding for federally mandated cleft/craniofacial care is essential, and a successful transition to a medical center-based model is possible using the procedures established at our center. PMID:8338866

  19. Point-of-care technology: integration for improved delivery of care.

    Science.gov (United States)

    Gregory, Debbie; Buckner, Martha

    2014-01-01

    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"? PMID:24896558

  20. The study of optimal nursing position in health care delivery system in Iran

    OpenAIRE

    Shahshahani, Maryam Sadat; Salehi, Shayesteh; Rastegari, Mohammad; Rezayi, Abdollah

    2010-01-01

    BACKGROUND: In the recent decade, due to the overwhelming importance of health and prevention of diseases, nurses, the greatest part of the health care system, are acting in any position of the health care delivery system; because nursing have a key role in promotion of health and health care everywhere. The objective of this research was to study the desired positions of nursing in the health care delivery system in Iran. METHODS: This was a triangulation study done on three steps during 200...

  1. Infection control and changing health-care delivery systems.

    OpenAIRE

    Jarvis, W. R.

    2001-01-01

    In the past, health care was delivered mainly in acute-care facilities. Today, health care is delivered in hospital, outpatient, transitional care, long-term care, rehabilitative care, home, and private office settings. Measures to reduce health-care costs include decreasing the number of hospitals and the length of patient stays, increasing outpatient and home care, and increasing long-term care for the elderly. The home-care industry and managed care have become major providers of health ca...

  2. Unmarried at delivery. I. The mothers and their care.

    Science.gov (United States)

    Henriques, J; Golding, J; Thomas, P

    1986-12-01

    Information on 934 never married mothers (Single) were compared with 301 who were widowed, divorced or separated (Once-married) and 15 225 who were married at the time of delivery and were part of the 1970 British Births Survey. Once the maternal age and parity differences had been taken into account the major findings concerned the mothers' health behaviour and the obstetric care they received. Single and Once-married mothers were markedly less likely than the Married group to have used contraceptives in the 18 months before conception, to know accurately the date of the last menstrual period, to commence antenatal care before the third trimester, and to attend antenatal or parentcraft classes. Both groups were more likely to smoke, the Once-married group having an especially high rate of heavy smokers. Single mothers were more likely to be anaemic during pregnancy and the Once-married to have a history of bleeding. Both groups were more likely to be delivered in a consultant unit. Relatively high proportions of Single and Once-married mothers had delivered without any pain relief. PMID:3803266

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

    Science.gov (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

    2016-10-01

    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. Health Care Delivery Meets Hospitality: A Pilot Study in Radiology.

    Science.gov (United States)

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

    2015-06-01

    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. PMID:25533732

  5. Comparative analysis of quality assurance in health care delivery and higher medical education

    OpenAIRE

    Busari, Jamiu O

    2012-01-01

    Quality assurance (QA) in higher medical education involves the development, sustenance, improvement, and evaluation of the standard of training of medical professionals. In health care delivery, QA focuses on guaranteeing and maintaining a high standard of the service provided in different health care systems. When the service delivered by the care provider is in accordance with what the recipients of health care expect, then quality in health care is considered to be present. There are seve...

  6. Closing the delivery gaps in pediatric HIV care in Togo, West Africa: using the care delivery value chain framework to direct quality improvement.

    Science.gov (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

    2016-03-01

    Providing quality care for all children living with HIV/AIDS remains a global challenge and requires the development of new healthcare delivery strategies. The care delivery value chain (CDVC) is a framework that maps activities required to provide effective and responsive care for a patient with a particular disease across the continuum of care. By mapping activities along a value chain, the CDVC enables managers to better allocate resources, improve communication, and coordinate activities. We report on the successful application of the CDVC as a strategy to optimize care delivery and inform quality improvement (QI) efforts with the overall aim of improving care for Pediatric HIV patients in Togo, West Africa. Over the course of 12 months, 13 distinct QI activities in Pediatric HIV/AIDS care delivery were monitored, and 11 of those activities met or exceeded established targets. Examples included: increase in infants receiving routine polymerase chain reaction testing at 2 months (39-95%), increase in HIV exposed children receiving confirmatory HIV testing at 18 months (67-100%), and increase in patients receiving initial CD4 testing within 3 months of HIV diagnosis (67-100%). The CDVC was an effective approach for evaluating existing systems and prioritizing gaps in delivery for QI over the full cycle of Pediatric HIV/AIDS care in three specific ways: (1) facilitating the first comprehensive mapping of Pediatric HIV/AIDS services, (2) identifying gaps in available services, and (3) catalyzing the creation of a responsive QI plan. The CDVC provided a framework to drive meaningful, strategic action to improve Pediatric HIV care in Togo. PMID:27391996

  7. Viewing Health Care Delivery as Science: Challenges, Benefits, and Policy Implications

    OpenAIRE

    Pronovost, Peter J.; Goeschel, Christine A.

    2010-01-01

    The need for health services research is likely to rise rapidly as the population ages, health care costs soar, and therapeutic and diagnostic choices proliferate. Building an effective and efficient health care delivery system is a national priority. Yet the national health care quality report concludes that we lack the ability to monitor progress toward even basic quality and patient safety goals effectively.

  8. Comparison of domiciliary and institutional delivery-care practices in rural Rajasthan, India.

    Science.gov (United States)

    Iyengar, Sharad D; Iyengar, Kirti; Suhalka, Virendra; Agarwal, Kumaril

    2009-04-01

    A retrospective cross-sectional survey was conducted to assess key practices and costs relating to home- and institutional delivery care in rural Rajasthan, India. One block from each of two sample districts was covered (estimated population--279,132). Field investigators listed women who had delivered in the past three months and contacted them for structured case interview. In total, 1947 (96%) of 2031 listed women were successfully interviewed. An average of 2.4 and 1.7 care providers attended each home- and institutional delivery respectively. While 34% of the women delivered in health facilities, modem care providers attended half of all the deliveries. Intramuscular injections, intravenous drips, and abdominal fundal pressure were widely used for hastening delivery in both homes and facilities while post-delivery injections for active management of the third stage were administered to a minority of women in both the venues. Most women were discharged prematurely after institutional delivery, especially by smaller health facilities. The cost of accessing home-delivery care was Rs 379 (US$ 8) while the mean costs in facilities for elective, difficult vaginal deliveries and for caesarean sections were Rs 1336 (US$ 30), Rs 2419 (US$ 54), and Rs 11,146 (US$ 248) respectively. Most families took loans at high interest rates to meet these costs. It is concluded that widespread irrational practices by a range of care providers in both homes and facilities can adversely affect women and newborns while inadequate observance of beneficial practices and high costs are likely to reduce the benefits of institutional delivery, especially for the poor. Government health agencies need to strengthen regulation of delivery care and, especially, monitor perinatal outcomes. Family preference for hastening delivery and early discharge also require educational efforts. PMID:19489423

  9. Appropriateness in health care delivery: definitions, measurement and policy implications.

    OpenAIRE

    Lavis, J N; Anderson, G M

    1996-01-01

    A major focus of the current health care debate is the notion that a substantial proportion of the health care delivered in Canada is inappropriate. There are two types of appropriateness: appropriateness of a service and appropriateness of the setting in which care is provided (i.e., inpatient v. outpatient or home care). Measuring both types objectively requires the comparison of observed patterns of care with explicit criteria for appropriate care. The few studies of appropriateness conduc...

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

    Directory of Open Access Journals (Sweden)

    Isha Gutgutia

    2014-06-01

    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

  11. Husbands' involvement in delivery care utilization in rural Bangladesh: A qualitative study

    OpenAIRE

    Story William T; Burgard Sarah A; Lori Jody R; Taleb Fahmida; Ali Nabeel; Hoque DM Emdadul

    2012-01-01

    Abstract Background A primary cause of high maternal mortality in Bangladesh is lack of access to professional delivery care. Examining the role of the family, particularly the husband, during pregnancy and childbirth is important to understanding women's access to and utilization of professional maternal health services that can prevent maternal mortality. This qualitative study examines husbands' involvement during childbirth and professional delivery care utilization in a rural sub-distric...

  12. Implementation of genomic medicine in a health care delivery system: a value proposition?

    Science.gov (United States)

    Wade, Joanne E; Ledbetter, David H; Williams, Marc S

    2014-03-01

    The United States health care system is undergoing significant change and is seeking innovations in care delivery and reimbursement models that will lead to improved value for patients, providers, payers, and employers. Genomic medicine has the potential to be a disruptive innovation that if implemented intelligently can improve value. The article presents the perspective of the leaders of a large integrated healthcare delivery system regarding the decision to invest in implementation of genomic medicine. PMID:24619641

  13. Health care delivery to personnel of nuclear power plants in the Czech Republic

    International Nuclear Information System (INIS)

    An overview is presented of the system of health care delivery to the personnel of nuclear power plants in Temelin and Dukovany, Czechoslovakia. The system of curative and preventivd care is described in detail, including preventive examinations, rehabilitation and spa treatment. The organisational structure is also described of health care institutions and the tasks are outlined of the works health care centres. (L.O.)

  14. Comparative analysis of quality assurance in health care delivery and higher medical education

    Directory of Open Access Journals (Sweden)

    Busari JO

    2012-12-01

    Full Text Available Jamiu O BusariDepartment of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The NetherlandsAbstract: Quality assurance (QA in higher medical education involves the development, sustenance, improvement, and evaluation of the standard of training of medical professionals. In health care delivery, QA focuses on guaranteeing and maintaining a high standard of the service provided in different health care systems. When the service delivered by the care provider is in accordance with what the recipients of health care expect, then quality in health care is considered to be present. There are several factors in higher medical education and health care that are responsible for the emergence of QA. These include externally imposed obligations requiring demonstration of public accountability and responsibility from educational institutions, as well as the need for activity-specific information by policy makers as an aid for important decision-making within educational institutions. In health care delivery on the other hand, the emergence of QA is linked to the need for containing rising health care costs in the face of limited resources and to guaranteeing high quality patient care in a changing health care environment where the power relationship between doctors and patients is shifting towards patients. Although medical education can be regarded as a distinct entity in the health care industry, it still remains an inherent part of the health care delivery system. As a result, different strategies aimed at guaranteeing and assuring high standards of health care and education in many countries tend to overlap. This paper reflects on whether quality assurance in health care delivery and medical education should be seen as separate entities.Keywords: quality assurance, health care, higher medical education

  15. Medical Service Provision and Costs: Do Walk-In Clinics Differ from Other Primary Care Delivery Settings?

    OpenAIRE

    Darrel J. Weinkauf; Boris Kralj

    1998-01-01

    Reductions in health care funding by both the federal and provincial governments in recent years have focused attention on the cost-effectiveness of health care delivery, particularly on the delivery of primary care services. We use data extracted from the Ontario Health Insurance Plan (OHIP) claims database to assess differences between walk-in clinics and other primary care delivery settings in initial visit costs, follow-up visit costs, service duplication, and diagnoses treated. Our analy...

  16. Counseling and Wellness Services Integrated with Primary Care: A Delivery System That Works

    OpenAIRE

    Van Beek, Ken; Duchemin, Steve; Gersh, Geniene; Pettigrew, Susanne; Silva, Pamela; Luskin, Barb

    2008-01-01

    Introduction: The continuity and coordination of care between medical and behavioral health services is a major issue facing our health care delivery system. Barriers to basic communication between providers of medical services and providers of behavioral health services, include: no coordination of services, and poor recognition of the relationship between medical and behavioral issues.

  17. Husbands' involvement in delivery care utilization in rural Bangladesh: A qualitative study

    Directory of Open Access Journals (Sweden)

    Story William T

    2012-04-01

    Full Text Available Abstract Background A primary cause of high maternal mortality in Bangladesh is lack of access to professional delivery care. Examining the role of the family, particularly the husband, during pregnancy and childbirth is important to understanding women's access to and utilization of professional maternal health services that can prevent maternal mortality. This qualitative study examines husbands' involvement during childbirth and professional delivery care utilization in a rural sub-district of Netrokona district, Bangladesh. Methods Using purposive sampling, ten households utilizing a skilled attendant during the birth of the youngest child were selected and matched with ten households utilizing an untrained traditional birth attendant, or dhatri. Households were selected based on a set of inclusion criteria, such as approximate household income, ethnicity, and distance to the nearest hospital. Twenty semi-structured interviews were conducted in Bangla with husbands in these households in June 2010. Interviews were transcribed, translated into English, and analyzed using NVivo 9.0. Results By purposefully selecting households that differed on the type of provider utilized during delivery, common themes--high costs, poor transportation, and long distances to health facilities--were eliminated as sufficient barriers to the utilization of professional delivery care. Divergent themes, namely husbands' social support and perceived social norms, were identified as underlying factors associated with delivery care utilization. We found that husbands whose wives utilized professional delivery care provided emotional, instrumental and informational support to their wives during delivery and believed that medical intervention was necessary. By contrast, husbands whose wives utilized an untrained dhatri at home were uninvolved during delivery and believed childbirth should take place at home according to local traditions. Conclusions This study provides

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

    OpenAIRE

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

    2014-01-01

    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...

  19. The Latina Paradox: An Opportunity for Restructuring Prenatal Care Delivery

    Science.gov (United States)

    McGlade, Michael S.; Saha, Somnath; Dahlstrom, Marie E.

    2004-01-01

    Latina mothers in the United States enjoy surprisingly favorable birth outcomes despite their social disadvantages. This “Latina paradox” is particularly evident among Mexican-born women. The social and cultural factors that contribute to this paradox are maintained by community networks—informal systems of prenatal care that are composed of family, friends, community members, and lay health workers. This informal system confers protective factors that provide a behavioral context for healthy births. US-born Latinas are losing this protection, although it could be maintained with the support of community-based informal care systems. We recommend steps to harness the benefits of informal systems of prenatal care in Latino communities to meet the increasing needs of pregnant Latina women. PMID:15569952

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

    Directory of Open Access Journals (Sweden)

    Scott Reeves

    2016-03-01

    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

  1. Redesigning pharmacy delivery processes of a health care complex.

    Science.gov (United States)

    Augusto, Vincent; Xie, Xiaolan

    2009-06-01

    This paper addresses a pharmacy delivery design problem with two types of human resources: pharmacy assistants and transporters within a hospital. Each medical unit of the hospital has a mobile medicine closet which is conveyed each week by transporters to the central pharmacy for inventory assessment and refill by assistants. Transportation is carried out by foot, by tractor or by truck depending on the location. The problem consists in creating a transportation and supply planning for each day of the week in order to balance workloads for both transporters and assistants while ensuring the availability of medicine to each medical service. A two-step approach using mixed-integer linear programming formulation is proposed to determine a near optimal schedule. Numerical results are given to assess its efficiency. The proposed approach is then combined with a simulation model to redesign the delivery process of the pharmacy department of a French university teaching hospital. Methodology of this real-life reengineering study is presented and discussed. PMID:19469456

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

    Directory of Open Access Journals (Sweden)

    Giri Sabitri

    2006-08-01

    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

  3. Improving the Quality of Workers' Compensation Health Care Delivery: The Washington State Occupational Health Services Project

    OpenAIRE

    Wickizer, Thomas M.; Franklin, Gary; Plaeger-Brockway, Roy; Mootz, Robert D.

    2001-01-01

    Researchers and health policy analysts in Washington State set out to determine the extent to which administrative process changes and delivery system interventions within workers' compensation affect quality and health outcomes for injured workers. This research included a pilot project to study the effects of providing occupationally focused health care through managed care arrangements on health outcomes, worker and employer satisfaction, and medical and disability costs. Based on the resu...

  4. Comparative analysis of quality assurance in health care delivery and higher medical education

    OpenAIRE

    Busari JO

    2012-01-01

    Jamiu O BusariDepartment of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The NetherlandsAbstract: Quality assurance (QA) in higher medical education involves the development, sustenance, improvement, and evaluation of the standard of training of medical professionals. In health care delivery, QA focuses on guaranteeing and maintaining a high standard of the service provided in different health care systems. When the...

  5. Deliveries among diabetic females; a tertiary care experience

    Directory of Open Access Journals (Sweden)

    Qummry Ali Hindi

    2012-10-01

    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.

  6. Institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Region, Central Ethiopia: A Community-based cross sectional study

    OpenAIRE

    Darega, Birhanu; Dida, Nagasa; Tafese, Fikru; Ololo, Shimeles

    2016-01-01

    Background Delivery at health institutions under the care of trained health-care providers and utilization of postnatal cares services plays vital roles in promoting child survival and reducing the risk of maternal mortality. More than 80 % of maternal deaths can be prevented if pregnant women access to essential maternity cares like antenatal care, institutional delivery and postnatal care services. Thus, this study aimed to assess institutional delivery and postnatal care services utilizati...

  7. Patient satisfaction with pharmaceutical care delivery in community pharmacies

    Directory of Open Access Journals (Sweden)

    Kassam R

    2012-04-01

    Full Text Available Rosemin Kassam1, John B Collins2, Jonathan Berkowitz31School of Population and Public Health, Faculty of Medicine, 2Department of Educational Studies, Faculty of Education, 3Sauder School of Business, University of British Columbia, Vancouver, British Columbia, CanadaBackground: The purpose of this study was to validate previously published satisfaction scales in larger and more diversified patient populations; to expand the number of community pharmacies represented; to test the robustness of satisfaction measures across a broader demographic spectrum and a variety of health conditions; to confirm the three-factor scale structure; to test the relationships between satisfaction and consultation practices involving pharmacists and pharmacy students; and to examine service gaps and establish plausible norms.Methods: Patients completed a 15-question survey about their expectations regarding pharmaceutical care-related activities while shopping in any pharmacy and a parallel 15 questions about their experiences while shopping in this particular pharmacy. The survey also collected information regarding pharmaceutical care consultation received by the patients and brief demographic data.Results: A total of 628 patients from 55 pharmacies completed the survey. The pilot study’s three-factor satisfaction structure was confirmed. Overall, satisfaction measures did not differ by demographics or medical condition, but there were strong and significant store-to-store differences and consultation practice advantages when pharmacists or pharmacists-plus-students participated, but not for consultations with students alone.Conclusion: Patient satisfaction can be reliably measured by surveys structured around pharmaceutical care activities. The introduction of pharmaceutical care in pharmacies improves patient satisfaction. Service gap details indicated that pharmacy managers need to pay closer attention to various consultative activities involving patients

  8. Care delivery value chains for ophthalmic clinics in Switzerland

    OpenAIRE

    Bühlmann Samuel

    2009-01-01

    Perceived patient value is often not aligned with the emerging expenses for health care services. In other words, the costs are often supposed as rising faster than the actual value for the patients. This fact is causing major concerns to governments, health plans, and individuals. Attempts to solve the problem have habitually been on the operational effectiveness side: increasing patient volume, minimizing costs, rationing, or closing hospitals, usually resulting in a zero-sum game. Only few...

  9. 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

  10. Economists' perspectives on health care delivery in California as of 1995.

    OpenAIRE

    Singer, S J

    1998-01-01

    The health care delivery system is made up of providers--hospitals and doctors--increasingly organized into medical groups. Medical groups interact with payors, primarily health maintenance organizations, that increasingly pass through both risk and prices from increasingly demanding purchasers. This article summarizes the present and future prospects for each of these groups.

  11. 45 CFR 50.5 - Waivers for the delivery of health care service.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Waivers for the delivery of health care service. 50.5 Section 50.5 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION U.S. EXCHANGE VISITOR PROGRAM-REQUEST FOR WAIVER OF THE TWO-YEAR FOREIGN RESIDENCE REQUIREMENT § 50.5...

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

    Directory of Open Access Journals (Sweden)

    John Diamond

    2013-06-01

    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.

  13. Treating Patients as Persons: A Capabilities Approach to Support Delivery of Person-Centered Care

    OpenAIRE

    Entwistle, Vikki A; Watt, Ian S

    2013-01-01

    Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights fro...

  14. Quality audit--a review of the literature concerning delivery of continence care.

    Science.gov (United States)

    Swaffield, J

    1995-09-01

    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. PMID:7551434

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

    Science.gov (United States)

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

    2016-08-01

    A major barrier to successful integration of acute care into health systems is the lack of consensus on the essential components of emergency care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of emergency care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on emergency care delivery at health facilities. Using the well-established approach developed in the WHO's Monitoring Emergency Obstetric Care, the workgroup identified the essential services delivered-signal functions-associated with each emergency care sentinel condition. Levels of emergency care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery. PMID:26202673

  16. Enhancing Health Care Delivery through Ambient Intelligence Applications

    Directory of Open Access Journals (Sweden)

    Constantine Stephanidis

    2012-08-01

    Full Text Available This paper presents the implementation of a smart environment that employs Ambient Intelligence technologies in order to augment a typical hospital room with smart features that assist both patients and medical staff. In this environment various wireless and wired sensor technologies have been integrated, allowing the patient to control the environment and interact with the hospital facilities, while a clinically oriented interface allows for vital sign monitoring. The developed applications are presented both from a patient’s and a doctor’s perspective, offering different services depending on the user’s role. The results of the evaluation process illustrate the need for such a service, leading to important conclusions about the usefulness and crucial role of AmI in health care.

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

    Directory of Open Access Journals (Sweden)

    Henrickson Michael

    2011-08-01

    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

  18. 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...... of primary care. Background As has been demonstrated in both public and private healthcare systems around the globe, risk stratification contributes to improved clinical management of populations. This includes the ability to: – Predict high-risk individuals for inclusion in population health management......, pharmacy management, and disease management programs. – Identify individuals at risk of hospitalization and re-hospitalization. – Identify patients whose pharmacy expenditures are greater than what is predicted based upon their morbidity profile alone. – Identify those at risk of uncoordinated care...

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

    OpenAIRE

    Elwyn, Glyn; Thompson, Rachel; John, Roshen; Grande, Stuart W

    2015-01-01

    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: ...

  20. Which experiences of health care delivery matter to service users and why? A critical interpretive synthesis and conceptual map

    OpenAIRE

    Entwistle, Vikki; Firnigl, Danielle; Ryan, Mandy; Francis, Jillian; Kinghorn, Philip

    2012-01-01

    Objective Patients' experiences are often treated as health care quality indicators. Our aim was to identify the range of experiences of health care delivery that matter to patients and to produce a conceptual map to facilitate consideration of why they matter. Methods Broad-based review and critical interpretive synthesis of research literature on patients' perspectives of health care delivery. We recorded experiences reported by a diverse range of patients on ‘concept cards’, considered why...

  1. An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans.

    Science.gov (United States)

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

    2015-12-01

    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. PMID:25893925

  2. The nursing organization and the transformation of health care delivery for the 21st century.

    Science.gov (United States)

    Gilmartin, M J

    1998-01-01

    Market transformations occurring within the health care industry require new patterns of organization and management to meet the increasing complexity of service delivery. A greater understanding of the innovation and entrepreneurial dynamic allows administrators, managers, and leaders to create a new vision of service delivery. Central management and leadership objectives include the development of service technologies that capitalize upon the inherent knowledge of workers to meet consumer needs. A strong sense of innovation and entrepreneurship leading to the introduction of new or improved nursing technologies is a primary component in the evolution of professional nursing practice for the 21st century. PMID:9505707

  3. Delivery of institutional long-term care under two social insurances: Lessons from the Korean experience.

    Science.gov (United States)

    Kim, Hongsoo; Jung, Young-Il; Kwon, Soonman

    2015-10-01

    Little is known about health and social care provision for people with long-term care (LTC) needs under multiple insurances. The aim of this study is to compare the profile, case-mix, and service provision to older people at long-term care hospitals (LTCHs) covered by the national health insurance (NHI) with those of older people at long-term care facilities (LTCFs) covered by the public long-term care insurance (LTCI) in Korea. A national LTC survey using common functional measures and a case-mix classification system was conducted with a nationally representative sample of older people at LTCFs and LTCHs in 2013. The majority of older people in both settings were female and frail, with complex chronic diseases. About one fourth were a low-income population with Medical-Aid. The key functional status was similar between the two groups. As for case-mix, more than half of the LTCH population were categorized as having lower medical care needs, while more than one fourth of the LTCF residents had moderate or higher medical care needs. Those with high medical care needs at LTCFs were significantly more likely to be admitted to acute-care hospitals than their counterparts at LTCHs. The current delivery of institutional LTC under the two insurances in Korea is not coordinated well. It is necessary to redefine the roles of LTCHs and strengthen health care in LTCFs. A systems approach is critical to establish person-centered, integrated LTC delivery across different financial sources. PMID:26305121

  4. Transforming Health Care Delivery Through Consumer Engagement, Health Data Transparency, and Patient-Generated Health Information

    Science.gov (United States)

    Wald, J. S.

    2014-01-01

    Summary Objectives Address current topics in consumer health informatics. Methods Literature review. Results Current health care delivery systems need to be more effective in the management of chronic conditions as the population turns older and experiences escalating chronic illness that threatens to consume more health care resources than countries can afford. Most health care systems are positioned poorly to accommodate this. Meanwhile, the availability of ever more powerful and cheaper information and communication technology, both for professionals and consumers, has raised the capacity to gather and process information, communicate more effectively, and monitor the quality of care processes. Conclusions Adapting health care systems to serve current and future needs requires new streams of data to enable better self-management, improve shared decision making, and provide more virtual care. Changes in reimbursement for health care services, increased adoption of relevant technologies, patient engagement, and calls for data transparency raise the importance of patient-generated health information, remote monitoring, non-visit based care, and other innovative care approaches that foster more frequent contact with patients and better management of chronic conditions. PMID:25123739

  5. Toward a Learning Health-care System - Knowledge Delivery at the Point of Care Empowered by Big Data and NLP.

    Science.gov (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

    2016-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Gebrehiwot Tesfay

    2012-10-01

    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

  7. Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services.

    Science.gov (United States)

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

    2015-12-01

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

  8. Medicaid Managed Care in an Integrated Health Care Delivery System: Lessons from Geisinger's Early Experience.

    Science.gov (United States)

    Maeng, Daniel D; Snyder, Susan R; Baumgart, Charles; Minnich, Amy L; Tomcavage, Janet F; Graf, Thomas R

    2016-08-01

    Many states in the United States, including Pennsylvania, have opted to rely on private managed care organizations to provide health insurance coverage for their Medicaid population in recent years. Geisinger Health System has been one such organization since 2013. Based on its existing care management model involving data-driven population management, advanced patient-centered medical homes, and targeted case management, Geisinger's Medicaid management efforts have been redesigned specifically to accommodate those with complex health care issues and social service needs to facilitate early intervention, effective and efficient care support, and ultimately, a positive impact on health care outcomes. An analysis of Geisinger's claims data suggests that during the first 19 months since beginning Medicaid member enrollment, Geisinger's Medicaid members, particularly those eligible for the supplemental security income benefits, have incurred lower inpatient, outpatient, and professional costs of care compared to expected levels. However, the total cost savings were partially offset by the higher prescription drug costs. These early data suggest that an integrated Medicaid care management effort may achieve significant cost of care savings. (Population Health Management 2016;19:257-263). PMID:26565693

  9. Primary Care Clinicians’ Perspectives on Reducing Low-Value Care in an Integrated Delivery System

    Science.gov (United States)

    Buist, Diana SM; Chang, Eva; Handley, Matt; Pardee, Roy; Gundersen, Gabrielle; Cheadle, Allen; Reid, Robert J

    2016-01-01

    Context: Perceptions about low-value care (eg, medical tests and procedures that may be unnecessary and/or harmful) among clinicians with capitated salaries are unknown. Objective: Explore clinicians’ perceived use of and responsibility for reducing low-value care by focusing on barriers to use, awareness of the Choosing Wisely campaign, and response to reports of peer-comparison resource use and practice patterns. Methods: Electronic, cross-sectional survey, distributed in 2013, to 304 salaried primary care physicians and physician assistants at Group Health Cooperative. Main Outcome Measures: Attitudes, awareness, and barriers of low-value care strategies and initiatives. Results: A total of 189 clinicians responded (62% response rate). More than 90% believe cost is important to various stakeholders and believe it is fair to ask clinicians to be cost-conscious. Most found peer-comparison resource-use reports useful for understanding practice patterns and prompting peer discussions. Two-thirds of clinicians were aware of the Choosing Wisely campaign; among them, 97% considered it a legitimate information source. Although 88% reported being comfortable discussing low-value care with patients, 80% reported they would order tests or procedures when a patient insisted. As key barriers in reducing low-value care, clinicians identified time constraints (45%), overcoming patient preferences/values (44%), community standards (43%), fear of patients’ dissatisfaction (41%), patients’ knowledge about the harms of low-value care (38%), and availability of tools to support shared decision making (37%). Conclusions: Salaried clinicians are aware of rising health care costs and want to be stewards of limited health care resources. Evidence-based initiatives such as the Choosing Wisely campaign may help motivate clinicians to be conscientious stewards of limited health care resources. PMID:26562308

  10. The Impact of Electronic Medical records on improvement of health care delivery

    Directory of Open Access Journals (Sweden)

    Taher Giaedi

    2008-01-01

    Full Text Available To The Editor: There is an increasing need to incorporate the use of electronic medical records EMR in our healthcare delivery. The advancement in information technology and its impact in all sectors including healthcare has accelerated this need amidst the ever growing challenges facing healthcare today. These challenges include; reducing preventable errors, improving communication among health care providers and facilities, and controlling the cost of medical care. I may argue that employing an electronic medical record system may be the one solution that will addresses all of these issues. The literature shows that Innovations in electronic record keeping have dramatically improved communication and patient safety without increasing costs.

  11. Southern California Edison's performance standards: an employer's key to quality care delivery.

    Science.gov (United States)

    Schmitz, M F; Ryan, P; Walker, J L; Sokolov, J J

    1993-01-01

    One of the most significant lessons learned from this process is that setting objectives with performance standards is the key to continuous quality improvement. The critical differences between health administration and health management are threefold: (1) performance standards are developed with clarity, (2) care delivery is monitored and measured against these standards, and (3) improvements are made based on information from these measurements. PMID:10130057

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

    Directory of Open Access Journals (Sweden)

    Kwedza Ru K

    2011-03-01

    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

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

    Directory of Open Access Journals (Sweden)

    Ramani KV

    2011-05-01

    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

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

    OpenAIRE

    Titaley Christiana R; Hunter Cynthia L; Dibley Michael J; Heywood Peter

    2010-01-01

    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 ...

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

    NARCIS (Netherlands)

    Brouwer, M.

    1979-01-01

    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

  16. Model for the cost-efficient delivery of continuous quality cancer care: a hospital and private-practice collaboration

    OpenAIRE

    Coyle, Yvonne M.; Miller, Alan M.; Paulson, R. Steven

    2013-01-01

    Cancer care is expensive due to the high costs of treatment and preventable utilization of resources. Government, employer groups, and insurers are seeking cancer care delivery models that promote both cost-efficiency and quality care. Baylor University Medical Center at Dallas (BUMC), a large tertiary care hospital, in collaboration with Texas Oncology, a large private oncology practice, established two independent centers that function cooperatively within the Baylor Charles A. Sammons Canc...

  17. Free-standing cancer centers: rationale for improving cancer care delivery.

    Science.gov (United States)

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

    1989-10-01

    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. PMID:2801600

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

    Directory of Open Access Journals (Sweden)

    Vijayaraghavan Prathiba

    2011-01-01

    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.

  19. Leveraging geographic information systems in an integrated health care delivery organization.

    Science.gov (United States)

    Clift, Kathryn; Scott, Luther; Johnson, Michael; Gonzalez, Carlos

    2014-01-01

    A handful of the many changes resulting from the Affordable Care Act underscore the need for a geographic understanding of existing and prospective member communities. Health exchanges require that health provider networks are geographically accessible to underserved populations, and nonprofit hospitals nationwide are required to conduct community health needs assessments every three years. Beyond these requirements, health care providers are using maps and spatial analysis to better address health outcomes that are related in complex ways to social and economic factors.Kaiser Permanente is applying geographic information systems, with spatial analytics and map-based visualizations, to data sourced from its electronic medical records and from publicly and commercially available datasets. The results are helping to shape an understanding of the health needs of Kaiser Permanente members in the context of their communities. This understanding is part of a strategy to inform partnerships and interventions in and beyond traditional care delivery settings. PMID:24694317

  20. The Effectiveness of Inpatient Rehabilitation in the Acute Postoperative Phase of Care After Transtibial or Transfemoral Amputation: Study of an Integrated Health Care Delivery System

    OpenAIRE

    Stineman, Margaret G.; Kwong, Pui L.; Kurichi, Jibby E.; Prvu-Bettger, Janet A.; Vogel, W Bruce; Maislin, Greg; Bates, Barbara E.; Reker, Dean M.

    2008-01-01

    Stineman MG, Kwong PL, Kurichi JE, Prvu-Bettger JA, Vogel WB, Maislin G, Bates BE, Reker DM. The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system. Arch Phys Med Rehabil 2008;89:1863-72.

  1. Emerging trends in the finance and delivery of long-term care: public and private opportunities and challenges.

    Science.gov (United States)

    Cohen, M A

    1998-02-01

    A number of key trends are emerging in long-term care related to financing, new models of service delivery, and shifts in consumer expectations and preferences. Taken together, changes occurring in these areas point to a rapidly transforming long-term care landscape. Financing responsibility is shifting away from the federal government to states, individuals, and their families; providers are integrating and managing acute and long-term care services and adding new services to the continuum of care; and consumers are thinking more seriously about how to plan and pay for their future care needs, as well as how to independently navigate the long-term care system. PMID:9499656

  2. Introduction to some fundamental concepts in the economic analysis of dental care delivery.

    Science.gov (United States)

    van der Wal, C J; Smithwick, C L

    1997-01-01

    This paper discusses some basic economic principles and concepts and how they relate to the analysis of dental care delivery. The fundamental theories of consumer behavior, profit maximization, information and transaction costs, and agency are considered. It is asserted that the information gap existing between patients and providers gives rise to a principal-agent problem, the operative element of this paper. The authors conclude that while under managed fee-for-service (MFFS) delivery systems, third-party administrators use financial, administrative, and utilization management tools to guide consumer and provider behavior, to reduce the size of the information gap, and achieve a more efficient allocation of resources, this does not occur under direct reimbursement (DR). PMID:9420386

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

    Directory of Open Access Journals (Sweden)

    ROLANDO R. CRUZADA, JR.

    2014-02-01

    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

  4. What's the diagnosis? Organisational culture and palliative care delivery in residential aged care in New Zealand.

    Science.gov (United States)

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

    2016-07-01

    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. PMID:25808936

  5. Relationship between professional antenatal care and facility delivery: an assessment of Colombia.

    Science.gov (United States)

    Trujillo, Juan C; Carrillo, Bladimir; Iglesias, Wilman J

    2014-07-01

    The determinants of maternal and child health have been the recurrent topics of study in developing countries. Using the Demographic and Health Survey (2010) of Colombia, this study aimed to identify the determinants for professional antenatal care and institutional delivery, taking into account the interdependence of these two decisions, which we consider using a bivariate probit model. This study found that when certain factors affecting both the decision to seek prenatal care and giving birth in a hospital are neglected, the results of the estimates are inefficient. Estimates show that the effects of education, parity, regional location and economic status on institutional delivery tend to be underestimated in a univariate probit model. The results indicate that economic status, level of education, parity and medical-insurance affiliation influenced the joint likelihood of accessing professional antenatal care and delivering in a health facility. An important finding is that mothers with a higher level of education are 9 percentage points more likely to access these two health services compared with mothers who are illiterate. Another observed finding is the regional disparities. The evidence indicates that mothers in the Pacific Region, the poorest region of Colombia, are 6 percentage points less likely to access such services. Thus, the results indicate that the Colombian health policy should emphasize increasing the level of schooling of mothers and establish health facilities in the poorest regions of the country to ensure that women in need are provided with social health insurance. PMID:23735737

  6. Did changing primary care delivery models change performance? A population based study using health administrative data

    Directory of Open Access Journals (Sweden)

    Klein-Geltink Julie

    2011-06-01

    attributed to incentive payments offered to physicians within FHGs and FHNs. However, these primary care delivery models need to be compared with other delivery models and fee for service practices in order to describe more specifically what aspects of model delivery and incentives affect care.

  7. 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

    2010-08-01

    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

  8. Role of health-care workers in the future delivery of health care.

    Science.gov (United States)

    Kaiser, L R

    1991-01-01

    There is no logical, linear way to approach a future in which knowledge and technology explode and new opportunities go hand-in-hand with rapid obsolescence. Teams and task groups will replace the vertical command structures of the past, making teamwork, flexibility, and imagination more important that absolute knowledge. Maximum downward task delegation and decentralization will empower workers at all levels while challenging the assumptions of licensure. As the health-care organization grows more ephemeral, management will become an increasingly subtle art. Visionary skills are essential in a dynamic, rapidly changing society where the past is no longer a guide for the future. PMID:1958819

  9. Using information technology for an improved pharmaceutical care delivery in developing countries. Study case: Benin.

    Science.gov (United States)

    Edoh, Thierry Oscar; Teege, Gunnar

    2011-10-01

    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. PMID:21519942

  10. A Guide to Emerging Strategies for Promoting Prevention and Improving Oral Health Care Delivery in Head Start Lessons from the Oral Health Initiative Evaluation

    OpenAIRE

    Patricia Del Grosso; Amy Brown; Sandra Silva; Jamila Henderson; Naomi Tein; Diane Paulsell

    2008-01-01

    This volume highlights service delivery approaches and strategies that show promise for improving the oral health care delivery system and promoting oral health. It includes descriptions and examples of implementation in different program settings and with different target populations.

  11. Impact of practice size on delivery of diabetes care before and after the Quality and Outcomes Framework implementation

    OpenAIRE

    Tahrani, Abd A.; McCarthy, Mary; Godson, Jojo; Taylor, Sarah; Slater, Helen; Capps, Nigel; Moulik, Probal; Macleod, Andrew F

    2008-01-01

    General practice characteristics are important for healthcare providers to maximise outcomes. Although different aspects of general practice characteristics have been studied previously, the impact of practice size on the delivery of care has been sparsely studied, particularly in relation to diabetes care. This brief report presents a longitudinal study in Shropshire (66 practices, 16 858 patients with diabetes) to assess the impact of practice size on diabetes care before and after implemen...

  12. The Global Role of Health Care Delivery Science: Learning from Variation to Build Health Systems that Avoid Waste and Harm

    OpenAIRE

    Mulley, Albert G.

    2013-01-01

    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 individ...

  13. An Innovative Program in the Science of Health Care Delivery: Workforce Diversity in the Business of Health.

    Science.gov (United States)

    Essary, Alison C; Wade, Nathaniel L

    2016-01-01

    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. PMID:27262477

  14. 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

    2011-05-15

    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.

  15. The experience of Ghana in implementing a user fee exemption policy to provide free delivery care.

    Science.gov (United States)

    Witter, Sophie; Arhinful, Daniel Kojo; Kusi, Anthony; Zakariah-Akoto, Sawudatu

    2007-11-01

    In resource-poor countries, the high cost of user fees for deliveries limits access to skilled attendance, and contributes to maternal and neonatal mortality and the impoverishment of vulnerable households. A growing number of countries are experimenting with different approaches to tackling financial barriers to maternal health care. This paper describes an innovative scheme introduced in Ghana in 2003 to exempt all pregnant women from payments for delivery, in which public, mission and private providers could claim back lost user fee revenues, according to an agreed tariff. The paper presents part of the findings of an evaluation of the policy based on interviews with 65 key informants in the health system at national, regional, district and facility level, including policymakers, managers and providers. The exemption mechanism was well accepted and appropriate, but there were important problems with disbursing and sustaining the funding, and with budgeting and management. Staff workloads increased as more women attended, and levels of compensation for services and staff were important to the scheme's acceptance. At the end of 2005, a national health insurance scheme, intended to include full maternal health care cover, was starting up in Ghana, and it was not yet clear how the exemptions scheme would fit into it. PMID:17938071

  16. Essential basic and emergency obstetric and newborn care: from education and training to service delivery and quality of care.

    Science.gov (United States)

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

    2015-06-01

    Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego's programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings. PMID:26115858

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

    Directory of Open Access Journals (Sweden)

    Paul A Bourne

    2010-08-01

    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

  18. Perceptions of student nurses regarding the delivery of quality nursing care in katutura health centre, Windhoek and khomas region

    Directory of Open Access Journals (Sweden)

    Hans Justus Amukugo

    2015-09-01

    Full Text Available The purpose of this study is to explore and describe the perceptions of nursing students regarding the delivery of quality nursing care in Katutuura Health Centre, Windhoek, and Khomas Region. A qualitative, exploratory, descriptive and contextual research designs were used in this study. An individual interview was conducted on ten (10 4th year nursing students at UNAM main campus with regard to the delivery of quality nursing care. The data showed that most students expressed shortage of staff, high number of patient attendance, insufficient equipment and insufficient time as factors that affect the delivery of quality nursing care. Possible interventions regarding resource management should be put into consideration, where extra nursing staffs needed to be trained and distributed among hospitals and clinics in Namibia.

  19. Predictors of Health Care Seeking Behavior During Pregnancy, Delivery, and the Postnatal Period in Rural Tanzania.

    Science.gov (United States)

    Larsen, Anna; Exavery, Amon; Phillips, James F; Tani, Kassimu; Kanté, Almamy M

    2016-08-01

    Objectives Four antenatal visits, delivery in a health facility, and three postnatal visits are the World Health Organization recommendations for women to optimize maternal health outcomes. This study examines maternal compliance with the full recommended maternal health visits in rural Tanzania with the goal of illuminating interventions to reduce inequalities in maternal health. Methods Analysis included 907 women who had given birth within two years preceding a survey of women of reproductive age. Multinomial logistic regression was used to assess the influence of maternal, household, and community-level characteristics on four alternative classes defining relative compliance with optimal configuration of maternal health care seeking behavior. Results Parity, wealth index, timeliness of ANC initiation, nearest health facility type, religion, and district of residence were significant predictors of maternal health care seeking when adjusted for other factors. Multiparous women compared to primiparous were less likely to seek care at the high level [RRR 0.16, 95 % confidence interval (CI) 0.06-0.46], at the mid-level (RRR 0.22, 95 % CI 0.09-0.58), and the mid-low level (RRR 0.27, 95 % CI 0.09-0.80). Women in the highest wealth index compared to those in the poorest group were almost three times more likely to seek the highest two levels of care versus the lowest level (high RRR 2.92, 95 % CI 1.27-6.71, mid-level RRR 2.71, 95 % 1.31-5.62). Conclusion Results suggest that efforts to improve the overall impact of services on the continuum of care in rural Tanzania would derive particular benefit from strategies that improve maternal health coverage among multiparous and low socioeconomic status women. PMID:27194528

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

    Directory of Open Access Journals (Sweden)

    Kristopher Hartwig

    2014-01-01

    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.

  1. Critical Care Delivery: The Importance of Process of Care and ICU Structure to Improved Outcomes: An Update From the American College of Critical Care Medicine Task Force on Models of Critical Care.

    Science.gov (United States)

    Weled, Barry J; Adzhigirey, Lana A; Hodgman, Tudy M; Brilli, Richard J; Spevetz, Antoinette; Kline, Andrea M; Montgomery, Vicki L; Puri, Nitin; Tisherman, Samuel A; Vespa, Paul M; Pronovost, Peter J; Rainey, Thomas G; Patterson, Andrew J; Wheeler, Derek S

    2015-07-01

    In 2001, the Society of Critical Care Medicine published practice model guidelines that focused on the delivery of critical care and the roles of different ICU team members. An exhaustive review of the additional literature published since the last guideline has demonstrated that both the structure and process of care in the ICU are important for achieving optimal patient outcomes. Since the publication of the original guideline, several authorities have recognized that improvements in the processes of care, ICU structure, and the use of quality improvement science methodologies can beneficially impact patient outcomes and reduce costs. Herein, we summarize findings of the American College of Critical Care Medicine Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery; 2) Process improvement is the backbone of achieving high-quality ICU outcomes; 3) Standardized protocols including care bundles and order sets to facilitate measurable processes and outcomes should be used and further developed in the ICU setting; and 4) Institutional support for comprehensive quality improvement programs as well as tele-ICU programs should be provided. PMID:25803647

  2. Coverage and Financial Risk Protection for Institutional Delivery: How Universal Is Provision of Maternal Health Care in India?

    Science.gov (United States)

    Prinja, Shankar; Bahuguna, Pankaj; Gupta, Rakesh; Sharma, Atul; Rana, Saroj Kumar; Kumar, Rajesh

    2015-01-01

    Background India aims to achieve universal access to institutional delivery. We undertook this study to estimate the universality of institutional delivery care for pregnant women in Haryana state in India. To assess the coverage of institutional delivery, we analyze service coverage (coverage of public sector institutional delivery), population coverage (coverage among different districts and wealth quintiles of the population) and financial risk protection (catastrophic health expenditure and impoverishment as a result of out-of-pocket expenditure for delivery). Methods We analyzed cross-sectional data collected from a randomly selected sample of 12,191 women who had delivered a child in the last one year from the date of data collection in Haryana state. Five indicators were calculated to evaluate coverage and financial risk protection for institutional delivery—proportion of public sector deliveries, out-of-pocket expenditure, percentage of women who incurred no expenses, prevalence of catastrophic expenditure for institutional delivery and incidence of impoverishment due to out-of-pocket expenditure for delivery. These indicators were calculated for the public and private sectors for 5 wealth quintiles and 21 districts of the state. Results The coverage of institutional delivery in Haryana state was 82%, of which 65% took place in public sector facilities. Approximately 63% of the women reported no expenditure on delivery in the public sector. The mean out-of-pocket expenditures for delivery in the public and private sectors in Haryana were INR 771 (USD 14.2) and INR 12,479 (USD 229), respectively, which were catastrophic for 1.6% and 22% of households, respectively. Conclusion Our findings suggest that there is considerably high coverage of institutional delivery care in Haryana state, with significant financial risk protection in the public sector. However, coverage and financial risk protection for institutional delivery vary substantially across

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

    Science.gov (United States)

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

    2001-01-01

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

  4. Health Systems Innovation at Academic Health Centers: Leading in a New Era of Health Care Delivery.

    Science.gov (United States)

    Ellner, Andrew L; Stout, Somava; Sullivan, Erin E; Griffiths, Elizabeth P; Mountjoy, Ashlin; Phillips, Russell S

    2015-07-01

    Challenged by demands to reduce costs and improve service delivery, the U.S. health care system requires transformational change. Health systems innovation is defined broadly as novel ideas, products, services, and processes-including new ways to promote healthy behaviors and better integrate health services with public health and other social services-which achieve better health outcomes and/or patient experience at equal or lower cost. Academic health centers (AHCs) have an opportunity to focus their considerable influence and expertise on health systems innovation to create new approaches to service delivery and to nurture leaders of transformation. AHCs have traditionally used their promotions criteria to signal their values; creating a health systems innovator promotion track could be a critical step towards creating opportunities for innovators in academic medicine. In this Perspective, the authors review publicly available promotions materials at top-ranked medical schools and find that while criteria for advancement increasingly recognize systems innovation, there is a lack of specificity on metrics beyond the traditional yardstick of peer-reviewed publications. In addition to new promotions pathways and alternative evidence for the impact of scholarship, other approaches to fostering health systems innovation at AHCs include more robust funding for career development in health systems innovation, new curricula to enable trainees to develop skills in health systems innovation, and new ways for innovators to disseminate their work. AHCs that foster health systems innovation could meet a critical need to contribute both to the sustainability of our health care system and to AHCs' continued leadership role within it. PMID:25738387

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

    OpenAIRE

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

    2014-01-01

    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 acup...

  6. Improving Blood Pressure Control in a Large Multiethnic California Population Through Changes in Health Care Delivery, 2004–2012

    OpenAIRE

    Shaw, Kate M.; Handler, Joel; Wall, Hilary K.; Kanter, Michael H

    2014-01-01

    The Kaiser Permanente Southern California (Kaiser) health care system succeeded in improving hypertension control in a multiethnic population by adopting a series of changes in health care delivery. Data from the Healthcare Effectiveness Data and Information Set (HEDIS) was used to assess blood pressure control from 2004 through 2012. Hypertension control increased overall from 54% to 86% during that period, and 80% or more in every subgroup, regardless of race/ethnicity, preferred language, ...

  7. Challenges Experienced by Rural Women in India Living with AIDS and Implications for the Delivery of HIV/AIDS Care

    OpenAIRE

    Nyamathi, Adeline M.; Sinha, Sanjeev; Ganguly, Kalyan K.; William, Ravi Raj; Heravian, Anisa; Ramakrishnan, Padma; Greengold, Barbara; Ekstrand, Maria; Rao, Pantangi Venkata Rama

    2011-01-01

    Researchers explored the barriers to AIDS care for rural women living with AIDS, and investigated alternative delivery models to increase the women’s adherence to anti-retroviral therapy. Community-based participatory research focus groups were conducted by the researchers with a convenience sample of 39 women living with AIDS from a Primary Health Center near Chennai, India and with nurses, physicians and Accredited Social Health Activists (Ashas), lay health care workers. The most prevalent...

  8. Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

    OpenAIRE

    Glazier Richard H; White Heather L

    2011-01-01

    Abstract Background Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. M...

  9. The inpatient hospital care delivery to disabled children and young people and those with complex health needs

    OpenAIRE

    Ilkhani, Mahnaz

    2013-01-01

    Introduction: Research suggests that parents of disabled children are dissatisfied with inpatient care delivery to their children. Objectives: - To explore the inpatient care of disabled children - To determine the rewards and challenges of working with disabled children and young people and those with complex health needs - To analyse contemporary nursing curricula in order to ascertain areas of teaching pertinent to disabled children and young people and those with comple...

  10. Reframing HIV care: putting people at the centre of antiretroviral delivery

    Science.gov (United States)

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

    2015-01-01

    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

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

    Science.gov (United States)

    Alotaibi, AK; Alotaibi, SK; Alshayiqi, M; Ramalingam, S

    2016-01-01

    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. PMID:27051375

  12. Optimizing information technology to improve sexual health-care delivery: public and patient preferences.

    Science.gov (United States)

    Ross, J D C; Copas, A; Stephenson, J; Fellows, L; Gilleran, G

    2007-07-01

    Information and communication technology (ICT) has the potential to improve the quality of care and efficiency in sexual health clinics, but its introduction requires input not only from health-care professionals and ICT specialists but also from service users and potential future users. In this study, views on ICT in relation to the delivery of sexual health services were assessed using a structured interview in two groups - a community sample of young people and a clinic sample of existing patients. In all, 542 community interviewees and 202 clinic patients participated. About 75% of respondents had access to the Internet and overall 60% reported that the self-collection of a sexual history on an electronic form was acceptable. Black Caribbean individuals had significantly less access to the Internet and a lower acceptance of electronic data collection. For booking an appointment, the majority of patients reported the telephone (community sample 93%, clinic sample 96%) or attending in person (community sample 77%, clinic sample 54%) to be acceptable, with a smaller proportion choosing email (community sample 10%, clinic sample 27%) or the Internet (community sample 7%, clinic sample 11%). Electronic booking was significantly less acceptable to Black Caribbean respondents. Although new technologies offer the opportunity to improve the quality of sexual health services, patient preferences and differences between groups in access to technology also need to be considered when services are reconfigured. PMID:17623499

  13. Recent Clinical Characteristics of Labors Using Three Japanese Systems of Midwife-Led Primary Delivery Care

    Science.gov (United States)

    Suzuki, Shunji

    2016-01-01

    Objective. The objective of this study was to describe the recent clinical characteristics of labor using 3 systems of Japanese midwife-led primary delivery care, as follows: (1) those intending to give birth at home managed by midwives who do not belong to our hospital, (2) those planning to give birth in our hospital managed by the same midwives, and (3) those planning to give birth managed by midwives who belong to our hospital. Methods. A retrospective cohort study was performed. Results. There were no significant differences in the obstetric or neonatal outcomes among the 3 groups. The rate of transfers during labor with the system involving midwives belonging to our hospital was higher than those with the other 2 systems. In addition, the timing of transfers in the system with the midwives belonging to our hospital was earlier than with the other 2 systems. Among the 3 groups, there were no significant differences in the rate of the main 2 indications for transfers: fetal heart rate abnormality and failure to progress. Conclusion. There were no significant differences in perinatal outcomes among the 3 systems; however, there were some differences in the status of transfers to obstetric shared care. PMID:27034827

  14. 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

    NARCIS (Netherlands)

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

    2015-01-01

    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 c

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

    Science.gov (United States)

    Painter, Kirstin

    2012-01-01

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

  16. An observational study to evaluate the maternal and neonatal outcome of forceps delivery in a tertiary care government hospital of a cosmopolitan city of India

    OpenAIRE

    Akanksha Lamba; Ramanjeet Kaur; Zulaihuma Muzafar

    2016-01-01

    Background: Operative vaginal delivery using obstetric forceps is a practice that dates back several centuries. Modern obstetrics practice has witnessed an increase in the caesarean section rates. The goal of forceps delivery is to mimic spontaneous vaginal birth, thereby expediting delivery with a minimum of maternal or neonatal morbidity. The main objective of study was to evaluate the maternal and neonatal outcome of forceps assisted deliveries in a tertiary care hospital over a period of ...

  17. A scoping review of the implications of adult obesity in the delivery and acceptance of dental care.

    Science.gov (United States)

    Marshall, A; Loescher, A; Marshman, Z

    2016-09-01

    Background Due to the increasing prevalence of obesity within the general population it is presumed that the prevalence of overweight and obese adults accessing dental services will also increase. For this reason dentists need to be aware of implications of managing such patients.Methods A scoping review was carried out. Both Medline via OVID and Scopus databases were searched along with grey literature databases and the websites of key organizations. Inclusion and exclusion criteria were established. The data were collected on a purpose-made data collection form and analysed descriptively.Results The review identified 28 relevant published articles and two relevant items of grey literature. Following review of this literature three themes relating to adult obesity in the delivery and acceptance of dental care emerged; clinical, service delivery and patient implications. The majority of the papers focused on the clinical implications.Conclusion On the topic of adult obesity and dental care, the majority of published and grey literature focuses on the clinical implications. Further research is needed on both the patients' perspectives of being overweight or obese and the delivery and acceptance of dental care and the service delivery implications. PMID:27608579

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

    Science.gov (United States)

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

    2011-07-01

    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. PMID:21545358

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

    Directory of Open Access Journals (Sweden)

    Indrapal Ishwarji Meshram

    2014-10-01

    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. The role of university hospitals as centers of excellence for shared health-care-delivery of in- and outpatients

    International Nuclear Information System (INIS)

    Problem. Health care delivery in Germany has to face severe challenges that will lead to a closer integration of services for in- and out-patients. University hospitals play an important role due to their activities in research, education and health care delivery. They are requested to promote and evaluate new means and ways for health care delivery. Methods. The Institute of Clinical Radiology at the University Hospital of the Ludwig-Maximilians-University started teleradiological services for hospitals and general practices in January 1999 in the framework of the ''Imaging services - teleradiological center of excellence''. Legal, technical and organizational prerequisites were analyzed. Results. Networks between university hospitals and general practices are not likely to solve all future problems. They will, however, increase the availability of the knowledge of experts even in rural areas and contribute to a quality ensured health care at the patients home. Future developments may lead to international co-operations and such services may be available to patients abroad. Conclusion. Legal, technical and organizational obstacles have to be overcome to create a framework for high quality telemedical applications. University hospitals will play an important role in promoting and evaluating teleradiological services. (orig.)

  1. Integration of legal aspects and human rights approach in palliative care delivery-the Nyeri Hospice model.

    Science.gov (United States)

    Musyoki, David; Gichohi, Sarafina; Ritho, Johnson; Ali, Zipporah; Kinyanjui, Asaph; Muinga, Esther

    2016-01-01

    Palliative care is patient and family-centred care that optimises quality of life by anticipating, preventing, and treating suffering. Open Society Foundation public health program (2011) notes that people facing life-threatening illnesses are deeply vulnerable: often in severe physical pain, worried about death, incapacitation, or the fate of their loved ones. Legal issues can increase stress for patients and families and make coping harder, impacting on the quality of care. In the absence of a clear legal provision expressly recognising palliative care in Kenya, providers may face numerous legal and ethical dilemmas that affect the availability, accessibility, and delivery of palliative care services and commodities. In order to ensure positive outcomes from patients, their families, and providers, palliative care services should be prioritised by all and includes advocating for the integration of legal support into those services. Palliative care service providers should be able to identify the various needs of patients and their families including specific issues requiring legal advice and interventions. Access to legal services remains a big challenge in Kenya, with limited availability of specialised legal services for health-related legal issues. An increased awareness of the benefits of legal services in palliative care will drive demand for easily accessible and more affordable direct legal services to address legal issues for a more holistic approach to quality palliative care. PMID:27563351

  2. A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination

    OpenAIRE

    Joshi, Chandni; Russell, Grant; Cheng, I-Hao; Kay, Margaret; Pottie, Kevin; Alston, Margaret; Smith, Mitchell; Chan, Bibiana; Vasi, Shiva; Lo, Winston; Wahidi, Sayed Shukrullah; Harris, Mark F

    2013-01-01

    Introduction Refugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care. Methods A systematic review of the literature, including published sys...

  3. Direct Engagement With Communities and Interprofessional Learning to Factor Culture Into End-of-Life Health Care Delivery.

    Science.gov (United States)

    Boucher, Nathan A

    2016-06-01

    Aging patients with advanced or terminal illnesses or at the end of their lives become highly vulnerable when their cultural needs-in terms of ethnic habits, religious beliefs, and language-are unmet. Cultural diversity should be taken into account during palliative care delivery (i.e., noncurative, supportive care during advanced illness or at the end of life). Providers and systems deliver disparate palliative care to diverse patients. I present 2 strategies to improve how culturally diverse populations are served during advanced illness: (1) health service provider assessment of local populations to understand service populations' cultural needs and guide services and policy; and (2) interprofessional education to improve multicultural understanding among the health care workforce. PMID:26985609

  4. Human resources for health care delivery in Tanzania: a multifaceted problem

    Directory of Open Access Journals (Sweden)

    Manzi Fatuma

    2012-02-01

    Full Text Available Abstract Background Recent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, we documented staffing levels and productivity in peripheral health facilities in southern Tanzania. Method A health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the survey, reasons for absenteeism, and experience of supervisory visits from District Health Teams. In-depth interview with health workers was done to explore their perception of work load. A time and motion study of nurses in the Reproductive and Child Health (RCH clinics documented their time use by task. Results We found that only 14% (122/854 of the recommended number of nurses and 20% (90/441 of the clinical staff had been employed at the facilities. Furthermore, 44% of clinical staff was not available on the day of the survey. Various reasons were given for this. Amongst the clinical staff, 38% were absent because of attendance to seminar sessions, 8% because of long-training, 25% were on official travel and 20% were on leave. RCH clinic nurses were present for 7 hours a day, but only worked productively for 57% of time present at facility. Almost two-third of facilities had received less than 3 visits from district health teams during the 6 months preceding the survey. Conclusion This study documented inadequate staffing of health facilities, a high degree of absenteeism, low productivity of the staff who were present and inadequate supervision in peripheral Tanzanian health facilities. The implications of these findings are discussed in the context of decentralized health care in Tanzania.

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

    Directory of Open Access Journals (Sweden)

    Pervin Jesmin

    2012-10-01

    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

  6. Distance decay in delivery care utilisation associated with neonatal mortality. A case referent study in northern Vietnam

    Directory of Open Access Journals (Sweden)

    Eriksson Leif

    2010-12-01

    Full Text Available Abstract Background Efforts to reduce neonatal mortality are essential if the Millennium Development Goal (MDG 4 is to be met. The impact of spatial dimensions of neonatal survival has not been thoroughly investigated even though access to good quality delivery care is considered to be one of the main priorities when trying to reduce neonatal mortality. This study examined the association between distance from the mother's home to the closest health facility and neonatal mortality, and investigated the influence of distance on patterns of perinatal health care utilisation. Methods A surveillance system of live births and neonatal deaths was set up in eight districts of Quang Ninh province, Vietnam, from July 2008 to December 2009. Case referent design including all neonatal deaths and randomly selected newborn referents from the same population. Interviews were performed with mothers of all subjects and GIS coordinates for mothers' homes and all health facilities in the study area were obtained. Straight-line distances were calculated using ArcGIS software. Results A total of 197 neonatal deaths and 11 708 births were registered and 686 referents selected. Health care utilisation prior to and at delivery varied with distance to the health facility. Mothers living farthest away (4th and 5th quintile, ≥1257 meters from a health facility had an increased risk of neonatal mortality (OR 1.96, 95% CI 1.40 - 2.75, adjusted for maternal age at delivery and marital status. When stratified for socio-economic factors there was an increased risk for neonatal mortality for mothers with low education and from poor households who lived farther away from a health facility. Mothers who delivered at home had more than twice as long to a health facility compared to mothers who delivered at a health care facility. There was no difference in age at death when comparing neonates born at home or health facility deliveries (p = 0.56. Conclusion Distance to the

  7. Closing the treatment gap for mental, neurological and substance use disorders by strengthening existing health care platforms: strategies for delivery and integration of evidence-based interventions

    OpenAIRE

    Shidhaye, Rahul; Lund, Crick; Chisholm, Dan

    2015-01-01

    This paper outlines the main elements and features of a mental health care delivery platform and its delivery channels. These include evidence-based interventions that can be delivered via this platform as well as broader health system strengthening strategies for more effective and efficient delivery of services. The focus is broadly on health systems perspective rather than strictly disorder-oriented intervention analysis. A set of evidence-based interventions within the WHO pyramid framewo...

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

    OpenAIRE

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

    2016-01-01

    The Solomon Islands Government is pursuing integrated care with the goal of improving the quality of health service delivery to rural populations. Under the auspices of Universal Health Coverage, integrated service delivery packages were developed which defined the clinical and public health services that should be provided at different levels of the health system. The process of developing integrated service delivery packages helped to identify key policy decisions the government needed to m...

  9. Systematic review of interventions to increase the delivery of preventive care by primary care nurses and allied health clinicians

    OpenAIRE

    McElwaine, Kathleen M; Freund, Megan; Campbell, Elizabeth M.; Bartlem, Kate M.; Wye, Paula M.; Wiggers, John H

    2016-01-01

    Background Primary care nurses and allied health clinicians are potential providers of opportunistic preventive care. This systematic review aimed to summarise evidence for the effectiveness of practice change interventions in increasing nurse or allied health professional provision of any of five preventive care elements (ask, assess, advise, assist, and/or arrange) for any of four behavioural risks (smoking, inadequate nutrition, alcohol overconsumption, physical inactivity) within a primar...

  10. Toward a Learning Health-care System – Knowledge Delivery at the Point of Care Empowered by Big Data and NLP

    Science.gov (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

    2016-01-01

    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

  11. Bridging the Gaps in Obstetric Care: Perspectives of Service Delivery Providers on Challenges and Core Components of Care in Rural Georgia.

    Science.gov (United States)

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

    2016-07-01

    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. PMID:27090413

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

    OpenAIRE

    Prabir Kumar Manna, Debasis De and Debidas Ghosh

    2011-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Marzieh Akbarzadeh

    2014-01-01

    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

    Directory of Open Access Journals (Sweden)

    Syarifah Nuraini

    2015-11-01

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

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

    2016-01-01

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

    Science.gov (United States)

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

    2016-05-25

    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

  18. 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

    2014-01-01

    in practice alongside chiropractors, these being massage therapists (82%), physiotherapists (58%) and acupuncturists (37%). Interestingly only 11% considered a medical practitioner to be an active participant in their current interprofessional service delivery. Danish chiropractors consider interprofessional...

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

    OpenAIRE

    Fadel, Shaza A; Ram, Usha; Shaun K Morris; Begum, Rehana; Shet, Anita; Jotkar, Raju; Jha, Prabhat

    2015-01-01

    Objective 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 ev...

  20. Identification and management of behavioral/mental health problems in primary care pediatrics: perceived strengths, challenges, and new delivery models.

    Science.gov (United States)

    Davis, Deborah Winders; Honaker, Sarah M; Jones, V Faye; Williams, P Gail; Stocker, Frederick; Martin, Elaine

    2012-10-01

    This study describes the experiences of and barriers for pediatricians in Kentucky in providing behavioral/mental health (B-MH) services in primary care settings. These data will serve as a foundation for improving service delivery. An online survey was completed by 70 pediatricians. Descriptive data are presented. More than 90% of the respondents said that they saw at least one patient a month with 1 of 10 specific B-MH diagnoses. Physicians' comfort with diagnosing and treating disorders varied widely by diagnosis, age-group, and drug classification. Major barriers to providing optimal care were inaccessibility of mental health professionals for consultation and referral, lack of communication, and lack of knowledge. Respondents were more likely to favor consultation and co-location models over an integration model of care delivery. Overall, the authors found that pediatricians are dealing with patients with B-MH problems for which they may not have been adequately trained. Communication and collaboration needs were identified. PMID:22514194

  1. Clergy as collaborators in the delivery of mental health care: an exploratory survey from Benin City, Nigeria.

    Science.gov (United States)

    James, Bawo O; Igbinomwanhia, Nosa G; Omoaregba, Joyce O

    2014-08-01

    The paucity of skilled manpower in sub-Saharan Africa limits the delivery of effective interventions for the mentally ill. Individuals with mental disorders and their caregivers frequently consult clergy when mental symptoms cause distress. There is an urgent need for collaboration with nonprofessionals in order to improve mental health care delivery and close the widening treatment gap. Using a cross-sectional descriptive method, we explored clergy's (Christian and Muslim) aetiological attributions for common mental illness (schizophrenia and depression) from Benin City, Nigeria, as well as their willingness to collaborate with mainstream mental health services. We observed that a majority of clergy surveyed were able to correctly identify mental illnesses depicted in vignettes, embraced a multifactorial model of disease causation, and expressed willingness to collaborate with mental health care workers to deliver care. Clergy with a longer duration of formal education, prior mental health training, and Catholic/Protestant denomination expressed a greater willingness to collaborate. Educational interventions are urgently required to facilitate this partnership. PMID:24599283

  2. Knowledge and performance of the Ethiopian health extension workers on antenatal and delivery care: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Medhanyie Araya

    2012-11-01

    Full Text Available Abstract Background In recognition of the critical shortage of human resources within health services, community health workers have been trained and deployed to provide primary health care in developing countries. However, very few studies have investigated whether these health workers can provide good quality of care. This study investigated the knowledge and performance of health extension workers (HEWs on antenatal and delivery care. The study also explored the barriers and facilitators for HEWs in the provision of maternal health care. Methods In conducting this research, a cross-sectional study was performed. A total of 50 HEWs working in 39 health posts, covering a population of approximately 195,000 people, were interviewed. Descriptive statistics was used and a composite score of knowledge of HEWs was made and interpreted based on the Ethiopian education scoring system. Results Almost half of the respondents had at least 5 years of work experience as a HEW. More than half (27 (54% of the HEWs had poor knowledge on contents of antenatal care counseling, and the majority (44 (88% had poor knowledge on danger symptoms, danger signs, and complications in pregnancy. Health posts, which are the operational units for HEWs, did not have basic infrastructures like water supply, electricity, and waiting rooms for women in labor. On average within 6 months, a HEW assisted in 5.8 births. Only a few births (10% were assisted at the health posts, the majority (82% were assisted at home and only 20% of HEWs received professional assistance from a midwife. Conclusion Considering the poor knowledge of HEWs, poorly equipped health posts, and poor referral systems, it is difficult for HEWs to play a key role in improving health facility deliveries, skilled birth attendance, and on-time referral through early identification of danger signs. Hence, there is an urgent need to design appropriate strategies to improve the performance of HEWs by enhancing their

  3. Understanding Models of Palliative Care Delivery in Sub-Saharan Africa: Learning From Programs in Kenya and Malawi.

    Science.gov (United States)

    Downing, Julia; Grant, Liz; Leng, Mhoira; Namukwaya, Elizabeth

    2015-09-01

    The need for palliative care has never been greater. From being significantly present in only five African countries in 2004, palliative care is now delivered in nearly 50% of African countries; however, less than 5% of people in need receive it. To scale-up palliative care, we need greater knowledge about how different models of palliative care work within different health systems. A case study evaluation was undertaken in Kenya and Malawi to define the models used, contextualize them, and identify challenges, best practices, and transferable lessons for scale-up. Visits were made to seven sites and, using an audit tool, data were collected from program staff, hospital staff, and local stakeholders, and care observed as appropriate. Three models of palliative care service delivery were identified, which supports the existing literature, that is, specialist, district hospital level, and community level. However, in looking further, findings show that the major determinants for each model were a set of philosophical questions and assumptions underpinning each and influencing staff and patient decision-making, planning, and allocation of resources. The health system structure and the beliefs about palliative care determined, and were determined most by, referrals, the patient journey, the centeredness of the model, and role definition and training. The models are also closely associated with the physical setting of services. Understanding how the services have developed because of, and indeed despite the geographical setting and the system level, provides us with a different set of indicators of program structure incorporated into the three models. The analysis of models provides pointers to future planning for palliative care. PMID:25936938

  4. Provision of Palliative Care in Low- and Middle-Income Countries: Overcoming Obstacles for Effective Treatment Delivery.

    Science.gov (United States)

    Hannon, Breffni; Zimmermann, Camilla; Knaul, Felicia M; Powell, Richard A; Mwangi-Powell, Faith N; Rodin, Gary

    2016-01-01

    Despite being declared a basic human right, access to adult and pediatric palliative care for millions of individuals in need in low- and middle-income countries (LMICs) continues to be limited or absent. The requirement to make palliative care available to patients with cancer is increasingly urgent because global cancer case prevalence is anticipated to double over the next two decades. Fifty percent of these cancers are expected to occur in LMICs, where mortality figures are disproportionately greater as a result of late detection of disease and insufficient access to appropriate treatment options. Notable initiatives in many LMICs have greatly improved access to palliative care. These can serve as development models for service scale-up in these regions, based on rigorous evaluation in the context of specific health systems. However, a multipronged public health approach is needed to fulfill the humane and ethical obligation to make palliative care universally available. This includes health policy that supports the integration of palliative care and investment in systems of health care delivery; changes in legislation and regulation that inappropriately restrict access to opioid medications for individuals with life-limiting illnesses; education and training of health professionals; development of a methodologically rigorous data and research base specific to LMICs that encompasses health systems and clinical care; and shifts in societal and health professional attitudes to palliative and end-of-life care. International partnerships are valuable to achieve these goals, particularly in education and research, but leadership and health systems stewardship within LMICs are critical factors that will drive and implement change. PMID:26578612

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Task Force Report 5. Report of the Task Force on Family Medicine’s Role in Shaping the Future Health Care Delivery System

    OpenAIRE

    Roberts, Richard G.; Snape, Pam S.; Burke, Kevin

    2004-01-01

    BACKGROUND Recognizing that the implementation of needed changes within family medicine will be enhanced through a concurrent effort to transform the broader health care system, this Future of Family Medicine task force was charged with determining family medicine’s leadership role in shaping the future health care delivery system.

  7. 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

    Science.gov (United States)

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

    2008-01-01

    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,…

  8. The global role of health care delivery science: learning from variation to build health systems that avoid waste and harm.

    Science.gov (United States)

    Mulley, Albert G

    2013-09-01

    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. PMID:23797914

  9. Advancing the Future of Patient Safety in Oncology: Implications of Patient Safety Education on Cancer Care Delivery.

    Science.gov (United States)

    James, Ted A; Goedde, Michael; Bertsch, Tania; Beatty, Dennis

    2016-09-01

    Emerging challenges in health care delivery demand systems of clinical practice capable of ensuring safe and reliable patient care. Oncology in particular is recognized for its high degree of complexity and potential for adverse events. New models of student education hold promise for producing a health care workforce armed with skills in patient safety. This training may have a particular impact on risk reduction in cancer care and ultimately improve clinical performance in oncology. A 1-day student program focused on the principles of patient safety was developed for the third-year medical school class. The core curriculum consisted of an online patient safety module, root cause analyses of actual patient safety events, and simulation scenarios designed to invoke patient safety skills. The program was successfully implemented and received an average of 4.2/5 on evaluations pertaining to its importance and effectiveness. Student surveys demonstrated that 59 % of students were not previously aware of system-based approaches to improving safety, 51 % of students had witnessed or experienced a patient safety issue, while only 10 % reported these events. Students reported feeling more empowered to act on patient safety issues as a result of the program. Educational programs can provide medical students with a foundation for skill development in medical error reduction and help enhance an organization's culture of safety. This has the potential to reduce adverse events in complex patient care settings such as clinical oncology. PMID:25893923

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

    Directory of Open Access Journals (Sweden)

    Faustine Williams

    2008-07-01

    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.

  11. 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

    2015-01-01

    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。

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

    OpenAIRE

    Claude Takenga; Rolf-Dietrich Berndt; Olivier Musongya; Joël Kitero; Remi Katoke; Kakule Molo; Basile Kazingufu; Malikwisha Meni; Mambo Vikandy; Henri Takenga

    2014-01-01

    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 i...

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

    OpenAIRE

    Zhang X.; Oyama T

    2016-01-01

    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 ...

  14. Adaptive leadership framework for chronic illness: framing a research agenda for transforming care delivery.

    Science.gov (United States)

    Anderson, Ruth A; Bailey, Donald E; Wu, Bei; Corazzini, Kirsten; McConnell, Eleanor S; Thygeson, N Marcus; Docherty, Sharron L

    2015-01-01

    We propose the Adaptive Leadership Framework for Chronic Illness as a novel framework for conceptualizing, studying, and providing care. This framework is an application of the Adaptive Leadership Framework developed by Heifetz and colleagues for business. Our framework views health care as a complex adaptive system and addresses the intersection at which people with chronic illness interface with the care system. We shift focus from symptoms to symptoms and the challenges they pose for patients/families. We describe how providers and patients/families might collaborate to create shared meaning of symptoms and challenges to coproduce appropriate approaches to care. PMID:25647829

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

    OpenAIRE

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

    2016-01-01

    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 lead...

  16. Out of pocket expenditure on utilization of ante-natal and delivery care services in India: analysis based on NSSO 60th round

    OpenAIRE

    Saraswati Kerketta

    2015-01-01

    Background: Maternal mortality is a major concern in India; it can be reduced by providing reproductive health care services to the pregnant women. Out of pocket expenditure is a major barrier to the mothers in access to the maternal care services in India. Methods: Data has been extracted from NSSO 60th round. Univariate and multivariate analysis has been carried out to examine the pattern and factors affecting out of pocket expenditure on ante natal and delivery care services in India. ...

  17. Do antenatal care visits always contribute to facility-based delivery in Tanzania? A study of repeated cross-sectional data.

    Science.gov (United States)

    Choe, Seung-Ah; Kim, Jinseob; Kim, Saerom; Park, Yukyung; Kullaya, Siril Michael; Kim, Chang-Yup

    2016-04-01

    There is a known high disparity in access to perinatal care services between urban and rural areas in Tanzania. This study analysed repeated cross-sectional (RCS) data from Tanzania to explore the relationship between antenatal care (ANC) visits, facility-based delivery and the reasons for home births in women who had made ANC visits. We used data from RCS Demographic and Health Surveys spanning 20 years and a cluster sample of 30 830 women from ∼52 districts of Tanzania. The relationship between the number of ANC visits (up to four) and facility delivery in the latest pregnancy was explored. Regional changes in facility delivery and related variables over time in urban and rural areas were analysed using linear mixed models. To explore the disconnect between ANC visits and facility deliveries, reasons for home delivery were analysed. In the analytic model with other regional-level covariates, a higher proportion of ANC (>2-4 visits) and exposure to media related to an increased facility delivery rate in urban areas. For rural women, there was no significant relationship between the number of visits and facility delivery rate. According to the fifth wave result (2009-10), the most frequent reason for home delivery was 'physical distance to facility', and a significantly higher proportion of rural women reported that they were 'not allowed to deliver in facility'. The disconnect between ANC visits and facility delivery in rural areas may be attributable to physical, cultural or familial barriers, and quality of care in health facilities. This suggests that improving access to ANC may not be enough to motivate facility-based delivery, especially in rural areas. PMID:26049085

  18. Measuring the Integration of Tobacco Policy and Treatment into the Behavioral Health Care Delivery System: How Are We Doing?

    Science.gov (United States)

    Christiansen, Bruce A; Macmaster, David R; Heiligenstein, Eric L; Glysch, Randal L; Riemer, Donna M; Adsit, Robert T; Hayden, Kristine A; Hollenback, Christopher P; Fiore, Michael C

    2016-01-01

    People with a mental illness and/or drug use disorder have a higher rate of smoking than adults in general. To address this challenge, recommendations include integrating tobacco-free policies and tobacco dependency treatment into the behavioral health care delivery system. Currently, little is known regarding levels of such integration. A 65-item Internet survey measuring integration assessed three areas: a) policies addressing the use of tobacco products; b) provision of evidence-based tobacco dependence treatment; and, c) capacity to help employees/volunteers quit tobacco use. The survey was distributed to representatives of all behavioral health programs in Wisconsin. The survey response rate was 27.1%. Programs, on average, were 40% integrated. A significant proportion of programs (20%) were less than 20% integrated. A few programs (4.3%) exceeded 80% integration. Integration of tobacco policies and treatment into the behavioral health care delivery system remains limited and there is a need for technical assistance and training. PMID:27180692

  19. Eleven Years of Primary Health Care Delivery in an Academic Nursing Center.

    Science.gov (United States)

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

    2003-01-01

    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.…

  20. A Study of Patients’ Perceptions of Diabetes Care Delivery and Diabetes

    Science.gov (United States)

    Raballo, Marzia; Trevisan, Martina; Trinetta, Anna Franca; Charrier, Lorena; Cavallo, Franco; Porta, Massimo; Trento, Marina

    2012-01-01

    OBJECTIVE We investigated the perceptions of diabetes care and diabetes in patients followed long-term by group or usual care. RESEARCH DESIGN AND METHODS Three open questions were administered to 120 patients (43 with T1DM and 77 with T2DM) who had been randomized at least 2 years before to be followed by group care and 121 (41 T1DM and 80 T2DM) who had always been on usual care. The responses were analyzed by propositional analysis, by identifying the focal nuclei, i.e., the terms around which all sentences are organized, and then other predicates, according to their hierarchical relationship to the nuclear proposition. Specific communicative units were arbitrarily classified into three categories: attitudes, empowerment, and locus of control. RESULTS Patients on group care showed more positive attitudes, higher sense of empowerment, and more internal locus of control than those on usual care. In addition, they expressed a wider and more articulated range of concepts associated with the care received and made less use of medical terminology (P < 0.001, all). Higher HbA1c was associated with negative attitudes (P = 0.025) and negative empowerment (P = 0.055). CONCLUSIONS Group treatment reinforces communication and peer identification and may achieve its clinical results by promoting awareness, self-efficacy, positive attitudes toward diabetes and the setting of care, an internal locus of control, and, ultimately, empowerment in the patients. PMID:22210565

  1. Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

    Directory of Open Access Journals (Sweden)

    Glazier Richard H

    2011-05-01

    Full Text Available Abstract Background Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. Methods Articles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, Embase, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand-search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attending physicians were included (n = 65. After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance. Results The majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69% and total hospital costs (70%; however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30, patients lost to follow-up (n = 42 and estimates of effect or random variability (n = 35; inappropriate use of statistical tests (n = 55; and failure to adjust for established confounders (n = 37. Conclusions Future research should include

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

    Directory of Open Access Journals (Sweden)

    Aremu O

    2011-07-01

    .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

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

    Directory of Open Access Journals (Sweden)

    Trindade Thiago G

    2006-12-01

    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

  4. Serving transgender people: clinical care considerations and service delivery models in transgender health.

    Science.gov (United States)

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

    2016-07-23

    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. PMID:27323926

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

    OpenAIRE

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

    2016-01-01

    Background A woman’s satisfaction with labour and delivery care service has a good effect on her health and subsequent utilization of the services. Thus knowledge about women’s satisfaction on labour and delivery care used to enhances the services utilization. The objective of this study was to assess the satisfaction of women’s towards labour and delivery care service and identify factors associated it at public health facilities in Arba Minch town and the surrounding district, Gamo Gofa zon...

  6. Delivery of surgical care in a district general hospital without high dependency unit facilities

    OpenAIRE

    Coggins, R

    2000-01-01

    BACKGROUND—Many hospitals lack the facilities for high dependency care, and patients requiring this level of care are nursed on the surgical ward. The aim of this study was to assess the extent of this problem in a district general hospital, looking at the impact of providing high dependency unit (HDU) care at ward level.
METHODS—A 28 bed surgical ward was studied for 39 consecutive days. Patients were assessed as being either appropriately placed (routine) or inappropriately placed (HDU). Nu...

  7. Closing the treatment gap for mental, neurological and substance use disorders by strengthening existing health care platforms: strategies for delivery and integration of evidence-based interventions.

    Science.gov (United States)

    Shidhaye, Rahul; Lund, Crick; Chisholm, Dan

    2015-01-01

    This paper outlines the main elements and features of a mental health care delivery platform and its delivery channels. These include evidence-based interventions that can be delivered via this platform as well as broader health system strengthening strategies for more effective and efficient delivery of services. The focus is broadly on health systems perspective rather than strictly disorder-oriented intervention analysis. A set of evidence-based interventions within the WHO pyramid framework of self-care, primary care, and specialist care have been identified; the main challenge lies in the translation of that evidence into practice. The delivery of these interventions requires an approach that puts into practice key principles of public health, adopts systems thinking, promotes whole-of-government involvement and is focused on quality improvement. Key strategies for effective translation of evidence into action include collaborative stepped care, strengthening human resources, and integrating mental health into general health care. In order to pursue these principles and strategies using a platform-wide approach, policy makers need to engage with a wide range of stakeholders and make use of the best available evidence in a transparent manner. PMID:26719762

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Human resources for health care delivery in Tanzania: a multifaceted problem

    OpenAIRE

    Manzi Fatuma; Schellenberg Joanna; Hutton Guy; Wyss Kaspar; Mbuya Conrad; Shirima Kizito; Mshinda Hassan; Tanner Marcel; Schellenberg David

    2012-01-01

    Abstract Background Recent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, we documented staffing levels and productivity in peripheral health facilities in southern Tanzania. Method A health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the ...

  10. The role of optometry in the delivery of eye health care in the European Union

    OpenAIRE

    Agarwal, R. K.

    2003-01-01

    The role of optometry in the delivery of eye healthcare in the UK is well recognised by the state and the British people. Optometry in Britain works very closely with medicine and is steadily moving forward as a profession complimentary to ophthalmology. However, with the exception of Ireland, the role of optometry in the rest of the European Union is restricted by national laws, decrees or acts like Actus Medicus to those professional activities which are normally carried out by dispensing o...

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

    OpenAIRE

    John Diamond; Linda Rush; Peter Tsasis; Evans, Jenna M

    2013-01-01

    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 ...

  12. Application of Handheld Tele-ECG for Health Care Delivery in Rural India

    OpenAIRE

    Meenu Singh; Amit Agarwal; Vineet Sinha; Rohit Manoj Kumar; Nishant Jaiswal; Ishita Jindal; Pankaj Pant; Munish Kumar

    2014-01-01

    Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. The purpose of our study was to use handheld tele-electrocardiogram (ECG) developed by Bhabha Atomic Research Center (BARC) to identify heart conditions in the rural underserved population where the doctor-patient ratio is low and access to health care is difficult. The objective of our study was clinical validation of handheld tele-ECG as a screening t...

  13. LOCATION AND PLANNING OF HEALTH CARE DELIVERY SYSTEM AT THE DISTICT LEVEL

    OpenAIRE

    Rajguru. S. A

    2015-01-01

    There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious, or other coordinate bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often e...

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

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    Stephen Whiting

    2016-03-01

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

  15. 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

    2007-08-01

    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

  16. 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

    2012-09-01

    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

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

    Directory of Open Access Journals (Sweden)

    Abha Singh

    2016-04-01

    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

  18. Toward a New Era of Policy: Health Care Service Delivery to First Nations

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    Miranda D. Kelly

    2011-05-01

    Full Text Available The disproportionate burdens of ill health experienced by First Nations have been attributed to an uncoordinated, fragmented health care system. This system is rooted in public policies that have created jurisdictional gaps and a long-standing debate between federal, provincial and First Nations governments as to who is responsible for First Nations health care. This article examines: (1 the policies that shape First Nations health care in Canada and in the province of British Columbia (BC specifically; (2 the interests of the actors involved in First Nations health policy; and (3 recent developments in BC that present an opportunity for change to First Nations health policy development and have broader implications for Indigenous health policy across Canada and worldwide.

  19. Globalization of health care delivery in the United States through medical tourism.

    Science.gov (United States)

    Kumar, Sameer; Breuing, Richard; Chahal, Rajneet

    2012-01-01

    This study highlights some of the inefficiencies in the U.S. health care system and determines what effect medical tourism has had on the U.S. and global health care supply chains. This study also calls attention to insufficient health communication efforts to inform uninsured or underinsured medical tourists about the benefits and risks and determines the managerial and cost implications of various surgical procedures on the global health care system into the future. This study evaluated 3 years (2005, 2007, and 2011) of actual and projected surgical cost data. The authors selected 3 countries for analysis: the United States, India, and Thailand. The surgeries chosen for evaluation were total knee replacement (knee arthroplasty), hip replacement (hip arthroplasty), and heart bypass (coronary artery bypass graft). Comparisons of costs were made using Monte Carlo simulation with variability encapsulated by triangular distributions. The results are staggering. In 2005, the amount of money lost to India and Thailand on just these 3 surgeries because of cost inefficiencies in the U.S. health care system was between 1.3 to 2 billion dollars. In 2011, because many more Americans are expected to travel overseas for health care, this amount is anticipated to rise to between 20 and 30.2 billion dollars. Therefore, more attention should be paid to health communication efforts that truly illustrate the benefits/risks of medical travel. The challenge of finding reliable data for surgeries performed and associated surgical cost estimates was mitigated by the use of a Monte Carlo simulation of triangular distributions. The implications from this study are clear: If the U.S. health care industry is unable to eliminate waste and inefficiency and thus curb rising costs, it will continue to lose surgical revenue to foreign health providers. PMID:22150120

  20. Ocular morbidity and health seeking behaviour in Kwara state, Nigeria: implications for delivery of eye care services.

    Directory of Open Access Journals (Sweden)

    Laura Senyonjo

    Full Text Available There is currently limited information as to which conditions are most prevalent in communities in developing countries. This makes effective planning of eye services difficult.3,899 eligible individuals were recruited and examined in a cross-sectional survey in Asa Local Government Area, Nigeria. Those who self-reported an ocular morbidity were also asked about their health-seeking behaviour. Health records of local facilities were reviewed to collect information on those presenting with ocular morbidities.25.2% (95% CI: 22.0-28.6 had an ocular morbidity in at least one eye. Leading causes were presbyopia and conditions affecting the lens and conjunctiva. The odds of having an ocular morbidity increased with age and lower educational attainment. 10.1% (7.7-13.0 self-reported ocular morbidity; 48.6% (40.4-56.8 of them reported seeking treatment. At the facility level, 344 patients presented with an ocular morbidity over one month, the most common conditions were red (26.3% or itchy (20.8% eyes.Ocular morbidities, including many non vision impairing conditions, were prevalent with a quarter of the population affected. The delivery of eye care services needs to be tailored in order to address this need and ensure delivery in a cost-effective and sustainable manner.

  1. Uneasy Tensions in Health Care Delivery in a Rural Appalachian Coal Mining Community: Envisioning Alternative Solutions

    OpenAIRE

    Lee, Renee Gravios

    1996-01-01

    Research consistently supports that some segments of society are at considerably higher risk for illness and death than the national average. While the existence and extent of poor health outcomes for these "vulnerable populations" are well documented, less research attempts to explain why such inequities persist and how they might be resolved. Thus, many vulnerable individuals fail to get adequate health care. ...

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

    Science.gov (United States)

    Zhang, Xing; Oyama, Tatsuo

    2016-01-01

    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. PMID:27051323

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

    Science.gov (United States)

    Peters, Mark J.

    2016-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Ploeg Jenny

    2008-02-01

    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

  5. Optimizing pain care delivery in outpatient facilities: experience in NCI, Cairo, Egypt.

    Science.gov (United States)

    Hameed, Khaled Abdel

    2011-04-01

    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

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

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    Rosen Daniel H

    2006-04-01

    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.

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

    Science.gov (United States)

    Randall, Thomas C.; Ghebre, Rahel

    2016-01-01

    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. PMID:27446806

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

    Science.gov (United States)

    Randall, Thomas C; Ghebre, Rahel

    2016-01-01

    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. PMID:27446806

  9. Applying dynamic simulation modeling methods in health care delivery research - the SIMULATE checklist: Report of the ISPOR simulation modeling emerging good practices task force

    OpenAIRE

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

    2015-01-01

    Health care delivery systems are inherently complex, consisting of multiple tiers of interdependent subsystems and processes that are adaptive to changes in the environment and behave in a nonlinear fashion. Traditional health technology assessment and modeling methods often neglect the wider health system impacts that can be critical for achieving desired health system goals and are often of limited usefulness when applied to complex health systems. Researchers and health care decision maker...

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

    OpenAIRE

    Audrey R. Chapman

    2008-01-01

    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 ...

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

    Directory of Open Access Journals (Sweden)

    Jorgensen ML

    2015-05-01

    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

  12. The Science And Art Of Delivery: Accelerating The Diffusion Of Health Care Innovation.

    Science.gov (United States)

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

    2015-12-01

    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. PMID:26643638

  13. Transforming healthcare delivery: Why and how accountable care organizations must evolve.

    Science.gov (United States)

    Chen, Christopher T; Ackerly, D Clay; Gottlieb, Gary

    2016-09-01

    Accountable care organizations (ACOs) have shown promise in reducing healthcare spending growth, but have proven to be financially unsustainable for many healthcare organizations. Even ACOs with shared savings have experienced overall losses because the shared savings bonuses have not covered the costs of delivering population health. As physicians and former ACO leaders, we believe in the concept of accountable care, but ACOs need to evolve if they are to have a viable future. We propose the novel possibility of allowing ACOs to bill fee-for-service for their population health interventions, a concept we call population health billing. Journal of Hospital Medicine 2016;11:658-661. © 2016 Society of Hospital Medicine. PMID:27596543

  14. Linking Tumor Registry and Medicaid Claims to Evaluate Cancer Care Delivery

    OpenAIRE

    Schrag, Deborah; Virnig, Beth A.; Warren, Joan L.

    2009-01-01

    The utility of Medicaid claims for studying cancer care is not known. Our objective was to evaluate how well Medicaid claims capture diagnostic and treatment information recorded by the California Cancer Registry (CCR). We compared cancer treatment from Medicaid claims with CCR data, using 1988-2000 cases matched with 1997-1998 Medicaid enrollment data. Medicaid claims corroborated diagnoses for 73 percent of breast and 68 percent of colorectal cancers in CCR. Medicaid claims confirmed surger...

  15. The race to the top initiative: towards excellence in health-care service delivery

    OpenAIRE

    Nahimana, E.; Iyer, H.; Manzi, A; A Uwingabiye; Gupta, N.; N Uwilingiyemungu; Drobac, P; L Hirschhorn

    2015-01-01

    Background: Since 2006, Rwanda has adopted performance-based incentives to boost the motivation of health-care workers and improve Millennium Development Goal (MDG) health indicators. However, performance-based incentives will often create a focus on final outcomes rather than the improvement of processes. Furthermore, national evaluation of district health facilities uses the same indicators irrespective of district-level differences in burden of disease and health priorities. In 2013, Partn...

  16. Personality Characteristics Of Teachers Involved In The Delivery Of Primary Healthy Care (Sevagram Experiment)

    OpenAIRE

    Singh D; Choudhury Roy D; Rao Pralhad N; Nayar S

    1990-01-01

    An attempt was made to study the personality traits influencing the performance of 17 primary school teachers selected under ICMR project in Wardha district, to investigate feasibility and effectiveness of their involvement as primary health care workers vis-Ã -vis the 19 community health volunteers introduced by the State Government in the non-teacher villages of the project at the same time. The results indicated that both the teachers and community health volunteers preferred preven...

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

    Directory of Open Access Journals (Sweden)

    Hudson SV

    2015-03-01

    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

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

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    Fennell Mary L

    2009-09-01

    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.

  19. A systematic approach to the identification and classification of near-miss events on labor and delivery in a large, national health care system.

    Science.gov (United States)

    Clark, Steven L; Meyers, Janet A; Frye, Donna R; McManus, Kathryn; Perlin, Jonathan B

    2012-12-01

    We describe a systematic approach to the identification and classification of near-miss events on labor and delivery in a large, national health care system. Voluntary reports of near-miss events were prospectively collected during 2010 in 203,708 deliveries. These reports were analyzed according to frequency and potential severity. Near-miss events were reported in 0.69% of deliveries. Medication and patient identification errors were the most common near-miss events. However, existing barriers were found to be highly effective in preventing such errors from reaching the patient. Errors with the greatest potential for causing harm involved physician response and decision making. Fewer and less effective existing barriers between these errors and potential patient harm were identified. Use of a comprehensive system for identification of near-miss events on labor and delivery units have proven useful in allowing us to focus patient safety efforts on areas of greatest need. PMID:23063015

  20. The Integration of Chinese Material Medica into the Chinese Health Care Delivery System, an Update.

    Science.gov (United States)

    Dang, Haixia; Wang, Qiong; Wang, Hainan; Yan, Ming; Liu, Xinmin

    2016-02-01

    Integration of Traditional Chinese medicine, including Chinese materia medica (CMM), into the national healthcare delivery system, is now an essential national policy in China and is increasing rapidly. This case study summarizes the profile of integration of CMM in China, describing markets, industries, management mechanisms, education, research and development, human resources and international cooperation related to Traditional Chinese medicine, and CMM in particular. It provides a basis for policies for integrating TM into national healthcare systems to save costs and improve the general health of the population. By the end of 2014, the overall sale value of CMM exceeded $US120bn, representing 31% of the total pharmaceutical industry markets in China. More than 200 CMM formulated drugs and 1100 prepared CMM are now on the national 'Essential Drug List' and the financial budget for CMM from the Chinese government in 2014 was approximately $US4.66bn, almost double that of 2011, indicating an increasing and long-term commitment to integrated medicine in China. PMID:26728426

  1. 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

  2. Application of Handheld Tele-ECG for Health Care Delivery in Rural India

    Directory of Open Access Journals (Sweden)

    Meenu Singh

    2014-01-01

    Full Text Available Telemonitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. The purpose of our study was to use handheld tele-electrocardiogram (ECG developed by Bhabha Atomic Research Center (BARC to identify heart conditions in the rural underserved population where the doctor-patient ratio is low and access to health care is difficult. The objective of our study was clinical validation of handheld tele-ECG as a screening tool for evaluation of cardiac diseases in the rural population. ECG was obtained in 450 individuals (mean age 31.49 ± 20.058 residing in the periphery of Chandigarh, India, from April 2011 to March 2013, using the handheld tele-ECG machine. The data were then transmitted to physicians in Postgraduate Institute of Medical Education and Research (PGIMER, Chandigarh, for their expert opinion. ECG was interpreted as normal in 70% individuals. Left ventricular hypertrophy (9.3% was the commonest abnormality followed closely by old myocardial infarction (5.3%. Patient satisfaction was reported to be ~95%. Thus, it can be safely concluded that tele-ECG is a portable, cost-effective, and convenient tool for diagnosis and monitoring of heart diseases and thus improves quality and accessibility, especially in rural areas.

  3. Patient involvement in problem presentation and diagnosis delivery in primary care.

    Science.gov (United States)

    Ijäs-Kallio, Taru; Ruusuvuori, Johanna; Peräkylä, Anssi

    2010-01-01

    This article reports a conversation analytic study of primary care physicians' orientations to different types of patients' problem presentation. Four types of problem presentation are examined: 1. symptoms only; 2. candidate diagnosis; 3. diagnosis implicative symptom description; and 4. candidate diagnosis as background information. The analysis shows that both in receiving the problem presentation at the beginning of the visit and in delivering a diagnosis later on, doctors address the patients' presentations which involved or implied a candidate diagnosis. In contrast, following a symptoms-only type of problem presentation such references predominantly are not made. The study suggests that patients' problem presentation have a crucial role in shaping the doctor's communication patterns also in the phases of consultation in which the patient's active participation is of lesser significance, such as the diagnostic phase. The findings are discussed in relation to the question of patient participation in the medical consultation. The data consist of 86 video-recorded Finnish primary care consultations for upper respiratory tract infection including both child and adult patients. PMID:22049636

  4. Optimal delivery of follow-up care following pulmonary lobectomy for lung cancer

    Directory of Open Access Journals (Sweden)

    Chen YY

    2016-03-01

    Full Text Available Ying-Yi Chen, Tsai-Wang Huang, Hung Chang, Shih-Chun LeeDivision of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan Introduction: The rationale for oncologic surveillance following pulmonary lobectomy is to detect recurrent disease or a second primary lung cancer early enough so that an intervention can increase survival and/or improve quality of life. Therefore, we reviewed literature for international guidelines and reorganized these useful factors associated with non-small-cell lung cancer (NSCLC recurrence as remedies in postoperative follow-up. Method: The population of interest for this review was patients who had been treated with complete resection for primary NSCLC and were in follow-up. Result: Guidelines on follow-up care for NSCLC vary internationally. Because of the production of progressive medical modalities, the current follow-up care should be corrected. Conclusion: The specific follow-up schedule for computed tomography imaging may be more or less frequent, depending upon risk factors for recurrence. Many different predictors of postoperative recurrence may help to optimize the patient selection for specified surveillance guidelines and personalized adjuvant therapies to prevent possibly occult micrometastases and to get a better outcome. Keywords: lung cancer, follow-up, surveillance, recurrence

  5. 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

    DEFF Research Database (Denmark)

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

    2007-01-01

    -randomised community trial assessed a new delivery system of IPTp through traditional birth attendants, drug shop vendors, community reproductive health workers and adolescent peer mobilisers (the intervention) compared with IPTp at health units (control). The study enrolled a total of 2081 pregnant women with the new......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...

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

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    E.V. Podchufarova

    2014-06-01

    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

  7. Personality Characteristics Of Teachers Involved In The Delivery Of Primary Healthy Care (Sevagram Experiment

    Directory of Open Access Journals (Sweden)

    Singh D

    1990-01-01

    Full Text Available An attempt was made to study the personality traits influencing the performance of 17 primary school teachers selected under ICMR project in Wardha district, to investigate feasibility and effectiveness of their involvement as primary health care workers vis-Ã -vis the 19 community health volunteers introduced by the State Government in the non-teacher villages of the project at the same time. The results indicated that both the teachers and community health volunteers preferred preventive and promotive health tasks and they showed no significant difference on the motivation and leadership orientation scale. The teachers, because of their job security and promotional avenues were satisfied with their achievements and were full of hopes and aspirations but the same was not true with the community health volunteers. This was due to their comparatively poor economic conditions and unstable sources of livelihood.

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

    Directory of Open Access Journals (Sweden)

    Wang Duolao

    2010-11-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Prabir Kumar Manna, Debasis De and Debidas Ghosh

    2011-01-01

    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.

  10. Anesthesia and critical-care delivery in weightlessness: A challenge for research in parabolic flight analogue space surgery studies

    Science.gov (United States)

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

    2010-03-01

    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 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 stability through an IV route (within multiple transport vehicles and differing gravitational environments

  11. 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

    OpenAIRE

    Omuta GED

    2016-01-01

    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. Meth...

  12. 人性化护理在产妇分娩中的临床效果观察%Clinical Effect Observation of Humanalized Nursing Care in the Delivery

    Institute of Scientific and Technical Information of China (English)

    李妙荣

    2013-01-01

    Objective:To explore the clinical effect of humanalized nursing care in the delivery.Methods:146 delivery women in our hospital from 2009 to 2011 were randomly divided into observation group and control group,73 cases in each group,delivery women in the control group were given routine nursing care,based on this delivery women in the observation group were given humanalized nursing care,observed maternal mode of delivery and duration of labor of two groups.Results:Daternal natural delivery rate of delivery women in the observation group was 83.6%,higher than that in the control group(61.6%),the average time of labor course in the observation group was less than that in the control group,the difference between two groups was statistically significant (P<0.05). Conclusion:Taking humanalized nursing care to delivery women can improve the natural birth rate significantly,shorten the time of labor course,and ensure the maternal and child safety,so it is worthy of further clinical using.%  目的:探讨人性化护理在产妇分娩中的临床效果。方法:将笔者所在医院2009年-2011年收治的146例产妇随机分为观察组和对照组,每组各73例,对照组产妇给予常规护理,观察组产妇在此基础上给予人性化护理,观察两组产妇的分娩方式及产程时间。结果:观察组产妇的自然分娩率为83.6%,显著高于对照组产妇的61.6%,观察组产妇各产程的平均时间均少于对照组产妇,组间差异均有统计学意义(P<0.05)。结论:对产妇实施人性化护理能够显著提高自然分娩率,缩短产程时间,从而保证母婴安全,值得临床进一步推广使用。

  13. 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

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

    Science.gov (United States)

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

    2015-01-01

    This study was undertaken to understand the factors that impact whether rural women obtain antenatal care (ANC) and choose to use hospital delivery services in central and western China. We chose to conduct field research with the rural residents in Hubei Province through a combination of random sampling and purposive sampling methods. A mixed method approach was taken to analyze the factors impacting the use of ANC and hospital delivery services from the perspective of the villagers. Our results indicate that the quality of the available ANC services is poor. In particular, women who have special circumstances and unplanned pregnancies or who become pregnant prior to marriage are confronted with inadequate ANC and hospital child delivery services. The factors that impact whether women use or not use ANC and hospital delivery services and that cause women to choose hospital or home delivery can be understood at three levels: macro, middle, and micro. We strongly suggest that the policies and projects that promote maternal healthcare in rural areas be sustained with an added focus on including women with special circumstances. Village doctors can be enlisted to regularly visit pregnant women at home and to provide extra explanation about the ANC services available and the purpose of maternal healthcare. These findings and suggestions can be used by local health providers and decision-makers to improve the quality of ANC and hospital delivery services. PMID:24446091

  15. The perspectives of clients and unqualified allopathic practitioners on the management of delivery care in urban slums, Dhaka, Bangladesh - a mixed method study

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    Wahed Tasnuva

    2010-09-01

    Full Text Available Abstract Background BRAC is implementing a program to improve maternal and newborn health among the urban poor in the slums of Bangladesh (Mansohi, funded by the Bill & Melinda Gates Foundation. Formative research has demonstrated that unqualified allopathic practitioners (UAPs are commonly assisting home-delivery. The objective of this study was to explore the role of unqualified allopathic practitioners during home delivery in urban slums of Dhaka. Methods This cross-sectional study was conducted between September 2008 and June 2009 in Kamrangirchar slum in Dhaka, Bangladesh, using both qualitative and quantitative research methods. Through a door-to-door household survey, quantitative data were collected from 463 women with a home birth and/or trial of labor at home. We also conducted seven in-depth interviews with the UAPs to explore their practices. Results About one-third (32% of the 463 women interviewed sought delivery care from a UAP. We did not find an association between socio-demographic characteristics and care-seeking from a UAP, except for education of women. Compared to women with three or more pregnancies, the highest odds ratio was found in the primi-gravidity group [odds ratio (OR: 3.46; 95% confidence interval (CI: 1.65-7.25], followed by women with two pregnancies (OR: 2.54; 95% CI: 1.36-4.77 to use a UAP. Of women who reported at least one delivery-related complication, 45.2% received care from the UAPs. Of 149 cases where the UAP was involved with delivery care, 133 (89.3% received medicine to start or increase labor with only 6% (9 of 149 referred by a UAP to any health facility. The qualitative findings showed that UAPs provided a variety of medicines to manage excessive bleeding immediately after childbirth. Conclusion There is demand among slum women for delivery-related care from UAPs during home births in Bangladesh. Some UAPs' practices are contrary to current World Health Organization recommendations and could be

  16. The disruptive consequences of discourse fragmentation in the organization and delivery of health care: a look into diabetes.

    Science.gov (United States)

    Nahon-Serfaty, Isaac

    2012-01-01

    The aim of this study is to contribute to a better understanding about how discourse fragmentation is affecting the way doctors perceive the patient's role and expectations that are being redefined under the influence of media and other information sources. The diabetes case provides the empirical evidence to support the fragmentation thesis. This condition offers a unique mix of complexity, scope, and controversy to understand the dialectics of discourse fragmentation. Through a combined analysis of media discourse and experts' discourse (researchers and clinicians), this article describes the connections between the macro (the realm of the public sphere) and the micro (the localized medical practice) in the context of health care delivery. The study concludes that a fragmented media discourse tends at the same time to nourish the public perception about the "diabetes complexities" (a multifaceted and growing epidemic), and to normalize some emerging concepts such as "prediabetes" and metabolic syndrome. This fragmentation seems to have a double-edged sword effect on doctor-patient relationships; in some occasions the atomized discourse about diabetes has a clear disruptive impact on their medical practice, adding an "extra burden" to the disease management, while in other opportunities it has a more convergent effect facilitating the dialogue and the interaction between the actors. PMID:22150024

  17. Morbidity of caesarean delivery: a comparative study between early and advanced stages of labour in an Indian tertiary care center

    Directory of Open Access Journals (Sweden)

    Amrutha Ramachandran

    2013-08-01

    Methods: A retrospective analysis of 131 women with singleton term pregnancies who underwent emergency caesarean section. The study was done in a tertiary care teaching hospital in India. In this study advanced labour was defined as one with cervical dilatation 8 cm or more at the time of caesarean section. The primary outcome variables were a maternal composite morbidity and a neonatal composite morbidity. Categorical data were compared using chi square test or Fischer’s exact test. Results: 73 women (56% underwent caesarean delivery in the early labour and 58(44% in advanced labour. 12/73 (16.4% patients in early stage of labour had at least one maternal complication (Composite maternal morbidity compared to 18/58 (31% women who had caesarean in advanced stage (p = 0.048. Seven patients out of 73 in the early labour and 14/58 in the advanced labour (p = 0.024 had at least one neonatal complication (Composite neonatal morbidity. Conclusions: The morbidity of primary caesarean sections done in the advanced stage of labour is associated with increased maternal and neonatal morbidity compared to that done in the early stage. A larger study will be needed to establish the inference. [Int J Reprod Contracept Obstet Gynecol 2013; 2(4.000: 646-650

  18. 欧洲卫生服务供给模式的改革%Health care delivery reforms in European countries

    Institute of Scientific and Technical Information of China (English)

    鲁菁; 方红娟; 王小万

    2011-01-01

    基于WHO欧洲委员会"增加财富与增进健康的卫生系统-塔林宪章"的卫生改革框架,卫生服务的供给模式已经成为欧洲卫生改革的重点.本文从卫生服务供给的角度介绍了欧洲国家近年来所实施的改革政策与措施.通过强调转变卫生服务模式,提高卫生系统的反应性,改善卫生服务的质量,加强公共卫生、疾病预防和健康促进,以及加强卫生人力资源建设等关键措施来完善卫生服务供给模式,为我国深化卫生改革提供了可以借鉴和学习的经验.%Based on the health reform framework of WHO European Commission"increasing wealth and the promotion of a healthy health system-Tallinn charter", Health care delivery has been the key point in the European health care reforms. This paper introduced the policies and measures of health care delivery reforms in recent years. European countries have changed their health care models, made health systems more responsive to patients needs; enhanced the quality of care; strengthened public health, disease prevention and health promotion; and invested in human and capital resources to improve health care delivery model. These policies and methods have provided valuable references to our deepening health reformation.

  19. Can Sierra Leone maintain the equitable delivery of their Free Health Care Initiative? The case for more contextualised interventions: results of a cross-sectional survey

    OpenAIRE

    Vallières, Frédérique; Cassidy, Emma Louise; McAuliffe, Eilish; Gilmore, Brynne; Bangura, Allieu S.; Musa, Joseph

    2016-01-01

    Background In 2010, the Ministry of Health and Sanitation in Sierra Leone launched their Free Health Care Initiative (FHCI) for pregnant and lactating mothers and children under-5. Despite an increase in the update of services, the inequitable distribution of health services and health facilities remain important factors underlying the poor performance of health systems to deliver effective services. This study identifies current gaps in service delivery across two rural locations served by t...

  20. 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)

    OpenAIRE

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

    2013-01-01

    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 car...

  1. 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.

    Science.gov (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

    2015-03-01

    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

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

    Directory of Open Access Journals (Sweden)

    Dooley Jessica

    2012-06-01

    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

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

    Science.gov (United States)

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

    2016-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Denise Cloutier

    2016-01-01

    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.

  5. Hospital-based community outreach to medically isolated elders. The nurse gerontologist is a key link in this health care delivery system in Wisconsin.

    Science.gov (United States)

    Haworth, M J

    1993-01-01

    The development of a hospital-based community outreach nursing program has been beneficial for St. Mary's Hospital in several ways. The outreach program has served a community need in that many elderly persons who were previously medically isolated have now been located and linked to the health care delivery system. The outreach program has reinforced the hospital's presence and leadership role in the community through its work with the elderly population. The hospital is seen as being committed to bringing health care services to its elderly neighbors. Through the establishment and coordination of health care services to previously isolated and unconnected elderly persons, there has been a broadened revenue base for hospital operations. The outreach program also supports the mission, philosophy, and objectives of the Daughters of Charity. The efforts of this outreach program have shown that high-quality, accessible, and coordinated care for the elderly population may be obtained using a nurse gerontologist. Efforts to expand the market share of elderly persons by the hospital has continued through the development of other innovative health programs, resources, and services. Hospital administrators need to develop programs and services that effectively utilize limited health care dollars and resources to improve the quality of health care within the community. PMID:8383077

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

    Science.gov (United States)

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

    2016-01-01

    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.

  7. 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.

    Science.gov (United States)

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

    2016-01-01

    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

  8. 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

    2006-03-01

    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

  9. A study of patients’ perceptions of diabetes care delivery and diabetes. Propositional analysis in people with type 1 and 2 diabetes managed by group or usual care

    OpenAIRE

    Raballo, Marzia; Trevisan, Martina; Trinetta, Anna Franca; Charrier, Lorena; Cavallo, Franco; Porta, Massimo; Trento, Marina

    2012-01-01

    OBJECTIVE We investigated the perceptions of diabetes care and diabetes in patients followed long-term by group or usual care. RESEARCH DESIGN AND METHODS Three open questions were administered to 120 patients (43 with T1DM and 77 with T2DM) who had been randomized at least 2 years before to be followed by group care and 121 (41 T1DM and 80 T2DM) who had always been on usual care. The responses were analyzed by propositional analysis, by identifying the focal nuclei, i.e., the terms around wh...

  10. 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)

    OpenAIRE

    Chemali ZN; Borba CPC; Henderson TE; Tesfaye M

    2013-01-01

    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, a...

  11. The Effects of a Locally Developed mHealth Intervention on Delivery and Postnatal Care Utilization; A Prospective Controlled Evaluation among Health Centres in Ethiopia

    Science.gov (United States)

    Shiferaw, Solomon; Spigt, Mark; Tekie, Michael; Abdullah, Muna; Fantahun, Mesganaw; Dinant, Geert-Jan

    2016-01-01

    Background Although there are studies showing that mobile phone solutions can improve health service delivery outcomes in the developed world, there is little empirical evidence that demonstrates the impact of mHealth interventions on key maternal health outcomes in low income settings. Methods A non-randomized controlled study was conducted in the Amhara region, Ethiopia in 10 health facilities (5 intervention, 5 control) together serving around 250,000 people. Health workers in the intervention group received an android phone (3 phones per facility) loaded with an application that sends reminders for scheduled visits during antenatal care (ANC), delivery and postnatal care (PNC), and educational messages on dangers signs and common complaints during pregnancy. The intervention was developed at Addis Ababa University in Ethiopia. Primary outcomes were the percentage of women who had at least 4 ANC visits, institutional delivery and PNC visits at the health center after 12 months of implementation of the intervention. Findings Overall 933 and 1037 women were included in the cross-sectional surveys at baseline and at follow-up respectively. In addition, the medical records of 1224 women who had at least one antenatal care visit were followed in the longitudinal study. Women who had their ANC visit in the intervention health centers were significantly more likely to deliver their baby in the same health center compared to the control group (43.1% versus 28.4%; Adjusted Odds Ratio (AOR): 1.98 (95%CI 1.53–2.55)). A significantly higher percentage of women who had ANC in the intervention group had PNC in the same health center compared to the control health centers (41.2% versus 21.1%: AOR: 2.77 (95%CI 2.12–3.61)). Conclusions Our findings demonstrated that a locally customized mHealth application during ANC can significantly improve delivery and postnatal care service utilization possibly through positively influencing the behavior of health workers and their

  12. The Day Care Needs of the Indigent Children of West Virginia, with Recommendations for a Model Day Care Program and Delivery System. Volume 2.

    Science.gov (United States)

    Hodges, Walter L.; And Others

    This volume describes and discusses six major proposals for a complete model system of day care for indigent children in West Virginia. The recommendations include: (1) developing more specific objectives to be accomplished for children, parents, care providers, and the state; (2) developing a public education program designed to help parents…

  13. Challenges in the Delivery of Quality Breast Cancer Care: Initiation of Adjuvant Hormone Therapy at an Urban Safety Net Hospital

    OpenAIRE

    Crowley, Meaghan M.; McCoy, Molly E.; Bak, Sharon M.; Caron, Sarah E.; Ko, Naomi Y.; Kachnic, Lisa A.; Alvis, Faber; Battaglia, Tracy A.

    2013-01-01

    Urgently needed interventions to reduce disparities in breast cancer treatment should take into account obstacles inherent among immigrant and indigent populations and complexities of multidisciplinary cancer care.

  14. A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination

    Science.gov (United States)

    2013-01-01

    Introduction Refugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care. Methods A systematic review of the literature, including published systematic reviews, was undertaken. Studies between 1990 and 2011 were identified by searching Medline, CINAHL, EMBASE, Cochrane Library, Scopus, Australian Public Affairs Information Service – Health, Health and Society Database, Multicultural Australian and Immigration Studies and Google Scholar. A limited snowballing search of the reference lists of all included studies was also undertaken. A stakeholder advisory committee and international advisers provided papers from grey literature. Only English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included. Results Twenty-five studies met the inclusion criteria for this review of which 15 were Australian and 10 overseas models. These could be categorised into six themes: service context, clinical model, workforce capacity, cost to clients, health and non-health services. Access was improved by multidisciplinary staff, use of interpreters and bilingual staff, no-cost or low-cost services, outreach services, free transport to and from appointments, longer clinic opening hours, patient advocacy, and use of gender-concordant providers. These services were affordable, appropriate and acceptable to the target groups. Coordination between the different health care services and services responding to the social needs of clients was improved through case management by specialist workers. Quality of care was improved by training in cultural sensitivity and

  15. The Vermont Model for Rural HIV Care Delivery: Eleven Years of Outcome Data Comparing Urban and Rural Clinics

    Science.gov (United States)

    Grace, Christopher; Kutzko, Deborah; Alston, W. Kemper; Ramundo, Mary; Polish, Louis; Osler, Turner

    2010-01-01

    Context: Provision of human immunodeficiency virus (HIV) care in rural areas has encountered unique barriers. Purpose: To compare medical outcomes of care provided at 3 HIV specialty clinics in rural Vermont with that provided at an urban HIV specialty clinic. Methods: This was a retrospective cohort study. Findings: Over an 11-year period 363 new…

  16. Dual-functional Polyurea Microcapsules for Chronic Wound Care Dressings: Sustained Drug Delivery and Non-leaching Infection Control

    Science.gov (United States)

    He, Wei

    A new design of dual-functional polyurea microcapsules was proposed for chronic wound dressings to provide both non-leaching infection control and sustained topical drug delivery functionalities. Quaternary ammonium functionalized polyurea microcapsules (MCQs) were synthesized under mild conditions through an interfacial crosslinking reaction between branched polyethylenimine (PEI) and 2,4-toluene diisocyanate (TDI) in a dimethylformamide/cyclohexane emulsion. An in-situ modification method was developed to endow non-leaching surface antimicrobial properties to MCQs via bonding antimicrobial surfactants to surface isocyanate residues on the polyurea shells. The resultant robust MCQs with both non-leaching antimicrobial properties and sustained drug releasing properties have potential applications in medical textiles, such as chronic wound dressings, for infection control and drug delivery.

  17. Variation in Hepatitis C services may lead to inequity of heath-care provision: a survey of the organisation and delivery of services in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Bennett-Lloyd Bethan

    2006-01-01

    Full Text Available Abstract Background Chronic hepatitis C infection (CHC is a major healthcare problem. Effective anti-viral therapy is available. To maximise population effectiveness, co-ordinated services for detection and management of patients with CHC are required. There is a need to determine patterns of healthcare delivery to plan improvements. A study was conducted to determine workload, configuration and care processes of current UK services available to manage patients with CHC. Methods A cross-sectional questionnaire survey of consultant members of British Association for the Study of the Liver (n = 53, Infectious Disease consultants (n = 43, and a 1 in 5 sample of Genito-Urinary Medicine (n = 48 and gastroenterologists (n = 200. Results Response rate was 70%. 40% of respondents provided a comprehensive service (included treatment and follow-up: speciality of clinical leads identified as Hepatology (37%; Gastroenterology (47%; and Infectious Disease (16%. The estimated number of patients managed by respondents was about 23,000 with an upward trend over the previous 3 years. There was variation between comprehensive service providers, including unit size, eligibility criteria for treatment, and drug regimes. Key barriers to quality of care identified were staffing capacity, funding of treatment and patient non-attendance. Most English strategic health authorities had at least one comprehensive service provider. Conclusion There was significant variation in all aspects of the patient pathway which may contribute to inequity of health care provision. Services need to be expanded to form geographical clinical networks, and properly resourced to ensure greater uptake and more equitable delivery of services if the future burden of chronic liver disease is to be reduced.

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

    OpenAIRE

    Bernardo Hernández; Eduardo Ortiz-Panozo; Ricardo Pérez-Cuevas

    2012-01-01

    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) ...

  19. Modelling successful primary care for multimorbidity: a realist synthesis of successes and failures in concurrent learning and healthcare delivery

    OpenAIRE

    Yardley, S; Cottrell, E.; Rees, E; Protheroe, J

    2015-01-01

    Background People are increasingly living for longer with multimorbidity. Medical education and healthcare delivery must be re-orientated to meet the societal and individual patient needs that multimorbidity confers. The impact of multimorbidity on the educational needs of doctors is little understood. There has been little critique of how learning alongside healthcare provision is negotiated by patients, general practitioners and trainee doctors. This study asked ‘what is known about how and...

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

    Directory of Open Access Journals (Sweden)

    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

  1. IMPACT ON HEALTH CARE DELIVERY SYSTEM DUE TO THE WORST FLOOD OF THE CENTURY IN KASHMIR, INDIA: AN OBSERVATIONAL ANALYSIS

    Directory of Open Access Journals (Sweden)

    Kouser

    2014-12-01

    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.

  2. 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.;

    2008-01-01

    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...

  3. The use of high definition video modules for delivery of informed consent and wound care education in the Mohs Surgery Unit.

    Science.gov (United States)

    Migden, Michael; Chavez-Frazier, Arianne; Nguyen, Tri

    2008-03-01

    The use of video in the informed consent process has been well documented in the literature to improve patient satisfaction, understanding, comprehension, and to decrease anxiety. At the MD Anderson Mohs Surgery Unit, we use high-definition (HD) audiovisual (AV) modules to assist with the delivery of informed consent and to educate patients on the subject of postoperative wound care. The purpose of this work was to develop HD-AV media to inform patients of the risks, benefits, and alternatives of Mohs surgery before they are asked to sign the consent form and to educate patients on basic wound care after Mohs Surgery. The use of a HD virtual surgeon and nurse in the videos educates the patient, allowing the surgeon and nursing staff to attend to other patients within the Mohs Surgery Unit. Using HD digital recording equipment, we captured real-time HD-AV media to explain the risks, alternatives, and benefits of Mohs surgery (surgeon explanation) and to give detailed instructions for postoperative wound care (nurse explanation). Once captured, HD modules were created and stored on a central University of Texas-MD Anderson Cancer Center server in the Texas Medical Center approximately 1 mile from the Mohs Surgery Unit. The full-screen HD modules are accessed on demand at the point of need with the use of standard institutional computers within any of the Mohs's center's examination/surgical suites. An early evaluation of this quality improvement initiative was performed to measure patient satisfaction, efficiency, and efficacy of the videos followed by physician/nurse discussion compared with physician/nurse discussion alone. Early evaluation of HD-AV modules used for the delivery of informed consent and postoperative wound care in the MD Anderson Mohs surgery Unit revealed that patient satisfaction was maintained and that this medium was preferred by patients in the video group over physician/nurse discussion alone. The HD modules allowed increased efficiency and

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

    Directory of Open Access Journals (Sweden)

    Caroline Free

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

  5. ASSISTÊNCIA AO PARTO NORMAL NO DOMICÍLIO ATENCIÓN DEL PARTO NORMAL EN CASA CARE TO NATURAL HOME DELIVERY

    Directory of Open Access Journals (Sweden)

    Rejane Marie Barbosa Davim

    2001-11-01

    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.

  6. 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

    Directory of Open Access Journals (Sweden)

    Heylen Elsa

    2011-10-01

    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

  7. Premature delivery

    Directory of Open Access Journals (Sweden)

    Bernardita Donoso Bernales

    2012-09-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Boustani MA

    2012-11-01

    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 (http://www.indydiscoverynetwork.org. To date, the network has: (1 accomplished the

  9. Born Too Soon: Care during pregnancy and childbirth to reduce preterm deliveries and improve health outcomes of the preterm baby

    OpenAIRE

    Requejo, Jennifer; Merialdi, Mario; Althabe, Fernando; Keller, Matthais; Katz, Joanne; Menon, Ramkumar

    2013-01-01

    Abstract Pregnancy and childbirth represent a critical time period when a woman can be reached through a variety of mechanisms with interventions aimed at reducing her risk of a preterm birth and improving her health and the health of her unborn baby. These mechanisms include the range of services delivered during antenatal care for all pregnant women and women at high risk of preterm birth, services provided to manage preterm labour, and workplace, professional and other supportive policies ...

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

    Directory of Open Access Journals (Sweden)

    Kassam R

    2012-06-01

    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

  11. Exploring primary care providers' interest in using patient navigators to assist in the delivery of tobacco cessation treatment to low income, ethnic/racial minority patients.

    Science.gov (United States)

    Lubetkin, Erica I; Lu, Wei-Hsin; Krebs, Paul; Yeung, Howa; Ostroff, Jamie S

    2010-12-01

    We examined attitudes and practices regarding tobacco cessation interventions of primary care physicians serving low income, minority patients living in urban areas with a high smoking prevalence. We also explored barriers and facilitators to physicians providing smoking cessation counseling to determine the need for and interest in deploying a tobacco-focused patient navigator at community-based primary care practice sites. A self-administered survey was mailed to providers serving Medicaid populations in New York City's Upper Manhattan and areas of the Bronx. Provider counseling practices were measured by assessing routine delivery (≥80% of the time) of a brief tobacco cessation intervention (i.e., "5 A's"). Provider attitudes were assessed by a decisional balance scale comprising 10 positive (Pros) and 10 negative (Cons) perceptions of tobacco cessation counseling. Of 254 eligible providers, 105 responded (41%). Providers estimated 22% of their patients currently use tobacco and nearly half speak Spanish. A majority of providers routinely asked about tobacco use (92%) and advised users to quit (82%), whereas fewer assisted in developing a quit plan (32%) or arranged follow-up (21%). Compared to providers reporting navigation services at their practices. Although most providers believe they can help patients quit smoking, they also recognize the potential benefit of having a patient navigator connect their patients with evidence-based cessation services in their community. PMID:20336355

  12. Using an SBAR - keeping it real! Demonstrating how improving safe care delivery has been incorporated into a top-up degree programme.

    Science.gov (United States)

    Whittingham, Katrina A; Oldroyd, Linda E

    2014-06-01

    Using a standard communication tool can enhance and provide focus, to ensure that communication is accurately recorded and understood (Marquis and Huston, 2009). The Situation, Background, Assessment and Recommendation (SBAR) approach is common place in healthcare situations today (Institute for Health Improvement, 2011), thus justifying the use of this contemporary way of communicating to structure this article. Patient safety, clinical effectiveness and person centred approaches to care, are top priorities in healthcare today. As nursing is in transition to an all degree profession, these dimensions of care should be integral to any "top-up" qualification. This paper discusses how this current clinical agenda was embedded into a top-up degree along with improvement methodology, in order to prepare newly graduated nurses for the world of modern healthcare. The module was developed and delivered in collaboration with clinical practice to maintain credibility and realism for the students. Based on Salmon's model of e-learning (Salmon, 2004), the completely online delivery meant that the students learning occurred whilst clinically based, allowing for theory and practice to interweave in a meaningful way, resulting in actual quality improvement. PMID:24559799

  13. Balancing student/trainee learning with the delivery of patient care in the healthcare workplace: a protocol for realist synthesis

    Science.gov (United States)

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

    2016-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Ameur Amal

    2012-11-01

    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

  15. Progress and delivery of health care in Bhutan, the Land of the Thunder Dragon and Gross National Happiness.

    Science.gov (United States)

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

    2011-06-01

    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. PMID:21418446

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

    Directory of Open Access Journals (Sweden)

    Bernardo Hernández

    2012-10-01

    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

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

    Directory of Open Access Journals (Sweden)

    Scott Gee

    2013-01-01

    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.

  18. 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

    Directory of Open Access Journals (Sweden)

    Landy Christine

    2009-04-01

    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

  19. Competence of birth attendants at providing emergency obstetric care under India’s JSY conditional cash transfer program for institutional delivery: an assessment using case vignettes in Madhya Pradesh province

    OpenAIRE

    Chaturvedi, Sarika; Upadhyay, Sourabh; De Costa, Ayesha

    2014-01-01

    Background Access to emergency obstetric care by competent staff can reduce maternal mortality. India has launched the Janani Suraksha Yojana (JSY) conditional cash transfer program to promote institutional births. During implementation of the JSY, India witnessed a steep increase in the proportion of institutional deliveries-from 40% in 2004 to 73% in 2012. However, maternal mortality reduction follows a secular trend. Competent management of complications, when women deliver in facilities u...

  20. 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)

    OpenAIRE

    El-Chemali, Zeina

    2013-01-01

    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 Ethiopi...

  1. Health care operations management

    OpenAIRE

    Carter, M W; Hans, E.W.; Kolisch, R.

    2012-01-01

    Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully selected papers dealing with optimization and decision analysis problems in the field of health care operations management.

  2. 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

    2012-09-13

    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

  3. Infant care following delivery (image)

    Science.gov (United States)

    ... determine the APGAR scores. If some cyanosis (bluish skin) is present, the APGAR scores are lower and oxygen may be administered. The oxygen can often be merely blown by the newborn's face, through the mask in front of the infant.

  4. 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

    2016-01-01

    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.

  5. 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

    2012-01-01

    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.

  6. 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

    Directory of Open Access Journals (Sweden)

    María Teresa Valenzuela Mujica

    2011-12-01

    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.

  7. Comparación de la atención del parto normal en los sistemas hospitalario y tradicional A comparison of vaginal delivery care between hospital and traditional systems

    Directory of Open Access Journals (Sweden)

    Rosa María Méndez-González

    2002-04-01

    Full Text Available Objetivo. Comparar la atención del parto por vía vaginal entre los sistemas hospitalario y tradicional, para identificar recursos y procedimientos utilizados, y la aparición de complicaciones maternas y neonatales derivadas del tipo de atención. Material y métodos. Estudio transversal realizado en tres hospitales de la ciudad de Mérida y cuatro municipios del estado de Yucatán, México, entre 1989 y 1990. La muestra estuvo constituida por 205 mujeres que tuvieron parto por vía vaginal. Se observó la atención del parto y, a los 15 días posparto, se les entrevistó para detectar complicaciones maternas y neonatales. Se calcularon proporciones y se aplicó ji cuadrada para compararlas. Resultados. Se presentaron complicaciones en ambos sistemas. Sin embargo, en el hospitalario predominaron las maternas y en el tradicional, las neonatales. El número total de complicaciones fue similar. Conclusiones. La calidad de la atención fue similar en ambos servicios. Las complicaciones observadas pueden atribuirse a los recursos y acciones utilizados en cada sistema. Se requieren más estudios de este tipo para contar con evaluaciones objetivas de las ventajas y desventajas de ambos sistemas y contribuir a mejorar la calidad de la atención materno-infantil.Objective. To compare vaginal delivery hospital and traditional care systems to identify resources and practices, as well as maternal and neonatal complications related to each system. Material and Methods. Between 1989 and 1990, a cross-sectional study was conducted in three hospitals of Merida City and four municipalities of the state of Yucatan. The study sample consisted of 205 women who had a normal vaginal delivery. Delivery procedures were observed and a questionnaire to identify complications was applied 15 days after childbirth. Data analysis consisted in comparison of proportions with the chi-squared test. Results. Maternal and neonatal complications were identified in both systems

  8. The primary care delivery system in New York’s low-income communities: Private physicians and institutional providers in nine neighborhoods

    OpenAIRE

    Prinz, Timothy S.; Soffel, Denise

    2003-01-01

    Despite a recent policy emphasis on managed care as the preferred method of financing and delivering care to Medicaid beneficiaries and other indigent populations, there is little information on the availability or the characteristics of primary care providers in low-income neighborhoods.

  9. A Practice Theory Approach to Understanding the Interdependency of Nursing Practice and the Environment Implications for Nurse-Led Care Delivery Models

    OpenAIRE

    Bender, M.(Fakultät für Physik, Ludwig-Maximilians-Universität München, München, Germany); Feldman, MS

    2015-01-01

    Nursing has a rich knowledge base with which to develop care models that can transform the ways health is promoted and valued. However, theory linking the environment domain of the nursing metaparadigm with the real-world environments where nurses practice and patients experience their health care is tenuous. Practice theory is used to foreground the generative role of nursing practice in producing environments of care, providing the basis for a metaparadigm relational proposition explicitly ...

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

    OpenAIRE

    Abha Singh; Chandrashekhar Shrivastava

    2016-01-01

    Background: Despite all advances in obstetrical care eclampsia remains a puzzle and it still kills. Due to good antenatal and peripartum care, developed countries have a minimum incidence, while such changes have not occurred in developing countries especially in peripheral areas. So the incidence remains high in developing countries like India. Fetomaternal outcome in eclampsia depends on nature of convulsion quality and speed of care. Obstetrical management with the objective and ldquo;Soo...

  11. 预见性护理对降低阴道分娩产后出血的效果观察%Nursing care to observe the effect of vaginal delivery to reduce postpartum hemorrhage

    Institute of Scientific and Technical Information of China (English)

    余利萍

    2014-01-01

    Objective To investigate the clinical effects of vaginal birth for women,to give access to nursing care interventions in reducing the incidence of postpartum hemorrhage.Methods Our hospital in March 2012——2014 in March 126 cases of maternal vaginal delivery.All maternal vaginal delivery using a random number table divided into D1 group(observation group,63 cases)and the D2 group(63 cases in the control group).D2 Group:Implementation of routine post-natal care;D1 group:Implementation of postpartum nursing care.D1 and D2 group comparison group after the completion of vaginal delivery of maternal care postpartum hemorrhage.Results In terms of incidence of postpartum hemorrhage,D1 D2 group were lower than maternal vaginal delivery is particularly significant(P<0.05).2h postpartum bleeding and bleeding both 24h,D1 D2 group was lower than that especially women(P<0.05).Conclusion For vaginal birth mothers,given the predictability of clinical nursing intervention in reducing the incidence of postpartum hemorrhage,and control other aspects of postpartum hemorrhage showed significant value,clinical care showed significant effects.%目的:探讨针对阴道分娩产妇,给予预见性护理干预在降低产后出血发生率方面获得的临床效果。方法选取我院2012年03月——2014年03月阴道分娩产妇126例。将所有阴道分娩产妇利用随机数表法分为D1组(观察组63例)与D2组(对照组63例)。D2组:实施产后常规护理;D1组:实施产后预见性护理。对比D1组与D2组阴道分娩产妇完成护理后产后出血情况。结果在产后出血发生率方面,D1组低于D2组阴道分娩产妇尤为显著(P<0.05)。在产后2h出血量以及24h出血量两方面,D1组低于D2组产妇尤为明显(P<0.05)。结论针对阴道分娩产妇,临床给予预见性护理干预,在降低产妇产后出血发生率以及控制产后出血量等方面表现出显著价值,临床表现出显著的护理效果。

  12. The History of Care for the Low-Incident Handicapped in the Territory of Guam: Is There a Necessary Development Change in the Delivery of Special Education Services?

    Science.gov (United States)

    Peckens, Gloria

    A brief history of care for handicapped individuals on Guam is traced from early refusal to acknowledge their existence, to their increased visibility and current efforts toward least restrictive placement for education and care. It is explained that societal attitudes toward the handicapped in Guam are characterized by pity, neglect and repulsion…

  13. Effect of health education and psychological care on women's mode of delivery and birth outcomes%健康宣教与心理护理对女性分娩方式及分娩结局的影响

    Institute of Scientific and Technical Information of China (English)

    田翠珍

    2014-01-01

    目的:分析健康宣教与心理护理对女性分娩方式及分娩结局的影响。方法选择在我院进行产检及分娩的产妇作为研究对象,分别接受常规护理及围生期健康宣教与心理护理,比较2组产妇接受不同护理干预措施后的分娩方式、分娩结局、产后负面情绪评分及产后抑郁等情况的差异。结果观察组顺产率、产妇状态良好率、新生儿状态良好率明显高于对照组(P<0.05);产后汉密尔顿郁抑量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分、产后抑郁症发生率明显低于对照组(P<0.05)。结论围生期健康宣教与心理护理可以有效增加产妇的顺产率,提高产妇及新生儿结局,减轻产后的负面情绪,具有积极的临床意义。%Objective To analyze the effect of health education and psychological care on women's mode of delivery and birth outcomes.Methods Chosen pregnant women in our hospital as research subjects,receive routine care and perinatal health education and psychological care, compared the mode of delivery, birth outcomes and postnatal negative emotions.Results observation group vaginal delivery rate(80.95%), maternal good condition rate(92.86%), neonatal good condition rate (94.05%) were significantly higher than the control group (P<0.05);Postpartum HAMD score(14.09±1.42), HAMA score(13.21±1.34), postpartum depression(2.39%) were significantly lower than the control group(P<0.05).Conclusion Perinatal health education and psychological care can effectively increase the birth rate of maternal and optimize maternal and neonatal outcomes,reduce postpartum negative emotions with positive clinical significance.

  14. 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

    OpenAIRE

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

    2016-01-01

    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 ...

  15. 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

    OpenAIRE

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

    2016-01-01

    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...

  16. Public health professionals' perceptions toward provision of health protection in England: a survey of expectations of Primary Care Trusts and Health Protection Units in the delivery of health protection

    Directory of Open Access Journals (Sweden)

    Horsley Stephen S

    2006-12-01

    Full Text Available Abstract Background Effective health protection requires systematised responses with clear accountabilities. In England, Primary Care Trusts and the Health Protection Agency both have statutory responsibilities for health protection. A Memorandum of Understanding identifies responsibilities of both parties, but there is a potential lack of clarity about responsibility for specific health protection functions. We aimed to investigate professionals' perceptions of responsibility for different health protection functions, to inform future guidance for, and organisation of, health protection in England. Methods We sent a postal questionnaire to all health protection professionals in England from the following groups: (a Directors of Public Health in Primary Care Trusts; (b Directors of Health Protection Units within the Health Protection Agency; (c Directors of Public Health in Strategic Health Authorities and; (d Regional Directors of the Health Protection Agency Results The response rate exceeded 70%. Variations in perceptions of who should be, and who is, delivering health protection functions were observed within, and between, the professional groups (a-(d. Concordance in views of which organisation should, and which does deliver was high (≥90% for 6 of 18 health protection functions, but much lower (≤80% for 6 other functions, including managing the implications of a case of meningitis out of hours, of landfill environmental contamination, vaccination in response to mumps outbreaks, nursing home infection control, monitoring sexually transmitted infections and immunisation training for primary care staff. The proportion of respondents reporting that they felt confident most or all of the time in the safe delivery of a health protection function was strongly correlated with the concordance (r = 0.65, P = 0.0038. Conclusion Whilst we studied professionals' perceptions, rather than actual responses to incidents, our study suggests that there

  17. Decision-making for delivery location and quality of care among slum-dwellers: a qualitative study in Uttar Pradesh, India

    OpenAIRE

    Sudhinaraset, May; Beyeler, Naomi; Barge, Sandhya; Diamond-Smith, Nadia

    2016-01-01

    Background In 2013, the Government of India launched the National Urban Health Mission (NUHM) in order to better address the health needs of urban populations, including the nearly 100 million living in slums. Maternal and neonatal health indicators remain poor in India. The objective of this study is to highlight the experiences of women, their husbands, and mothers-in-law related to maternal health services and delivery experiences. Methods In total, we conducted 80 in-depth interviews, inc...

  18. Acute and Impaired Wound Healing: Pathophysiology and Current Methods for Drug Delivery, Part 1: Normal and Chronic Wounds: Biology, Causes, and Approaches to Care

    OpenAIRE

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

    2012-01-01

    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 ini...

  19. Influence of prenatal fever on delivery and nursing care%产前发热对产妇分娩的影响及护理

    Institute of Scientific and Technical Information of China (English)

    张慧珠; 郭芳; 何超; 钟俊敏

    2011-01-01

    目的:探讨产前发热对产妇分娩的影响及相应护理方法.方法:将204例分娩前发热产妇作为观察组,进行回顾性病例分析;同时随机抽取同期产前无发热产妇200例作为对照组.分析、比较两组分娩、新生儿窒息及产后出血等情况,并制定出系统护理措施.结果:观察组羊水污染、剖宫产、新生儿窒息发生率明显高于对照组(P<0.01).结论:产妇产前发热对分娩有不良影响,采取针对性的护理方法具有重要临床意义.%Objective:To discuss the influence of prenatal fever on delivery and proper nursing methods. Methods: 204 pregnant women with prenatal fever before delivery were taken as observation group and the clinical history of them was retrospectively analyzed; another 200 randomly selected pregnant women without prenatal fever at the same time were taken as control group. The delivery, neonatal asphyxia and postpartum hemorrhage of those puerperant were compared between the two groups and the systematic nursing measures were implemented. Results: The incidence of amniotic fluid pollution , cesarean section and neonatal asphyxia was significantly higher in the observation group than those in the control group ( P <0. 01 ). Conclusion: The influences of prenatal fever on delivery are obvious and taking appropriate nursing methods has the important clinical significance.

  20. Orphan Care in China

    Directory of Open Access Journals (Sweden)

    Meng, Liu

    2009-07-01

    Full Text Available Orphan care in China was once provided by the central government as a means of social control. The centralized welfare delivery guaranteed some of the poorest orphans to be protected by the government. Since the economic reform, the central government started to relinquish its control over social welfare delivery, new forms of orphan care were introduced into China, sharing the responsibilities and burdens for caring the orphans. Yet, many issues and problems exist in social delivery due to a lack of finances, professionals, and policy support. In this chapter, we will discuss the background of social welfare changes in China, as pertains to orphan care, focusing on the different types of orphans as a result of social issues, service delivery, barriers and solutions. It is claimed that during the reform, the burden of orphan care in China may not be reduced in the coming future, and we offer suggestions to cope with that.

  1. Exploring Primary Care Providers’ Interest in Using Patient Navigators to Assist in the Delivery of Tobacco Cessation Treatment to Low Income, Ethnic/Racial Minority Patients

    OpenAIRE

    Lubetkin, Erica I.; Lu, Wei-Hsin; Krebs, Paul; Yeung, Howa; Ostroff, Jamie S.

    2010-01-01

    We examined attitudes and practices regarding tobacco cessation interventions of primary care physicians serving low income, minority patients living in urban areas with a high smoking prevalence. We also explored barriers and facilitators to physicians providing smoking cessation counseling to determine the need for and interest in deploying a tobacco-focused patient navigator at community-based primary care practice sites. A self-administered survey was mailed to providers serving Medicaid ...

  2. The Impact of Youth and Family Risk Factors on Service Recommendations and Delivery in a School-Based System of Care

    OpenAIRE

    Whitson, Melissa L.; Connell, Christian M.; Bernard, Stanley; Kaufman, Joy S.

    2011-01-01

    The present study examines the impact of child and family risk factors on service access for youth and families in a school-based system of care. Regression analyses examined the relationships between risk factors and services recommended, services received, and dosage of services received. Logistic regression analyses examined the relationship between risk factors and whether or not youth received specific types of services within the system of care. Results revealed that youth with a person...

  3. Sexual risk behaviors among HIV-infected South Indian couples in the HAART era: implications for reproductive health and HIV care delivery

    OpenAIRE

    Kartik K Venkatesh; Srikrishnan, AK; Safren, Steven A.; Triche, Elizabeth W.; Thamburaj, E.; Prasad, Lakshmi; Lurie, Mark N; Kumar, M. Suresh; N Kumarasamy; Solomon, Suniti; Mayer, Kenneth H.

    2011-01-01

    The current study examines sexual behaviors among HIV-infected Indians in primary care, where access to highly active antiretroviral therapy (HAART) has recently increased. Between January to April 2008, we assessed the sexual behaviors of 247 HIV-infected South Indians in care. Multivariable logistic regression models were used to determine predictors of being in a HIV-seroconcordant primary relationship, being sexually active, and reporting unprotected sex. Over three-fourths (80%) of parti...

  4. Building the eye care team

    OpenAIRE

    Thulasiraj Ravilla; Gnanasekaran Chinnathambi

    2014-01-01

    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.

  5. The Impact of Customer Care on Experiences in Service Quality Delivery(a case study of Labadi Beach Hotel-Ghana)

    OpenAIRE

    Hanyabui, Akpabli; Ossai, Uche

    2008-01-01

    ABSTRACT COURSE: Bachelor Thesis in Business Administration 15 ECTS AUTHORS: Ossai Uche, (21st March 1980), Västerås. Prosper Akpabli Hanyabui, (17th March 1980), Västerås. PROBLEM STATEMENT How can Labadi Beach Hotel improve on customer care activities in order to create a positive customer experiences in the hotel? PURPOSE: The purpose of this study is to describe what Labadi Beach Hotel is doing and what they could do to improve customer care. Furthermore we shall also find out the problem...

  6. The Policy and the Practice: Early-Career Doctors and Nurses as Leaders and Followers in the Delivery of Health Care

    Science.gov (United States)

    Barrow, Mark; McKimm, Judy; Gasquoine, Sue

    2011-01-01

    There are increasing calls, from a range of stakeholders in the health sector, for healthcare professionals to work more collaboratively to provide health care. In response, education institutions are adopting an interprofessional education agenda in an attempt to provide health professionals ready to meet such calls. This article considers the…

  7. Respiratory Home Health Care

    Science.gov (United States)

    ... Health Care Font: Aerosol Delivery Oxygen Resources Immunizations Pollution Nutrition Exercise Coming Of Age Older Adults Allergy ... it is so cold it could hurt your skin. Make sure your electrical system doesn’t overload ...

  8. Maternal care

    OpenAIRE

    2001-01-01

    In June 2000 a distinguished group of obstetricians, midwives, general practitioners, and medical statisticians came together to discuss maternal care. Chaired by Professor James Drife from Leeds, discussion ranged over many topics, including: the changing role of the obstetrician, general practitioners, and the increasing status and responsibility of midwives. Other subjects include the induction of labour, obstetric analgesia and anaesthesia, and debates about the place and kind of delivery...

  9. Lessons for non-VA care delivery systems from the U.S. Department of Veterans Affairs Quality Enhancement Research Initiative: QUERI Series

    Directory of Open Access Journals (Sweden)

    Solberg Leif

    2009-02-01

    Full Text Available Abstract The U.S. Veterans Health Administration (VHA may have a very different structure and function from the organizations and practices that provide medical care to most Americans, but those organizations and practices could learn a lot from the VHA's Quality Enhancement Research Initiative (QUERI. There are at least six topics of increasing importance for implementation research where QUERI experience should be of value to other non-VHA organizations, both within and external to the United States: 1 Researcher-clinical leader partnerships for care improvement; 2 Attention to culture, capacity, leadership, and a supportive infrastructure; 3 Practical economic evaluation of quality implementation efforts; 4 Human subject protection problems; 5 Sustainability of improvements; and 6 Scale-up and spread of improvements. The articles in Implementation Science's QUERI Series provide the details of those lessons for others who are willing to invest the time to translate them into their different settings.

  10. Delivery of health care for cardiovascular and metabolic diseases among people living with HIV/AIDS in African countries: a systematic review protocol

    OpenAIRE

    Watkins, David A.; Tulloch, Nathaniel L.; Anderson, Molly E.; Barnhart, Scott; Steyn, Krisela; Levitt, Naomi S.

    2016-01-01

    Background People living with HIV (PLHIV) in African countries are living longer due to the rollout of antiretroviral drug therapy programs, but they are at increasing risk of non-communicable diseases (NCDs). However, there remain many gaps in detecting and treating NCDs in African health systems, and little is known about how NCDs are being managed among PLHIV. Developing integrated chronic care models that effectively prevent and treat NCDs among PLHIV requires an understanding of the curr...

  11. Lack of confidence among trainee doctors in the management of diabetes: the trainees own perception of delivery of care (TOPDOC) diabetes study

    OpenAIRE

    George, J T; Warriner, D.; McGrane, D.J; Rozario, K.S.; Price, H. C.; Wilmot, E.G.; Kar, P.; Stratton, I.M.; Jude, E.B; McKay, G A

    2011-01-01

    Background: There is an increased prevalence of diabetes. Doctors in training, irrespective of specialty, will have patients with diabetes under their care. Aim: To determine levels of confidence of doctors in training in the management of diabetes and establish their training needs in this area of clinical practice. Design: A national online survey of trainee doctors in the UK using a pre-validated questionnaire. Methods: A four-point confidence rating scale was used to rate conf...

  12. A cross-sectional study of antenatal care services utilization, delivery practices and factors affecting them in urban slum area of India in 2015

    OpenAIRE

    Suresh K. Mangulikar; Howal, Prashant V.; Kailash P. Kagne

    2016-01-01

    Background: Antenatal care (ANC) is one of the important factors in reducing maternal morbidity and mortality has wide regional variation. The present study was carried out in an urban slum area to determine the pattern of utilization of ANC services, awareness regarding Janani suraksha yojana (JSY) national programme and MEMS (Maharashtra emergency medical services) toll free helpline number (108 and 102). Methods: A community based cross sectional study was conducted in urban slum area ...

  13. Challenges of nurse delivery of psychological interventions for long-term conditions in primary care: a qualitative exploration of the case of chronic fatigue syndrome/myalgic encephalitis

    Directory of Open Access Journals (Sweden)

    Peters Sarah

    2011-12-01

    Full Text Available Abstract Background The evidence base for a range of psychosocial and behavioural interventions in managing and supporting patients with long-term conditions (LTCs is now well-established. With increasing numbers of such patients being managed in primary care, and a shortage of specialists in psychology and behavioural management to deliver interventions, therapeutic interventions are increasingly being delivered by general nurses with limited training in psychological interventions. It is unknown what issues this raises for the nurses or their patients. The purpose of the study was to examine the challenges faced by non-specialist nurses when delivering psychological interventions for an LTC (chronic fatigue syndrome/myalgic encephalomyelitis [CFS/ME] within a primary care setting. Methods A qualitative study nested within a randomised controlled trial [ISRCTN 74156610] explored the experiences and acceptability of two different psychological interventions (pragmatic rehabilitation and supportive listening from the perspectives of nurses, their supervisors, and patients. Semi structured in-depth interviews were conducted with three nurse therapists, three supervisors, and 46 patients. An iterative approach was used to develop conceptual categories from the dataset. Results Analyses identified four sets of challenges that were common to both interventions: (i being a novice therapist, (ii engaging patients in the therapeutic model, (iii dealing with emotions, and (iv the complexity of primary care. Each challenge had the potential to cause tension between therapist and patient. A number of strategies were developed by participants to manage the tensions. Conclusions Tensions existed for nurses when attempting to deliver psychological interventions for patients with CFS/ME in this primary care trial. Such tensions should be addressed before implementing psychological interventions within routine clinical practice. Similar tensions may be found

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

    OpenAIRE

    Jauregui, María Luz; Silvestre, Carmen; Valdes, Pedro; de Gaminde, Idoia

    2016-01-01

    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, in...

  15. 人性化护理在分娩陪伴中的应用效果观察%The observation of the effect for the application of humane care in delivery company

    Institute of Scientific and Technical Information of China (English)

    刘玉娥; 贺惠琴

    2012-01-01

    To observe the effect for the application of humane care in delivery company. Methods 150 cases of maternal natural delivery in our hospital from January 2010 to February 2011 were chosen as the research object. They were randomly divided into the observation group and the control group. The control group was taken with conventional methods of care for nursing. The observation group was taken with the humane care methods of care. The cesarean section rate, satisfaction rate and care before and after the HAM A, HAMD, and SCL-90 score in the birth process for the two groups were compared. Results The three process in the observation group were shorter than the control group, the rate of turning the cesarean section was lower than the control group, and postpartum observation group HAMA, HAMD scores were lower than the control group. The SCL-90 score was higher than that in the control group. The total satisfaction rate of the maternal in the observation group was significantly higher than the control group. The above-mentioned indicators of the formation were compared, the differences were significant (P < 0. 05). Conclusion The effect of the application of humane care in childbirth accompany has a good effect. It is with many advantages, can be applied in such maternal.%目的 观察人性化护理方法在分娩陪伴中的应用效果.方法 选取2010年1月~2011年2月在本院顺产的150例产妇作为研究对象,将其随机分为观察组和对照组,对照组采用常规护理方法进行护理,观察组采取人性化护理方法进行护理,比较两组患者三个产程、转剖宫产率、满意率及护理前后HAMA、HAMD及SCL-90评分.结果 观察组的三个产程均短于对照组,转剖宫产率低于对照组,产后观察组的HAMA、HAMD评分低于对照组,SCL-90评分高于对照组,观察组的产妇总满意率明显高于对照组,上述指标组建比较,差异均具有统计学意义(P<0.05).结论 人性化护理在分娩陪伴

  16. The practice of physicians and nurses in the Brazilian Family Health Programme – evidences of change in the delivery health care model

    Science.gov (United States)

    Peres, Ellen M; Andrade, Ana M; Dal Poz, Mario R; Grande, Nuno R

    2006-01-01

    The article analyzes the practice of physicians and nurses working on the Family Health Programme (Programa de Saúde da Família or PSF, in Portuguese). A questionnaire was used to assess the evidences of assimilation of the new values and care principles proposed by the programme. The results showed that a great number of professionals seem to have incorporated the practice of home visits, health education actions and planning of the teams' work agenda to their routine labour activities. PMID:17107622

  17. The practice of physicians and nurses in the Brazilian Family Health Programme – evidences of change in the delivery health care model

    Directory of Open Access Journals (Sweden)

    Andrade Ana M

    2006-11-01

    Full Text Available Abstract The article analyzes the practice of physicians and nurses working on the Family Health Programme (Programa de Saúde da Família or PSF, in Portuguese. A questionnaire was used to assess the evidences of assimilation of the new values and care principles proposed by the programme. The results showed that a great number of professionals seem to have incorporated the practice of home visits, health education actions and planning of the teams' work agenda to their routine labour activities.

  18. The practice of physicians and nurses in the Brazilian Family Health Programme – evidences of change in the delivery health care model

    OpenAIRE

    Andrade Ana M; Dal Poz Mario R; Peres Ellen M; Grande Nuno R

    2006-01-01

    Abstract The article analyzes the practice of physicians and nurses working on the Family Health Programme (Programa de Saúde da Família or PSF, in Portuguese). A questionnaire was used to assess the evidences of assimilation of the new values and care principles proposed by the programme. The results showed that a great number of professionals seem to have incorporated the practice of home visits, health education actions and planning of the teams' work agenda to their routine labour activit...

  19. The practice of physicians and nurses in the Brazilian Family Health Programme - evidences of change in the delivery health care model.

    Science.gov (United States)

    Peres, Ellen M; Andrade, Ana M; Dal Poz, Mario R; Grande, Nuno R

    2006-01-01

    The article analyzes the practice of physicians and nurses working on the Family Health Programme (Programa de Saúde da Família or PSF, in Portuguese). A questionnaire was used to assess the evidences of assimilation of the new values and care principles proposed by the programme. The results showed that a great number of professionals seem to have incorporated the practice of home visits, health education actions and planning of the teams' work agenda to their routine labour activities. PMID:17107622

  20. Oral delivery of anticancer drugs

    DEFF Research Database (Denmark)

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

    2013-01-01

    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-nanocarriers in the...

  1. 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; Kracht, Thorben

    2010-01-01

    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 m...... memory function with half-increment dosing, versus NovoPen® Junior and HumaPen® Luxura™ HD in pediatric subjects, their parents, and health care professionals (HCPs).......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...

  2. Effect of midwifery care on the progress of advanced maternal mode of delivery and birth process%助产护理对高龄产妇分娩方式及产程进展的影响

    Institute of Scientific and Technical Information of China (English)

    邓华

    2015-01-01

    Objective:To study the Nursing Midwifery intervention mode of delivery on maternal age and birth process signiifcance.Methods: in our hospital 80 advanced maternal age, they were randomLy divided into two groups, the intervention group and control group. The control group routine obstetric nursing measure parturient, on this basis, take the midwifery care interventions on maternal intervention group. Comparison of two groups of maternal labor time and mode of delivery.Results:in the duration of labor and the natural birth rate, mothers in the intervention group was signiifcantly lower than the control group, signiifcant difference statistically signiifcant (P< 0.05).Conclusion: taking midwifery nursing intervention can make the elderly primipara cesarean section rate decreased obviously, reduce the delivery risk, ensure the safety of mother and child.%目的:研究对高龄产妇的分娩方式和产程进行助产护理干预的意义。方法选取我院80位高龄产妇,将其随机分为两组,干预组和对照组。对对照组产妇实施常规产科的护理措施,在这个基础上,对干预组产妇采取助产护理干预措施。对两组产妇的产程时间和分娩方式进行比较。结果在产程时间和自然分娩率,干预组的产妇明显比对照组低,显著性差异,在统计学上意义(P<0.05)。结论采取助产护理干预措施可以使高龄初产妇的剖宫产率明显降低,降低分娩风险,确保母子的安全。

  3. Out of Place: Mediating Health and Social Care in Ontario's Long-Term Care Sector

    Science.gov (United States)

    Daly, Tamara

    2007-01-01

    The paper discusses two reforms in Ontario's long-term care. The first is the commercialization of home care as a result of the implementation of a "managed competition" delivery model. The second is the Ministry of Health and Long-Term Care's privileging of "health care" over "social care" through changes to which types of home care and home…

  4. Big Data and Ambulatory Care

    OpenAIRE

    Thorpe, Jane Hyatt; Gray, Elizabeth Alexandra

    2014-01-01

    Big data is heralded as having the potential to revolutionize health care by making large amounts of data available to support care delivery, population health, and patient engagement. Critics argue that big data's transformative potential is inhibited by privacy requirements that restrict health information exchange. However, there are a variety of permissible activities involving use and disclosure of patient information that support care delivery and management. This article presents an ov...

  5. Lean health care.

    Science.gov (United States)

    Hawthorne, Henry C; Masterson, David J

    2013-01-01

    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. PMID:23802475

  6. Consent and widespread access to personal health information for the delivery of care: a large scale telephone survey of consumers' attitudes using vignettes in New Zealand

    Science.gov (United States)

    Whiddett, Dick; Hunter, Inga; McDonald, Barry; Norris, Tony; Waldon, John

    2016-01-01

    Objectives In light of recent health policy, to examine factors which influence the public's willingness to consent to share their health information in a national electronic health record (EHR). Design Data were collected in a national telephone survey in 2008. Respondents were presented with vignettes that described situations in which their health information was shared and asked if they would consent to such sharing. The subset, consisting of the 18 vignettes that covered proving care, was reanalysed in depth using new statistical methods in 2016. Setting Adult population of New Zealand accessible by telephone landline. Participants 4209 adults aged 18+ years in the full data set, 2438 of which are included in the selected subset. Main outcome measures For each of 18 vignettes, we measured the percentage of respondents who would consent for their information to be shared for 2 groups; for those who did not consider that their records contained sensitive information, and for those who did or refused to say. Results Rates of consent ranged from 89% (95% CI 87% to 92%) for sharing of information with hospital doctors and nurses to 51% (47% to 55%) for government agencies. Mixed-effects logistic regression was used to identify factors which had significant impact on consent. The role of the recipient and the level of detail influenced respondents' willingness to consent (p<0.0001 for both factors). Of the individual characteristics, the biggest impact was that respondents whose records contain sensitive information (or who refused to answer) were less willing to consent (p<0.0001). Conclusions A proportion of the population are reluctant to share their health information beyond doctors, nurses and paramedics, particularly when records contain sensitive information. These findings may have adverse implications for healthcare strategies based on widespread sharing of information. Further research is needed to understand and overcome peoples' ambivalence towards

  7. Information Sharing for Care Coordination

    OpenAIRE

    Amir, Ofra; Grosz, Barbara J.; Stern, Roni; Sanders, Lee M.

    2013-01-01

    Teamwork and care coordination are of increasing importance to health care delivery and patient safety and health. This paper describes our initial work on developing agents that are able to make intelligent information sharing decisions to support a diverse, evolving team of care providers in constructing and maintaining a shared plan that operates in uncertain environments and over a long time horizon.

  8. 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

    1992-12-01

    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.

  9. Responsive foams for nanoparticle delivery.

    Science.gov (United States)

    Tang, Christina; Xiao, Edward; Sinko, Patrick J; Szekely, Zoltan; Prud'homme, Robert K

    2015-09-01

    We have developed responsive foam systems for nanoparticle delivery. The foams are easy to make, stable at room temperature, and can be engineered to break in response to temperature or moisture. Temperature-responsive foams are based on the phase transition of long chain alcohols and could be produced using medical grade nitrous oxide as a propellant. These temperature-sensitive foams could be used for polyacrylic acid (PAA)-based nanoparticle delivery. We also discuss moisture-responsive foams made with soap pump dispensers. Polyethylene glycol (PEG)-based nanoparticles or PMMA latex nanoparticles were loaded into Tween 20 foams and the particle size was not affected by the foam formulation or foam break. Using biocompatible detergents, we anticipate this will be a versatile and simple approach to producing foams for nanoparticle delivery with many potential pharmaceutical and personal care applications. PMID:26091943

  10. The image of care delivery by Public Health Nurses as disseminated in Revista da Semana (1929) La imagen del cuidado prestado por las Enfermeras de Salud Pública publicada en la Revista de la Semana (1929) A imagem do cuidado prestado pelas enfermeiras de saúde pública veiculada na Revista da Semana (1929)

    OpenAIRE

    Anna Karina de Matos Deslandes; Simone Aguiar; Mercedes Neto; Fernando Rocha Porto

    2013-01-01

    OBJECTIVE: to analyze the images of Public Health Nurses in care delivery to society, disseminated by the Revista da Semana, in 1929. METHOD: historical-semiotic study. The documents used were images, to which an analysis matrix was applied, including fashion and body language literature, besides others to address the study object. The data were interpreted in the light of the sociologist Pierre Bourdieu's notions of object representations and body hexis. RESULTS: the distinctive use of unifo...

  11. "Uberizing" home care in Ontario.

    Science.gov (United States)

    Wojtak, Anne; Stark, Linda

    2016-07-01

    This article looks at home care in Ontario and its role as a foundation for a sustainable healthcare system in the future. Beginning with the history and evolution of the service delivery model, it examines current challenges and opportunities to unleash the potential of home care within a more integrated model for patient-centred care for the future. An in-depth look at how to better coordinate, integrate, and fund care for patients is highlighted. PMID:27269814

  12. Equity in health care delivery and finance

    OpenAIRE

    John Roemer

    2003-01-01

    Much has happened in the theory of distributive justice during the last 30 years, in the period, roughly, since Rawls published his magisterial work1. As occurs in most fields following a great contribution, that work has been subjected to critique, amended and ramified, so that what Rawls proposed now appears as an early ancestor of contemporary theories of distributive justice, or equity. In this paper, I locate what I think is the main trend in this developing theory, and then to try to ap...

  13. Science of Human Caring

    OpenAIRE

    Foss-Durant, Anne M.

    2014-01-01

    Background: When state-mandated ratios were enacted, our leadership team began exploring the care delivery model. Increasing the number of nurses on each unit provided an opportunity to refocus care on the relationship with the patient and family. During the initial phases of this transition work, we engaged frontline staff in dialogue. What surfaced were feelings of being overwhelmed, anxiety about being able to complete everything before the end of the shift, feelings of defeat or illness b...

  14. Teamwork for eye care

    Directory of Open Access Journals (Sweden)

    M Babar Qureshi

    2014-04-01

    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.

  15. Teamwork for eye care

    OpenAIRE

    M Babar Qureshi

    2014-01-01

    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.

  16. Ocular delivery of macromolecules

    OpenAIRE

    Kim, Yoo-Chun; Chiang, Bryce; Wu, Xianggen; Prausnitz, Mark R.

    2014-01-01

    Biopharmaceuticals are making increasing impact on medicine, including treatment of indications in the eye. Macromolecular drugs are typically given by physician-administered invasive delivery methods, because non--invasive ocular delivery methods, such as eye drops, and systemic delivery, have low bioavailability and/or poor ocular targeting. There is a need to improve delivery of biopharmaceuticals to enable less-invasive delivery routes, less-frequent dosing through controlled-release drug...

  17. Outcomes of vaginal delivery and cesarean in Mashhad Ghaem University Hospital

    Directory of Open Access Journals (Sweden)

    Hassan Boskabadi

    2014-03-01

    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. Primary Care: Medicine's Gordian Knot.

    Science.gov (United States)

    Oddone, Eugene Z; Boulware, L Ebony

    2016-01-01

    Primary care is the cornerstone of effective and efficient healthcare systems. Patients prefer a trusted primary care provider to serve as the first contact for all of their healthcare questions, to help them make important health decisions, to help guide them through an expanding amount of medical information and to help coordinate their care with all other providers. Patients also prefer to establish an ongoing, continuous relationship with their primary care provider. However, fewer and fewer physicians are choosing primary care as a career, threatening the foundation of the health system. We explore the central challenges of primary care defined by work-force controversies about who can best deliver primary care. We also explore the current challenging reimbursement model for primary care that often results in fragmenting care for patients and providers. Finally, we explore new models of primary care health delivery that may serve as partial solutions to the current challenges. PMID:26802754

  19. Building the eye care team

    Directory of Open Access Journals (Sweden)

    Thulasiraj Ravilla

    2014-07-01

    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.

  20. Postpartum Depression: Is Mode of Delivery a Risk Factor?

    OpenAIRE

    Asli Goker; Emre Yanikkerem; M. Murat Demet; Serife Dikayak; Yasemin Yildirim; KOYUNCU, Faik M

    2012-01-01

    There are various factors related to postpartum depression. In this study we have aimed to determine the effect of mode of delivery on the risk of postpartum depression. A total of 318 women who applied for delivery were included in the study. Previously diagnosed fetal anomalies, preterm deliveries, stillbirths, and patients with need of intensive care unit were excluded from the study. Data about the patients were obtained during hospital stay. During the postpartum sixth week visit Edinbur...

  1. Policy for Prevention of a Retained Sponge after Vaginal Delivery

    OpenAIRE

    Garry, David J.; Sandra Asanjarani; Geiss, Donna M.

    2012-01-01

    Background. Policies for sponge count are not routine practice in most labor and delivery rooms. Ignored or hidden retained vaginal foreign bodies has potentially significant health care morbidity. Case. This was a case of a retained vaginal sponge following an uncomplicated spontaneous vaginal delivery. Delivery room policy resulted in the discovery of the sponge on X-ray when an incorrect sponge count occurred and physical exam did not find the sponge. Conclusion. This emphasizes the use of...

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  3. Healthcare Delivery Systems at Higher Educational Institutions in India

    Directory of Open Access Journals (Sweden)

    Rajiv Chintaman Yeravdekar

    2014-01-01

    Conclusions: The collective responses obtained could provide the basis for a policy formulation. The policy formulation in turn could be the basis of a national consensus for health care delivery systems operational at higher educational institutions in India.

  4. Formal dementia care among first nations in southwestern Ontario.

    Science.gov (United States)

    Finkelstein, Sara A; Forbes, Dorothy A; Richmond, Chantelle A M

    2012-09-01

    This article explores how dementia care is provided to First Nations communities in southwestern Ontario. Data were collected through in-depth interviews with health care providers and analysed using a constructivist grounded-theory methodology. Two interrelated frameworks for understanding dementia care were identified: a care delivery framework and a knowledge framework. The care delivery framework identified care goals, care elements being provided, care barriers, and strategies and solutions to deliver care and overcome barriers. The knowledge framework defined four groups of knowledge stakeholders: persons with dementia, informal care providers, formal care providers, and the First Nations community. It identified the knowledge each stakeholder held or needed and processes of sharing - or failing to share - knowledge in dementia care. Several barriers, many created by a lack of knowledge, negatively impacted dementia care. However, health care professionals had effective strategies for providing care, designed to overcome barriers and which encompassed elements of knowledge sharing. PMID:22828489

  5. Effective health care for older people living and dying in care homes: a realist review

    OpenAIRE

    Goodman, Claire; Dening, Tom; Gordon, Adam L.; Davies, Susan L.; Meyer, Julienne; Martin, Finbarr C; Gladman, John R F; Bowman, Clive; Victor, Christina; Handley, Melanie; Gage, Heather; Iliffe, Steve; ZUBAIR, MARIA

    2016-01-01

    Background Care home residents in England have variable access to health care services. There is currently no coherent policy or consensus about the best arrangements to meet these needs. The purpose of this review was to explore the evidence for how different service delivery models for care home residents support and/or improve wellbeing and health-related outcomes in older people living and dying in care homes. Methods We conceptualised models of health care provision to care homes as comp...

  6. Patient's Guide to Aerosol Drug Delivery

    Science.gov (United States)

    ... to use that device), and age (airway size, respiratory rate, lung vol- umes) are substantial challenges for effective aerosol drug delivery. You will need to gain a clear understanding of these ... from the respiratory therapist or other health care professional to provide ...

  7. Viewing eCare through Nurses' Eyes: A Phenomenological Study

    Science.gov (United States)

    Willey, Jeffrey Allan

    2013-01-01

    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…

  8. eDelivery

    Data.gov (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....

  9. Advocacy for eye care

    Directory of Open Access Journals (Sweden)

    Thulasiraj D Ravilla

    2012-01-01

    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.

  10. Office of Disability, Aging and Long-Term Care Policy

    Science.gov (United States)

    ... direct care workforce. Division of Behavioral Health and Intellectual Disabilities Policy The Division of Behavioral Health and Intellectual Disabilities Policy focuses on financing, delivery, and quality of ...

  11. NEW DRUG DELIVERY SYSTEM

    OpenAIRE

    Sarkar Biresh K; Jain Devananda; Banerjee Angshu

    2011-01-01

    Incorporating an existing medicine into a new drug delivery system can significantly improve its performance in terms of efficacy, safety, and improved patient compliance. The need for delivering drugs to patients efficiently and with fewer side effects has prompted pharmaceutical companies to engage in the development of new drug delivery systems. Today, drug delivery companies are engaged in the development of multiple platform technologies for controlled release, delivery of large molecule...

  12. Competition in the Dutch Health Care Sector

    OpenAIRE

    Schut, Erik

    1995-01-01

    textabstractFor more than two decades, Dutch health policy has been marked by a search for a suitable market order in health care. Suitable in the sense of maintaining universal access, containing the growth of health care expenditure and improving the technical and allocative efficiency of health care delivery. This search was spurred by the seemingly uncontrollable escalation of health care expenditure during the early 1970s. The solution initially put forward to control health care cost in...

  13. [Managed care. Its impact on health care in the USA, especially on anesthesia and intensive care].

    Science.gov (United States)

    Bauer, M; Bach, A

    1998-06-01

    Managed care, i.e., the integration of health insurance and delivery of care under the direction of one organization, is gaining importance in the USA health market. The initial effects consisted of a decrease in insurance premiums, a very attractive feature for employers. Managed care promises to contain expenditures for health care. Given the shrinking public resources in Germany, managed care seems attractive for the German health system, too. In this review the development of managed care, the principal elements, forms of organisation and practical tools are outlined. The regulation of the delivery of care by means of controlling and financial incentives threatens the autonomy of physicians: the physician must act as a "double agent", caring for the interest for the individual patient and being restricted by the contract with the managed care organisation. Cost containment by managed care was achieved by reducing the fees for physicians and hospitals (and partly by restricting care for patients). Only a fraction of this cost reduction was handed over to the enrollee or employer, and most of the money was returned with profit to the shareholders of the managed care organisations. The preeminent role of primary care physicians as gatekeepers of the health network led to a reduced demand for specialist services in general and for university hospitals and anesthesiologists in particular. The paradigm of managed care, i.e., to guide the patient and the care giver through the health care system in order to achieve cost-effective and high quality care, seems very attractive. The stress on cost minimization by any means in the daily practice of managed care makes it doubtful if managed care should be an option for the German health system, in particular because there are a number of restrictions on it in German law. PMID:9676303

  14. Bedside Reporting: Protocols for Improving Patient Care.

    Science.gov (United States)

    Ferguson, Teresa D; Howell, Teresa L

    2015-12-01

    Bedside reporting continues to gain much attention and is being investigated to support the premise that "hand-off" communications enhance efficacy in delivery of patient care. Patient inclusion in shift reports enhances good patient outcomes, increased satisfaction with care delivery, enhanced accountability for nursing professionals, and improved communications between patients and their direct care providers. This article discusses the multiple benefits of dynamic dialogue between patients and the health care team, challenges often associated with bedside reporting, and protocols for managing bedside reporting with the major aim of improving patient care. Nursing research supporting the concept of bedside reporting is examined. PMID:26596661

  15. REVIEW OF FOCUSSED ANTENATAL CARE

    Directory of Open Access Journals (Sweden)

    Sreelatha

    2015-09-01

    Full Text Available INTRODUCTION: Antenatal care is a comprehensive antepartum programme which involves a coordinated approach to medical care , continuous risk assessment , and psychological support that optimally begins before conception and extends throughout the postpartum period and int erconceptional period . [1] One of major responsibility of obstetrician providing antenatal care is to identify high risk factors based on past history, examination and investigation results. The objective of antenatal care therefore is to assure that every wanted pregnancy results in the delivery of a healthy baby without impairing the mothers health . [2] In a 1914 study by Williams antenatal care reduced fetal mortality by 40%

  16. Decolorization of four dyes by a mixed culture of Trametes sp. SQO1 and Chaetomium sp. RO1%Trametes sp.SQ01和Chaetomium sp.R01混合培养对四种染料的脱色

    Institute of Scientific and Technical Information of China (English)

    杨秀清; 王婧人; 赵晓霞; 薛瑞

    2011-01-01

    Four dyes including Congo red, acid red, orange G and bromphenol blue were decolorized by a mixed fungal culture of Trametes sp. SQO 1 and Chaetomium sp. R0I, which were newly developed in our laboratory. The results indicated that MnP activity in the mixed culture of strain S001 and R0I increased approximately 5.5 times over that obtained from a pure culture of SQOI. The amount and timing of strain R01 had a marked effect on MnP production by SQOI. If the inoculum of strain ROI was too high or too low, the MnP activity decreased in the mixed culture. As the inoculation time of strain R01 was delayed, MnP activity was gradually reduced. MnP production was inhibited by about 40% ~75% by the four dyes in mixed culture of SQOI and R01. The decolorization rates of mixed culture of strain SQ01 and R01 were increased by 20% ~ 50% compared to that of the monoculture of SQOI. After 3 days, 75% ~94% of four dyes were decolorized by mixed culture of SQ01 and R01 ,while the decolorization rate was only about 41% 75% by strain SQ01 cultured alone. The time-point of dye addition remarkably influenced the efficiency of decolorization by the mixed culture. The decolorization rates of dyes added to the medium after 4 days of mixed cultivation were significantly higher as compared to dyes added at the outset of mixed cultivation. In addition to biodegradation, biosorption also played an important role in the decoiorization process. The biosorption of orange G, bromphenol blue and acid red accounted for 2% ,5% and 15% of the total color removal,respectively. However,the biosorption rate of congo red reached up to 60%.To date, this is the first report of decolorizing dyes by mixed fungal cultures. The high efficiency of the decolorization ability indicates that the mixed culture has broad application prospects in dye decolorization treatment.%利用本实验室新构建的白腐菌Trametes sp.SQ01和毛壳菌Chaetomium sp.R01混合培养体系,对刚

  17. Measuring integrated care

    DEFF Research Database (Denmark)

    Strandberg-Larsen, Martin

    2011-01-01

    respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser...... 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...... of secondary data from the Danish healthcare system and Kaiser Permanente, California were used to compare population characteristics, professional staff, delivery structure, utilisation, quality measures and direct costs. A cross-sectional survey among primary care clinicians in Denmark and in Kaiser...

  18. Integrated delivery systems. Evolving oligopolies.

    Science.gov (United States)

    Malone, T A

    1998-01-01

    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. PMID:10180497

  19. NEW DRUG DELIVERY SYSTEM

    Directory of Open Access Journals (Sweden)

    Sarkar Biresh K

    2011-05-01

    Full Text Available Incorporating an existing medicine into a new drug delivery system can significantly improve its performance in terms of efficacy, safety, and improved patient compliance. The need for delivering drugs to patients efficiently and with fewer side effects has prompted pharmaceutical companies to engage in the development of new drug delivery systems. Today, drug delivery companies are engaged in the development of multiple platform technologies for controlled release, delivery of large molecules, liposome, taste-masking, oral fast- dispersing dosage forms, technology for in- soluble drugs, and delivery of drugs through intranasal, pulmonary, transdermal, vaginal, colon, and transmucosal routes.

  20. Strengthening of primary health care: Key to deliver inclusive health care

    Directory of Open Access Journals (Sweden)

    Rajiv Yeravdekar

    2013-01-01

    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. 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

    2009-03-01

    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

  2. Data Management for Evaluating Complications of Health Care

    OpenAIRE

    Streed, Stephen A.; Massanari, R. Michael

    1988-01-01

    This paper describes the design and operating characteristics of a microcomputer-based data management system for assessing complications associated with the delivery of health care. The system was developed in response to the need to promote “risk management” as an essential component of the Quality Assurance effort within the health care delivery environment. The system herein described allows the epidemiological evaluation of complications of health care in a tertiary care referral center....

  3. Utilising inorganic nanocarriers for gene delivery.

    Science.gov (United States)

    Loh, Xian Jun; Lee, Tung-Chun; Dou, Qingqing; Deen, G Roshan

    2016-01-01

    The delivery of genetic materials into cells to elicit cellular responses has been extensively studied by biomaterials scientists globally. Many materials such as lipids, peptides, viruses, synthetically modified cationic polymers and certain inorganic nanomaterials could be used to complex the negatively charged plasmids and deliver the formed package into cells. The recent literature on the delivery of genetic materials utilising inorganic nanoparticles is carefully examined in this review. We have picked out the most relevant references and concisely summarised the findings with illustrated examples. We further propose alternative approaches and suggest future pathways towards the practical use of multifunctional nanocarriers. PMID:26484365

  4. 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)

    王新侠

    2016-01-01

    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.

  5. Facilitators and barriers of implementing the chronic care model in primary care: a systematic review

    OpenAIRE

    Kadu, Mudathira K; Stolee, Paul

    2015-01-01

    Background The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identi...

  6. Physicians, the Affordable Care Act, and Primary Care: Disruptive Change or Business as Usual?

    OpenAIRE

    JACOBSON, Peter D.; Jazowski, Shelley A.

    2011-01-01

    The Patient Protection and Affordable Care Act1 (ACA) presages disruptive change in primary care delivery. With expanded access to primary care for millions of new patients, physicians and policymakers face increased pressure to solve the perennial shortage of primary care practitioners. Despite the controversy surrounding its enactment, the ACA should motivate organized medicine to take the lead in shaping new strategies for meeting the nation’s primary care needs. In this commentary, we arg...

  7. From Practice Culture to Patient Outcomes: Improving Primary Care Through Interdisciplinary Health Care Teams

    OpenAIRE

    Grace, Sherry M.

    2013-01-01

    Background: In 2011, a large integrated healthcare organization implemented a primary care team redesign in five pilot practices to improve the delivery of patient-centered chronic illness care and augment the physician-medical assistant dyads by adding two new primary care team roles for each practice - a nurse care manager (NCM) and a patient health coach (PHC). This work examines three aspects of implementing the care team redesign: 1) The facilitators and barriers of implementation, 2) Th...

  8. Caring for quality of care: symbolic violence and the bureaucracies of audit

    OpenAIRE

    Emmerich, Nathan; Swinglehurst, Deborah; Maybin, Jo; Park, Sophie; Quilligan, Sally

    2015-01-01

    Background This article considers the moral notion of care in the context of Quality of Care discourses. Whilst care has clear normative implications for the delivery of health care it is less clear how Quality of Care, something that is centrally involved in the governance of UK health care, relates to practice. Discussion This paper presents a social and ethical analysis of Quality of Care in the light of the moral notion of care and Bourdieu’s conception of symbolic violence. We argue that...

  9. Project delivery system (PDS)

    CERN Document Server

    2001-01-01

    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.

  10. Creating learning environments for compassionate care: a programme to promote compassionate care by health and social care teams

    OpenAIRE

    Bridges, J.; Fuller, A.

    2014-01-01

    Background The consistent delivery of compassionate health and social care to older people is a matter of global concern to the nursing profession and the public it serves. The development and evaluation of effective interventions to address this concern is of prime importance. Aims and objectives This paper draws on findings from previous research to propose the use of a novel implementation programme designed to improve and support the delivery of compassionate care by health an...

  11. Comparison of Perinatal Outcome of Preterm Births Starting in Primary Care versus Secondary Care in Netherlands: A Retrospective Analysis of Nationwide Collected Data

    Science.gov (United States)

    van der Ven, A. J.; Schaaf, J. M.; van Os, M. A.; de Groot, C. J. M.; Haak, M. C.; Pajkrt, E.; Mol, B. W. J.

    2014-01-01

    Introduction. In Netherlands, the obstetric care system is divided into primary and secondary care by risk level of the pregnancy. We assessed the incidence of preterm birth according to level of care and the association between level of care at time of labor onset and delivery and adverse perinatal outcome. Methods. Singleton pregnancies recorded in Netherlands Perinatal Registry between 1999 and 2007, with spontaneous birth between 25+0 and 36+6 weeks, were included. Three groups were compared: (1) labor onset and delivery in primary care; (2) labor onset in primary care and delivery in secondary care; (3) labor onset and delivery in secondary care. Multivariable logistic regression analyses were performed to calculate the risk of perinatal mortality and Apgar score ≤4. Results. Of all preterm deliveries, 42% had labor onset and 7.9% had also delivery in primary care. Women with labor onset between 34+0 and 36+6 weeks who were referred before delivery to secondary care had the lowest risk of perinatal mortality (aOR 0.49 (0.30–0.79)). Risk of perinatal mortality (aOR 1.65; 95% CI 1.20–2.27) and low Apgar score (aOR 1.95; 95% CI 1.53–2.48) were significantly increased in preterm home delivery. Conclusion. Referral before delivery is associated with improved perinatal outcome in the occurrence of preterm labor onset in primary care. PMID:25610468

  12. Comparison of Perinatal Outcome of Preterm Births Starting in Primary Care versus Secondary Care in Netherlands: A Retrospective Analysis of Nationwide Collected Data

    Directory of Open Access Journals (Sweden)

    A. J. van der Ven

    2014-01-01

    Full Text Available Introduction. In Netherlands, the obstetric care system is divided into primary and secondary care by risk level of the pregnancy. We assessed the incidence of preterm birth according to level of care and the association between level of care at time of labor onset and delivery and adverse perinatal outcome. Methods. Singleton pregnancies recorded in Netherlands Perinatal Registry between 1999 and 2007, with spontaneous birth between 25+0 and 36+6 weeks, were included. Three groups were compared: (1 labor onset and delivery in primary care; (2 labor onset in primary care and delivery in secondary care; (3 labor onset and delivery in secondary care. Multivariable logistic regression analyses were performed to calculate the risk of perinatal mortality and Apgar score ≤4. Results. Of all preterm deliveries, 42% had labor onset and 7.9% had also delivery in primary care. Women with labor onset between 34+0 and 36+6 weeks who were referred before delivery to secondary care had the lowest risk of perinatal mortality (aOR 0.49 (0.30–0.79. Risk of perinatal mortality (aOR 1.65; 95% CI 1.20–2.27 and low Apgar score (aOR 1.95; 95% CI 1.53–2.48 were significantly increased in preterm home delivery. Conclusion. Referral before delivery is associated with improved perinatal outcome in the occurrence of preterm labor onset in primary care.

  13. 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)

    2011-01-01

    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

  14. 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.

    2011-01-01

    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

  15. Team networking in palliative care.

    Science.gov (United States)

    Spruyt, Odette

    2011-01-01

    "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. PMID:21811361

  16. Team networking in palliative care

    Directory of Open Access Journals (Sweden)

    Odette Spruyt

    2011-01-01

    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.

  17. Improving Palliative Cancer Care.

    Science.gov (United States)

    Del Ferraro, Catherine; Ferrell, Betty; Van Zyl, Carin; Freeman, Bonnie; Klein, Linda

    2014-01-01

    Over a decade ago, the Institute of Medicine (IOM) presented Ensuring Quality Cancer Care in the United States, with recommendations for change (IOM, 1999). However, barriers to integrating palliative care (PC) to achieve high-quality care in cancer still remain. As novel therapeutic agents evolve, patients are living longer, and advanced cancer is now considered a chronic illness. In addition to complex symptom concerns, patients and family caregivers are burdened with psychological, social, and spiritual distress. Furthermore, data show that PC continues to be underutilized and inaccessible, and current innovative models of integrating PC into standard cancer care lack uniformity. The aim of this article is to address the existing barriers in implementing PC into our cancer care delivery system and discuss how the oncology advanced practice nurse plays an essential role in providing high-quality cancer care. We also review the IOM recommendations; highlight the work done by the National Consensus Project in promoting quality PC; and discuss a National Cancer Institute-funded program project currently conducted at a National Comprehensive Cancer Center, "Palliative Care for Quality of Life and Symptoms Concerns in Lung Cancer," which serves as a model to promote high-quality care for patients and their families. PMID:26114013

  18. Integrated care for patients with rheumatoid arthritis

    OpenAIRE

    Verhoef, John

    2007-01-01

    This thesis describes an example of optimization of the traditional multidisciplinary team care model and evolving arthritis care models with emphasis on the question how theoretical models of the system theory and communication can be used to analyse, evaluate, and optimize care delivery. With respect to the team care model we used a rehabilitation tool, for which we developed an accompanying computer application. This thesis contributes to the use of theoretical models, measurement instrume...

  19. Supporting collaboration in multidisciplinary home care teams.

    OpenAIRE

    Pinelle, David; Gutwin, Carl

    2002-01-01

    Collaboration is an important part of healthcare delivery. However, in home care, collaboration is difficult due to the mobility and schedule variability of the workers. In this paper, we investigate the difficulties inherent in home care collaboration. We present the results of a study carried out with home care clinicians in Saskatoon District Health, and identify five areas of collaboration that are difficult for home care workers: scheduling, information dissemination, information retriev...

  20. Patient satisfaction with home-birth care in The Netherlands.

    NARCIS (Netherlands)

    Kerssens, J.J.

    1994-01-01

    One of the necessary elements in an obstetric system of home confinements is well-organized postnatal home care. In The Netherlands home care assistants assist midwives during home delivery, they care for the new mother as well as the newborn baby, instruct the family on infant health care and carry

  1. Leader of the Maternity care: Doctors or midwives

    DEFF Research Database (Denmark)

    Wagle, Rajendra R.

    2004-01-01

    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...

  2. Monitoring and delivery of sedation.

    Science.gov (United States)

    Sheahan, C G; Mathews, D M

    2014-12-01

    Sedation for medical procedures is provided in a variety of clinical settings by medical personnel with differing levels of education and training. Although generally a safe practice, there is a degree of morbidity and mortality associated with sedation practice. Monitoring standards continue to be refined by professional societies with the goal of improving care. The depth of sedation should be monitored with clinical criteria. Processed electroencephalographic monitors currently do not contribute significantly to sedation care. Monitoring ventilation using pulse oximetry should be abandoned for more direct methods, such as capnography-transcutaneous carbon dioxide, respiratory acoustical and thoracic impedance monitoring could also play a role. Propofol has become widely utilized for sedation, although there are concerns about its margin of safety and synergistic interactions with other agents. Dexmedetomidine and propofol/ketamine also have utility. Patient-controlled sedation pumps and target-controlled infusion devices have been developed to improve patient care and satisfaction. A computer-assisted propofol sedation device to be used by non-anaesthesiologists has been approved in the USA by the Food and Drug Administration. More computer-assisted sedation delivery devices are likely to be developed, but their clinical utility is unclear. PMID:25498581

  3. Current perspectives on intrathecal drug delivery

    Directory of Open Access Journals (Sweden)

    Bottros MM

    2014-11-01

    Full Text Available Michael M Bottros,1 Paul J Christo2 1Division of Pain Medicine, Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, 2Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Advances in intrathecal analgesia and intrathecal drug delivery systems have allowed for a range of medications to be used in the control of pain and spasticity. This technique allows for reduced medication doses that can decrease the side effects typically associated with oral or parenteral drug delivery. Recent expert panel consensus guidelines have provided care paths in the treatment of nociceptive, neuropathic, and mixed pain syndromes. While the data for pain relief, adverse effect reduction, and cost-effectiveness with cancer pain control are compelling, the evidence is less clear for noncancer pain, other than spasticity. Physicians should be aware of mechanical, pharmacological, surgical, and patient-specific complications, including possible granuloma formation. Newer intrathecal drug delivery systems may allow for better safety and quality of life outcomes. Keywords: pain control, intrathecal analgesia, drug delivery systems

  4. Grant R01NS046606 | Division of Cancer Prevention

    Science.gov (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.

  5. Grant R01CA138800 | Division of Cancer Prevention

    Science.gov (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 R01CA107408 | Division of Cancer Prevention

    Science.gov (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 R01CA161534 | Division of Cancer Prevention

    Science.gov (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 R01NR014068 | Division of Cancer Prevention

    Science.gov (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 R01EB019337 | Division of Cancer Prevention

    Science.gov (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. From Hospital Deliveries to Home Birth

    OpenAIRE

    Van Der Woude, Carol

    2001-01-01

    Working in a busy labor/delivery unit gave me insight into the care that my Lamaze childbirth education students would encounter. I was troubled by the number of interventions taking place. The interventions interfered with a woman's ability to work with her labor; some interventions were actually creating problems or even crises. My experiences at this hospital motivated me to become involved with home birth, restoring my belief that birth is a normal process.

  11. Risk factors for recurrent preterm delivery in three university hospitals

    Directory of Open Access Journals (Sweden)

    Davari Tanha F

    2007-06-01

    Full Text Available Background: Preterm labor is defined as delivery before 37 weeks of gestation. Recurrence of preterm labor in future pregnancies is 6-8%. History of preterm labor is a strong risk factor for future preterm labor. Preterm labor is the leading cause of neonatal mortality in developed countries, but permanent morbidity in these premature neonates has many side effects for the newborn as well as their family members and society. For this reason we conducted a survey to identify risk factors for recurrent preterm delivery among primiparous women with previous preterm delivery. Methods: This prospective case–control study included patients from three university hospitals, namely Imam Khomeini, Shariati and Mirza Koochakkhan Hospitals, all in Tehran, Iran. Subjects, including 539 primiparous women who delivered preterm (22–36 weeks, were divided into two groups: 47 had a second preterm delivery (study group and 492 had first preterm delivery (control group. Exclusion criteria were induced preterm delivery due to medical indications in mother and primigravid. Data collection and analysis was performed using SPSS 10 and t-test and χ2 test were used to analyze the significance of the results. Results: From a total of 6,537 deliveries, we found 539 cases of preterm delivery, among which 47 cases were identified as recurrent preterm delivery. The control group was composed of 492 deliveries. The recurrence of preterm delivery was 8.7%. Uterine anomaly, cardiovascular, renal and thyroid disease in mother and blood group A had a significant correlation with recurrent preterm delivery. Conclusion: Expectant mothers with uterine anomalies, cardiovascular, renal or thyroid diseases or group A blood type should receive extra care, observation and instructions in order to limit the risk of preterm delivery and its subsequent effects.

  12. TRANSDERMAL DRUG DELIVERY SYSTEM: REVIEW

    OpenAIRE

    Vishvakarama Prabhakar; Agarwal Shivendra; Sharma Ritika; Saurabh Sharma

    2012-01-01

    Various new technologies have been developed for the transdermal delivery of some important drugs. Today about 74% of drugs are taken orally and are found not to be as effective as desired. To improve such characters transdermal drug delivery system was emerged. Drug delivery through the skin to achieve a systemic effect of a drug is commonly known as transdermal drug delivery and differs from traditional topical drug delivery. Transdermal drug delivery systems (TDDS) are dosage forms involve...

  13. NOVEL APPROACH: MICROSPONGE DRUG DELIVERY SYSTEM

    Directory of Open Access Journals (Sweden)

    Shyam Sunder Mandava et al.

    2012-04-01

    Full Text Available Transdermal drug delivery system (TDS is not practically for delivery of materials whose final target is skin itself. Application topical agents generally offer many problems such as rashes, skin irritancy and burning sensation etc due to higher percutaneous absorption of drugs on the skin. Some conventional dosage e.g., gels and ointments. Which are often aesthetically unappealing, greasiness and stickiness etc. that often result into lack of patient compliance. For reduce this side effects, microsponge technology offers many advantage over the conventional drug delivery. The microsponge based drug delivery system is a unique technology for controlled release and enhanced drug deposition in the skin while minimizing transdermal penetration of topically active agents. Drug loaded microsponge consist of microporous beads, typically 10-25 μm in diameter. Microsponge delivery system (MDS can provide increased efficacy for topically active agents with enhanced safety, extended product stability, enhanced formulation flexibility, reduced side effects and improved aesthetic properties in an efficient and novel manner. In addition these are non-irritating, non-allergenic, non-mutagenic, and non-toxic. MDS technology is being used currently in cosmetics, over-the-counter skin care, sunscreen and prescription products.

  14. 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

    2015-01-01

    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."

  15. Effect of Organizational Culture on Patient Access, Care Continuity, and Experience of Primary Care.

    Science.gov (United States)

    Hung, Dorothy; Chung, Sukyung; Martinez, Meghan; Tai-Seale, Ming

    2016-01-01

    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. PMID:27232685

  16. An opportunity for coordinated cancer care: intersection of health care reform, primary care providers, and cancer patients.

    Science.gov (United States)

    Collins, Lauren G; Wender, Richard; Altshuler, Marc

    2010-01-01

    The US health care system has become increasingly unsustainable, threatened by poor quality and spiraling costs. Many Americans are not receiving recommended preventive care, including cancer screening tests. Passage of the Affordable Care Act in March 2010 has the potential to reverse this course by increasing access to primary care providers, extending coverage and affordability of health insurance, and instituting proven quality measures. In order for health care reform to succeed, it will require a stronger primary care workforce, a new emphasis on patient-centered care, and payment incentives that reward quality over quantity. Innovations such as patient-centered medical homes, accountable care organizations, and improved quality reporting methods are central features of a redesigned health care delivery system and will ultimately change the face of cancer care in the United States. PMID:21131791

  17. Patient and health care professional views and experiences of computer agent-supported health care

    Directory of Open Access Journals (Sweden)

    Ron Neville

    2006-03-01

    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.

  18. Global Delivery Models

    DEFF Research Database (Denmark)

    Manning, Stephan; Larsen, Marcus M.; Bharati, Pratyush

    2013-01-01

    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...... that service providers who differentiate based on speed of service delivery are likely to set up GDM structures, and that these structures positively affect deal renewal rates if speed is important for clients in selecting vendors. Findings imply that, as co-location becomes less necessary for providing...... digitalized services, time zones increasingly affect....

  19. 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...

  20. 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

    2011-07-01

    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

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

    OpenAIRE

    Mertz, Elizabeth A.; Finocchio, Len

    2010-01-01

    The objective of this paper is to describe the purpose, rationale and key elements of the special issue, Improving Oral Healthcare Delivery Systems through Workforce Innovations. The purpose of the special issue is to further develop ideas presented at the 2009 Institute of Medicine (IOM) workshop, Sufficiency of the U.S. Oral Health Workforce in the Coming Decade. Using the IOM discussions as their starting point, the authors evaluate oral health care delivery system performance for specific...

  2. Comparison of Delivery Strategies for Pharmacogenetic Testing Services

    OpenAIRE

    Haga, Susanne B.; Moaddeb, Jivan

    2014-01-01

    The number and use of pharmacogenetic tests to assess a patient’s likelihood of response or risk of an adverse event is expanding across medical specialties and becoming more prevalent. During this period of development and translation, different approaches are being investigated to optimize delivery of pharmacogenetic services. In this paper, we review preemptive and point-of-care delivery approaches currently implemented or being investigated and discuss the advantages and disadvantages of ...

  3. Engineered nonviral nanocarriers for intracellular gene delivery applications

    International Nuclear Information System (INIS)

    The efficient delivery of nucleic acids into mammalian cells is a central aspect of cell biology and of medical applications, including cancer therapy and tissue engineering. Non-viral chemical methods have been received with great interest for transfecting cells. However, further development of nanocarriers that are biocompatible, efficient and suitable for clinical applications is still required. In this paper, the different material platforms for gene delivery are comparatively addressed, and the mechanisms of interaction with biological systems are discussed carefully. (paper)

  4. The Effects of Collaborative-­‐Care Training on Paraprofessional Case Managers' Perceived Self-­‐Efficacy, Knowledge, and Behaviors for Depression-­‐Related Services Delivery

    OpenAIRE

    Landry, Craig M.

    2014-01-01

    Depression is one of the leading causes of disability in the world and affects about 10 percent of adults in the United States. Under-resourced communities of color often have low access to professional providers of evidence-based depression care. The purpose of this dissertation was to compare the effectiveness of a community engagement intervention across social service agencies relative to a more traditional technical assistance based training implementation strategy on participation in ...

  5. 42 CFR 457.1005 - Cost-effective coverage through a community-based health delivery system.

    Science.gov (United States)

    2010-10-01

    ... health delivery system. 457.1005 Section 457.1005 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... through a community-based health delivery system. (a) Availability of waiver. The Secretary may waive the... health care delivery system, such as through contracts with health centers receiving funds under......

  6. The implementation of integrated care: the empirical validation of the Development Model for Integrated Care

    OpenAIRE

    Ahaus Kees TB; Vermeulen Robbert P; Minkman Mirella MN; Huijsman Robbert

    2011-01-01

    Abstract 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 like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the i...

  7. Organizational Fragmentation and Care Quality in the U.S. Health Care System

    OpenAIRE

    Randall D. Cebul; James B. Rebitzer; Taylor, Lowell J.; Mark Votruba

    2008-01-01

    Many goods and services can be readily provided through a series of unconnected transactions, but in health care close coordination over time and within care episodes improves both health outcomes and efficiency. Close coordination is problematic in the US health care system because the financing and delivery of care is distributed across a variety of distinct and often competing entities, each with its own objectives, obligations and capabilities. These fragmented organizational structures l...

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

    OpenAIRE

    Arrow, Kenneth; Auerbach, Alan; Bertko, John; Casalino, Lawrence Peter; Crosson, Francis; Enthoven, Alain; Falcone, E.; Feldman, R.C.; Fuchs, Victor; Garber, Alan; Gold, Marthe Rachel; Goldman, D A; Hadfield, Gillian; Hall, Mark Ann; Horwitz, Ralph

    2009-01-01

    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspective...

  9. Assisted Vaginal Delivery

    Science.gov (United States)

    ... having a repeat assisted vaginal delivery in a future pregnancy? If you have had one assisted vaginal ... Education Green Journal Practice Management Coding Health Info Technology Professional Liability Managing Your Practice Patient Safety & Quality ...

  10. Project Delivery Methods.

    Science.gov (United States)

    Dolan, Thomas G.

    2003-01-01

    Describes project delivery methods that are replacing the traditional Design/Bid/Build linear approach to the management, design, and construction of new facilities. These variations can enhance construction management and teamwork. (SLD)

  11. Primary Health Care Models: A Review of the International Literature

    OpenAIRE

    Julia Abelson; Brian Hutchison

    1994-01-01

    A common element in many countries’ health system reform agenda is an emphasis on changes to the organization, financing and delivery of primary health care. Numerous objectives for primary health care reform have been cited in jurisdictions around the world with different approaches being taken toward achieving stated objectives. This paper reviews the literature which has described and evaluated experiences with different primary health care delivery models in Canadian and other jurisdictio...

  12. Case management for long-term and acute medical care

    OpenAIRE

    Capitman, John A.

    1988-01-01

    Case management has developed as an administrative service for controlling costs and improving the quality of health and social service delivery. Long-term care case management combined with service expansion has been examined in some detail with varied results. Less research has focused on case management for users of high-cost medical care. This overview highlights five programs and patient groups where integrated delivery and/or financing of medical and long-term care services are being de...

  13. Policy for Prevention of a Retained Sponge after Vaginal Delivery

    Directory of Open Access Journals (Sweden)

    David J. Garry

    2012-01-01

    Full Text Available Background. Policies for sponge count are not routine practice in most labor and delivery rooms. Ignored or hidden retained vaginal foreign bodies has potentially significant health care morbidity. Case. This was a case of a retained vaginal sponge following an uncomplicated spontaneous vaginal delivery. Delivery room policy resulted in the discovery of the sponge on X-ray when an incorrect sponge count occurred and physical exam did not find the sponge. Conclusion. This emphasizes the use of protocols to enhance patient safety and prevent medical error.

  14. Policy for prevention of a retained sponge after vaginal delivery.

    Science.gov (United States)

    Garry, David J; Asanjarani, Sandra; Geiss, Donna M

    2012-01-01

    Background. Policies for sponge count are not routine practice in most labor and delivery rooms. Ignored or hidden retained vaginal foreign bodies has potentially significant health care morbidity. Case. This was a case of a retained vaginal sponge following an uncomplicated spontaneous vaginal delivery. Delivery room policy resulted in the discovery of the sponge on X-ray when an incorrect sponge count occurred and physical exam did not find the sponge. Conclusion. This emphasizes the use of protocols to enhance patient safety and prevent medical error. PMID:22312370

  15. [Transdermal Delivery of NSAIDs].

    Science.gov (United States)

    Nakajima, Takehisa; Makino, Kimiko

    2015-11-01

    Skin has been studied as administration site of drug for its systemic effects, since systemic therapeutic agents can be delivered for long time with a controlled ratio, escaping from the first pass effect by liver by the transdermal delivery, which can decrease the dosage form. The low permeability of drug molecules through stratum corneum has been the limiting factor for developing transdermal delivery system of therapeutic agents. To enhance the permeability of drug molecules, many studies have been reported. PMID:26689064

  16. Continuous software delivery

    OpenAIRE

    KRMAVNAR, NINA

    2015-01-01

    The main purpose of the thesis is the demonstration of one of the best possible approaches to an automated continuous delivery process as it relates to certain application types. In the introductory part, the main reason for choosing the subject is presented, along with a few examples of why nowadays - in order to keep pace with the competition - such an approach seems necessary. Following chapters discuss the basics of software delivery, starting with configuration and version control manage...

  17. Breastfeeding After Cesarean Delivery

    Science.gov (United States)

    ... Prenatal Baby Bathing & Skin Care Breastfeeding Crying & Colic Diapers & Clothing Feeding & Nutrition Preemie Sleep Teething & Tooth Care Toddler Preschool Gradeschool Teen Young Adult Healthy Children > Ages & Stages > Baby > Breastfeeding > Breastfeeding After ...

  18. Prenatal Care

    Science.gov (United States)

    ... am thinking about getting pregnant. How can I take care of myself? You should start taking care of ... What should I do — or not do — to take care of myself and my unborn baby? Follow these ...

  19. Self Care

    Science.gov (United States)

    ... Care Connections Experiences Research Learning Evaluation Print Email Self Care If you are living with a chronic ... help you cope can make a real difference. Self-care techniques are things you can do for ...

  20. Polymers for DNA Delivery

    Directory of Open Access Journals (Sweden)

    A. J. Domb

    2005-01-01

    Full Text Available Nucleic acid delivery has many applications in basic science, biotechnology, agriculture, and medicine. One of the main applications is DNA or RNA delivery for gene therapy purposes. Gene therapy, an approach for treatment or prevention of diseases associated with defective gene expression, involves the insertion of a therapeutic gene into cells, followed by expression and production of the required proteins. This approach enables replacement of damaged genes or expression inhibition of undesired genes. Following two decades of research, there are two major methods for delivery of genes. The first method, considered the dominant approach, utilizes viral vectors and is generally an efficient tool of transfection. Attempts, however, to resolve drawbacks related with viral vectors (e.g., high risk of mutagenicity, immunogenicity, low production yield, limited gene size, etc., led to the development of an alternative method, which makes use of non-viral vectors. This review describes non-viral gene delivery vectors, termed "self-assembled" systems, and are based on cationic molecules, which form spontaneous complexes with negatively charged nucleic acids. It introduces the most important cationic polymers used for gene delivery. A transition from in vitro to in vivo gene delivery is also presented, with an emphasis on the obstacles to achieve successful transfection in vivo.

  1. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care

    OpenAIRE

    Darko Gvozdanovi_; Miroslav Kon_ar; Vinko Kojund_i_; Hrvoje Jezid_i_

    2007-01-01

    In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on...

  2. Understanding Business Models in Health Care.

    Science.gov (United States)

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

    2016-05-01

    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. PMID:27018909

  3. Accountable Care Organizations: Integrated Care Meets Market Power.

    Science.gov (United States)

    Scheffler, Richard M

    2015-08-01

    Will accountable care organizations (ACOs) deliver high-quality care at lower costs? Or will their potential market power lead to higher prices and lower quality? ACOs appear in various forms and structures with financial and clinical integration at their core; however, the tools to assess their quality and the incentive structures that will determine their success are still evolving. Both market forces and regulatory structures will determine how these outcomes emerge. This introduction reviews the evidence presented in this special issue to tackle this thorny trade-off. In general the evidence is promising, but the full potential of ACOs to improve the health care delivery system is still uncertain. This introductory review concludes that the current consensus is to let ACOs grow, anticipating that they will make a contribution to improve our poor-quality and high-cost delivery system. PMID:26124304

  4. Team Networking in Palliative Care

    OpenAIRE

    Odette Spruyt

    2011-01-01

    "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 f...

  5. Finding economies of scale and coordination of care along the continuum to achieve true system integration.

    Science.gov (United States)

    Davies, Maura

    2014-01-01

    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. PMID:25671876

  6. The Family Practitioner's Role in Newborn Delivery at Ochsner

    Science.gov (United States)

    Geno, Charles Edward

    1999-01-01

    Family practice physicians have contributed significantly to the care of maternity patients nationwide, but since the 1970s the number of family practice physicians delivering babies has decreased at a steady pace. In rural areas especially, family physicians are often the sole providers of care. Without these rural doctors providing maternal care, the risk of poor maternal/infant outcome increases. In the 1990s, it was found that residents of family medicine who are taught obstetrics all or in part by other family practice doctors are more likely to provide this kind of care when they finish residency. With this information, the Residency Review Committee that oversees national residency guidelines added the requirement that in all family practice residencies at least one practitioner must provide maternity care in an ongoing basis. To meet this challenge the country's medical training institutions quickly had to find new ways to teach and provide coverage for family practitioners involved in newborn delivery. Ochsner has developed credentialling for staff family practitioners to provide this care. Staff family practitioners are involved in the prenatal care of pregnant patients and have the opportunity to supervise their residents during labor and delivery. With the assistance of the obstetrical staff the Family Practice Residents' experience has greatly increased, reaching nearly 70 deliveries in 1998 alone with projections of over 100 for 1999. PMID:21845122

  7. POLYMERS IN DRUG DELIVERY SYSTEMS

    OpenAIRE

    Patel, P. K.

    2012-01-01

    The future of pharmaceutical industry is now shifting from new drug research to novel drug delivery systems. Biopharmaceuticals present challenges because of their unique nature and difficulty in delivery through conventional routes. These challenges inspire for the invention of new medical grade polymers for novel drug delivery systems. Polymeric drug delivery systems bring a true benefit over glass. Polymer provide improved robustness against breakability and better ergonomy, while deliveri...

  8. Seamless health care for chronic diseases in a dual health care system: managed care and the role of family physicians.

    Science.gov (United States)

    Lee, A

    1998-01-01

    Neither private nor state run health care systems are perfect. Although there is increasing evidence that Health Maintenance Organizations (HMOs) provide comparable care at lower cost, HMOs tend to select healthy patients. The dual health care system in Hong Kong spends about 3.9 per cent of GDP, with health indices among the best in the world. Hong Kong still faces the problem of escalating health care expenditure. One should take advantage of the dual health care system to evolve a new paradigm for a primary-led seamless health care service. The Diabetes Centre of a university teaching hospital together with the University of Community and Family Medicine has started a structured shared care programme in diabetes mellitus, involving general practitioners in both the private and public sectors integrating the primary and secondary care, and the private and public sectors. This programme starts to develop an infrastructure for providing quality care at an affordable cost for a large pool of patients with chronic disease. Unlike other "managed care schemes", this one is not run by profit-oriented companies, but by health professionals with an interest in providing best possible care at an affordable cost. The "disease management" approach needs a care delivery system without traditional boundaries; and a continuous improvement process which develops and refines the knowledge base, guidelines and delivery system. PMID:10351265

  9. Home care 2012: Achievements, challenges, opportunities

    OpenAIRE

    Mackenzie, Isobel

    2012-01-01

    This video clip comprises the Keynote Address: “Home care 2012: Achievements, challenges, opportunities” held at the 21st Annual John K. Friesen Conference, "Innovations in Home Care: A Public Policy Perspective," MAY 16-17, 2012, Vancouver, BC. Presented by Isobel Mackenzie, Chief Executive Officer, Beacon Community Services. It is well known that jurisdictions with more comprehensive and integrated home care delivery systems are able to extend independent living for older people for...

  10. Marketing quality and value to the managed care market.

    Science.gov (United States)

    Kazmirski, G

    1998-11-01

    Quantifying quality and marketing care delivery have been long-term challenges in the health care market. Insurers, employers, other purchasers of care, and providers face a constant challenge in positioning their organizations in a proactive, competitive niche. Tools that measure patient's self-reported perception of health care needs and expectations have increased the ability to quantify quality of care delivery. When integrated with case management and disease management strategies, outcomes reporting and variance analysis tracking can be packaged to position a provider in a competitive niche. PMID:10338715

  11. Advanced SLARette delivery machine

    International Nuclear Information System (INIS)

    SLARette 1 equipment, comprising of a SLARette Delivery Machine, SLAR Tools, SLAR power supplies and SLAR Inspection Systems was designed, developed and manufactured to service fuel channels of CANDU 6 stations during the regular yearly station outages. The Mark 2 SLARette Delivery Machine uses a Push Tube system to provide the axial and rotary movements of the SLAR Tool. The Push Tubes are operated remotely but must be attached and removed manually. Since this operation is performed at the Reactor face, there is radiation dose involved for the workers. An Advanced SLARette Delivery Machine which incorporates a computer controlled telescoping Ram in the place of the Push Tubes has been recently designed and manufactured. Utilization of the Advanced SLARette Delivery Machine significantly reduces the amount of radiation dose picked up by the workers because the need to have workers at the face of the Reactor during the SLARette operation is greatly reduced. This paper describes the design, development and manufacturing process utilized to produce the Advanced SLARette Delivery Machine and the experience gained during the Gentilly-2 NGS Spring outage. (author)

  12. How to achieve care coordination inside health care organizations: Insights from organization theory on coordination in theory and in action

    DEFF Research Database (Denmark)

    Prætorius, Thim; C. Becker, Markus

    2015-01-01

    Understanding how health care organizations can achieve care coordination internally is essential because it is difficult to achieve, but essential for high quality and efficient health care delivery. This article offers an answer by providing a synthesis of knowledge about coordination from...... contribution of, e.g., routines like those guided by care pathways or of artefacts like displays. The coordination insights are also discussed as regards inter-organizational care coordination....

  13. Vaginal delivery versus cesarean section for term breech delivery

    Directory of Open Access Journals (Sweden)

    Babović Ivana

    2010-01-01

    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

  14. [Costs of maternal-infant care in an institutionalized health care system].

    Science.gov (United States)

    Villarreal Ríos, E; Salinas Martínez, A M; Guzmán Padilla, J E; Garza Elizondo, M E; Tovar Castillo, N H; García Cornejo, M L

    1998-01-01

    Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities. PMID:9528219

  15. Global Delivery Models

    DEFF Research Database (Denmark)

    Manning, Stephan; Møller Larsen, Marcus; Bharati, Pratyush M.

    2015-01-01

    Global delivery models (GDMs) are transforming the global IT and business process outsourcing industry. GDMs are a new form of client-specific investment promoting service integration with clients by combining client proximity with time-zone spread for 24/7 service operations. We investigate...... 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...

  16. Modularity in Cancer Care Provision

    DEFF Research Database (Denmark)

    Gobbi, Chiara; Hsuan, Juliana

    2012-01-01

    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...... treatment service. Customization is obtained by combining different components in the diagnosis phase (examinations) and different treatment options in the treating phase. Findings show that the process of delivery cure for cancer is highly modularized and customization is driven by cancer specificity (type...

  17. Patient safety in primary care has many aspects: an interview study in primary care doctors and nurses.

    NARCIS (Netherlands)

    Gaal, S.; Laarhoven, E. van; Wolters, R.J.; Wetzels, R.; Verstappen, W.H.J.M.; Wensing, M.J.P.

    2010-01-01

    RATIONALE, AIMS AND OBJECTIVES: Scientific definitions of patient safety may be difficult to apply in routine health care delivery. It is unknown what primary care workers consider patient safety. This study aimed to clarify the concept of patient safety in primary care. METHODS: We held 29 semi-str

  18. Periviable births: communication and counseling before delivery.

    Science.gov (United States)

    Srinivas, Sindhu K

    2013-12-01

    The potential delivery of an extremely premature infant presents a clinical situation that raises a complex combination of medical, social, ethical, religious, and economic issues. It is a unique medical encounter such that it is not all about "curing" the patient. Rather, it is an encounter where counseling is assisting families in deciding between life and death underscoring the stressful nature for both patients and providers. As with any other condition, health care providers are responsible for discussing all potential options and outcomes for families presented with the threat of an extremely premature infant. These decisions include but are not limited to place and mode of delivery, resuscitation decisions, and palliative management. Given the urgency of the situation, the emotionally charged nature of the decision, and the relative unpredictability prior to presentation, this particular situation poses unique challenges for all involved and mandates the need to have carefully constructed guidelines and processes for care and counseling that meet the needs of all involved. PMID:24290401

  19. A Medical Delivery Device

    DEFF Research Database (Denmark)

    2010-01-01

    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 by...

  20. Service Delivery Indicators : Kenya

    OpenAIRE

    Martin, Gayle H.; Pimhidzai, Obert

    2013-01-01

    Without consistent and accurate information on the quality of services, it is difficult for citizens or politicians (the principal) to assess how service providers (the agent) are performing and to take corrective action. The service delivery indicators (SDI) provide a set of metrics to benchmark the performance of schools and health clinics in Africa. The indicators can be used to track p...

  1. Determinants of underutilisation of free delivery services in an area with high institutional delivery rate: A qualitative study

    Directory of Open Access Journals (Sweden)

    Vijay Silan

    2014-01-01

    Full Text Available Background: There has been an increase in institutional delivery rates in India in the recent years. However, in areas with high institutional delivery rates, most deliveries (>50% occur in private institutions rather than in government facilities where zero expense delivery services are being provided. Aim: This study aimed to understand, from the community health volunteers′ viewpoint, the reasons for underutilization of zero expense delivery services provided in government health facilities. Materials and Methods: Five Focused Group Discussions (FGD were conducted among Accredited Social Health Activist (ASHAs of a Primary Health Centre (PHC in Dayalpur village, Haryana in December 2012. Participants were asked to articulate the possible reasons that they thought were responsible for expectant mothers not choosing to deliver in government health facilities. Verbal informed consent was obtained from all participants. Result: The commonly stated reasons for underutilization of government health facilities for delivery services were lack of quality care, abominable behaviour of hospital staff, poor transportation facilities, and frequent referrals to higher centres. Conclusion: This study reflected the necessity for new policies to make government health facilities friendlier and more easily accessible to clients and to make all government hospitals follow a minimum set of standards for providing quality care.

  2. Economic and societal dimensions of nanotechnology-enabled drug delivery

    NARCIS (Netherlands)

    Kulve, te H.; Rip, A.

    2013-01-01

    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

  3. Acute care management of spinal cord injuries.

    Science.gov (United States)

    Mitcho, K; Yanko, J R

    1999-08-01

    Meeting the health care needs of the spinal cord-injured patient is an immense challenge for the acute care multidisciplinary team. The critical care nurse clinician, as well as other members of the team, needs to maintain a comprehensive knowledge base to provide the care management that is essential to the care of the spinal cord-injured patient. With the active participation of the patient and family in care delivery decisions, the health care professionals can help to meet the psychosocial and physical needs of the patient/family unit. This article provides an evidence-based, comprehensive review of the needs of the spinal cord-injured patient in the acute care setting including optimal patient outcomes, methods to prevent complications, and a plan that provides an expeditious transition to rehabilitation. PMID:10646444

  4. Comparison of delivery strategies for pharmacogenetic testing services.

    Science.gov (United States)

    Haga, Susanne B; Moaddeb, Jivan

    2014-03-01

    The number and use of pharmacogenetic tests to assess a patient's likelihood of response or risk of an adverse event is expanding across medical specialties and becoming more prevalent. During this period of development and translation, different approaches are being investigated to optimize delivery of pharmacogenetic services. In this paper, we review pre-emptive and point-of-care delivery approaches currently implemented or being investigated and discuss the advantages and disadvantages of each approach. The continued growth in knowledge about the genetic basis of drug response combined with development of new and less expensive testing technologies and electronic medical records will impact future delivery systems. Regardless of delivery approach, the currently limited knowledge of health professionals about genetics generally or PGx specifically will remain a major obstacle to utilization. PMID:24384556

  5. Obstetric Care Consensus No. 4: Periviable Birth.

    Science.gov (United States)

    2016-06-01

    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

  6. Does prenatal care benefit maternal health? A study of post-partum maternal care use.

    Science.gov (United States)

    Liu, Tsai-Ching; Chen, Bradley; Chan, Yun-Shan; Chen, Chin-Shyan

    2015-10-01

    Most studies on prenatal care focus on its effects on infant health, while studying less about the effects on maternal health. Using the Longitudinal Health Insurance claims data in Taiwan in a recursive bivariate probit model, this study examines the impact of adequate prenatal care on the probability of post-partum maternal hospitalization during the first 6 months after birth. The results show that adequate prenatal care significantly reduces the probability of post-partum maternal hospitalization among women who have had vaginal delivery by 43.8%. This finding suggests that the benefits of prenatal care may have been underestimated among women with vaginal delivery. Timely and adequate prenatal care not only creates a positive impact on infant health, but also yields significant benefits for post-partum maternal health. However, we do not find similar benefits of prenatal care for women undergoing a cesarean section. PMID:26189913

  7. Daily Care

    Science.gov (United States)

    ... to Know Online Tools Enhancing Daily Life Daily Plan Activities Communication Food & Eating Music & Art Personal Care Incontinence Bathing ... Tweet Email | Print Create a Daily Routine Daily Plan Activities Communication Food/Eating Get Tips on Personal Care Bathing ...

  8. Hair Care

    Science.gov (United States)

    ... Body Looking and feeling your best Hair care Hair care Short, long, curly, straight, up, down. Hair options can seem endless! Not all of what makes your hair look good comes from the outside, though. Good ...

  9. Continuing Care

    Science.gov (United States)

    ... Care Obesity at Midlife May Speed Alzheimer’s Onset Hello from my mom Easing the Behavior Problems of ... Managers Continuing Care FOR MORE ARTICLES CLICK HERE Hello from my mom Common Estate Planning Errors Alzheimer’s ...

  10. Tracheostomy care

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000076.htm Tracheostomy care To use the sharing features on this ... through your nose and mouth. Caring for Your Tracheostomy Once the hole in your neck is not ...

  11. Promoting Patient- and Family-Centered Care Through Personal Stories.

    Science.gov (United States)

    Johnson, Beverley H

    2016-03-01

    Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among patients, their families, and health care professionals. It redefines the relationships in health care by placing an emphasis on collaborating with patients of all ages, and their families, at all levels of care, in all health care settings, and in organizational change and improvement. This collaboration ensures that health care is responsive to an individual's priorities, preferences, and values. In patient- and family-centered care, patients define their "family" and determine how they and their family will participate in care and decision making. While patient- and family-centered care can improve the experience of care, safety, and quality, it also can improve the learning environment for students and trainees. The author shares personal stories to illustrate the core concepts of patient- and family-centered care, when they are present in health care interactions, and when they are not. Drawing from these stories and the author's experience in working with academic medical centers and other health care organizations over many decades, recommendations for changes in medical education are suggested that can contribute to the development of a health care workforce with the skills and commitment to partner respectfully, effectively, and authentically with patients and families. The implementation of the Affordable Care Act gives new impetus for building a health care delivery system and related educational programs to support patient- and family-centered practice. PMID:26796094

  12. Birth delivery assisted by nurse-midwife: perspectives and controversies

    Directory of Open Access Journals (Sweden)

    Selma Aparecida Lagrosa Garcia

    2010-12-01

    Full Text Available Objectives: To present the conflicts in birth deliveries assisted by nurse midwife and propose ways to minimize them. Methods: We researched the historical evolution of childbirth and the actions that were necessary for the training of professionals. Codes of Ethics of Nursing and Medicine, the current law, basic books of obstetrics and gynecology, articles from medical and nursing journals, with Lilacs and Medline as data sources; laic texts and others from non-governmental organizations (NGO were surveyed. Conflicts were identified in birth deliveries by nurse midwife, for which we propose ways of acting. Results: The analysis of research material shows that the time of delivery, initially at home and afterwards in institutions, brought interventionism in this activity; that social and human aspects of birth and delivery were minimized and birth delivery changed into medical act. We found a strong link between the focus in humanization at child delivery and its assistance by nurses. Conclusions: We conclude that even with legal and ethical support the delivery care by nurse midwife is a source of conflict between the health team, particularly with regard to the limits of performance of the nurse and doctor. Such conflicts must be identified and discussed in the institutions and they should invest in teamwork and have clear protocols defining boundaries of responsibility.

  13. Scaling up the delivery of refractive error services within a district health system: the KwaZulu-Natal, South Africa experience

    OpenAIRE

    Naidoo, Kovin S; Naidoo, Kesi; Maharaj, Yashika; Ramson, Prasidh; Wallace, Diane; Dabideen, Reshma

    2013-01-01

    Background In South Africa, the health service is based on a Primary Health Care (PHC) philosophy with the District Health System (DHS) as the locus of delivery. However eye care services, particularly primary eye care, refractive error and low vision, have not been prioritised accordingly. Hence the aim of the Giving Sight to KwaZulu-Natal (GSKZN) project was to integrate the delivery of eye care services into the district health system, with emphasis on addressing the need for uncorrected r...

  14. 'Fried chicken' medicine: the business of primary care.

    Science.gov (United States)

    Culley, G A

    1994-01-01

    The current environment of pressures for health care reform have created a renewed interest in primary health care delivery. In most health care reform scenarios, family physicians and other primary care doctors are the case managers for all health care delivery. At the same time, there are intense activities from investment banking firms, insurance companies, hospitals, and home health companies, directed toward the purchase of primary care practices and organizing primary care delivery systems. These organizations seek to profit either from ancillary services generated by primary care or from capitation for a population of managed-care patients. Based on personal employment experiences with a for-profit hospital company, the author illustrates the difficulty in developing and managing primary care as a business and the inevitable conflict between management and primary care physicians. The article has detailed advice for family physicians to aid them in carefully examining organizational culture, financial structuring, physician relations, and operational aspects of any for-profit or hospital primary care system before deciding to become part of it. PMID:8289054

  15. What Role Does Obstetrical Care Play in Childbirth?

    Science.gov (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 ...

  16. Medicaid and Managed Care: Key Data, Trends, and Issues

    Science.gov (United States)

    ... improvements in quality, holding plans accountable for measurable performance and aligning payment incentives with care delivery goals. At the same time, weaknesses in monitoring and oversight of risk-based MMC have also been documented. 5 2 00 ...

  17. Experts Foresee a Major Shift From Inpatient to Ambulatory Care.

    Science.gov (United States)

    Beans, Bruce E

    2016-04-01

    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. PMID:27069342

  18. Cationic Bolaamphiphiles for Gene Delivery

    Science.gov (United States)

    Tan, Amelia Li Min; Lim, Alisa Xue Ling; Zhu, Yiting; Yang, Yi Yan; Khan, Majad

    2014-05-01

    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.

  19. Health care law versus constitutional law.

    Science.gov (United States)

    Hall, Mark A

    2013-04-01

    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. PMID:23262771

  20. Social video content delivery

    CERN Document Server

    Wang, Zhi; Zhu, Wenwu

    2016-01-01

    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...

  1. Terplex Gene Delivery System.

    Science.gov (United States)

    Kim, Sung Wan

    2005-01-01

    Polymeric gene delivery systems have been developed to overcome problems caused by viral carriers. They are low cytotoxic, have no size limit, are convenient in handling, of low cost and reproducible. A Terplex gene delivery system consisting of plasmid DNA, low density lipoprotein and hydropholized poly-L-lysine was designed and characterized. The plasmid DNA, when formulated with stearyl PLL and LDL, forms a stable and hydrophobicity/charge-balanced Terplex system of optimal size for efficient cellular uptake. DNA is still intact after the Terplex formation. This information is expected to be utilized for the development of improved transfection vector for in vivo gene therapy. Terplex DNA complex showed significantly longer retention in the vascular space than naked DNA. This system was used in the augmentation of myocardial transfection at an infarction site with the VEGF gene. PMID:16243067

  2. Compact SPS - Power delivery

    Science.gov (United States)

    Pospisil, M.; Pospisilova, L.

    1982-09-01

    The power deliverable by a compact solar Space Power Station (SPS) is a function of its outer surface shape. Methods of fitting the power delivery curve of such a system to different patterns of daily power demand are considered that involve the appropriate choice of the number of satellites, their maximal power, height to width ratio and the shift of longitude with respect to the receiving station. Changes in the daily delivery curve can be made by altering the longitudes and orientations of the satellites. Certain limitations to the choice of parameters exist, such as: the height to width ratio should be near 1.2, and the sum of longitude and orientation changes will probably not be greater than 50 deg. The optimization of the peak to average power ratio is also discussed.

  3. Mucoadhesive drug delivery systems

    Directory of Open Access Journals (Sweden)

    Rahamatullah Shaikh

    2011-01-01

    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. Pyomyositis after vaginal delivery.

    LENUS (Irish Health Repository)

    Gaughan, Eve

    2011-01-01

    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.

  5. Nanocarriers for skin delivery of cosmetic antioxidants

    Directory of Open Access Journals (Sweden)

    Lucia Montenegro

    2014-08-01

    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.

  6. Intrapartum considerations in prenatal care.

    Science.gov (United States)

    Ehrenberg, Hugh M

    2011-12-01

    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. PMID:22108081

  7. Software Delivery Concept

    OpenAIRE

    Maula, Marjo

    2014-01-01

    The purpose of this study was to create a software delivery concept for ERP in IT-project, comparable metrics for the project management and make a improvement list of the future actions. Both qualitative and quantitative research methodology was utilized in this study. The qualitative research data consists of six in-depth interviews. The interviews were done with project people and people who are working in global projects. Quantitative data research data was gathered with a quest...

  8. Nanovehicular intracellular delivery systems.

    Science.gov (United States)

    Prokop, Ales; Davidson, Jeffrey M

    2008-09-01

    This article provides an overview of principles and barriers relevant to intracellular drug and gene transport, accumulation and retention (collectively called as drug delivery) by means of nanovehicles (NV). The aim is to deliver a cargo to a particular intracellular site, if possible, to exert a local action. Some of the principles discussed in this article apply to noncolloidal drugs that are not permeable to the plasma membrane or to the blood-brain barrier. NV are defined as a wide range of nanosized particles leading to colloidal objects which are capable of entering cells and tissues and delivering a cargo intracelullarly. Different localization and targeting means are discussed. Limited discussion on pharmacokinetics and pharmacodynamics is also presented. NVs are contrasted to micro-delivery and current nanotechnologies which are already in commercial use. Newer developments in NV technologies are outlined and future applications are stressed. We also briefly review the existing modeling tools and approaches to quantitatively describe the behavior of targeted NV within the vascular and tumor compartments, an area of particular importance. While we list "elementary" phenomena related to different level of complexity of delivery to cancer, we also stress importance of multi-scale modeling and bottom-up systems biology approach. PMID:18200527

  9. PERSEPSI IBU HAMIL TENTANG ANTENATAL CARE DAN PERSALINAN

    Directory of Open Access Journals (Sweden)

    Andryansyah Arifin

    2012-11-01

    Full Text Available The antenatal care coverage for first visit was 92.72%. It meant that almost all pregnant mothers had ever contacted with health services. But the four time visits of pregnant mothers to health facilities reported only 75.6% and pregnant mothers who got standar antenatal care services was even lower just about 60,0%. The national target for 80.0% of deliveries by the health personals in year 2000 was only reached by Bali Province. For other provinces, particularly at rural areas in Java Provinces, the coverage of delivery was only 44.6%. The objectives of this study were to measure pregnant mothers' knowledge and perseption regarding pregnancy  and delivery cares, A cross sectional study was conducted at 20 health centers located in Jember and Kedin Dtstricts of East Java Province, in Semarang and Demak Districts of Central Java Province and in Lombok Tengah District of West Nusa Tenggara year 2003. There were 159 pregnant mothers randomly selected and the variable to be studied are collected by interviewed the pregnant mothers and observation during antenatal care delivery services. Results indicated that mothers' knowledge about pregnancy and delivery cares were very low. During antenatal care, pregnant mothers mentioned that they got very little information from midwives about pregnancy care and the importance of deliveries by healthy personals. Factors considered for choosing TBA for helping delivery were not only economtc factor but the TBA's nearness and provided that they more complete services than midwives. It is recommended that mtdwives have to improve their interpersonal communication skills and to provide better quality services to pregnant mothers.   Keywords: perception, antenatal care, deliveries by health personals

  10. The health care information directive

    OpenAIRE

    Goel Vivek; Upshur Ross EG

    2001-01-01

    Abstract Background Developments in information technology promise to revolutionise the delivery of health care by providing access to data in a timely and efficient way. Information technology also raises several important concerns about the confidentiality and privacy of health data. New and existing legislation in Europe and North America may make access to patient level data difficult with consequent impact on research and health surveillance. Although research is being conducted on techn...

  11. 77 FR 26280 - Patient Safety Organizations: Voluntary Relinquishment From CareRise LLC

    Science.gov (United States)

    2012-05-03

    ... organizations whose mission and primary activity is to conduct activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety and Quality Improvement Final Rule (Patient... of health care delivery. The Patient Safety Rule, 42 CFR Part 3, authorizes AHRQ, on behalf of...

  12. Health-care quality promotion through infection prevention: beyond 2000.

    OpenAIRE

    Gerberding, J. L.

    2001-01-01

    Health-care value purchasing, complex health-care systems, and information technology are the three most important change drivers influencing the interrelated themes of the 4th decennial conference: accountability, quality promotion through infection prevention across the health-care delivery system, and medical informatics. Among the change drivers influencing themes of future conferences may be a societal mandate for health promotion and health-care access for all.

  13. Integrated care approaches and skills mix policies in Europe

    OpenAIRE

    Antunes, Ana Vanessa

    2013-01-01

    ABSTRACT - Background: Integration of health care services is emerging as a central challenge of health care delivery, particularly for patients with elderly and complex chronic conditions. In 2003, the World Health Organization (WHO) already began to identify it as one of the key pathways to improve primary care. In 2005, the European Commission declared integrated care as vital for the sustainability of social protection systems in Europe. Nowadays, it is recognized as a core component of h...

  14. Primary care obstetrics and perinatal health in the Netherlands.

    OpenAIRE

    Hingstman, L.

    1994-01-01

    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 assistants. To gain a better understanding of this unique situation, the structure of Dutch obstetric care is examined with special attention to the four pillars on which the system rests: the special prot...

  15. A framework for health care planning and control

    OpenAIRE

    Hans, Erwin W.; Houdenhoven, van, M.; Hulshof, Peter J.H.

    2011-01-01

    Rising expenditures spur health care organizations to organize their processes more efficiently and effectively. Unfortunately, health care planning and control lags far behind manufacturing planning and control. Successful manufacturing planning and control concepts can not be directly copied, because of the unique nature of health care delivery. We analyze existing planning and control concepts or frameworks for health care operations management, and find that they do not properly address v...

  16. Across the health-social care divide: elderly people as active users of health care and social care.

    Science.gov (United States)

    Roberts, K

    2001-03-01

    Several ways in which elderly people may assume an active role when using welfare services are discussed here. Selected findings are presented from a study that explored the experience and behaviour of elderly people on discharge from inpatient care with regard to criteria indicating user influence or control (namely participation, representation, access, choice, information and redress). Data were collected via semistructured interviews with service users (n = 30) soon after their return home from hospital. A number of differences were revealed between health care and social care in relation to users being provided with opportunities to assume an active role and in being willing and able to assume an active role. These differences were manifest in elderly service users accessing services, seeking information, exercising choice and acting independently of service providers. It appeared paradoxical that contact points were more easily defined with regard to health care yet users were more likely to exercise choice and act independently in securing social care. It is suggested that social care needs and appropriate service delivery are more easily recognised than making the link between perceived health care needs and appropriate services. In addition, it appeared that informal and private providers are more widely available and accessible for social care. If comprehensive continuing care is to be provided, incorporating both health and social care elements, greater uniformity appears to be required across the welfare sector. Lessons for social care provision from the delivery of health care suggest the clear definition of contact points to facilitate service use. Making health care more accessible, however, does not appear to be easily attainable due to the monopoly provision of health care and the lack of direct purchasing power by potential users. PMID:11560726

  17. Patient Involvement in Safe Delivery: A Qualitative Study

    Science.gov (United States)

    Olfati, Forozun; Asefzadeh, Saeid; Changizi, Nasrin; Keramat, Afsaneh; Yunesian, Masud

    2016-01-01

    Introduction: Patient involvement in safe delivery planning is considered important yet not widely practiced. The present study aimed at identifythe factors that affect patient involvementin safe delivery, as recommended by parturient women. Methods: This study was part of a qualitative research conducted by content analysis method and purposive sampling in 2013. The data were collected through 63 semi-structured interviews in4 hospitalsand analyzed using thematic content analysis. The participants in this research were women before discharge and after delivery. Findings were analyzed using Colaizzi’s method. Results: Four categories of factors that could affect patient involvement in safe delivery emerged from our analysis: patient-related (true and false beliefs, literacy, privacy, respect for patient), illness-related (pain, type of delivery, patient safety incidents), health care professional-relatedand task-related factors (behavior, monitoring &training), health care setting-related (financial aspects, facilities). Conclusion More research is needed to explore the factors affecting the participation of mothers. It is therefore, recommended to: 1) take notice of mother education, their husbands, midwives and specialists; 2) provide pregnant women with insurance coverage from the outset of pregnancy, especially during prenatal period; 3) form a labor pain committee consisting of midwives, obstetricians, and anesthesiologists in order to identify the preferred painless labor methods based on the existing facilities and conditions, 4) carry out research on observing patients’ privacy and dignity; 5) pay more attention on the factors affecting cesarean. PMID:26755469

  18. Variation in the use of alternative levels of hospital care for newborns in a managed care organization.

    OpenAIRE

    Roblin, D. W.; Richardson, D K; Thomas, E; Fitzgerald, F; Veintimilla, R.; Hulac, P.; Bemis, G.; Leon, L.

    2000-01-01

    OBJECTIVE(S): To assess the extent to which variation in the use of neonatal intensive care resources in a managed care organization is a consequence of variation in neonatal health risks and/or variation in the organization and delivery of medical care to newborns. STUDY DESIGN: Data were collected on a cohort of all births from four sites in Kaiser Permanente by retrospective medical chart abstraction of the birth admission. Likelihood of admission into a neonatal intensive care unit (NICU)...

  19. Multifunctional Nanoparticles for Drug Delivery Applications Imaging, Targeting, and Delivery

    CERN Document Server

    Prud'homme, Robert

    2012-01-01

    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.

  20. Metrology for drug delivery.

    Science.gov (United States)

    Lucas, Peter; Klein, Stephan

    2015-08-01

    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. PMID:25879307

  1. Drug delivery goes supercritical

    OpenAIRE

    Patrick J. Ginty; Martin J. Whitaker; Shakesheff, Kevin M.; Howdle, Steven M.

    2005-01-01

    In the field of drug delivery, the ability to control the size, morphology, and release of drug particles is fundamental to good targeting, but is often hampered by harsh processing conditions or inadequate methods; likewise for the processing of polymeric controlled-release systems. However, the use of supercritical fluids such as supercritical CO2 (scCO2) has provided a ‘clean’ and effective alternative to traditional methods of drug and polymer processing. In particular, scCO2 has a number...

  2. Anemia and Oxygen Delivery.

    Science.gov (United States)

    Bliss, Stuart

    2015-09-01

    Clinical assessment of tissue oxygenation is challenging. Anemia reflects a decreased oxygen carrying capacity of the blood and its significance in the perioperative setting relates largely to the associated risk of insufficient oxygen delivery and cellular hypoxia. Until meaningful clinical measures of tissue oxygenation are available in veterinary practice, clinicians must rely on evaluation of a patient's hemodynamic and ventilatory performance, along with biochemical and hemogasometric measurements. Blood transfusion is used commonly for treatment of perioperative anemia, and may improve tissue oxygenation by normalizing the rheologic properties of blood and enhancing perfusion, independent of increases in oxygen carrying capacity. PMID:26033442

  3. Construyendo a Natural Delivery

    OpenAIRE

    Duque Vélez, Andrés Felipe

    2014-01-01

    Natural Delivery es una compañía creada por un grupo de jóvenes emprendedores de la Universidad EAFIT quienes identificaron en el mercado local de Medellín la oportunidad de replicar un modelo de negocio totalmente nuevo para la ciudad, pero exitoso en otras partes del mundo: Una propuesta de comida saludable a domicilio con la cual el consumidor puede comprar desde uno hasta 120 platos que le permiten llevar un estilo de vida saludable -- La propuesta de valor radica en una alimentación gour...

  4. Recent expansions in an emergent novel drug delivery technology: Emulgel.

    Science.gov (United States)

    Ajazuddin; Alexander, Amit; Khichariya, Ajita; Gupta, Saurabh; Patel, Ravish J; Giri, Tapan Kumar; Tripathi, Dulal Krishna

    2013-10-28

    Emulgel is an emerging topical drug delivery system to which if more effort is paid towards its formulation & development with more number of topically effective drugs it will prove a boon for derma care & cosmetology. Emulgels are either emulsion of oil in water or water in oil type, which is gelled by mixing it with gelling agent. Incorporation of emulsion into gel increases its stability & makes it a dual control release system. Due to lack of excess oily bases & insoluble excipients, it shows better drug release as compared to other topical drug delivery system. Presence of gel phase makes it a non greasy & favors good patient compliance. These reviews give knowledge about Emulgel including its properties, advantages, formulation considerations, and its recent advances in research field. All factors such as selection of gelling agent, oil agent, emulsifiers influencing the stability and efficacy of Emulgel are discussed. All justifications are described in accordance with the research work carried out by various scientists. These brief reviews on formulation method have been included. Current research works that carried out on Emulgel are also discussed and highlighted the wide utility of Emulgel in topical drug delivery system. After the vast study, it can be concluded that the Emulgels appear better & effective drug delivery system as compared to other topical drug delivery system. The comprehensive analysis of rheological and release properties will provide an insight into the potential usage of Emulgel formulation as drug delivery system. PMID:23831051

  5. Ideal antenatal care-does it exist?

    OpenAIRE

    Sanjay Singh; Manash Biswas

    2016-01-01

    Antenatal care is systematic supervision of a pregnant mother and its objective is to ensure a normal pregnancy with delivery of a healthy baby from a healthy mother. It is quite effective in reduction of maternal and perinatal mortality and morbidity. Varied antenatal care protocols exist in the literature and all aim towards the same goal. This review endeavours to find out a protocol that is ideal and that suits every pregnant woman, every institute and every country in the world. The revi...

  6. Organization theory. Analyzing health care organizations.

    Science.gov (United States)

    Cors, W K

    1997-02-01

    Organization theory (OT) is a tool that can be applied to analyze and understand health care organizations. Transaction cost theory is used to explain, in a unifying fashion, the myriad changes being undertaken by different groups of constituencies in health care. Agency theory is applied to aligning economic incentives needed to ensure Integrated Delivery System (IDS) success. By using tools such as OT, a clearer understanding of organizational changes is possible. PMID:10164970

  7. The process of end-of-life care delivery to the families of elderly patients according to the Family Health Strategy Cuidar de familias de ancianos en final de vida en la Estrategia Salud de la Familia Cuidar de famílias de idosos em final de vida na Estratégia Saúde da Família

    Directory of Open Access Journals (Sweden)

    Lucía Silva

    2013-02-01

    Full Text Available OBJECTIVE: To understand the process of end-of-life care delivery to the families of elderly patients according to a Family Health Strategy (FHS team, to identify the meanings the team attributes to the experience and to build a theoretical model. METHOD: Symbolic Interactionism and Grounded Theory were applied. Fourteen professionals working in an FHS located in a country town in the state of São Paulo were interviewed. RESULTS: Through comparative analysis, the core category overcoming challenges to assist the family and the elderly during the dying process was identified, and it was composed of the following sub-processes: Identifying situational problems, Planning a new care strategy, Managing the care and Evaluating the care process. CONCLUSION: the team faces difficulties to achieve better performance in attending to the biological and emotional needs of families, seeking to ensure dignity to the elderly at the end of their lives and expand access to healthcare.OBJETIVO: comprender, por medio del equipo de la Estrategia Salud de la Familia (ESF, el proceso de cuidar de familias con ancianos que se encuentran en situación de final de vida, tratamos de identificar los significados que el equipo atribuye a la experiencia y con ellos construir un modelo teórico. MÉTODO: se utilizó el interaccionismo simbólico y la teoría fundamentada en los datos. Fueron entrevistados 14 profesionales de la ESF de un municipio del interior del estado de São Paulo. RESULTADOS: el análisis comparativo identificó la categoría central "superando los desafíos para acoger a la familia y al anciano durante el proceso de morir", compuesta por los subprocesos: Identificando la problemática de la situación, Planificando una nueva estrategia para el cuidar, Manejando el cuidado y Evaluando la trayectoria de cuidado. CONCLUSIÓN: el equipo enfrenta dificultades para alcanzar un mejor desempeño, acogiendo las necesidades biológicas y emocionales de las

  8. Exploring the role nurses play at different stages of the birthing process. Developing strong and long-term relationships with women by examining relationship-building stages prior to delivery, during delivery, and after delivery.

    Science.gov (United States)

    Peltier, J W; Schibrowski, J A; Westfall, J

    2000-01-01

    The health care community is becoming increasingly aware of the need to develop strong and long-term relationships with the women who make up the majority of the health care market. The perceived quality of obstetric care positively impacts future revenue streams by creating "family" loyalty for an umbrella of other health services offered by the provider organization. This article examines the differential impact that various service performance dimensions have on women's perceptions of quality for different stages of the birthing process, and how relationship-marketing principles can be utilized to develop loyal partnerships. The three distinct relationship-building stages are examined--birthing experiences prior to delivery, during delivery, and after delivery--along with their implications for perceptions of quality analyzed. PMID:11185870

  9. Structuring networks for maximum performance under managed care.

    Science.gov (United States)

    Miller, T R

    1996-12-01

    Healthcare providers interested in forming delivery networks to secure managed care contracts must decide how to structure their networks. Two basic structural models are available: the noncorporate model and the corporate model. The noncorporate model delivery network typically has a single governing body and management infrastructure to oversee only managed care contracting and related business. The corporate model delivery system has a unified governance management infrastructure that handles all of the network's business. While either structure can work, corporate model networks usually are better able to enforce provider behavior that is in the best interest of a network as a whole. PMID:10163003

  10. Learning from UK primary care.

    Science.gov (United States)

    Hays, Richard

    2009-03-01

    The Australian Government is wise to examine other health care systems as it strives to improve the quality of care and address rising costs to both governments and individuals. Focus is currently on the United Kingdom, whose National Health Service (NHS) stands out as one that delivers good care at a reasonable price to all who need it. The Australian and UK systems have many similarities: universal access, tax payer support, no or low cost at point of delivery, and good population health outcomes. They also face similar pressures on services from aging, increasingly unwell yet expectant populations.However, there are also differences, largely in the way that health care is funded, organised and delivered. The NHS is a huge system for 60 million people in four home countries with diverging policies. Within England, the system is managed through 10 strategic health authorities, each responsible for about 5 million people and having the right to interpret national policy. Population based health care, including tertiary care, is funded locally via primary care trusts. PMID:19283244

  11. Patient satisfaction with home-birth care in The Netherlands.

    OpenAIRE

    Kerssens, J. J.

    1994-01-01

    One of the necessary elements in an obstetric system of home confinements is well-organized postnatal home care. In The Netherlands home care assistants assist midwives during home delivery, they care for the new mother as well as the newborn baby, instruct the family on infant health care and carry out household duties. The growing demand for postnatal home care is difficult to meet; this has resulted in a short supply of the most popular day care programme and a level of provision which doe...

  12. Hospice Care

    Science.gov (United States)

    ... hospice social worker, or directly from the insurance company. Local civic, charitable, or religious organizations may also ... of Health FOLLOW US Facebook Twitter Instagram YouTube Google+ LinkedIn GovDelivery RSS CONTACT INFORMATION Contact Us LiveHelp ...

  13. Sociocultural determinants of home delivery in Ethiopia: a qualitative study

    Directory of Open Access Journals (Sweden)

    Kaba M

    2016-04-01

    availability of supplies and equipment were found to maintain the preference to deliver at home.Conclusion: The government’s endeavor to improve maternal health has generated positive results with more women now attending antenatal care. Yet over 80% of women deliver at home and this was found to be the preferred option. Thus, the current form of intervention needs to focus on factors that determine decisions to deliver at home and also focus on investing in improving service delivery at health facilities. Keywords: maternal health service, utilization of maternal health, antenatal care, cultural determinants

  14. Magnetic targeted drug delivery

    Directory of Open Access Journals (Sweden)

    Timothy Wiedmann

    2009-10-01

    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.

  15. Supportive Care.

    Science.gov (United States)

    Olsen, Pia Riis; Lorenzo, Rosalía

    2016-01-01

    This chapter takes its point of departure in psychosocial aspects of supportive care in adolescent and young adult cancer care. The purpose is to describe some of the challenges that these young people face following a cancer diagnosis and guide healthcare professionals in how to provide care that improves the quality of life. In most hospitals and healthcare systems, adolescents and young adults are cared for and treated in settings for children or adults. Accordingly, healthcare professionals may lack attention to and knowledge about what characterize young peoples' life situation, their special needs and how to meet them. The topics we include in the chapter are the following: the youth friendly environment, social support and social network, parents, information during a psychosocial crisis event, the use of HEADSS, peer support, fertility, body image and self-esteem, after treatment and future challenges and palliative and end of life care. PMID:27595353

  16. Specifying process requirements for holistic care.

    Science.gov (United States)

    Poulymenopoulou, M; Malamateniou, F; Vassilacopoulos, G

    2013-09-01

    Holistic (health and social) care aims at providing comprehensive care to the community, especially to elderly people and people with multiple illnesses. In turn, this requires using health and social care resources more efficiently through enhanced collaboration and coordination among the corresponding organizations and delivering care closer to patient needs and preferences. This paper takes a patient-centered, process view of holistic care delivery and focuses on requirements elicitation for supporting holistic care processes and enabling authorized users to access integrated patient information at the point of care when needed. To this end, an approach to holistic care process-support requirements elicitation is presented which is based on business process modeling and places particular emphasis on empowering collaboration, coordination and information sharing among health and social care organizations by actively involving users and by providing insights for alternative process designs. The approach provides a means for integrating diverse legacy applications in a process-oriented environment using a service-oriented architecture as an appropriate solution for supporting and automating holistic care processes. The approach is applied in the context of emergency medical care aiming at streamlining and providing support technology to cross-organizational health and social care processes to address global patient needs. PMID:23514044

  17. The role of technology in reducing health care costs. Final project report

    Energy Technology Data Exchange (ETDEWEB)

    Sill, A.E.; Warren, S.; Dillinger, J.D.; Cloer, B.K.

    1997-08-01

    Sandia National Laboratories applied a systems approach to identifying innovative biomedical technologies with the potential to reduce U.S. health care delivery costs while maintaining care quality. This study was conducted by implementing both top-down and bottom-up strategies. The top-down approach used prosperity gaming methodology to identify future health care delivery needs. This effort provided roadmaps for the development and integration of technology to meet perceived care delivery requirements. The bottom-up approach identified and ranked interventional therapies employed in existing care delivery systems for a host of health-related conditions. Economic analysis formed the basis for development of care pathway interaction models for two of the most pervasive, chronic disease/disability conditions: coronary artery disease (CAD) and benign prostatic hypertrophy (BPH). Societal cost-benefit relationships based on these analyses were used to evaluate the effect of emerging technology in these treatment areas. 17 figs., 48 tabs.

  18. Do integrated care structures foster processes of integration? A quasi-experimental study in frail elderly care from the professional perspective

    OpenAIRE

    Janse, Benjamin; Huijsman, Robbert; de Kuyper, Ruben Dennis Maurice; Fabbricotti, Isabelle Natalina

    2016-01-01

    Objective This study explores the processes of integration that are assumed to underlie integrated care delivery. Design A quasi-experimental design with a control group was used; a new instrument was developed to measure integration from the professional perspective. Setting and participants Professionals from primary care practices and home-care organizations delivering care to the frail elderly in the Walcheren region of the Netherlands. Intervention An integrated care intervention specifi...

  19. The emerging EU quality of care policy

    DEFF Research Database (Denmark)

    Vollaard, Hans; van de Bovenkamp, Hester M.; Vrangbæk, Karsten

    2013-01-01

    Despite the fact that Member States and many citizens of the EU like to keep healthcare a foremost national competence and the EU treaties state that Member States remain primarily responsible for the organization and delivery of health care services, the European Union (EU) has expanded its...

  20. Care for the World of Work

    Science.gov (United States)

    Akabas, Sheila; Bellinger, Susan

    1977-01-01

    Considers the double barriers obstructing the delivery of mental health service to the working class--the stigma of mental illness and the lack of referral channels--and how the social worker-trainer's role can help develop preventive mental care for the working man. (Author/RK)